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 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
Disability Support Services
Who are we funding?
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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? - $1.1b
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
4.1
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
21.8
21.8
21.8
23.7
26.3
0.0%
0.0%
8.7%
11.0%
Total
% annual increase hours
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?
Disability Support Services
Growth in Residential Care
Growth in Residential
2010/11
2011/12
2012/13
2013/14
2014/15
Cost of Residential Care
$403m
$453m
$450m
$492m
$506m
Client Numbers
Annual Cost per Client
Annual % Increase
7,644
$53k
7,581
$60k
13%
7,543
$60k
0%
7,553
$65k
9%
7,314
$70k
6%
Increase of 6% on $506m is $30m
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
30,575
1.1%
June 2011
23,553
2011/12
31,010
1.4%
2012/13
31,200
0.6%
2013/14
31,630
1.4%
June 2012 June 2013 June 2014
23,990
24,919
26,678
437
929
1,759
1.9%
3.9%
7.1%
2014/15
32,357
2.3%
May 2015
27,652
974
3.7%
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.
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
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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
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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
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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 MacNeill
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 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…
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 MacNeill
Quality Improvement Lead
Pam_MacNeill@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%
6.02%
5.59%
Cerebrovascular accident
(disorder)
Cerebral palsy (disorder)
19.45%
Multiple sclerosis
6.71%
7.25%
17.89%
Amputation of lower limb
7.28%
7.76%
16.03%
Disorder of musculoskeletal
system
Parkinson's disease
Developmental delay
Disorder of cardiovascular
system
Autistic disorder
Disability Support Services
All Clients by Age Group
24.10%
5.66%
10.98%
0-4
5-14
32.46%
26.80%
15-64
65-79
80 +
Disability Support Services
Total Assessments Completed
by Age Band and 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%
11.29%
10.00%
7.47%
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
Maori
15.94%
5.02%
Asian
8.52%
70.51%
Disability Support Services
Total Assessments Completed
by Ethnic Group and Funding Availability
100.00%
90.00%
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 $50k,
bilaterals $80k
• Processers replaced every
6-8 years costing $10k
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
• MoH 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
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RFP on GETS website 21st 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
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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
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Seven ‘Real Skill’ Areas
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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
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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
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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
Disability Support Services
Working with Māori
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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
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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
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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
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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
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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
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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
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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
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Model of Care
Standardisation of practice
Nationally consistent access
Configuration of workforce
Integration with other services
Disability Support Services
Key Findings
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Professionals not available in teams
Access to paediatricians
Gaps - Mild to Moderate needs
Communication needs
ASD/Sensory problems
Staffing
Disability Support Services
Key Findings
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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
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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
Disability Support Services
Key issues for families
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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
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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
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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 L2 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