Submission to the review team appointed by the Ministry of Health. February 2005.

This consultation

Several blind and vision-impaired members of the Foundation as well as Foundation staff have attended feedback sessions around the country, and the Foundation has already given the project some details on specific matters (e.g. equipment supply). This submission draws on the experiences of individual members of the Foundation who are or have been clients of the ESS agencies (Enable NZ and Accessable).

Use of ESS agencies by Foundation members

Foundation members report finding out about ESS through professionals that include optometrists, ophthalmologists, audiologists, and Foundation staff. Other sources of information are specialist advocacy groups, caregivers, family members, and peers.

Ministry of Health, Enable and Accessable staff demonstrate a very good understanding of the information needs of people who cannot read standard print without assistance and who, for socio-economic reasons, often do not have a computer than enables them to access information on web pages. The Foundation's accessible format production services can assist agencies to make their written information available to people who require, braille, audio formats, large print, and accessible electronic text.

The Foundation's accredited assessors report some very positive experiences. For example, "Accessable have been dealing efficiently with all of my applications. Recently I have been getting an emailed approval letter literally within a couple of hours of faxing through an application and price quote."

Email systems for all ESS processes handled by Enable and Accessable would be a significant advantage, particularly for those assessors who are vision impaired.

Variations in inerpretation

Some assessors experience variations in the way staff at the agencies require forms to be filled in and in how they are processed. Criteria may be applied differently by Enable and Accessable, e.g. one agency funds NOIR glasses (specialised tinted sunglasses) and the other will not.

The Foundation believes that Objective 7 of the New Zealand Disability Strategy ("Create long-term support systems centred on the individual") can be advanced by standardising procedures across Accessable and Enable.

Mobility aids: canes

The long cane is a commonly used mobility device which enables the blind person to probe the environment, identifying landmarks, objects at ground level or dips in the walking surface. The support cane is used by people who need additional support because of physical mobility issues. Occasionally a person might need to use both a long cane and a support cane.

Some people choose to carry a symbol cane; this does not probe the environment or offer support but acts to identify the user as someone with impaired vision. For many people it is vital to signal that they are vision impaired; this allows other members of the public to take care around that person, particularly when the blind or vision-impaired person is crossing a road. Lapel badges are another method people use to show that they are blind, vision-impaired, or blind and hearing impaired. It is unfortunately the case that the white cane symbol is not guaranteed to elicit the right response from members of the public. There is anecdotal evidence that the white cane symbol is not universally understood.

Other mobility aids

Other devices use echo location to detect the presence of objects; such devices can locate objects at head height and are in some cases a very helpful option for a person who has motor difficulties with his or her hands. Guide dogs, each of which costs the Foundation approximately $22,500 to breed, raise, train and match, can enable a blind person to move independently, confidently, and safely.

Orientation and Mobility services

The Foundation's Orientation and Mobility instructors deliver instruction programmes tailored to the travel and safety needs of individual blind or vision-impaired people. A cane is prescribed as appropriate.

Unmet need: the funding of canes

Experience shows that funding for a cane for a child of school age can be declined unless the assessor can state the cane is necessary for mobility in the home. Many blind people do not require a mobility aid within their own dwelling - their dwelling is a space they know well and does not pose the hazards that are present the moment they step through the front gate. Often a cane for a child will be funded because it is regarded as necessary for full time education. Foundation members and assessors are aware of inconsistencies in applying the eligibility criteria.

When a cane breaks or is damaged, a replacement is required immediately; that need is no less urgent than for a first issue.

Deafblind people's needs

Deafblind people in particular tend not to fit the vocational or educational requirements for ESS funding, and are therefore assigned a low priority under the criteria. Objective 8 of the New Zealand Disability Strategy ("Support quality living in the community for disabled people") can be met only if disabled people are able to move around the community. Indeed, the ability to move confidently around one's community is one of the stages towards participation in employment and the economy (see New Zealand Disability Strategy Objective 4). For many individuals this is a gradual process. A mobility aid is an enabling device that allows a person to get out and about, developing the potential to move into employment.

Unmet need: communication tools and technology

Access to society's written information is a basic right. People who cannot read and write the printed word are significantly disadvantaged in their access to information in the public domain. Books, magazines, billboards, television, the images on computer screens, instruction manuals, signs, maps, labels on pill bottles, newspapers, notes jotted down by family members - these are just a few of the reading needs blind and vision-impaired people have.

Delays in approval and funding

Foundation members and staff are concerned that the priority ratings accorded to communications aids by Enable and Accessable are generally P2. This entails a time delay (which can be several months or longer) in receiving approval and funding. Such delay compromises personal independence, interaction with government and other agencies, and the opportunity to participate successfully in education and employment.

Deafblind people: unique communication needs

Deafblind people have unique communication needs. For some deafblind people braille is their only means of accessing society's written information. Some require a fax machine and/or computer. Other equipment needs are hearing aids, silent alerts, and FM communication devices. The communication requirements of deafblind people can be the most pressing yet in many cases fall within the lowest ESS priority because the individual cannot satisfy the vocational or education criteria.

Why communication tools are vital

There are important health and safety issues inherent in a person's ability to communicate effectively with others.

The New Zealand Disability Strategy (especially Objective 3) stresses the need for lifelong learning opportunities for disabled people. For blind, deafblind and vision-impaired citizens, support to acquire the right communications tools is vital. The ability to communicate is a basic human right (see NZ Disability Strategy Objective 8.3; and the UN draft disability treaty asserts "the right to seek, receive and impart information on an equal basis with others").

Unmet need: spectacles

Enable and Accessable will fund prescribed spectacles for an individual when the corrected vision is still within the registration criteria for the Foundation. However, there are too few optometrists who are accredited assessors for ESS, and ESS does not fund individuals to travel to an optometrist who can carry out the assessment.

There is one fact of life true for all members of the Foundation: they cannot get in a private car and drive to an appointment. Travel difficulties and the associated costs (especially in rural places and smaller towns not served by easily accessed public transport or Total Mobility funding for taxi travel) are frequently a barrier to making an application for spectacles.

There is anecdotal evidence that some of the accredited assessors do not seem fully aware of the policy with respect to the funding of spectacles. This is not directly an Accessable and Enable responsibility, but more coordinated information sharing would ensure that assessors and clients better understand policy details and procedures.

District Health Board funds are made available to assist patients with travel costs. Blind and vision-impaired people should not face discrimination in accessing essential health services.

Recommendations

• A process review of Enable and Accessable criteria procedures in order to develop a national standard and provide certainty for Enable/Accessable staff, assessors, and clients (see NZ Disability Strategy, Objective 7).
• Expand the ESS eligibility criteria to include specifically the mobility aids that are essential for the independence and safety of blind, vision-impaired, and deafblind people of all ages (see NZ Disability Strategy, Objective 8).
• Acknowledge that access to appropriate adaptive communications technology is essential for blind, vision-impaired, and deafblind people - the ability to communicate effectively is necessary for health, safety, employment, and lifelong learning (see NZ Disability Strategy, Objective 8.3).
• Acknowledging the need for funding support to enable clients, where required, to travel to an optometrist who is an accredited ESS assessor.

Conclusion

The Foundation believes that the ESS project has the capacity to build on some successful processes administered by Enable and Accessable.