Herald on Sunday Editorial: ACC culture change overdue

ACC Minister Judith Collins. File photo / Ross Setford

Opinion

Get two or more people talking and it won't be long before someone comes up with a disobliging story about the Accident Compensation Corporation. Along with the Inland Revenue Department, ACC has become - not suddenly, but gradually and steadily - a branch of the state service that we love to hate.

A recent piece in our Insight pages revealed a culture of bullying and intimidation at Inland Revenue in which the systems of the bureaucracy were insensitive to the human dimension of the work it was required to carry out. The guiding assumption too often seemed to be that the service's "clients" were trying to pull a fast one and should be treated as criminals, which is what they would be, given half a chance.

The same philosophy seems to have become ingrained in the working ethos of the ACC. This week's revelations that its staff are paid bonuses for getting long-term claimants off the corporation's books chime with the impression that it is focused more on its bottom line than on the welfare of the people it is charged with serving.

The 1972 bill creating ACC covered earners only, but was amended by the Kirk Labour Government the very next year - before the law came into force on April 1, 1974 - to extend cover to non-earners, including students and visitors to the country. That universality is one of its greatest features.

The system by which primary medical treatment is delivered to victims of injury stands comparison with any country's. Most people are quickly patched up and recuperate rapidly. But in cases of more serious injury, it is less successful. Judicious spending of levy-payers' money requires recourse to the cheapest treatment options first, and it can take painful months, if not years, before ACC will pay for the sophisticated (read expensive) procedures that might have solved the problem early on.

It is easy to see the rationale for such an approach, which is logical on the macro level, if sometimes cruel to individuals. Likewise the end to fully-funded physiotherapy, which was the major treatment method paid for by ACC: there was good evidence of over-treatment that may have felt nice, but was not clinically required.

It is much harder to justify - if it is not simply for the purpose of cynical cost-cutting - the recent upsurge in refusals of surgical claims on the grounds that the injury concerned is degenerative rather than being the result of a singular trauma. The predilection of ACC's medical assessors for finding degeneration cannot be entirely unrelated to the lucrative contractual arrangements they enjoy and would not want to imperil.

Taken in conjuction with the bonus-payment regime - which is admitted and endorsed by new ACC Minister Judith Collins - it creates the strong impression of an organisation more concerned about its dollars than its duty.

Plainly there was need for financial rigour. The incoming National Government inherited a corporation whose claim costs had risen 57 per cent in the previous four years and liabilities for which no provision existed of $13 billion. Under the chairmanship of John Judge, its financial position has been rapidly rebuilt.

The fact that Collins has shown Judge the door lends weight to her promise that she is going to improve the culture of the organisation. But it remains to be seen whether she will deliver. We all accept that there are some people who will defraud the system and they deserve to be caught and punished. But most of us are not fraudsters and do not deserve to be treated as such.

Whether Collins or her departmental executives like it or not, ACC is a system of social welfare, the result of a contract by which we surrendered the right to sue in return for a guarantee that we would be looked after when we needed it. It is not a business whose clients are a liability. If the minister wants to preside over a culture change, she should start by making that plain to everyone who works for her, starting tomorrow.