Better lives through innovative planning and budgeting: the role of Individualised Funding (IF)

Rob GillBusiness Development and Support Manager

Structure of presentation

Introduction – what’s all the fuss about natural supports?

Recent changes to disability services in New ZealandIndividualised Funding (IF) – putting people in the centreThe evidence in favour of IF

Discussion & Questions

Te Pou’s role and key relationships

Natural Supports - a youngster resting with Mum

NZ disability service reform timeline

1990s Reforms began with closures of institutions2001 Long-term support systems focus on the person2003 The ‘Ordinary Life Report’ reveals poor outcomes2005 Individualised Funding appears formally as a pilot project2006 The era of large institutions ends2009 A new model is approved incorporating IF

Te Pou becomes NZ’s disability workforce centre2010 An IF market is established with 12 providers2011 The 2nd Canterbury earthquake (IF arrangements are durable)2011 ‘sleep-over’ case minimum wage ruling in the Supreme Court

Business case for IF

Issue – service quality is elusive in spite of regulations Cause – Funding ‘buckets’ are seen to be too rigidly tied to specific purposes and contracting too focused on the service provided rather than meeting genuine needs and producing improved services (MOH, 2009, p.48) Need – new services that deliver value to consumers, providers and tax payers. Solution - Individual “budgets hand control to service users and give them the flexibility to tailor care to meet their specific needs (Alakeson, 2008, British Medical Journal)

Stage One = assessment and choice

Stage Two – negotiation and delivery

Stage Three – verification, invoicing and payment

NZ IF snapshot

began in Christchurch in late 1990s only one provider from 2005 to July 2010 IF is offered nationally from 2007 IF numbers have quadrupled since in the past 2 years Two of 12 providers offer national coverage about 1000 people currently use IF satisfaction is very high (90+% on average)

NZ IF criteria in brief The applicant (or their agent) must be willing and able to

manage the budget there is no minimum or maximum threshold for funding the budget holder must agree to certain responsibilities and

obligations

What are the various labels for IF? Personalisation is used some countries (usually in mental

health)

In Australia – individualised support packages, direct payments

In the UK – individualised budgets, direct payments

In the USA & Canada – service vouchers, self-directed care, brokered support, cash and counselling

What is IF? A flexible funding allocation method based on need Control of funding transfers to the eligible person All funding is managed by the person (or their appointed

agent)

What are the guiding principles of IF?

Values = person-centred support and personalisation

social model of disabilitychoice, flexibility and regular reviewsaccessible tailored supportinformed decision makingservice users determine their own level of supportindividual plans are used as tools to negotiate individual budgetsplanning is undertaken with an independent facilitator individual needs assessments determine funding packages

What is individualised funding usually used for? home based support services (not usually residential) legitimate services that meet agreed needs services that help people to experience quality of life

Real examples1. Three adolescent men who wanted to remain living as

flatmates2. Pre-school brothers with ASD3. A Maori woman living rurally with chronic health conditions4. A young man who lives for rugby5. A senior manager who travels frequently

How does individualised funding work? disabled people describe what they want to achieve objectives are agreed that matter to each person personal packages of care are linked to agreed objectives tailored, responsive and flexible support is available services are ‘ordered’ by the person service delivery is verified payment is claimed employees or suppliers are paid

Average IF packages (hours per week) as at April 2011

Small: up to 20 10 $13,000

Medium: 21-45 29 $37,700

Large: 46 or more 63 $81,900

What help do budget holders need? accessible information training - essential skills (e.g. communication and

negotiation) assistance with financial and employment responsibilities Introductions to other budget holders learning and development support (in the good and bad

times)

What responsibilities do budget holders accept? Employing, contracting or purchasing services being a good employer or giving clear instructions as a

client tax compliance budget management health and safety (for themselves and others) emergency planning

How does society benefit from IF? ‘market’ forces cause the ‘system’ to be more flexible service users experience better health and quality of life participation in paid work or study improves socioeconomic status improves opportunities to build leadership capability scarce funding is used more effectively social care budgets are better managed

Statistically significant improvements in mental health and physical health were reported for IF budget holders in NSW (Fisher & Campbell-McLean, 2008)

Why do these benefits arise? pay and conditions for support workers improve staff turnover reduces workers are strongly commitment to individual service users support arrangements offer flexibility

A youngster ready to go again!

Closing questions and comments

Service reform might seem like someone else's businessbut you can make a powerful difference for good!

Thank you for your participation