How to be an accessibility winner - a Blind Low Vision perspective

Digital accessibility consultant Callum McMenamin, founder of Open Access, talks about creating inclusive digital environments for blind and low vision people, particularly within health and social care. 

Callum shares his journey into accessibility, his work on government web standards, and the creation of the “Accessibility Loser Board” that highlights areas needing urgent improvement. 

The discussion explores challenges and systemic barriers in health and disability services, and the role of standards and emerging technologies like AI in shaping a more accessible and equitable digital future for all New Zealanders.

Transcript

Rebecca McBeth (00:05)

Kia ora koutou and welcome to eHealth Talk NZ. I'm Rebecca McBeth, I'm the media editor at HINZ, and this episode is the second in a four-part collaborative podcast series with Blind Low Vision New Zealand. Today, I'm joined by digital accessibility consultant, Callum McMenamin, to discuss the role of technology in disability support.

Callum is the founder of Open Access, a consultancy that helps organisations make their digital products genuinely accessible. He previously worked as a web standards consultant for government agencies, including the Department of Internal Affairs, where he contributed to development of the New Zealand Government Web Accessibility Guide and helped shape digital accessibility policy and practice. So welcome on the show, Callum, lovely to have you.

To begin, can you tell us what led you into working in digital accessibility?

Callum McMenamin (00:59)

Yeah, kia ora. So from a very young age, ⁓ I've always been obsessed with computers. I was like programming ⁓ various things as a kid. Then I did a computer science degree at University of Canterbury. And throughout that whole time, I've been slowly losing my vision from Stargardt disease, which causes macular degeneration at a young age. Usually people get that when they're much older.

So sort of this combination of really loving computers ⁓ and also becoming disabled, I sort of thought, well, how do I combine these? One day I saw a job posting at the Ministry of Social Development's national office to work on their digital accessibility. And I got the job. And I spent sort of the next year and a half there helping to build their digital accessibility team.

and they were dedicated to improving the accessibility of the welfare system. Then I sort of bounced around different government agencies, ⁓ ended up helping to write the accessibility standards ⁓ that are currently used across government also built the automated accessibility ⁓ measuring system. So yeah, that's a bit of a background on how I got involved in accessibility.

Rebecca McBeth (02:14)

it's obviously a passion for you. So as you said, you did build the system that measures web accessibility across government websites. And since then, you've launched the New Zealand Government Agency Accessibility Loser Board which sounds interesting. What is that? And why did you create it?

Callum McMenamin (02:30)

Yeah, so years ago, I sort of had this idea to automatically measure all government agency public websites for accessibility problems. know, things that might make it difficult for disabled people to use those services. So some websites, you can't increase the font size without it breaking. Some websites, the text is hard to read because the color contrast is really low, you know, like light blue text on a white background.

all of these sorts of things are not allowed under the web accessibility standard. So I sort of started building the system that crawls government websites. It's kind of like a Google crawler and it runs these automated tests. And then I got hired by the Department of Internal Affairs and I sort of said to them, I can donate all of this code to this government department, but I want to work on this project and embed it into the government. And they agreed.

So I spent the next two years in DIA integrating the system into the ⁓ Department of Internal Affairs. And just recently, they've started publishing publicly the data from that program. So they scanned 517 government websites, scanning up to 100 pages per website, and they publicly released the data. So that's quite exciting. And from that publicly released data,

Now I work as an independent consultant. I took that data and I built a loser board. I thought about a leader board, but it was a bit boring. So I sort of want to focus on where the problems are in government rather than saying, you know, here's no problems. So that's why it's focusing on being a loser board. And that's been really cool. I've sort of heard from various agencies that things like league tables can motivate positive change. So that's the idea behind it.

Rebecca McBeth (04:14)

So what does it tell us about accessibility across government agency websites and what has the reaction been so far?

Callum McMenamin (04:22)

Yeah, so it's basically told us that on average there are around four issues per web page across the government. So four accessibility issues per page. It's important to note that this system, automated testing, can only detect 10 to 20 % of problems. So we're only measuring a small percentage of the full set of problems that can occur with accessibility.

So the reality is probably five to 10 times worse. So if we're detecting four issues per page, there might be ⁓ in reality 20 to 40 issues per page. ⁓ there's room for improvement basically. One thing I found is that out of the 40 or so government agencies involved, zero agencies fully passed all of the tests.

So every single agency had at least one website that had a problem. So there are no agencies currently complying with the mandatory web accessibility standard. Some of the agencies are doing really well. Whaikaha Ministry of Disabled People comes out quite well. But some agencies are doing very poorly. So yeah, there's a wide range of performance across the public service. The reception has been...

broadly positive people have really liked having access to this data. I have had a few complaints come in where people get upset if they might know who built a particular website and it comes out as the worst one in the list that can sometimes upset people. ⁓ But this the standard has been around for ⁓ like over two decades. The government has had quite a bit of time to meet it.

Sometimes objective measurement can paint websites in a bad light, but maybe that's just the way it should be painted. Yeah, so the real response should be to look at the data and fix problems that are identified basically.

Rebecca McBeth (06:17)

absolutely. And you obviously believe that standards are the solution to many of these accessibility problems, but obviously they also need to be monitored and enforced. So why do think the New Zealand government is struggling to do this? Why are none of their websites compliant?

Callum McMenamin (06:35)

standards and technical standards can help us specify what makes something accessible. you know, we need to require websites to be able to increase their font sizes for people with low vision and to be compatible with screen readers for people who are blind. Videos need captions, all these sorts of things. So the New Zealand government has a pretty good standard.

The web accessibility standard, it was recently updated. It's broadly based on international guidelines called the Web Content Accessibility Guidelines. Governments around the world implement that same set of guidelines. So great, we've got a good standard. That's step one. Step two is the ⁓ measurement against that standard. That's broadly been where New Zealand government has failed over the past couple of decades. There have been self-assessments where they asked

agencies to mark their own homework, but they discovered that agencies were really bad at marking their own homework. Their own self-assessments were inaccurate. And it didn't seem to really motivate change. There were no leaderboards from those self-assessments, just a high-level summary report. So now we've got this automated system. Measurement is starting to be done every three months. So we can track progress. then the last step is enforcement. And this is where

the probably the biggest failure has occurred. So there is just no enforcement mechanism. Cabinet has mandated many government agencies to meet this standard. But what's the consequence if they don't? Well, there is no consequence. No one does anything about it. Public service chief executives can ignore directives from cabinet and nothing happens. You know, we like to think we have a central government, but New Zealand's central government is actually highly decentralized.

where each agency has its own little kingdom. they have a high degree of autonomy and control over how they implement their digital services. That's slowly being resolved through the creation of things called system leads. There's one for digital, which is the government chief digital officer. But it's far from being resolved. It is more symptomatic of New Zealand's human rights system in general.

New Zealand has, in my opinion, a very weak human rights enforcement system. We have a Human Rights Act that says you can't discriminate on the basis of disability, but you can. You can discriminate on the basis of disability and often there is zero consequence unless you go through a lengthy and very slow human rights complaint process with the Human Rights Commission, which not many people do. Very, very few people do that.

Rebecca McBeth (09:04)

your experience, would it be hard for these agencies to fix their websites, involve a lot of time, resource, or are most of them quite simple fixes?

Callum McMenamin (09:12)

⁓ Yeah, so it depends on the scale of the agency. So some New Zealand government agencies have hundreds of websites. I'm just over the years ⁓ There's just been this horrific sprawl of websites just popping up everywhere So for those agencies that have hundreds of websites like MSD like MBIE and DIA It's very very difficult because the problem is spread out amongst so many websites

The problems that are identified are usually pretty easy to fix if you're a good web developer. It's just the sheer quantity of them. It is also much more expensive to remediate and fix a website after it's been built The cheapest thing to do is to build websites that are accessible from the start.

so you don't have to go back and redo everything. That has been another area of systemic failure, where government agencies often outsource their web development to private companies. In their contracts with those companies, they forget to specify the mandatory web standards that they're meant to follow in their contracts. So then the developers that they hire do not meet those standards, and then they get a non-compliant website as a result.

It's kind of like asking a builder to build a house but not specifying the building code. That's kind of what that's like. That is slowly resolving. Some agencies are putting it in their contracts with vendors. But then often the vendors don't know how to meet the standards and then they supply a non-compliant website. And because the agency isn't really aware of how to measure against those standards, they get delivered non-compliant websites and they don't realize.

And that's why a centralized measurement system like it has now been implemented, it doesn't matter if your agency is aware of the standards or not, it's going to be reported on. So that's one way of solving that.

Rebecca McBeth (11:00)

And you mentioned that we're kind of in line with our international peers in terms of the standard, but not the implementation. would you say that, New Zealand government agencies are behind other countries that we'd usually compare ourselves with in terms of accessibility?

Callum McMenamin (11:15)

⁓ yeah, New Zealand is like extremely far behind in terms of accessibility and disabled people's rights. Compared to the EU, to the UK, even the US as well, they've all got far better systems in place. In the US, for instance, if you're a disabled person and a website isn't accessible, you can sue the company.

responsible and make a lot of money from that ⁓ and that's what happens. So a lot of the companies and stuff in the US are really afraid of breaching these accessibility requirements. In New Zealand, our culture is, she'll be right, let's just kind of ignore the problem and, you know, kick the can down the road. So yeah, it is not a fantastic system. It could be easily resolved with good legislation that

enforces the requirements in some way. So for instance, fines for non-compliance. One thing I've thought about is each public service chief executive gets paid depending on their performance. Add accessibility as one of those KPIs they have to meet. And I think that would very quickly motivate change. So the solutions are not that difficult. It's just they haven't been implemented.

Rebecca McBeth (12:24)

So if we look across government services now, we know that disability is often treated in silos. You've got health, social care, housing, education, and they don't connect well. I'm wondering how this disconnection affects people's ability to access the services and the entitlements that they're eligible for.

Callum McMenamin (12:45)

Yeah, so that's a big problem. One of the interesting things is the New Zealand government's web accessibility standards apply to many different agencies except the health system. So there's even disparities in terms of how our standards apply to agencies. That problem probably going to be resolved soonish, but it's been a longstanding issue. So yeah, the thing around the disconnection between government agencies.

⁓ For instance, in the health system specifically, if you're a disabled person and let's say you're blind and you go to different GP practices, you kind of have to re-explain your entire disability every single time, every different person you interact with. And that's generally caused by disability and accessibility data not being properly associated with an individual's NHI.

So for instance, a solution to that problem would be, let's say I go to a GP practice, the first thing that should show up on their computer screen is, hey, this person's blind, don't give them written information, email it to them. That kind of system, as far as I'm aware, has not been implemented. There was work underway to implement it. I think it was called like a health passport or something like that. But I believe there were some restructures in the public service.

where disability support services got shifted from the Ministry of Health into the Ministry of Disabled People, and I think that caused that work to halt. So, yeah, unfortunately, it's not being resolved at this moment. However, that has appeared in the latest draft of the New Zealand Disability Strategy to solve that problem. Some of the other things are that the welfare system, for instance, with MSD interacts with the health system primarily through

a thing called the Work Capacity Medical Certificate. that link between the health system and the welfare system can cause problems as well, especially if that data isn't entered correctly, for instance. one of the core problems as well is with disability, there's a range of services that the government provides, but there's no one...

really to help you navigate them or even know that they exist. You kind of just have to know that they're there or have a friend who's an expert. You know, there's definitely a really big problem in that area. So there's certainly a bit of fragmentation going on, I would say.

Rebecca McBeth (14:56)

Yeah, I mean, even just within the health system, as you said, there are silos, let alone between the health system and other government services. And yeah, that inability to see you as a whole person and everything that you require is, I imagine, only becomes more acute if you've got a disability. So we know that information about, as you mentioned there, about services that are available.

Callum McMenamin (15:09)

Mm.

Rebecca McBeth (15:20)

If it is there, it's not always accessible either, particularly for blind and low vision people. So how does that add to the inequities you might experience?

Callum McMenamin (15:25)

Mm-hmm.

information about services that are available is often stored in various different websites. There's no central place to go to. So you just have to hope that you find the right government website that points you into the right place. And hopefully that website's accessible. But from the data we have, there's broad accessibility failure across government websites. On top of that, there's additional complication digital exclusion.

Some people cannot afford a smartphone. They can't afford a laptop. They can't afford a data connection because, you know, New Zealand has extremely expensive data, especially for phones. So that can cause massive barriers. And DIA did some research on that, you know, what are the causes of digital exclusion. And they did focus on disabled people as well. So even when it's digitally available,

not everyone has access to digital technology to access it. If you go to your doctor or whatever, often the doctors are not aware of what services and supports are available. You go to MSD. It's all very transactional. No one really sits with you to help you navigate the full complexity of the system. and that's probably the biggest gap that I'm aware of.

And I think that often gets left to charities and NGOs. So Citizen Advice Bureau, for instance, is often left to fill in the gaps of service provision that the government fails to provide.

Rebecca McBeth (16:52)

Yeah, that role of like a navigator is so important, particularly for people who are vulnerable and might not have the knowledge or the digital literacy to be able to navigate on their own. given that that's part of the problem, can you talk about the role you see for digital tools and emerging technologies like AI to help connect services, improve accessibility, help people become more aware of what they're entitled to and how to access it?

Callum McMenamin (17:20)

One of the main things I see with AI is it has made developing digital services a lot easier. So I use AI extensively in my life to write code, especially for my website. And it is very, very easy to build large complex systems.

when you're assisted with AI as a developer. I think that could help improve things like the health system because there's so many parts of the health system that are still paper-based, that haven't been properly digitized and are not accessible. So maybe that barrier preventing health services from becoming digitized is going to be lower because writing code is much easier. The other part of that is code quality. So...

When you write some code, does that result in an accessible service or not? AI at the moment isn't terribly good at writing fully accessible code, because it's trained on what's available on the internet currently, which is a lot of bad practice. But I'm hopeful that it will get better as time goes on. So hopefully the websites that we have, AI will play a bigger role and things will be more correct because it won't be subject to human error.

other part is navigating government systems. Lots of people already ask AI, know, what services are available to me? How do I navigate this system? And AI often provides very good answers to that. Especially now that most AI services will literally search the internet for authoritative sources to reference you know, it probably gives pretty good advice now, but that's only going to improve. So maybe that connector role

⁓ gets automated to a degree. The other part is that I'm aware that MSD is undergoing some changes to enable a thing they call automated decision making and that's where algorithms are going to be making choices around people's lives. ⁓ So whether they're eligible for certain services or not will begin to become more and more automated.

That has a range of benefits if it's implemented correctly. So first of all, you don't have to wait six weeks to get a decision because a computer just does it immediately. Often people get human error in their cases where maybe they're eligible for certain services, but a human screws up the assessment. And then suddenly they're denied. Maybe algorithms can reduce that amount of error so that people actually receive the correct services without those issues. So yeah, those are sort of the two main.

main benefits around that. There's been instances where it's gone horribly wrong, like Australia with the robo-debt scandal that occurred. obviously the humans involved need to design a system with appropriate safeguards to make sure people aren't harmed through algorithmic decisions that are incorrect.

Rebecca McBeth (19:54)

if we think about the social determinants of health that we were discussing, do you think that better data sharing between government systems would make a material difference to the lives of blind low vision people such as yourself?

You spoke about the Work Capacity Medical Certificate, for example, something like that might pre-populate with information, or yeah, mean that you don't have to continually get the same information to different agencies, for example.

Callum McMenamin (20:20)

yeah, one of the main connections between the health system and the welfare system is that Work Capacity Medical Certificate. It's a certificate that, like, if you're disabled, for instance, and you can't work, or there's no accessible work around you that is available, you'll basically go to a doctor and they fill out an MSD certificate that says, like, this is your health condition, this is your capacity to work, those sorts of things.

So one of the problems with that certificate is it's often filled out incorrectly. There's some questions on there that are very easy to misinterpret those misinterpretations result in incorrect information being sent to MSD. And then MSD will then make the incorrect determinations on what you're eligible for based on that faulty certificate. and often a doctor, you you've got a 15 minute appointment.

Disability is usually So I understand that it's very difficult for GPs to fill out those certificates accurately when you've got such a limited amount of time to actually figure out what's going on in someone's life. some changes I think could occur is the detection of errors.

So I think AI and algorithms could be really useful where maybe humans are the ones that make those decisions and fill out those forms. But maybe a large language model could, take a look over over someone's medical record and say, hang on, this certificate that was just filled out is not consistent with this person's medical history. Maybe double check it. that kind of thing could could certainly help in the reduction of errors.

Rebecca McBeth (21:51)

And obviously the more data that it has access to, the more it can check across different agencies like housing or education and suggest other things that the person might be eligible for beyond the health and social care system.

Callum McMenamin (22:03)

Yes. ⁓

So MSD data shows that about a quarter of people on a benefit are being underpaid according to their correct entitlements. So, you know, the thing that's often in the media is overpayments, but that's actually a very small percentage. The larger problem in the welfare system is underpayment, where someone is eligible for particular things, but they're not receiving it. The biggest contributor to that is

when particular benefits require someone to continually update their data, like how much is their rent? How much is their power bill? How much are their disability costs and those sorts of things? Often people don't update their information frequently enough or they don't know that they have to or they don't know how. And then this results in systemic underpayment across the welfare system. So when we talk about

social determinants of health, income is probably one of the biggest ones. Where if you don't have enough money, you can't access health services on an equal basis with others. that 25 % of people receiving underpayments has been pretty consistent for a very long time. There's not much being done to address it. So perhaps... ⁓

There's some kind of way of solving that through increased automation through AI. yeah, that's one of the biggest issues that I think about.

Rebecca McBeth (23:23)

And so just finally, what do you believe, or what would you like to see happen at a systems level to make sure that disabled people are supported to live well full lives?

Callum McMenamin (23:33)

Yeah, so obviously I love standards and I wish that accessibility standards were broader and more mandatory. So if something isn't accessible to you, you can get it fixed. Just here's one example. Medication in New Zealand often doesn't have Braille labeling, but in the EU, that's ⁓ like a mandatory thing. Every medication has Braille on it. Often the font sizes on medication are so small that you can hardly read them.

⁓ So these are really simple things that can all be addressed with standards and they just need to be made mandatory. So for instance, Pharmac could just say, hey, we're not going to buy your drug if your packaging isn't accessible, for instance. We just need those steps to be taken, And that would just be through a broader, more effective disability rights system, which probably will require new

Rebecca McBeth (24:20)

Well, thanks for joining me today, Callum. It's been so interesting to explore the themes related to the experience of blind and low vision people in the health and the social care and other systems. And we will continue to look at that in future episodes. So be sure to like and subscribe to this podcast to learn more. Mā te wā.