Medicandus

Medicandus

People on the DSP are not wasting money, unlike the politicians who stigmatise them

Hidden among the chocolates and general festivity over the weekend was a nasty little surprise for those who receive the Disability Support Pension (DSP). Apparently the Federal Government’s suspicion of unAustralian freeloading now includes those under 35 who are receiving the DSP.

On the one hand it is heartening to see that the substantial social and economic cost of losing young people to the workforce has been recognised. Importantly, it seems there are resources on offer to help ameliorate the problem. I have said consistently for a long time that it is always good economics to provide effective, individualised assistance to those who struggle to be well enough to work instead of just paying them a pension.

Less impressively, the proposed means of achieving this laudable end is likely to be a monstrous waste of taxpayers’ money. The reason I am pessimistic about what I have heard is that I fear Minister Andrews is merely aping the appallingly misconceived efforts of his conservative colleagues in the UK.

Driven by the economic imperative to reduce the cost of long-term disability, the UK government employed health service provider Atos to do exactly the type of independent medical assessments for disability pensioners that are being contemplated here. The result?

Atos was sacked after audits found that the medical assessments were ‘flawed and unacceptable’ in 40% of the cases audited. Instances of repugnant injustice have surfaced. Of the 1.8 million assessments conducted since 2009, one third have been the subject of appeals, of which one in three was upheld. The cost of the appeals process alone has been estimated at £60 million. As well as the poor quality of the medical reports, disability groups have been scathing in their feedback regarding the accessibility and sensitivity of the entire process. It should be pointed out that Atos was selected as the sole contractor for these reports in a competitive tender process which supposedly guaranteed the best available service. One wonders why our government thinks we can do it any better.

Currently, obtaining a DSP is not a straightforward process. Applicants are required to obtain reports at their own expense from the GP plus any treating specialist. I do a couple of these most weeks. The reports are assessed by Centrelink and a decision is made. Contrary to what appears a widespread belief among politicians and talkback radio callers, these people are financially and socially desperate. They will have exhausted any available resources including superannuation, friends, family and insurance before applying. If they have been working steadily before they became injured or sick, they are usually in the process of losing their house or flat. Their world is contracting to be able to manage with capabilities that are a fraction of what they previously were. It is not an easy time for anyone. Do we really want to add insult to disadvantage by demanding that they undergo a demeaning kangaroo court to parade their disability on demand in order to keep the meagre resources they have left?

Those who have been on DSP for some time, particularly the age group identified by Minister Andrews for extra resources, have a combination of physical and mental health issues which render them uncompetitive in the job market. I would have concerns about any process which placed greater weight on an independent medical examination than reports from GPs and specialists who know the applicant well and have primary responsibility for managing their care. Asking a doctor who is unfamiliar with their case to make a definitive judgement regarding work readiness borders on the unethical when you consider how useless such assessments generally are. The ability of even a highly standardised functional capacity evaluation in predicting successful return to work is poor. It is only really worthwhile as part of a wider rehabilitation effort, not as a binding decision-making tool with major financial and social consequences.

Like any rehabilitation physician, I would welcome new expenditure to help young disabled people into the workforce. If one starts from the assumption that all DSP recipients are bludgers and require them to ‘prove’ their disability on demand, only hostility and injustice will result. Much better to start from the assumption that extra resources applied in an evidence-based and consumer-friendly fashion will always be the most cost-effective solution.

I encourage the Minister to seek input from the rehabilitation and occupational medicine workforce as well as disability sector groups to ensure that the resources available for this initiative are not wasted. I’d suggest starting with funding disability awareness training for large employers to make them aware that disabled workers in general have less sick leave and better attendance than most of their more able bodied colleagues if a suitably welcoming environment is provided. I also suggest a scheme to help young disabled workers self-insure for their WorkCover premiums. This would remove at a stroke the major unspeakable concern of prospective employers of the chronically sick or injured. I’m sure there are many other better suggestions from those who would like to work but can’t be competitive to employers under the current system. Perhaps instead of judging DSP recipients about their ‘fitness to work’ we should assess employers on their ‘fitness to employ’. I have heaps of patients who could still be at work if that was in place.

Reducing the economic burden of the DSP will not be cheap, but if done as an exercise in evidence-based collaboration it will be genuinely cost-effective in the long term. The worst thing to do would be to waste yet another chance for positive change by reinforcing negative stereotypes of disability. Perhaps you can’t help getting sick or injured, but knowingly replaying another government’s shameful travesties is just inexcusable.