Janice Roberts. Qualifications to Make Comment on Green Paper

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1 Response to Green Paper Provided by Janice Roberts- Bachelor Applied Science (Social Work) Accredited, MAASW, Diploma in Nursing Mobile Qualifications to Make Comment on Green Paper This document represents my personal opinions and is not related to any organization/s with whom I currently have a working or consultancy relationship. My qualifications to make comment and recommendations include over 30 years working in both the government hospital system and a subsequently developed ethically based private Social Work-Case Management business for catastrophically injured clients. I use up-to-date research as well as outcome based practice based studies to enhance my work with clients wherever possible and am familiar with research methodologies. I am and have been involved in a range of activities with both private and public hospitals and tertiary institutions which are aimed at improving services to patients and I believe some of this work could assist in the development and implementation of the change management process from a fault based system to a non-fault system for some claimants in Western Australia and I am familiar with the NSW and Victorian current systems and the national and state NDI/NDIS systems. I have developed and delivered a range of training packages on acquired brain injury for private and government organisations. Having started working with the Insurance Commission of Western Australia staff in 1983 at Royal Perth Hospital I have been through many changes ranging from working directly with Commission staff attending the hospital/s and meeting with the inpatients and myself to discuss the services needed that the Commission was able to approve funding for to the current system which rarely allows claimants to meet Commission staff. I appreciate the increased complexity of claims and the need for any new system to meet future claimants needs in an efficient, cost effective manner with a high level of satisfaction from consumers and service providers and am most agreeable to offer my services to assist this goal. Janice Roberts 1

2 SCHEME OPTION SELECTED I AM IN FAVOUR OF OPTION 2 FOR THE BELOW REASONS. As a Social Worker and later Social Worker- Case Manager working with individuals with complex catastrophic injuries over many years both before and after settlements I am aware that persons who may have received what appeared to be a reasonable claim at the time were often not able to have their needs met over the period of time the claim was to address. The reasons for this are multifactorial and include a number of reasons some of them certainly related to client and family management of funds and even to poor Trust management as the injured party lacked capacity to manage their own financial affairs and a Trust was appointed by the State Administrative Tribunal. Increased life expectancies with improved medical treatments or a deterioration in an injured person s condition necessitating an increase in services can have an effect especially when a claim is based on life expectancy rates and projected service costs over that period of time. Claims also certainly highlight the importance of family and other contact and support systems and how difficult it can be to maintain persons with complex injury management needs at home when these systems break down for whatever reason. Family inputs can be included in persons 24/7 care needs during settlement and these are lower paid than commercial service costs. Therefore a certain amount of family input needs to be maintained to ensure the claimants care and safety needs are met as 24/7 commercial care is not able to be paid by the settlement. However this is now unusual as most counsel do claim commercial costs where support and supervision are needed full time. I have however included this as an ongoing concern as a high care severely brain injured young woman s claim was recently addressed in this manner and has created a difficult situation as her parents are separated. On a personal basis I have been involved with many clients who have insufficient funds to meet their ongoing care needs and prior to the current proposal of a no fault system I have been in favour of a structured settlement for some persons with very high care needs. Such a settlement would ensure treatment and equipment needs are met along the continuum of time and need. Additional funding from economic loss and pain and suffering could be used for items not able to be claimed for in the current system such as accommodation above and beyond what was considered to be reasonable. If a no-fault insurance scheme is introduced which ensures whole of life services for items and services attributable to the accident are guaranteed then I believe the positive features of such a system outweigh the negative features and I would offer my support for such a system. I DO NOT AGREE WITH THE INSURANCE COMMISSION APPOINTING A RELATIONSHIP MANAGER TO MANAGE THE COST OF YOUR CARE without a definition of the role, qualifications of the persons involved and a JDF which includes this persons level of authority and what reasonable appeal processes 2

3 are included where disagreements and dispute can be addressed. I believe one of the most significant failings of the current system is one where Insurance Commission counsel and staff demonstrate inconsistency across claim management processes due to individual personal value systems, lack of clinical expertise, poor appreciation and understanding about variances created not only by clinical pathology but also by the individuals personal circumstances which can play a significant role in their capacity to progress and resilience building. I strongly believe that initial intake assessments involve a heath care professional with demonstrated expertise in working with claimants who fit the catastrophic injury type definition as per page 15 of the Green Paper. Whilst the FIM score is cited as he tool used to define the level of functional limitation there are other tools readily available to assess functional and cognitive performance and which require minimal training to administer and report on and staff could be trained to use these and the outcome for the staff would be an increased understanding of their individual clients strengths and weaknesses. I have also referred to this matter in Recommendations and Information- To assist in the operationalization of Scheme Option 2 RECOMMENDATIONS AND INFORMATION TO ASSIST the OPERATIONALISATION OF SCHEME OPTION 2 1. If this option is selected it will need to be introduced carefully over time in conjunction with the community and users. There will need staff engaged who are health care professionals who have a demonstrated capacity to work with the individuals with the diagnostic groups stated. There are persons in Perth with the qualifications needed who are already working towards improving services for patients who would be Commission clients. These persons understand what the individual patients needs are likely to be and what services are available to meet these. They have a knowledge of the hospital systems. Whilst an initial cost increase may occur this business model will almost certainly pay for any increases as educated, competent staff will be have an understanding of the importance of initially improving discharge planning which will reduce recidivism rates, of working collaboratively with the injured party and their family if available, access to services and resources needed to maintain the persons rehabilitation focus. It is not suggested that these staff personally manage claimants rather that their levels of clinical competence allow them to consider claims, case by case and the range of community based service providers they may need and the options available and then monitor the system developed. The NSW system has a report on improved quality of life when such a system is made available to clients. Quality of life studies evidence that when general wellbeing improves for the individual their rehabilitation progresses the associated costs to the insurer reduce. Cost efficiencies and improved service delivery could be made to the Commissions current system and any developed system by the employment of some staff who have formal and demonstrated education and expertise in for example spinal injuries and acquired brain injuries on the catastrophic team. 2. As previously stated there has been a number of developments, working parties and reviews that can assist in helping claimants navigate the health care system. In regard to spinal claimants I was involved on a working party regarding Improving Discharge Care and Planning for Spinal Cord Injured Patients in Western Australia A great deal of work was provided by the persons involved including 2 Nurse Managers, the Senior Social Worker and I attach a copy of the document for reference. The recommendations include pp 10 item 3.6 for compensable patients-that a case manager be appointed prior to discharge to facilitate a timely and safe discharge for the patient. This person should have experience with SCI patients and expert knowledge of the care and equipment necessary to 3

4 achieve a successful and sustainable discharge. Inclusion of suitably educated health care professionals with demonstrated competency to engage as case managers for catastrophically injured individuals is a common theme across much of the recent research and literature in this area. This includes outcome based studies from NSW which would be most relevant to the development and implementation of a no fault system in WA. 3. A paper developed by the Australian Association of Social Workers group Social Workers in Brain Injury Practice Group provided a response for Reform to the NSW Compulsory Third Part Green Slip Insurance Scheme in February Many of the features of this response are relevant to the Western Australian situation and I have therefore attached a copy of the document for reference. 4. It has been noted by myself and others that the Green Paper does not comment on the needs children and young adults separately. No case studies related to this group are included and I have been requested to highlight this to the persons involved in the development of the Green Paper 5. In 2010 the Commission funded an extensive study in conjunction with the School of Population Health at the University of Western Australia. The Study Evaluating the Costs, Accessibility and Availability of Services for those with Catastrophic Injury in WA. Whilst no firm recommendations were made the Discussion area page 148 highlighted many areas identified as needing attention and the Conclusion items area page 149 are recommended as being appropriate to be forwarded to the Health Consumers Council of WA for action with the relevant agencies. This document highlights from a qualitative perspective some of the relevant issues for injured parties insured and uninsured. As such it could be a useful tool for assisting in the development of a new system. Copies of this large document are available through the Commission. As I was involved in the study I have a copy. 6. NSW have had a great deal of experience in the development of a no fault injury management system for no catastrophic injury claimants. Regular substantive reviews have been conducted which address the system features including the Law Society which confirms the often unnecessary and often repeated medical assessment system MAS which can increase applicant distress. This is certainly a costly situation which can occur in Perth and it is stated on page 12 of the document A Guide for People Injured in a Motor Vehicle Crash that nonattendance without good reason, your right to commence or move forward with legal proceedings may be suspended. In NSW a suggested strategy is for repeat assessments to only review injuries in dispute and their percentage. ADR to be encouraged. Pointless referrals can ascribe to profiteering by providers and increase costs. All providers to meet quality standards and the client to always be the main beneficiary with referral fees and rewards to be abolished. An ADR system and an established advocacy system could assist in reducing conflict and encourage all parties to work collaboratively thereby assisting the injured party to progress. 7. The State Head Injury Unit provides 4 times a year comprehensive training to families of individuals with acquired brain injuries as well as to organisations employing support workers who work with ABI persons. Having done the training and used the training for families and staff I consider it to be an excellent introduction to assisting in understanding the complexities of ABI. The SHIU also can provide a Case Management service to individuals who meet the appropriate selection criteria. The service is provided by trained therapists and Social Workers who have demonstrated clinical expertise in working with ABI clients and their families. The service is located at Sir Charles Gardner Hospital in Nedlands and available on self-referral or referral from another health. As a public health service in a public teaching 4

5 hospital it has a waiting list system and is a valuable resource option for country patients who can combine other outpatient visits when they come to Perth. SHOULD THE NEW SCHEME HAVE EXCLUSIONS? This is a contentious issue in WA which has one of the highest use of drugs of addiction and regular well publicised driving offences many stated as being caused by one or more of the items cited in the Green Paper pp 26. As a Social Worker I do not believe any system should encourage poor road safety by ignoring traffic infringements. However I also believe that I am not able to provide an answer except through the use of the Justice system for offenders and ensuring offenders have mandatory nonnegotiable treatments for any drug and /or alcohol behaviors. Encouragement of government by the Commission to improve the public transport system is also recommended. SUMMARY I believe any new system needs to be carefully developed and reviewed through a community consultation process before implementation. There are numerous recent state, federal and international examples which may provide tools change from a fault to a no fault system if that is the decision of government. Whilst the current system is described as a conflict system which fails to deliver a universal service to all claimants any replacement system must not be worse and the business model developed ensures a sustainable, easy to navigate fair system to provide the range of services and equipment injured Australians will need to maximise their rehabilitation potential. Thank you for allowing me the privilege to to comment on an area which I believe is so important for Western Australians Janice Roberts Janirobe@bigpond.com