Meeting Notes: Health and Disability Reference Group Meeting 7 December 2016

Meeting Notes: Health and Disability Reference Group Meeting 7 December 2016 On 7 December 2016, the following items were discussed by the Health and Disability Reference Group (the Group):

 Disability Confident Employer Research

 Disability Confident Campaign

 Two-way communications between GPs and Work and Income

 Targeted Health Intervention review

 Service Delivery Update

 People First NZ employment project

1 Summary of actions and next steps

Actions Responsibility By when Send out Disability Confident Employer research Grant Cleland March 2017 report Provide a summary of initiatives and Ministry of Social March 2017 trials and numbers of people by Development different types of health and disability Provide feedback to David Bratt on Group members March 2017 review of Target Health Interventions Organise a workshop alongside the Ministry of Social January 2017 next meeting to discuss the different Development roles and strengths of Work and Income and providers Send link to Workability Conference Claire Stewart March 2017 sessions Group members to send through All 1 February 2017 ideas for the agenda related to improving employment outcomes for disabled people and people with health conditions

1 2 Key messages  The role of the Group is to provide a forum for MSD to test ideas at different stages of the process and to disseminate information to wider networks.

 Most items that are brought to the Group are not confidential and can be shared with broader networks. If this is not the case, the Group will be advised.

 Messaging and language should be inclusive across health and disability e.g. include specific reference to mental health and addictions.

 There is a gap in information sharing. Two-way communication between Work and Income and GPs is one mechanism, but requires further discussion.

 The scope of the Targeted Health Interventions review should be widened to include access to dental treatment, addiction treatment services and counselling services.

 There needs to be clarity for the sector about similar work e.g. Disability Confident Employer and Employability. There needs to be greater sharing of ideas and information to strengthen alignment and work together to improve employment outcomes for disabled people and people with health conditions.

Agenda item: Welcome and housekeeping

Grant Cleland welcomed everyone to the group, noted apologies from Neville Corkery, Rose Wilkinson, Anne Hawker, Gaye Austin

Attendees introduced themselves: Helen Robertshaw, Thomas Bryan, Stephen Bray, Michael Aldridge, Kay Brereton, Shelly Hannah, Tane Taylor, Tyron Pini, John Grant, Kim Gosman, Grant Cleland, Nic Johnson, Kevin Harper, David Bratt, Francis van der Krogt, Marion Blake, Claire Stewart, Amy Hamerton, Esther Harcourt

Role of the Health and Disability Reference Group

As part of the introductions, a discussion arose about the role of the Group. There were questions about the history, membership and purpose of the Group and how to deal with conflicts of interest.

When Sacha O’Dea joined the meeting, she outlined that the Group has two purposes:

2  To provide a forum for MSD to test ideas at different stages of the process

 To disseminate information to wider networks.

Feedback from the Group is discussed by the BPS 1 Service Design Committee, a group of high-level decision-makers.

Key points from the discussion:

 MSD expects members to seek input from their wider networks.

 Most items that are brought to the Group are not confidential and can be shared with networks. If this is not the case, the Group will be advised. MSD will include under each item on the agenda what kind of input the Group is being asked to provide.

 Members who identify that they have a conflict of interest in relation to a specific item should raise it with the Chair.

 MSD will provide timely feedback about what has happened with the issues the Group has raised.

 The Group needs greater clarity about what happens next. MSD will only come back to the Group on an issue if there is another stage where input is required.

 Any concerns about an individual should be raised directly with Sacha (by email at any time).

 It would be useful to have the history/background to the Group to the Terms of Reference.

Disability Confident Employer research Grant presented the findings of the research report “Building disability confident employers and workplaces” (see attached presentation).

Questions/comments from the discussion:

 Are employers getting information on time (for example about Supported Employment organisations)?

 Employment of people with mental health conditions is better represented in the international literature (e.g. there are more random control trials) than employment of other disabled people.

3  The term disabled people could exclude people with mental health conditions, as employers don’t consider them as disabled, and people with mental health conditions themselves don’t identify as disabled.

 It is important to note that while there will be different responses for different groups, potential solutions to the issues raised in the report will benefit both groups.

 Pre-employment funding could overcome some of the barriers to work e.g. funding for items that will help someone get into work.

 General attitudes of employers and society are not covered in the research findings, but can be either a barrier or enabler. For example, employers’ experiences with disabled people outside of work (e.g. family members) often mean that they are willing to employ disabled people.

Grant explained that the governance group overseeing the research will consider the findings and make recommendations based on them.

Action: Grant to send out full research report to the Group.

Disability Confident Campaign

Georgina Muir from MSD joined the group to talk about the Disability Confident Campaign, a campaign led by Minister for Disability Issues Hon Nicky Wagner that targets employers.

It was launched at the end of November in Auckland and hosted by Business NZ, with major employers speaking (ACC, Z Energy and ANZ) and the Paralympics video.

Next steps are a toolkit for employers, a social media campaign, a website and postcards. Newsletter articles will be prepared for employer networks e.g. business.govt.nz mailing list, Chambers of Commerce. The campaign ends in June.

 We should be targeting the Public Sector, as a model for what success looks like. We need more research in the public sector about what works.

 MSD has conducted a disability survey of employees. The toolkit has originally been prepared for the public service and has been adapted for a private sector audience.

4  It is a confusing landscape with Project 300, Hidden Talent Tour, Employability and Disability Confident. From MSD’s perspective, the Disability Confident campaign is just another avenue to get the information out to employers.

 The use of the term disability includes people with mental health conditions and additions under a label they don’t recognise and respond to. It is the same reason many in that group don’t access the Disability Allowance.

 In the short term, the measures of success for the Disability Confident campaign are about getting the information out to employers, and include hits on the website, downloads and feedback about the usefulness of the material.

 There needs to be a focus on people being retained in the workforce e.g. through a Mindful Employer campaign.

 There should be a campaign for larger employers – starting with the major companies.

 Make use of other reference groups e.g. Health and Safety in Employment Group.

 The launch of Employability was not well managed regionally – people were invited at the last minute.

Two-way communication between GPs and Work and Income Dr David Bratt outlined the two-way communication work, which seeks to address the issue GPs have raised in surveys and at conferences that Work and Income asks for information from them but doesn’t feed back what has been done with that information.

David raised the following specific issues:

 How do we gain consent from the person to feed back to GPs about what has happened with the information from the GP?

 What sort of information would be useful for the person?

 When should information sharing occur? In what context?

The mechanism being considered is Healthlink (the current portal, e.g. for sending hospital discharge summaries back to GPs).

 The issue of two-way communication is broader: there is also an onus on Supported Employment agencies to share information with the GP and for Work and Income to

5 share information with Supported Employment agencies. However, the IT costs associated with sharing information can be prohibitive for NGOs.

 A set of standard messages will be developed to make the process easy for case managers (and therefore more likely to occur). There needs to be more discussion about what those messages are. Initially the messages are likely to be basic, and once those have been trialled, there could be discussions about whether to expand.

 The communication needs to be timely – e.g. the GP needs to know quickly whether or not a medical certificate has been accepted.

 Consent and transparency are vital. Communication needs to be for benefit of the person.

 There is agreement about the principle of sharing information. To make it happen there needs to be funding, but there needs to be demonstration that it works to get the funding.

Targeted Health Intervention review David then outlined the origins of Targeted Health Interventions. They came from the PATHS programme, which was set up to fund a health intervention where that would remove a barrier to work (an early example of the investment approach). It is still operating in Counties/Manukau DHB region. As Targeted Health Interventions, it was handed over to regions.

Work and Income is now looking to develop a nationally consistent version. There would be a tiered system for approvals, depending on the cost of the intervention: 1. Service Centre 2. Regional 3. National. A report will be prepared by April. David will come back to the next Group meeting to discuss what Targeted Health Interventions would look like.

 How does this relate to the packages of care work with DHBs? This work has overridden existing Reach programmes.

 If there has been an evaluation of PATHS, the new intervention should build on it.

 There needs to be a more integrated response that looks at the underlying issues and barriers and takes full account of the complexity of problems. A range of interventions need to be considered e.g. addiction treatment, counselling, dental treatment.

Action: Group members to send any feedback on the review to David.

6 Service Delivery Update Warren Hudson and Dee Mitchell provided an update from Service Delivery.

The work Service Delivery is undertaking is driven by the valuation of the welfare system, which looks at the long-term liability of different groups of beneficiaries.

There are a number of trials underway:

 Oranga Mahi – a $9 million trial being led by Kamal Acharya (who could attend next time to provide more information).

 Mana Taimahi – a partnership between PHOs and Work and Income.

 Young SLP Trial – a three-year formal trial with a full evaluation.

 SLP Trial – anyone on SLP can work with someone to help them move into work. Approx. 300 people have joined since May/June.

Work and Income has also been making changes so that the information in the system reflects clients’ strengths and interests. This has included changes to medical certificates. There is also ongoing work to build staff capability

 Are clients being referred to Supported Employment agencies? Are referrals tracked?

 Internal and external relationships need improve to deliver a better service to disabled people and people with health conditions.

 How can Work and Income work more effectively in the regions, e.g. with stakeholders?

 There is a fragmented environment, with a conflict between contracting out and growing skills in-house. There needs to be a focus on the right service for the individual.

 Supported Employment providers never turn people away. Work and Income needs to refer more people to providers. It has a major gatekeeping role.

 There needs to be great trust and information sharing between Work and Income and providers. There are some good examples of staff who proactively engage, but turnover can be an issue.

7  A champion or key point of reference in the regions is vital, and it should be someone who can make quick decisions. The differing levels of success between regions in the launch of Employability reflect the presence or absence of a champion in the region.

 Look at what has been contracted out to see what works. Supported Employment is effective. There could be data analysis to see what is a successful outcome.

 The current approach is excluding Supported Employment providers and GPs and not drawing on their knowledge. Sometimes it takes all three working together to get an outcome for someone.

 MSD tries to do everything and be everything. MSD needs to ask ‘What are we good at? What are others better at?’ The client should be at the centre and there needs to be a better understanding of what providers can do and what MSD can do. There could be a trial partnership between MSD and a provider.

 MSD should use the College of GPs – work as a health issue. It should also come to GPs and discuss how to take a whānau approach to working with people.

 There needs to be a path to good employment e.g. training to join the workforce. This doesn’t come into the MSD mindset.

 People going into part-time employment should be valued. Many people live with someone who is working, so are not Work and Income clients, but we should still value getting them into work.

 MSD and Ministry of Health should partner to introduce a Mindful Employer Programme to keep people in work.

 Consent and privacy issues make two-way information sharing difficult.

 Work and Income needs to make greater use of co-design to understand what people need from Work and Income and what is actually going to make the difference.

Action: MSD to prepare a one-pager setting out all the trials and initiatives. It should also include a breakdown of the different health and disability types and if possible, the numbers being placed into work.

Action: MSD to organise a workshop to coincide with the next meeting (e.g. the day after) for those who are interested to discuss the different roles and strengths of Work and Income and

8 providers. Consider using an external facilitator. Scenarios about clients could help to set the scene.

People First NZ employment project Michael Aldridge and Annemarie Kirkpatrick presented on the People First project “Having the slice of my life – promoting employment for people with learning disability in New Zealand.”

A video was created featuring a People First member who has worked at Domino’s Pizzas for 7 years and is now a head dough-maker. The main accommodation he needed was time – extra training to understand the job.

People First has been taking the video to Rotary Groups around the country.

Action: Claire is to follow up and send links from the Workability Conference.

Closing comments and key messages

The Group agreed the key messages and action points (see front of minutes).

Esther Harcourt will be taking over the support of the Group from Amy Hamerton.

A final issue was raised about security in service centres. In response to the Worksafe sentencing, MSD is expected to increase security again and require ID and a booked appointment to enter from Monday 12 December 2016. The security measures can be intimidating for clients.

The next meeting will be around the second week of March. The CQ venue is not accessible for wheelchairs, so another venue should be booked next time.