Value for Money and Policy Review of Disability Services in Ireland

1. Value for Money and Policy Review of Disability Services in Ireland Presentation to the Irish Association of Supported Employment. 14th November 2012 Colm Desmond, PO Disability Services Unit, Department of Health 25/08/2014 Disability Services Value for Money and Policy Review 1

2. Background Review commenced in July 2009 Scope of the review: Define and describe the objectives of the disability services; Consider the extent to which existing policies are consistent with delivery of those objectives; Assess whether current policies and investments arising from those policies are sustainable in the context of the changing economic climate; and Propose the policy changes, if any, needed to ensure that overall objectives are delivered. 25/08/2014 Disability Services Value for Money and Policy Review 2

3. Background (Cont’d) The review comprised two strands: A examination of the effectiveness and efficiency of the current disability services programme; and A review of current policy in relation to disability services funded from Health Vote 25/08/2014 Disability Services Value for Money and Policy Review 3

4. Limitations • A number of factors limited the ability of the project team to look at the sector in totality: • The size & diversity of the sector & time factor; • Lack of agreed units of outputs for some services; • Lack of outcome measurement / reporting; • Lack of comparable financial data, collected in a consistent manner; • Capacity of some agencies to engage with the review notwithstanding their willingness to do so.

5. Final report signed off by VFM Steering Group on 5th June 2012 Review approved by Government and published in July 2012 Agencies requested to examine recommendations & draw up a plan of action Implementation planning has commenced in DoH and HSE Current Position 25/08/2014 Disability Services Value for Money and Policy Review 5

6. Key Message The Review proposes a fundamental change in approach to the governance, funding and focus of the Disability Services Programme, with the migration from an approach that is predominantly centred on group-based service delivery towards a model of person-centred and individually chosen supports 25/08/2014 Disability Services Value for Money and Policy Review 6

7. Key Findings 85% of expenditure is on pay, 15% on non-pay 45% of direct pay is on residential services, 19% on day services, 11% on multi disciplinary services, 9% management & admin, 4% respite, 12% other services No national guidelines on rostering practices, skill mix or staff/client ratios, although these are essential components of the cost of providing services. Services are heavily professionalised 25/08/2014 Disability Services Value for Money and Policy Review 7

8. Key Findings (Cont’d) Past: focus on inputs, outputs and global costs. Future: focus on outcomes and unit costs, but: no common definition of outcomes, and no national measurement or monitoring; Insufficient information to determine unit costs at individual service user level, consequently no analysis or monitoring. 25/08/2014 Disability Services Value for Money and Policy Review 8

9. Employment - Key Findings The provision of Health supports plays a vital part in enabling a person with disabilities to access education and employment. Most people accessing specialist disability services are not in employment in the open labour market. (Expert Reference Group reported that 2,389 of 25,302 people using day services could be considered to be in the workplace (9%) ) 25/08/2014 Disability Services Value for Money and Policy Review 9

10. Employment – Recommendations 1 Indicators should be developed to measure the effectiveness of the disability services in promoting personal progress through access to day services and supports. The health sector should continue to be responsible for providing health-relatedsupports to facilitate access to mainstream services in the following areas: education, employment, housing, transport, healthcare and community inclusion e.g. personal assistance supports for adults who live in the community or therapy supports for children attending schools etc. Disability Services Value for Money and Policy Review

11. Employment – Recommendations 2 • In the absence of day service standards being set and monitored by HIQA, the HSE should establish a framework whereby they can satisfy themselves, within the context of the SLA process, of the outcomes and quality of day services through dissemination of quality assurance guidelines, self-evaluation and continuous quality improvement protocols.

12. Challenges Capacity of the system to implement the recommendations Need to increase efficiency of current system pending migration to new model and achievement of target cost per place Implementation of standardised assessment method for services and needs Change-over to provision of services based on identified need and personal choice 25/08/2014 Disability Services Value for Money and Policy Review 12

13. Opportunities 25/08/2014 Disability Services Value for Money and Policy Review 13 Current financial climate will provide an impetus for innovative solutions Opportune time to make changes to staff mix and embedded rostering practices Desire amongst many service users and their families for greater choice, control, independence and social inclusion Realisation by service providers that the landscape has changed and they must change with it Innovative practices already evident on the ground

14. Implementation • Framework for implementation will depend heavily on new structure of Health Service • Options are currently being considered for a national implementation plan for VFM • Would welcome feedback and input from sector to the report and to implementation

15. Implementation Priorities Strengthen national disability function Initiate demonstration projects to drive migration towards person-centred model Put in place commissioning and procurement framework Develop national resource allocation model which will provide a framework for individualised budgeting & ‘money follows the patient’ Establish strategic information requirements 25/08/2014 Disability Services Value for Money and Policy Review 15

16. Immediate Actions Streamline SLA process Standardise financial reporting Each agency to examine VFM findings and draw up plans for: audit of rosters, review of skill mix, critical examination of cost base, reduction in average cost per place (for a range of service types and support needs) Introduce unique identifier to support a move to individualised resource allocation and service provision 25/08/2014 Disability Services Value for Money and Policy Review 16

17. Conclusion Report sets out a clear direction for the development of disability services Policy direction is in line with the findings of various public consultations and recent HSE reports (Adult Day Services, Congregated Settings) Broad welcome for the policy expected from people with disabilities and families, and disability agencies, but concerns about continuity of service pending migration to new model, and also the effects of the country’s current financial difficulties. 25/08/2014 Disability Services Value for Money and Policy Review 17