A Response from the Provincial Network
The consultations questions provided by the ministry are focused on what individuals and families perceive as valuable supports and services. The members of the Provincial Network will participate in providing this feedback through their various organizations and networks. However, as the Provincial Network our feedback will focus on the systemic issues that we believe will be critical in enabling the success of the transformation.
The Opportunities and Action document points out that transformation of developmental services depends on maintaining a healthy agency sector. It goes on to state that the agency system is vital to ensuring that the community capacity exists to support community living for people who have a developmental disability. In support the agency sector the ministry will work with the sector to develop human resource strategies that will include addressing issues related to Pre and in-service training.
The Provincial Network strongly agrees that the agency sector will play a pivotal role in the successful transformation of developmental services. However there are several issues that concern us regarding the assumptions that underlie the plan for change in the agency sector and some of the strategies proposed to effect the changes.
In the section on the plan for system transformation it is suggested that new funding approaches for those people who choose to receive support through an agency will give people greater say in how services are offered. It also suggests that agencies would welcome the opportunity to work creatively with families on developing innovative approaches to providing services. For families and individuals who choose direct funding as an option it is suggested that this will offer increased choice and flexibility that will stimulate innovation and creativity. Also in our conversations with the ministry the new funding approaches have been compared to market forces that will correct and shape better performance from transfer payment agencies. Accordingly we are concerned that the Ministry views the current system as lacking in creativity, innovation, flexibility, responsiveness and accountability. We are also concerned that the new approaches to funding are viewed as sufficient to promote the changes that are described in Opportunities and Action.
The agency sector has a long and rich history of creativity and innovation. This has been realized through flexible, responsive and accountable service delivery. On the other hand improvements are needed and performance on these characteristics is not always even. However, it is important to understand the root causes of any malaise in our ability to excel. Over the past fifteen years we have seen the continuous erosion of our capacity as a direct result of costs exceeding funding. Over the same period we have experienced an alarming decline in the availability of qualified staff. We have also struggled with the changing needs of the people we support. These needs require new skills from a diminished pool of qualified staff and additional expenditures from insufficient budgets. As well agencies have devoted substantial time and energy in supporting the ministry’s initiatives for either reduced spending or increased spending. Over this period of time our efforts in the domains of creativity and innovation have too often been spent protecting the status quo from decline. This would not have been our choice but it has been the reality of operating a community agency throughout the past two decades.
From our perspective the achievement of innovation, creativity and flexibility is more contingent on adequate funding than a correction to the funding approach. Although we agree that portable and individualized funding to agencies will potentially promote positive change there are other significant issues that need to be addressed in order to achieve the kinds of change that is envisioned. These include:
The need to simplify access for individuals and families is fully supported by the provincial network. However, we strongly urge that any improvements to access not be embedded in a single model or structure. Rather we recommend the development of well defined common functions and standards which would constitute requirements in the development of the access process in each region. This would enable the regions to design access to meet the unique characteristics of their community.
We agree that the end goal is to create a simple, easily understood and easily navigated access process. However that does not necessarily translate into a simple operational system. What lies behind a simple experience in accessing services is a complex organization of information, expertise and resources. The task of delivering improved access is further complicated by the variations in technology and information capacity as well as the diversity in populations and geography across regions. It is clear that regions will proceed towards an end goal of simplified access with different levels of capacity and readiness. Therefore we recommend that the functions and standards for access align with benchmarks that will guide development over a defined timeline that includes the scheduled introduction of improved technology, tools and resources. This approach both supports implementation and manages change by setting targets that are commensurate with capacity and resources.
We believe that the goal of improving access is best achieved through a networked approach. Access to ?what? will continue to be a challenge for the near future. In reality most people who experience the access process will have little to access or navigate in terms of Ministry funded supports and services. Access should never be a place where people simply wait. One of the most meaningful functions for access is connecting people who are waiting for funding to community resources, alternatively funded services and supports provided through community agencies, family networks and meaningful information. These connections can only be realized through a network that brings together all relevant sources of information and resources that are more immediately available to support individuals and families. A collaborative network that undertakes this task and includes all stakeholders is an integral part of access.
The need for a collaborative network is further indicated when considering the nature of access. Access is not a single point in an individuals or family’s life. The interaction between services, supports and access is an ongoing reflection of changing needs and circumstances. A collaborative network can create processes to assess and support changing needs while individuals and families are waiting for Ministry funding. As well a network approach creates the opportunity for people to make choices regarding access that are based on faith, culture and affiliation.
The Provincial Network recognizes planning as an important support for individuals and families. Opportunities and Action outlines the Ministry’s plan to establish a network of community-based independent planners/service brokers to assist individuals and families to develop their plans, to assist in finding appropriate supports and to provide ongoing advice. Families will not be required to use these services and can develop their plans on their own or seek planning support from an agency. Providing individuals and families with a choice as to who provides this service is fully supported by the Provincial Network. However, it is of concern that there appears to be an inequity in the Ministry’s investment in the planning options available to families and individuals.
Planning delivered through agencies is typically an additional responsibility for support workers who already have a full workload. Often these workers are funded through non Ministry sources such as United Way and fundraised dollars. Planning has been offered through community agencies because of the recognition of its importance in helping families and individuals. However this service has not been adequately funded nor has it been the focus of Ministry funds. What concerns us is the advent of fully funded independent planners who are compensated beyond what the agency sector can afford and offering time and expertise that is dedicated to planning.
As the Ministry suggests only a small percentage of families will choose services outside of the agency sector. So for those families that make this choice a well resourced planning service will be established and readily available. Will the families who choose to have planning support from the agency sector receive the same benefits? It is our recommendation that equivalent levels of funding be directed towards the agency sector for the purpose planning for families and individuals. It is also our recommendation that independent planners not be attached to an agency that is constituted to deliver these services. This creates artificial barriers between agencies that are portrayed as being independent and those that are portrayed as being encumbered by self interests. This is a divisive and unsubstantiated distinction.
Service brokerage appears to be an attractive area for system transformation in part because of the scarcity of resources available to families and individuals. It is clear that part of the rationale for funding service brokerage is based on the belief that it will mitigate the demands for more costly supports. For example the prospect of a service broker recruiting a student to provide respite has tremendous cost benefits over the more expensive formal respite provided by an agency. The higher costs of the formal system are related to the numerous regulations and legislative requirements to which community agencies are accountable as well as the higher wages that are required for a workforce that receives benefits and higher than minimum wage compensation. The extent to which the example of hiring a student can be realized across a full range of supports and services is yet untested. The extent to which this example is desirable is questionable.
There is absolutely no doubt that the relationship that the student can offer through friendship is invaluable and there are so many ways in which that can be facilitated. But to see the work of that student as a less expensive alternative to a regulated workforce is an entirely different set of considerations. The compensation for workers in the developmental services is critically low in comparison to any related sectors. To further erode the stability of the workforce by investing in mechanisms that will search out unqualified employees who will work for cheaper wages is not helpful to the overall goal of sustaining a viable and qualified workforce is the developmental services. Of equal concern is that these workers could fall outside of the requirements of accountability, outcome reporting, serious occurrence reporting, health and safety inspections, liability protection and compliance with labor laws.
We are not suggesting that the hiring of students for informal support should in any way be discouraged. Within an array of supports and services there certainly is a role for unregulated workers but this role should be limited to casual and social support. However when unqualified workers become the mainstay of government funded supports the possibility of an informal and unregulated sector emerges.
We have additional concerns regarding the role of service brokerage in ‘shopping? for services on behalf of a family or individual within the agency sector. As we have mentioned we have an overall concern with the introduction of market competitiveness in the developmental services and its potential negative influence on collaboration and service delivery. The influence of a service broker can foster competition and division or collaboration. The issue is the extent to which the service broker is accountable to either outcome. The conduct, professionalism and performance of a service broker must be subject to the same level of accountability that is required from the agency sector. The accountability must be measured against both the families and individuals feedback as well the degree to which the activities of a service broker support the efforts of agencies to collaborate in meeting the needs of families and individuals.
Notwithstanding our concerns we acknowledge that some families and individuals want the option for independent planners/service brokers. We believe that this option should be made available to them. We also believe, however, that the demand for this option will be limited. Therefore we would recommend that funding for the areas independent planning/service brokerage be kept to a minimum and that new funding be directed towards services and supports whether through an agency or direct funding approach. Further we recommend that both effectiveness and cost effective criteria govern investments in access.
Families and individuals are better served when government, agencies, networks and community work together as a system. A mature system undertakes initiatives to achieve quality improvement and assurance, strategic planning, information sharing, research and development and performance evaluation. We think that the key to successful transformation is the ability of the developmental services sector to behave as a system and achieve these system features. We recommend that the Ministry make specific investments to build on system processes and structures that already exist within the regions and further strengthen the sectors ability to realize maturity as a system.