Rob Gill - Plans to Reality Froum -


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Presentation by Rob Gill (Business Development and Support Manager - Te Pou - New Zealand) at the 'Plans to Reality Forum - Exploring the new planning process for people with disabilities", that was held on Tuesday 15 November 2011,

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  • Sara Bennet and Denise Bijoux, 2009
  • Opportunities Use IF to improve outcomes for service users and carers based on evidence from standardised measures of quality of life and health ( Bennett and Bijoux, 2009) Match services more closely to people’s lives (Soltani, Pei-Chun & Mahmoudi, 2007)
  • Rob Gill - Plans to Reality Froum -

    1. 1. Better lives through innovative planning and budgeting: the role of Individualised Funding (IF) Rob Gill Business Development and Support Manager
    2. 2. Structure of presentation <ul><li>Introduction – what’s all the fuss about natural supports? </li></ul><ul><li>Recent changes to disability services in New Zealand </li></ul><ul><li>Individualised Funding (IF) – putting people in the centre </li></ul><ul><li>The evidence in favour of IF </li></ul><ul><li>Discussion & Questions </li></ul>
    3. 3. Te Pou’s role and key relationships
    4. 4. Natural Supports - a youngster resting with Mum
    5. 6. NZ disability service reform timeline <ul><li>1990s Reforms began with closures of institutions </li></ul><ul><li>2001 Long-term support systems focus on the person </li></ul><ul><li>2003 The ‘Ordinary Life Report’ reveals poor outcomes </li></ul><ul><li>2005 Individualised Funding appears formally as a pilot project </li></ul><ul><li>2006 The era of large institutions ends </li></ul><ul><li>2009 A new model is approved incorporating IF </li></ul><ul><li>Te Pou becomes NZ’s disability workforce centre </li></ul><ul><li>2010 An IF market is established with 12 providers </li></ul><ul><li>2011 The 2 nd Canterbury earthquake (IF arrangements are durable) </li></ul><ul><li>2011 ‘sleep-over’ case minimum wage ruling in the Supreme Court </li></ul>
    6. 7. Business case for IF <ul><li>Issue – service quality is elusive in spite of regulations </li></ul><ul><li>  </li></ul><ul><li>Cause – F unding ‘buckets’ are seen to be too rigidly tied to specific purposes and contracting too focused on the service provided rather than meeting genuine needs and producing improved services (MOH, 2009, p.48) </li></ul><ul><li>  </li></ul><ul><li>Need – new services that deliver value to consumers, providers and tax payers. </li></ul><ul><li>  </li></ul><ul><li>Solution - Individual “budgets hand control to service users and give them the flexibility to tailor care to meet their specific needs (Alakeson, 2008, British Medical Journal) </li></ul>
    7. 9. Stage One = assessment and choice
    8. 10. Stage Two – negotiation and delivery
    9. 11. Stage Three – verification, invoicing and payment
    10. 12. NZ IF snapshot <ul><li>began in Christchurch in late 1990s </li></ul><ul><li>only one provider from 2005 to July 2010 </li></ul><ul><li>IF is offered nationally from 2007 </li></ul><ul><li>IF numbers have quadrupled since in the past 2 years </li></ul><ul><li>Two of 12 providers offer national coverage </li></ul><ul><li>about 1000 people currently use IF </li></ul><ul><li>satisfaction is very high (90+% on average) </li></ul>
    11. 13. NZ IF criteria in brief <ul><li>The applicant (or their agent) must be willing and able to manage the budget </li></ul><ul><li>there is no minimum or maximum threshold for funding </li></ul><ul><li>the budget holder must agree to certain responsibilities and obligations </li></ul>
    12. 14. What are the various labels for IF? <ul><li>Personalisation is used some countries (usually in mental health) </li></ul><ul><li>In Australia – individualised support packages, direct payments </li></ul><ul><li>In the UK – individualised budgets, direct payments </li></ul><ul><li>In the USA & Canada – service vouchers, self-directed care, brokered support, cash and counselling </li></ul>
    13. 15. What is IF? <ul><li>A flexible funding allocation method based on need </li></ul><ul><li>Control of funding transfers to the eligible person </li></ul><ul><li>All funding is managed by the person (or their appointed agent) </li></ul>
    14. 16. What are the guiding principles of IF? <ul><li>Values = person-centred support and personalisation </li></ul><ul><li>social model of disability </li></ul><ul><li>choice , flexibility and regular reviews </li></ul><ul><li>accessible tailored support </li></ul><ul><li>informed decision making </li></ul><ul><li>service users determine their own level of support </li></ul><ul><li>individual plans are used as tools to negotiate individual budgets </li></ul><ul><li>planning is undertaken with an independent facilitator </li></ul><ul><li>individual needs assessments determine funding packages </li></ul>
    15. 17. What is individualised funding usually used for? <ul><li>home based support services (not usually residential) </li></ul><ul><li>legitimate services that meet agreed needs </li></ul><ul><li>services that help people to experience quality of life </li></ul><ul><li>Real examples </li></ul><ul><li>Three adolescent men who wanted to remain living as flatmates </li></ul><ul><li>Pre-school brothers with ASD </li></ul><ul><li>A Maori woman living rurally with chronic health conditions </li></ul><ul><li>A young man who lives for rugby </li></ul><ul><li>A senior manager who travels frequently </li></ul>
    16. 18. How does individualised funding work? <ul><li>disabled people describe what they want to achieve </li></ul><ul><li>objectives are agreed that matter to each person </li></ul><ul><li>personal packages of care are linked to agreed objectives </li></ul><ul><li>tailored, responsive and flexible support is available </li></ul><ul><li>services are ‘ordered’ by the person </li></ul><ul><li>service delivery is verified </li></ul><ul><li>payment is claimed </li></ul><ul><li>employees or suppliers are paid </li></ul>
    17. 19. Average IF packages (hours per week) as at April 2011 Small: up to 20 10 $13,000 Medium: 21-45 29 $37,700 Large: 46 or more 63 $81,900
    18. 20. What help do budget holders need? <ul><li>accessible information </li></ul><ul><li>training - essential skills (e.g. communication and negotiation) </li></ul><ul><li>assistance with financial and employment responsibilities </li></ul><ul><li>Introductions to other budget holders </li></ul><ul><li>learning and development support (in the good and bad times) </li></ul>
    19. 21. What responsibilities do budget holders accept? <ul><li>Employing, contracting or purchasing services </li></ul><ul><li>being a good employer or giving clear instructions as a client </li></ul><ul><li>tax compliance </li></ul><ul><li>budget management </li></ul><ul><li>health and safety (for themselves and others) </li></ul><ul><li>emergency planning </li></ul>
    20. 22. How does society benefit from IF? <ul><li>‘ market’ forces cause the ‘system’ to be more flexible </li></ul><ul><li>service users experience better health and quality of life </li></ul><ul><li>participation in paid work or study improves </li></ul><ul><li>socioeconomic status improves </li></ul><ul><li>opportunities to build leadership capability </li></ul><ul><li>scarce funding is used more effectively </li></ul><ul><li>social care budgets are better managed </li></ul><ul><li>Statistically significant improvements in mental health and physical health were reported for IF budget holders in NSW (Fisher & Campbell-McLean, 2008) </li></ul>
    21. 23. Why do these benefits arise? <ul><li>pay and conditions for support workers improve </li></ul><ul><li>staff turnover reduces </li></ul><ul><li>workers are strongly commitment to individual service users </li></ul><ul><li>support arrangements offer flexibility </li></ul>
    22. 25. A youngster ready to go again!
    23. 27. Closing questions and comments <ul><li>Service reform might seem like someone else's business </li></ul><ul><li>but you can make a powerful difference for good! </li></ul><ul><li>Thank you for your participation </li></ul>