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

Disability Support Services

DSS OverviewWho do we support and how much does it

cost?

August 2015

Toni Atkinson

Group Manager


Ministry of Health


Welcome – who are the team?

Pam MacNeill – 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


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%)


How much do we fund? - $1.1b


Growth in Community Care

11% increase on $256m is $28mWhat’s driving this?

Changing expectations, reduction in natural support, fewer people in residential with

higher support needs, other?

Average Hours Per Week 2010/11 2011/12 2012/13 2013/14 2014/15

Household Management 4.1 4.0 4.1 4.1 4.3

Personal Care 9.0 9.5 9.6 9.6 10.7

Supported Living 8.7 8.3 8.1 10.0 11.3

Total 21.8 21.8 21.8 23.7 26.3

% annual increase hours 0.0% 0.0% 8.7% 11.0%


Growth in Residential Care

Increase of 6% on $506m is $30mWhat’s driving this?

Greater risk, new H&S legislation, sleepover funding, more complex

clients, other?

Growth in Residential 2010/11 2011/12 2012/13 2013/14 2014/15

Cost of Residential Care $403m $453m $450m $492m $506m

Client Numbers 7,644 7,581 7,543 7,553 7,314Annual Cost per Client $53k $60k $60k $65k $70k Annual % Increase 13% 0% 9% 6%


Growth in Client Numbers

Additional 727 clients with an average package size of $28k is $20m, plus

32,357 clients with an increase in average package size of $1k is $32m.

Year 2010/11 2011/12 2012/13 2013/14 2014/15

Total Client Numbers 30,575 31,010 31,200 31,630 32,357 % increase 1.1% 1.4% 0.6% 1.4% 2.3%

Year June 2011 June 2012 June 2013 June 2014 May 2015Ave Package Size 23,553 23,990 24,919 26,678 27,652 $ Increase 437 929 1,759 974 % increase 1.9% 3.9% 7.1% 3.7%


Cost Drivers• Reduction in natural supports

• Greater expectations from disabled people and their families

• Aging population

• Impact of new Health and Safety legislation


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


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.


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.


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.


Thank you

Any questions?


Putting People First

August 2015

Pam MacNeill

Quality Improvement Lead

Cheryll Graham

Senior Advisor, Disability


Putting People First

A Review of Disability Support ServicesPerformance and Quality Management Processes

for Purchased Provider Services

Prepared for

Hon Minister Ryall, Minister of Health

November 2013


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.


Recommendation 11:

Identify what drives exceptional performance and design organisational and personal KPIs around this to support positive behaviours and outcomes.


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.


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.


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.


Recommendation 10:

Attract, recruit, and retain appropriately skilled disabled people, and others with a high level of experience of disability and disability issues.


Intern Programme


Mainstream Employment Programme


Recommendation 13:

The Ministry of Health adopts a policy of having no tolerance for the abuse that is inflicted on disabled people.


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.


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…


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.


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.


Recommendation 32:

The Panel of Experts provides specialist knowledge, expertise and advice to support CRMs to resolve challenging or complex complaints and issues.


Recommendation 26:

Replace the current Certification audit and developmental evaluation with an enhanced developmental evaluation9, 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…


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…


Recommendation 35:

Ensure the role NASCs play supports the well-being 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.


Contacts

Pam MacNeill

Quality Improvement Lead

[email protected]

Cheryll Graham

Senior Advisor, Disability

[email protected]


Service Access Update

28 August 2015

Phil Wysocki

Manager Service Access Team


Ministry of Health


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


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


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


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







Cochlear Implants• Delivered by Northern and

Southern Cochlear Implant Trusts

• Contract for 16 newborns, 30 children and 40 adults each year

• Each implant costs $50k, bilaterals $80k

• Processers replaced every 6-8 years costing $10k


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


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


Low Vision

• Government Health Select Committee Hearing into Low Vision in 2014

• MoH commissioned a Stocktake of existing adult services in NZ


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


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


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


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


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


DIAS & NASC Review

• RFP on GETS website 21st Aug• Review project begins late Oct• Phase 1 completed Mar 2016• Phase 2 completed Sept 2016


Thank you

Any questions?

[email protected]


Culturally Responsive Services in the Disability

Sector


Outline

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

Disability


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


Whāia te Ao MāramaPriority 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)


Whāia te Ao MāramaPriority 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)


Whāia te Ao MāramaPriority 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)


Whāia te Ao MāramaPriority 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)


Let’s Get Real Disability Framework

• Seven ‘Real Skill’ Areas1. Working with disabled people

2. Working with Māori

3. Working with families and whānau

4. Working with communities

5. Challenging stigma and discrimination

6. Upholding law, policy and practice

7. Maintaining professional and personal development


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


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, mihimihi, pōwhiri for new staff


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


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


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


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


Family and Community ServicesAugust 2015

Amanda [email protected]


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


Update

• Auckland cross agency project

• ASD provider training

• Child Development Services

• Facility based respite

• Carer support


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


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


Child Development Services

• Stocktake is completed• Key findings• Next steps• Currently meeting with all CDS and CE • Plan for service improvement

completed late 2015


Child Development Services

• Model of Care• Standardisation of practice• Nationally consistent access• Configuration of workforce• Integration with other services


Key Findings

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


Key Findings

• Foetal Alcohol Spectrum Disorder• BSS and Parenting programs• Palliative Care• Gap between CDS and MOE• Capacity for and impact of new

initiatives


Respite and Carer Support


Facility Based Respite• Develop sustainable service model• Establish a prioritisation process for people

requiring facility based respite• In scope: all services under the DSS213

Service Specification• Out of scope: In home support, Carer Support,

after school care, school holiday programs and IF respite


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


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


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


COMMUNITY LIVING TEAM

CLT/ CRM role

What do we need to do differently?

Younger People in Aged Care

Incidents Reported

High and Complex FrameworkLee Henley – Manager CLT


CONTRACT RELATIONSHIP MANAGER


WHAT TO EXPECT FROM YOUR CRM

• Responsiveness

• Good Advice

• Knowledge of your contract

• Knowledge and advice

• Constructive ideas

• “Go to” person

What can your CRM do for you?


WHAT DO WE NEED TO DO DIFFERENTLY?


DOING IT DIFFERENTLYHearing from our Stakeholders

Continuum of Services


YOUNGER PEOPLE IN AGED CARE SERVICES


YOUNGER PEOPLE IN AGED CARE SERVICES

Alternative pathways

Standardised approach for assessment

Working Closely


DSS PROVIDERS AND REPORTED INCIDENTS


DSS REPORTED INCIDENTS

Approximately 960 providers nationally

44 providers (4.5%) reported 2014/15

Required to report

Standard incident reporting form


HIGH AND COMPLEX FRAMEWORK (HCF)


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


Community Residential

Support Services

High and Complex

Framework

HCF MAINSTREAM FLOWExit from High and Complex Framework

Entry to High and Complex Framework

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COMMUNITY LIVING TEAMCRM role?

What do we need to do differently?

People in aged care?

Incidents Reported?

Transition between HCF and mainstream services?

Lee Henley - [email protected]


Update onDSS Service Specifications

andContract Streamlining

August 2015

Barbara Crawford DSS Manager Strategy and Contracts Support


New Contracting Framework• For contracts between government agencies

and NGOs• Consistent with the Government Rules of

Sourcing 2014



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)


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


What has happened so far?• Multiple workshops with:

• Disabled people who use the services• Families / whānau / carers• Providers• Disabled Persons’ Organisations


Contd.• Results-Based Accountability training• Performance measures developed for each

service type:• How much? • How well? • Is anyone better off?


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



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 L2 National Certificate in Health, Disability and Aged Support


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


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


Communications• Updates will be placed on the DSS

pages of the MOH website

• Any queries can be directed to

• [email protected]


Documents

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