Crisis Mode: NZ’s Poorly Planned Disability Transformation

Little over a year since the newest big pilot launched, one of New Zealand’s biggest players released a report stating that the disability support sector has entered full crisis mode.

NZDSN certainly pulled no punches in its latest report, stating that “the disability sector is in crisis at every level” in an explosive overview that estimated $574m shortfall in funding.

Whether you agree with the report or not, you’d be a poor fool to say that it simply reflects the financial interests of providers and attempts to scaremonger the Government.

The proof of the effects this funding model is having on real disabled people couldn’t be clearer.

Such reading makes a mockery of the “nobody left behind” and “choice, control, flexible” values that have underpinned the most ambitious change to disability support system since the closing of the large institutions. If anything, the uncertainty and stress on the system matches (if not beats) that of what was experienced in the nineties and early 2000s.

NZDSN estimates 15,000 people within the regions where new support pilots are taking place (Waikato, Christchurch and the MidCentral) have missed out on getting some kind of disability support.

15,000 people, more than a handful (making somewhere around 25% extra unmet need) in an approach where $24m of taxpayer money was spent on development.

But what exactly was designed and how well was it actually developed in the first place?

That’s the question that will be asked by the appropriate parties, and as much as it seems that they will be the ones tasked with easing the uncertainty ahead, they were let down by some pretty shoddy advice and a clear lack of awareness from those disability community representatives that themselves forgot about or didn’t understand the reality that was burning below the surface.

Chaotic Feeling Underpins Life In New Disability Pilot

Words like “try, learn and adjust” that came out of the MidCentral project were as clear a sign as any that there were few answers on what to expect, but more importantly, they provided absolutely zero clue on how to address the issues that were coming.

Just over a year since launching Mana Whaikaha, the feeling on the ground in the MidCentral has been described as one of chaos after long periods of time with deep-rooted uncertainty.

Such sentiments are echoed in previous and ongoing work in other parts of the country. The Real Michael Pulman understands that connectors in the Waikato have been told that their jobs are only certain until June 2020, with further announcements not expected to be made until earlier in the year.

In his interview with RNZ on Monday, NZDSN boss Dr Garth Bennie was exactly right when he said that the pilots were originally about testing the designs, offering disabled people a choice of their supports rather than taking from a set menu.

One must also ask how cutting runaway costs could possibly have ever been managed with the growing demand not being a prospect, but a certainty. To even attempt to answer that, there needs to be an honest admission about what was going on behind the scenes.

It was never simply about “Enabling Good Lives” for disabled people and their families. It was about attempting to adhere to a set list of principles and do it with very little to no extra funding with tangible impact in the long term.

What’s been a constant reminder in 2019 is that disability support services are flying blind into the future. Perhaps this was always the case, perhaps this is identifiable in the wider health and social service sectors, but it’s dangerous to assume that small parts of the country can successfully show enough result to transform a system nationwide.

And yet, that’s the very assumption that’s come from all this, whatever is happening in these new spaces will soon be the status quo for all. It worked well for persons X, Y and Z so let’s build on that and repeat the formula.

There is merit in arguing directly against that. The poorest outcomes in the new pilots should be the examples used when decisions are made about what to do next.

That’s not all positive and rosy though is it? Now more than ever there seems to be much logic in stopping, having a big rethink and getting it right if the basic human rights of many disabled people are to be met.

All that starts with an admission that what we’re doing currently just isn’t working.

NZDSN REPORT: https://www.nzdsn.org.nz/wp-content/uploads/2019/11/NZDSN-Sector-Briefing-Final-14-11-2019.pdf

Inadequate Disability Support Is Ruining One Too Many Lives

The disability sector now has a choice to make, either throw out the entire script and start again or consider the true lack of options it has in a support system where costs will continue to rise and packages won’t be enough.

The real financial deficit facing the disability support system is well over the $90million originally projected, double that figure and you might be getting slightly close to the actual number. Some reports estimate around $150million total, but people The Real Michael Pulman spoke to this week suggested the system is looking at a $190million gap.

That’s a result of Government not giving enough funding despite injection, the mismanagement of that funding, the pay equity deal, rising demand and subsequent costs of providing support to disabled people, just to give a few examples.

Then came Enabling Good Lives, and later on, Mana Whaikaha. Two pilots that are made of up everything that disabled people and families need, except the funding as it turns out.

Inadequate Support No New Thing With EGL & Mana Whaikaha

The concept of and the principles driving Enabling Good Lives/Mana Whaikaha are fantastic, nobody can question that.

Of course, disabled people should have more control over when and how they receive the care supports that help them be in the best possible position to have as equal a life as possible, compared to the non-disabled (or whichever term you prefer).

But if those principles and the people who talk about them so much can’t influence a better delivery of this new system given all the information and downright proof that it does deliver those better life outcomes, when it works for the individual, then surely something is amiss here.

This new system, if it is to be worthy to its name, must give people the sole determination of how much support they receive. Financial implications for the Ministry be damned.

The example of Faisal Al-Harran in Mana Whaikaha is no isolated incident, but it’s not primarily the fault of just a lack of funding, it’s also down to the decisions that are being made by the NASC (Needs Assessment Coordinators) in the MidCentral and also, clearly, the failure of the connectors working with this man.

Going back to the very beginning of Mana Whaikaha, those who helped co-design the scheme had already aired much concern over the NASC being involved at all. Their objections were likely overruled, and then came the realisation that there weren’t enough connectors, but at that point, it was all systems go, around the time when we started hearing the talk of a ‘try, learn, and adjust approach’.

Those involved took what was being injected financially from Government and went about implementing Mana Whaikaha from October 1st 2018.

Then, the firestorm happened, on a scale that should’ve been predicted but wasn’t.

That firestorm was demand, well over a decade worth of demand for more adequate support that had been unmet, to the point where families were literally uprooting their lives and moving to the MidCentral to sign up. People like Al-Hassan have quickly discovered that Mana Whaikaha and this “bright new future” for disability supports was filling a gap, but not enough of a gap to truly quantify in the “better life outcomes” that he and his family were likely looking for.

But is anyone surprised, really? Likely not, but just who’s responsible for stories like Al-Hassan’s is up for debate.

Stories like this are not isolated, and as time has gone on, it’s become harder and harder for people, especially those newly entered into these new schemes, to get the outcomes they are looking for. In the Waikato, some who entered the Enabling Good Lives demonstration early on (including myself), particularly those with high needs, were able to get more flexibility than those who came later on.

Dig Deeper, Bring The Real Truth To Light 

In the wake of April’s revelations that the Ministry of Health was stopped in making radical changes to disability support that would’ve seen $10million cut in the first year and a further $40million the next two years, the same familiar arguments over Government treatment of disabled people have come to light.

In his piece for the Spinoff, long-time disability advocate Chris Ford wrote that he wanted to see a disability support system that allows disabled people to “lead flourishing lives as participating citizens, with the full support of the state”.

But where does the responsibility of Government really sit in the wider picture of improving life outcomes for disabled people? The financials serve as a basis for enabling disabled people to access the supports and the equipment they need to be on a level playing field with everyone else.

All disabled people want and should be asking for is to have the same access to communities, education, services, and employment as their non-disabled peers have. It’s not much to ask and it doesn’t take a mountain of money, but a monumental shift in attitude.

In terms of Mana Whaikaha and the wider Enabling Good Lives direction, the Government is already looking at the costs of this and comparing them to the older services landscape before. If that is the direction and what the Government are mostly looking for in their evaluations, it paints a dark picture moving forward.

The entire system, not just the shiny new parts of it, cannot remain sustainable without a significant funding increase and couldn’t well before now. It requires a long-term commitment to ensure that disabled people and families get the supports that they feel are enough.

That’s the only way this is going to be a successful system for the people. You can have the most flexible support system in the world, but if a person isn’t getting enough to meet their needs, how effective is it really?

For example, if a person needs 24-hour care but can only get 10-hours per day, that system is a total failure for that person.

It’s not about filling gaps in the system to keep providers happy, it’s about filling the needs of the people that this entire sector should be striving to support. We aren’t just talking about the financials either, we are talking about attitude, and for all the talk of a more inclusive and self-determine disability support system in New Zealand, the majority of attitudes in the wake of this sad saga have been anything but.

There needs to be a spoken acknowledgement that the Government can afford to provide substantial funding increases to solve a lot of these problems, and then some. Government does have the purse, a very large one in fact, but do we as disability leaders have the gusto to call their clear and obvious discriminatory practices into question?

It’s one thing to say it at a group meeting or create a petition, it’s quite another to go through each individual case of this systematic abuse and bring it to light. Do that, and you’ll get a clear picture of what’s really going on here.

It’s Time To Question Our Disability Leaders (Not Just Government And Providers)

The wider disability community has every right to question the effectiveness of its leaders and the advice they give to officials as a $100m and counting overspend on Disability Support Services continues.

Don’t just blame the government or say that disability support providers are simply trying to protect their own interests. This problem is far greater than that, and crying about it won’t help. Accountability needs to occur and hard questions should rightly be asked.

This should serve as a strong reminder to sector leaders that they simply didn’t get the actual resources required to deliver on the promises that they, and the Government, were making to the community. 

The disability sector now needs to find a way to get harder and demand that such an oversight never happens again.

The fallout from the report over the weekend has been intense as disabled people and sector leaders react to what’s become a major issue with serious ramifications for the Disability Support Services landscape moving forward.

If cuts to services were to be made on the scale that was being planned, it would make a mockery of what has been a substantial amount of work done over the course of many years to ‘Enable Better Lives for disabled people and families.

Plans by Government officials made for chilling reading that would make even the most positive of disability advocates cringe.

Cutting, wherever and whenever possible, the in-home personal care and community participation supports, on a mass scale was just one of the desired directions that officials were going to take in order to decrease spending by $10million this year and a further $20million in the years after.

The time for the disability community to ask some hard questions of its own leaders is now, and I’ll tell you why.

An Oversight On The Actual Realities Of Disability Support

This has been a substantial oversight on the part of those leaders, the officials in Wellington, and many of those involved in table discussions that have chewed up so much time and investment that many people rightly felt only scratched the surface of what was actually happening in the disability sector.

The resulting actions played a key part in a near $100million overspend on services.

Those actions didn’t have enough accountability for the appropriate parties, they lacked the evidence to suggest a long-term solution other than stating demand-driven support models are the ‘right thing to do’, and all decisions were primarily made on a faith-based approach when in reality there was no reason for decision-makers to have any trust that officials wouldn’t attempt to cut back on supports.

It’s all very well and good to point the finger of blame factors like provider HR costs, the pay equity deal, rising residential service costs, increasing high and complex needs, or more people accessing services. All of these factors are real and have valid concerns, but they aren’t new problems.

This is why I label it an oversight and the reason why many should now be questioning the advice that has been given to Ministries.

These factors didn’t appear to be addressed in the funding models that were accepted by those responsible for ensuring that disability support is delivered in a way that lives up to the principles driving system change.  

Principles and flashy policy documents are just words on a page if the product or service doesn’t deliver in the way promised.

If the disability sector was as united as some say it is, then why was Enabling Good Lives/Mana Whaikaha left out of discussions surrounding the radical plans to cut $10million in support for the next year alone?

Surely people being affected by changes to NASC were going to be asking ‘what next’ and looking at how they could utilise what was only ever referred to as a ‘PILOT’ by top-ranking officials.

That ‘PILOT’, as well as the Waikato EGL demonstration, were both in holding periods until further decisions were made about rolling out a new system nationally.

That rollout was never certain and yet all the discussion suggested that a model such as this was going to be the way of the future, again, acting in good faith that the appropriate levels of funding would be provided once the level of evidence supporting such a system was provided.

Funding requirements in sustaining the new disability support options (EGL/Mana Whaikaha) for disabled people as well as keeping the status quo are not, and were not being met. This is no longer a point of opinion but unquestionable fact.

It’s also a fact that advocates and some organisations were raising from the very outset. Those leaders, our leaders, heard those concerns and many advocated fairly, yet we still find ourselves facing substantial cuts and organisations are labelling the current situation as a ‘crisis’.

Or is all this being hyped up so certain entities can protect their own interests? You be the judge of that.

Five Challenges for the Disability Sector in 2019

2019 is a crucial year for the disability sector and its challenges are familiar, from funding to information, to new prototypes and putting the work into all the talk. Here are my five challenges for the disability sector in 2019.

Funding: Providing real “choice and control” support options and room for changing need

Late in 2018, a report published by NZDSN and Deloitte claimed that the disability sector is currently underfunded to the tune of $150million, citing a 12% gap between Government funding and the actual costs for supporting disabled people in New Zealand.

Providers argue that the underfunding across the sector has been a long-held problem and that without increases, their ability to provide more flexible support options will remain compromised. $49.04million is currently allocated to the MidCentral prototype, a much talked about trial that aims to provide more flexible support options and choice to disabled people and their families.

For disabled people and families, it is important that their funding packages are allocated to have significant, not minor, room for changing and increasing care needs. What this really means is having the ability to increase funding if required, and to do it quickly. The belief in many circles is that investing earlier can lead to lower costs for supporting disabled people, particularly if alternative futures other than Residential Care/Group Homes are found. But what for those with changing and increasing needs?

The new system being trialed in the MidCentral, and previously in the Waikato, shows that supports can be flexible in terms of how they are delivered. This is especially true in the cases of being slightly more cost-effective, removing the “man in the middle” in a lot of cases to keep down HR and other managerial costs, but the actual support budgets themselves are often fixed and difficult to increase by large amounts if needs suddenly increase due to prolonged sickness or advanced deterioration of existing conditions.

If NZDSN and Deloitte’s report is to be believed, one could argue that the $150million funding gap in the sector goes well beyond just services. The more discussion, investigation of, and critical evaluation across all levels of funding, as well as comparison with other sectors, will be vital in 2019.

Information: Relaying information to, for, and about the sector in a modern way

How information is relayed to disabled people and families needs a serious shakeup in 2019.

We live in the digital age, and it’s time that news, views, and discussions pertaining to disability are presented in a modern way. Written text via monthly newsletters is no longer the only way information should be shared with the community. Video in the form of YouTube and live-streaming platforms like Twitch and Mixer, pictures via Instagram and Facebook, and audio through podcasts on services such as iTunes are just a few of these more modern ways of communicating. Many organizations and a handful of influencers are well established on some of these platforms, but the majority remain underutilized, and it’s disappointing because this can and should be leading to many job opportunities across the sector, jobs that disabled people are well capable of doing.

Beyond that though, we need to get away from this subconscious fear that information needs to be censored. Information needs to be carefully and strategically released to the community, but it also needs to talk to the people in the community, not just at them. The sector likes to focus on the good stories, but many of the elements for change can actually be found in the bad stories. This information also needs to be accessible for all, i.e available in easy read and accessible to the deaf via captions in videos, but it doesn’t need to be as rigorously controlled as it is. There is often paranoia about misinformation spreading through the community due to the impact that this could have on the so-called “safety” of disabled people, and/or some of the tired concerns around privacy. Information and opinion-sharing throughout the disability sector is important, but it needs to be free flowing, carefully and clearly articulated, but most of all, much, much more immediate.

For all disabled people and everyone else working towards a better tomorrow for this sector, we need to know what’s going on, where it’s going on, and why it’s happening. How else can we critically evaluate and strategise for the future? We could also rely on what the Ministry, their subsequent officials, and a handful of local leaders and influencers tell us, but what about the views of those outside those circles?

MidCentral: Ensuring transparency and effective change for disabled people

“One of the things that has become very apparent to me and is very clear in my mind is that we’ve got, I would say, decades of not just unmet need in the community but unrecognized need”.

Those were the words of Lorna Sullivan, head of the Connector/Tuhono team in the MidCentral.

Currently, numbers in the MidCentral indicate that 500 disabled people and families have already come on-board the prototype since it’s launch in October 2018. This is, already, a similar amount of people that the Waikato demonstration of Enabling Good Lives has supported, but over the period of three years, not two months. It is clear that the numbers of people coming onto the prototype in the MidCentral are higher than allocated, and on current trajectory, expected to rise again.

Sullivan also urged providers to move away from notions that responses to disabled people’s needs can be standardized.

“We have to shift away from this idea that we are a service”, Sullivan said.

What has become absolutely transparent since the launch of Mana Whaikaha is that providers, for the most part, have been woefully underprepared for the change that the prototype is trying to give to disabled people. This was something that was predicted and has come to fruition, funding gaps or not.

The challenge now, for Sullivan and her team, appears to have become not only about ensuring that they can work alongside disabled people to create better outcomes, but it’s also becoming about taking providers by the hand and directing them on the type of changes needed to their own systems. Furthermore, connectors in the MidCentral haven’t had the ongoing training and development due to the increasing numbers coming onto the prototype, and Sullivan says that this needs to be addressed early in 2019.

Leadership: Lack of strategic, on the ground, by the people leadership

The state of leadership across the disability sector is seriously lacking, and in 2019, this presents perhaps our biggest challenge, both in terms of finding fresh leadership and investing in it.

Also, using social media to demand change from Government and other mainstream agencies for things like access whilst using the term ‘ableism’ is inherently not leadership, and shouldn’t be recognized as such. The increasing discourse and labeling of non-disabled people as ‘ableists’ needs to stop, fast. This point is as equally applicable to this particular challenge of leadership as it is to the previous information talking point.

The biggest problem here is investment, both from a financial perspective and a hands-on perspective. There have been many strongly-willed, capable, and determined leaders that were initially projected to be the big change makers in the disability sector. Some of them have, and continue to do amazing things both in New Zealand and internationally, but it would be fair to say that without some form of financial incentives moving forward, i.e jobs for disabled people where the development and enhancing of their already strong leadership skills takes place, these potential leaders will be forced to look elsewhere and go down alternate avenues where their talents won’t be fully realized in order to find an opportunity that financially rewards them.

This has already proven to be a big loss for the disability sector, and if it continues, it will hamper the efforts of what new support models are trying to accomplish in theory, because as it stands right now, terms like “social investment” and “capability” are areas of the sector that are big on words, but little on action. People need and deserve to be paid for their time, another reason why further investment across all areas of the sector is needed, and potential investment that could see big returns.

Less Hui, More Doi: For the benefit of the people

One of the things Lorna Sullivan raised recently was the deep sense of isolation disabled people and families are feeling from their own community. This is also something that is a familiar conversation point around the leadership tables, and yet we still have this problem.

This isolation is as much a social issue as it is a service issue.

For one, many families don’t know who to turn to for information, for the support that is both hands-on and effective, as well a general understanding of how to navigate the system. People are still going to have to navigate through the disability system in one way or the other to access supports. Connectors are only one part of the puzzle, and even that requires a small amount of navigation and awareness to access in the first place. There needs to be more support and resourcing, not only for the navigation aspect, but also understanding the practical “how to’s” when it comes to managing support budgets, hiring and firing support workers, and employment law.

Simply having such teaching resources available on websites isn’t enough. Because often people won’t search for help until they actually need said help, and this is often at a time when additional, hands-on, responsive, and effective support is most required. My guess, however, would be that many people don’t care about these things. They just want the flexible support options that work for them, owned by them, and directed by them. But let’s be real for a moment, in order to achieve something like that, you have to have a certain amount of knowledge and resource behind you.

Practicing what we preach isn’t just about changing how support is delivered, it’s about ensuring that this support actually addresses not only the current need, but perhaps the underlying needs as well, and a large amount of this requirement is in understanding. To do that, you’ve really got to look at the individual and their unique context, and that’s where you design a support structure that truly works for them. That takes a lot of time, experiment, and often a lot of going back to the drawing board at each individual level, so it’s vital that more investment of time and understanding is implemented across the sector.

It isn’t about investing heavily early, it’s about finding the sweet spot for each individual. For that individual, their lives aren’t a box on a checklist to be ticked off, their lives are uniquely theirs, and they are relying on this sector to listen to, include, and advocate for them.

An audio version of this blog can be found here: 

https://soundcloud.com/realmichaelpulman/5-challenges-for-the-disability-sector-in-2019

All resources used in the creation of this blog can be found here:

https://www.nzdsn.org.nz/wp-content/uploads/2018/12/NZDSN-Newsletter-December-2018.pdf

https://www.nzdsn.org.nz/wp-content/uploads/2018/12/FINAL_Developing-a-Workforce-to-Support-Disabled-People-and-their-Whanau.pdf

Lorna Sullivan – Thinking and Acting Differently for System Transformation

http://www.enablinggoodlives.co.nz/system-transformation/transformation-papers/system-transformation-updates/september-cabinet-papers/

All Systems Go In The MidCentral As Mana Whaikaha Officially Kicks Off

The time for talk is over, Mana Whaikaha is a go, and the latest round of implementing a new disability support system that aims to give disabled people more choice and control begins.

Around 150 people in the MidCentral are already slated to be a part of the early stages of the prototype, and outside of the region, people will be watching the rollout keenly with a sense of cautious optimism.

In the back of many minds is the question of what the end result of the “try, learn, and adjust” approach in the MidCentral will mean for how disability support is delivered in other regions around New Zealand once all is said and done. But for now, the team in the MidCentral will have two years to iron out the kinks in what is a bold new way of both implementing and delivering support to disabled people and families.

Like Christchurch and Waikato before them, the MidCentral has the opportunity to test out what phrases like “choice and control” and “person-centered supports” look like in practice, but this will be the first look at an implementation of a policy for disability supports has been designed alongside members of the disability community.

The seeds for change on how disability services are delivered were first signaled in 2008, so it has taken ten years of long, tireless, and often thankless work that’s been performed amongst either growing skepticism. That hard work needs to be acknowledged, as does the clear benefit of a co-design process, something that has never happened in the development of disability policy in New Zealand before.  

Mana Whaikaha, as the prototype will be known by, means to reflect people’s strength, influence, and dignity, as well as their life essence. The brand was co-designed in 2018 by a group of disabled people, whanau representatives, providers, and Government officials who wanted to decide on branding that would represent the new disability system, with a key emphasis being on waka, the Maori translation for boat.

The waka, according to branding information, is a positive and uplifting symbol with disabled people and whanau having the control they want for their lives.

Mana Whaikaha will have 16 connectors available right across the MidCentral region. The connector will work alongside disabled people and families in the new system to access services and support, whilst always acting as an ally. In previous demonstrations of Enabling Good Lives, the connector role has worked well, and there is every reason for it to do the same in the MidCentral, provided workloads are managed well and each participant in the MidCentral gets adequate support based on the context of their needs.

Mana Whaikaha To Work In Space Of Ever-Growing Hope And Concern

Concerns amongst some disabled pundits remain over the cost of implementing Mana Whaikaha beyond the MidCentral.

Some say that the cost of implementing such a system nationwide would be too expensive for the Government to consider and that by the time it comes to regions outside of the MidCentral, the product would effectively be watered down and be unable to provide enough flexible funding options for real choice and control versus what may be possible in the existing system already. 

Others argue that certain sections of the disability community were left out of the process of designing this bold new system altogether, including the deaf community. The team in the MidCentral have countered this by employing at least one connector with NZSL expertise. Concerns over how workers rights will be protected remain, as do concerns about how capped the funding model for individuals will be. 

But there is no doubting that despite the concerns, MidCentral has a big opportunity to get themselves on the front foot over the next two years.

In terms of funding for participants in the MidCentral, information on the new Mana Whaikaha website suggests that decisions will be made by a funding coordinator. Prior to this, participants will be required to fill out a funding form, with an estimate of the amount and cost of the support being a requirement on that form.

This suggests that it will be crucial for both the person applying for help and their connector to have a good idea about what the package could look like prior to going for approval.

All Systems Go In The MidCentral As Mana Whaikaha Officially Kicks Off

There is every reason to be equally as optimistic and cautious about the rollout of Mana Whaikaha, but the foundations of delivering quality support for disabled people should always be about individuals and their own contexts.

Delivering quality support for disabled people is about taking into account the context in which those supports are delivered, and how those supports act as the backbone to everything else that occurs in that person’s life. To understand that on an individual level takes time, and it is important that the connectors in the MidCentral are not pushed for time so they can truly build that relationship and subsequent understanding for the people they are supporting.

And thus, as the exciting next phase of how the disability support system implements its changes begins, we must always keep the people, their contexts, and what works best for them at the absolute forefront of our minds.

The best of luck to the team on the ground in the MidCentral.