EGL demonstrations Cabinet paper 2014
- Executive summary
- Progress on the Christchurch demonstration of the EGL approach
- Wider policy implications identified through the Christchurch demonstration
- High-level design of the Waikato demonstration of the EGL approach
- Financial implications
- Legislative, gender and human rights implications
- Regulatory impact and compliance cost statement
- Disability perspective
1. This paper reports on the progress of the demonstration of the Enabling Good Lives (EGL) approach in Christchurch, and seeks agreement on the high-level design for a demonstration of the approach in the Waikato.
2. In September 2012, the Ministerial Committee on Disability Issues endorsed a long-term direction for change to the disability support system across government agencies. The direction, based on the EGL approach, seeks to ensure disabled people have greater choice and control over their supports and their lives.
3. To gather information about how the EGL approach works and how to implement changes across the disability system, Cabinet agreed to a three-year demonstration of the EGL approach, and mandated the Ministerial Committee on Disability Issues to make decisions on the detailed design in July 2013 [CAB Min (13) 24/6 refers]. Cabinet invited the Minister for Disability Issues to provide a progress report on the demonstration in Christchurch in late December 2014.
4. Budget 2013 included $1 million per year over three years for the additional costs associated with the demonstration in Christchurch.
5. The key elements of the design for Year One of the Christchurch demonstration are individualised and integrated funding, and direct purchasing of support by disabled people. Funding from the Ministries of Health, Education, and Social Development was pooled within the Vote Health, National Disability Support Services non-departmental appropriation. This was allocated as personal budgets for participants to use to purchase individual supports.
6. Year One of the Christchurch demonstration had 52 participants with a focus on school leavers aged 18-21 years, with high and very high needs – as verified through the Ministry of Education’s Ongoing Resourcing Scheme (ORS). The first annual formative evaluation of the demonstration in Christchurch showed that two-thirds of the participants chose to purchase different supports from those traditionally available. Participants and their families also reported that the horizons for the participants had widened with some of the young people attending courses, undertaking work experiences and/or planning to live away from home.
7. The first evaluation also identified some challenges resulting from attempting to fit the EGL approach within the current service delivery model. For example, the Needs Assessment and Service Co-ordination (NASC) process meant that some participants experienced a delay in accessing their personalised budget. Responding to these challenges has resulted in changing the priority for Year Two of the demonstration from initial thinking about widening the participant group beyond school leavers, to developing a new funding allocation tool and alternative purchasing options for participants.
8. Budget 2014 included $3.82 million over three years ($1.1m in 2014/15 and $1.36 million in 2015/16 and 2016/17) for a demonstration of the EGL approach in the Waikato. In conjunction with the Waikato Leadership Group, officials have developed a high-level design with four action areas – each focusing on a different group of disabled people and their families.
9. Both demonstrations of the EGL approach focus on using existing resources more effectively. Services are funded within the existing baselines of Votes Health, Education, and Social Development that are targeted to the more flexible purchase of disability supports.
10. On 12 September 2012, the Ministerial Committee on Disability Issues endorsed eight principles for a long-term direction for change to the cross-government disability support system, based on the EGL approach, to give disabled people greater choice and control over their supports and their lives. The following principles would guide the transformation of the disability support system:
- beginning early
- ordinary life outcomes for disabled people
- mainstream/universal services first
- mana enhancing/strengths based
- easy to use
- relationship building.
11. On 12 July 2013, Cabinet agreed to a three-year demonstration of the EGL approach in Christchurch 2014 [CAB Min (13) 24/6 refers]. The purpose of the demonstration is to provide a group of disabled people with greater choice and control over their supports and lives, to gather information about how the EGL approach works, and how it might be possible to implement changes across the whole of the disability support system.
12. Cabinet invited the Minister for Disability Issues to provide a progress report on this demonstration in 2014 [CAB Min (13) 24/6 refers], and mandated the Ministerial Committee for Disability Issues to make decisions on the detailed design and implementation of the demonstration.
13. Budget 2013 included $500,000 over three years ($100,000 in 2013/14, and $200,000 in 2014/15 and 2015/16) for building the skills and confidence of disabled people and their families in the Waikato. Budget 2014 included $3.82 million over three years ($1.1m in 2014/15 and $1.36 million in 2015/16 and 2016/17) for a demonstration of the EGL approach in the Waikato. The Waikato demonstration will expand the evidence available to inform the case for transforming the disability support system.
14. The Ministerial Committee for Disability Issues provides high-level ministerial oversight of the overall EGL work programme. A Joint Agency Group of Deputy Chief Executives from the Ministries of Health, Education and Social Development, with a senior representative from ACC, oversee the demonstrations in Christchurch and the Waikato.
Overview of the Christchurch demonstration
15. On 23 September 2013, the Ministerial Committee on Disability Issues agreed the design for Year One of the Christchurch demonstration proposed by the Demonstration Director, based on advice from the National EGL Leadership Group and the EGL Local Advisory Group in Christchurch. The central elements of the design are:
- the demonstration is co-designed by government and the disability sector
- access to independent facilitation for the participants
- participants have personal plans and budgets
- individualised and integrated funding is used for the direct purchasing of supports by disabled people, supported by a host organisation
- funding from the Ministries of Health, Education and Social Development was pooled within the Vote Health, National Disability Support Services non-departmental appropriation it was allocated as personalised budgets that demonstration participants used to purchase supports to implement their plan (in accordance with broad purchasing guidelines). The pooled funding includes:
- most support funded through the Vote Health, National Disability Support Services non-departmental appropriation, reflecting the cost of disability support that is allocated by the NASC to people who are part of the demonstration
- a fiscally neutral transfer from Vote Education, Interventions for Target Student Groups departmental appropriation, reflecting the costs that would have been incurred in providing special education support to people who are now part of the demonstration, if the demonstration had not proceeded
- a fiscally neutral transfer from Vote Social Development, Vocational Services non-departmental appropriation, reflecting the costs that would have been incurred in providing vocational services to people who are now part of the demonstration, if the demonstration had not proceeded.
There were 52 participants in Year One of the demonstration
16. The target group was school leavers, aged between 18 and 21 years in Christchurch City, with high and very high needs - as verified through the Ministry of Education's ORS. In addition, 10 other participants outside the core criteria joined at the discretion of the Demonstration Director.
Evaluation findings regarding the Christchurch demonstration
17. Evaluation of the demonstration is being undertaken jointly by the Ministries of Health, Education, and Social Development, and includes annual formative assessments that will be followed by a summative evaluation after three years. These evaluations are actions within the Disability Action Plan approved by the Ministerial Committee on Disability Issues and noted by Cabinet [CAB Min (14) 18/4 refers].
18. The first annual formative assessment was undertaken soon after implementation. This included surveying some participants, families, schools, service providers, and independent facilitators, as well as local and national officials. The initial assessment identified the following successes:
- the disability sector supports the co-design process
- independent facilitators assisting participants to navigate their way through the options are crucial for the development of individual plans and identifying new supports
- participants have more choice and control over their lives, and their supports.
19. Two-thirds of participants chose to purchase different supports from those they would have traditionally been offered, had they not been in the demonstration. Families reported feeling hopeful, more confident, and positive about changing the life of their disabled young person for the better.
20. Participants reported an increase in their circles of support. There was an emphasis on meeting new people, building relationships and making friends. Some participants were also attending courses and/or undertaking work experience and this was further helping to cement their goals for their future. Some of the young people had plans to live away from home in their community, and at least one participant had the long-term goal to go flatting.
The evaluation identified some challenges …
21. The current system of disability supports is mainly based on the funder determining the level of support purchased, rather than disabled people having the authority and flexibility to purchase their own support. The EGL approach represents a different way of delivering support services for disabled people. Trying to fit this approach into the current service delivery model across agencies revealed the following issues:
- The rapid early implementation did not allow sufficient time for engaging with the local NASC, schools and other existing disability support organisations to identify the impact the demonstration may have on them. This complicated relationships and meant the work and time needed to implement changes was under-estimated.
- While participants left school in October/November 2013, the proposed financial allocations to individuals were not finalised until March 2014. This - coupled with the NASC being given little support in developing and implementing the process changes required - meant some participants experienced a delay in accessing their personal budget allocation.
- Some participants who directly purchased services from a GST registered provider in effect ended up with a reduction in their personal allocation because they could not claim GST back from the Ministry of Health. By contrast, participants who chose a government agency to purchase the same type of service on their behalf had the GST component paid directly by Government to the GST registered provider.
… that has resulted in changes to Year Two of the Christchurch demonstration
22. Building on the achievements of Year One, including the access to independent facilitation and individualised budgets, Year Two of the demonstration will focus on developing, testing and implementing the highest priority new components of the EGL approach. This aims to address the difficulties experienced in adding bits on to the existing system. The priority components are:
- further development of the new funding allocation tool based on, and currently being trialled, by the New Model work in the Bay of Plenty that can be extended to include vocational and educational support needs
- identifying alternative purchasing options for participants
- ensuring financial sustainability
- clarifying the role of independent facilitators
- further developing and implementing a person-directed planning process.
23. To support the focus on this system development work, the participant group for the demonstration will continue to be limited to high and very high needs school leavers until March 2015. In February 2015, consideration will be given to whether to include a wider range of participants in the demonstration at that stage (for example, younger children, older people and people in residential services who express an interest in moving into a home of their own) or to delay that until the 2015/16 financial year.
24. Year One of the Christchurch demonstration of the EGL approach has shown there are some cost pressure implications for the government.
25. First, some of the participants required a lot of support from an independent facilitator to develop their personal plan and the skills to implement their plan. The main consequence has been higher than expected costs for independent facilitation.
26. A second source of cost pressure arises from providing participants with personal budgets from the cross-agency pooled funding. In the past, take-up of disability support services has been lower than the eligibility levels. Disabled people are eligible for services based on assessed need. If, in the past, a service was not available or what was available was not suitable, take-up was lower than allocation. However, if disabled people are given their allocations as a personal budget and have choice about what supports they could purchase, it is expected that they will be more likely to use their allocations and therefore the total volume of services consumed will increase (along with expenditure).
27. This paper proposes the high-level design of a demonstration of the EGL approach in the Waikato. Similar to the Christchurch demonstration, I am seeking Cabinet agreement to delegate decisions about the detailed design and implementation of the demonstration to the Ministerial Committee on Disability Issues.
28. The Waikato Leadership Group was established to provide input from disabled people, families, local officials, and providers to work on a demonstration of the EGL approach in the Waikato.
29. The high-level design of the Waikato demonstration builds on the strengths in the Waikato. The Waikato Leadership Group have identified these as:
- strong local networks with some skills in planning and facilitation
- disabled people are leaders in their community
- families have high expectations for their disabled family members
- providers who are committed to change, and who can create new responses outside the existing menu of service options
- strong engagement with, and understanding of, the EGL approach through the disabled persons, family and provider forums.
30. The Waikato Leadership Group is keen to build on the work of Choice in Community Living - an element of the Disability Support Services' New Model within the Ministry of Health. This model is being trialled in the Auckland and Waikato regions and, since late 2013 when it began, over 92 people have been supported to transition to a home of their own in the community. Choice in Community Living supports providers through a more flexible funding model. The Waikato Leadership Group wants to explore ways in which this flexible funding model could be further developed.
Overall success criteria for the demonstration of the EGL approach in the Waikato
31. The overall measures of success for the demonstration are as follows:
- disabled people are recognised and work as skilled and expert leaders across the sector
- disabled people, families, and whānau control and direct supports, including service provision
- disabled people, families, and whānau are informed and effective participants in the design, monitoring and evaluation of the demonstration
- EGL processes work well for disabled people, families and whānau
- disabled Māori and whānau are effectively engaged and participate in EGL Waikato
- disabled Pacific people, families and Pacific communities are effectively engaged and participate in EGL Waikato
- a collective understanding is built up of what is happening both in the disability sector and other sectors in the Waikato
- creative individual approaches are developed
- collaborative approaches increase, both within and across the forums and within provider groups
- providers are supported as they move through a period of change
- there is information available for the Government to make informed decisions about transforming the disability support system in a way that is financially sustainable, throughout the country.
32. The detailed design will include an evaluation plan that will include monitoring reports and annual formative evaluations.
There are four proposed action areas for the Waikato demonstration
Action Area One: Increasing individual choice in all aspects of life including where you live, who you live with and what you do in the day, which includes building on the “Choices in Community Living” approach
33. The target group for this action area are people who receive disability support services with a primary focus on people:
- aged under 65 who are in, or are considering entry into, residential or aged care, and who want something different, and choose to be part of the demonstration
- who are less able to advocate for themselves, or who do not have people in their lives who can ensure their voice is heard.
34. The scope for this action area is 20-35 disabled people living in rural and urban areas in 2015/2016, with 20-40 additional participants in 2016/2017.
Action Area Two: Māori disabled and their whānau are fully involved in the design and implementation of the demonstration in the Waikato
35. The Leadership Group has identified disabled Māori and their whānau as a priority group. The newly appointed co-directors have begun the process of engaging with Tainui and Te Piringa to ensure key people are part of the design and implementation. Disabled Māori, whānau, Māori providers and iwi will all be involved in the design process. Potential links with Whānau Ora and other Māori initiatives in the Waikato will also be explored.
36. The scope will be 20-30 disabled Māori and their whānau living in rural and urban areas in 2015/2016 with 20-30 additional participants in 2016/2017.
Action Area Three: Disabled children and young people have the same life experiences and outcomes as other children and young people
37. The target group will be families and whānau of disabled children and young people - with a primary focus on families and whānau who are engaged with the EGL family forums, or have been recently told their child has a disability, or families who want something different.
38. The scope will be 15-20 families and whānau with children aged 0-18 years in 2015/2016, with 20-40 additional family and whānau in 2016/2017.
Action Area Four: Increasing employment outcomes for disabled people
39. The target group for this action area will be disabled people who, with a small amount of assistance, can get and retain on-going paid employment. The priority focus will be on disabled people who participate in the employment or disability forums, as well as other disabled people who want employment.
40. The scope for action area four will be 15-20 people under the age of 65 years in 2015/2016, with 25-30 additional participants in 2016/2017.
Funding and services in scope
41. Like the Christchurch demonstration, the Waikato demonstration will be guided by the principle of fiscal neutrality. It is expected that the Waikato demonstration will draw from the following funding and support:
- Ministry of Health funding as allocated by the local NASC organisation, which includes all disability support services such as residential care, home and community support, supported living, respite care and carer support – this funding may be used to purchase support from contracted providers, or can be accessed through an individualised funding arrangement.
- Ministry of Social Development Employment, Participation and Inclusion funding, which covers specialist employment and community participation services and very high needs funding.
- Ministry of Education ORS funding for students with high and very high needs, and flexible use of specialist support. This will be worked through with local families and whānau, schools and early childhood services.
42. Some services and funds allocated to an individual, for example, income support, will not be within the scope of funds that can be used flexibly in the demonstration. However, some funding and services will be considered in planning and facilitation for the person, such as ACC services, the Ministry of Health’s equipment and modification funding, and the Ministry of Social Development’s Disability Allowance and general employment assistance, even though these are outside the initial scope.
43. Year One of the Christchurch demonstration showed that pooling disability support funds currently managed within a particular Vote, and enabling participants to use the combined funds more flexibly, provided disabled people with more control and choice over their supports. Achieving this for the Waikato demonstration requires a similar pooling of some funds and flexibility around what can be purchased. I propose that the final decisions on the funding mechanism are delegated to the Minister of Finance and the Vote Ministers (Health, Education, and Social Development) after the detailed design is determined.
44. The Christchurch demonstration has largely used existing mechanisms within the health funding system to manage the pooling and management of applicable funds and for the allocation and administration of personalised budgets, with some manual work-arounds.
45. The Waikato EGL demonstration intends to adopt a different approach. This is likely to involve further development of the supported self-assessment and funding allocation tools being developed for Christchurch, but will have applicable funding allocated and managed by the demonstration itself, rather than by an agency external to the demonstration. The use of a different model in the Waikato will give a broader range of experience to draw upon when advice is being prepared on the wider transformation of the disability support system.
46. I propose that the Waikato demonstration be governed through the following arrangements:
- A Joint Agency Group will be responsible for achieving the demonstration outcomes and make joint decisions that are within the agencies’ delegated authority. This group will report to the Ministerial Committee on Disability Issues, and will be advised by the National EGL Leadership Group.
- Demonstration Co-directors will be responsible for implementing the demonstration, and will be supported and advised by the Waikato EGL Leadership Group and officials.
47. The Ministries of Health, Education, and Social Development jointly lead this work, with support from ACC. They will continue to ensure the co-ordination and co-operation between agencies that is crucial for an integrated and flexible disability support system.
48. The Ministries of Health, Education and Social Development jointly developed this paper. The Ministry of Transport, ACC, Canterbury Earthquake Recovery Authority, Housing New Zealand Corporation, the State Services Commission, the Treasury, the Ministry of Women, the Ministry of Pacific Island Affairs, Te Puni Kōkiri, and the Offices for Disability Issues and Senior Citizens were consulted.
49. The Department of Prime Minister and Cabinet was informed.
50. Governance groups for the EGL demonstrations have been consulted in the development of this paper. In addition, disabled people, families and service providers have been involved in the design of both demonstrations.
Comment from the National EGL Leadership Group
51. The demonstration of the EGL approach in Christchurch and the proposed design for the Waikato demonstration employ processes where officials, the National EGL Leadership Group, local disabled people and their families, and providers work in partnership to find new ways of supporting disabled people achieve an everyday life. Moreover, the EGL approach adheres to the following Articles of the United Nations Convention on the Rights of Persons with Disabilities: Article 4.3, Article 9, Article 19, Article 24, and Article 27.
52. The National EGL Leadership Group is pleased that Government has committed funds for a second demonstration of the EGL approach, as this will provide a broader experience base and better understanding of what it takes to implement an Enabling Good Lives approach.
53. Recognising that Pacific disabled people experience barriers to participation in community life, with evidence of ‘low uptake’ of disability support towards independent living, it is critical that the demonstrations adopt ‘inclusive actions’ to enable a Disability Support System that is responsive to diverse populations such as Pasifika.
54. Budget 2013 included $3 million over three years for the additional costs of a demonstration of the EGL approach in Christchurch.
55. Budget 2014 included $3.8 million over three years for a demonstration of the EGL approach in the Waikato.
56. The demonstrations focus on using existing resources more effectively. As such, services will be funded from within the existing baselines of Votes Health, Education, and Social Development that are targeted to the purchase of disability supports. Government agencies are contributing in-kind resourcing to implement the demonstrations. Resources will also be sourced from the wider sector, for example, contracted providers or NASC organisations.
57. There are no legislative or gender implications arising from this paper. The proposals are consistent with the Human Rights Act 1993 and the New Zealand Bill of Rights Act 1990.
58. A Regulatory Impact and Compliance Cost analysis is not required as there are no regulatory proposals arising from this paper.
59. The proposals in this paper are consistent with the United Nations Convention on the Rights of Persons with Disabilities and the New Zealand Disability Strategy. In addition, disabled people and service providers have been involved in the design of both demonstrations.
60. I will work with relevant Ministers on an announcement about the Waikato demonstration, subject to Cabinet agreement on the high-level design. Any communication will be clear that the final decisions, including those on funding, are subject to final agreement by Ministers. At the same time, government agencies will be releasing the results of the Year One evaluation of the Christchurch demonstration.
61. It is recommended that the Committee:
1 note that in July 2013, Cabinet agreed to a three-year demonstration of the EGL approach in Christchurch [CAB Min (13) 24/6 refers]
2 note that 52 disabled people participated in Year One of the demonstration of the EGL approach in Christchurch
3 note that an evaluation of Year One of the demonstration of the EGL approach in Christchurch identified some key successes as well as some challenges
4 note that Budget 2014 provides funding for a demonstration of the EGL approach in the Waikato
5 note that officials have developed the proposed design for the Waikato demonstration with the Waikato EGL Leadership Group
6 agree that the demonstration of the Enabling Good Lives approach in the Waikato should have the following four action areas:
6.1 Action Area One - people aged under 65 of age who are in, or considering going into, residential care/aged care or who are less able to advocate for themselves
6.2 Action Area Two – Māori disabled and their whānau
6.3 Action Area Three - families and whānau with children and young people with disabilities aged between 0-18 years
6.4 Action Area Four – disabled people aged under 65 who want employment
7 note that the services and funding in scope for the Waikato demonstration include: Ministry of Health funding allocated by the local NASC organisations; Ministry of Education ORS funding; and Ministry of Social Development employment and community participation services and very high needs funding and workforce training funding such as Vocational and Support Services
8 authorise the Minister of Finance and Vote Ministers (Health, Education, and Social Development) to make the necessary decisions on the funding arrangements, including on the allocation and management of applicable funds pooled for the demonstration of the EGL approach in the Waikato demonstration
9 agree to the following arrangements for governance of the Waikato demonstration:
9.1 the Ministerial Committee on Disability Issues will provide Ministerial oversight of the EGL work programme, with decisions affecting Vote responsibilities remaining with Vote Ministers
9.2 the Joint Agency Group of Deputy Chief Executives from the Ministries of Health, Education and Social Development will be responsible for achieving the demonstration outcomes
9.3 the Co-Directors will implement the actions of the demonstration in the Waikato
10 agree that the Minister for Disability Issues work with other relevant Ministers to announce the design of the Waikato demonstration
11 note that government agencies will release the results of the Year One evaluation of the Christchurch demonstration at the same time as the announcement is made on the Waikato design.
Hon Nicky Wagner
Minister for Disability Issues (Oct 2014-Oct 2017)
 In July 2014, the Chair of Cabinet Social Policy Committee agreed to defer the progress report from August until December 2014.
 A key component of obtaining input is through three forums, one each for disabled people, families and providers.
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