Auditor-General's overview

E ngā mana, e ngā reo, e ngā karangarangatanga maha o te motu, tēnā koutou.

In 2014, we looked at how well the Accident Compensation Corporation (ACC) used a case management approach to support claimants to recover and rehabilitate from serious injuries. We wanted to know how well ACC worked with claimants so that they received the highest practicable standard of service and whether it treated them fairly.

We found that ACC did not provide claimants who had different types of treatment and rehabilitation needs with a consistent quality of service. This included the extent to which ACC put claimant needs at the centre of treatment and rehabilitation decisions.

We concluded that ACC needed to have a more "claimant-centred" approach, particularly for claimants with complex needs.

I decided to carry out a follow-up audit to see what progress ACC had made in addressing the four recommendations we made in 2014.

ACC has made good progress in implementing three of the four recommendations we made in 2014:

• Case managers now have better access to guidance and advice to make the most appropriate decisions about treatment and rehabilitation for claimants.
• Claimants now have easier ways of providing feedback during their recovery. ACC is learning from, and acting on, claimant feedback more transparently. It has also strengthened its internal monitoring of, and reporting on, the quality of its services and how it builds staff capability to reach expected levels of performance.
• Claimants with complex needs can now expect a more consistent service through a case management approach designed to support them. This approach is called Partnered Recovery. ACC is actively seeking feedback from these claimants to help it understand and address their support needs better.

The pathway to a full rehabilitation and return to a claimant's previous life (as far as these can be achieved) can involve moving from the care of ACC to other public organisations, such as Work and Income. This transition can lead to claimants feeling uncertain and anxious. This is particularly acute for those needing interim income support while seeking new or different employment.

We expected to see a clear framework and processes that support a seamless and well co-ordinated transition. A framework would support case managers to do all they practically can to plan for, inform, and prepare claimants for this transition.

In my view, ACC has not made enough progress in improving its processes to prepare claimants for this transition. I would like to see ACC do more to address this fourth recommendation.

Planning and preparing for this transition is critical, both when the claimant enters the ACC system and throughout their time with ACC. This needs to involve the claimants, their whānau, their treatment and rehabilitation providers, ACC case managers, and the staff of other relevant public organisations.

In 2017, ACC began testing and refining a new case management approach called Next Generation Case Management. The new approach aims to put claimants at the centre of ACC's case management services by better understanding their wider needs and challenges to recovery, and by working more closely with those who need the most support.

Although ACC has been developing the Next Generation Case Management approach for some time, it has not fully embedded the approach yet. This means that it is too early to know with certainty whether it will fully realise its potential benefits. Although it has taken some time to fully implement the Next Generation Case Management approach, there are some positive signs. For example, ACC's initial monitoring suggests that, under the new approach, claimants see their interaction with ACC as fairer and that they are more satisfied with the support they get from ACC. In my view, the Next Generation Case Management approach has the potential to support better claimant outcomes.

The Next Generation Case Management approach is consistent with ACC's goal towards becoming more claimant-centred. I acknowledge ACC's commitment to continuously improving the approach by growing staff capability, monitoring case management performance, and developing insights from claimant feedback.

I encourage ACC to continue to focus on better understanding and meeting the wider needs of claimants and build further momentum in fully embedding Next Generation Case Management within its organisation.

I strongly encourage ACC to fully evaluate the approach once it is embedded.

This would assure ACC and the public that the approach is achieving the benefits that ACC expects and represents value for money. These benefits include improved consistency of services to claimants, a better ability to meet the diverse needs of claimants, faster recovery outcomes where possible, and well-co-ordinated support for long-term claimants.

Making the results of that evaluation and other measures of performance readily accessible to the public will also provide more transparency on how well the Next Generation Case Management approach is meeting its objectives. This will improve accountability for an important public service.

While doing this follow-up work, we noted some performance data that indicates that ACC needs to focus on improving its relationship with the providers it works with. ACC acknowledges this and is working on initiatives to make it easier to lodge claims, improve communications, and simplify the processes related to claimant care.

Although this wasn't a specific focus of our follow-up work, I encourage ACC to improve its performance in this area.

I thank the staff of ACC for their support and co-operation during our work and for their ongoing commitment to the recovery of New Zealanders who suffer injury.

Nāku noa, nā

John Ryan
Controller and Auditor-General

24 November 2020