Submission to the Social Services Select Committee on the Inquiry into the Quality and Care of Service Provision for Disabled People

 The Royal New Zealand Foundation of the Blind (the Foundation) is constituted under the Royal New Zealand Foundation of the Blind Act 2002. It is the primary provider of vision-related habilitation and rehabilitation services to over 11,500 blind, deafblind and vision-impaired New Zealanders (members).

Members directly elect the Foundation's Board of Directors and participate in consultations around strategic and business planning. As an organisation which is accountable to its membership, the Foundation encourages member feedback, supports a network of Community Committees at the local level, and works closely with nine consumer organisations that undertake a range of advocacy activities. 

To be eligible for membership, and thereby receive services, a person must, in the opinion of a registered ophthalmologist or optometrist, have a visual acuity that does not exceed 6/24 in the better eye with corrective lenses, or have serious limitations in the field of vision such that their field of vision is generally not greater than 20 degrees at the widest diameter.  As such members are blind or vision-impaired and may also be deafblind.

Members of the general public who support the aims of the organisation can join the Foundation as associate members and participate in the election for the one Director elected by the associate membership.

Profile of members

The Foundation has approximately 11,500 members who are eligible to receive services. More than two-thirds of Foundation members are over the age of 65 (16% are aged 65-79 years, and 52% are aged 80 years or older).  Twenty four percent of members are aged 20 to 64 years of age and nearly 7 percent of members are younger than 20 years of age.

Foundation membership is predominantly New Zealand European (83.9%). Māori make up 6% of membership. Almost 2.8% of members are of Pacific Island ethnicity and 1.3% are Asian. "Other" ethnicities make up the remaining 6% of members.

Age-related macular degeneration is the most common eye condition reported by members. Specialists who refer people to the Foundation have identified some 150 different eye conditions among its membership. The Foundation itself is a provider of habilitation and rehabilitation services, not clinical eye health services.  In many cases the Foundation provides specialist sensory services that are post-clinical care. The ophthalmologist, realising that no clinical intervention will remedy or prevent the worsening of the patient's eye condition, refers the patient (or, in the case of a child, the family) to the Foundation for service.

Vision and Mission

The Foundation's vision is that blind and vision-impaired people have the same opportunities and choices as other citizens to participate fully in society. Its mission is to remove the barriers faced by individuals and to promote their participation in all aspects of life. The Foundation collaborates with organisations working to minimise the incidence of preventable blindness. Considerable effort is put into helping central and local government and district health boards understand that, in line with the New Zealand Disability Strategy, they can create a community which is equitable for blind, deafblind, and vision-impaired citizens.

Funding of the Foundation

The Foundation has an annual operating budget of just over $21 million.  The sources of revenue include approximately $11 million raised by the Foundation through fundraising programmes, $3 million from other sources (property, investments and sales) and $7 million from government sources.  Of these, the Ministry of Health funds the Foundation approximately $5 million for some of the habilitation and rehabilitation services provided by the Foundation, the Ministry of Education funds the Foundation approximately $1 million to provide educational materials in formats accessible to blind and vision-impaired children and the Ministry of Social Development funds the remainder, approximately $1 million, for vocational placement and support services provided to members.  Library services and Guide Dog services are nearly 100 percent funded through public donations, bequests and sponsorship.

Services across the Lifespan 

The Foundation undertakes assessments and service programmes in such specialist vision areas as orientation and mobility training for adults and children, adaptive communication and technology instruction, the skills of adaptive daily living, counselling and employment services. Guide dog and library (talking and braille book) services are available to members. There are programmes specific to the needs of Māori and Pacific communities. The Foundation delivers advice and training on access and disability issues to a wide range of public and private organisations.

Each year thousands of volunteers give direct support to Foundation members and contribute to the Foundation’s work in general. Seventeen locality offices and over 40 community committees support Foundation members. 

Within its business and strategic planning the Foundation is committed to continuous improvement in service delivery. This includes researching the needs of members in particular age and ethnic groups and further refining services to meet those needs.

Differences in Disability Types

Before responding to the specific Terms of Reference of the Inquiry we wish to stress to the Committee that not all disability is the same.  Obviously, the Foundation’s focus is sight loss.  Sight loss is generally sub-categorized within disability as a sensory impairment but even within sensory impairment it is important not to assume similarity.  This can be seen by comparing employment rates of those with vision loss with those with hearing loss.  Research undertaken by the Ministry of Social Development demonstrates that people who were blind or visually impaired were least likely to be offered employment compared with all disability types, while people with a hearing loss were the most likely to be offered employment.  As they conclude, a better understanding needs to be gained of the factors that “support people with disabilities into … employment …, the nature of the support required to facilitate increased employment, how to overcome “demand side” barriers to employment …, and what mechanisms are required to facilitate sustainable employment for those with disabilities.”[1] 

Inquiry into the quality and care of services provision for disabled people – Terms of Reference Number One

We offer the following response to the first Term of Reference: Current service provision arrangements for people with a disability and future direction (including home based, residential, vocational and community).

• Historical changes in provision of care.  
• ­Has New Zealand achieved appropriate models of care and choice,  what changes are desirable including issues of continuum of care - what's working successfully and why? 
• ­The right of those with a disability to live a life of independence and freedom (what are barriers and how can they be overcome?)

The Foundation has provided services to blind and vision-impaired people for over 115 years and hence feels qualified to comment on historical changes in the provision of care.  Like other institutions, the Foundation has amended and refined its approach to the provision of services as more effective methods of providing service have become understood, in response to different philosophies that have dominated thinking and subject to available revenue.  This has seen an historic shift from residential or hostel accommodation accompanied by sheltered workshop employment to integration and mainstreaming.   Most recently for the Foundation, however, there has been a shift in governance from a focus on being ‘for’ the blind to being ‘of’ the blind.  This change has brought its own challenges, including an increased need for, and costs associated with, consultation.  We see ‘self-determination’ based on effective self-governance and responsiveness to the holistic needs of the individual as key themes for the future.

More generally, the other most significant change has, arguably, been a shift in thinking away from the medical model of disability, which focused on the individual, to the social model of disability, which defines society as disabling.  Within the social model of disability it is recognized that societal barriers need to be dismantled to ensure effective and full participation in society.  “The exclusion of disabled people from many activities such as employment, education and housing was a crucial aspect of the social model.”[2]

While the Foundation strongly supports the perspective reflected in the social model of disability and the need for effective advocacy to reduce and, ultimately, eliminate barriers to effective participation in all facets of life by blind, vision-impaired and deafblind people, it is recognized that focusing on advocacy to remove barriers is not sufficient.  Research undertaken with members of the Foundation suggests that both the medical model and the social model have some validity.  Blind, deafblind and vision-impaired people indicated that they need change in both the socio-political environment including in areas such as attitudes and transit systems and assistance with overcoming the direct and indirect consequences of vision impairment such as through training in adaptive and assistance technologies.[3]

As with other not-for-profits in the Voluntary sector, the Foundation is constrained in undertaking advocacy activities by funding constraints.  Ideally, the Foundation would be resourced by Government to advocate on behalf of its members.  Funding for such activity is not without precedent in Public Health contracts where various agencies have been contracted to, among other things, advocate for a range of strategies which improve public health, such as anti-smoking policies. 

The Foundation is also constrained by serious funding limitations in terms of the services it provides to members (or potential members) which could assist members to overcome the direct and indirect consequences of vision impairment such as through training in adaptive and assistance technologies.  Demand for our services or potential services exceeds our ability to supply services and yet what we actually supply far exceeds what we are funded by Government to supply.  Furthermore, the Foundation’s eligibility criteria are limited to those with the most severe sight-loss, so that services are not overly diluted. This means that interventions can not always be provided early enough for some people experiencing sight-loss, potentially resulting in job losses or downward social mobility.  Funding limitations also affect our ability to ‘case search’ within our membership for those who we could offer specific services t.

We note that there has been a historic tendency for ‘pendulum swing’ mentalities such as occurred with the shift from hostel to community based service delivery from the 1980s.  However, there are often benefits to be obtained from taking a balance between types of care.  No one model necessarily fits all people, all of the time, in all situations. Rather it is necessary to tailor services to the individual, especially those with multiple disabilities, and ensure that there are clear accountability arrangements no matter which agency or agencies are providing support.  However, such a strategy requires a high skill level to understand individual needs, tailor packages and provide services.  Such shifts are rarely accompanied by adequate resourcing and may be compounded by siloed funding streams within and across Health, Education or Social Development. The Foundation is continually reviewing and trialing service delivery models as a consequence of scarce resources.

Transitional provisions also need to be put in place for those leaving residential care and re-entering the community.  The closure of Kimberly House needs to be supported by an appropriate level of care so that social isolation does not occur.  Blind, deafblind and vision-impaired people are particularly at risk group of experiencing social isolation. 

With reference to successful approaches, the vocational services provided by the Foundation have, along with other services, changed over the years.  Currently employment consultants from the Foundation work in partnership with members to find work which matches the skills, qualifications and interests of our members. This includes the provision of pre-employment skills, support into a position and post-employment support.  However, barriers remain, as evidenced by the employment research cited above.  Furthermore, in an ideal world we would be able to provide these services earlier for those people experiencing progressive sight losses.  

The cost of disability must be recognized and appropriate responses in the form of financial support safeguarded, where they already exist, or implemented, where they do not.  People with a range of disabilities, including those who are blind, vision-impaired or deafblind need funding support whether in the paid workforce or not if they are to participate on an equal basis with their sighted peers. Independent research commissioned by the Foundation revealed that “the costs of blindness in New Zealand are wide ranging and significant.  Key cost areas are related to carrying out domestic tasks, day to day travel, shopping, recreation and use of specialized equipment.”[4]   It should also be noted that “many disabled people who currently work only part-time have the potential to engage in full-time work if better employment support mechanisms were available and employers had a greater willingness to employ them.”[5]  

As a minimum, the Blindness Benefit must be maintained so that blind people are not disadvantaged by participating in the workforce. It should be noted that the costs of blindness are lifelong and permeate all facets of a person’s life from health, housing, recreation to employment costs. Secondly, attitudinal barriers need to be broken down so that people with disabilities are given the opportunity to show what they can do, free of prejudice.  There is a need to change social attitudes.  One excellent example of a social marketing campaign recently undertaken for mental health was the “Like Minds, Like Mine” campaign.  This campaign set out to de-stigmatize mental health as a disability.  A similar social marketing campaign should be aimed at other sensory disabilities, including blindness and vision-impairment.  A campaign could consider shifting the emphasis from ‘disabled’ people to ‘people’ living with disability. Other campaigns could focus on employers ‘giving blind people a go’ and promoting the values blind people bring to an organization.

Legislative change needs to ensure that there is an equal playing field.  For example, employers can be made aware that workplaces can be made accessible through a variety of strategies such as accessible software or by environmental design which includes consideration of size, lighting, contrast, signage and colour. However, if an employer perceives that they will incur costs over and above those required to employ a sighted person, they are less likely to employ a blind person.  Employers should not be financially disadvantaged by employing a person with a disability.  To counter this issue the government needs to fund a range of services and interventions that assist blind and vision-impaired people to participate equally in the workforce. This may include areas such as funding for adaptive technology software, applying contrast, additional lighting or tactile marking in workplaces. In the case of the built environment, accessibility for blind and vision-impaired people should be mandated.  Legislative requirements should remove the element of choice regarding accessible physical environments such as through mandating Road Transport Safety Standard 14. This is also likely to be of more general value as our population ages.

It is worth noting that we live in an increasingly visual society – many key messages are delivered via visual media.  The deaf community has recently achieved the right to have information conveyed in Sign Language.  The blind community also needs to have visual information ‘translated’ or described in words so that it is accessible to blind and vision-impaired people.  Audio described television would be one step towards increasing accessibility. This is now a legislative requirement in a number of countries, including the United Kingdom. 

Access barriers also exist in the form of waiting lists.  The Foundation deeply regrets that access to rehabilitation services provided by the Foundation is, in some instances, delayed by waiting lists.  Waiting lists are caused by a range of factors including available funding and human resources.  In terms of human resources, the Foundation has recently found itself disadvantaged as an employer by higher pay rates being funded and paid in the public sector. A benchmarking study recently undertaken by us has indicated that the Foundation may be 10 to 15 percent behind comparable employers.  This compounds recruitment and retention issues, despite our best efforts to be a good employer and offer other intangible rewards to staff. This contributes to a cycle of decreasing ability to provide the services our members’ request.  

Parliament included in the 1994 Copyright Act Section 69 which permitted prescribed bodies to produce materials in accessible formats without the need to clear copyright or pay royalties. This simple legislative provision substantially sped up the production of materials by eliminating the time previously spent on copyright clearance (which could take months or years to obtain). There remains however, a need to expand this legislation to permit the import and export of special format materials between countries with similar legislation. Currently the Foundation has to clear copyright on all accessible format books imported from the UK, Canada, the United States and Australia.

There is also a need for on-going education and monitoring regarding legislative requirements in New Zealand.  Despite legislation enshrining the right of access by a guide dog handler accompanied by a guide dog, the Foundation hears of frequent examples where guide dog handlers are denied access to taxis and restaurants because of their dog.  Similarly, the Human Rights Commission published a watershed Inquiry into Accessible Public Transport in October 2005. Government increased its funding of Total Mobility following extensive consultation. Nonetheless, there remains considerable disparity in transport provisions across the country and even between New Zealand’s major cities. We also note that a differential is created in terms of the quality of care and support available to those whose lose their sight accidentally (and hence are covered by ACC) and those who have a congenital or age-related condition which causes their sight-loss. 

In terms of barriers to living independently, barriers are best mitigated by early intervention and family support, particularly in the case of children.  Key interventions include the acquisition of personal skills and peer contact; access to information (including accessibility of public libraries and websites); accessible public transport; effective environmental design; access to technology and training in the use of adaptive technologies, and; access to equipment. Older people also require early interventions to reduce social isolation (which can lead to depression) and maintain the skills required to remain in their own homes.  Such skills include learning techniques and making adaptations to support daily living activities such as meal preparation and orientation and mobility.

Inquiry into the quality and care of services provision for disabled people – Terms of Reference Number Two 

We offer the following comments in response to the second Term of Reference: The way National Standards of care are determined, implemented and monitored, and any lessons learned from historical complaints and systemic failure.

­That monitoring is carried out in the most effective way to ensure quality of care and support of individual disabled people and how best outcome is measured.

• Is the certification process a meaningful way of ensuring service quality?
• That the current understanding of quality, as determined by the Standards, is appropriate to the function of supporting valued lives for disabled people. (Can the current auditing methods be improved?)

­Contemporary issues relating to provider organizations that have caused public concern.

The Foundation is not convinced that certification is the best way of ensuring service quality.  We are not currently required to be certified.  Whatever standards are set must be applicable to rehabilitation and habilitation as well as support services (the category that most other disability organizations define their services as fitting), but in being broad enough to be applied across a number of disabilities, standards may not necessarily prove an effective tool to meet specific disability needs.  We think that using international blindness-specific standards which also conform with New Zealand service standards will provide a more relevant measure of our core business.  Standard development, setting, monitoring and review processes need to include people with the specific disability covered by the standard and the organizations involved.

In relation to Home Care Support, the standards and career paths of providers needs to be lifted.  This should be accompanied by an appropriate qualification, perhaps at the level of a Certificate, and by remuneration that recognizes that the carer’s role is of value to the community. Home care agencies also need to be routinely monitored to ensure standards are maintained and contractual requirements met. This will support the desired outcome of aging in place.

The audit system selected should be outcome focused and consumer-centric. In other words, the consumer of the service should determine what outcomes are relevant and meaningful.  Outcome indicators obviously need to be measurable and verifiable although we acknowledge that this is fraught with difficulty as it is difficult to demonstrate a direct link between the Foundation’s interventions and a specific outcome (such as remaining on one’s own home rather than having to move into a rest-home).   Ideally, the system should also be both internationally benchmarked, or recognized, and be able to measure organizational competence through one audit system.

The Foundation is also concerned about the possibility of audit ‘overload’, especially given that we have various funding streams.  Multiple audits could result in unsustainable compliance costs which would draw funds away from service provision. We suggest that consideration be given to an all-in-one audit system.  This also need not necessarily be required annually, following successful completion of one such audit.  An audit every three years should be sufficient for established organizations, such as the Foundation as we do not have 24 hour care or support requirements.

Inquiry into the quality and care of services provision for disabled people – Terms of Reference Number Three

We offer the following comments in response to the third Term of Reference:  The advocacy and/or complaints process for clients, and their families, residents and the public.

• ­Is there a need for improved advocacy mechanisms - particularly for the most vulnerable?
• ­Is there a need for improved complaints mechanisms?

We consider that the existing complaints mechanisms are reasonably effective and accessible.  However, we suggest that advocacy systems need to focus more on empowering individuals and/or consumer groups to be their own advocates.  The two keys to this include education and access to information.  

Community education campaigns should be designed to inform people of their rights and strategies for self-advocacy and supported by training and education for medical and allied health professionals.  The Foundation offers blindness awareness training to employers, training institutions and others.  Most importantly, blind, vision-impaired and deafblind people need to be consulted at the outset of the policy process and in the design of services so that their needs can be met effectively by service providers, no matter what services they are accessing.    

A range of people with sight-loss do not access services for a variety of reasons.  Reasons for not accessing available services are many and varied, however we suggest that there are people who would be eligible and could benefit from our member services if they were aware of and could better access information about them.   While the Foundation plays its part in communicating its services, local care networks, possibly through District Health Boards, should ensure that there are mechanisms to increase access to information regarding service availability.  Information should be available through various channels including the telephone and world-wide-web.  

We consider that improved advocacy is required for vulnerable groups such as blind and low-vision children and for deafblind citizens.

Inquiry into the quality and care of services provision for disabled people – Terms of Reference Number Four

We offer the following brief comments in response to the forth Term of Reference:  The level of accountability, funding, information sharing, transparency and collaboration between relevant Ministries, community agencies and providers.

That there is clear accountability and understanding between the various government agencies and providers of disability services.

• How responsive, effective and efficient are the current contracting arrangements, and how can they be improved?
• Are the government departments working in tune with the practical application of the New Zealand Disability Strategy?

­Office of Disability Issues

Different government agencies appear to have different approaches and models that are not always well reconciled.  For example, the Ministry of Health has tended to be driven by a medical model of disability although they have responsibility for funding the delivery of disability services.  The Ministry also provides secretariat support to the Health and Disability Ethics Committee.  Our recent experience suggests that the Committee is more in tune with medical or health perspectives than with disability perspectives.  As a recent example of this, to ensure the accessibility of an ethics committee application to blind people, we encouraged the secretariat to provide our application to Committee members electronically so that the application could be readily accessed by blind and vision-impaired people. The secretariat declined our request.  

The Foundation considers that there is a need for greater inter-Ministry engagement particularly between Health, Education and Social Development. In particular, we suggest that consideration needs to be given to how to obtain the best outcome, not who holds the budget.  This may require greater flexibility between Ministries and more inter-Ministry working parties. 

With regard to current contracting arrangements, the Foundation has found contracting with various Ministries difficult.  While we have recently achieved satisfactory conclusions to contracts commencing in July 2006 the process has been stressful.  In particular, we were very concerned about the possibility of having to contract individually with 21 District Health Boards,  as this would have increased the time invested in the contracting round exponentially, and, we feared, reduced the total funding we would have achieved.  While this did not occur, we consider that contracting arrangements must be able to be negotiated through one national agency or organizations like ours would not be able to continue delivering services.  Secondly, our experience in the most recent contracting round was that Ministries were not responsive – correspondence was not responded to in a timely manner and written confirmation of contractual matters was left to the last minute, leaving our organization vulnerable and unable to plan for the future effectively.  The duration of contracts is also an issue.  While we have achieved a three-year contract, this was not certain, and once again, makes planning and operational management vexed.  Contracts need to be negotiated in a timely manner and have at least a three-year duration to support both service provision and investment in training.  They must also be focused on workable outcomes, not ideology.

An example of poor agency cooperation experienced recently by the Foundation involved Pharmac. We applied to Pharmac to fund a specific glucose strip which was required to support an audible glucose meter for diabetics.   Blind or vision-impaired diabetics can not see the result of a self-administered test on a standard machine.  The Foundation has a national contract (through Capital and Coast District Health Board) to assess, teach adaptive skills and, if required, provide audible glucose meters to those diabetics who are unable to read a standard glucose meter.  However, Pharmac has effectively discriminated against blind and vision-impaired people, by refusing to fund the product required to meet their needs because they entered into a bulk-purchasing contract (until 2008) which did not take into consideration the needs of blind and vision-impaired people – this when one of the complications of poorly controlled diabetes is vision-loss.  The cost to an individual who now has to fund the glucose strip personally is $700 - $1150 every year, a sum that many blind or vision-impaired diabetics have great difficulty finding.  The cost savings made by Pharmac are likely to be totally outweighed by the cost to the public health system from complications resulting from uncontrolled diabetes.

We gave the example above of our employment services, which have been successful in getting our members into work.  However, the Ministry of Social Development contract is focused on getting people into work, not on supporting people to keep their existing job.  So while we receive funding to find new jobs, we have new members who may be struggling to keep their job due to a deteriorating eye condition.  There are a range of services we could offer these members, including adaptive technology training, but the Foundation is not supported through government funding to provide these services.

Inquiry into the quality and care of services provision for disabled people – Terms of Reference Number Five

We offer the following comments in response to the fifth Term of Reference:  The quality of training, career structure and workplace conditions of the disability workforce.

• ­Framework qualifications
• ­Workforce planning
• ­The level of availability of academic teaching, training, theory and learning in New  Zealand

For the Foundation, the single biggest issue for workforce planning at this time is associated with paying market wages.  In our rehabilitation services we have traditionally sought to attract teachers, nurses, occupational therapists, physiotherapists and other allied health professionals.  Unfortunately the pay rates for these disciplines are significantly higher than what we can afford to pay.  We also have difficulty attracting people to our Scholarship programmes as the pay rates offered in the sector are not attractive to someone looking for a career in the health and disability sector. We also have similar issues with attracting information technology staff whom we engage not just to support our IT infrastructure but to teach blind, deafblind and vision-impaired people skills that will help them to remain in or find employment or cope with everyday life. The effect of not being able to offer market rates of pay is that our ability to attract and retain a quality workforce is compromised.  

The recent increase in funding provided to District Health Boards to increase the wages of nursing staff, occupational therapists and other allied health professionals employed in public hospitals has had a flow on effect to our organization.  Additional costs and employment retention issues have hit the Foundation.  We consider that the funding has not been applied equitably across the sector and we see it as discriminatory that government policy, which has determined that staff working in DHBs are worthy of salary increases, is not applied even handedly throughout the voluntary sector.  Thanks to government policy, we now appear even less attractive as an employer of allied health professionals and are losing qualified staff.  This of course affects our ability to provide what our members consider are essential services in the rehabilitation area. 

Due to the relatively low incidence of blindness, resulting in the requirement for a relatively small workforce, accessing training funding for low numbers of staff is difficult. Although support is available for the development of learning outcomes, funding for the actual delivery of the educational and training programmes is required

Ongoing, ring-fenced funding for disability-related research initiatives needs to be made available in a sustainable manner.  This should be available to organizations like the Foundation which is committed to being evidence-driven, not just academic institutes. 

Inquiry into the quality and care of services provision for disabled people – Terms of Reference Number Six

We offer the following comments in response to the sixth Term of Reference:  An assessment of the extent to which the New Zealand Disability Strategy is central to the wellbeing, rights and care of disabled people.

The Foundation is of the view that the New Zealand Disability Strategy has been a useful tool for improving a wide range of activities and services and for increasing understanding of disability-related matters. We applaud the Hon Ruth Dyson as the Minister of Disability Issues for bringing the Strategy to fruition. The Strategy needs to be a living document.  As such it needs to be reviewed and updated over time and recognize the need to maintain gains won for the disability community while continuing the momentum for new victories that will result in a fully inclusive society for the blind, vision-impaired and deafblind citizens of New Zealand. 

Conclusion

The Royal New Zealand Foundation of the Blind thank the Committee for providing this important opportunity to comment on the quality and care of services provision for disabled people.

The Foundation considers that the most important issues that need to be addressed in the recommendations made by the Committee include the need to

• ­substantially increase accessible information throughout the community and improve access to the built environment to encourage more independent travel
• ­continue to remove barriers to the full participation of blind, deafblind and vision-impaired people such as through social marketing campaigns, audio-described visual material and legislation requiring compliance with NZ Standard 4121 and RTS 14 for environmental design
• ­provide full government funding to cover the costs of rehabilitation services to be provided by adequately trained and remunerated staff
• ­provide full government funding to cover the costs of quality support services provided by suitably trained and remunerated staff
• ­deliver funding increases provided to the public sector equitably across the voluntary sector
• ­consider the needs of people holistically and deliver interventions when the interventions can most benefit the individual, such as focusing on early interventions for children and their family; keeping people in their job, not getting people back into the workforce after they have lost their job, and teaching the elderly coping and adaptation skills so they can age in place.

We thank the Committee for considering our submission and request to be heard by the Committee.

Paula Daye

Chief Executive

The Royal New Zealand Foundation of the Blind 

[1] Jensen J. et al 2005. Disability and work participation in New Zealand: Outcomes relating to paid employment and benefit receipt. Ministry of Social Development. pp.35-36, 52.

[2] Mellsopp S. 2005. ‘You live too far out’ The Impact of the Health Reforms on Disabled Rural Women. Thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy.  Massey University. p.63.

[3] LaGrow ..Daye 2005. p183..

[4] Gravitas Research and Strategy Ltd and Market Economics Ltd. 2006. The Cost of Blindness in New Zealand. The Royal New Zealand Foundation of the Blind.

[5] Jensen J. et al 2005. Disability and work participation in New Zealand: Outcomes relating to paid employment and benefit receipt. Ministry of Social Development. p.51