DSS Overview Who do we support and how much does it cost? August 2015

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

2. 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

3. 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%)

4. How much do we fund? - $1.1b

5. Growth in Community Care 11% increase on $256m is $28m What’s driving this? Changing expectations, reduction in natural support, fewer people in residential with higher support needs, other?

6. Growth in Residential Care Increase of 6% on $506m is $30m What’s driving this? Greater risk, new H&S legislation, sleepover funding, more complex clients, other?

7. 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.

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

9. 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

10. 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.

11. 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.

12. 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.

13. Thank you • Any questions?

14. Putting People FirstAugust 2015 Pam MacNeill Quality Improvement Lead Cheryll Graham Senior Advisor, Disability

15. Putting People FirstA Review of Disability Support ServicesPerformance and Quality Management Processesfor Purchased Provider Services • Prepared for • Hon Minister Ryall, Minister of Health • November 2013

16. 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.

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

18. 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.

19. 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.

20. 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.

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

22. Intern Programme

23. Mainstream Employment Programme

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

25. 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.

26. 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…

27. 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.

28. 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.

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

30. 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…

31. 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…

32. 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.

33. Contacts Pam MacNeill Quality Improvement Lead Pam_MacNeill@moh.govt.nz Cheryll Graham Senior Advisor, Disability Cheryll_Graham@moh.govt.nz

34. Service Access Update28 August 2015 Phil Wysocki Manager Service Access Team Disability Support Services Ministry of Health

35. 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

36. 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

37. 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

38. 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

44. 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

45. 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

46. 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

47. Low Vision • Government Health Select Committee Hearing into Low Vision in 2014 • MoH commissioned a Stocktake of existing adult services in NZ

48. 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

49. 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

50. 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