Ryall Tony: New Zealand Public Health and Disability Amendment Bill (No 2) — First Reading Second Reading In Committee Third ReadingText is incorporated into the Bound VolumeRyall Tony: New Zealand Public Health and Disability Amendment Bill (No 2) — First Reading Second Reading In Committee Third Reading[Sitting date: 16 May 2013. Volume:690;Page:10116. Text is incorporated into the Bound Volume.]Hon TONY RYALL (Minister of Health): I moveThat the New Zealand Public Health and Disability Amendment Bill (No 2) be now read a first time. It is the Government’s intention that this legislation should pass through all stages today. The New Zealand Public Health and Disability Amendment Bill (No 2) is the Government’s solution to the decisions made by the High Court and the Court of Appeal in relation toMinistry of Health v Atkinson and Others. This is a compassionate and responsible solution. It does shift the boundary between family and taxpayer responsibilities but it has landed in a fair and reasonable place. The Ministry of Health advises that New Zealand will be only the third country in the world after Sweden and the Netherlands that will pay a wage to some family members caring for other family members.For over 20 years under Governments of all hues the Ministry of Health has operated a blanket policy of not paying family members for the support they provide to disabled family members receiving disability support services. Support by Governments has consistently been based on the principle that families have primary responsibility for the well-being of each other within their family. Care and support provided by family members to their loved ones are part of that responsibility and are provided out of love and affection and not for money. The Government’s primary role in this regard is to support families in their role. That is why public funding for care and support is targeted to meet the needs that families are unable to meet.TheAtkinson court case raised issues that went to the heart of the relative obligations of families and the Government and the degree of responsibility that family members in different situations have for each other. The court in theAtkinson case found that the Ministry of Health under all Governments had a policy on disability support funding that was unjustifiably discriminating against parents caring for adult disabled children. This bill takes account of the court’s decision and clarifies the Government’s position on paying family carers. The bill provides certainty without the further need to resort to the courts on individual cases and it manages the significant financial risks for the Government. This approach balances the interests of disabled people family carers and taxpayers in challenging fiscal times.The Government provides over $1 billion each year to fund support services for over 30000 disabled people. The majority of these people are supported by family members in some way and the Government recognises the crucial role that families play in supporting and maintaining the well-being of disabled people in our nation. It is—and it remains—a fundamental tenet of Government-funded support services that generally families have prime responsibility for the well-being of their members but clearly change is needed. In some circumstances providing ongoing support for people with lifelong disabilities can place an unreasonable demand on families. In particular the situation of family members supporting adults with lifelong disabilities is an extraordinary circumstance involving a burden of care beyond that ordinarily required or obliged of family members.In consulting the disability and family carer communities on the issue of paying family carers submitters told the Ministry of Health that if prioritisation is required thepriority should be on disabled people with the highest needs. Support should be given to those families who need it most and submitters wanted some flexibility to deal with individual circumstances in their best interests. The Government recognises that changing the policy to pay all categories of family carers would result in unmanageable fiscal costs to the Crown. In considering targeting the Government decided that the fairest way of managing these risks was to provide support to those people who need it most. The bill reflects this community feedback. It allows and supports a pragmatic and compassionate solution to a difficult situation facing family carers. It amends the New Zealand Public Health and Disability Act to enable the Crown through the Ministry of Health or a district health board to adopt policies and make payments to family carers of specified disabled family members.The bill provides for clarity about which support services are provided and under which specified circumstances. The approach recognises that the Government’s responsibility is to support families in their caring role. The policy cannot support all groups. This means people will not generally be paid to provide health or disability support services to their family members. This is particularly so for those parents who care for their non-adult children and for spouses who care for each other. The societal expectations and responsibilities for care in these situations are substantially different from those of parents who care for their disabled adult sons and daughters. The bill will allow the Ministry of Health to introduce a new policy of paying parents and resident family members other than spouses to provide disability supports to disabled adults aged 18 and over in high and very high need situations.The bill is a significant change in that eligible disabled people will now have the choice of employing a family member to provide them with support at home. This approach is consistent with the Government’s overall direction for disabled people to have more choice and control in their everyday lives. The Government in this Budget has committed $92 million over 4 years to implement this policy. The Ministry of Health will allocate funding to adult disabled people in high and very high need situations who wish to employ their parents or resident family members to provide personal care and household management supports they have been assessed as needing. There will be some flexibility within the policy to consider disabled people in particular circumstances who do not meet the eligibility criteria but where payment is clearly desirable. An example might be disabled people living in remote rural areas where alternative care is not available.The new family care policy does not affect the existing arrangements for those non-family members who have always been able to be paid to provide home support for a disabled family member who does not live with them. The Ministry of Health also provides the carer support subsidy totalling $34 million per annum to unpaid full-time carers to reimburse some of the costs of bringing in another support person to give the main carer a break from their caring roles. In addition the Ministry funds respite services of $17 million per annum to support short-term breaks for full-time family carers. The Ministry of Social Development does provide income support to the vast majority of those disabled people being cared for as adults.The Crown has acted in good faith to respond to the court’s decisions. We have carefully balanced providing the best supports for those families with the greatest need while being responsible with limited taxpayers’ funds. We have landed in a fair place. The bill clarifies the Government’s position on paying family carers and provides certainty without the need to resort to the courts on individual cases. The bill provides flexibility to implement and modify policies on paying family carers in the future. This issue has challenged Governments of all parties for 20 years. As recently as April 2008 the previous Government rejected paying family carers.This bill meets three central issues. The first is the need for each disabled person to receive the most appropriate care to enable a good life. The second is to recognise the extraordinary work done by family members in many hundreds of homes caring for family members with very high or high needs. The third is for support to be fiscally affordable for our country. I am pleased to be able to present this bill today and I commend the bill to the House.