Right care, first time

This week we found out that Christchurch man Bill Dalley has been on ACC for 24 years. He fell off a horse in 1981 and has not worked since. A judge in the Christchurch District Court ruled that despite chronic back pain it was ‘only Dalley's entrenched disability beliefs which are holding him back from actually getting out and working’.

This story has sparked debate on the number of long-term ACC claimants. Under the previous National Government, the number of long-term claimants dramatically decreased, while under the current Labour-led Government those numbers have been steadily creeping up again.

Year / Claims / Net change in year (negative is a reduction)
1997 to 1998 / 27,027 / N/A
1998 to 1999 / 22,748 / -4,279
1999 to 2000 / 18,768 / -3,980
2000 to 2001 / 16,382 / -2,386
2001 to 2002 / 14,530 / -1,852
2002 to 2003 / 14,266 / -264
2003 to 2004 / 13,888 / -378
2004 to 2005 / 13,243 / -645
2005 to 2006 / 13,348 / 105

ACC is a compulsory insurance scheme, and there are genuine long-term claimants who are entitled to receiving help. We would like to think that Mr Dalley is an extreme case. Ideally, we would like to avoid having people become long-term claimants because of delays in getting proper treatment and assessment in the first instance.

In the June 15 edition of Pansy Speak, I wrote about a person who told me it had become very seductive for him to become a long-term claimant. During his first week off work with his injury he was impatient to get back, but as it took longer and longer to resolve his case, his motivation began to fade.

Expert medical assessors need to be used at the outset to make sure patients get prompt treatment and rehabilitation. Worryingly, this doesn’t appear to be the case. I have received complaints regarding the quality of medical assessors provided by ACC. In one case, it appears ACC used a person who was not vocationally registered, while another person has claimed that their assessor had been suffering from Alzheimer’s at the time of their assessment. Work is under way on these cases.

There appears to be a pattern developing. Patients who don’t get top-notch care at the outset of their injury take longer to recover. If a patient doesn’t receive a quality diagnosis then they don’t get quality rehabilitation and their injury could plague them for years. If the right care is given at the outset of an injury, most people can expect to be able to resume their normal life.

I have been meeting with health professionals who tell me that ACC’s contract price for 'common' surgery has been driven below long-term sustainable levels, and this leads to ACC patients being given a lower priority on waiting lists.

This is echoed in the interim report by David Goddard QC into the funding and accreditation of physiotherapy by ACC. He says ACC is aware of the need to review funding arrangements and has commissioned modelling work regarding sustainable levels of payment.

Going on the information available it’s hard to know what a sustainable rate of payment would be. You would expect that a monopoly insurer of ACC’s size would have come to grips with that by now.

In the meantime, the spotlight will need to stay on ACC’s competence, effectiveness, and timeliness in getting the right care first time for claimants.

Pansy Wong

www.pansywong.co.nz
www.national.org.nz
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ENDS