Consultation Report Streamlined Contracts Project Disability Support Services



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Consultation Report


Streamlined Contracts Project

Disability Support Services

Project:

Streamlined Contracts Project

Date:

4 December 2015


Author:

Adrienne Percy

Streamlined Contracts Programme Manager






Report approved

Barbara Crawford

Manager, Strategy and Contracting Team



Signature:

Date: 4 December 2015


Purpose of the report

This report provides a summary of responses to Disability Support Services’ (DSS) public consultation on the new contract documents prepared under the streamlined contracting framework (SCF). It also notes any changes made to the contract documents in response to the feedback received in the consultation.

The public consultation was open from 22 May to 22 July 2015. The Ministry received 36 responses to the survey as well as 227 written comments via the survey and in separate email feedback.

Streamlined contracting

The Ministry of Health contracts with a large number of NGOs to provide health, disability and social services to people in New Zealand. As part of a government-wide programme, the Ministry is introducing an improved framework for managing these contracts, in response to requests from NGOs for a simpler interface. Over time, this will increase efficiency and reduce duplication of reporting and compliance costs.

The key elements of the contracting framework are:


  • Outcome agreement: a common contract template

  • Framework terms and conditions: standard government terms and conditions

  • Results Based Accountability™ (RBA): a practical approach to measuring outcomes.

DSS service specifications

As part of the transition to streamlined contracts, the Ministry has updated the DSS service specifications to incorporate appropriate contractual performance measures using RBA. This work has been done in consultation with representatives of disabled people using the services, their families and whānau, carers, providers and the Disabled Persons’ Organisation.

Each contract includes an outcome agreement and up to three levels of service specifications. The outcome agreement specifies standard requirements for Ministry of Health contracts, and includes the RBA performance measures for each contract. (Note: the service specifications need to be read in conjunction with the outcome agreement.)

Tier one


This service specification applies to all DSS contracts irrespective of service type. It contains elements that are common to all services, such as DSS principles, population outcomes, experience statements and indicators, cultural values, quality management etc.

Tier two


These service specifications define the specific services that will be delivered. They are to be read in conjunction with the overarching tier one specification. Tier two specifications have been developed for:

  1. Community Residential

  2. Contract Board

  3. Foster Care

  4. Community Day Services (formerly Day Programmes)

  5. Facility Based Respite (formerly Out of Family Respite)

  6. RIDSAS (Regional Intellectual Disability Supported Accommodation Services)

  7. Aged Care Facilities for Younger People with Lifelong Disabilities (formerly Younger Persons in Aged Care).

  8. Home and Community Support Services.

Tier three


Tier three service specifications supplement certain tier two specifications. They provide additional requirements that apply to specific types of service users eg, children aged 16 years or under. They should be read in conjunction with the tier one and relative tier two specifications. Tier three specifications have been developed for:

  1. Facility Based Respite (16 years and under)

  2. Out-of-family Residential Services for children and young people.

Objectives

The consultation sought to bring the expertise, perspectives and ideas of affected groups into the discussion and improve the quality of the contract documents. It also gave all interested parties an opportunity to present their views.

The consultation sought to assess:


Consultation process

Participants

An invitation to participate in the consultation was emailed to 530 organisations, groups and individuals (who were also encouraged to share the invitation with others), along with appropriate reminders near the closing date. The consultation was also publicised on the Ministry’s website and the government’s consultation website.

Feedback was sought from the following groups in particular:


  1. NGO providers

  2. disabled people

  3. disabled people’s families, whānau, guardians, advocates and others

  4. carers

  5. Disabled Persons Organisations and other representative and advocacy groups of the above stakeholders

  6. Disability Support Services’ consumer consortium, Māori leadership group, Faiva Ora Pasifika disability advisory group

  7. evaluation and audit agencies

  8. other state sector government agencies.

Survey

Participants were emailed a link to the survey on the Ministry’s website, from where they were able to download the relevant contract documents to read, and offer their responses via an online survey. The survey questions are provided in Appendix 1.

Most responses to questions were made via a five point scale (strongly agree to strongly disagree). Additional comments were received through the use of free text fields. Participants submitted their feedback anonymously or in confidence. This summary of survey results does not identify any individuals or groups who responded to the survey.

Survey responses


36 responses were received from people who identified themselves according to the categories below.

Service provider (eg, an organisation contracted to provide disability support services)

30

Disabled person

2

Disabled person's family, whanau or carer

0

Disabled persons' organisation

1

Provider peak body

1

Foster parent

1

Government agency

1

Total

36

Assuming the invitation to participate was only received by the 530 people to whom the email invitation was sent, the response rate was 6.8 percent. In total 227 comments were received via the survey and in other feedback received by email.

Responses from NGOs

Twenty three responses were received from NGOs that are currently providing disability support services to the Ministry under contract, in the following categories. (Note that some providers offer services in more than one category.)




Community residential support services

16

Home and community support services

8

Community day services (formerly Day programmes)

9

Community residential support services within aged care

facilities for younger people (formerly Younger persons in aged care)



2

Facility based respite (formerly Out of family respite)

7

Regional intellectual disability supported accommodation services (RIDSAS)

6

Contract board

3

Foster care

3



Feedback on the outcome agreement

Eighteen responses were made to questions about the outcome agreement by NGO providers; 15 of these were positive or neutral responses to questions about the document being easy to read, satisfactory and fit for purpose. Two positive responses were made by non-providers to questions about the outcome agreement.


Twenty three written comments relating to the outcome agreement were received via the survey and in separate email feedback. Each comment was recorded, considered by the Ministry and a decision made as to whether the outcome agreement would be modified in response to the comment.
As well as small wording changes, the following changes were made to the outcome agreement:

  • clarification regarding the ownership of new intellectual property (section 12)

  • removal of an unnecessary Quality of Information clause (Appendix 3)

  • removal of a duplicated payment clause (Appendix 5)

  • change to the Withholding payment clause (Appendix 5)

  • change to the Dispute resolution clause (Appendix 11)

  • addition of a Survival clause (Annex B).

Feedback on the tier one service specification

Seventeen responses were made to questions about the tier one service specification by NGO providers; 14 of these were positive or neutral responses to questions about the document being easy to read, satisfactory and fit for purpose.


Four responses were made to this service specification by non-providers. Three out of four respondents agreed or strongly agreed that the service specification promoted the rights and safety of disabled people and supported disabled people to make choices and have control in their lives. Two out of four disagreed that the service specification recognised the important role of family, whānau and caregivers.
A total of 17 comments relating to the tier one service specification were received via the survey and in separate email feedback. As above, each comment was recorded, considered and where appropriate, the specification was modified.

Feedback on the tier two service specifications

Responses relating to the tier two service specifications were made according to each service type, as described below.


Community residential support services


Twelve responses were made by providers regarding the specification for community residential support services; 8 out of 12 respondents said the specification was easy to read and understand, while 7 out of 12 agreed or strongly agreed that they knew what their obligations under the specification were. Less than half of the providers who responded were satisfied with the specification although most of these indicated that they would be happy if some changes were made. There was significant support for the overall approach to the update of this specification.
Extensive and very useful email feedback was provided by one disabled person and two family members of a person with a disability. Two neutral survey responses were made by non-providers to this service specification.
Fifty three comments were made about this specification. In response, a number of changes were made to the service specification including:

  • more consistent wording throughout the document

  • reference to types of disability removed

  • addition of short term goals to the personal planning section

  • term ‘core competencies’ removed from the outcome measures and replaced with the achievement of the National Certificate in Health, Disability, and Aged Support (Level 2)

  • references to relationships with partners and spouses added

  • responsibility for the provision of incontinence products was clarified.

Although no feedback was received about the children’s residential tier three service specification, a number of changes were made to the document. These reflect feedback on the community residential support services specification, and improved the consistency of wording across the specifications.


Home and community support services


Four responses were made by providers regarding the specification for home and community support services. Half of these were positive or neutral about the document being easy to read and understand, and knowing what their obligations under the specification were. One provider was satisfied with the specification and believed the performance measures would be useful to their organisation. Three positive responses were made by non-providers.
Twenty four comments were made about this specification. In response, a number of changes were made to the service specification including:

  • reference to ‘core services’ and ‘flexible services’ removed

  • ‘registered nurses’ section removed

  • added reference to requirement for cultural competency

  • term ‘core competencies’ removed from the outcome measures and replaced with the achievement of the National Certificate in Health, Disability, and Aged Support (Level 2).

Community day services


Nine responses were made regarding the specification for community day services. Seven of these were positive or neutral about the document being easy to read and understand, and knowing what their obligations under the specification were. Half of the providers were satisfied with the specification and believed the performance measures would be useful to their organisation. No responses were made by non-providers.
Twelve comments were made about this specification. In response, a number of changes were made to the service specification including:

  • clarification of the weeks / times day services are expected to operate

  • term ‘core competencies’ removed from the outcome measures and replaced with the achievement of the National Certificate in Health, Disability, and Aged Support (Level 2).



Community residential support services within aged care facilities for younger people


One neutral response from a non-provider was received about this service specification. No feedback from providers about this specification was received.
A number of changes were made to this specification to make it more consistent with the other DSS specifications.

Facility based respite


Four responses were made by providers regarding the facility based respite specification. Half of these were positive or neutral about the document being easy to read and understand, and knowing what their obligations under the specification were. One provider was satisfied with the specification and believed the performance measures would be useful to their organisation. No responses from non-providers were made regarding this specification.
Eighteen comments were made about this specification. In response, a number of changes were made to the service specification including:

  • changed wording of performance measure regarding involvement in governance

  • a number of wording changes to improve accuracy and clarity.

Four responses were made by providers regarding the tier three specification for children’s facility based respite. Half of these were positive or neutral about the document being easy to read and understand, and knowing what their obligations under the specification were. Two providers were not satisfied with the specification and believed the performance measures would not be useful to their organisation. No responses from non-providers were made regarding this specification.


Regional intellectual disability supported accommodation services (RIDSAS)


Seven responses were made by providers regarding the RIDSAS specification. Four of these were positive or neutral about the document being easy to read and understand, and knowing what their obligations under the specification were. Five providers were not satisfied with the specification and three providers believed the performance measures would not be useful to their organisation. No responses from non-providers were made regarding this specification.
Thirteen comments were made about this specification. In response, a number of changes were made to the service specification including:

  • change to allow Care Managers to hold a relevant social science qualification or a health and disability qualification

  • clarification of the provider’s responsibility to support the disabled person to meet their legal obligations.

Contract board


Four responses from providers were made regarding the service specification for contract board. Two were positive about the document being easy to read and understand, and knowing what their obligations under the specification were. Half of these were satisfied with the specification and believed the performance measures would be useful to their organisation. One neutral response from a non-provider was made regarding this specification.
Five comments were made about this specification. In response, a number of changes were made to the service specification including:

  • ‘facility manager’ wording removed

  • wording simplified to be clearer.



Foster care


Three responses were made regarding the service specification for foster care. One was positive about the document being easy to read and understand, and knowing what a provider’s obligations under the specification were. Two were not satisfied with the specification and believed the performance measures would not be useful to their organisation. No responses from non-providers were made regarding this specification.
Four comments were made about this specification. In response, a number of changes were made to the service specification including:

  • reference to the Provider Caregivers Manual removed

  • reference to professional supervision replaced by requirement to ensure staff implement best practice in their work.



Performance measurement tools

In questions about performance measurement tools, 45% of respondents said their organisation uses Results Based Accountability, while 96% of respondents said their organisation used other performance measurement tools.


General comments

The Ministry would like to thank every individual and organisation who gave feedback and offered comments on the updated contract documents. We also recognise the contribution made by those who attended workshops in early 2015 to develop the service specifications and RBA measures.


Overall, the feedback was very helpful and instructive, and the responses were appreciated by the Ministry. Several small but important modifications, as well as many wording changes, were made to the documents in response to the feedback received.
The Ministry notes there is some way to go on the uptake by providers of RBA as a useful performance measurement tool. The Ministry will continue to work with the Ministry of Business, Innovation & Employment and other government agencies to provide information and support to providers adopting RBA.
Some comments that represent the range of survey responses are listed below:


  • Generally we are very impressed with the language, tenor, and philosophies of support expressed throughout these service specifications. With further work on the RBA framework and clarification as commented throughout these will be robust specifications.




  • Applaud MoH for the level of consultation that has occurred with respect to the work to date.




  • The RBA could go much further.




  • The aim of streamlined contract reporting is supported with a focus on the delivery of outcomes and measurement of outcomes across organisations.




  • In completing this survey I've "downvoted" many of the service specifications. This is somewhat unfair as most of them are very close to the being acceptable and the residential spec is very high quality. However, most of the specifications have one or two sections that have … ambiguous or incorrect requirements that need addressing.

Appendix 1: Survey questions



Questions for NGOs that provide disability support services.

Question 1

Having read the outcome agreement including its appendices:



Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

  1. The outcome agreement is easy to read and understand.
















  1. I know what I have to do to meet my obligations under the outcome agreement.
















  1. I am satisfied with this outcome agreement.
















If you answered disagree or strongly disagree to any questions, please tell us what your concerns are.



Question 2

Having read the Tier 1 service specification:



Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

  1. The Tier 1 service specification is easy to read and understand.
















  1. I know what I have to do to meet my obligations under the Tier 1 service specification.
















  1. I am satisfied with this service specification.
















If you answered disagree or strongly disagree to any questions, please tell us what your concerns are.



Question 3

Having read the Tier 2 (or 2 and 3) service specification:



Yes

No

  1. My NGO is currently using Results Based Accountability.










  1. My NGO is currently using other performance measurement tools.







If you answered yes to part b, please tell us about the tools you are using.

(Note: please email us [streamline@moh.govt.nz] if you would like to provide more detailed information).





Question 4

Having read the Tier 2 service specification:



Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

  1. The Tier 2 service specification is easy to read and understand.
















  1. I know what I am required to do to meet my obligations under the Tier 2 service specification.
















  1. The performance measures will be useful to my NGO (eg, to support improvement).
















  1. I am satisfied with this service specification.
















If you answered disagree or strongly disagree to any questions, please tell us what your concerns are.

Questions for disabled people, family, whānau, family carers, disabled persons’ organisations and other interested people.

Question 5

Having read the Tier 1 service specification:



Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

  1. Achieving the population outcomes in the Tier 1 service specification will improve the lives of people with disabilities.
















  1. The Tier 1 service specification promotes the rights and safety of disabled people.
















  1. The Tier 1 service specification empowers disabled people to make choices and have control in their lives.
















  1. The important role of family, whānau and caregivers is recognised in the population outcomes.
















If you answered disagree or strongly disagree to any questions, please tell us what your concerns are.



Question 6

Having read the Tier 2 service specification:



Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

  1. Providing the services described in this specification will enable the people who receive them to live a good life.
















  1. The performance measures will measure things that are important to people who receive the service.
















  1. The important role of family, whānau and caregivers is recognised in this service specification.
















If you answered disagree or strongly disagree to any questions, please tell us what your concerns are.



Question 7

Having read the Tier 3 service specification:



Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

  1. Providing the services described in this specification will enable the people who receive them to live a good life.
















  1. The performance measures will measure things that are important to people who receive the service.
















  1. The important role of family, whānau and caregivers is recognised in this service specification.
















If you answered disagree or strongly disagree to any questions, please tell us what your concerns are.



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