13	Services for people with a disability
The Australian, State and Territory governments aim to maximise opportunities for people with a disability to participate actively in the community, by providing services and support for people with a disability, their families and carers. A definition of disability is provided in box 13.1.
Following negotiations among the Australian, State and Territory governments in 2003, all jurisdictions entered a third five year disability services agreement — the Commonwealth State/Territory Disability Agreement (CSTDA) — for the period 1 July 2002 to 30 June 2007. This agreement forms the basis for the provision and funding of specialist services for people with a disability who require ongoing or long term episodic support. 
Services for people with a disability can be grouped into income support, disability support services and relevant generic services provided to the community as a whole. The Review of Government Service Provision generally does not report information on income support. Disability support services are primarily delivered under the CSTDA, as well as through programs such as Home and Community Care (HACC). The HACC program aims to prevent inappropriate or premature admission to residential care by providing basic maintenance and support services to frail older people, younger people with a disability, and their carers. An estimated 68.5 per cent of HACC clients in 2003‑04 were aged 70 years or over, while 31.5 per cent were aged under 70 years ( Report on Government Services 2005 (2005 Report) table 12A.32). Performance information on the HACC program is provided in the ‘Aged care services’ chapter. This Report does not provide performance information on rehabilitation services for people with a disability. 

Box 13.1	Definition of disability 	
Disability is conceptualised as being a multidimensional experience for the person involved, relating to body functions and structures, activities, and the life areas in which the person participates (WHO 2001). The International Classification of Functioning, Disability and Health also recognises the role of physical and social environmental factors in affecting disability.
The Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers was conducted in 1981, 1988, 1993, 1998 and 2003, and was based on the International Classification of Functioning, Disability and Health and its predecessor. The 2003 survey defined a disability as a limitation, restriction or impairment that has lasted, or is likely to last, for at least six months and restricts everyday activities.
Self‑care, mobility and communication are defined as core activities. The ABS defines levels of core activity limitation as follows:
•	mild — where a person does not need assistance and has no difficulty with self‑care, mobility and/or communication, but uses aids or equipment
•	moderate — where a person does not need assistance, but has difficulty with self‑care, mobility and/or communication
•	severe — where a person sometimes needs assistance with self‑care, mobility and/or communication tasks; has difficulty understanding or being understood by family or friends; or can communicate more easily using sign language or other non‑spoken forms of communication 
•	profound — where a person is unable, or always needs assistance, to perform self‑care, mobility and/or communication tasks.
The CSTDA (2003, p. 9) defines people with a disability (who would receive CSTDA funded services) as:
People with disabilities attributable to an intellectual, psychiatric, sensory, physical or neurological impairment or acquired brain injury (or some combination of these) which is likely to be permanent and results in substantially reduced capacity in at least one of the following:
•	self-care/management
•	mobility
•	communication,
requiring significant ongoing and/or long term episodic support and which manifests itself before the age of 65. 	
Source: ABS (2004a); WHO (2001); CSTDA (2003).	

Some mainstream services provided to the community as a whole — for example, vocational education and training (VET), school education, public hospital care, specialised mental health services and public housing — are covered elsewhere in this Report. Other mainstream services provided to people with a disability — such as transport and utility services at concessional rates — are outside the scope of this Report. 
In recognition of the changing information needs in the disability services field, a redeveloped national minimum data set (NMDS) collection under the CSTDA was implemented during 2002‑03. Given this redevelopment, data for 2002‑03 collected under the new NMDS were available for reporting for most jurisdictions only for the period 1 January 2003 to 30 June 2003. Full year data will be reported in the 2006 Report. The redevelopment of the NMDS under the CSTDA has resulted in some reductions in data quality in the first collection that impose limitations on the ability to generalise from the data (box 13.7, 2005 Report)
Indigenous data in the services for people with a disability chapter
The services for people with a disability chapter in the Report on Government Services 2005 (2005 Report) contains the following data on Indigenous people:
•	Indigenous representation per 1000 people in accommodation support services, from 1 January 2003 to 30 June 2003.
•	Indigenous representation per 1000 people in employment services, from 1 January 2003 to 30 June 2003.
•	Indigenous representation per 1000 people in community access services, from 1 January 2003 to 30 June 2003.
Supporting tables
Supporting tables for data within the services for people with a disability chapter of the compendium are contained in the attachment to the compendium. These tables are identified in references throughout this chapter by an ‘A’ suffix (for example, table 13A.3 is table 3 in the services for people with a disability attachment to the compendium). As the data are directly sourced from the Report on Government Services 2005, the compendium also notes where the original table, figure or text in the 2005 Report can be found. For example, where the compendium refers to ‘2005 Report p. 13.15’ this is page 15 of chapter 13 and ‘2005 Report, 13A.2’ is attachment table 2 of attachment 13 of the Report on Government Services 2005.
Service use by Indigenous people
An important indicator of access is the comparison between the representation of all people with a disability who use CSTDA funded services and the representation of people with a disability from special needs groups, for example Indigenous people. The data for this indicator is provided on a comparable basis.
Box 13.2	Service use by special needs groups	
The representation of people from special needs groups accessing CSTDA funded services is included as an output (access) indicator of governments’ objective that access to appropriate services should be equitable for all members of the community. One special need group are people who have an Indigenous background. 
This indicator compares the proportion of service users per 1000 Indigenous people with the proportion of all service users per 1000 people in the Australian population. The disability service types reported are accommodation support, employment and community access services. For accommodation support services, only people aged under 65 years are included in the population counts for both the special needs groups and the Australian population. For employment and community access services, only people aged 15–64 years are included in these population counts.
Holding other factors constant, the proportion of service users per 1000 people from a special needs group should not vary significantly from the proportion of all service users per 1000 people in the Australian population. While a markedly lower proportion may represent reduced access for a special needs group, it may also represent strong alternative support networks (and thus a lower level of need), or the individual choice of people with a disability not to access CSTDA funded services. Similarly, while a higher proportion may suggest poor service targeting or the lack of alternate support networks, it may also reflect the special needs group having a greater prevalence of disability. 
CSTDA funded services are provided on the basis of need and available resources. This indicator does not provide information on whether the services are appropriate for the needs of the people receiving them, or correctly targeted to those most in need. The indicator also does not take account for informal assistance that may be significant for special needs groups. Results for outer regional and remote users of accommodation support services, for example, need to be considered with care because alternatives to government funded accommodation support services are available in these areas. Specifically, accommodation support services in outer regional and remote areas are largely provided informally, making use of local area coordinators and local community resources. 	

Nationally, the proportion of the Indigenous population who used accommodation support services from 1 January 2003 to 30 June 2003 (2.1 Indigenous service users per 1000 Indigenous people aged under 65 years) was higher than the proportion of the total population who used these services (1.4 service users per 1000 people aged under 65 years in the total population). A lower proportion of the Indigenous population than of the total population used accommodation support services in Queensland, SA, Tasmania and the ACT. Across jurisdictions, the proportion of Indigenous people using accommodation support services ranged from 10.6 per 1000 Indigenous people in Victoria to 0.3 per 1000 Indigenous people in the ACT (figure 13.1).
Figure 13.1	Users of accommodation support services per 1000 people, by Indigenous status, 1 January 2003 to 30 June 2003a, b, c, d, e, f
	
a Data for Indigenous users per 1000 were derived by dividing the number of Indigenous service users by the number of Indigenous Australians aged under 65 years, multiplied by 1000. b Where Indigenous status was inconsistently recorded for the same user, the user was counted as an Indigenous Australian. c Data for all service users exclude 588 service users whose Indigenous status was not reported, so totals may differ from other tables. d Data for users of CSTDA funded accommodation support services exclude psychiatric services identified by the jurisdiction. e Service user data are estimates after a statistical linkage key is used to account for individuals who received services from more than one service type outlet from 1 January 2003 to 30 June 2003. Individuals might have accessed services from more than one State or Territory over the six month period. f The service user data used to derive this indicator have quality issues related to the development of the new CSTDA NMDS. These issues include differences in the proportion of service outlets that responded across jurisdictions (2005 Report, box 13.7). This indicator thus needs to be interpreted with care.
Source: ABS (2002, 2004b); AIHW (unpublished); table 13A.2; 2005 Report, p. 13.28, figure 13.11.
Nationally, the proportion of the Indigenous population who used employment services from 1 January 2003 to 30 June 2003 (4.6 Indigenous service users per 1000 Indigenous people aged 15–64 years) was higher than the proportion of the total population who used these services (4.0 service users per 1000 people aged 15–64 years). A higher proportion of the Indigenous population than of the total population used employment services in all jurisdictions except Queensland, WA, Tasmania and the NT. Across jurisdictions, the proportion of the Indigenous population accessing employment services ranged from 9.8 service users per 1000 Indigenous people in Victoria to 2.2 service users per 1000 Indigenous people in the NT (figure 13.2).
Figure 13.2	Users of employment services per 1000 people, by Indigenous status, 1 January 2003 to 30 June 2003a, b, c, d
	
a Data for Indigenous users per 1000 were derived by dividing the number of Indigenous service users by the number of Indigenous Australians aged 15–64 years, multiplied by 1000. b Where Indigenous status was inconsistently recorded for the same user, the user was counted as an Indigenous Australian. c Data for all service users exclude 2117 service users whose Indigenous status was not reported, so employment services users per 1000 total population aged 15–64 years may differ from other figures. d Service user data are estimates after a statistical linkage key is used to account for individuals who received services from more than one service type outlet from 1 January 2003 to 30 June 2003. Individuals might have accessed services from more than one State or Territory over the six month period. 
Source: ABS (2002, 2004b); AIHW (unpublished); table 13A.4; 2005 Report, p. 13.29, figure 13.12.
Nationally, the proportion of the Indigenous population who used community access services from 1 January 2003 to 30 June 2003 (3.5 Indigenous service users per 1000 Indigenous people aged 15–64 years) was higher than the proportion of the total population who used these services (2.2 service users per 1000 people aged 15–64 years). A higher proportion of the Indigenous population than of the total population used community access services in all jurisdictions except Tasmania. Across jurisdictions, the proportion of the Indigenous population accessing community access services ranged from 11.2 service users per 1000 Indigenous people in Victoria to 2.0 service users per 1000 Indigenous people in Queensland (figure 13.3).
Figure 13.3	Users of community access services per 1000 people, by Indigenous status, 1 January 2003 to 30 June 2003a, b, c, d, e, f, g
	
a Data for Indigenous users per 1000 were derived by dividing the number of Indigenous service users by the number of Indigenous Australians aged 15–64 years, multiplied by 1000. b Where Indigenous status was inconsistently recorded for the same user, the user was counted as an Indigenous Australian. c Data for all service users exclude 7615 service users whose Indigenous status was not reported, so totals may differ from other tables. d Service users who accessed the service type ‘recreation/holiday programs’ (service type 3.02) were not required to complete the item on Indigenous status; however those who did provide a response are included in the data. e Data for users of CSTDA funded community access services exclude psychiatric services specifically identified by the jurisdiction. f Service user data are estimates after a statistical linkage key is used to account for individuals who received services from more than one service type outlet from 1 January 2003 to 30 June 2003. Individuals might have accessed services from more than one State or Territory over the six month period. g The service user data used to derive this indicator have quality issues related to the development of the new CSTDA NMDS. These issues include differences in the proportion of service outlets that responded across jurisdictions (2005 Report, box 13.7). This indicator thus needs to be interpreted with care.
Source: ABS (2002, 2004b); AIHW (unpublished); table 13A.6; 2005 Report, p. 13.30, figure 13.13.

References 
ABS (Australian Bureau of Statistics)  2002, Australian Demographic Statistics, Cat no. 3101.0, Canberra.
—— 2004a, Disability, Ageing and Carers Australia: Summary of Findings 2003, Cat. no. 4430.0, Canberra. 
—— 2004b, Experimental projections of the Aboriginal and Torres Strait Islander population 30 June 2001 to 30 June 2009, Cat. no. 3238.0, Canberra.
CSTDA (Commonwealth State/Territory Disability Agreement) 2003, Agreement between the Commonwealth of Australia and the States and Territories of Australia in Relation to Disability Services, Australian Government Department of Family and Community Services, Canberra.
WHO (World Health Organisation) 2001, ICIDH‑2: International Classification of Functioning, Disability and Health, Final draft, Full version, Geneva.