Injury Prevention, Rehabilitation, and Compensation Amendment Bill [first reading]

Tariana Turia; Co-leader, Maori Party

Tuesday 24 October 2006; Maori Party Spokesperson for ACC; 4pm

I was pleased to see in the explanatory note to this Bill, that the Government states it has a commitment to a fair and sustainable ACC system. And I want to commend the Minister for her willingness to consider strategies that work in the ACC system to respond to the priorities for tangata whenua. Tena koe Ruth.

There are two key issues that we want to raise about this Bill. It is a Bill to discuss the merging together of two accounts - if you like, balancing of the books.

But it is also an Bill which provides an opportunity to discuss access - which it must be said, the Bill does not address well.

A fair and sustainable ACC system, must address the inequities that have been identified for so many Maori, who either do not access ACC or whose claims are declined.

A fair and sustainable ACC system must address the lack of cultural fit.

The other night, I was reading the classic health resource, Mauriora : the dynamics of Maori health. And in it, Professor Mason Durie stated his theory on cultural fit, and I quote:

"The degree of comfort individuals feel with seeking health services impacts on their use of services and in turn health outcomes. .....

The delivery of care in a culturally appropriate manner is an important element in determining both the willingness of people to access services and the success of any treatment or care then delivered".

The Maori Party comes to the Injury Prevention, Rehabilitation, and Compensation Bill, thus thinking about these challenges.

- What degree of comfort do Maori have with the ACC system?

- What are the health outcomes that they achieve?

- How effective is the delivery of culturally appropriate care?

And the results are not good news.

Despite the fact that tangata whenua have a higher injury rate across the board, they are significantly less likely to make an ACC claim, and they are more likely to be declined cover.

In other words, application and take up rate of ACC by Maori is significantly lower than non-Maori.

Although Maori made up 14% of the working-age population; in the 2005/2006 year, Maori were 11.3% of new claimants; and 9.8% of ongoing claimants; while being over-represented in injury statistics across all age groups and in employment and sport.

What is interesting is that there is an even higher proportion of Maori claimants being declined ACC support.

This data is, however, probably still an under-statement of the real situation for Maori.

It is, by any one's accounts, a depressing story. Indeed, when one looks at Maori in the peak fitness age - the 24 - 34 year old age group, we find that injury is the leading cause of death, accounting for 52% of deaths of Maori at this age.

It is obvious from statistics about workplaces for Maori that they are over-represented in high-risk industries. Maori aged 25-64, particularly men, are more likely to be injured at work than non-Maori. And this reflects the types of occupations in which Maori men are over-represented, such as in manual and trade occupations.

But there is also the bizarre fact that Maori are under-represented in claims and entitlements from ACC.

For the 2005 calendar year, the rate claim per 1000 New Zealand Europeans was 361 per 1000, compared to 289 per thousand Maori.

It's not a trick question - but what explanation can there possibly be to respond to the fact that all the reports say that Maori have greater need but then ACC reports less access to treatment?

Dr Peter Jansen's recent research on Maori consumer use and experience of ACC services reveals Maori are currently not receiving entitlements to care, rehabilitation, and compensation at a level comparable to the proportion of Maori in the population.

His research identifies four key barriers to care:

- Cost of care: The cost of a GP visit often discourages Maori from seeking assistance. Other perceived costs, including prescriptions and travel expenses, are also barriers. Many also express concerns at the loss of their job, believing that the 80 per cent of previous income, ACC covers will not be adequate to cover their household expenses. 80 percent of an already low income just won't pay the bills.

- Communication: difficulty navigating the system; or perhaps a lack of awareness of the ACC entitlements. Out of the 651 participants in the survey, only 56% said that the GP had given them everything they needed to know about ACC.

- Structural: barriers may be created from distance from the GP; or not being able to make appointments in time.

- Cultural fit: Dr Jansen's research reported consumer experiences where they felt there was no respect for Maori; they couldn't trust the GP; or they perceived a level of racism. Other comments reported the discomfort consumers felt in not being able to have their whanau with them.

Madam Speaker, I have taken some time to share these results with the House today, because I believe the real and significant disparities between Maori and non-Maori accessing ACC must be addressed if we are ever to achieve a fair and sustainable system.

Auckland GP Dr David Jansen confirms that disparities exist between Maori and non-Maori even when poverty is taken out of the equation. Fewer diagnostic tests are ordered for Maori, Maori make fewer ACC claims and die on average up to ten years earlier than non Maori.

The Maori Party is disappointed that this Bill, far from addressing these inequities may actually, as an accident of its design, exacerbate even further the inequities experienced by Maori.

For in merging the Employers' Account and the Self-Employed Work Account into a single Work Account, the concern is that there will be disproportionate impacts on the self-employed, an increasing number of which are Maori, as levies will almost certainly increase.

There will be levy rate increases for self-employed people in high risk industries like fishing, faming and forestry.

And of course these three areas - fishing, faming and forestry - are areas where tangata whenua will be particularly affected.

And this is where our antennae really shot up. This Bill will create another increased cost that the Maori fisheries industry will need to absorb in addition to the wages of foreign fishing vessels issue; that we have been rigourously opposing over the last month.

We are also aware that costs will be increased for new businesses and those newly self-employed as ACC requires the next year's levy in advance.

In a practical sense this means two years worth of payments have to be paid upfront.

The possible consequences of these high levies might be that self-employed/ small businesses are faced with difficult choices like cutting back on health and safety equipment, thus setting them up for future accidents.

Given the high propensity for Maori to be involved in both high risk and low paid occupations, the risk of compromises being made on occupational health and safety is just far too great.

Returning again, to this concept of ACC as a fair and sustainable system, an issue which sticks out is around the redistribution of $96m of levy reserves from the Employers Account to the Self-Employed Work Account.

While there is a $400m surplus in the Employers Account, the Self-Employed Work Account is in deficit.

Employers have thus questioned the justice in transferring the surplus for use by groups that have not contributed to it. Employers are saying that it is not right that their levies are being used to prop up self-employed; without due and informed consultation with all parties. One has to ask why the Government couldn't come to the party, and prop up the Self-Employed Work Account?

There needs to be more consultation and dialogue on the issue. The Bill is rather evasive, suggesting that the usual consultation process on the 2007/08 regulations should be by-passed as there will be insufficient time to consult.

The Maori Party would simply ask that the questions that have arisen even in our brief analysis, warrant making time available.

Time to consider why providers are seeming to give lesser and lower quality care to indigenous people.

Time to consider how Maori can identify when it is appropriate to seek treatment for injury.

Time to consider how Maori with injury differ in expectations from other consumers.

Time to consider the degree of comfort; the cultural fit; the health outcomes, in order to ensure that future generations of Maori have an opportunity to live their full lives to their potential.

We will support this Bill through to Select Committee stage in order to provide the time and opportunity for these questions to be heard.

Tena tatou katoa.

ENDS

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