The recent focus on assisting people to move from the Disability Support Pension (DSP) to participation in the paid workforce where possible has been welcomed by APMA. Many of our members, and other people living with pain, would love to remain in or return to the workplace. APMA has made its cautious support for the reforms clear in a detailed submission recently to a Senate Committee examining a Bill before Parliament to give effect to a major plank of the reforms. You can access the APMA submission here. APMA Vice-President Paul Murdoch subsequently addressed the Committee in hearings held on September 6.
The Advisory Committee - which 12 months reviewing the impairment tables which are used to determine eligibility for DSP - highlighted the health and social benefits of work. These include not only the financial benefits, but also that working is generally good for health and well-being, and is important for identity, self-worth and social participation. Whilst some people with persistent pain are profoundly disabled and must be able to access the safety net which the DSP provides, those who have some capacity to work should receive encouragement and support to do so.
The Government recently announced its acceptance of the Advisory Committee’s major recommendation, revised impairment tables for use in assessing a person’s work-related impairment. The tables will be able to be regularly updated in response to developments in medical and rehabilitation practices, as they will be reissued in the form of a legislative instrument issued by the Minister. Other reforms have included a new Health Professional Advice Unit within Centrelink, additional payments to treating doctors where the Unit requests further information and an expansion of the Disability Employment Services. APMA has been working and lobbying to ensure that these changes actually assist the objective of assisting people with persistent pain to work, rather than merely moving people from a disability support pension onto the lower payment level and insecurity of an unemployment benefit.
Important additional action required from the Government to ensure the reforms will be successful include: ensuring people with persistent pain can access appropriate assessment and treatment for their condition in a timely manner to limit the severity and chronicity of the condition, as well as encouraging and requiring more flexibility and accommodations in Australian workplaces from employers (including access to assistive technologies).
A range of disability and consumer representatives were involved in reviewing and oversighting the implementation of the new Impairment Tables. They included Mental Health Council of Australia CEO Frank Quinlan, who said the overhaul is long overdue. “It looks much more at what people are able to do successfully in society, or in their day-to-day life, rather than looking at simply listing particular medical diagnoses” he said. A major change is that the previous practice of using a ‘miscellaneous’ table to assess pain will cease, and functional impairment due to pain will be assessed using whichever of the revised tables apply to the area(s) of function affected. This change will help to address the current inadequate treatment of people living with pain whose condition(s) are not properly investigated, diagnosed or treated – and who are then just left to languish on a disability pension without access to effective rehabilitation or employment assistance.
The new impairment tables will make it clear that a superficial medical report of ‘pain’ is unacceptable. The proposed tables state: “Pain is a symptom and not a diagnosis. It is important that the cause of pain is properly diagnosed and treated. There are a range of treatment options for the management of pain. Significant, ongoing pain that is not substantiated by the diagnosis of an underlying condition and a report from a medical specialist and/or pain management clinic requires consideration of whether the person’s condition has been fully diagnosed, treated and stabilised.”
The use of the new Impairment Tables will commence in January 2012, for assessment of new applications for the DSP. It has been reported that people currently in receipt of DSP will not be affected. In an interview on 30 July, Minister for Families, Housing, Community Services and Indigenous Affairs Jenny Macklin MP said “This is about people in the future. So it’s people who will apply for the DSP from the 1st of January next year.” This has been a critical issue for APMA – a number of people with persistent pain and other medical conditions where pain is a seriously disabling element who are currently receiving DSP may be reviewed at some stage over coming years. The possibility that the new assessment standards might be applied to them – with a requirement to return to work – or more likely the lower payment of a sickness benefit - could cause significant anxiety for many unless it is clear agreement that current recipients will not be significantly disadvantaged by review under the new Tables.
APMA has continued to lobby for increased pain management resources and services to ensure that the huge number of Australians with disabling persistent pain can be assessed and managed. APMA has also made a number of comprehensive further representations and submissions to the responsible Department (FaHCSIA) to ensure that the revised functional-based impairment tables – and the accompanying guide - properly recognise the full range of dysfunction which can result from persistent pain. Face-to-face and teleconference meetings involving APMA representatives have also taken place.
APMA does not accept or support some of the hysterical predictions that people with chronic pain will now not be able to apply for or obtain the DSP. A key objective of the National Pain Strategy is to reduce the economic cost to people with pain (and their families) of sub-optimal management of pain (4.1 and 4.2) and we anticipate that this new approach will help to meet that objective. As APMA Secretary Lil Carrigan says, “It’s about assessing people on their ability to be part of the workforce and encouraging and supporting them to be part of it to the maximum of their capacity wherever they can”. Whilst we have not been able to reach agreement about the use of the new Tables for reviews of existing DSP recipients, FaHCSIA have agreed to a range of measures to ensure no existing recipient will lose access to the DSP unless it can clearly be demonstrated that payment of the DSP is not appropriate. APMA will continue to closely monitor the development of the final Tables, and their application by Centrelink, and keep members informed.
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