Gordon Campbell on the incentive payments at ACC

The chances of achieving culture change at the Accident Compansation Corporation would seem to be almost zero if those in charge of the organisation cannot see that when you create a system of paying staff a bonus to cull ACC claimants, then this payment just might conceivably cloud their clinical judgement. That’s what bribes are meant to do – to achieve a pre-determined outcome. The desired outcome here is pretty clear. It is to tip people off ACC and into the category of being a job seeker, where they are likely to receive a lesser payment on welfare.

The corruption of the ACC scheme appears to be systemic. Not only case managers on the front lines, but team leaders, technical claims managers and branch managers also qualify for the incentive payments. On RNZ this morning, outgoing ACC chief executive Ralph Stewart stressed that the payments are only a small part of the remuneration package – but that is hardly re-assuring, or convincing. After all, surely an incentive payment has to be big enough to influence performance. That’s why it exists. In an ACC context, where clinically assessed assessment is supposed to be the determining factor in decision making, there is no place whatsoever for payments that threaten to skew the process.

Everyone, it seems, but ACC Minister Judith Collins can see the potential for abuse here. According to Stewart, ACC has two goals: to rehabilitate claimants and to manage its finances, and those two things are kept entirely separate. Ah-huh. Nothing is to be read – apparently – into the existence of the incentive scheme for the past three years, and the way the numbers of long term claimants have plunged over that period. Back in the real world though, the findings of say, the NZ Herald, appear considerably more credible:

In 2010 and again this year, the Herald ran a series of articles about the ACC’s hard line with claimants, particularly those making claims for surgery. During the series, more than 400 people complained about their ACC cases. Some lawyers and independent orthopaedic surgeons criticised ACC over its crackdown on surgery access.

They alleged it relied on brief, weak opinions from its doctors, some of whom had retired from treating patients and were often not specialists in the areas they advised on.

That kind of thing – the systematic denial of entitlements – is the core problem with ACC. In the name of cost cutting, a culture has been fostered that treats long term ACC claimants as malingerers. They are not. They have been the victims of accidents and the payment they receive is not a welfare handout – it is compensation for (a) an ongoing condition that may always prevent them from going back to work and for (b) agreeing to forego the right they otherwise had to sue for damages. ACC claimants have agreed not to pursue the route of suing for compensation in return for the state intervening, and providing an adequate level of compensation. The state is now not only welshing on its side of the contract – it is paying enforcers to help them to do so.

Can Judith Collins be relied on to clean out this perverse organization, and get it back on track? Clearly not. As she already shown with the Bronwyn Pullar case, Collins doesn’t seem to grasp the issues at stake. In her view, the main concern raised by the Pullar case was poor communication practices by ACC, and not a culture of denial when it comes to entitlements. With these incentive payments, she seems similarly unable to get it. The incentive payments “are a good thing” she says, if they get people back to work. “I don’t see any problem with that, but where I do see a problem is if anyone’s being forced off ACC when they’re simply not able to work, and I think that’s a different thing altogether,” Really? So if you pay case managers and their supervisors to terminate client entitlements – because that saves the organization money – and then lo, that outcome eventuates and people go off the books, we are supposed to believe these things are entirely unrelated? C’mon. That’s not just corrupt, it’s insulting.