Engagement Workshops ‘ Health and Disability Kaiawhina, Care and Support Workforce Plan ’ A 20 Year Horizon and 5 Ye

1. Engagement Workshops‘Health and Disability Kaiawhina, Care and Support Workforce Plan’A 20 Year Horizon and 5 Year Action Plan “Starting Points”

2. A Definition The non-regulated workforce refers to those occupational groups not covered by the Health Practitioners Competence Assurance Act 2003 ( Health Workforce NZ (2011), Aged Care Workforce Service Forecast. Wellington)

3. NZNO Submission to the Human Rights Council – Universal Periodic Review New Zealand, 2013 “there has been significant growth in the employment of a non-regulated workforce with … no single definition of the non-regulated health workforce, or any agency responsible for collecting workforce data. … including no discussion around how non-regulated health care workers will contribute to the collaborative team to improve health outcomes”

4. Demand for a workforce plan Recent publications that have highlighted the need for a non-regulated workforce development plan include: ‘Rising to the Challenge’, the Mental Health and Addiction Service Development Plan 2012 – 2017 Disability Workforce Action Plan 2013 – 2016 Ministry of Health Statement of Intent 2012/13 - 2014/15 MSD, The New Zealand Carer’s Strategy, 2008 HWNZ, Aged Care Workforce Service Forecast, 2011

5. Key findings from the Thornton Aged Residential Care Service Review, 2010 • by 2026, residential aged care workforce demand will increase between 50% and 75% (FTE) • there is little data to inform us about the current workforce in aged care • few opportunities exist for national benchmarking

6. ‘Rising to the Challenge’, the Mental Health and Addiction Service Development Plan 2012-2017 There will be significant growth and change in mental health and addiction services with the on-going shift to community based services and the growth in NGO provision of both support and clinical services. This direction includes non-regulated workers fulfilling a wide range of roles.

7. The disability workforce action 2013/16 plan ‘The disability workforce action 2013/16 plan aims to have a workforce that adds value to the lives of people with disabilities. To achieve this vision over the next three years, the plan pursues to increase the skills of the disability workforce, increase the skills of people with disabilities, improve the learning options of carers and family/ whanau who support people with disabilities, improve information about the disability workforce and improve integration of disability workforce development’

8. DHB Regional & District Plans DHBs are increasingly cognisant of the need to give focus to the role of the non-regulated worker in the healthand disability workforce. The following extracts are from a sample of DHB and Regional Service Plans for 2013-2014 which make reference to the development of the non-regulated workforce.

9. Northern Regional Service Plan ‘…to build and align the capability of the workforce to deliver new models of care ….particularly to support integrated care and a greater level of community-based service. There are opportunities to better utilise the non-regulated workforce….. We also need to be at the forefront of evaluating and implementing new roles in key areas.’

10. Counties Manukau DHB ‘when compared to the population we serve, there is much we must do to address the significant under-representation of the Māori and Pacific workforce in clinical staff groups. At the same time, emphasis on our non-regulated and non-clinical workforce would greatly increase the proportion of Māori and Pacific people on our staff while clinical staff may take longer’ Page 75

11. Central Regional Service Plan Consolidation of training resources to ensure economies of scale and sharing good practice 3. Conduct a stocktake of education and training available to staff in the Central region for both regulated and non-regulated workforces 7. Develop a regional plan to build workforce capability for mental health and addiction services including the non-regulated workforce Page 75-78

12. South Canterbury DHB ‘We have embarked on plans to develop the non-regulated workforce and have undertaken a stocktake of qualifications/training of health care assistants/associates and orderlies to ascertain the individual and organisational needs for the future and to facilitate the creation of a potential career path for these workers’ Page 60

13. Developing Models of Care and Support A shift from: • institutions to integrated services and community based support • a service delivery focus to a ‘person-centred’ approach • the involvement of family/whānau in service planning. Changes have resulted in workers: • increasingly expected to engage in a greater level of complexity in their work. • requiring a flexible set of skills and competency

14. Models of Care and Support include: • recovery, resilience, strengths based • restorative, rehabilitation/habilitation • individualised funding, local area coordination, enabling good lives • whānau ora, peer support • health promotion, strengthening communities Advancing the role of the non-regulated workforce as contributing and valued team members within integrated service delivery

15. Career Pathways Caring Counts (2012) found that of the approximate 48,000 aged care workers: • 61% of the community support workers have no formal qualifications • 46% have no qualifications. This report strongly recommends investment in training that will meet the skill sets required for the non-regulated workforce to respond to new models of care

16. Nelson Marlborough District Health Board,Census of Care and Support Workers, 2008 Data gathered found that of the non-regulated workforce the following % had no qualification: • Mental Health – 45% no qualifications (note: this group had the greatest number of workers qualified to Level 4 and above) • Disability -73% no qualifications • Home Support - 66% no qualifications If this DHB information is indicative of a national picture the need for both training and career pathways is great.

17. 2013 NZQA Mandatory review of Qualifications Levels 2-6 • The NZQA qualification review of health, disability, social service and whānau ora involved extensive consultation to inform the framework development of qualifications with educational and employment pathways, including from unregulated to regulated roles. • The changing models of care require new roles and new functions to be captured and supported in the review. • The new qualifications are being future proofed to enable flexibility and reflect changing models and Government strategies and targets

18. Health Workforce NZ’s Annual Plan Outcomes The unregulated workforce contributes directly to the following 2012/2013 HWNZ outcomes • A flexible workforce, to respond to the shift to primary and community models of care, and the integration between institutional and community settings • A financially viable and sustainable workforce, through freeing up of expensive clinician time and developing the unregulated workforce • A workforce that better reflects the demography of the population being cared for • An expanded health workforce through the development of new roles and expansion of existing roles

19. Process

20. References • Disability Workforce Action Plan, 2013 – 2016 • Gough, J. and Associates, Census of Care and Support Workers, Nelson • Marlborough DHB (2008) • Health Workforce NZ (2011), Aged Care Workforce Service Forecast. Wgtn • Human Rights Commission (2012) Caring Counts, the Report of the inquiry into the Aged Care Workforce, Wellington • NZNO (2013), Submission to the 18th Session of the Human Rights Council – Universal Periodic Review New Zealand • Ministry of Health, The Mental Health and Addiction Service Development Plan 2012-2017 ‘Rising to the Challenge’ • Ministry of Health Statement of Intent, 2012/13 - 2014/15 • MSD, The New Zealand Carer’s Strategy, 2008 • Thornton, G. (2010), Aged Residential Care Service Review, NZ • Timmins, N. and Ham, C. (2013) The quest for integrated health and social care- A case study in Canterbury New Zealand, The King’s Fund, UK

21. Further Reference Material If you know of any other information/publications that would add depth and richness to this work, please could you send it to: action@careerforce.org.nz