Minutes of the Disability Support Advisory Committees Meeting held on Tuesday,19May2009, commencing at 10.00am,in the Southland DHBBoardRoom, Old Nurses Home, SouthlandHospital.

Present:Mr N CookChairman

Mrs H M Algar

Mr P A Barron

Mr S Bhatia

Ms M L Carr

Mrs H Clay

Ms K Goffe

Dr J M MacPherson

Mr P Wards

Ms D Wilson

In Attendance:Mrs J TurnerAge Concern Southland

Mr B Rousseau Regional Chief Executive Officer

Mrs L O’SheaChief Operating Officer/Regional Deputy Chief Executive Officer (COO/RDCEO), Southland DHB

Mr D ChrispRegional General Manager, Planning and Funding

Dr R Morris Regional Clinical Advisor Community Services

Ms L IllingworthSenior Portfolio Manager, Regional Planning and Funding

Ms G GoodgerCommunications Officer, Otago DHB(via Videoconference)

Mrs J FanninBoard Secretary (Minute Taker)

1.0WELCOME

The Chairman, Mr N Cook, welcomed everyone to the combined Disability Support Advisory Committee (DSAC) meeting.

It was noted that the four Needs Assessment Service Co-ordinators for the Older Persons Service from Otago DHB were attending via Videoconference as observers.

2.0MEMBERS’ DECLARATION OF INTEREST

The Chairman called for any adjustments or amendments to the Interests Register. He reminded members of their responsibility to advise the meeting immediately should any potential conflict, actual or perceived, arise during discussions.

Mrs H Clay requested that her interest be noted on the register as she had a close association, with her daughter having a disability.

3.0PRESENTATION – MRS JEANETTE TURNER, AGE CONCERN SOUTHLAND

Mrs J Turner advised that she was the Co-ordinator for Elder Abuse and Neglect Prevention for Age Concern Southland. She tabled pamphlets detailing the services that Age Concern Southland provide (included in the Items of Interest). In discussion, the following key points were noted:

  • In her role, Mrs Turner advised that she deals with welfare of the older people over the age of 65.
  • Age Concern has an accredited visitor service and provides meals for the older people.
  • The role interacts with the Needs Assessment Service Co-ordinators (NASC) team at SouthlandHospital.
  • Approximately 10-15 welfare calls are received per week.
  • Age Concern is funded through the Ministry of Social Development (MSD)
  • Take away meals for older people are provided through Senior Citizens. Free delivery of meals is provided across Invercargill.
  • Bus trips are provided.
  • Age Concern Southland is significantly reliant on volunteer workers. The activities run by volunteers were outlined.
  • The importance of networking with SouthlandHospital and other health agencies was highlighted.
  • Mrs Turner outlined the neglect prevention side of her role and noted that this could prevent abuse happening.
  • One particular case was outlined where PHO funding had been obtained by Age Concern Southland to provide respite care for an older person to get a hip replacement. Members expressed concern at the situation and the Regional Chief Executive Officer (RCEO) highlighted the need for management to be made awareof cases such as those outlined, as discharge planning always takes place prior to an operation being approved. The COO/RDCEO outlined the process that takes place and Mrs Turner undertook to liaise with SouthlandHospital for future cases, so clarification could be obtained on the process. The COO/RDCEO requested that Age Concern SouthlandcontactSouthland DHB’s Patient Support Facilitator in the first instance. She advised that some cases were complex and the SouthlandHospital team worked with outside agencies to assist infacilitating the finalisation of requirements for individuals. The RCEO advised the need for further details to be provided in relation to the case outlined by Mrs Turner.

The DSAC Chairman thanked Mrs Turner for her presentation and asked that she liaise with Southland DHB’s Patient Support Facilitator in future cases where Older People did not appear to be getting the service they should through Southland DHB. He also requested that details of the case highlighted be provided, so the SouthlandHospital team could follow up on the concerns raised.

Dr Roy Morrisjoined the meeting at 10.27am.

4.0PREVIOUS MINUTES

MovedMsKGoffe, seconded Ms DWilson, that the minutes of the Disability Support Advisory Committees meeting held on21April 2009 be approved and adopted as a true and correct record subject to an amendment being made to the penultimate paragraph under 13.0 Items of Interest on page eight of the minutes, i.e. the wording ‘to discuss the setting up’ is to be removed. The wording will now read‘at the meeting of the Consumer Consortium’.

Carried

5.0MATTERS ARISING

Discussion was held in relation to the resolution on page six of the minutes of the meeting held on 21 April 2009, relating to the body of work looking at the configuration of disability support services for the over 65s. It was noted that the resolution had not been ratified at the Board meeting of the Otago DHB held on 7 May 2009 and concerns relating to the process were outlined. The resolution had been ratified at the meeting of the Southland DHBheld on 14 May 2009, subject to the minutes of the 21 April 2009 DSAC meeting being ratified at the DSAC meeting on 19 May 2009. Mrs Algar noted the need for a supporting statement around the proposed resolution to reflect the intent of what the body of work was. The RCEO requested clarification on what members were wanting and noted that the Planning and Funding team was already progressing the body of work looking at the configuration of disability support services for the over 65s within available funding. Ms Carr advised the need to establish the scope of the body of work referred to in the resolution.

The Regional General Manager, Planning and Funding (RGMP&F), Mr David Chrisp, advised on the work currently being undertaken by the Planning and Funding team within existing resources and advised that a more significant piece of work could be undertaken, including looking at ‘best practice’ within other DHBs in this area. However, additional resource would be needed to complete something on a wider scale.

The Chairman outlined his understanding of the discussion held on 21 April 2009 and noted that following discussion on the day, the combined DSACs decided to take a general approach when formulating the resolution. Ms Carr advised that the body of work was decided on following the workshop on DSS. She noted this was a focus for the DSACs and stated the need for the combined DSACs to receive regular monthly reports on progress.

The RCEO clarified the body of work that needs to take place as outlined below:

  • Short term tactical NASC work.
  • Strategic level of work where experts need to be involved in terms of aged care. There was a need to involve Geriatricians, etc., including Professor Matthew Parsons, a Professor in Gerontology based in Auckland. Southland and Otago DHBs needed to determine how to provide the best configuration of services for the elderly within the available funding.

Members agreed that the record of the meeting in the minutes dated 21 April 2009 was accurate. In discussion it was agreed that Planning and Funding should provide the combined DSACs with a one page document outlining the workplan for the body of work looking at the configuration of disability support services for the over 65s. Once ratified by the combined DSACs, the one page document would also serve as a framework for the Planning and Funding team to report against on a monthly basis.

The RCEO advised that the correct process was followed on the day and he stated that the resolution would now go back to the Otago DHB for ratification at the June 2009 meeting.

The Chairman requested that Planning and Funding provide an outline of the workplan, as suggested by the RCEO, to accompany the recommendation to go back to the Otago DHB Board meeting for ratification on 4 June 2009. He requested that the outline of the workplan and recommendation also be included in the Southland DHBBoard agenda for information for the meeting to be held on 11 June 2009. It was agreed that the workplan should also identify the recommended priority areas with timeframes.

Ms Carr noted previous discussion at the Hospital Advisory Committee (HAC)in relation to the elder care continuum work being done within the Provider Arm and the need to incorporate that into the wider strategy. The RCEO confirmed that discussion had been held at the HAC around the lack of Hospital level aged care facilities in the community and the impact on the ability to discharge from the hospital. There was a desire to ensure that the combined DSACs understood the issue for HAC. The RCEO advised that the workplan would address the concerns as outlined.

6.0ACTION SHEET

Health Forums – The RGMP&F advised that it was desirable to run the Health Forums as outlined, but suggested that due to resourcing issues, the Health Forums be incorporated with other forums being organised for separate issues.

Establishing Links with Disability Groups in Otago – the RGMP&F advised that it was still intended to establish links with disability groups in Otago, similar to the approach taken by the Southland DHB and an update would be provided at the combined DSACs meeting to be held on 21 July 2009.

Otago Pan Disability Agency Workshop/Forum – the RGMP&F advised that dialogue was continuing with the Otago Pan Disability Agency. The Agency had indicated that they would not be proceeding with a workshop/forum in the short term. Ms Carr suggested that a way forward may be for the group to look at specific issues, e.g. the PHO development and Chronic funding paper to provide a response from the sector. The RGMP&F undertook to meet with the Otago Pan Disability Agency and report back to the combined DSACs meeting.

Dr Roy Morris provided an update for members’ information, advising that he had put the Otago Pan Disability Agency in Otago in touch with the PHO General Managers and CEOs. He advised that he had also passed on the details for Mrs Clay and Mr Wards, as the community representatives on the combined DSACs. He advised that he had gained permission from the authors to use the resource tool which was adopted by Canterbury DHB. He suggested that this matter be brought back to the June 2009 meeting for discussion.

Ms Wilson clarified that the term ‘Pan Disability Group’ meant all disabled people and highlighted the need to distinguish this from the management group referred to, which was a service provider.

In response to a suggestion by the RCEO, it was agreed that the action point relating to the Otago Pan Disability Agency Management Group should be removed from the action sheet. The RCEO advised that the Group could be linked to the workplan which is to be developed. Mr Barron noted the constructive dialogue with the Group and their suggestions to address areas such as the deficit situation. Ms Carr undertook to speak with the Group and report back to members.

Report on MoH funding following presentation by Mr D Funnell – a report from Mr Funnell is pending.

Configuration of Disability Support Services for the over 65s – work is progressing in relation to this and regular monthly reporting will be provided.

7.0MINISTRY OF HEALTH DVD – ‘WITH SUPPORT I CAN’

Due to time constraints, members viewed the first two of five narratives from people with disabilities on the ‘With Support I Can’ DVD. The DVD is available to members if they wish to view the remaining narratives.

8.0PLANNING AND FUNDING REPORTS

Allocated Funding Responsibility for Long Term Support Services for People with Chronic Health Conditions Aged Under 65 Years – the RGMP&F provided a brief background on the paper included in the agenda and the allocation of the Interim Funding Pool, which was allocated by the previous Minister of Health, Hon Pete Hodgson. He requested feedback from members on the discussion document in relation to administration of the funding and whether it should be administered by the DHBs nationally under population based funding (PBF) or whether it should remain with the Ministry of Health (MoH) to administer. Feedback from members would be used to complete the questionnaire.

Ms Carr noted the definition of a disability on page nine of the discussion document and queried why mental health services provided in the community do not sit within the auspices of the DSACs, as they are provided under the same criteria of causing a disability for more than six months. She advised the benefits to be gained by bringing Mental Health, Chronic Conditions and Disability Support for Older Persons under one ‘umbrella’ and having a super Needs Assessment Support Co-ordination (NASC) unit that would be the gate keeper into the services and allocate resources, control the budget, etc. The Chairman concurred that it would be beneficial and simplify the processif one organisation, either the DHBs or the MoH, control the funding for all three areas. The RGMP&F agreed that it would be beneficial to simplify the process by allocating the funding for the areas outlined above to the one funder. Mrs Algar noted the synergy between the current discussion and the primary carepaper included for discussion in the CPHAC agenda and suggested the concept of person whanau centred continuum of care and delivery of services would allow more flexibility to address people’s needs in a much more efficient and fiscally effective way with better outcomes. The RCEO advised that DHBs did not have providers who could provide all the care that an individual needs and he noted the complexity of the range of care that an individual could require. The RCEO advised that funding was provided around the core health services that were readily identifiable. Mr Barron advised that this matter had been debated at the community consultation on workforce in Central Otago and he advised the need for innovative solutions to the issues.

Following lengthy discussion, the Chairman summarised by stating that the combined DSACs were interested in innovative solutions and he suggested that an approach be made to the MoH to ascertain if money could be sourced to allow the combined Otago DHB and Southland DHB region to undertake a pilot programme looking at individual based care with overall Needs Assessment Service Co-ordination and Case Co-ordination. It was suggested that the pilot should form part of the workplan for the body of work being undertaken by the Planning and Funding team in relation to the configuration of disability support services.

Dr Morris advised that the DHBs were looking at running a trial in a geographically distinct PHO area with a potential control in another geographically distinct area called ‘Year of Care’ or ‘Year of Change’ which would look at ways of better co-ordinating care. He advised that the results of that trial would be reported back to the combined DSACs over the next 18 months. Mr Barron stated that the ‘Patient Journey’ and ‘Continuum of Care’ were relevant to the matters being discussed. The RCEO advised that there would be a presentation to the next HAC meeting in relation to the ‘Patient Journey’. The difference between patients and people with a condition with disabling effects was stated.

Disability Support Services Activity

The RGMP&F tabled a report on the implementation of budget management for Disability Support Services (appendix 1). He advised that a meeting was held with the Home Based Support providers on 15 May 2009. Discussion was held at the meeting on the impact on their business of reducing the allocation of home based support. The providers were cognisant of the issues faced by the DHBs and raised two issues the DHBs should take into consideration:

  • If quick gains were required in this area, the time required by the NASCs and the resourcing to undertake the reassessments.
  • A good communications strategy needed to be in place to keep the public and the providers informed.

Ongoing dialogue would continue with the Home Based Support providers and other sectors of the disability support services community, including residential care providers to explain strategies and obtain feedback.

In response to a query, the RGMP&F clarified the termNASC and the role of theNASC service. It was noted that NASC at Otago DHB sits within the provider arm and at Southland DHB the NASC service sits within planning and funding.

InterRAI National DHB Implementation Project

Ms Leanne Illingworth, Senior Portfolio Manager, spoke to the report on InterRAI attached to the agenda. She advised that InterRAI was an assessment tool that is being rolled out across the DHBs over the next four years by the MoH. Some DHBs were already actively using the assessment tool and Otago and Southland DHBs were expecting to implement InterRAI by 2010/11. Discussion had been held on an earlier implementation date, but this was being reassessed due to other priorities at the current time.