Cabinet paper summary - April, 2018 Posted by Posted by Loren Savage on 26 April 2018 Posted on: 26 April 2018

This paper seeks agreement to start a new disability support system on 1 October in MidCentral DHB region and to spend $23.84 million from Budget 2017.

MidCentral includes the Palmerston North, Horowhenua, Manawatu, Otaki, and Tararua districts in the north island. 

The new system has been designed together with disabled people, whānau, and others in the disability sector, and is based on the Enabling Good Lives’ vision and principles.

Its objectives are to give disabled people and their whānau more options and decision making authority about their lives and supports, to improve their outcomes, and create a more cost-effective disability support system.

The key features include:

• People are welcomed into the system in multiple ways, and can then be provided with information, linked with a Connector, peer network, government agency or disability organisation.

• Access to Connectors - someone who can walk alongside disabled people and whānau to help them identify what they want in their lives, how to build that life, and the range of supports available.

• Easy to use information and processes for disabled people and whānau.

• Connected support across government, a Government Liaison supporting person, in the background, to access other government services (e.g. benefit applications), and to build positive relationships with other parts of government (e.g. learning support in school). 

• A straightforward processfor accessing funding, with flexibility about what can be purchased and easy reporting on how funding has been used.

• Capability funding for disabled people and whānau, allocated by the Regional Leadership Group.

• Greater system accountability to disabled people and their whānau – disabled people and whānau are involved in monitoring and evaluating the system, and making recommendations to Ministers about changes to the system.

Existing support will continue on 1 October

While everyone in MidCentral will be part of the new system from 1 October, disabled people and whānau will continue to receive the support they were receiving on 30 September 2018.

Change will occur when disabled people and whānau contact the new teams to consider options or a Connector engages with disabled people and whānau on their regular review date.  

The Teams

There will be two teams set up and based in MidCentral:

1. The Disabled People and Whānau supporting team will be a new team made up of Connectors and a Network Builder, reporting to the Ministry of Health.
   
   
2. The System Enabling team will be made up of Information Specialists, Government Liaison, and business and administration roles.  This will be delivered through Enable (the existing Needs Assessment and Service Coordination [NASC]). The new team will be made up of a mix of current employees and new staff who are recruited.

This is an interim and pragmatic step ahead of decisions on future organisational arrangements for the disability support system.

Governance

There are a range of governance and advisory groups that have been put in place so that a wide range of views can be heard.   The voices of disabled people and whānau are part of each governance and advisory group.

A sub-group of the MidCentral Regional Leadership Group will make decisions relating to the two new teams and the implementation and operation of the new system in MidCentral.  They will operate like a board and will formally advise the Ministry of Health.

The Minister for Disability Issues and Associate Minister of Health will approve the terms of reference for the MidCentral Regional Governance Group.

Monitoring and evaluation

The new system will be monitored and evaluated. Disabled people will be involved in assessing the new system to help us understand:

• If there are improved life outcomes for disabled people and their whānau, ie including health and wellbeing, physical and financial security, relationships, social inclusion, self-determination, and self-fulfilment

• Where improvements are needed

• What needs to be changed or expanded

• If and how the approach should be expanded

Funding

The $23.84 million allocated over two years will set up the new system in MidCentral and continue the EGL demonstrations in Christchurch and Waikato.

The majority of the funding will be used to increase support for disabled people and whānau, through the following ways:

1. Additional direct support allocated to disabled people and whānau. The direct support will mainly fund early interventions and improved access to specialist services.

2. Additional indirect supportfor disabled people and whānau, delivered mostly by Connectors, as well as a focus on building the capability of disabled people, whānau, support workforce and providers, and funding EGL workshops across New Zealand. This will enable disabled people to identify new possibilities for their life, and build networks and skills to make them a reality.

3. Infrastructure - This includes the back-office team, ie the System Enabling team, and the national and regional governance.

4. One-off costs. These include the team co-designing the transformed system with the disability community, an interim IT solution, and monitoring and evaluation.

5. Funding to continue the Christchurch and Waikato EGL demonstrations until June 2020 when they are due to be transformed.

Table 3: Proposed use of Budget 2017 contingency funding

Decisions on the detailed design of the funding allocation, accountability for funding, and financial risk management will be sought from Ministers in June 2018.

Try, learn, and adjust approach

There will be a ‘try, learn and adjust’ approach taken when the new system is up and running in MidCentral. 

Feedback from disabled people and whānau will help improve and finalise the system before it is rolled out across New Zealand.  

Decisions on the final model and expansion beyond MidCentral will be sought from Cabinet in late 2020. 

Financial implications

Funding for a nationwide rollout of the new system would be sought through following Budgets. Estimates of the ongoing costs could be $140-$160 million a year.  There will also be funds needed for an updated nationwide IT solution and for organisational and governance changes.

The amount of additional funding sought may change following what is learnt in MidCentral. This includes refining the final model and the extent of increased demand from people who are new to the disability support system.

Future policy work

Developing a new system creates a wide range of policy and operational issues.  There is work under way or planned on:

• Disability support funding from across government

• The tax treatment of disability support funding paid to disabled people and whānau

• Further developing safeguarding arrangements

• The impact of GST

• How to implement the government’s approach to paying family carers

• Eligibility and developing options to enter the new system

• Work on means testing and

• Legislative work.

Machinery of government review

The Cabinet paper includes the process for making decisions about the future organisational arrangements.  This is called a Machinery of Government review.  It will involve representatives from the disability sector and officials, and is expected to be finished by late 2020.