Part 2: The Working New Zealand: Work-Focused Support Programme

Ministry of Social Development: Changes to the case management of sickness and invalids' beneficiaries.

In this Part, we describe:

Sickness benefits and invalids' benefits

The administration of sickness and invalids' benefits is governed by provisions in the Social Security Act 1964 (the Act). These benefits are available to people 16 years of age or older, until they become eligible for New Zealand Superannuation.

Sickness benefits are paid to people with short-term medical conditions. A person can receive a sickness benefit only if their medical condition temporarily limits their ability to work.

Invalids' benefits are paid to people with severe longer-term illnesses or disabilities (that is, medical conditions lasting two years or more). A person may be eligible to receive an invalid's benefit if their medical condition permanently and severely restricts their ability to work.

Appendix 2 has more detailed information about how people qualify for a sickness benefit or an invalid's benefit.

For both sickness benefits and invalids' benefits, the most commonly reported diagnoses are psychological and psychiatric conditions, and musculoskeletal conditions. This pattern – of stress and depression accounting for a significant and growing proportion of people in this beneficiary group, and for a large proportion of total expenditure – is consistent with overseas experience.

Purpose of the Programme

The Programme was announced by the then Minister for Social Development and Employment in October 2006. It introduced measures designed to support beneficiaries – such as those on the unemployment benefit – into work where appropriate, and help beneficiaries prepare for a return to work as soon as their circumstances allowed.

Beneficiaries were placed in one of three different service groups:

  • Work Support – for people able to work immediately;
  • Work Development Support – for people who might be able to work if they had extra support to do so, as well as for beneficiaries whose personal circumstances meant that they were not able to work immediately but might be able to do so in the future with the right support in the right job; and
  • Community Support – for people whose personal circumstances meant they were considered unlikely to be able to work in the foreseeable future.

In September 2007, the Programme was extended to include sickness and invalids' beneficiaries.

Changes to Work and Income's case management of sickness and invalids' beneficiaries

Extending the Programme meant a more comprehensive case management approach to dealing with sickness and invalids' beneficiaries. Systems and processes were set up to ensure that case managers had access to better information so they could make more effective decisions, and could access services for these beneficiaries.

Some of the major changes introduced included:

  • amendments to the Act;
  • a redesigned medical certificate for health practitioners to complete;
  • additional staff, including regional health advisors and regional disability advisors, to support case managers in their decision-making;
  • an online medical database to help case managers in assessing applications; and
  • a fund enabling the Ministry to purchase health and disability services for beneficiaries.

The first priority for case managers is establishing eligibility for a benefit. Case managers mainly do this by considering the information provided in the redesigned medical certificate. For some beneficiaries, the case manager will use the new resources available, such as the online medical database and the regional advisors.

Once a benefit is granted, beneficiaries are given the opportunity to engage with their case manager – to attend meetings with their case manager, and prepare a Personal Development and Employment Plan. The planning process is designed to identify measures that will help the person into employment.

Participating in this planning for work is an option for all sickness and invalids' beneficiaries. The planning process is designed to include regular reviews, and requires beneficiaries to show a commitment to the goals in the plan. Beneficiaries are not required to carry out any work, work experience, or medical treatment as part of their plan.

Amendments to the Social Security Act 1964

The Programme was supported by amendments to the Act that introduced the capacity to require sickness and invalids' beneficiaries to participate in work planning. A sanction could be applied – a reduction in the person's benefit – if they refused to take part in the planning process, or failed to demonstrate a commitment to the goals in the plan.

In practice, these powers had not been used for sickness and invalids' beneficiaries. Under the Ministry's policy, it was more appropriate for people receiving a sickness or invalid's benefit to take part voluntarily.

Changes to the medical certificate

During 2007, Work and Income consulted with health practitioners to redesign the medical certificate. Work and Income wanted to collect more detailed and relevant information to use when determining eligibility for the sickness benefit or invalid's benefit.

The redesigned medical certificate, introduced in September 2007, requires the health practitioner – who could be a medical practitioner (usually a GP), dentist, or midwife – to:

  • describe the person's medical condition using specific codes (known as READ codes) that are also used by the Accident Compensation Corporation;2
  • describe how the person's medical condition affects their ability to work and when they are able to return to work, including any restrictions on the type of work that they can carry out or workplace modifications that might be needed;
  • identify any other interventions that could help the person into work and provide any comments that would help the case manager to determine the appropriate support for the person; and
  • assess when the person is likely to be able to return to work.

The information in the medical certificate is important. It helps the case manager to determine whether a person will be eligible for the sickness or invalid's benefit. It is also useful in identifying which services or interventions might help the beneficiary return to work and the likely timing of their return to work.

Work and Income issued health practitioners with a comprehensive guideline in September 20073 and a handbook in June 2008.4 The guideline described how to fill out the medical certificate, why particular information was sought, and what Work and Income staff did with the information provided. The handbook provided reference material about Work and Income's processes, and information on health-related benefits, assistance, and services.

New advisors and other staff to assist case managers

The Ministry recruited specialist advisors and co-ordinators to work with employers, service providers, GPs, and case managers (see Figure 1). The new roles included 13 regional health advisors (and one principal health advisor), 13 regional disability advisors (and one principal disability advisor), 55 new employment co-ordinators, and 13 regional health and disability co-ordinators. These advisors and co-ordinators:

  • advise Work and Income staff (usually case managers) on health and disability issues, a person's ability to work, and the services available to help someone return to work; and
  • work with employers and beneficiaries, establish and maintain relationships with external agencies, and provide links to programmes that help people move towards employment.

The 13 regional health and disability co-ordinators have an important education role with GPs and other health and disability providers, and liaise with particular medical practices.

Figure 1
Responsibilities in relation to sickness and invalids' beneficiaries

Case manager Has primary responsibility for benefit-related issues. Receives and approves applications, carries out case management that includes identifying and facilitating services required to help beneficiaries back into work. Supported by regional health advisors, regional disability advisors, and employment co-ordinators. Manages beneficiary information.
Health practitioner (usually a GP) Examines the person, and fills out the medical certificate so that the person may present it along with an application form to Work and Income.
Principal regional health advisor and principal regional disability advisor Work with regional managers and contribute to community networks. Provide support to the regional health advisors and regional disability advisors.
Regional health advisor Works with the case manager to identify the service and support needs of the beneficiary, reviews applicant files and supporting health information. Advises on health factors associated with an application, expected outcomes, normal duration of the illness or disability, benefit reviews, and entitlement to services. Has a relationship with GPs.
Regional disability advisor Responsible for advising on disability factors associated with a person's application, obstacles to employment, benefit reviews, and services.
Health and disability co-ordinator Works with GPs to improve the standard of medical certificates they complete.

Works with all health and disability providers to improve their understanding of Work and Income's operational processes and to strengthen Work and Income's relationship with regional providers.
Employment co-ordinator Works with beneficiaries (including sickness and invalids' beneficiaries) to explore employment options. Markets beneficiaries to potential employers. Helps people move towards employment, and co-ordinates support to help them stay in employment.

New medical database to help case managers

The Medical Disability Advisor is a computer-based resource. It describes medical conditions and includes information on the likely duration and recovery time for each condition.

The Medical Disability Advisor was introduced to help case managers:

  • understand the beneficiary's medical condition;
  • determine the likely duration of a medical condition before the beneficiary can reasonably be expected to return to work; and
  • decide whether the reassessment period recommended in the medical certificate needs to be reviewed by a regional health advisor or regional disability advisor.

Funds to purchase services that would help beneficiaries into work or support them in the community

A Health and Disability Innovation Fund for Pilot Health Services (the Innovation Fund) was approved by the Government in 2007. It enabled the Ministry to purchase health and disability services for groups of sickness and invalids' beneficiaries whose medical conditions presented a barrier to them seeking or securing work.

Through the Innovation Fund, the Ministry purchased health-related services from district health boards, primary health organisations, and other agencies. The services included services to address drug and alcohol problems, pain management, access to surgery, and mental health services.

To purchase these services, the Ministry received funding of $5 million for the 2007/08 financial year, and expected to receive $10 million for each subsequent year until 2011/12.

However, the 2009 Budget included an announcement that the Innovation Fund would not continue beyond 30 June 2009.

Savings estimated to be achieved as a result of extending the Programme

In a March 2007 paper to Cabinet, the Ministry quoted estimated annual savings of $49 million by 2010/11, subject to various assumptions. These savings were expected to be achieved through an increase in the number of people who moved off the sickness benefit or invalid's benefit into work, with people expected to spend less time on those benefits. Some people were also expected to continue receiving the benefit but do new part-time work, lowering the average level of benefit payment.

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