Briefing
Date:
5 December 2023
For:
Hon Penny Simmonds, Minister for Disability Issues
File reference:
REP/WHK/23/12/008
Security level:
In Confidence
Whaikaha functions and actions for
safeguarding disabled people and ensuring
the quality of disability supports
Purpose
This briefing provides an overview of:
• Quality and safeguarding issues for the disability community.
• Existing Whaikaha mechanisms to monitor the quality of disability supports and
services.
• What Whaikaha does to improve the quality of disability supports and ensure
the safeguarding of disabled people who are at risk of abuse or neglect.
• A recently published report into complaints management at IDEA Services, as
an example of a recent Whaikaha action to improve the quality of services.
We would welcome the opportunity to discuss this work programme with you.
Executive summary
We know that disabled people and tāngata whaikaha Māori are much more likely to
experience victimisation, violence, and sexual assault than other New Zealanders.
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For example, disabled adults are 52% more likely than non-disabled adults to be
sexually assaulted in their lifetime.
1 The Royal Commission of Inquiry into Abuse in State Care, the Waitangi Tribunal
Inquiry Wai2575 and the cross-Government National Strategy to Eliminate Family
Violence and Sexual Violence (Te Aorerekura) have all highlighted the high rates of
violence against disabled people and the need for Whaikaha to strengthen the
quality and safeguarding mechanisms for the disability support system.
Whaikaha is committed to enhancing the rights of disabled people and ensuring
they are free from abuse, violence, and neglect, also known as safeguarding.
As the funder of disability supports, Whaikaha has a responsibility to ensure the
supports and services we commission meet the quality expected by disabled people
and their families and whānau, and that they are keeping disabled people safe from
abuse and neglect. This responsibility is implemented through the commissioning
and contracting roles that Whaikaha undertakes for the Crown. Whaikaha does not
have any legislative powers to ensure quality and safeguarding of disabled people.
We also recognise that other agencies and organisations have a part to play, such
as the Police, Oranga Tamariki, the Health and Disability Commissioner (HDC), and
the Coroner. The Human Rights Commission (HRC) and the Office of the
Ombudsman alongside disabled people through their membership organisations
also have a role as independent complaints organisations, and together form an
Independent Monitoring Mechanism (IMM). We have reporting requirements for the
IMM and the United Nations Convention Against Torture and other Cruel, Inhuman
or Degrading Treatment for Punishment (UNCAT).
The quality and safeguarding actions Whaikaha is taking are:
• Improving our capacity and capability relating to quality assurance and
safeguarding, including increased audit, evaluation, and investigation
capacity.
1 Te-Aorerekura-National-Strategy-final.pdf (tepunaaonui.govt.nz)
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• Making improvements to our existing quality mechanisms (complaints,
critical incident reporting, death reporting, and audit, evaluation, and
investigation processes).
• Improving data management and reporting, including developing non-
identifying data analysis that can be published.
• New quality improvement and safeguarding services that focus on the voice
and safety of disabled people, such as:
o The Disability Abuse Prevention and Response team (DAPAR).
o Growing Voice and Safety - People for Us (a disabled person-led peer
monitoring service).
o Growing Voice and Safety - Assisting Change (an improvement advisory
service for providers).
o Developing and implementing a safeguarding work programme for
disabled adults as part of implementing Action 28 of Te Aorerekura –
the cross agency National Strategy to Eliminate Family Violence and
Sexual Violence.
o Developing a new strategic quality framework for a transformed system
(engagement and design for this to occur throughout 2024).
These actions will align with other system transformation actions across
Whaikaha, such as the My Home My Choice programme, the Monitoring,
Evaluation, Analysis and Learning (MEAL) programme, and the wider system
transformation work programme.
Disabled people, tāngata whaikaha Māori and whānau will be closely involved in
driving these actions.
An example of a recent action Whaikaha has undertaken to improve the quality
of disability supports is the review of complaint management at IDEA Services. In
2023 Whaikaha commissioned a review, from an independent barrister, into the
processes and practices for managing complaints about the delivery of disability
support services by IDEA Services. The review also sought recommendations on
how Whaikaha could improve its approach to responding to complaints about
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service providers. The report made a number of recommendations for IDEA and
for Whaikaha to improve complaint management and rebuild trust with the
disability community.
Recommendations
It is recommended that you
note the contents of this briefing.
Hon Penny Simmonds
Minister for Disability Issues
Date
Ben O’Meara
Deputy Chief Executive Policy, Strategy and Partnerships
Date
Actions for private secretaries:
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Current quality and safeguarding issues
1. Tāngata whaikaha Māori and disabled people experience violence and abuse
that is common with all abusive relationships - physical, sexual,
psychological/emotional, and financial abuse, including patterns of power,
control and coercion. In addition, tāngata whaikaha Māori and disabled people
also experience other forms of abuse that are more specific to disabled people,
such as discrimination and ableism, limited disability specific support options,
services not being driven by or focused on a person’s will and preference,
restraint and control, human rights violations, abuse of authority by a legal
representative, institutional abuse, discrimination and neglect.
2. As well as these issues, a range of other factors can increase a person’s risk of
being targeted for abuse and harm; for instance, the degree of autonomy that
people have over their lives, and being reliant on others (who may misuse their
position) for making decisions on vital needs, including mobility, access to
information, control of finances, and provision of care and support.
3. There are significant gaps in terms of systems and policies to safeguard people
in these situations. In addition to the support worker relationship, in cases of
intimate partner violence and intrafamilial abuse, the primary aggressor can be
the disabled person’s primary carer. There is currently a gap in the knowledge
and skills of the police and family violence systems to safely respond to these
situations. There is limited data on the prevalence of abuse of disabled people,
but what there is clearly indicates high levels of abuse and harm. See Appendix
One for definitions of safeguarding, vulnerable adult and adult at risk.
Whaikaha quality mechanisms
4. The mechanisms Whaikaha currently has in place to monitor quality are
implemented through the contracts between Whaikaha and disability providers.
Whaikaha:
4.1.
Receives and manages critical incident reports for all Whaikaha
contracted services. During 2023 Whaikaha has received an average of
182 critical incident reports per month. Reporting of critical incidents
and deaths | Whaikaha - Ministry of Disabled People
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4.2.
Receives and manages notifications of deaths of disabled people in
Whaikaha funded residential care. During 2023 Whaikaha has received
an average of 11 death reports per month. Reporting of critical
incidents and deaths | Whaikaha - Ministry of Disabled People
4.3.
Audits, evaluates and investigates Whaikaha contracted providers. Audit
and evaluation | Whaikaha - Ministry of Disabled People
4.4.
Manages complaints about the quality of Whaikaha contracted disability
supports and services. During 2023 Whaikaha has received an average
of 6 complaints per month. Complaints and feedback | Whaikaha -
Ministry of Disabled People
5. Data from the Whaikaha critical incident reporting shows that, in the seven
months from March to September 2023
2:
5.1.
There were 1374 critical incidents reported by contracted providers.
5.2.
Of these, 573 (41.7%) were reports of abuse or assault (of disabled
people or disability support staff).
5.3.
Of these, 214 (relating to 133 different individuals) were reports of
abuse or assault of disabled people, (either by other disabled people,
staff, or another group)
5.4.
Over 96% of these 214 incidents relating to abuse or assault of disabled
people were reported by either residential services or High and Complex
services under the Intellectual Disability (Compulsory Care and
Rehabilitation) Act (IDCC&R).
5.5.
Demographic analysis of the 133 individual disabled people impacted by
the incidents relating to abuse or assault of disabled people shows:
o
Their ethnicity distribution is similar to that of the ethnicity
distribution of disabled people in Whaikaha-funded residential
services.
2 On 1 March 2023 Whaikaha updated how critical incidents are categorised and provides identifiable data, which
for the first time enables us to analyse the demographic breakdown of critical incidents. Therefore the data is taken
from this time period.
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Table 1: Prioritised ethnicity breakdown by count and percentage of the 133
disabled individuals assaulted compared with disabled people in Whaikaha
funded residential services.
Māori
Pacific
Asian
European
Not
/ Other
stated
Reports of
24
7
6
96
-
abuse or
(18.0%)
(5.3%)
(4.5%)
(72.2%)
assault
Disabled people
1,174
280
194
5,280
127
in Whaikaha
(16.6%)
(4.0%)
(2.7%)
(74.8%)
(1.8%)
funded
residential
services
5.6.
Approximately half of these incidents were abuse or assault of female
disabled people and half related to male disabled people. This reflects
the gender distribution of disabled people in Whaikaha-funded
residential services.
5.7.
Younger people are overrepresented in the abuse or assault incidents
reported to Whaikaha. Nearly 60% of these incidents were of disabled
people aged between 20-39 years old. Whereas the 20–39 years old
age group makes up just over 26% of all disabled people in Whaikaha-
funded residential services.
5.8.
Almost all the disabled people with reported assault/abuse incidents
have either an intellectual disability (69.2%) or are autistic (22.6%).
5.9.
Autistic people are over-represented in the abuse or assault statistics.
Autistic people had 22.6% of the reported assaults, compared with the
approximately 8% of disabled people in Whaikaha-funded residential
services who are autistic.
5.10. The percentage of people assaulted who have an intellectual disability is
similar to the percentage of people with an intellectual disability living in
Whaikaha-funded residential services.
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6. Whaikaha is working to address the high proportion of critical incident reports
in High and Complex services under the IDCC&R
3. We will do this through:
6.1.
The Whaikaha High and Complex Framework Strategy. High and
Complex Framework Strategy | Whaikaha - Ministry of Disabled People
6.2.
Working with the Ministry of Health to investigate using the Health
Quality and Safety Commission adverse event reporting framework
used by hospitals.
Improvements to quality and safeguarding mechanisms
7. Whaikaha considers that the existing quality mechanisms are not sufficient in
terms of depth and breadth to provide monitoring oversight and service
improvement to the standard expected by disabled people, tāngata whaikaha
Māori and whānau.
8. There is an increased expectation from the disability community that the
perspectives of disabled people, tāngata whaikaha Māori and whānau are
stronger in the work of Whaikaha, including in the quality mechanisms.
9. The findings of the Royal Commission of Inquiry into Abuse in State Care and
the Waitangi Tribunal Inquiry Wai2575 are expected to further highlight the
need for Whaikaha to strengthen the quality and safeguarding mechanisms for
the disability support system.
10. Whaikaha has made a commitment to broaden our approach to safeguarding
and improving the quality of supports and services for disabled people and
tāngata whaikaha Māori. Improvements in the disability support system will
include:
10.1. Clearer authority to investigate and act.
10.2. More independent checks on services.
10.3. Trusted mechanisms for disabled people, tāngata whaikaha Māori and
whānau to share their experiences and concerns.
10.4. More support for providers to improve their services.
3 Refer to the High and Complex BIM
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10.5. Improved capacity and capability in Whaikaha to respond to quality and
safeguarding concerns, particularly allegations of abuse and neglect of
disabled people and tāngata whaikaha Māori.
Safeguarding work programme
11. Whaikaha is responsible for the implementation of Te Aorerukura Action 28
(Safeguarding Responses for Disabled and Vulnerable Adults). Budget 2023
allocated $6.11 million over 4 years to increase access to specialist supports
through the Waitematā Safeguarding response and expanding the initiative to
other localities, while also supporting improved access to mainstream family
violence and sexual violence services.
12. As part of this Whaikaha has developed a plan to implement a safeguarding
approach that protects and promotes tāngata whaikaha Māori and disabled
people’s rights, culture, identity and wellbeing, prevents and responds to
violence, abuse and neglect, and is aligned with Enabling Good Lives (EGL)
principles. We will:
12.1. Improve our established quality and monitoring mechanisms and
processes so we prevent further abuse.
12.2. Develop and implement a Safeguarding approach that puts into practice
the EGL approach and Te Tiriti o Waitangi principles.
12.3. Work in collaboration with other agencies to implement safeguarding
Actions.
13. To date Whaikaha has:
13.1. Established a new community-led Disability Abuse Prevention and
Response team (DAPAR). The team is disabled-led and made up of
trained specialists in family violence and safeguarding adults from
abuse. They respond to tāngata whaikaha Māori and disabled people
who are experiencing violence or who are unable to protect or remove
themselves from abusive situations because of their needs for disability
support. DAPAR will implement a cross agency approach in Waitematā
and begin to provide national coverage for people using Needs
Assessment and Coordination Services (NASC), and those working with
the EGL sites.
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13.2. Finalised the evaluation of the Waitemata Safeguarding Adults from
Abuse pilot in collaboration with Te Puna Aonui.
13.3. Established a Whaikaha Specialist Situations of Concern Panel to receive
and consider referrals from disabled people, tāngata whaikaha Māori,
and providers, relating to abuse, violence, neglect and any other form
of human rights infringement and to make recommendations on action.
Referrals arrive through the general Whaikaha email contact inbox,
individual staff, and through quality mechanisms relating to individual
situations of concern. This process will be further developed and opened
to the community.
13.4. Developed a draft road map for the implementation of the safeguarding
framework.
13.5. Funded and co-developed with tāngata whaikaha Māori a draft kaupapa
Māori community approach to safeguarding. This aims to action the
intention to ensure safeguarding is Māori focused with a whānau-
centric, Māori-led model.
14. The foundation for this work was provided in part by the Waitemata evaluation.
We are awaiting publication of this evaluation.
The implementation of new quality initiatives to build the voice and
safety of disabled people
15. Whaikaha is currently implementing two new quality initiatives to build the
voice and safety of disabled people. The initiatives are:
Growing Voice and Safety – People for Us
16. Whaikaha has designed this service to focus on the voice, good lives and
human rights of disabled people and tāngata whaikaha Māori, while also
reducing the risks and occurrences of neglect and abuse in services.
17. The People for Us service will partner with disabled people, tāngata whaikaha
Māori and whānau for early identification of those most at risk of harm who are
not living a good life. The initial priority groups are likely to be those living in
residential services, who have little or no family or whānau contact, limited
community engagement and may communicate in a variety of ways.
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18. The service will sit externally from Whaikaha and be independent from service
providers funded by Whaikaha. People for Us will provide another mechanism
to seek the perspectives of disabled people and build a picture of concerns,
issues and trends, that will be fed into the Whaikaha quality system.
19. People for Us will support disabled people and tāngata whaikaha Māori who are
experiencing harm or who are at high-risk of harm to connect to the right
support pathways. This could include referrals to the Disability Abuse
Prevention and Response (DAPAR) Team, the Police, My Home My Choice
project, independent advocates, community networks, EGL
connectors/kaitūhono, or NASC.
Growing Voice and Safety – Assisting Change
20. Whaikaha has designed this initiative to provide targeted developmental
support to service providers who support disabled people who are considered
most at risk of abuse and harm, those identified to have a pattern of quality
issues and who wish to develop their service in line with the principles of EGL.
21. Whaikaha intends to contract a provider for the improvement advisory service.
The contracted organisation will source a pool of specialist advisors with a
diverse range of skill sets and experience, then act as a broker, matching an
advisor to work alongside a provider for a short time to support them to
address their specific quality issue(s). This will include culturally appropriate
matches for kaupapa Māori and Pacific providers. Whaikaha will also fund a
contribution to the intensive advice.
22. The providers supported under this initiative could be identified through the
existing Whaikaha audit/developmental evaluation programme, or through
other existing quality mechanisms.
Improvements to existing quality mechanisms
23. We have made improvements to the reporting of critical incidents that occur in
Whaikaha funded services and deaths that occur in Whaikaha funded residential
services. These improvements have resulted in updates to the reporting forms,
which can be found
at Reporting of critical incidents and deaths | Whaikaha -
Ministry of Disabled People. These improvements aim to gather useful
information to inform decisions about triage and management of
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the incidents or deaths, to provide a clearer perspective from the disabled
person and whānau relating to the incident or death, and to provide improved
data for robust analysis.
24. We are also in the process of improving our standard operating procedures for
our existing quality mechanisms. In particular, we are aiming to improve the
ways that disabled people, tāngata whaikaha Māori and whānau can share their
experiences and provide feedback on the quality of their disability supports. The
updated standard operating procedures will be published as they are
completed, and will cover complaints, critical incidents, deaths and audits,
evaluations, and investigations.
25. Whaikaha is developing data analysis relating to the quality of disability
supports to ensure the data is robust. Working in partnership with
representatives from the disability community, relevant datasets will be
published on our website.
26. We have also approved increased capacity for the audit, evaluation, and
investigation programme to undertake independent checks of services against
their contracts.
Development of a new quality framework that is fit for purpose for a
transformed disability support system
27. Whaikaha is currently undertaking a procurement process to engage an
organisation to design a quality framework that is fit for purpose for a
transformed disability support system. The engagement and design of this
framework will occur during 2024.
28. The outcome of the framework will be that Whaikaha, disabled people, tāngata
whaikaha Māori and whānau have appropriate mechanisms and powers to
ensure that disability supports are of high quality and enable disabled people to
have a good life. This framework will need to:
28.1. Enable disabled people and tāngata whaikaha Māori to have greater
choice and control over their lives and supports, including assessing the
quality of their support.
28.2. Clarify when Whaikaha will ‘step in’ where quality of support is a
concern.
28.3. Outline the range of quality mechanisms needed.
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28.4. Provide the appropriate authority for the actors and mechanisms to
work effectively.
28.5. Drive better outcomes for disabled people, tāngata whaikaha Māori and
whānau.
The Disabled Monitoring Evaluation Analysis and Learning (MEAL)
Strategy
29. The MEAL Strategy models and mandates a partnership approach for all aspects
of evaluating disability system transformation initiatives. The Strategy is
overseen by an Insights Alliance, which is a tripartite arrangement between the
Ministry, disabled people and tāngata whaikaha Māori.
30. Within the MEAL action plan, safeguarding is being evaluated in an integrated
way using a developmental process. This will include a try learn and adjust
approach to improving responses and approaches to support disabled people
and tāngata whaikaha Māori who are at risk.
31. The intention is that all new projects for evaluating improvements to current
disability supports are reviewed by the Insights Alliance to reflect the
partnership approach for evaluation.
32. The aim is to gather data of all kinds including qualitative anonymised voice
data. Outcomes will reflect the priorities that are defined by disabled people
and tāngata whaikaha Māori alongside the government’s monitoring
requirements for public expenditure.
Report into the processes and practices for managing
complaints about the delivery of disability supports by IDEA
Services
33. In 2023 Whaikaha commissioned independent Barrister Rachael Schmidt-
McCleave to undertake a review into the processes and practices for managing
complaints about the delivery of disability supports by IDEA Services. This
review was commissioned in response to concerns from family and whānau
about the standard of disability support services provided by IDEA Services,
and the way IDEA Services responded to complaints. IDEA Services is the
largest provider contracted by Whaikaha.
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34. The review made a number of recommendations for:
34.1.
IDEA Services on how to effectively respond to complaints. 34.2.
Whaikaha on ways that we can strengthen processes and practices for
managing complaints about service providers, including IDEA Services.
Whaikaha has accepted all the recommendations that relate to our role.
35. We will continue to work collaboratively with IDEA services, our other service
providers and the disabled community so that there is predictability and
transparency in how Whaikaha will respond to complaints about service
providers. Associated with this is the need to rebuild trust with IDEA Services
and the community when responding to complaints.
36. We will work with IDEA Services and the community to strengthen processes
and practices for managing complaints.
37. We have proactively released the report on our
website: Cabinet Papers and
information Releases | Whaikaha - Ministry of Disabled People
Author: Lara Penman, Manager Quality and Performance Team, Policy, Strategy and
Partnerships
Responsible manager: Trish Davis, Group Manager Quality and Insights, Policy,
Strategy and Partnerships
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Appendix One: Definitions
38. Safeguarding: Being broader than child and adult protection, safeguarding
relates to the actions taken to promote, enhance and protect a person’s life
outcomes, human rights, decision making, choice and control, safety, wellbeing
and culture, citizenship, and quality of life.
39. Vulnerable Adults: Identifying ‘Vulnerable Adults’ and responding to changes in
the Crimes Act 1961, introduced in 2012, mean that certain people are legally
responsible for protecting ‘vulnerable adults’ from serious harm. The Act defines
a ‘vulnerable adult’ as a person “who is unable, by reason of detention, age,
sickness, mental impairment, or any other cause, to withdraw themselves from
the care or charge of another person”.
40. Adult at risk: The disability community and family violence experts prefer this
term instead of vulnerable adult. An Adult at Risk is defined as someone who
meets all three of the following criteria:
40.1. A person (aged 18 years or over) who has an unmet need for
appropriate support, and
40.2. who is experiencing (or at risk of) harm, violence, abuse, and neglect,
and
40.3. because of an unmet need for support, is unable to protect themself.
41. An adult at risk can be any person who meets the above definition, they may or
may not be a disabled person.
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IN-CONFIDENCE
Briefing
Date:
5 December 2023
For:
Hon Penny Simmonds, Minister for Disability Issues
File reference:
REP/WHK/23/11/007
Security level:
Legally Privileged
Whaikaha - Ministry of Disabled People
Funded Disability Supports
Purpose
1 This briefing provides you with further information about disability supports
funded by Whaikaha – Ministry of Disabled People (Whaikaha).
Executive summary
2 Whaikaha funds disability support for a relatively small part of the New Zealand
population, but it is a diverse population with a wide range of needs. That
diversity continues to grow, as our population mix changes, for example, there is
a growing proportion of young people with autism.
3 Disability Support Services has developed a range of service options (about 36
different service lines) across the 30 years of its’ existence and has around 800
contracts with 476 disability support providers. Whaikaha has inherited this
service complexity from the Ministry of Health.
4 Updates and developments to these services have lagged behind the changing
nature of the community we serve, and there is a view amongst parts of the
community that effort put into improving existing services diverts effort away
from introducing a transformed disability support system.
5 Several service lines are showing cost growth and are likely to cost more as the
system struggles to meet the needs of the population we serve in the post–COVID
environment. These are:
• Residential Care, and particularly residential care individual rate services; and
• Individualised Funding.
6 Both services are seeing growth in demand, and growth in the cost of meeting
that demand, when other parts of the disability support system struggle to
respond to the needs of disabled people and family/whānau more directly.
7 Individual rates in Residential Care occur when a disabled person requires 24/7
supports of a nature and intensity not well reflected by the contracted rate.
Individual rates are growing faster than the general growth in Disability Support
Service costs. Whaikaha is developing further advice on how this growth can be
stabilised in the near term to manage fiscal risk within this financial year.
8 Flexible Purchase Guidelines were introduced to Individualised Funding and Carer
Support in 2020 and became permanent in 2021. The Flexible Purchase Rules
were introduced quickly during COVID, without all the features needed to manage
this funding in the Enabling Good Lives sites. Service development has not been
able to keep pace with uptake or the changes in use.
9 Whaikaha is preparing further advice on how a reset can provide greater certainty
for disabled people and whānau in the use of flexible funding, as well as
addressing the financial pressure that growth in Individualised Funding is putting
on our financial position.
10 Growth in these service lines is likely to reflect challenges in other parts of
disability support services. For example, a lack of access to respite for some
families leads to use of a greater quantity of Individualised Funding. Limited
availability of behaviour support will see families seeking flexibility in their
Individualised Funding to live with difficult situations, or over time translate to
higher costs in sustaining residential care arrangements.
11 We expect to update you on progress we are making on service development
priorities early in the New Year.
12 Other areas requiring particular attention include:
• Services under the High and Complex Framework
1 (compulsory care) where
we have an ongoing work programme to respond to concerns raised in 2021
(prior to the establishment of Whaikaha – Ministry of Disabled People) by the
Ombudsman about the planning and resourcing of forensic intellectual
disability services under the High and Complex Framework;
• Living options for disabled people, including residential care pricing issues and
responding to concluding observations made by the United Nations, which
recommended further deinstitutionalisation and a move away from the use of
group homes; and
• Pay Equity claims and upcoming settlement processes.
1 The High and Complex Framework (HCF) supports people under the Intellectual Disability (Compulsory
Care and Rehabilitation) Act 2003 (the IDCCR Act) and other relevant legislation. It provides a
diversionary pathway for offenders with intellectual disabilities who have been found unfit to stand trial
on or be convicted of an imprisonable offence. This includes providing more appropriate supports with a
strong rehabilitative focus. About 200 to 300 people are supported under the HCF at any time
2
REP/WHK/23/11/007 Whaikaha – Ministry of Disabled People Funded Disability Supports
13 Officials are available to meet with you to discuss in more depth any of the service
areas set out in this briefing.
Recommendations
It is recommended that you:
a)
Note Whaikaha – Ministry of Disabled People serves a small but
Noted
diverse population, with a wide range of support needs
b)
Note that whilst supports play an important role in people’s lives
Noted
now, overall service development has not kept pace with the
changing needs of the population, or the ways that people seek
to live in New Zealand
c)
Note that challenges meeting needs are appearing in part as
Noted
increased costs in some key service lines, such as Residential
individual rates and Individualised Funding
Noted
d)
Note that Whaikaha is reviewing:
• the residential care model and pricing,
• capacity and fitness for purpose challenges in the High and
Complex Framework, and
• preparing for potential future pay equity settlements
e)
Note that a separate briefing is being provided on current
financial pressures in the disability support system
Noted
f)
Note that a separate briefing is being provided on Disability
System Transformation
Noted
g)
Note that we will provide you with a fuller briefing on service
development priorities
Noted
Hon Penny Simmonds
Minister for Disability Issues
Date
Signatory
Amanda Bleckmann, DCE Commissioning, Design, and Delivery
Date: 30 November 2023
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About the Disability Support System
Eligibility
1
Disability Support Services (DSS) was separated from the health system in 2022
as part of the Health Sector Reforms. Whaikaha – the Ministry of Disabled People
was established in July 2022 and responsibility for the delivery of DSS
transferred from the Disability Directorate within the Ministry of Health - Manatū
Hauora - (MoH) to the Ministry.
2
The establishment of the Ministry was a significant step towards moving the
disability system away from the medical model of disability
2 to the social model
which underpins the United Nations Convention on the Rights of Persons with
Disabilities (UNCRPD) and Enabling Good Lives vision and principles.
3
The Ministry commissions and in some instances delivers (through our Enabling
Good Lives sites) disability supports for people with a long-term physical,
intellectual, sensory disability or autism that arises before age 65 years. This is
funded by a $2.275 billion annual appropriation.
4
On any given day the Ministry commissions DSS for almost 50,000 disabled
people, tāngata whaikaha Māori and their whānau. Figure 1 below shows the
growth of the people supported through Disability Support Services since 2008.
The Ministry annually supports around 100,000 people with equipment or
modification services (all ages).
Figure 1
2 In 1976 the London Union of the Physically Impaired Against Segregation challenged the 'medical model
of disability' that viewed disability as a personal problem. This was part of the beginning of a new ‘social
model of disability’ that recognised people might have impairments, but it was society that disabled
them. Much later, in New Zealand, this need for a shift in models would finally be realised by moving
disability support services from the Ministry of Health (MoH) to the new Ministry – Whaikaha - Ministry of
Disabled People. https://www.whaikaha.govt.nz/about-us/who-we-are/our-whakapapa/
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5
To be eligible to be assessed for Disability Support Services a person must:
• have an intellectual, sensory disability, or physical disability or autism (or a
combination of these); and
• their impairments must be likely to continue for at least six months; and
• their impairments must limit their ability to function independently, to the
extent that ongoing support is required.
6
Of the almost 50,000 New Zealanders receiving disability support through the
Ministry:
• 42 percent have an intellectual disability as a principal disability (many of
whom also have a physical disability)
• 34 percent have autism as a principal disability
• 20 percent have a physical disability as their main disability.
7
The prevalence of disability is proportionally higher among Māori and Pacific
peoples than other ethnicities in Aotearoa New Zealand: 26 percent of Māori and
19 percent of Pacific peoples identify as disabled. Tāngata whaikaha Māori
(Disabled Māori) are overrepresented compared to the portion of New Zealand’s
overall population who are Māori. For a range of reasons, including cultural
perspectives on disability, under-reporting is likely among Pacific people.
8
Supports for disabled people are fragmented and do not form a coherent system.
Disabled people and their family/whānau report that the disability system is
difficult to navigate, and that they would like to see a more consistent system
that aligns with the Social Model of Disability.
9
Specific supports for disabled people are commissioned, funded, or provided
through various agencies, including Whaikaha – Ministry of Disabled People, Te
Whatu Ora (Health New Zealand), ACC, Ministry of Social Development and the
Ministry of Education.
10 New Zealand has five main different disability support systems for different
populations. These are:
•
Injury-acquired disabilities, which are supported by ACC
•
aged care related impairments, which are supported by Te Whatu Ora
services
•
long term health conditions, (eg. diabetes) where this leads to impaired
independent functioning, which are supported by Te Whatu Ora services
•
mental illness, where this impairs independent functioning, is supported by
Te Whatu Ora; and
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•
Intellectual, Physical, and Sensory disability support for people who
acquire their disability before age 653, which are supported by disability
support services funded by the Ministry.
11 It is not always clear which disability support system an individual may be
eligible for. For example, people with some rare disorders, can find it hard to find
a system whose eligibility criteria they fit within.
12 As well, there are different levels of service provided by each of these systems,
which has resulted in some communities of disabled people seeking expansion of
eligibility criteria for supports funded by the Ministry.
Access to Disability Support Services
13 Most of the services we commission are allocated via a Needs Assessment and
Service Co-ordination service (NASC). NASCs work with disabled people and their
family/whānau to identify a disabled person’s eligibility, goals, strengths, and
support needs. They also assist with accessing other supports that might be
needed.
14 There are ten NASCs across Aotearoa New Zealand, serving 15 regions.
Needs Assessment
15 A facilitated needs assessment is the process of working with the disabled person
and their family/aiga/whānau/welfare guardian, to identify the disabled person’s
strengths and goals, priorities, and disability support needs.
16 Once the assessment is completed the disabled person and the facilitator agree
on the identified goals and disability support needs and how they are to be
prioritised.
Service Coordination
17 Service coordination is the process of assisting the disabled person to have their
needs met from all appropriate supports that are available in the community.
This might include contributions made to the disabled person from friends, family
and others in their life, services provided by other government agencies, and
allocating supports and services that are funded by providers contracted by the
Ministry. This combination of supports and services makes up the person’s
support package and is what assists them to meet the support needs and goals
identified in their needs assessment.
18 Once the support package has been agreed the service coordinator then puts the
disability support services in place. When the disabled person has chosen a
service provider/s, the NASC service coordinator gives that service provider an
authority to provide services so that they can deliver the service to the
3 On first presentation to NASC.
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individual. Support Allocation information is also passed to the Ministry to
activate provider payment.
19 NASCs review support packages every 1-2 years and a face-to-face
reassessment of their disability support needs is carried out every 3-5 years to
ensure the person is receiving the most appropriate services available.
20 A person or their family/whānau can request an earlier review if:
• their disability support needs change
• their eligibility has changed or expired (e.g. eligibility for a community
services card)
• they have high or complex needs
• they are experiencing a crisis.
21 Over the past two years, NASC service demand has grown and the majority of
NASCs are experiencing wait lists.
22 In the 2022/2023 budget NASCs received a significant increase of funding to
reduce wait lists. However, NASCs are experiencing a 6 percent growth in
referrals across the country.
23 Appendix 1 sets out further detail on the NASC process.
Accessing DSS support through Enabling Good Lives sites
24 Three Enabling Good Lives sites have been established to demonstrate the
potential of the Enabling Good Lives approach or, in the case of Mana Whaikaha,
to prototype a transformed disability support system. People can access disability
support through these sites, in line with the eligibility criteria for each.
25 The three Enabling Good Lives sites are in the Christchurch (2013), Waikato
(2015) and MidCentral (2018)
4 regions:
• Enabling Good Lives Christchurch works with school leavers, (defined as
Ministry of Education Ongoing Resourcing Scheme-verified students who
have left or are leaving a high school in the Christchurch, Selwyn, Rangiora
or Kaiapoi areas from 2013 onwards)
• Enabling Good Lives Waikato works with people who choose to opt into the
site (within the limits of EGL Waikato’s capacity to serve people), and has
some priority criteria for young people, Māori and Pacific People
• Mana Whaikaha, the MidCentral Enabling Good Lives site, works with any
person eligible for disability support, within that region who wishes to access
supports funded by the Ministry.
4 The MidCentral site was gifted the name Mana Whaikaha, under which it operates.
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26 Across the three sites, the Enabling Good Lives teams work with over 4,000
disabled people and their families/whānau. While the three sites were set up with
different mandates, the philosophy that underpins the approach is consistent
across all three sites.
27 A key element of Enabling Good Lives is the investment in disabled people,
tāngata whaikaha Māori and whānau leadership, both in community (through
Regional Leadership Groups) and in individual lives and family/whānau. The
Enabling Good Lives approach in the sites includes disabled people having access
to a connector/kaitūhono and a flexible personal budget.
28 There is an emphasis on enabling the disabled person to build a good life in a
community who values who they are and what they have to offer.
29 The Enabling Good Lives approach is for everyone. All people can express
preference at some level – even if only to let others know that what they are
doing right now does not work for the disabled person. The Ministry is increasing
its expectations of the people and systems that serve disabled people to take the
time to recognise and grow the way that all people form and express their will
and preference.
30 The Enabling Good Lives approach is closely aligned with the UNCRPD, in
particular Article 19 which focuses on Living in the Community.
31 Some of the outcomes evident in the current sites include:
• Equity of access in a system that can flex and shift with the community it
serves. There has been increased engagement for tāngata whaikaha Māori
and whānau, Pacific people, as well as families with young children.
• There has been decreased use of congregate care. There are alternatives to
taking a break and sustaining carer wellbeing, outside of facility-based
respite.
• The development of options for living outside of the family home that does
not bundle accommodation with support. These options include flatting,
boarding, life share, and home ownership arrangements. The aim is to
ensure that the full range of living options available to non-disabled New
Zealanders are available to disabled people. The overall number of people in
full time residential care across the Mid-Central region has decreased by 15
percent.
• Traditional day services across the three sites are either under-utilised or
have changed to offer what people want as people move to expecting more
flexible and meaningful options in their lives.
32 The experience for disabled people, tāngata whaikaha Māori and family/whānau
results in more choice and control and higher aspirations.
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Provision of Disability Support Services
33 Whaikaha – Ministry of Disabled People has around 800 contracts with 476
disability support providers. Some providers are small, and others deliver
nationwide services. Services range from equipment to support and/or retain
independence, support with daily activities (e.g. personal care and household
management), through to residential support, as well as supporting family
caregivers (respite and carer support).
34 Support takes place in communities, private homes, and residential facilities.
Appendix 2 shows a demographic overview of disabled people funded by
Whaikaha. Appendix 3 shows the cost of the support.
35 Figure 2 shows the number of people receiving support by support type.
Figure 2 5
36 Disabled people received funded support through:
•
Standard contract arrangements
•
Specialist supports and/or
•
Flexible options.
37 Support commissioned through standard contract agreements includes:
• Facility-Based Supports such as Residential Care for people
to live in a group home, alone where required, or in an aged residential care
facility – especially where people have higher medical needs requiring
5 As people may receive more than one type of support, the sum of figures in this graph will be
greater than the number of people receiving DSS.
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hospital level care. There is also facility-based respite, which is intended to
provide short term relief support in a residential setting.
• There are approximately 7,550 disabled people living in Residential Care with
the majority (6,550) in group homes. Around half of disability support
appropriation is used for disabled people in Residential Care.
• Community Supports assist people to live in their community. This includes
supported living, household management and personal care.
• Community Day Services include the Ministry funding day supports to enable
disabled people to participate in their community through things such as
social activities and daily living skills. MSD is currently the primary funder of
day services.
6
• Disability Information and Advisory Services provide independent information
and advice to people and their family/whānau and support the activities of a
number of disabled person and family/whānau-led organisations and
networks.
• NASC organisations support people through allocating funding and advising
on or co-ordinating supports for eligible people.
• The High and Complex Framework provides for the compulsory care and
rehabilitation of intellectually disabled people in the criminal justice system.
It supports around 200-250 disabled people, many of whom have committed
serious offences.
38 The Ministry also contracts for specialist services. These are:
• Child Development Services to provide specialised services to
support tamariki to reach their developmental milestones
• Equipment and Modification Services to provide free or subsidised equipment
and modifications
• Behaviour Support Services to provide people with access to specialists in
addressing behaviour that is harmful to the disabled person or others
• Specialised interventions within the High and Complex Framework.
High and Complex Framework
39 The High and Complex Framework (the Framework) supports people under the
Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 and other
relevant legislation. It provides a diversionary pathway for offenders with
6 Whaikaha – Ministry of Disabled People has a residual role in funding some day services for
people who were de-institutionalised from large facilities e.g. the Kimberly Centre
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intellectual disabilities who have been found unfit to stand trial on, or be
convicted of, an imprisonable offence.
40 The statutory and regulatory responsibilities for the Intellectual Disability
(Compulsory Care and Rehabilitation) Act 2003 remain with Manatū Hauora,
Ministry of Health (MOH). MOH has commenced the policy work to determine the
long-term location of the statutory functions under the Act. Since 1 July 2022,
Whaikaha has been responsible for the commissioning, planning, and funding
functions of the Framework.
41 There are around 250 disabled people supported under the High and Complex
Framework. Tāngata whaikaha Māori are overrepresented in the Framework with
approximately 40 percent of the people being Māori. The inpatient forensic
services commissioned under the Framework are delivered by Te Whatu Ora in
Waitemata, Waikato, Capital, Coast and Hutt Valley, Canterbury, and Southern
districts. The forensic community services are commissioned through seven non-
governmental organisations.
42 MOH and Whaikaha – Ministry of Disabled People have a Memorandum Of
Understanding (MOU) setting out the arrangements for the ongoing operation of
the Act and an agreed joint workplan.
Flexible funding supports
43 In addition to contracted supports there are also more flexible options for people
who are seeking more choice and control over their supports.
Individualised Funding
44 Individualised Funding is a mechanism to purchase Household Management,
Personal Care and Respite. Individualised Funding is accessed through a NASC
and allocated to a disabled person so they can engage their own support.
45 Individualised Funding is an option people can choose, where
• they do not consider contracted Household Management, Personal Care and
Respite services will effectively support them, and are seeking to create more
tailored support; and/or
• choice and control over who and how that support is delivered is particularly
important to the disabled person and their family/whānau.
46 Enhanced Individualised Funding (EIF)
7 was introduced in 2011 to provide more
flexible support. Flexible Purchasing Guidelines were developed to support
disabled people in how they use EIF.
47 In 2020, new Flexible Purchase Guidelines were applied to Individualised Funding
in 2020 and made permanent in 2021.
7 Available in the Bay of Plenty only
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48 The Flexible Purchase Guidelines were introduced quickly during COVID, without
all the features found useful to manage this funding in the Enabling Good Lives
sites, such as Connectors and planning. Service development has not been able
to keep pace with uptake or the evolution of service use.
49 There has been increasingly high uptake of the flexible funding arrangements
due to the additional benefits they can provide.
50 The Ministry is preparing further advice on how a ‘reset’ can provide greater
certainty for disabled people and family/whānau in the use of flexible funding,
and managing within our financial appropriation.
Carer Support
51 Carer Support is a subsidy for the disabled person or their family/whānau to
organise relief support to give the main carer a break.
52 Many families and carers find it difficult to find someone else who can, or is
willing to, provide support whilst they take a break. The Flexible Purchase
Guidelines were also applied to Carer Support from 2020 to assist families to
have greater options about how they take breaks and sustain whanau resilience
and wellbeing.
Choice in Community Living
53 Choice in Community Living (CiCL) is an alternative to residential services and is
for people with high disability support needs. It aims to provide disabled people
more control over where they live, who they live with and how they are
supported.
54 CiCL is a type of hosted support based on a person's plan. Funding
is managed by the disabled person and their family/whānau and with the
person’s chosen CiCL provider. The Flexible Purchasing Guidelines apply to CiCL.
55 CiCL is currently available in the Auckland, Waikato, Hutt Valley, Otago and
Southland regions.
Personal Budgets
56 Enabling Good Lives Personal budgets are available in the Enabling Good Lives
sites.
57 A Personal Budget is allocated to support people to achieve the outcomes
outlined in their plan they have developed with their kaitūhono/connector.
58 Unlike Individualised Funding, which involves ‘cashing up’ hours of support that
might otherwise be allocated, Personal Budgets are set as amounts for
implementing a specific plan. Personal Budgets are ‘plan led’ rather than
‘assessment led’. The final allocation is informed by a benchmarking tool to
ensure that fair allocation to people in broadly similar situations,
59 Disability funding can be deposited directly into a specific bank account
established for this purpose with some oversight by the Enabling Good Lives
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team. The disabled person may choose to have a Host to help manage their
Personal Budget.
Issues
60 Disability supports provide essential services that many disabled people and
family/whānau could not do without. However, many service lines are outdated,
service gaps have emerged, and there is significant work required to ensure that
the disability support system is fit for the future.
Financial pressures
61 Over multiple financial years Disability Support Services has experienced:
• Growth in the number of people supported.
• Changes to the cost of labour, particularly the remuneration of support
workers, and settlements that change support worker remuneration.
• Growing waiting lists for specialist services, Residential Care, Needs
Assessment and Service Coordination, and increasing pressure on services
supporting autistic people.
• Changes in the role of families in providing care as financial pressures on
families and whānau have increased.
• Ongoing increases in the cost of Residential Care, especially an increasing
proportion of prices being agreed case-by-case basis (through individual
rates), rather than contracted rates.
• Increased flexibility of funding has enabled disabled people to overcome
some of the quality and/or supply constraints in the traditional system and to
make greater use of service allocations, which has come at an increased cost
to the Ministry.
62 Providers continue to express concern that they are not sufficiently funded for
the services they deliver, and that pricing is not equitable across contracts and
funders, stating that:
• Whaikaha – Ministry of Disabled People, Te Whatu Ora, and ACC pay different
rates for similar services, which are often delivered by the same providers,
using the same workforce. Our rates have often lagged behind those of other
funders.
• Historical price increases provided by Manatū Hauora from 2016/17 onwards
were consistently lower than underlying inflation and wage pressures.
• Recent price increases are not sufficient to cover wage and other cost
increases. Wages, the largest part of most providers’ costs, are growing at
around 4 percent per annum; general inflation is at around 7 percent; price
uplifts provided by the Ministry for 2023/24 were between 3 and 4 percent.
• Oncost rates underestimate actual provider costs by around 5 percent.
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• Current provider funding levels are not sustainable, as evidenced by
providers exiting the market or showing poor financial positions.
63 We have prepared a more detailed briefing on our analysis of the cost and
volume pressures on Disability Support Services, and our suggested approach to
these in the lead up to Budget 2024.
Residential Services
64 Whaikaha – Ministry of Disabled People wants all eligible disabled New
Zealanders to enjoy the full range of living situations that are available to their
non-disabled peers. Currently, the support system is overly reliant on Residential
Care to respond to situations where disabled people require an accommodation
solution.
65 Residential Care provides reassurance to many families that their disabled
family/whānau members are in a structured environment that intended to
support and care for them, and provides continuity in the life of the disabled
person when family/whānau becomes less available to them.
66 At the same time, the Royal Commission into Abuse in State Care, and the
Ministry’s own complaint and quality review systems call into question the safety
of these settings.
67 The United Nations has recommended that New Zealand create and resource a
comprehensive deinstitutionalisation strategy. The recommendations explicitly
note group homes as a form of institution.
68 Where the service provider is also the landlord, the ability to appropriately
manage complaints about their services can be affected. This may result in the
disabled person feeling that they are unable to complain about the service for
fear of losing their home.
69 Whilst an ‘all in one’ service can provide reassurance to families that things won’t
fall through the cracks, it also brings together significant control over the life of
the disabled person. As a bundled service model, there are obvious conflicts of
interest between, for example, the same people that supports your routines also
setting what those routines might be.
70 The Ministry is leading residential reform through a multi-year project with
disabled people, tāngata whaikaha Māori, family/whānau and providers called –
My Home My Choice; Nōku te kāinga noho, nōku te whakatau.
71 My Home My Choice is working to transform the way people in residential
services are assisted so they have more choice and control in their lives. This
means ensuring a range of options are available for people who want alternatives
to residential care, and increasing the control that disabled people, who choose
to live in residential services, have over how they live day to day.
72 While the number of people accessing residential services has remained
reasonably consistent over time, the cost of providing residential services has
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increased significantly. For example, in 2016 there were 7,500 people in
Residential Care at a cost of $650m. In 2023, the same number of people are
supported in Residential Care at a cost over $1bn.
73 There is a longstanding lack of suitable residential services for disabled people
under the age of 65 years in the Auckland region. Lacking alternatives, wait lists
around the country, particularly in Auckland, are growing.
74 Given the ongoing shortages for suitable living arrangements, in some cases,
disabled people aged under 65 years may be inappropriately placed in aged
residential care facilities.
Residential Pricing
75 Residential Care is the costliest category of disability supports services. There are
14 different pricing tools used by NASCs across the country, inherited from
historical contracting approaches. This results in different pricing paid for similar
services, and sometimes for the same person when they move, which in turn
results in inequitable and potentially unsustainable funding received by
providers.
76 Current prices do not necessarily reflect the costs of providing the service.
77 There is a strong case for a new single pricing model. Since 2012, there have
been several attempts to introduce a single pricing mechanism to achieve
equitable funding. The estimated cost of implementation, however, has been
unaffordable.
78 Payment for Residential Care is split across multiple funding mechanisms:
• the contract price (usually a day of service)
• Advance Interim Payments for pay equity costs (reflecting pay equity costs
have not yet been included directly in prices across all residential providers)
• the residential support subsidy to support living costs (paid by MSD as an
alternative to benefit and other income support options)
• client contributions, where applicable
• sleepover costs (bulk funding for the cost of providing support through the
night).
79 We are working to reduce the range of payment mechanisms. Multiple payment
mechanisms complicate the process of establishing the true cost of service for
any individual, or house.
80 We are scoping a project with a renewed focus on the pricing of Residential
Care. While the work will commence as soon as practical, we will take a staged
approach across financial years.
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High and Complex Framework
81 Due to the separation of the statutory functions from the commissioning
functions of the Framework, there is a Memorandum of Understanding (MOU)
between Manatū Hauora and Whaikaha – Ministry of Disabled People. The MOU
sets out the arrangements for the ongoing operation of the Act and an agreed
joint workplan.
82 In 2021, the Ombudsman’s Office released an investigation report ‘Oversight: An
investigation into the Ministry of Health’s stewardship of hospital-level secure
services for people with an intellectual disability’. The Oversight Report identified
that the current Framework does not always meet the needs of all the people it
supports. A range of issues were identified including:
• living environment and infrastructure deficits
• workforce shortages
• Te Tiriti o Waitangi principles are not well embedded into the approach
• funding and capacity challenges which can result in critical issues.
83 The Ministry has developed a work programme to respond to the key issues
identified in the Oversight Report and in the wider Framework.
84 We released the High and Complex Framework Strategic Intent in June 2023 in
response to the Ombudsman’s Oversight Report. Work has commenced on
implementing the Strategic Intent, noting that new funding will have to be
sought for some of the key initiatives. The Ministry is working closely with
Treasury on investment into infrastructure and support to improve the living
environment and infrastructure issues identified in the Oversight Report.
85 The current situation for the High and Complex Framework is extremely
challenging due to a national workforce shortage. The impact of this is that there
are bed shortages in both Te Whatu Ora-funded forensic hospitals and
community-based accommodation for people who require secure care and
rehabilitation. The most acute area is the Te Whatu Ora, Capital, Coast and Hutt
Valley District.
86 In addition, the performance of the Forensic Coordination Service (FCS):
Intellectual Disability
8 has declined significantly over the last 18 months. This
contract is currently held with Te Whatu Ora, Capital, Coast and Hutt Valley
District.
87 Due to its significant concerns, the Ministry is not renewing the contract for the
Forensic Coordination Service, which expires in early March 2024. Due to the
specialist nature of the service and much of the expertise sitting within Whaikaha
8 national service coordination service for people under the High and Complex Framework
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– Ministry of Disabled People, it has been decided to bring the FCS into the
Ministry, with an intention of it being recommissioned via the All of Government
(AOG) procurement process and returning to the community in 2025.
Pay Equity
88 The Support Workers (Pay Equity) Settlements Act 2017 formalised the
settlement of a legal claim that support workers were paid less than other
workforces because the workforce is predominately female. The Act specified
minimum hourly wage rates payable by employers to support workers from 1
July 2017. The Support Workers (Pay Equity) Settlements Act was amended in
mid-2022 to extend the expiry date to 31 December 2023, and update the
minimum wage rate.
89 In July 2022 the PSA, E tū and the New Zealand Nurses Organisation (NZNO)
raised a pay equity claim representing care and support workers employed in the
funded sector. The claim holds significant financial implications. There is an
estimated 61,500 care and support workers across the health and disability
workforce.
90 Concern has been raised about the claim process. This means a settlement is
unlikely to occur before December 2023.
91 Te Whatu Ora as lead funding agency has commissioned a technical review of the
pay equity process that has occurred to date. The review will inform a report to
Ministers ahead of endorsement of the next milestone in the process, with an
update on the proposed outcome of the claim, funding level and methodology,
and any potential flow-on impacts to Te Whatu Ora employed and funded
workforces and workforces of other funders.
Next Steps 92 The Ministry is working with Treasury to ensure the sustainability of Disability
expenditure through a joint programme of work (Disability Financial
Sustainability Review), with a particular focus on maintaining expenditure within
fiscal expectations.
93 We will provide you with further briefings on the implications for service change
or service delivery in the near term.
94 Officials are available to brief you further on any of the matters contained in this
report.
Author: Rachel Daysh, Group Manager, System Design. Commissioning, Design and
Delivery
Responsible manager: Amanda Bleckmann, Deputy Chief Executive, Commissioning,
Design and Delivery
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IN-CONFIDENCE
Appendix 1- The NASC Process
Appendix 2– Demographic overview
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Appendix 3– Annual Actuals, Budget, and Full Year Forecast
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