Watch previous provider quality forums

[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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updating the critical incident form to match 
these other changes, and we want to support you  

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 to meet your obligations to report SEC 
1 and SEC 2 harm events to Te Tāhū Haora. So  

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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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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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of the major or severe harms that might occur in 
your services. But some of them won't meet the  

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criteria for SAC and some of them will. The harms include but are not exclusive to  

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SAC one or two, and the non-critical incidents are 
moderate or minor harm and they relate to SAC three  

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or four. At the moment if you see that line that 
goes between the between the orange and the green  

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that's currently lower down, we're more into the 
moderate. We're asking for moderate - moderate harms  

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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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harms. If you think I haven't explained that 
very well, which is fine, the next two slides  

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say what I just said more eloquently. And so 
this is what we define as critical, and these are  

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sort of always report events, and that's where 
there is either a severe harm or a major harm. And  

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the difference between what we at DSS requires for a 
severe harm versus the ST criteria -  it's the same  

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wording the same level of severity um but we... 
Oh oh sorry um but um in the purple text you  

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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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00:34:07,360 --> 00:34:20,240
we say that DSS severe harms include but are 
not limited to those that meet the SAC one criteria.   

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00:34:20,240 --> 00:34:25,680
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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00:35:02,400 --> 00:35:08,960
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  

318
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  

333
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  

334
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 

335
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  

338
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  

339
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  

340
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  

347
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  

348
00:43:47,760 --> 00:43:53,680
relationship with the consumer. The beauty of the 
learning review methodology is that it does take  

349
00:43:53,680 --> 00:44:03,200
into consideration the harm that could be 
experienced by care workers as well, and can  

350
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,  

351
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,  

352
00:44:18,400 --> 00:44:24,160
and the reporting requirements for Worksafe so 
as Rebecca's highlighted, this is around harm to  

353
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.

354
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.   

355
00:44:44,960 --> 00:44:54,800
I think. So why concentrate on post-event 
responses rather than prevent preventative

356
00:44:54,800 --> 00:45:04,000
measures? 
[Rebecca] I'm liking that! Look, preventative measures is still  

357
00:45:04,000 --> 00:45:12,560
absolutely a fundamental thing to do 
in these care provision services, however  

358
00:45:12,560 --> 00:45:17,920
 it is part of what we do. This is 
acknowledging that harm does occur  

359
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  

360
00:45:25,040 --> 00:45:30,800
the role of preventative measures - we absolutely 
support learning opportunities or improvement  

361
00:45:30,800 --> 00:45:36,480
opportunities - but it's also about addressing 
harm that we know occurs regardless of best

362
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  

363
00:45:48,480 --> 00:45:56,400
colleague to give you a quick break and 
short break. So, my DSS colleagues,  

364
00:45:56,400 --> 00:46:04,240
 this question is for us. What sort of critical 
incidents reporting would you expect to see  

365
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.  

366
00:46:16,240 --> 00:46:22,720
Our only lever for requiring 
reporting of critical incidents is through  

367
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  

368
00:46:28,880 --> 00:46:33,920
a provider - say for example if someone's 
using their IF budget or personal budget -   

369
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  

370
00:46:39,920 --> 00:46:45,280
we don't actually require if hosts 
to do that either at the moment.

371
00:46:49,600 --> 00:46:59,520
[Solmaz] Thank you Lara, and again a question for 
DSS - how will critical incident reporting be  

372
00:46:59,520 --> 00:47:07,200
shared with relevant NASCs to support 
resource reviews for people provider

373
00:47:07,200 --> 00:47:10,089
support?

374
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  

375
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.

376
00:47:30,640 --> 00:47:40,960
Do providers still need to report to Worksafe when harm occurs to people they support?  

377
00:47:42,800 --> 00:47:49,280
uh and have Te Tāhū Haora and Yeses 
done work with Worksafe to

378
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  

379
00:47:56,480 --> 00:48:03,600
who can answer that for you. 
[Caroline] yeah thank you. So the legislative legislation health and  

380
00:48:03,600 --> 00:48:08,480
safety reguirement legislation's quite clear in terms 
of what needs to reported to Worksafe, and  

381
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  

382
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  

384
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  

388
00:48:48,640 --> 00:48:53,680
understand. And as Rebecca highlighted in 
our presentation, please just pick up the  

389
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  

390
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. 

391
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   

392
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  

395
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  

399
00:50:28,240 --> 00:50:37,120
Safety Act 2001 that requires all certified 
providers to notify the director general of  

400
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  

401
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  

402
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  

403
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  

404
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  

405
00:51:14,800 --> 00:51:24,880
three and four incidents handled, particularly 
when they indicate patterns that could  

406
00:51:24,880 --> 00:51:34,000
suggest abuse? Perhaps there should be a process 
for reporting such incidents at a local level  

407
00:51:34,000 --> 00:51:39,760
perhaps through NASCs to ensure 
timely intervention and safeguarding

408
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  

409
00:51:48,160 --> 00:51:53,920
amount of discomfort about us not knowing about 
those lower level incidents and harms that happen,  

410
00:51:53,920 --> 00:52:00,800
and we all know that sometimes 
those lower level ones can be sort of  

411
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.  

412
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  

413
00:52:16,400 --> 00:52:23,120
as possible from those lower severity harms. 
However we can't collect data on everything - that  

414
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  

415
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  

416
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  

417
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  

418
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  

419
00:52:53,280 --> 00:52:58,240
process within my organiaation to think about 
how I might treat a cluster or an escalation  

420
00:52:58,240 --> 00:53:07,040
a little bit differently" and and DSS 
really wants to be able to get assurance that  

421
00:53:07,040 --> 00:53:11,600
providers are doing a great job at that, 
and that'll be part of our regular  

422
00:53:11,600 --> 00:53:17,520
audit process - checking how well providers 
are managing that for those lower severity

423
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  

424
00:53:29,920 --> 00:53:39,280
or critical incident report to our funder 
MSD DSS, should we send a copy  

425
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  

426
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  

427
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  

428
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  

429
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  

430
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  

431
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  

432
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 

433
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!  

434
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  

435
00:54:52,880 --> 00:55:01,040
can answer. Will the HCSS severity criteria 
also be reviewed to be consistent with DSS

436
00:55:01,040 --> 00:55:10,080
criteria?
[silence]
[Lara] Is that you Rebecca?

437
00:55:11,440 --> 00:55:17,760
[Rebecca] Um sorry, I'd need further expansion on 
what the HCSS severity criteria?  I'm  

438
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  

439
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  

440
00:55:30,960 --> 00:55:38,880
um yeah there will be some consistency across 
the board of the SAC guides. Sorry, apologies  

441
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.  

442
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  

443
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]

444
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  

445
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  

447
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.

449
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  

450
00:57:00,800 --> 00:57:06,240
questions from from the audience. I think 
we've had about 140 people on this call,  

451
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.  

452
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  

454
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  

455
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  

456
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.  

458
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.  

459
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  

460
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  

463
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!