"Sex-abuse cuts ‘all about costs’"

By TIM HUME – Sunday Star Times

A former senior ACC manager says the corporation’s cuts to sexual abuse counselling are “all about costs”, contrary to ACC Minister Nick Smith’s claims they were about ensuring best practice for clients.

David Rankin, now Child Youth and Family’s senior medical adviser, has also revealed an advisory group of eight eminent psychiatrists cautioned ACC against introducing a Diagnostic and Statistical Manual (DSM-IV) diagnosis of mental injury as the threshold for victims of sex crimes to access support.

“They said, ‘Be very careful, this is not what it’s used for, this is not what it’s all about’,” Rankin told the Sunday Star-Times. “They said: ‘It doesn’t indicate severity, it only indicates the presence of a condition and it doesn’t in any way tell you what treatment is needed.”‘

ACC controversially introduced the requirement last year, cutting access to treatment for hundreds, before partially restoring support last month. Two suicides have been linked to the cuts.

Rankin, who was ACC’s general manager of health purchasing until 2006, says the main goal of the changes was to cut costs.

“ACC’s an insurance company. Its premium-payers are grizzling.”

ACC was “under extraordinary pressure to reduce its costs” and “anybody that looks at the counselling costs for sexual abuse must come to the conclusion that there is wasted money,” he said. Although sensitive claims represented only a small amount of ACC’s total spending, it was an area where the corporation had “extraordinary exposure” to liabilities.

In 2004, Rankin commissioned research into sexual abuse counselling that was co-authored by Auckland University professor Felicity Goodyear-Smith.

He said the research was commissioned because “ACC was concerned at the increase in cost in counselling”.

ACC has been criticised for commissioning the research from Goodyear-Smith, who is married to a convicted sex offender and is the daughter-in-law of Centrepoint’s convicted paedophile founder Bert Potter. She has been an outspoken critic of sexual abuse counselling, labelling it “a scam”.

Her research included a recommendation that victims be assessed with a DSM-IV mental injury diagnosis, which later appeared as a requirement in ACC’s “clinical pathway”, despite not having been specified in the Massey guidelines, a widely accepted “best practice document” which ACC said guided how the pathway was formulated.

Rankin said Goodyear-Smith’s research had set out to determine whether psychologists provided more effective treatment than less-qualified counsellors.

He had been “stunned” when her research had not borne out their expectation that they would.

He said he had been aware of Goodyear-Smith’s links to sex offenders and strong views, and for that reason stipulated “that I personally read what she said before we published it”.

He blocked a number of her recommendations. “We acknowledged the agenda and protected both herself and us against it,” he said.

He did not feel her background disqualified her from objective research, stressing that the research was “numerical” and adding “most people researching in that area have got a bias one way or the other”.

Green MP Kevin Hague said he believed the commissioning of Goodyear-Smith reflected the corporation’s agenda to cut costs.

“If it’s a numerical analysis you want, the public health departments of our universities are packed with biostatisticians who could do that. Why would you choose the researcher with the most extreme view about the topic itself to do this neutral task?

“They used Goodyear-Smith because they knew she would recommend less treatment and less costs for people who had been sexually abused. That, to me, is a scandal.”

ACC Minister Nick Smith said he couldn’t comment on ACC’s objectives in Rankin’s time. But he insisted that changes to sensitive claims over the past 12 months had had nothing to do with cost-cutting, but focused on clinical care.

He said an independent clinical panel came to the same conclusion.

“There’s been a lot of politics around trying to frame the debate around sensitive claims in context of bigger financial issues around ACC, but the paper trail and the involvement of the clinicians driving this makes it plain these are quite distinct.”

He was “uneasy” about Goodyear-Smith’s involvement, but had seen no evidence her work had influenced the pathway.


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