Áiseanna Tacaíochta Realising Equality through Active Participation 3 rd December 2014 Supporting Innovation and Change through the AT Model Sheila Marshall Area Operations Manager HSE North Dublin

HSE North Dublin - Profile Population: 244,324 (Census 2011) 10% population growth in North Dublin since 2006 over the national average of 8.2%. North Dublin has the largest population growth over DML (8.6%) HSE South (7.4%) and HSE West (7.7%) Covers a wide geographical area. GMS Patients – 33% of population (82,505) Further 2% eligible for GP Visit only cards (5187) Age profiles under 4 years= 8.3%, under 19 years = 28%, over 65 = 10.9% Deprivation score: 42% of population classed in the high, medium or low deprived category. Persons with disabilities: 7.4% of population.

HSE North Dublin Disability Services No of Home Care Packages: 292 No of private residential placements: 89 Budget: €50.2m

Policy Documentation United Nations Convention on the Rights of Persons with Disabilities – Article 19 Requires that people with disabilities can live independently and be included in the community, with choices equal to others. Programme for Government (2011 – 2016) Commits to the introduction of personalised budgets for disability services. The National Disability Strategy. Time to Move On from Congregated Settings.

Policy Documentation HSE’s New Directions Personal Support Services for Adults with Disabilities Report. Personal Support Services for Adults with Disabilities underpinned by the Core Values of: - Person Centredness - Community Inclusion and Active Citzenship - Quality

Policy Documentation Promoting Inclusion and Participation - Strategic Plan – National Disability Association. Strategic Priority 1: National Disability Strategy Strategic Priority 2: Living Independently in the community. Strategic Priority 3: Universal Design of the environment. Strategic Priority 4: Effective and efficient organisation.

Promoting Inclusion and Participation - Strategic Plan – National Disability Association. Strategic Priority 2: The National Disability Authority’s policy advice, based on research evidence, and on learning from other jurisdictions, is that better outcomes for people with disabilities can be achieved by refocusing the current spending and orientation of disability services away from block-funding of providers and towards a more personalised approach.

Policy Documentation Value for Money (VFM) and Policy Review of Disability Services in Ireland – approved by Government Decision of 17 th July 2012 Steering Group Project Initiation Document – September 2014.

VFM Working Groups Established in Working Group 1: Person-Centred Model of Services and Supports – Strategic Planning Working Group 2: Person-Centred Model of Services and Supports – Implementation, Oversight and Support. Working Group 3: People with Disabilities and Community Involvement.

VFM Working Groups Cont. Established in Working Group 4: Quality and Standards. Working Group 5: Management and Information Systems. Working Group 6: Governance and Service Arrangements.

VFM Working Group 1 – sub group 2 Evaluation Process: Service Delivery Models and Demonstration Projects: Terms of Reference: Develop the baseline data and comprehensive evaluation process to evaluate existing services and new demonstration projects, and assess suitability for wider application. The Health Service will develop a mechanism to enable this work to be carried out in an appropriate manner.

VFM Working Group 1 – sub group 2 Cont. The work will seek to use research and analytical capacity to support this work, rather than the Health Service itself resourcing this input separately. The work will involve a statement of current projects and the evaluation of these projects and their subsequent learning will inform the development of alternative service options. The output from this work will inform the decisions on the Annual Service Plan and Operational Plan for Social Care.

VFM Working Group 1 – sub group 2 Cont. Based on the output of the work outlined above and input from the other working groups an implementation plan will be developed, taking account of any policy appraisal, the scale of organisational change and associated capacity constraints.

Áiseanna Tacaíochta (ÁT) Direct Payments Model “Supports people with disability to move away from dependency on service providers and to gain control over their own budgets, their own services and, ultimately, their own lives. By self managing and taking new responsibilities, our Leaders move from being passive users of services to becoming active business people in the community” – An Introduction to Áiseanna Tacaíochta – 2014.

ÁT Direct Payments Pilot In October 2010 Genio provided funding to ÁT in the sum of €60,000 to support five individuals to establish a system for managing their own funding and directing their own supports. AT proceeded to establish a pilot system of Direct Payments with 4 Personal Assistant (PA) users. With ÁT as the proposed intermediary who facilitates the financial transfer of funds from the HSE to the individual Leaders by itself negotiating an omnibus SLA with the HSE and a Grant Aid Agreement with each Leader. ÁT submitted a business plan to HSE North Dublin in March 2011.Successful discussions were held with the Regional Specialist for Disabilities and the Disability Manager.

ÁT Direct Payments Pilot The first meeting of the ÁT Pilot Monitoring Group was held in November The membership comprised representatives from ÁT, the Irish Wheelchair Association (IWA), HSE North Dublin and HSE Dublin North Central. Project suspended for a period during 2012 to deal with a number of issues including TUPE arrangements. Evaluation and risk assessment (Finance/HR/contingency arrangements etc) was submitted to the HSE in February 2013 – describing ÁT’s governance arrangements/operating procedures and its planning and financial reporting. In March 2013, HSE North Dublin agreed to enter into a Service Level Agreement with ÁT for the clients that were current to the service, thereby bringing the pilot phase to a successful conclusion.

ÁT Direct Payments Model – post pilot phase Further funding was secured from Genio - €50,000, in addition to financial support from the National Lottery and funding from membership subscriptions. ÁT currently has 21 members with an additional 5 joining in January Aim to have 50 members by Development of training programmes. Virtual Office and online hub for members. HSE North Dublin continues to support the model – currently funding 18,972 hours per annum (€355,123)

Direct Payments - The Future Legislation VFM Governance document – HSE framework for implementation. Models of good practice Learning Sustainability for AT model – 50 participants Selective application – may not suit every person using PAs. Legal capacity and contractual status. Continuing fiscal and economic challenges