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February 10 2012

ARCHIVED EMS Demand and Budget Management Update - Enable New Zealand Region

Currently the Priority Two list for all requests is:

Equipment $1,767,798

Vehicles $191,158

Housing $3,936,130

Please note the vehicles purchase and housing modification purchase figures are before any outcome from Income and Cash Asset testing.

Priority One

Enable New Zealand wishes to acknowledge the diligent and considered work undertaken by EMS Assessors and clinical leaders using the Priority One process. This work has meant that people who have the greatest needs are being provided with EMS solutions as quickly as possible.

Information regarding processing times for equipment and housing, expenditure and Priority One volumes are posted on disabilityfunding.co.nz, these are regularly updated (processing times daily, DHB expenditure quarterly and Priority One volumes monthly).

EMS Equipment Processing Times

EMS Housing Processing Times

DHB Spend Information

To manage the budget and process MOH List Equipment and Priority One applications Enable New Zealand needs to receive a maximum of 200 Priority One applications each month. When less applications for Priority One are received then the timeframe for funding approval may reduce, currently this is at 20 working days. The variety and variable volume of Priority One requests across the country are noted. Those areas which are over represented with Priority One will be experiencing some additional scrutiny of requests by Enable New Zealand to ensure we have a shared understanding of the intent and application of the Priority One process. As a last measure an area may have an enforced target of Priority One applications per month.

To clarify a process issue with Priority One; where the EMS Assessor is also the professional leader for that department or DHB, they will also need to get their Priority One request signed off by a third party and not by themselves. In such cases the intent of peer review needs to be applied, i.e. there will be a line manager, or colleague or clinical supervisor that is available to the EMS Assessor to use fo the Priority One process. For more clarification and assistance on the Priority One process please contact any of the professional advisory team at Enable New Zealand.

Priority Two Equipment Requests

Work is progressing with matching items coming into the returned equipment stores with requests for solutions for disabled people on the Priority Two list. It is extremely unlikely that funding will be available in the foreseeable future for purchasing the items waiting on the Priority Two list. Where a person has waited 6 months for a EMS solution and does not meet the Priority One threshold a review of the person's needs is required by the EMS Assessor. Possible outcomes of this review are;

  • The application will be withdrawn as the eligibility criteria of ‘essential’ for an EMS funded solution is no longer met.
  • The recommended solution is reviewed and stepped down (perhaps to an MOH Equipment list item) as the person clearly has not experienced the episode that they were identified as being at risk from. Please notify Enable New Zealand of any change in recommended solution.
  • The needs for the client now meet the Priority One indicators and the process may be followed to gain Priority One status.

Procurement

Enable New Zealand has been undertaking a new round of procurement for Preferred Supply and MOH List equipment. We had very valuable assistance in the selection process from Allied Health professionals from around New Zealand and we wish to acknowledge their expertise, experience and willingness to be involved in the process. When purchasing from suppliers greater volume means better pricing. As Enable New Zealand purchases equipment for the EMS contract, ACC and the DHB short term loan pool, the volume of items we went to tender on has been significant. At this stage it appears that significant further savings to the EMS budget have been achieved and new MOH Equipment List and Preferred Supply lists will be available to EMS Assessors shortly.

Enable New Zealand will be reviewing past volumes, demand and usage of equipment to ensure the lists match what is needed for disabled people, EMS Assessors and the budget management requirements. This may mean some items are added, more options provided or items removed from the lists.

Priority Two Housing Modification Requests

The Housing Priority Two list is a concern to Enable New Zealand, unlike the Priority Two equipment list requests Enable New Zealand is not able to match items in the Store with the request in the applications. It is highly unlikely that any funding will be available for Priority Two Housing modifications now and into the foreseeable future.  Enable New Zealand needs EMS Assessors assistance in this area.

  • Where the request meets Priority One indicators please make sure the request is submitted using the Priority One process.
  • Where a person’s needs have changed and the P2 application can be withdrawn it is very important that EMS Assessors inform Enable New Zealand no matter how small the request may seem to be, so that we can accurately reflect the amount of people on the Priority Two list.

Evaluation of the available statistics for housing modifications have identified the greatest area of concern is with bathroom requests. This spreadsheet notes the number of requests received from each DHB area for Wet Area Showers (please note this is numbers of requests not approved and completed volumes). EMS Assessors will be aware these types of modifications are very high cost, take considerable time and effort to complete and often require additional work with Income and Cash Asset testing. Currently there is 236 bathroom requests on the Priority Two list with the vast majority of these (95%) being Wet Area Showers. In regard to the Wet Area Shower indicators discussions review of the requests currently on the Priority Two list is warranted. Enable New Zealand will be providing DHB assessment services with the list of requests for bathroom modifications and seeking further information as to how to manage these applications.

Enable New Zealand has had discussions with some DHB’s over the Wet Area Shower volume figures and the following issues/approaches from some DHB’s have been noted from these meetings.

  • Some applications are made at the request of the client and are not supported by the EMS Assessor.
  • There is no standardised assessment tool for assessment of ‘risk’ i.e. the risk of falls scenario is often cited in EMS Assessor reports
  • Internal peer review ensures standardisation/moderation of applications
  • Pushing alternative methods of undertaking an activity
  • The acceptance of ‘strip washing’ as a viable alternative
  • The need to educate referees and reduce referrals which specify solutions and raise client/family expectations
  • Encouraging lower priority situations to self fund – i.e. hand rails
  • Ask the key question ‘what would happen if we did nothing?’
  • Apply ‘strong’ interpretation of the criteria

We would welcome feedback regarding this area, please send to david.guest@enable.co.nz.  We are keen to assist the profession with evaluation of process and assessment standards.

Enable New Zealand’s professional advisors will be at Show Your Ability and are available to further discuss these issues.

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