Disability Support Services DSS Overview Who do we

Disability Support Services DSS Overview Who do we support and how much does it cost? August 2015 Toni Atkinson Group Manager Disability Support Services Ministry of Health

Disability Support Services Welcome – who are the team? Pam Mac. Neill – Putting People First Cheryll Graham – Senior Advisor Amanda Smith – Chief Advisor IDCCR Act Phil Wysocki – Service Access Inia Eruera – Senior Advisor Amanda Bleckmann – Family and Community Lee Henley – Community Residential Barbara Crawford – Contracts and Strategy

Disability Support Services Who are we funding? • • 32, 387 clients get regular supports More males (56%) than females (44%) 16% Maori, 6% Pacific, 5% Asian, 69% Other 38% of clients are under the age of 19, and 8% are over the age of 65 47% of clients live in their own or the family home, 18% live in a community residential service Most live in Auckland (30. 4%) followed by Canterbury (13. 5%), Waikato (9. 6%) and Wellington (9. 1%) Principal disabilities include intellectual (46%), physical (27%), sensory (4%), ASD (16%), neurological (2%)

Disability Support Services How much do we fund? - $1. 1 b

Disability Support Services Growth in Community Care Average Hours Per Week 2010/11 2011/12 2012/13 2013/14 2014/15 Household Management 4. 1 4. 0 4. 1 4. 3 Personal Care 9. 0 9. 5 9. 6 10. 7 Supported Living 8. 7 8. 3 8. 1 10. 0 11. 3 21. 8 23. 7 26. 3 0. 0% 8. 7% 11. 0% Total % annual increase hours 11% increase on $256 m is $28 m What’s driving this? Changing expectations, reduction in natural support, fewer people in residential with higher support needs, other?

Disability Support Services Growth in Residential Care Growth in Residential 2010/11 2011/12 2012/13 2013/14 2014/15 Cost of Residential Care $403 m $450 m $492 m $506 m 7, 644 $53 k 7, 581 $60 k 13% 7, 543 $60 k 0% 7, 553 $65 k 9% 7, 314 $70 k 6% Client Numbers Annual Cost per Client Annual % Increase of 6% on $506 m is $30 m What’s driving this? Greater risk, new H&S legislation, sleepover funding, more complex clients, other?

Disability Support Services Growth in Client Numbers Year Total Client Numbers % increase Year Ave Package Size $ Increase % increase 2010/11 2011/12 2012/13 2013/14 2014/15 30, 575 31, 010 31, 200 31, 630 32, 357 1. 1% 1. 4% 0. 6% 1. 4% 2. 3% June 2011 June 2012 June 2013 June 2014 May 2015 23, 553 23, 990 24, 919 26, 678 27, 652 437 929 1, 759 974 1. 9% 3. 9% 7. 1% 3. 7% Additional 727 clients with an average package size of $28 k is $20 m, plus 32, 357 clients with an increase in average package size of $1 k is $32 m.

Disability Support Services Cost Drivers • Reduction in natural supports • Greater expectations from disabled people and their families • Aging population • Impact of new Health and Safety legislation

Disability Support Services What can we do about it? • Review contracts to ensure value for money (efficient and effective services) • Review allocation processes to identify any growth of support functions (HM/PC for medication management, therapy) • Look for any duplication of funding (ASD) • Continue demonstrating new models to transform the system

Disability Support Services New Model Update • • Looking at extending the Choice in Community Living regions, focusing on clients wanting to move from residential care Ongoing evaluation of Local Area Coordination in BOP, Hutt and Southland/Otago Further development of the Supported Self Assessment as a more respectful way of identifying client needs Reviewing purchasing guidelines that support Enhanced Individualised Funding.

Disability Support Services Enabling Good Lives Update • • • Christchurch 3 year demonstration due to end June 16 – planning for how we continue to work in an EGL way post June Waikato are planning to work with up to 105 people this year. Systems and processes to work with this group now in place Implications for system transformation currently being assessed – need to incorporate findings from Chch evaluation and New Model work in thinking about the future.

Disability Support Services Summary • • We need to look at how to maximise disability support funding to get the best outcomes for clients To do this we will be reviewing a number of traditional supports to see if services can be delivered in a better way We will continue to learn from trialling new things and incorporate these learnings into system transformation We are keen to work with you as providers in this process of transforming the system.

Disability Support Services Thank you Any questions?

Disability Support Services Putting People First August 2015 Pam Mac. Neill Quality Improvement Lead Cheryll Graham Senior Advisor, Disability

Disability Support Services Putting People First A Review of Disability Support Services Performance and Quality Management Processes for Purchased Provider Services Prepared for Hon Minister Ryall, Minister of Health November 2013

Disability Support Services Recommendation 1: Embrace good performance and actively promote this, by: • Clearly defining and communicating what constitutes good performance and expected outcomes – and monitor against these • Supporting and encouraging best practice – and how this can be achieved • Show-casing great examples – including how these were achieved.

Disability Support Services Recommendation 11: Identify what drives exceptional performance and design organisational and personal KPIs around this to support positive behaviours and outcomes.

Disability Support Services Recommendation 5: Encourage new providers of both residential services and other support options to enter the disability sector. Recommendation 9: Support the development of more flexible support options to better meet the needs of disabled people with high and complex needs.

Disability Support Services Recommendation 6: Support good practice by encouraging and supporting providers to take part in peer reviews and communities of practice – particularly where providers are isolated. Recommendation 36: Ensure providers offer a consistently high standard of care and support.

Disability Support Services Recommendation 8: Only contract with residential providers who support those with high and complex needs, if they have staff with the requisite skills and experience.

Disability Support Services Recommendation 10: Attract, recruit, and retain appropriately skilled disabled people, and others with a high level of experience of disability and disability issues.

Disability Support Services Intern Programme

Disability Support Services Mainstream Employment Programme

Disability Support Services Recommendation 13: The Ministry of Health adopts a policy of having no tolerance for the abuse that is inflicted on disabled people.

Disability Support Services Recommendation 14: Ensure those who cannot speak themselves – and their families – are fairly represented at forums that result in decisions affecting their future care needs and the future of the sector.

Disability Support Services Recommendation 16: Set up a Panel of Experts to provide expert advice and support to the Ministry. Membership on the panel should be based on the fit between the individual’s specialist knowledge and expertise and the range of skills needed to respond to the serious incidents, complaints and issues that occur in the sector…

Disability Support Services Recommendation 17: Conduct a timely, independent investigation into all serious complaints in a manner that is fair and equitable to all concerned. Those members of the Expert Panel who have the most appropriate skills undertake the investigation and report back to the Ministry.

Disability Support Services Recommendation 18: Ensure the findings of the Panel are binding, so the Ministry has the power to effect change and hold providers to account for implementing the changes needed. This is essential to assuring the future safety of residents.

Disability Support Services Recommendation 32: The Panel of Experts provides specialist knowledge, expertise and advice to support CRMs to resolve challenging or complex complaints and issues.

Disability Support Services Recommendation 26: Replace the current Certification audit and developmental evaluation with an enhanced developmental evaluation 9, which assesses all residences on average once every three years. This needs to be supplemented by the safety requirements in the Standards that relate to disabled people, including: • Safe medication practices and procedures • Quality food and nutrition • Waste disposal and infection control…

Disability Support Services Recommendation 27: The Ministry contract for the use of the best developmental evaluation tool and process available in the market place. It is recommended that this cover: • Identity and autonomy • Choice and control • Relationship & partnership • Belonging and personal networks…

Disability Support Services Recommendation 35: Ensure the role NASCs play supports the wellbeing of disabled people. In particular, ensure there is transparency and consistency in information and decision making, and disabled people are supported to choose those services or provider(s) that best meets their needs, personal goals and preferences.

Disability Support Services Contacts Pam Mac. Neill Quality Improvement Lead Pam_Mac. Neill@moh. govt. nz Cheryll Graham Senior Advisor, Disability Cheryll_Graham@moh. govt. nz

Disability Support Services Service Access Update 28 August 2015 Phil Wysocki Manager Service Access Team Disability Support Services Ministry of Health

Disability Support Services Environmental Support Includes: • All people with a long term disability who need equipment (including over 65’s) • Housing and vehicle modifications • Hearing Loss Services • Vision Loss Services

Disability Support Services Equipment & Modification Services Prioritisation Tool • Transparent and fair process to determine access to funding for equipment • Aims to ensure that those with the greatest need and ability to benefit get funding for equipment and modifications

Disability Support Services EMS Prioritisation Tool • Fully implemented nationally from August 2014 • To date just over 14, 200 assessments completed through the Tool • 90% of people have received funding • 10% haven’t received funding

Disability Support Services EMS Prioritisation Tool • For those who don’t receive funding the assessor discusses alternative supports • Increase in demand for low cost equipment • 80% of equipment provided is low cost • If needs change person can request another assessment

Disability Support Services Top Ten Clients by Disability (all clients) Osteoarthritis 6. 02% Cerebrovascular accident (disorder) Cerebral palsy (disorder) 5. 59% 19. 45% Multiple sclerosis 6. 02% 6. 71% 7. 25% 17. 89% 7. 28% 7. 76% 16. 03% Amputation of lower limb Disorder of musculoskeletal system Parkinson's disease Developmental delay Disorder of cardiovascular system Autistic disorder

Disability Support Services All Clients by Age Group 5. 66% 24. 10% 10. 98% 32. 46% 26. 80% 0 -4 5 -14 15 -64 65 -79 80 +

Disability Support Services Total Assessments Completed by Age Band Funding Availability 100. 00% 92. 53% 93. 94% 88. 71% 90. 00% 85. 86% 84. 83% 80. 00% 70. 00% 60. 00% Available 50. 00% Not Available 40. 00% 30. 00% 20. 00% 10. 00% 7. 47% 11. 29% 14. 14% 15. 17% 6. 06% 0. 00% 0 -4 5 -14 15 -64 65 -79 80 +

Disability Support Services All Clients by Ethnic Group European/Other Pacific 5. 02% Maori Asian 15. 94% 8. 52% 70. 51%

Disability Support Services 100. 00% 90. 00% Total Assessments Completed by Ethnic Group and Funding Availability 87. 39% 90. 69% 90. 11% 89. 74% 82. 81% 80. 00% 70. 00% 60. 00% 50. 00% Available 40. 00% Not Available 30. 00% 20. 00% 17. 19% 12. 61% 10. 00% 9. 31% 9. 89% 10. 26% 0. 00% European/Other Maori Pacific Asian Not Stated/Dont Know

Disability Support Services Cochlear Implants • Delivered by Northern and Southern Cochlear Implant Trusts • Contract for 16 newborns, 30 children and 40 adults each year • Each implant costs $50 k, bilaterals $80 k • Processers replaced every 6 -8 years costing $10 k

Disability Support Services Cochlear Implants • Investment over the last 3 years nearly doubled • 2012/13 increased number of adults from 20 - 40 per year • 2014/15 introduced bilateral implants for children

Disability Support Services Cochlear Implants • Still challenges for the numbers of adults waiting for an implant • Prioritised against a number of clinical criteria which means some wait a long time • One-off funding over the last 3 years however unlikely currently

Disability Support Services Low Vision • Government Health Select Committee Hearing into Low Vision in 2014 • Mo. H commissioned a Stocktake of existing adult services in NZ

Disability Support Services Low Vison Stocktake Findings • No agreed standard service model • Services are very variable depending on person’s age and where they live • There will be an increased demand for services as the population ages

Disability Support Services Low Vision Recommendation • Establish a Low Vision Reference Group with representation from people with low vision and other key stakeholders (optometrists, opthalmologists, etc) • To be established over the next couple of months

Disability Support Services Low Vision Key Tasks • Develop a national strategic plan for Low Vision • Provide advice on development of a model of support to ensure good access nationally • Evaluation

Disability Support Services NASC • NASC development programme for 2015 in partnership with NASCA • Focus on NASC practice • Consistency around assessment and allocation practice • Tools to support improved practice

Disability Support Services DIAS & NASC Reviews • Review in line with our commitment to review our service delivery models • RFP on GETS website • Project over two phases • Phase 1: DIAS review • Phase 2: NASC review

Disability Support Services DIAS & NASC Review • • RFP on GETS website 21 st Aug Review project begins late Oct Phase 1 completed Mar 2016 Phase 2 completed Sept 2016

Disability Support Services Thank you Any questions? phil_wysocki@moh. govt. nz

Disability Support Services Culturally Responsive Services in the Disability Sector

Disability Support Services Outline • • • Definition – Culturally responsive practice Whāia Te Ao Mārama – Māori Disability Action Plan Let’s Get Real – Real Skills for People Working in Disability

Disability Support Services Culturally Responsive Practice • This means that integrating cultural considerations into every day practice becomes business as usual • Integration of culture into everyday practice implies that a person’s cultural identity is acknowledged as important and central to their wellbeing and world view • Therefore all people who are supporting disabled people should seek to gain a deeper understanding of that person’s heritage, their connections to family and extended whānau, land, rivers, mountain, sea and environment

Disability Support Services Whāia te Ao Mārama Priority 1: Improved outcomes for Māori disabled 1. 1 Require providers to ensure that personal plans to support Māori disabled are culturally appropriate and specifically identify and address the individual’s cultural needs (2012– 17) 1. 2 Provide a range of new and innovative support options for supporting disabled people that offer Māori disabled and their whānau more personalised support arrangements and greater choice and control over the supports they use (2013– 14)

Disability Support Services Whāia te Ao Mārama Priority 2: Better support for whānau 2. 1 Improve caregiver training to ensure whānau have access to culturally appropriate training to address the needs of Māori disabled (2013– 17) 2. 2 Develop the New Model for Supporting Disabled People to respond to whānau needs and priorities (2012– 13)

Disability Support Services Whāia te Ao Mārama Priority 3: Good partnerships with Māori 3. 1 Improve the quality, reliability and comparability of national information about the demographics of, and disability supports provided to, Māori disabled (2012– 17) 3. 2 Improve the quality of the community engagement process with Māori, particularly with hapū, iwi, and community leaders and groups (2012– 17)

Disability Support Services Whāia te Ao Mārama Priority 4: Responsive disability services for Māori 4. 1 Strengthen the cultural competencies of workers in the disability sector through the development and delivery of Māori cultural training (2012– 17) 4. 2 Support the Māori disability workforce to develop leadership skills and career pathways (2012– 17)

Disability Support Services Let’s Get Real Disability Framework • Seven ‘Real Skill’ Areas 1. 2. 3. 4. 5. 6. 7. Working with disabled people Working with Māori Working with families and whānau Working with communities Challenging stigma and discrimination Upholding law, policy and practice Maintaining professional and personal development

Disability Support Services Working with Māori • • • Recognise that disabled people may consider waiata, karakia and te reo Māori as contributors to their wellbeing and living a good life Use available resources, such as te reo Māori speakers, and written information in both English and Māori when appropriate Integrate te ao Māori and te reo Māori into service delivery

Disability Support Services Working with Māori • • Essential - Understand that disabled people and their whānau may wish to nominate a person to speak on their behalf, and support the involvement of nominated speakers Leader - Actively support systems, processes, policies and practice that reflect appropriate kaupapa for Māori e. g. karakia, mihi, pōwhiri for new staff

Disability Support Services Working with Māori • • Essential - Is familiar with local Māori groups (e. g. mana whenua), and their roles, responsibilities and relationships with each other, as guardians of Māori cultural knowledge and te reo Māori Leader - Develops and maintains relationships and partnerships with local Māori

Disability Support Services Hauora Māori • • Essential – Develop an understanding of Māori models or perspectives of wellbeing in service delivery (e. g. whare tapawhā) Leader – Promote and provide processes and practices that meet cultural needs, such as: use of whānau ora principles, resource allocation to prioritise and reduce Māori health inequalities, activities that measure cultural effectiveness of performance and service delivery

Disability Support Services Whakawhanaungatanga • • Essential – Aware of Māori methods of interaction that support relationships, particularly with whānau (establishing links). Nō hea koe? Where are you from? Understands that some people are disconnected from whakapapa whānau Leader – Promote environments that are conducive to whānau, for meetings/hui with whānau and needs assessments (e. g. at an appropriate time and place). Inclusive of other concepts of whānau

Disability Support Services Conclusion • • • Aim for culturally integrated practice Build relationships with Māori Gain support from Māori staff, advisors, kaumātua and kuia Model the principles from governance through to all levels of operations Cultural responsiveness is business as usual

Disability Support Services Family and Community Services August 2015 Amanda Bleckmann amanda_bleckman@moh. govt. nz

Disability Support Services Family and Community Services • • Home and Community Support Services/IF Child Development Services Respite and Carer Support Day Services Behaviour Support Individual Wraparound Services ASD Foster Care

Disability Support Services Update • Auckland cross agency project • ASD provider training • Child Development Services • Facility based respite • Carer support

Disability Support Services Auckland Cross Agency Project • Joint initiative DSS, MOH and CYFS • Auckland DHBs • Children and young people 12 -17 • Up to 50 children per annum • Develop cross agency solutions for children with high and complex needs

Disability Support Services ASD Provider Training • • • April 2014 eligibility clarification Need for NASC and Provider training NASC training delivered Provider training needs identified Need for training at an advanced level Te Pou

Disability Support Services Child Development Services • • • Stocktake is completed Key findings Next steps Currently meeting with all CDS and CE Plan for service improvement completed late 2015

Disability Support Services Child Development Services • • • Model of Care Standardisation of practice Nationally consistent access Configuration of workforce Integration with other services

Disability Support Services Key Findings • • • Professionals not available in teams Access to paediatricians Gaps - Mild to Moderate needs Communication needs ASD/Sensory problems Staffing

Disability Support Services Key Findings • • • Foetal Alcohol Spectrum Disorder BSS and Parenting programs Palliative Care Gap between CDS and MOE Capacity for and impact of new initiatives

Disability Support Services Respite and Carer Support

Disability Support Services Facility Based Respite • • Develop sustainable service model Establish a prioritisation process for people requiring facility based respite In scope: all services under the DSS 213 Service Specification Out of scope: In home support, Carer Support, after school care, school holiday programs and IF respite

Disability Support Services Key issues for families • • Access when they want it Compatibility/Client mix People with physical disabilities Wanting services up to 21 and/or across life span • Transportation

Disability Support Services Key issues for providers • • • Sustainable service model Want to provide a flexible range of respite options Compatibility Referrals for urgent and unplanned respite Often cannot provide urgent and unplanned respite without additional funding Cancellations

Disability Support Services Carer Support • Want to make Carer Support more flexible and responsive to full time carer needs • As a result of the recent court case, we need to remove the ‘employer’ interpretation

Disability Support Services COMMUNITY LIVING TEAM CLT/ CRM role What do we need to do differently? Younger People in Aged Care Incidents Reported High and Complex Framework Lee Henley – Manager CLT

Disability Support Services CONTRACT RELATIONSHIP MANAGER

Disability Support Services WHAT TO EXPECT FROM YOUR CRM • Responsiveness • Knowledge and advice • Good Advice • Constructive ideas • Knowledge of your • “Go to” person contract What can your CRM do for you?

Disability Support Services WHAT DO WE NEED TO DO DIFFERENTLY?

Disability Support Services DOING IT DIFFERENTLY Hearing from our Stakeholders Continuum of Services

Disability Support Services YOUNGER PEOPLE IN AGED CARE SERVICES

Disability Support Services YOUNGER PEOPLE IN AGED CARE SERVICES Alternative pathways Standardised approach for assessment Working Closely

Disability Support Services DSS PROVIDERS AND REPORTED INCIDENTS

Disability Support Services DSS REPORTED INCIDENTS Approximately 960 providers nationally 44 providers (4. 5%) reported 2014/15 Required to report Standard incident reporting form

Disability Support Services HIGH AND COMPLEX FRAMEWORK (HCF)

Disability Support Services HIGH AND COMPLEX FRAMEWORK (HCF) Shared project work Development of a bed strategy Provision of care and rehabilitation guidelines Improved data collection Transition pathways across the continuum of supports

Disability Support Services HCF MAINSTREAM FLOW High and Complex Framework Overlap of Continuum Exit from High and Complex Framework Community Residential Support Services Entry to High and Complex Framework

Disability Support Services COMMUNITY LIVING TEAM CRM role? What do we need to do differently? People in aged care? Incidents Reported? Transition between HCF and mainstream services? Lee Henley - lee_henley@moh. govt. nz

Disability Support Services Update on DSS Service Specifications and Contract Streamlining August 2015 Barbara Crawford DSS Manager Strategy and Contracts Support

Disability Support Services New Contracting Framework • For contracts between government agencies and NGOs • Consistent with the Government Rules of Sourcing 2014

Disability Support Services

Disability Support Services New structure of DSS contracts • Outcome Agreement (includes performance measures) • Tier 1 Service Specification (DSS Overall) • Tier 2 Service Specification (e. g. Respite) • Tier 3 Service Specification (e. g. Children’s respite)

Disability Support Services Service Specifications in Scope • • RIDSAS Community Residential Children’s Residential YPD Home and Community Support Services Foster Care and Contract Board Respite and Children’s Respite Day Programmes

Disability Support Services What has happened so far? • Multiple workshops with: • Disabled people who use the services • Families / whānau / carers • Providers • Disabled Persons’ Organisations

Disability Support Services Contd. • Results-Based Accountability training • Performance measures developed for each service type: • How much? • How well? • Is anyone better off?

Disability Support Services Contd. • DSS Outcome Agreement (OA) developed (this replaces the Head Agreement) • Tier 1 developed • Service specs have been updated • 8 -week online consultation period closed on 22 July

Disability Support Services

Disability Support Services Feedback received • From 35 people / organisations • Lots of positive feedback supporting the new approach and outcomes focus • A number of changes made e. g. • % staff meeting core competencies changed to % staff holding L 2 National Certificate in Health, Disability and Aged Support

Disability Support Services What will happen next? • 1 October – Day Programmes OA in place • 1 November – HCSS OA in place • 1 December – remaining in scope OAs in place • New reporting mechanisms developed to receive reports on new performance measures

Disability Support Services Dec. 2015 – Dec. 2016 • Review usefulness of the new performance reporting and amend performance measures as appropriate • Update most of the remaining SS in consultation with the sector • Look at better ways of managing DSS contracts

Disability Support Services Communications • Updates will be placed on the DSS pages of the MOH website • Any queries can be directed to • Barbara_Crawford@moh. govt. nz

Disability Support Services