Watch previous provider quality forums

[Jacinda Allwood]
OK, Kia ora, everybody. Ko Jacinda Allwood tōku ingoa. Hello and welcome. I'm one of the principal advisors here in the Quality and Performance team here at DSS and would like to welcome you through to the second of our forums that we're running for 2025

I'll be opening up with opening karakia. I'll be following on with some general housekeeping and instructions for you, and then I'll introduce Sue Sherrard, who is the first speaker of the session from DSS. She will introduce the topic and she will introduce the speakers thereafter.

(Karakia)

So welcome everybody. You will have been entered into this DSS Quality Forum. The topic is the Growing Voice and Safety Initiatives. You will all have your cameras turned off and your microphones turned off.

And fortunately, or unfortunately, you are unable to adjust that at this time, so they will remain off. We will be taking questions in this forum and we will be using the Q&A function -  so in the top of your screen, please click on the Q&A function button. We have actually disabled the chat for this forum, so there's only one function that we will be running the questions and answers through for convenience and so we don't get all confused.

When you go into your Q&A function, you should have a little icon with “Ask a question” which sits beside your name or your initials or your photo if you're there.

If it doesn't say “ask question”, and if it says something about start a discussion, please tick on the down arrow and click on “Ask a question” because otherwise we won't be able to manage the questions properly.

Are there any other instructions that we have? If you want to ask a question, please do so throughout the course of the discussions while people are speaking. If someone has already asked a question that you would like to ask as well, please don't add it in, because it might get quite tricky to manage that with so many people on the call. We have about 100 and.10 people at the moment, which is fantastic.

If you are interested in hearing the answer to a question that someone else has asked, there is an upvote button to the left of the question when it pops up in that Q&A function. There will be a little up arrow, and if you hover over that it will give you a vote, so you just click on that to vote for that question. So please use the upvote button and I will reiterate this later when we get to the Q&A section.

After we have the speakers, we will then move into the Q&A session for the first topic that we're talking about, and then we will introduce the second topic with the speaker and we'll do questions on that second topic afterwards.

But Sue will be explaining all that, and again, I'll reiterate how the Q&A function will work when we get to the time. We will also allow people to ask a question verbally if that's what you would like. So please use the “raise your hand icon”, click on that, and we will try to get to questions that have come up in order. So click on your raised hands and make a note of the question that you are going to ask, so you don't forget by the time we get to you. If we don't manage to get to all the questions, we'll cover some off at the end of the session if there's time, or we will definitely put them on the DSS website when we post the video of this forum.

So that was the other thing. We are recording this forum and you will have all had to to select that you're OK with the forum being recorded before you ask a verbal question if you choose to. I'm happy to manage that so your voice just appears and not your camera, but we can manage that at the time.

You've heard enough from me. I'm sure you want to hear more about the topic at hand, so I it is my great pleasure to introduce Sue Sherrard to you. Sue is one of the principal advisors in our Quality and Performance team at DSS and she will introduce the topic. Over to you, Sue.

[Sue Sherrad]
Kia ora, Jacinda. Thank you so much and thank you to everyone for being here this afternoon. It's a huge pleasure to have this opportunity to talk with you about the Growing Voice and Safety initiatives that the Disability Support Services are developing.

I'm Sue Sherrard. I am, as Jacinda said, a principal advisor with our DSS team. I identify as a disabled woman and I've worked for many, many years in the disability sector.

This is exciting times. Let me tell you a little bit about one of the services and this service is called People for Us. And after we've had our presentations around People for Us, then we'll move into the assisting change topic.

So People for Us is a peer visiting service and it's a really exciting opportunity. We think it's coming out of the quality space because we really want to have the voice of disabled people included in our quality services.

So way back in ‘23, we really did a large engagement around this People for Us idea and we talked with over 420 people and really got a positive go ahead that People for Us sounded like a great idea. We took that information, and we worked alongside the Insights Alliance and developed this new service.

From there we had a procurement process, and let me tell you that takes a long time, and came out with three wonderful suppliers who are working in partnership. and collaborating together, and they're going to talk to us this afternoon about their approach to this People for Us visiting service. I really want to acknowledge the members of the Insights Alliance, and for Lara Penman, who really was significant in the development of this work. And of course my co lead who has sadly left at this point in time, but Kate Cosgriff, we couldn't have done this work without you, Kate, so thank you.

What is People for Us? Well, it's a peer service who will visit disabled adults, tangata whaikaha Māori and Tagata Sa'ilimalo, who were also disabled Pacific people and whānau. It's about visiting people who live in a DSS contracted residential service to find out - and this is our priority - to find out if they are safe, living their good life and experiencing high quality support and services, they will assist those with safety or well-being concerns to follow the relevant pathways to resolve them.

This really grew out of wanting to increase the voice of disabled people and their safety. We know that disabled people experience higher rates of abuse and harm when compared with non-disabled people. And the Royal Commission of Inquiry into Abuse in Care also recognised that inadequate monitoring and support for well-being contributed to the abuse of disabled people in care. This is a really important service, and we believe it will have quite an impact once we start working alongside those people in residential services, so this is an opportunity.

Safeguarding is about protecting a person's right to make their own decisions about their life, including decisions about their safety and well-being. It means taking action to prevent, identify and respond to situations. Where a person is at risk, or experiencing at risk of or experiencing violence, abuse or neglect, People for Us as a DSS safeguarding an initiative that is about identifying and responding.

What will People for Us do? Well, disabled peer workers will visit disabled adults who live in residential services to find out if they are safe, living their good life and experiencing high quality support and services.

They will assist those to who need some kind of follow up into the relevant pathway to resolve issues. Peer workers is a new role in the disability support system. The peer worker is a disabled person or tangata whaikaha Māori, employed to check in with other disabled people regarding their well-being and safety. The peer role is different to other roles in disability support system, including the support worker, a mentor, a connector or a navigator. And People for Us is a free service.

We've got some speakers who are coming to talk about how they and their service is going to really deliver the People for Us work, so I'm not going to say too much more about it. I am going to take this opportunity to again, thank you for coming and being here.

And I'm going to pass over to Gary from People First to talk about their delivery of the people for our service. Kia ora, Gary.

[Gary Bashman]
I'm the manager of People for Us at People First New Zealand. People First is a disabled people's organisation that's run by and for adults with learning disabilities or intellectual disabilities. We've got members across six regions and 41 local groups around the country and all of our members have a learning disability. One of our Kaupapa is about learning about rights and self advocacy.

And because of this, and because the majority of people in DSS funded care have learning disability, we were really interested in being part of People for Us and submitted a tender. And clearly with my presence here, we were successful in that and since that time we've been working to establish the service. I just thought I'd talk you through some of the steps that we imagine - how the visit will happen, and then talk very briefly about what this means for you as providers and members of NASCs.

So the first step is that we will either be contacting a provider about a visit which we are calling a proactive visit, or we'll have received a referral from either an individual, a self referral or a third party. We'll then contact you about setting up the visit because obviously we need to be able to talk to you before we come into one of the houses that you're responsible for.

As Sue's mentioned, the visit team will be a person with a disability, and it’s been announced since we're having a two person visiting team, a peer with a disability and an assistant for that person. At the moment we're thinking the visit consists of three kind of separate parts, some whanaungatanga.

We need to get to know people, understand who they are, and they need to understand who we are. We need to talk to them about getting consent for the information or the conversation that we then have with them. And then we want to have what's we're referring to as a guided conversation, focusing on the points that Sue mentioned -  safety, living a good life and receiving quality services and support.

After we've had that visit, we'll determine if any action is required. We're doing a bit of categorisation work around that at the moment, so we're sort of assuming that we will make some kind of determination based on whether actions needed for the individual in relation to their relationship with the provider, whether there's a safety concern, or whether there are systemic issues that might have arisen for safety.

Once again, Sue's mentioned that will probably be a result in an escalation to a third party, and almost certainly that will be the case. We're just trying to work out some of the detail of that might be that we're organising a meeting with, you know, the people in this audience or staff in the House to discuss issues raised by the person we visited.

That would only be with the permission of the person that we have visited as well. Or we might be working with the individual and or their whānau to help them develop some knowledge about their rights and self-advocacy, you know, building up their skills as well. We think the point of this, the key I guess, is doing something that keeps a person safe and or makes a difference in their life.

In terms of the relationship with providers, I guess some key points we wanted to put out there. First, we're not an audit. We're more interested in safeguarding, looking after the people that whose voices don't often get heard and saying that, we're very much centred on the people we're visiting.

This needs to be about them from our perspective, but we also realise we need to be working with you and providers and NASCs to make this happen. Our ideal is that you end up seeing us as a service that adds value for your residents and you'll be welcoming us in.

It's one of those situations that, you know, especially the people in this audience, you can't always be there to talk to the people in your houses. So we're hoping that we can be the people that can have those conversations and find out what's happening for those people in their lives.

A really quick overview of what we're doing. We're one of three providers as noted working really closely, but I think the idea is that we bring our individual flavour to how we work. So I'll pass you back to Sue to introduce the next presenter.

[Sue]

Kia ora, Gary. Thank you so much for that introduction from People First. Appreciate it. And with great pleasure, I believe we are going next to, uh, Warren from Te Ahi Kaa. So welcome, welcome, Warren. Lovely to have you with us. Kia ora.

[Warren Katipa]

Kia ora Sue. Ngā mihi atu kia koe, o mihi kia ā rātou. Tēnā te mihi, tēnā te mihi atu kia koutou. 

Thank you for having me on. My name is Warren Katipa, from the Waikato and I work for currently the operations manager for Te Ahi Kaa. And I'll be taking you through just a little bit about People for Us. I just want to say that's carrying on from Gary. I think Gary said most of it of what what we do.

Just who is Te Ahi Kaa? We're a Kaupapa Māori provider located in Te Puaha, Waikato down in the toward the Port Waikato region. We're established back in 2016 with the vision from our kaumatua and whānau and we deliver a range of different health and social services, including having a rongoā clinic in our in our premise, but we have services grounded in mātauranga.

Just to expand on also with Te Ahi Kawi, I suppose you could view it as being coming around a fire to be able to solve solutions for the community. So just with our our framework that we're taking in regards to people, People for Us is using the Te Paerata framework. Obviously we're taking control of the taiao or the environment.

And then being able to be the kaitiaki for the region, the area that we're working in, looking then seriously into whakapapa, where people were from and our whanaungatanga, being able to you know bringing all our whānau together, but the ultimate goal of being able to unite in the pursuit of mana motuhake – or to be self-determining. So that's a framework that we're going to push in terms of how he would roll out People for Us. As Gary mentioned, he's mentioned a lot of different processes and we'll be following similar ones, however, we'll be following this particular framework.

Just in regards to some of the processes that we would also consider is similar to actually being on a marae, we would walk through in terms of right from the front gates in terms of the waharoa from the car park, establishing intentions and trust our karanga with respect and inclusion through the recognition of others and their roles and contribution, that when we also then get welcomed down through the whakaeke, being respectful and mindful in these spaces and being ready to engage coming into this this space. Then we have our mihi and we have our speeches, sharing our stories and our intentions.

And obviously with the way out to supporting and strengthening that that bond and connection and that's where we bring in the Hongi, pressing of the noses and building the close relationships and trust is probably the main things that we want to build with our clients. So and then finally finishing off with most of those things that we always have as the hākari is the feast. To me that was where we do the whakanoa. We really bring everything together, celebrating partnership and collaboration. And then we have the poroaki, which is a farewell, ending with respect with future intentions and just so a couple last things, the final wrap up of these things.

So Ti Ahi Kaa will be starting the Our People for House programme in Kirikiriroa, in the Hamilton region and over time we'll expand it to the greater Waikato region. We're going to start small and then build from there because we want to ensure that we get the right processes, and look after the clients because they deserve to be looked after the right way. So we want to make sure that we have our systems in place to be able to continually look after our kaitiaki.

We also have our website up and running for more information about People for Us providing pathways to other things that we can look at for looking after our kaitiaki and making sure they're well established.

And then being able to, you know, having that lovely space in Kirikiriroa for you to be able to come down, visit us, have a cup of tea. And as my CEO Danielle said, and you hopefully you should be lucky to actually come out and actually have a fried bread.
'Cause you know when we have that kai, that kai brings us all together with lovely, great intentions and to be able to actually have the right intentions and that is looking after our people. Kia ora tatou.

[Sue Sherrard]
Kia ora Warren, thank you so much. Really appreciate your korero this afternoon and obviously that you have stepped in at short notice, so we acknowledge that and thank you and our hearts are with Danielle at this time.

It's my great pleasure to now welcome Tevita, and Tevita is going to introduce himself and he is from Vaka Tautua. So warm Pacific greetings, Tevita. Lovely to have you with us this afternoon.

[Tevita Tuita]

Kia ora koutou katoa, warm Pacific greetings ‘Oku ou fie tuku ‘ae faingamalie ko eni ke fai ha fakamalo ki he DSS koe ‘uhi koe faingamlie ‘oku ou pukepuke he efiafi ko eni keu fai ha talanoa mei he Vaka Tautua fekau’aki moe polokalama ngaue People for Us.

(English version: "Greetings to you all, warm Pacific greetings. I would like to take this opportunity to express my thanks to the DSS for the opportunity I have this afternoon to give a talanoa from Vaka Tautua about the People for Us programme.")

Thank you Sue, kia ora koutou katoa, warm Pacific greetings.

As I mentioned, my name is Tevita Tuita. I am the team lead for People for Us here at Vaka Tautua and I'm going to take you guys through a few slides on my presentation.

I also wanted to talk to you guys about Vaka Tautua, who Volataua is.

Volataua is a Pacific for Pacific National Pacific services for mental health, disability and social services. We operate in Auckland, Canterbury, Otago and Wellington.

Here is our workforce, our Pacific workforce. We we are madeout of community social workers, community navigators, peer workers, community support workers. And we work along across services, as I mentioned, mental health, disability, social services.

We are honored to be part of People for Us, as it has been mentioned that the People for Us was created in response to finding from the Royal Commission of inquiries into abuse and care. But what we as Vaka Tautua are best interested in is to
look at utilising or delivering this service into our Pacific community to have an impact, to show the light and help our disabled community to uphold their rights, to enhance their mana and their dignity and to look at what good lives look like for our disabled community. We deliver this work by listening to people are not often not heard, in their own views. We built trust and relationships with them, not only the tangata, but with their family, their support networks, the provider that support them.

As our safeguarding Pacific holistic approach, we look at safeguarding everyone and make sure that we're there. As mentioned before, we're not an audit service, but we're there to support the tagata sa’ilimalo and the aiga and also the provider that we work with, we're committed, we're cultural and communication responsiveness. So we ensure that our Pacific values is incorporated within our service delivery.

How do we do this work? As mentioned, delivery is led by peer workers with lived experience to have a conversation with tagata sa’ilimalo in Malo and DSS funded homes. We use the Easy Read materials, the resources to enable us to communicate with them and to have a better understanding through talanoa using these these materials to unfold the unmet needs in those homes, and for us to be able to work with them, identify the needs and then work with them towards looking at the brighter future, as I mentioned.

We focus and give them hope, give them life, give them, give them light and uphold their rights. We engage with tagata sa’ilimalo and their families, and as I mentioned in residential disability providers. We also work alongside the whānau. The whānau and the ‘aiga are really important in their life. We're the secondary support system. We need to work with them with their support networks. We also support pathways when concerns are raised - response pathways. So we have that in place that we identify concern in regards to neglect, harm and abuse. We follow our response pathways.

Our Pacific strengths in action.

 We draw into our Pacific shared values. As we believe as a Pacific organisation, we hold on to our Pacific shared values. For example, the alofa, respect the vā, the talanoa. We engage better with Pacific people through our talanoa, and the talanoa approach is we tell the story or we talanoa until it's finished.

When it's finished, that's when we look at the bigger picture of our disabled person and how can we better support them through our integrated model of care. Then we can navigate through the system to make it work for them. We collaborate with families and providers, tagata sa’ilimalo stories shared and treated with care and confidentiality. Privacy is one of the things that’s a barrier for Pacific people, but knowing who works for Vata, knowing who's there in our Pacific workforce and it's all about the the the privacy of the the information, sharing the information. So we have a better system that we protect the privacy and the stories of (our community).
I want to ensure that they are in a safe, safe space in our hand and in our practice, empowering people to recognize their rights and well-being. Yeah, so that's how we we deliver this very important mahi and our Pacific Space.

And the last one slide is how we think about this very important work together. We make the difference to People for Us. It's not just a service, it's a movement of safeguarding. We honour the Pacific disabled voices and let's continue to uplift, protect and stand alongside our communities. Thank you so much.

One more thing, People for Us deliver across regions. Thank you so much.

[Jacinda] 
Kia ora, Tevita, thank you so much for your presentation.

So now that that comes to the end of the three providers of the People for Us service, and while I'm introducing the Q&A part of the session, we've got a few minutes set aside at this point to ask specific questions around the People for Us service and those questions can be directed to any one of the providers.

Our spotlighting expert will be looking after spotlighting - Sue who will manage any questions that come in, as well as the three providers that you've heard from so far. We don't have any questions in the Q&A function as yet, so whether or not nobody has any questions or you're not able to use the Q&A function, which is not ideal, so hopefully that's not the case, but we do have the option for people to raise their hands as well if you would like to ask a question verbally.

So we'll just give everybody a minute or two. And we'll start with the written questions that have come through through the Q&A function. So um, we will commence with the first question and our colleague Solmaz Nazari will be reading out those questions. Thank you.

[Solmaz Nazari Orakani]
Yes, I am Solmaz, I am Senior Advisor in Quality team and the first question is can you please reiterate the areas that the providers are operating in.

[Sue Sherrard]
Kia ora Sue here. Um, I think, uh, Tevita, you said that the area you were working in was Auckland and Warren said, I think that, um, Te Ahi Kara is starting out in Kirikiriroa Hamilton. And Gary, would you like to talk about People First?

[Gary Basham]
Kia ora. So we're a national provider, so everywhere, but we're starting our build in also in Kirikiriroa, here in Wellington, in Christchurch and Ōtepoti Dunedin. So be the four places that we're starting very soon, but growing to be national.

[Sue Sherrard]
Kia ora. Thanks, Gary.

Solmaz Nazari Orakani
Kia ora, thank you so much. And the next question is, how is this similar or different to the DAPAR contract?

[Sue Sherrard]
OK, so People for Us is again similar to DAPAR in some ways, in terms of it's not a crisis service. This service is about visiting people in residential service and working with them so that we can understand, and they can understand, what their current experience is in terms of their safety and their well-being and then working towards response pathways should that be needed.

One of the response pathways will be into a DAPAR service, and so we are currently in contract negotiations around who will be providing the DAPA service and so that's just one of the response pathways. Others will include family a whānau. Possibly NASC and EGL sites, maybe things like health service or social service. So there's there's a variety of different ways that People for Us will refer into different response pathways.

[Solmaz Nazari Orakani]
Thank you, Sue. Kia ora. And uh, the next question from, uh, one of our attendees. So Jay's asked about what is the referral pathway please.

[Sue Sherrard]
The referral pathway that's at this point in time is still being really finalised, but each of our providers will be available through their websites.

And I know, uh, Vakatoto, I think you said, um, Tevita, that your website was up and running or was that you Warren? Would one of you like to comment?

[Tevita Tuita]
We're working on, sorry, we're working on a website and the electronic referral process. Thank you.

[Sue Sherrard]
Warren, would you like to add a comment there from Te Ahi Kaa?

[Warren Katipa]
Yes, it's the same with us. We're just currently in the process on how to make it a lot more easier, especially with the referral process.

[Sue Sherrard]
Nice. So people can refer themselves, family can refer, anyone concerned can refer into the people for our service and then we will also, as Gary talked about, be reaching in and visiting through the provider networks, Gary, would you like to make a comment around that?

[Gary Basham]
I think like everybody else, we're building a website. We're also exploring an 0800 or a free phone number for people as well. We think we might learn a lot of different ways about how people want to refer, and we want to just be responsive and as Warren said, make it as easy as possible for that to happen.

[Sue Sherrard]
Kia ora. Thanks, Gary.

[Solmaz Nazari Orakani]
Thank you so much.

[Sue Sherrard]
I think Tevita just wanted to add something.

Solmaz Nazari Orakani
Yes, sure.

[Tevita Tuita]
Yeah, I just wanted to add on, while we were working on our website and all that anyone can just ring up 0800 825 282 and be put through to myself during work hours and then we will create a pathway to engage with those inquiries into People for Us. Thank you.

[Sue Sherrard]
Kia ora. Thanks, Tevita.

[Solmaz Nazari Orakani]
And we have one more question. Can you please detail your plans to connect with people living in services who experience significant communication barriers?

[Sue Sherrard]
Nice. This is really important because it is the population that we are most concerned about and really want to get alongside. And so how people communicate is really critical to the service and the success of really bringing their voice and their experience into this space. So we've doing some training and working alongside people. I'm gonna throw to you, Gary, to see if there's some other things that you've been considering.

[Gary Basham]
Yeah, I mean, as you say, it's super important doing a lot of thinking about this. We've got a meeting next week with an organisation called More Talk who specialise in speech and language therapists who specialise in working with people with different communication styles. Where part of People First is Easy Read as well. So we're making sure that a lot of our information is in the Easy Read (format) so it's easier for people in particular with learning disability to be able to absorb that, but we sort of recognize that we're going to have to involve wider people around the person that we're visiting potentially to make sure that we are able to, you know, understand and hear the stories that they've got to tell us.

[Sue Sherrard]
Oh, nice one. Thanks, Gary. Appreciate that. And I see Jacinda is waiting in the wings. Kia ora, Jacinda.

[Jacinda Allwood]
Kia ora, Sue. Thanks so much for that, and thank you for the questions that you've posted in the in the Q&A function. Everybody, we will move on to the Assisting Change service now just so we can cover off the information that we've got for you. But we will come back to some of those other questions if we have time at the end.

So I'll hand back over to Sue to introduce the Growing Voice and Safety Assisting Change initiative and our speaker. Thanks, Sue.

[Sue Sherrard]
Kia ora, Jacinda, thanks so much. I'm feeling very, um, just so excited to be able to also introduce the assisting change work that has been going on now for maybe five months or so. I'm looking at John who's nodding at me. So yes, Assisting Change is again, a quality initiative and it's about how can we support providers with quality questions, concerns, issues possibly in ways that are useful to providers.

We know as the quality team that there are various ways quality issues come into us and we become aware sometimes of more and it's this. This service is not so much about individuals, but it's about providers and recognizing that sometimes there are patterns that we can recognize within the quality team. And so we can often pick up issues. Also our portfolio managers within DSS come to us with questions about “0is this an issue that perhaps assisting change could support if it is?”.

Then we contact to Te Pou Wairoa, who is the provider of the Assisting Change work and they will work together and I'm going to get John to talk about how they do this.

But really, it's about setting up systems to support providers to manage issues that they might come up with. So that's enough for me and kia ora, John, I know you are here from Te Pou Wairoa.

[John Taylor]
Yes, I am talking about Te Pou Wairoa, which has the Assisting Change contract. So I'll talk a little bit about Te Pou Wairoa, and then how we hope to work and some of the projects we've been working on. We established specifically do this work, and we are a disabled person and family led organisation that is about to support the voice and leadership of disabled people, tangata whaikaha Māori families and whānau.

And we have as our foundation principles Te Treati O Waitangi, Enabling Good Lives and the United Nations Convention on the Rights of Persons with Disability. Our name comes from was gifted to us by Ngāti Awa ki re Awa o Te Atua, Iramoko Marae and they are closely associated with the work that we're doing.

Our goal is to support providers to insure, to assist disabled people to have the best life that they can have, and the way it works is that if a provider is finding that there's some systemic issues going on for them, either within their control or without of their control, they can talk to their contract relationships manager or - what's the new name for that? Sorry, I can't remember - and a referral can come through to Te Pou Wairoa.

The way we operate is that we have a range of associates who work for the organisation, and other associates are people like Grant Clayland, Lorna Sullivan, Jonathan Tautari, Poroto Naropu, Jane Bawden. There's a bunch of us who have a fairly long history in the sector, and we all have different expertise that we can bring to support providers to do what they need to do. Our way of operating is to figure out with the provider what the issue is, look at a range of options for how things might change so it's more successful in supporting disabled people and then help them bring about whatever change is required.

Some of the things that we're working on at the moment, just to give you some examples how this looks, is that we are working with one organisation that has had a number of people in senior management leave the organisation through, well, frankly through death and through other unfortunate situations. So we're supporting that organisation to develop the expertise of the current senior managers, we're working with another organisation to look at Enabling Good Lives training and how to imbue the organisation with Enabling Good Lives and the processes that would put that into effect. We are working with another organisation to think about alternative alternatives to their current respite model. The current respite model is an in-house in residence one and they want to do things differently. So working with them.

One of the larger projects we're working on is to think about one organisation's having quite a bit of or has had quite a bit of trouble in working out a pathway for people with learning disability or intellectual disability who also experience mental health distress. Now, for most of you will know this is an issue right across the country, so in one area we're working with this provider to try and develop a pathway and we're working with mental health services and a whole bunch of other organisations to think about how we can successfully work with people who have a learning disability, and who might also experience mental distress because you know the current situation of how that works and it's not very successful.

We are working with another organisation on some individualized service design for some people are they're supporting who have very high and complex needs, and we've also established a very small provider group who want to think about things such as how they can make sure their housing is the best housing they can find for disabled people and suits future demand, how they can think about outcome measurements to see if what they're doing works well for people.

We're hoping in time that we'll be seen as a partner to to assist them to do better, rather than somebody who gets called in when things aren't going well.

Yeah, that’s it in brief. Depo by order. Hope that is obvious helps.

[Sue Sherrard]
That was that was great, John. Thank you. And some of this information, once you've done the thinking and figured out some of the pathways that you talked about, will go up on the website and be freely available to anyone.

[John Taylor]
Absolutely. It's a very good point. Yes, thank you. So, a lot of the learnings we take out of this, we'll anonymise it and we'll make it available to providers on our website which is tepouwaiora.org.nz, and over time there'll hopefully be a section which you can go on to and if you've got a similar issue, you can read what's happened before, make contact and we'll better put you in touch with other providers who have gone through that journey.

[Sue Sherrard]
Awesome. Hey, thanks, John. Thanks for sharing the work for Te Pou Waiora under the assisting change banner of Growing Voice and Safety. Jacinda, have we got some questions?

Jacinda Allwood
Kia ora Sue and thank you to both yourself and John, Gary, Tavita and Warren for sharing some of the updates on this, these really important initiatives and services that are going to be rolled out shortly.

So we don't have any raised hands, so this is your opportunity to star and shine and ask your question verbally if you'd like to, and I’m more than happy to just have your microphone turned off so we don't have to have your camera. If you would like to ask a question, you should be able to access the raise hands function on this Teams forum, but we don't have any as such.

I'll just keep an eye on that for the next couple of minutes and hand over to Solmaz because I think we have a few more written questions. So thank you.

[Solmaz Nazari Orakani]
So the question for Gary, do you have services available in Whangarei?

[Gary Basham]
Not as yet. As I said, we're just in the very early starting place and so the four places we're starting would be in the Waikato region, Lower Hutt, Christchurch and Dunedin.

[Solmaz Nazari Orakani]
Thank you so much. And the next question is from Adrian. How far out are plans to provide services in Northland?

[Gary Basham]
I wonder if Adrian is working with Helen to ask both those questions. It's probably for me again as well. I think what we need to do is we need to develop a plan for growth and have a good chat with Sue about the timeline for growing. So no, no details on that as yet.

[Sue Sherrard]
Nice.

[Gary Basham]
But you know, we we're keen to get up and get running as quickly as we can.

[Sue Sherrard]
It's certainly, certainly beginning to work alongside people as soon as we can. And it's, yeah, exciting times and we will be putting more information up on the website, the DSS website and so people can refer there as well to really get a sense of how things are going, we want this to succeed. It's really important for disabled people. So we're encouraging the start small and build slowly and and try and learn and adjust as we go. So kia ora, thanks for the question.

[Solmaz Nazari Orakani]
Thank you, Sue. And another question about “is there any plan or process being put in place to deal with the barrier individuals are currently experiencing with accessing support through NASC specifically for supported living services?”

[Sue Sherrard]
I think that question is sort of outside of the People for Us service. We are aware certainly that very sadly the abuse of disabled people is very widespread, but we had to make a call to start somewhere. We decided that working with the people in residential service who may communicate in a variety of different ways, and those who have limited contact with family or whānau and community - that that's our beginning audience, that's our beginning participants for People For Us, and we will grow from there. That's certainly the aim.

[Solmaz Nazari Orakani]
Many thanks. And we have a question for John. “Is there any intention to share with the sector any solution that might be common across providers?”

Which means mental health pathway for people with intellectual disabilities.

[John Taylor]
Yes, there is. I've just actually posted there about this, but this is quite a long project. So we're not anticipating anything will happen particularly quickly, but we are working with the NASC mental health providers in the area, a number of disability support providers. We're working with Te Whatu Ora's disability team. So the whole range of people involved in this project now looking for a solution to get a pathway where we can work with disabled people who might experience mental distress and put some processes in place where it's less likely to be an issue in the first instance, and then look at some ways that we can have some immediate support for providers and families when things might get a little bit difficult, and also have some longer term processes for assisting those individuals. So it's a multifaceted sort of thing, and we're only really at the front end of getting that sorted. I'm hoping by the end of the year we'll have some stuff out there because it is, from my own practices, something that is critically required across the country. Yep.

[Solmaz Nazari Orakani]
Many thanks, and we don't have any question in the Q&A function now.

[Sue Sherrard]
Right. Thanks so much.

[Jacinda Allwood]

Yes, thanks, Omaz. I was just having difficulty turning on my microphone then to jump in here as well. There's always got to be one in these things, doesn't there? So, that's excellent managing to cover off the questions within time. Hopefully there's no other burning questions, but you absolutely can contact one of the four providers of these services. Um, I think we have a little slide that we might just put up shortly. I think I've got the 0800 number that you talked about – Tevita? Was it Tevita that had an 0800 number? So I'll see if I got the numbers correct with that slide shortly and you can contact Te Pou Waiora through their website, which will pop up shortly.

And if you have any questions about this, you can absolutely contact DSS. So as Sue said, we will update our website with information about the contact details and referral pathways once they are finalised and sorted, and once the suppliers have their websites set up and there are 0800 numbers if they choose to have an 0800 number established, but you can either go to the DSS website and find the information, or you can e-mail us at our Quality team shared mailbox and we will distribute your questions if you have any to the appropriate person.

The (email) address which you all probably have is quality at msd.govt.nz., But you may already have that on speed dial on your computers!

I would just like to say another warm thank you to all of the attendees who came and gave up an hour of their time on this Tuesday afternoon. I don't know what the total numbers were, but I did spot 137 at one point. So that's amazing to have so many people attend and listen to what we're trying to share at these forums. Please give us any feedback if this style of forum worked for you, including the Q&A functions and the option to ask questions verbally if people choose to. If you don't like that, please tell us as well, and we can adapt that for future forums to make it work to your needs.

I'd also like to thank all of the speakers once again for coming and sharing a bit about the work that they're developing and we are really excited in DSS to get these initiatives and services off the ground. Supporting providers and supporting disabled people to have a voice, and giving people other opportunities and avenues to speak to someone if they have any issues, and to support them through the pathways to help both the disabled people, their families and whānau and providers enable our disabled people to have a better life and live a better life.

I think we'll wind up the session for today and give you all a couple of minutes back in your afternoon. So, um I will close us off with a closing karakia here.

(karakia)

So thank you everybody. Have a lovely evening, everybody.

[Jacinda] Kia ora koutou and welcome to the first  DSS provider quality forum. Ko Jacinda Allwood toku ingoa. Good morning everybody, my name is Jacinda Allwood. I'm a Principal Advisor in the Quality and Performance team here at DSS. I'll open us up 
with opening karakia, then follow on with some general housekeeping and then I will introduce you to the three speakers we'll be having today.

Whakataka te hau ki te uru
Whakataka te hau ki te tonga
Kia mākinakina ki uta
Kia mātaratara ki tai
E hī ake ana te atākura
He tio, he huka, he hauhū
Tihei mauri ora!

Thank you, it looks like we have numbers ramping up - we've got over 100 people that have joined the call now which is fabulous.

So people will just be joining us as they come in and there will be no announcements so we won't be interrupted. But the housekeeping - you will all see that your cameras have been switched off and your microphones have been muted when you have entered the forum. They will stay that way and presenters 
will be spotlighted and so you'll be able to see the presentations as well.

They will be sharing their screens with PowerPoint presentations as they speak. This session is being recorded so that we can post it on the DSS website following the forum for people who have missed out, or if you want to go back and watch this all over again. 

Question time - there will be some time at the end of the session for questions. Preferably we'd like people to use the chat function so you can put in questions through the chat function at any time throughout the presentations, but we won't be addressing any of the questions till the end.  

Please indicate who your question is for if it's not really obvious, and we will be monitoring those in the background. If your question's already been asked and you've noticed that, please don't ask it again. Instead maybe um give it a thumbs up or a a like emoji and we will be ordering it in the background, so if you're  liking a question um a lot of times then that's more guaranteed to be asked. We'll get to as many of the questions as we can but we may run out of time so we'll just manage that towards the end of the session.

So I would first like to hand over to Carmela Petagna. Carmela is the General Manager of the Quality and Insights team here at DSS and she will do a short introduction. Over to you Carmela.

[Carmela] All righty can you hear me okay Jacinda? 

[Jacinda] yes

[Carmela] yeah okay perfect all right. Ko Carmela Petagna toku ingoa. I am the group manager at the moment of the Quality team here at DSS and I'm delighted actually to welcome you all. We've  
got 123 people now registered and it's fabulous to have you all here at what is our inaugural Provider Quality Forum.

Now we aim to host these every two months and perhaps even more frequently dependent on the need, what feedback we get and the number of topics that we've got that are of interest to all providers and maybe some subgroups of providers.

So we are here to add value and to work with you all as providers. Today hopefully you will have a chance to meet some of our Quality team members which is great as we take you through some of the changes that we propose to our critical incident management processes.

We're supported today uh by Te Tāhū Hauora which we're 
delighted to be working with them. 

Just a little bit of context  - the provider quality forum initiative has really been set up and the recent establishment actually of the DSS national Quality Leaders Group have been set up so that DSS is improving its direct engagement with its contracted providers. We've heard a lot from people to say you know we "it's one-way traffic, we give you a lot but we don't get anything back in return", so this is our way of improving that and we hope it's a sign of things to come.  

We've plans underway to establish a series of topics for the provider quality forums and if you have any ideas that you'd like to submit then please email those to us directly. Jacinda will cover some of that off at the end of the presentation today I'm sure.

And just a reminder - Jacinda's already spoken about the questions. This is our first forum and we may not get it all right so bear with us. And for the questions - it's important that we stay focused on the quality topics that we're covering today. We 
won't stray into other topics because there are many going on across the DSS programs of work so we will try and stay focused today. Our aim is to respond to as many as we can, and if we can't, we'll theme them as Jacinda said and we aim to put a lot of this material on the website.

So again, I'm delighted to welcome you all - great to see you all and I'll hand back to Jacinda to take us through the proceedings thank you. 

[Jacinda] that's great thanks Carmela, so I will hand over pretty 
much straight away to the first speaker that we have today. This forum is being co-hosted by the DSS quality team as well as Te Tāhū Hauora the Health Quality and Safety Commission. So first  up we have Rebecca Mitchell from Te Tāhū Hauora who will be talking about the healing, learning and improving from harm policy. Over to you Rebecca!  

[Rebecca] Thank you Jacinda. So I'm Rebecca, I am the system safety advisor here at Te Tāhū Hauora and it's a great pleasure to be with you today. My colleagues Caroline Tyler - our senior manager for the system safety team, and Leona Dan, the specialist in system safety are also here with me and you may hear from them again in the question time. So I'm going to just start by sharing my presentation.

Sound okay? So thank you for the opportunity to be with you all today and giving up the valuable time in your day to join us. This is an exciting time for us as we near the launch of the onboarding of the disability support providers to our policy and orientate you all to our reporting requirements. So what I'm going to cover briefly in the short time that we have today is how the policy and the associated reporting to Te Tāhū Hauora is about being open to learn, and our emphasis is really on sharing these learnings and improving as a result.  

I'm going to give you a brief overlook of the draft severity assessment code guide for disability service providers, and then perhaps most importantly, give some more information about the ongoing support that we can provide to you all.

So who are we? It's a great question. We are Te Tāhū Hauora, otherwise known as the Health Quality and Safety Commission. You probably know a little bit about us, but just for a bit more 
background, we came into being in 2010 and are a crown entity so this means that we're separate to the minister and other government agencies such as the Ministry of Health or Ministry of Social Development. Our objectives under the legislation is to lead and coordinate work across the health sector for the purposes of monitoring and improving the quality and safety of services, and helping providers to improve the quality and safety of those services. That is to involve inform, influence and improve.

So in February 2022 the revised NAPRA health and disability standard was launched, and it marked the national adverse events reporting policy a criterion within this.

Service providers shall follow the national adverse event reporting policy for internal and external reporting to reduce preventable harm by supporting systems, learnings service. Providers encompasses disability services, meaning that services must now meet the standard. This is following the adverse event policy and reporting harm - so the revised policy which is now called "healing, learning and improving from harm".

It was developed during 2022 and involved a commission-led co-design process with a national working group that included health and disability sector represent representatives from across the country. The aim of the policy is to improve consumer and health care worker safety by supporting organisations to heal, learn and improve following harm.

In keeping with our increasing awareness of how language influences our approach and understanding of these types of events, you may hear us refer to harm events - this is what 
we previously referred to as adverse events.  

We are still evolving too so you may hear us use these interchangeably to help introduce the policy. 

I'm going to share a short video which helps to really ground the policy, and show its application.

Okay so following an extensive evaluation of other definitions and using the feedback from the ROU, we have defined both harm and its individual components. We recognised in the revised policy that harm comes in different forms especially from a Te Ao Māori worldview, and therefore the policy needed to be clearer.

So there are now four different definitions of harm that includes the physical, the psychological, cultural and spiritual. The policy has eight principles as listed here. So consumer and whānau participation - this is an active engagement with the person 
who has been harmed and/or with their whānau to understand their experience of the harm and to include them throughout the review process.  

Culturally responsive practice - this is about asking how best can we meet your needs during the process, what does this look like for you, and then doing your best to do so. This is about consumers, whānau and care workers' cultural values and beliefs.

Equity - we often focus on reducing in inequities when delivering care but it can be equally important to reduce inequities during the review process itself to reduce the chance of compounding 
the original harm.

 Open communication - again this is with all involved. We have moved beyond open disclosure but rather keeping communication lines open throughout the entire review period.

Restorative practice or responses and the Te Ao Māori concept of hohou te rongo is about speaking openly about what has happened to understand the human impact and to consider how to make that situation right again. This is a type of restoration practice carried out by skilled facilitators. Safe reporting, system accountability and system learning is all about creating a culture of openness, learning and responsiveness.

For an example an organisation that is regularly reporting harm events is not one to be critical of, but rather shows that they 
have a culture where its care workers feel safe to report the harm, acknowledge it and then learn from it. It's the quiet ones that are more concerning.

We promote the learning review as the preferred methodology as there needs to be a new way to review harm in light of modern understanding of safety. We provide support for this methodology by running workshops that simulate learning review. We prefer it because the learning review methodology seeks to limit any further harm to on all those involved in these often distressing events. It limits the role of biases in reviews by focusing on understanding why rather than apportioning blame.  

It is well suited for the health and disability sector because it can account for the complex system in which we work, and the way in which we work, and is largely carried out by humans and all the complexity that we bring to a situation. It gives everyone involved a voice and understands that as care workers we all turn up to work to deliver the best care we can, but the system itself can trip us up.

So what is this method? The learning reviews use a three-phased approach. It's used to understand the event and then to develop learning opportunities. The first phase is collecting information by understanding there is not a single source of truth but a range of perspectives to consider.

The second phase is taking these sources of information to understand the influences and context to the actions, or inactions, that led to the unintended harm, presenting these to a group who are familiar with the work and environment, and seek to understand how the harm emerged and then consider what system level changes can be made to limit the opportunity for the same harm to occur.

The third phase is about having a developed network to be able to share the learning and action the changes required, thereby promoting a learning and improving culture.

So we are aware that there is already some engagement within the disability support sector with our policy and who are using the learning review methodology already.

We've recently had some of the learnings from this process shared with us. The feedback from using this methodology is that they found value in the sense making aspect, and it helped connect the reviewers to the work being carried out. And the perspectives of those doing it is it took no longer than other traditional review methods. Especially for ones that require - if there's been a death in care - and require that complex level review, there was also an emphasis and understanding of the need to care for those involved in a harm event, and again, both care worker and the person who was harmed thereby reducing the compounded harm that reviews can often cause.

So this is the end goal and what we should all be striving for by utilising the principles of the policy and reviewing harm: it is to understand the harm, restore the relationship, learn from what the event told us about the system, and identify an opportunity to intervene or disrupt the system.

So we also need you to tell us about the harm, and this is the reporting requirement so harm events that happen within your organisation that meet the definition of a severity assessment code one or two must be reported through to us at Te Tāhū Hauora within 30 working days.   

This is done by completing a submission, undertaking a review and then submitting a Part B along with a copy of your anonymised report within 120 working days. From 1 July 2025 we will have a new submission portal for you which means that you don't have to deal with our old portal which was less than ideal.

Our new portal is very user-friendly and has been streamlined with a focus on relieving the reporting burden. It has also got some new features meaning you can keep better track of what events have 
been submitted, and where, to review these.  

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However to focus on what needs to be 
reported first, I'll just touch on what  

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is a severity assessment code one or two. 
These are our established descriptors  

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 of the categories of harm that we give 
to the health and disability sector on what  

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to report. Our requirement is in these red 
and orange boxes.  the SAC severe and SAC 2 major  

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events - so those are the types of events 
that you'll need to report through to us. The  

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SAC 3 and SAC four in the yellow and green boxes 
should still be reported within your organisation  

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and reviewed for learning opportunities, 
but they do not need to come through to Te Tāhū Hauora

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For each provider type we developed 
these severity assessment code guides that  

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relate to specific areas across the health and 
disability system. So for example, there's one for  

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mental health, for hospitals, age residential 
care, and this is the guide that will be  

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in draft form that's available for 
disability services. It's been developed and  

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tested with some disability providers, and this is 
best reflected the examples of harm that they've  

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seen in their experience. However, we are aware  
that as the disability support providers start  

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reporting through to us, there may be situations 
that we haven't anticipated or covered here yet,  

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but we will have the flexibility to review and 
amend these guides as we go forward. So I've  

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got here a few examples of what's been included. 
It's not an exhaustive list but there's the  

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um the in this grade out box, here is the 
definition, so it is severe - death or harm,  

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causing severe loss of function and/or requiring 
life saving intervention. So this means that  

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without that intervention, the person would have 
died. So suspected suicide, departures from care  

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plans, delays in care delivery that result in 
death or severe harm are the type of events  

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that we would have reported through to us 
as a SAC one. Note here on the second line  - 

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uh sorry the first bullet point - that the cause 
of death is not related to the natural cause of  

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illness or treatment. So for example not a 
premature death from underlying heart failure.

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SAC 2 is a slightly more lengthy 
list, and it is what I have here is for it is   

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the events related to major harm resulting in 
loss of function and/or requiring significant  

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intervention, meaning a hospital admission for 
urgent care. So include it. Again what you  

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would expect to see at this level - so self 
harm, delayed recognition of deterioration,   

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falls resulting in a fracture of a major bone, a 
stage three or four pressure injury. Perhaps  

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the most important slide - how can we support you! 
So um there's a variety of ways in which we do  

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this. We run the learning from harm workshops, there's the in-person workshops that are  

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currently scheduled for Christchurch, 
Hamilton, Palmerston North and Auckland. See our website!  

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We do run bespoke workshops as well - whether 
in person or virtual. We do need a minimum of  

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15 people so smaller providers may need to 
band together. We've also got a range of  

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e- modules and templates on our website that 
are really uh helpful for undertaking this. We'll  

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also with the launch of our new submission 
portal, we will need to hopefully come back  

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to you in this forum and walk you through that as 
well. I've included our email there at the bottom.

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harm.event@hqsc.govt.nz if you have any um further 
questions or want to talk about more. To  

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finish, here's a QR code which will helpfully 
link you through to our supporting resources.  

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Thank you again for the opportunity to 
presentation. We do understand that this does signal a  

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change in the way that things are done, but we are 
in this together and I'm here to support you.  

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Tena koutou ka toa. I'll hand you back to Jacinda, thank you.

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[Jacinda] Rebecca thank you so much for that presentation, 
and it's great to know that there's support out  

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there for providers. What we will do is we'll post that email in the chat as well so that  

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people could have access to it through the chat. And answering one of the questions, we will make  

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the presentations available following this forum. So I will move straight on. We we can see that  

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there's some questions coming through in the chat 
which is great. We are looking at those in the  

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background, and we'll deal with those at the end. 
The next presenter who is Lara Penman who  

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is Principal Adviser in the Quality team here at 
DSS, and she'll be talking about how we're working  

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to align our DSS critical reporting with the 
Te Tāhū Hauora policies so over to you Lara.

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[Lara] Thank you Jacinda. Ko Lara Penman toku ingoa. Nice to have you along to hear a bit of the story of the work that  

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we're doing.  I'll share my 
presentation if I can click the right buttons (!). 

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I also just want to acknowledge there's been 
a bit of work with a few uh providers already,  

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and help building and testing this already, so 
just want to acknowledge and thank those who have  

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contributed to this so far. So what we're 
doing in DSS is a project to align the critical  

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incident process that we have for providers to 
the Te Tāhū Hauora healing learning and improving  

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 policy that you've just heard about. So today 
I'm going to talk about our current approach.  

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I'm going to talk about our future proposal and 
what changes we're proposing, and the next steps.  

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So currently in your contracts - all DSS contracted 
providers - there is a clause there that requires  

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you to report critical incidents within 24 hours. This is across all different service types. 

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So what is a critical incident? Our definition 
of that is an event where there is severe or  

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major harm to the person. DSS has this 
rule of requiring critical incident reporting  

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 as part of our stewardship and commissioning 
role, so that when a critical incident report  

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comes in, we check it to see that providers are 
doing a great job at delivering safe and quality  

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supports and that you're managing that incident 
well. About 75% of the reports that come in  

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come from community residential services. I think that's great that community residential services  

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are reporting so well - but we suspect there's 
probably other service types out there that  

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aren't reporting where they should be so we really 
want to encourage a strong reporting culture to  

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inform ongoing service improvement. As Rebecca said -  
"it's the quiet ones we get worried about"  

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There's a link to the DSS website where you 
can find out more if this is news to you! So  

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here's a bit of data to see about how the critical 
incidents we've had reported to us over the  

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first quarter of this year. So you can see we get 
on average about 282 critical incident reports  

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each month, and me and others on the team read 
every single one of them. These are our  

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current categories that we have - you can see most 
of them are around hospitalisation of the disabled  

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person, followed by abuse or assault by a 
disabled person to a non-disabled person. That's  

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usually assault of a staff member. Police or 
emergency services involved comes up next, and that  

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is mostly being about ambulance callouts. Abuse 
or assault of a disabled person is next, and that's  

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often between flatmates in a house. Restraint 
or seclusion is next and remember just  

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remember that uh seclusion is only permissible in 
hospital level services like our um RIDs services  

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so there are strict rules around when and where 
and how seclusion and restraint is managed. Then  

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we've got serious injury and um a few stragglers 
down the end. So what we are doing is updating  

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our critical incident categories and severity 
threshold to align with Te Tāhū Hauora as  

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you've heard about. So there are DSS providers 
who are contractually or legally required, so those  

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that are legally required are required because 
they are certified providers under the Health and  

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Disability Safety Act um and must comply with 
Ngā Paerewa. However also we have uh clauses in our  

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contract requiring compliance with npa also so 
most providers will be covered under this so you  

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uh because you are required to comply with Ngā Paerewa
you are required to report harm events to Te Tāhū Haora.

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As Rebecca has talked about, that's going to be um a new thing for you. For

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many of you to be thinking about how you do it. 
So we want to try and align our process as  

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much as possible to reduce the burden for you, 
so we want to improve our targeting of the most  

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high-risk incidents, align the process and support 
learning and improvement. So in a nutshell there's  

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four main changes that we want to go live from 
the 1st of July. What we're doing is raising the  

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threshold of what we class classify as critical, so 
it aligns with the severity assessment codes that  

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Rebecca talked about, so it aligns with those 
SAC one and SAC 2 ratings. We're updating  

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the DSS critical incident categories based on 
some feedback we've had from providers. We're  

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00:31:12,960 --> 00:31:19,600
updating the critical incident form to match 
these other changes, and we want to support you  

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00:31:19,600 --> 00:31:27,760
 to meet your obligations to report SEC 
1 and SEC 2 harm events to Te Tāhū Haora. So  

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00:31:27,760 --> 00:31:34,800
in this diagram you can see a triangle with an 
orange triangle at the top, and the bottom half is  

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green. So the top part of the triangle is what we 
classify as DSS critical incidents, and those are  

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those incidents that are severe life-threatening 
or major harms. And you can see the little circle  

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00:31:49,040 --> 00:31:58,080
in there to that says SAC one or two, and that's 
to reflect that DSS wants to know about all  

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00:31:58,080 --> 00:32:06,880
of the major or severe harms that might occur in 
your services. But some of them won't meet the  

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00:32:06,880 --> 00:32:15,680
criteria for SAC and some of them will. The harms include but are not exclusive to  

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00:32:15,680 --> 00:32:22,960
SAC one or two, and the non-critical incidents are 
moderate or minor harm and they relate to SAC three  

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00:32:22,960 --> 00:32:30,560
or four. At the moment if you see that line that 
goes between the between the orange and the green  

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00:32:30,560 --> 00:32:36,400
that's currently lower down, we're more into the 
moderate. We're asking for moderate - moderate harms  

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00:32:36,400 --> 00:32:43,120
we're lifting that up so it's we'll be collecting 
more of ...focusing more on the severe or major  

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00:32:43,120 --> 00:32:50,080
harms. If you think I haven't explained that 
very well, which is fine, the next two slides  

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00:32:50,080 --> 00:32:59,520
say what I just said more eloquently. And so 
this is what we define as critical, and these are  

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00:32:59,520 --> 00:33:07,440
sort of always report events, and that's where 
there is either a severe harm or a major harm. And  

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00:33:07,440 --> 00:33:14,160
the difference between what we at DSS requires for a 
severe harm versus the ST criteria -  it's the same  

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00:33:14,160 --> 00:33:22,800
wording the same level of severity um but we... 
Oh oh sorry um but um in the purple text you  

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00:33:22,800 --> 00:33:28,560
can see the difference. So for DSS it includes 
but is not limited to incidents that meet  

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the S1 criteria versus in Te Tāhū Hauora - the 
condition of that harm is that the harm must  

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00:33:38,160 --> 00:33:43,520
 be an event where that was the result of a 
departure from the planned provision of support 

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00:33:43,520 --> 00:33:49,440
differs from the immediate expected outcome of 
care, or was not related to the natural course of  

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00:33:49,440 --> 00:33:57,040
illness and treatment. Now you don't always know 
that straight away, so that's why we know the  

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00:33:57,040 --> 00:34:02,400
cause or the reason behind the harm - you just know 
that a harm happened but you don't know why, if it  

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00:34:02,400 --> 00:34:07,360
had anything to do with the departure from the 
provision of support immediately.  So that's why  

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we say that DSS severe harms include but are 
not limited to those that meet the SAC one criteria.   

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This slide gives the same information 
but for three and four. This might be easier  

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00:34:25,680 --> 00:34:32,880
for future to look and read and digest later, 
once we send the slides out. But the point  

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is that we're matching moderate harm and minor 
harm to that, and whilst we don't require  

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00:34:40,320 --> 00:34:47,040
you to report these harms to us, we still expect 
providers to be doing a great job at managing  

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00:34:47,040 --> 00:34:53,040
those harms and learning and reviewing and you 
know, preventing an escalation into more serious

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00:34:53,040 --> 00:35:02,400
harms. Okay so what do providers need to do 
so for the orange ones uh which are critical  

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incidents? You are required to 
always report those to DSS within 24 hours.  

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That's the current process, that's what you do at 
the moment. We just got a few tweaks to it. We  

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00:35:14,800 --> 00:35:22,560
expect you to manage review and learn from the 
incident. The additional requirement is that  

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00:35:22,560 --> 00:35:27,840
for those critical 
incidents you need to review it to determine  

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00:35:27,840 --> 00:35:36,000
if that incident meets the SAC one or two criteria, 
and if so Te Tāhū Haora within 30 working days  

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00:35:36,000 --> 00:35:44,000
using their part A form with a provisional 
SAC 1 or SAC 2 rating. And then after 120  

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00:35:44,000 --> 00:35:52,640
working days you need to provide the full 
learning report, so that's the additional step  

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00:35:52,640 --> 00:36:04,080
 that you'll need to take. We 
anticipate that the volume of SAC one or  

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00:36:04,080 --> 00:36:09,600
two reports that you sent to Te Tāhū Haora would have been 
much smaller than the volume that you send to us.   

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00:36:10,800 --> 00:36:16,080
And non-critical incidents you don't need to 
report to us, you don't need to report to to Te Tāhū Haora, 

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00:36:16,080 --> 00:36:22,960
 however we both expect you to be doing awesome 
jobs at managing reviewing and learning from the

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00:36:22,960 --> 00:36:33,440
incident. Okay so here is our updated critical 
incident categories. We've reviewed them  

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00:36:33,440 --> 00:36:40,080
based on some feedback from yourselves. There's 
currently about 11 categories and not all of them  

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00:36:40,080 --> 00:36:45,040
are terribly useful, so we've done an 
exercise and reviewed them. Probably the  

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00:36:45,040 --> 00:36:50,560
biggest change is that we have removed the 
category called 'hospitalisations' because that  

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00:36:50,560 --> 00:36:57,760
is more of an outcome of an incident. Rather 
than the incident saying, we've beefed up the  

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00:36:57,760 --> 00:37:04,000
incident category called 'serious medical 
event' or 'serious injury of a disabled person'  

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00:37:04,000 --> 00:37:07,840
so we expect that's where most of the ones 
that you would have previously reported  

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00:37:07,840 --> 00:37:13,920
under 'hospitalisation' will go. Under 
that one we've added 'self harm', we've  

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00:37:13,920 --> 00:37:21,120
split 'abuse' or 'assault' from two 
categories to three categories, depending on who is  

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00:37:21,120 --> 00:37:30,560
involved in that abuse. And yeah, that's 
our proposal of 10 different category types.

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00:37:32,240 --> 00:37:38,560
So here's a bit of an example. Let's say that 
there's a serious medical event or serious injury  

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00:37:38,560 --> 00:37:45,520
of a disabled person that happens in your service, 
so you'll need to work out, okay was this a severe  

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00:37:45,520 --> 00:37:52,960
harm, a major harm, moderate harm or a minor harm? 
So we will produce guidance that will help you  

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00:37:52,960 --> 00:38:02,320
work that out - you and your teams. So let's 
say use the example of a choking - somebody choked  

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00:38:02,320 --> 00:38:09,680
and they needed to be admitted into 
hospital perhaps, resulting in aspiration pneumonia...

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00:38:09,680 --> 00:38:17,920
that would meet the definition of major 
harm. So the difference, as Rebecca said, is about  

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00:38:17,920 --> 00:38:26,720
was there - did it require life-saving intervention 
or severe loss of function? Major is essentially  

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00:38:26,720 --> 00:38:33,280
did they needed to be admitted to hospital. 
Moderate harm is did they need kind of moderate  

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00:38:33,280 --> 00:38:40,080
medical intervention, like they had to go to their 
GP or ED? Things like that, and a minor harm would  

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00:38:40,080 --> 00:38:46,800
be they needed a bit of first aid or just a a 
small intervention in the home. So we're  

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00:38:46,800 --> 00:38:52,720
developing guidance to help you work through  
that for all of the different incident types.

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00:38:55,840 --> 00:39:00,880
We are also doing updates to 
our critical incident form.

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00:39:00,880 --> 00:39:06,160
I hope we are being quite intentional about 
not making too many changes for you, because  

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00:39:06,160 --> 00:39:11,600
we know that has flowing effects for you and 
your own processes within your organisation.

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00:39:11,600 --> 00:39:17,200
So we're trying to limit it to the ones we 
have to do, so they're pretty minor changes.  

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00:39:17,200 --> 00:39:23,040
The key changes are we're updating the incident 
categories to reflect on new categories. There's  

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00:39:23,040 --> 00:39:28,880
a new field where you have to choose a severity 
level. You have to choose whether it is a severe  

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00:39:28,880 --> 00:39:35,680
harm or a major harm based on the guidance we'll 
provide you, and that might give you a bit of  

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00:39:35,680 --> 00:39:42,240
a flag - oh might this end up being a SAC one or 
might this end up being a SAC two in the future. 

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00:39:42,240 --> 00:39:48,160
There's a new box - new boxes to indicate 
that you've notified next of kin, a care worker  

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00:39:48,160 --> 00:39:54,240
or a safeguarding organisation. Given the Royal 
Commission Inquiry into Abuse in Care, we're just  

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00:39:54,240 --> 00:40:00,480
really aware that we need to be really 
proactive about how we are engaging with  

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00:40:00,480 --> 00:40:05,360
safeguarding support for disabled people .
We've done a bit of rearranging so it fits  

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00:40:05,360 --> 00:40:11,760
and flows better, and the instructions page 
is much clearer. So we'll publish that  

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00:40:11,760 --> 00:40:20,800
on our website once we've updated it and 
tested it with some of you. And here is our  

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00:40:20,800 --> 00:40:31,200
next steps. So if you've got your thoughts, 
suggestions, concerns then send us an email  

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00:40:31,200 --> 00:40:38,560
in the quality inbox. What we are going to 
be doing is working with the quality leaders group,  

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00:40:38,560 --> 00:40:46,080
which is a few provider quality leads, to kind 
of finalise and endorse these, and then we'll be  

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00:40:46,080 --> 00:40:53,280
able to publish them on our DSS website, hopefully 
by the 20th of June. Now don't freak out - although  

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00:40:53,280 --> 00:40:58,880
I say go live on the 1st of July, we don't expect 
you to have magically changed all your systems and  

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00:40:58,880 --> 00:41:05,840
processes by then. That's just the date that we'll 
start expecting you to... that we can accept the  

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00:41:05,840 --> 00:41:12,480
new form and new process. But we'll give you 
three months transition period to implement your  

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00:41:12,480 --> 00:41:21,920
new system so by the 30th of September we will... 
by the 1 of October we will only accept  

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00:41:21,920 --> 00:41:28,920
reports using our new form. So that is the story 
um and I will hand it back over to Jacinda.

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00:41:28,920 --> 00:41:45,440
[Jacinda] thank you that's great, thank you Lara. Yeah 
obviously a lot to digest, you've had two  

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00:41:45,440 --> 00:41:51,600
quite substantial presentations there. We do 
have some time for question time now. And they were  

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00:41:51,600 --> 00:41:55,600
a little bit more speedy - Rebecca and Lara - than 
they could have been, so we might be able to get  

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00:41:55,600 --> 00:42:01,680
through most of the questions. I see there's about 
six or seven in the chat, and these have been 

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00:42:01,680 --> 00:42:06,960
summarised a little bit, some of them um slightly 
paraphrased, so if we're getting it a little bit  

336
00:42:06,960 --> 00:42:13,040
wrong then please feel free to to correct us.  
So we'll go through, then what we'll do is we will...  

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00:42:13,040 --> 00:42:19,360
I will pass over to um a colleague from the DSS 
Quality team um introduce you to... well she can  

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00:42:19,360 --> 00:42:25,440
introduce herself - Solmaz Nazari Orakani, and she'll 
read out the questions and then direct them to  

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00:42:25,440 --> 00:42:29,680
the most relevant person to respond to those 
questions, so you might get to meet a couple  

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00:42:29,680 --> 00:42:36,480
of other people particularly from Te Tāhū Haora, who 
are in the background ready to respond. So I will  

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00:42:36,480 --> 00:42:46,880
hand over to you now Solmaz, to read out the first 
question.
[Solmaz] Thank you so much. My name is Solmaz Nazaro, kia ora e te whānau.   

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00:42:46,880 --> 00:42:58,000
I'm a senior advisor in the Quality team at DSS. So 
we have several questions. I am going to read  

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00:42:58,000 --> 00:43:12,560
the questions for you, yeah. So the 
first question um I'm assuming that it's for Te Tāhū Haora. 

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00:43:12,560 --> 00:43:22,000
So it asks why does the definition of harm not 
include workers? It refers to negative consequences  

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00:43:22,000 --> 00:43:33,600
for consumers and whānau - why are worker excluded? 
Rebecca?
[Rebecca] Thank you for the question. 

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00:43:33,600 --> 00:43:40,960
The definition of harm is because consumers 
are at the centre of what we do, and it is  

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00:43:40,960 --> 00:43:47,760
about the care provision to them as well, so it is 
about the the healing and the restoration of the  

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00:43:47,760 --> 00:43:53,680
relationship with the consumer. The beauty of the 
learning review methodology is that it does take  

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00:43:53,680 --> 00:44:03,200
into consideration the harm that could be 
experienced by care workers as well, and can  

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00:44:03,200 --> 00:44:12,400
be addressed through that process. I hope that 
answers your question. 
[Other speaker] I'll just add to that, Rebecca,  

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00:44:12,400 --> 00:44:18,400
so in terms of harm to workers you will still 
follow the Worksafe health and safety legislation,  

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00:44:18,400 --> 00:44:24,160
and the reporting requirements for Worksafe so 
as Rebecca's highlighted, this is around harm to  

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00:44:24,160 --> 00:44:36,240
consumers who are in care, as opposed to harm 
to workers. That's outside the scope of our policy.

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00:44:36,240 --> 00:44:44,960
[Solmaz] thank you so much, thank you and the 
next question is for you again, I think.   

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00:44:44,960 --> 00:44:54,800
I think. So why concentrate on post-event 
responses rather than prevent preventative

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00:44:54,800 --> 00:45:04,000
measures? 
[Rebecca] I'm liking that! Look, preventative measures is still  

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00:45:04,000 --> 00:45:12,560
absolutely a fundamental thing to do 
in these care provision services, however  

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00:45:12,560 --> 00:45:17,920
 it is part of what we do. This is 
acknowledging that harm does occur  

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00:45:17,920 --> 00:45:25,040
 within um service provision, and uh we 
need to address it.  So it's not to diminish  

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00:45:25,040 --> 00:45:30,800
the role of preventative measures - we absolutely 
support learning opportunities or improvement  

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00:45:30,800 --> 00:45:36,480
opportunities - but it's also about addressing 
harm that we know occurs regardless of best

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00:45:36,480 --> 00:45:48,480
intentions. anything further to add? okay thank 
you 
[Solmaz] Thank you so much, I'm going to ask the DSS  

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00:45:48,480 --> 00:45:56,400
colleague to give you a quick break and 
short break. So, my DSS colleagues,  

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00:45:56,400 --> 00:46:04,240
 this question is for us. What sort of critical 
incidents reporting would you expect to see  

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00:46:04,240 --> 00:46:16,240
from IF host who are not responsible for direct 
provision of support services?
[Lara] I can answer that.  

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00:46:16,240 --> 00:46:22,720
Our only lever for requiring 
reporting of critical incidents is through  

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00:46:22,720 --> 00:46:28,880
the contracts that DSS has with providers, 
so if we don't have a a contract with  

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00:46:28,880 --> 00:46:33,920
a provider - say for example if someone's 
using their IF budget or personal budget -   

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00:46:33,920 --> 00:46:39,920
then we've got no way to compel them to 
report a critical incident to us. And  

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00:46:39,920 --> 00:46:45,280
we don't actually require if hosts 
to do that either at the moment.

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00:46:49,600 --> 00:46:59,520
[Solmaz] Thank you Lara, and again a question for 
DSS - how will critical incident reporting be  

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00:46:59,520 --> 00:47:07,200
shared with relevant NASCs to support 
resource reviews for people provider

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00:47:07,200 --> 00:47:10,089
support?

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00:47:10,089 --> 00:47:18,400
[Lara] Yeah good question! I think that's an opportunity for us to think about isn't it? um yep 
great let's let's think about how  

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00:47:18,400 --> 00:47:30,640
we might do that well.
[Solmaz] Thank you so much, and I'm going back to the colleagues.

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00:47:30,640 --> 00:47:40,960
Do providers still need to report to Worksafe when harm occurs to people they support?  

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00:47:42,800 --> 00:47:49,280
uh and have Te Tāhū Haora and Yeses 
done work with Worksafe to

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00:47:49,280 --> 00:47:56,480
align?
[Lara] Sure, sorry I'll hand over to Caroline who you may hear in the background  

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00:47:56,480 --> 00:48:03,600
who can answer that for you. 
[Caroline] yeah thank you. So the legislative legislation health and  

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00:48:03,600 --> 00:48:08,480
safety reguirement legislation's quite clear in terms 
of what needs to reported to Worksafe, and  

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00:48:08,480 --> 00:48:13,520
you know disability support services is one of 
the last provider groups that we've worked with  

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00:48:13,520 --> 00:48:20,000
um under the um NAPA era standard, and we do 
understand that people struggle a little bit  

383
00:48:20,000 --> 00:48:25,440
with this, so the SAC guide is designed to help 
support you with separating what we mean by  

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00:48:25,440 --> 00:48:31,280
staff harm and consumer harm. But we will 
work with you with this. You know, this is all  

385
00:48:31,280 --> 00:48:37,440
new to all of you, and this is expected as of the 
1st of July. The learning from harm workshops  

386
00:48:37,440 --> 00:48:42,480
that we can do with you, we can do these 
virtually for you, we can do these in person  

387
00:48:42,480 --> 00:48:48,640
at no charge. They will help you unpick 
this, and we can use scenarios so that helps you  

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00:48:48,640 --> 00:48:53,680
understand. And as Rebecca highlighted in 
our presentation, please just pick up the  

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00:48:53,680 --> 00:48:58,080
phone and give us a call or email us directly 
and we can help work through with you, whether  

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00:48:58,080 --> 00:49:02,960
it's something that has to go to Worksafe, or 
whether it's something that would come to us. 

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00:49:04,240 --> 00:49:15,200
[Solmaz] Thank you so much and SAC one should include 
the hospitalisation in the description?
[Rebecca] yeah so   

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00:49:15,200 --> 00:49:22,000
just got to be careful around the hospitalisation, 
because going to hospital itself does not  

393
00:49:22,000 --> 00:49:31,120
mean it equates directly to a Sac one event.  
So that's why uh we've used the phrases "death  

394
00:49:31,120 --> 00:49:36,880
or harm causing severe loss of function and/or 
requiring life-saving intervention". So I think  

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00:49:36,880 --> 00:49:43,040
with the requiring life-saving intervention, it's 
implied somewhat that it would be a hospital as  

396
00:49:43,040 --> 00:49:51,200
well, but I think we don't specifically 
mention hospitalisation because there's...

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00:49:58,480 --> 00:50:15,720
[Solmaz] I think something happened we lost Rebecca. um so 
next question for the colleagues in DSS.

398
00:50:15,720 --> 00:50:28,240
Do providers still need to report under 
section 31 of the Health and Disability Services  

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00:50:28,240 --> 00:50:37,120
Safety Act 2001 that requires all certified 
providers to notify the director general of  

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00:50:37,120 --> 00:50:45,520
subsections?
[Lara] Yes it's still a requirement, but 
what we're doing is working with HealthCert on its  

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00:50:45,520 --> 00:50:49,680
a next phase, about how we can streamline that for 
you because it might feel like "oh we're having  

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00:50:49,680 --> 00:50:56,640
to report to so many places!" and we want 
to try and streamline that for you. So we'll  

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00:50:56,640 --> 00:51:05,120
 talk to Health Cert and come back to you with 
where that's landed.
[Solmaz] Thank you so much, and the next  

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00:51:05,120 --> 00:51:14,800
question is for my colleague in DSS. In terms 
of prevention, of early intervention, how are SAC  

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00:51:14,800 --> 00:51:24,880
three and four incidents handled, particularly 
when they indicate patterns that could  

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00:51:24,880 --> 00:51:34,000
suggest abuse? Perhaps there should be a process 
for reporting such incidents at a local level  

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00:51:34,000 --> 00:51:39,760
perhaps through NASCs to ensure 
timely intervention and safeguarding

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00:51:39,760 --> 00:51:48,160
measures. 
[Lara] This is something we've grappled with too, 
as we've lifted the threshold. There's a certain  

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00:51:48,160 --> 00:51:53,920
amount of discomfort about us not knowing about 
those lower level incidents and harms that happen,  

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00:51:53,920 --> 00:52:00,800
and we all know that sometimes 
those lower level ones can be sort of  

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00:52:00,800 --> 00:52:08,480
 precursors or kind of red flags that something 
is escalating and building up to a higher severity.  

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00:52:08,480 --> 00:52:16,400
So we are we are all interested in learning as 
early as possible, and making changes as early  

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00:52:16,400 --> 00:52:23,120
as possible from those lower severity harms. 
However we can't collect data on everything - that  

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00:52:23,120 --> 00:52:28,640
would be too much burden for you, and it would 
be really difficult for us to really focus in and  

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00:52:28,640 --> 00:52:36,800
hone in to target those most severe incidents. 
What we do - what we are thinking about is  

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00:52:36,800 --> 00:52:42,000
whether if you noticing in your systems there's 
a cluster of incidents that are happening that  

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00:52:42,000 --> 00:52:46,080
you think "oh they're lower level but there's a 
whole lot of them with this person and they're  

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00:52:46,080 --> 00:52:53,280
really escalating, I might just report that to to 
DSS as a as a cluster. I might have an internal  

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00:52:53,280 --> 00:52:58,240
process within my organiaation to think about 
how I might treat a cluster or an escalation  

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00:52:58,240 --> 00:53:07,040
a little bit differently" and and DSS 
really wants to be able to get assurance that  

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00:53:07,040 --> 00:53:11,600
providers are doing a great job at that, 
and that'll be part of our regular  

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00:53:11,600 --> 00:53:17,520
audit process - checking how well providers 
are managing that for those lower severity

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00:53:17,520 --> 00:53:29,920
harms.
[Solmaz] Thank you so much, and another question 
for my colleague in DSS. When we send a harm  

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00:53:29,920 --> 00:53:39,280
or critical incident report to our funder 
MSD DSS, should we send a copy  

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00:53:39,280 --> 00:53:44,800
to HealthCert as well? 
[Lara] oh yeah that's the same as the previous question about the section  

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00:53:44,800 --> 00:53:51,440
31s. Yes we'll get back to you on that. 
[Solmaz] Thank you so much and is the reporting  

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00:53:51,440 --> 00:54:02,880
form completed electronically online?
[Lara] We would love to have that but  for DSS we still have our  

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00:54:02,880 --> 00:54:08,720
 a Word document that you fill in and email 
to us, and we enter into a spreadsheet. However we  

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00:54:08,720 --> 00:54:14,640
have got in the works to get an IT solution 
that will help us make that more automated. One  

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00:54:14,640 --> 00:54:22,560
day we'll have a sexy new um uh portal like 
Te Tāhū Haora do for their reporting. As  

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00:54:22,560 --> 00:54:31,280
Rebecca said the Te Tāhū Haora portal goes live on 
the 1 of July.
[Solmaz] thank you so much and...
[Rebecca] I'm so sorry  

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00:54:31,280 --> 00:54:36,400
to interrupt, we've just answered in the 
chat that yeah ours is online thank you Lara 

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00:54:36,400 --> 00:54:41,920
for highlighting that as well. We've waited a 
long time so we're happy to have that going now!  

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00:54:41,920 --> 00:54:52,880
[Solmaz] Thanks, thank you so much and this question is for 
um the DSS colleagues or their colleagues, either  

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00:54:52,880 --> 00:55:01,040
can answer. Will the HCSS severity criteria 
also be reviewed to be consistent with DSS

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00:55:01,040 --> 00:55:10,080
criteria?
[silence]
[Lara] Is that you Rebecca?

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00:55:11,440 --> 00:55:17,760
[Rebecca] Um sorry, I'd need further expansion on 
what the HCSS severity criteria?  I'm  

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00:55:17,760 --> 00:55:23,760
not sure if that's a typo?
[Lara]  the home and community 
support services - you've got SAC guidance  

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00:55:23,760 --> 00:55:30,960
for home and community support 
[Rebecca] Oh yeah, in 
process, that's on the to-do list so  

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00:55:30,960 --> 00:55:38,880
um yeah there will be some consistency across 
the board of the SAC guides. Sorry, apologies  

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00:55:39,600 --> 00:55:47,680
[Solmaz] thank you so much, and I'm just mindful of time 
I think the last question for my colleague at DSS.  

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00:55:47,680 --> 00:55:57,760
When reporting to DSS of this cluster of 
events, what we put this under in the new  

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00:55:57,760 --> 00:56:07,920
report form? 
[Lara] uh yeah I'll let you know once 
we've once we've once we've figured that out [laughs]

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00:56:08,800 --> 00:56:16,000
[Solmaz] thank you so much and..
[Rebecca] Sorry Solmaz, just to... from our 
perspective, you would need to put for  

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00:56:16,000 --> 00:56:23,200
a cluster of events, we would be um wanting Part 
A's submitted for those.  It could then be a later  

446
00:56:23,200 --> 00:56:28,960
part B for the cluster of events but yes we would 
require that you can review them as a cluster and  

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00:56:28,960 --> 00:56:38,960
report them as a part B but individual part A's 
for each event yeah.
[Solmaz] Thank you so much, I  

448
00:56:38,960 --> 00:56:52,240
think it's all questions we received so far, thank 
you so much, and I'm going to hand over to Jacinda.

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00:56:52,240 --> 00:57:00,800
[Jacinda] From both Te Tāhū Haora,  and and DSS colleagues 
it's been great to have a bunch of really good  

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00:57:00,800 --> 00:57:06,240
questions from from the audience. I think 
we've had about 140 people on this call,  

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00:57:06,240 --> 00:57:13,680
so it's been a large group and it's been very 
clean, so from our perspective so we appreciate it.  

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00:57:13,680 --> 00:57:19,360
As it has been referred to, DSS is sort of running 
on the smell of an oily rag a little bit - we don't  

453
00:57:19,360 --> 00:57:28,320
have the mod cons tech as yet but we'll try 
and improve the technical knowhow prior to the next  

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00:57:28,320 --> 00:57:36,560
forum that we run. So as as we've said, this is 
not the end of things. You do have the email  

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00:57:36,560 --> 00:57:43,440
addresses for both DSS and Te Tāhū Haora, of which 
I've just put again in the chat so you've got them  

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00:57:43,440 --> 00:57:48,560
down the bottom of the chat if you have further 
questions or comments or suggestions. You can go  

457
00:57:48,560 --> 00:57:54,240
to either organisation, we'd be really really 
happy to help from hear from you about those.  

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00:57:54,240 --> 00:57:59,440
This is a this the first of many forums. 
We'd love to run these every couple of months.  

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00:57:59,440 --> 00:58:05,840
As Carmela alluded to, we have a bunch of topics 
that we're really keen to proceed with and discuss  

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00:58:05,840 --> 00:58:11,280
with providers, but if you do have suggestions 
about what you'd like to be covered, we'd be really  

461
00:58:11,280 --> 00:58:20,400
happy to hear about those as well. Any other 
final questions? I think we've we've got one minute  

462
00:58:20,400 --> 00:58:27,360
 to go, so maybe it's time to to close this up. We 
will, as I've said post the recording of this forum  

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00:58:27,360 --> 00:58:31,520
onto the DSS website. We're just getting a page 
established for that, and we will let providers  

464
00:58:31,520 --> 00:58:37,680
know where that is, and how you can find them. We'll be posting dates for future forums and 

465
00:58:37,680 --> 00:58:42,880
topics once they've been decided so you can, with a 
little bit more advanced notice choose which ones  

466
00:58:42,880 --> 00:58:50,800
um are of most interest to you, and we will try and 
work out a less administrative burdensome  

467
00:58:50,800 --> 00:58:56,560
registration system in future. It's been great 
to have you all here today, appreciate that time is  

468
00:58:56,560 --> 00:59:05,760
precious and we really support working with you 
together on this really important mahi. So I will  

469
00:59:05,760 --> 00:59:15,520
close us off now with a closing karakia and we can 
come back to any of those of you who have asked  

470
00:59:15,520 --> 00:59:22,480
questions. I had just noticed that there's 
a ETA on the slides -  I'll find out  

471
00:59:22,480 --> 00:59:28,800
what the ETA is on the web page. If we are 
going to have a bit of a delay with that we  

472
00:59:28,800 --> 00:59:33,920
can probably just send them out so I'll check 
with our Te Tāhū colleagues and DSS and  

473
00:59:33,920 --> 00:59:42,000
maybe we can send them out um to attendees more 
quickly. So we'll come back to you on that okay?  

474
00:59:42,000 --> 00:59:46,320
Any other questions we'll deal with after the 
presentation, so thank you again for your time,  

475
00:59:46,320 --> 00:59:56,360
it's been great having you all here this afternoon 
and I'll close us out now with a closing karakia:

476
00:59:56,360 --> 01:00:02,672
Kia whakairia te tapu
Kia wātea ai te ara 

477
01:00:02,672 --> 01:00:02,791
Kia turuki whakataha ai 

478
01:00:02,791 --> 01:00:03,040
Kia turuki whakataha ai
Haumi e. Hui e. Tāiki e!

479
01:00:03,040 --> 01:00:11,680
Thank you so much everybody and 
have a really pleasant Tuesday evening!