Physical Disability Council of NSW AGM presentation

21 October 2009

I would like to begin by acknowledging the Gadigal people of the Eora nation, traditional owners of the land on which we meet.

Thank you Anne-Mason and Ruth for this invitation to address your AGM on health access issues, and in particular access to height adjustable examination beds in primary health care facilities.

Being the opportunist that I am I cannot miss this chance to also update you on progress in relation to the proposed Premises Standards – an issue I know your members will be keenly interested in.

In some ways the issue of height adjustable examination beds is a classic case study of community advocacy.

It starts with individuals identifying problems that need to be fixed based on their own life experiences; it involves individuals and their organisations researching the legal, political, policy and practical possibilities for achieving change; it requires the development of strategies, alliances and partnerships to pursue a goal; it demands a prolonged and tenacious determination to stick with it and it often requires a willingness to achieve progressive change through compromise without loosing site of the end game.

This particular issue is also a good example of the difficulties of using legal processes, which rely on individual discrimination complaints, to drive change in our community.

A little bit of history

While most of you are aware of the history of this advocacy let me remind you of the main goal and milestones.

Work on trying to ensure all General Practices in Australia provide access to height adjustable examination beds arose out of research completed in 2004 by Sheila King from Access for All Alliance, a small community group based in Hervey Bay in Queensland .

Members of Access For All Alliance were concerned they were not getting the same level of health care as other patients because they were missing out on regular examinations and screening because they could not use the fixed height examination tables.

It was clear that access to height adjustable examination beds would make examinations easier for many patients with a disability and older patients.

Sheila decided that data on what happened in other parts of Australia would be valuable and went about contacting almost every GP surgery in Australia to ask if they had height adjustable examination beds. You cannot get much more tenacious than that and we must all acknowledge Sheila's invaluable contribution to this advocacy.

Sheila presented her research at a Health Access Forum the Human Rights Commission hosted in 2005 and subsequently a number of advocacy groups, led by Women with Disabilities Australia and People with Disability Australia, decided to advocate on this issue as a priority.

Rather than pursue a legal strategy using discrimination complaints as the primary tool for achieving change, community groups decided to try and develop a partnership approach with the Royal Australian College of General Practitioners (RACGP). RACGP is a membership based organisation that supports GP's and one of its responsibilities is to develop GP Standards against which GP's are accredited.

While RACGP is not the only body representing GP's or primary health care services it is the major one and has a history of positive support for equitable health outcomes for people with a disability.

The decision to not pursue a complaint driven strategy was, I think, the correct decision.

First it would have been extremely difficult to find people willing to lodge complaints against their own GP. The nature of the relationship between patient and GP is complex and making that relationship adversarial would be difficult for most people. Second, most GP's are independent small businesses so success with one GP would not result in systemic change across the profession. Third, because each GP is a small business there could be no confidence a positive outcome could be achieved in each case.

The goal identified by community groups was to get RACGP to make the provision of height adjustable examination beds a mandatory requirement for all its members through the GP Standards accreditation process.

To do this community groups worked closely with this Commission to develop a number of arguments as to why height adjustable examination beds should be provided. This included reference to human rights principles; non-discrimination obligations; health access equality commitments and Occupational Health and Safety responsibilities.

They then presented these arguments to RACGP, the Federal Department of Health and the then Minister.

I don't need to tell anyone in this room that a well developed, legitimate argument does not always win the day when it comes to politics and the needs of organisations to act on behalf of its members. While the essential validity of the argument was well received by both the Minister and RACGP neither was willing to take action to address the issue immediately and conclusively.

At a political level the Minister was not willing to either provide additional one-off funding to assist GP's to purchase height adjustable examination beds, nor instruct RACGP it must change its GP standards to make them mandatory. This reluctance was in part an unwillingness to subsidise small business and in part a wariness of opening the door to any number of other claims other advocacy groups might have.

While the RACGP mounted an education campaign to inform its members of the importance of having height adjustable examination beds, worked with the community sector to develop minimum technical requirements for the beds and included height adjustable examination beds as a non-mandatory requirement in the GP Standards, they were not willing to go that extra step and make them mandatory at that stage. They did, however, agree to revisit this issue at the next review of the GP Standards.

These were important outcomes and RACGP was commended for taking this action. It did not, however, get us to where we want to be.

So by late 2007 we were in a situation where we had an education campaign run by RACGP with community input; a set of minimum technical and design requirements for height adjustable examination beds; a non-mandatory reference in the GP Standards encouraging GP practices to purchase height adjustable examination beds and a commitment from the Commission and community groups to continue to advocate for mandatory requirements in the future.

The future

Well the future is now.

The RACGP has just started the process of reviewing the content of the current GP Standards and the work undertaken by PDCN provides us with the perfect opportunity to renew our advocacy on this issue. Just last week RACGP called for submissions which are due by the end of November.

This PDCN report draws together the literature and research undertaken by others, summarises the advocacy that has taken place previously and adds a powerful voice of the experience of PDCN members.

The survey is a great example of the value membership based organisations can bring to an issue. While organisations like the Commission can talk endlessly about human rights, international conventions, legal liability and social inclusion it is the very personal stories of failure, farce and distress that this report provides that drives home the need for further change.

The report clearly shows that PDCN members continue to experience significant difficulties in accessing a thorough and dignified examination because of the unavailability of height adjustable examination beds. Effectively only 2 out of 10 of your members reported they had access to one when visiting their GP.

The report's conclusion, I think, captures the current situation perfectly, and I quote:

“While there appears to be Government and professional body support of equitable health outcomes for all Australian's the survey undertaken by PDCN shows that there has been little change in the availability of height adjustable examination tables and a continuing danger of inequitable health outcomes for patients with physical disability”.

Interestingly, data collected by AGPAL, one of the GP Standards accrediting agencies, suggests that just fewer than 50% of practices have one or more height adjustable examination bed.

The most recent data up to September 2009 reports that of 2815 practices surveyed 1353 had at least one height adjustable bed. Of these 211 reported one adjustable bed, 1014 reported 2, 115 reported 3 and 157 reported several. One practice reported it had 13 height adjustable beds.

The fact that there is a discrepancy between the experiences of PDCN members which showed that only 20% had access to height adjustable examination beds and the reports from AGPAL which suggested just under 50% of GP's had height adjustable examination beds is interesting.

There could be a number of explanations for this discrepancy including continuing lack of awareness amongst GP's of the value of using height adjustable examination beds where one is available.

What is important, however, is that whatever way you look at the available data it is clear that despite 5 years of improvements since 2004, when Sheila Kings research showed only about 5% of GP's had height adjustable examination beds, people with a disability are still in danger of receiving poorer health care outcomes for the simple reason their Doctors cannot ensure adequate examinations and screening.

The task before PDCN and the wider disability and aged sector now is to use this report and its findings in the most strategic way to ensure improvements.

I know that you have already provided copies of the report to the RACGP and Department of Health and that discussions have taken place with my office and representatives from Women with Disabilities Australia, People with Disability Australia and the ageing sector concerning how to best provide input to the GP Standards Review.

You are right in your assessment that there is support for improved access to equitable health outcomes in Government and professional bodies like RACGP, but experience has shown us that good will on the part of those in a leadership role does not always translate into action.

For RACGP to make the move to mandatory requirements for height adjustable examination beds its leadership needs to be confident it can deliver change without disturbing its own internal political balances. As a membership based organisation it needs to be confident its membership will recognise and accept the validity of the change in an environment where there are other competing and legitimate demands for resource allocation.

Over the next few weeks you need to use your report to help the leadership of RACGP to conclude they can make the changes we all want.

As submissions on the GP Standards are due by the end of November now is the time for anyone concerned about this matter to have their say. I am sure PDCN will be providing its members with assistance to make submissions, but let me just say the more stories of your personal experiences the better.

Once you have achieved your goal with RACGP members we need to look at how we can extend that advocacy to other medical and health related services in the private and public sector.

We also need to continue to look at ways of working with Government and organisations like RACGP and the AMA to close the continuing gap between the health outcomes for people with a disability and the broader community.

Again, congratulations on the publication of this report, it is authoritative, timely and a significant contribution to an issue – if you pardon the expression - we need to put to bed.

Premises Standards

Let me turn now to progress in the development of the Premises Standards.

I am sure I do not need to provide this audience with a long account of the history of the development of the proposed Premises Standards.

Work in earnest started on the draft in 2000 after the then Government changed the DDA to allow for the development of a Disability Standard in this area.

This amendment allows for a mechanism that will clarify accessibility requirements under the DDA and ultimately ensure consistency between building law and the DDA.

The effect of a Premises Standard would be that owners, developers and managers of buildings used by the public would be able to meet the objectives of the DDA (as they apply to buildings) by meeting the requirements of the Premises Standards .

Rather than develop Premises Standards as a separate and additional code to be followed by the building industry the intention is, once the Premises Standards is completed, to change the Building Code of Australia access provisions to reflect what the Premises Standards require.

This will mean that the building industry can continue to use the new BCA confident that compliance with a new BCA would ensure compliance with the Premises Standards and therefore the DDA.

Too long a journey

In 2000 the Commonwealth Government asked the Australian Building Codes Board (ABCB) to develop proposals for a Premises Standards. The ABCB established the Building Access Policy Committee (BAPC) which included representatives from government, people with a disability, building professionals and the property sector.

The BAPC developed a draft Premises Standards which was released for public comment in 2004. Following consultation members of the BAPC tried to find agreement on how to finalise the draft, but there were significant differences of view on some key issues including, for example, circulation space dimensions, access to upper floors in small buildings and whether or not to require access to common areas in apartment blocks.

In 2005 the ABCB sent a report to Government identifying areas where agreement could not be reached and where Government needed to make final decisions. It was hoped that Government would make necessary decisions and finalise the Premises Standards, but unfortunately that did not happen.

In late 2008 the Government held more discussions with representatives from the disability and building sectors and in December 2008 presented a draft Premises Standards to Parliament. This draft was immediately referred to a Parliamentary Committee on Legal and Constitutional Affairs for investigation.

During the first half of 2009 the Committee conducted a number of public hearings and received more than 140 submissions on the draft. The Committee delivered its report to Parliament in June 2009 and made a number of recommendations for changes to the draft.

The Government is yet to respond to the recommendations in detail, but public statements by the Attorney General and activity we know is going on indicate there is a desire to finalise the Premises Standards as quickly as possible – perhaps by the end of this year.

Some of the proposed changes

While debate and disagreement will continue about some of the proposed improvements in access in the Premises Standards and some of the things that aren't there, it is clear that new buildings and buildings undergoing renovation will provide far better access than required under the current BCA.

Among the improvements are:

• Significant increases in the number of unisex accessible toilets required in buildings
• The introduction of ‘ambulant accessible' toilet cubicles within toilet blocks
• Improved circulation space in new accessible toilets, lifts and around doorways
• Introduction of passing and turning spaces on a range of passageways
• Improved information and signage about accessible facilities
• Increased number of hotel/motel accessible rooms
• Increased number of wheelchair accessible spaces in theatres and cinemas

Are we there yet?

Despite the years we have all been working on this there are still some hurdles to jump. It's a bit like “the hip bone's connected to the leg bone and the leg bones connected to the shin bone”.

Before the Premises Standards can be completed the revised technical details contained in relevant Australian Standards, which are referenced in the Premises Standards, have to be finalised. I understand from discussions we have had today with Standards Australia that this is close to completion which is extremely encouraging.

Once this has been done the Premises Standards have to go through a formal Parliamentary process before being adopted. Once that has been completed the Australian Building Codes Board has to begin the process of changing the BCA so that it reflects what is in the Premises Standards. This means that even with the best will in the world it will still be some time before the process is completed.

My own view is that unless Government decides to trigger the Premises Standards before changes to the BCA are finalised formal implementation is not likely to occur until early 2011. In the meantime a massive information and education campaign needs to be mounted to ensure that designers, builders and certifiers are equipped with the knowledge and skills to get it right.

A few months ago I hosted a meeting of 20 leading advocacy organisations from the disability and aging sector to discuss the proposed Premises Standards and the Parliamentary report. That group endorsed a unanimous statement which included the following statement:

“The draft DDA Premises Standards create a basis for an agreed way forward to ensure the formal legal rights to access can be made effective in the real world. They have been the subject to debate between interested parties – organisations of and for people with disability, the building industry, regulators and Government – for more than 10 years. Agreement on a draft that can be endorsed by the Australian Parliament is long overdue. There should be no further delay.”

The Parliamentary Committee investigation into the draft Premises Standards was unanimous in its view that it should be introduced without delay.

Committee Chair, Mark Dreyfus, said in his introduction to the report:

“People with a disability have waited more than long enough for better access to premises.”

I agree with both these statements. We are not there yet, but all the indications are that it won't be long.

Thank you for your time this evening and I am happy to take a few questions.