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APPENDIX A SELECTION OF COMMENTS FROM COALITION MEMBERS AROUND THE PROVINCE
Subject: MCFD/CLBC governance model My concerns: 1. The lack of information coming from CLBC or MCFD on the progress of transformation. The actual facts, figures and plans. Example: there is no discussion in communities about Community Councils yet implementation is planned for this year. Are the people on the Councils volunteers, elected or appointed? The model talks about Councils liaising with individuals and families in communities. Two questions: What about confidentiality? Are the councils going to be made up of consumers or professionals? 2. No talk in the model about IF. One of the main pillars of the vision of transformation. 3. Information that comes out is not in plain language so families and individuals understand it. 4. Two managers in each community. This is not only not cost effective families, individuals and caregivers will be dealing with two managers rather then one. The model shows that the families, individuals and caregivers go through the facilitator well we all know with the case loads they are going to have that we will be bypassing them to get services and information. In the original discussions there was an avenue for families, individuals and caregivers that did not wish to use a facilitator. We know there are families that can do that and this was supposed to help with case load. Where is that in the model? 5. No information on the appeal process and just what does referral to other services mean? If you get through eligibility you still have to get the plan excepted. No different then before except it will take longer as you have to keep going back to facilitator and take one step at a time. 6. Facilitators job description no different then a Social Worker except there will be less of them and they are expected to spend more time with each consumer building plans. The Social Worker was never responsible for making the decisions on eligibly or whether a person was going to get funding. They took direction from the money people and said yes or no as they were told. Do not see any difference here. 7. CLBC a new layer of bureaucracy no different from what health did putting in Vancouver Island Regional Health Board. They are appointed, responsible to MCFD and not the consumer. 8. What I would like to see are flow charts of the envisioned model to make a comparison to what we have been given. (side by side) 9. The model shows CLBC organizational structure how about one with MCFD's organizational structure, before CLBC and now, so we can see for ourselves that forming CLBC has reduced the government bureaucracy? 10. CSSEA criteria for eligibility makes it impossible for small non-profits to participate increasing their costs and work load. Definitely did not help with more individual services. Where in this model is the avenue for families, individuals and caregivers to give input to these types of bureaucratic decisions? Parent of an adult child Volunteer of a service provider Vancouver Island ______________________________________________________________________
1) I did not see any mention of individualized funding in this entire proposal. WHAT HAPPENED TO THAT??? 2) This thing is full of job descriptions, etc. all in bureaucratic language. Trying to read it is difficult -- but it sure sounds like there will be MORE bureaucracy and I thought the point of the exercise was to have less bureaucracy. 3) What authority do the "planners" actually have? I can see the point of dividing planning and funding functions to get rid of conflict of interest, but what is the point of all that planning if planners do not have access to sufficient funding for individuals? 4) All those "flow charts" and tables are very difficult for the average reader like myself to understand -- but it certainly does not look like a simpler process than what is in place now. 5) I am very concerned that most of the emphasis seems to be on "accountability" which is all well and good in terms of individuals actually getting what the service providers say they are giving -- but it is hard not to see this word "accountability" as meaning "control over expenses" and I am gravely concerned that there will never be enough money in the "system" to meet people's needs, but the "blame" will be shifted onto this so-called "independent authority" and away from Government -- much like what has happened with the School Boards in our Province in recent years. This document is NOT easy for the average person to understand and if you really want feedback from us at the "consumer" level, a plain-language version might be helpful. Probably Executive Directors and so forth can understand it well enough, but for most of us, I believe this document won't get many comments because people will feel that they simply do not understand it but it "must be okay" if the people they trust -- i.e. the Community Living Coalition -- have participated in drafting it. I believe this needs to be addressed. Sincerely, Cathy Lafortune
______________________________________________________________________ Hello, I have a 24-year old daughter with high needs. Waiting for residential funding since 1999. Having had high hopes for this new individual funding concept, with all the many hours of input, just to see that bureaucrats win again and take the pie. What can you tell me? When can parents get the help they need? After so many years of trying to water down the main concepts of helping the individual and his/her family, I bet you have already full knowledge what the Bureaucrats pay, benefits and their "Rights" will be. Can you tell me, what my daughter will be entitled to receive? Gudrun Cave Nanaimo ______________________________________________________________________
I am writing to you as a service provider. My initial response in reading the report was one of exasperation and frustration. Our hope was a model that would be individual, family and community driven. Instead we have a model that is bureaucracy focused and supportive of maintaining the employees that are currently with Community Living Services. These are the same people that have made the lives of many families in our area a living hell over the past few years. One document that I read stated that 400 current Community Living employees would make the transition to CLBC. I suppose they will need these 400 people to help maintain the current level of paper shuffling and stacking that occurs. This is not what families need. They do not care about accountability to the government but they do need support for their families. We live in an area that has been severely under serviced for almost as long as I can remember. Ten years ago this began to change. Changes are not always a good thing, and from that point on our services were decreased, under supported and under funded. Waitlist grew out of control, and still no one would address the concerns and crisis that were arising with the families in our community. Families were left to flail with crisis, children were hospitalized and yet others were sent out of our community because we did not have the services to support their needs and there was no crisis plan in place. The frightening thing is that we do have the capacity in our community to address all the issues, but the one thing that was lacking was the support of a Community Living Office who cared about our families needs. From this we have dealt with years of being told “no”, the fact that there is no crisis plan, having to send young children out of our community and away from their families for short and long term care. No one should ever have to send their child away from home. One of my concerns with the Transformation document is “The Principles”. These sound great, but they are just words on paper. They mean nothing as they are principles that should already exist. In our communities families and individuals with disabilities do not feel safe and secure. They have the sense that there is no one out there who has any concern for their well being. There is no respect or trust, and even though many families are near crisis, there is no focus on planning to support these families. The Principles are only the beginning of the shallowness of this entire document. Service providers and families have made great concessions over the past couple years to help balance budgets, increase capacity and support the fact that we need to have a slim and trim service that provides effective and efficient supports in the community. Why are we all making these sacrifices and in return we get back the same blundering bureaucratic mess from the same heartless people as we had in the past. Service delivery has become more about quantity and accountability, not quality of service. Supports and services to families that have worked well have been slashed to increase capacity with existing dollars. So now we have had to cut programs that are already under serviced to provide even less adequate amounts of service to families on wait lists just so someone can spend an afternoon patting themselves on the back for the great job they did in making these changes happen. These changes did not happen in a cooperative working relationship; they happened because we were threatened that all services would be cut if we did not comply. This is another great example of the trust and respect that does not exist. Service changes continue, and now we are not even trusted to deliver the services we are contracted to do. We must now change from a direct payment that offers stability to a small contractor to billing for services. If anything we have so little available that we always do more than we are contracted to do. This is because we believe in the people we support, and will not sit by to see people deal with their stress and crisis alone. Our hopes and dreams for the future where our families would have less stress, and could actually receive the services they need to keep their family healthy, happy and together in their own community are gone. If all else failed, families could look at Individualized Funding options, but they do not see to even be under consideration in this report. With this plan the future looks pretty grim. Thank you for the opportunity to express my concerns and frustration. Name Withheld by Request ______________________________________________________________________
The primary difference between the vision of 2001, when many of us saw a draft organizational structure of what is now known as CLBC, and the (lack of) vision presented in January of 2005, appears to be a win for a bureaucratic structure over one that allows for actual community development. It seems to have strayed far from the path of innovation, and replicates a failed and failing system that will eventually collapse as it too (along with services) is unsustainable. This underlying problem will transcend any effort to change the culture of an entire ministry migrating directly into CLBC. No one would have thought to incur a great deal of work to change a system that was not already dysfunctional. This characteristic can be demonstrated in any number of areas, all easily identified. One small example lies in the search for information management technology. Not only is the situation stagnant after over a decade of fruitless endeavours by the MCFD but after an apparent attempt to involve the community, we are now told that it will take a further 18 months to deploy any technology into the field. No business could survive for a month with this kind of approach, and after a decade of many millions of tax dollars expended, there remains no visible or tangible asset.
Although it is not part of the service delivery model, it is worth noting due to budget constraints if for no other reason, that the Ministry's approach of sending 2 FTE's to every office in order to capture information and enter it into a data system that is (we are told) very labour intensive, and which cannot "speak" to other MCFD technology systems. If Ministry staff have been unable to enter data since 1986, is it prudent to attempt this by simply adding staff? It has been the Ministry's sole method of problem solving for so long, that continues unchallenged. But what is the cost of this approach, no matter how well-intentioned? Why does the Ministry continue to reject the offers of service providers to give them the data they need? What is lacking that precludes acceptance of an offer made by "partners"?
It is a fearful thing to think that this type of approach will be duplicated by CLBC. Will the government or the Ministry ever really forego the power and control that would allow the community to respond and develop? This refers not only to technology (systems that can actually communicate with each other and government) but also to the sustainable supports to those who live with disabilities, which will only be possible with strong community involvement.
A decade ago Doug Allen proposed a Ministry that could run very effectively on 250 FTEs. The draft organizational structure for CLBC (2001) suggested a provincial organization of 220 FTEs that would serve families and individuals well. Now there are 400 FTEs "needed". At the same time as funding for an additional 180 FTEs is apparently available, the Ministry claws back money from service providers, including benefits to staff who actually provide the supports needed. How do we answer those families and individuals who remain on wait lists year after year? How do we justify these priorities?
In 2001, only two positions reported directly to the CEO; in 2005, six positions report directly to the CEO. Regardless of job title or "rank", this appears to be a 300% increase. In 2005, a whole new level of management has been inserted which was not deemed necessary at all in 2001. The Ministry states that demographics suggest an increase of close to 4% annually in terms of services pressures. Given that the community has no further capacity to give back money or to increase service levels, what will CLBC do in order to "transform" the system? What about the Ministry's three year financial plan and its impact? If the government is eager to "devolve services" it is because of its fiscal agenda. Is CLBC unaware of this struggle? Surely not. Has the question been asked: what is the actual operating budget of CLBC as an organization separate to the budget for contracted services? If is essential that we have clean information on this, or embarking on this proposed model could lead to tragic consequences.
Treasury Board is willing to fund a grant of $325,000 to do research around "cost effective" models. Hopefully this research will actually provide a clear picture of what most consumers (in any market place) already know: that quality is economy in the long run, and that duplication of effort makes for an inefficient business. It is in the context of "no loss of position" (in the 2005 model) that one must put the examination of any "cheaper" models of direct services.
The Community Coalition had a deal with this government and that deal is being broken. The government said they would help and encourage us to let the community develop the necessary resources in community, simply so that appropriate support services would be sustainable. What opportunities for true innovation remain in the bloated 2005 model? How will the community ever receive the investment it needs to develop a sustainable infrastructure? The needs of the Ministry appear to regularly supersede the needs of our most vulnerable citizens. The notion that one could "form CLBC" inside the Ministry and then "pop it out into the community" while "changing it afterwards" is naive in the extreme. History is filled with examples of how this has not worked. It would be an overwhelming challenge for most people and most organizations, and presupposes both a level of awareness and a total commitment to participate in order for a cultural transformation ever to take place. Will the hiring of an "expert" in changing an organizational culture do the trick? Who will be responsible for the outcome of this endeavour? If the culture is not transformed, then what?
The Authority has stated that it will become accredited by the end of its first two years of operation. Only a very superficial understanding of accreditation would suggest such a bold statement. Family members state quite openly that no "satisfaction survey" would ever suggest that the current model of CLBC would receive consumer approval. This would likely be accurate from the perspective of other community stakeholders at well. There simply is no language in the current (2005) model which suggests an understanding of what truly is a community driven philosophy. Values and ethics must underpin the entire organizational structure and culture, not be the faint hope of a tonic injected after the fact.
At this juncture, to have any credibility, the organizational structure must show people with impeccable community experience and demonstrated leadership filling every management position. The essence contained in the 2001statement that allowed then Minister Hogg to speak with passion must be rediscovered. Perhaps Minister Hagen, a principled man, can guide the Board into a reality where this is possible. Shakespeare said "it is a consummation devoutly to be wished". And so it is.
Jordan Thurston, Service Provider ________________________________________________________________
Our daughter has cerebral palsy and gets individual funding through the CSIL Program, Ministry of Health. She has autonomy and a full life where she is included in community. She is very happy. Changes need to be made to the MCFD CL service model so all individuals with developmental disabilities have opportunities for autonomy/self determination and an inclusive community life like people who qualify for the CSIL program have. It is that simple. Everyday, our family is incredibly grateful that our daughter gets the correct kind of service and support. Please make the changes. Do the right thing. People are worth it. Janice, Robert and Melanie Maxwell ______________________________________________________________________
I have a concern about the approach that is being taken with accountability. The document talks a lot about accountability to the Ministry and the bureaucrats but makes very little reference to accountability to families and/or service users. Although there is some lip service to this issue, most of the accountability mechanisms described in the document are administrative and focused on relationships between bureaucrats and service providers. In addition, I disagree with the delegation of service monitoring to the Operations Analysts. The facilitators are the people who will have the most contact with the service user and the family and be most familiar with their goals and wishes. The facilitator is more appropriately placed to gather feedback from users and families about whether the service is meeting the original goals. Finally, in failing to mention Individualized Funding, the document ignores a very efficient accountability mechanism - if the service user/family doesn't like it, they'll take their money elsewhere! I also think that the sections on strategic planning fail to give the community the role it would like to have in deciding how community living services should look in the future. The planning process should be driven by the community, not simply involve us. Finally, the term "Operations Analysts" has to go. The term is horribly inaccessible and bureaucratic. Thanks Fiona Lewis Friend of a person who receives MCFD services. North Vancouver ______________________________________________________________________
Hello, I have read the service model and I have been supportive of CLBC concept from beginning: 1) New model is more bureaucratic focused than I would have thought. The original concept was not so. The key, I suppose, to having two managers in a center is selection. There can be benefits to having two distinct roles. The contract manager process is an excellent tool for change, innovation, partnerships etc. in each community. The first few years of CLBC will be developmental and may benefit from two distinct managers. The paramount success will of course come from the people in the positions and not the positions. Eddie Bartnick has highlighted this in his critiques. If the same people occupy the same positions, the culture will unlikely change. How did the service model change so? Will government let go of power and transfer to CLBC at a structural level? 2) Family input and participation of community must be the foundation of service delivery. Without this, little will change. Again, if the bureaucracy still exists in the end, the determining factor to success might just be to ensure the managers positions are filled with staff/individuals who are not bureaucratic by nature.(open to taking direction as opposed to giving it and able to give direction when necessary, trust, values etc) 3) The decrease in autonomy for planners is noticed in the model but again, selecting appropriate managers may reduce the lack of autonomy the model portrays. The best leaders/managers will create an atmosphere that will allow for independence and creativity.( Selection is the key to the success of the model ) 4) No mention of individualized funding is noted. Why? Thanks for the opportunity to provide feedback. The model shows a thought out process. It changed somewhat from the original design and appears more bureaucratic. I believe it is the people who are bureaucrats and not the positions and that the positions must be filled appropriately from the start date, to assist this necessary transformation. The challenge then becomes a labour relations issue for excluded positions. My thought is that communities and families deserve more right to how and who fills the positions, than the people currently in them? Further, the Director positions are integral to the success of the model and the people in it (trust, input, accountability, direct access etc.) A key component for the hiring body is that they are able to select managers who have a demonstrated ability to take direction from citizens and families and are able to put individual needs first. Cliff Andrusko, Social Worker Community Living Services for Adults ______________________________________________________________________
Dear Committee Members, It does not seem to me that this board is hearing anything parents are saying. It also seems as though someone has decided this is the way it will be from now on and we as family\advocates have no more say in how service will be delivered to our family member(s)? Our family member(s) are vulnerable enough without stressed out parents, who are told by some Ministry staff if we are stressed out to put our family member in care. When do you stop? When do you listen? When do you realize that IF was in place from birth to death you would save millions of dollars on all the staff you put in place who make our life more difficult? It seems the only reason is to hire more bureaucrats to make money off our family members with disabilities. Is that the legacy that this board\Ministry wants to leave? Enough already!!!!! Questions: 1. When you say, "....families will always be actively involved in planning and decisions but they may not always be the final decision makers", what specifically do you mean? 2. Will not allowing CLBC to make decisions for my son result in no funding? 3. Is IF even an option? Will the money follow the PWD? 4. Why are so many people getting paid to watch so many other people? (see the structure) Is this money coming from the Budget for PWD in BC? 5. Why are there not more parents involved in this "new" structure? The simple structure recommended before this report would work, it would save money, it would make our lives easier, it had checks in place why was it changed? 6. The adults you are taking "care" of are our family members why are you presuming that you know what they need and we don't? 7. There are professionals who value the contributions and knowledge of families of PWD's. Where does this component exist in this plan? How long have they worked in the field? How many PWD have they known? Yes, it does matter! (how many VP's do you really need)? 8. How many of your new ministry staff will actually know the PWD and how well will they know them in order to make service decisions for them? Will they require more "professional" input before the service is approved? Where is the money coming from for all the consultants who these people hire when they don't know what decision to make for our family member(s)? I know this happens as I have been in this system for 16 years and will be spending the rest of my life in it to make sure my son gets the support he needs. How many of these people hired can say the same? Comments\Recommendations: I find some of this document to be very vague and open to interpretation by your staff in what kind of "power" they may have over our family member(s) and I think the document should include: "Families\advocates who are active in the PWD"s life and have the legal right to speak for their family member\friend will be the final decision maker in all programs for the person(s) they support and the funding for their family member(s)\friend will support their decision(s)". If you are referring to PWD who have no family members\advocates in this document please clarify that. If you are presuming that you can make decisions for PWD who have active family members\advocates who have advocated for their family member\friend from birth please clarify that. In my opinion the money saved from some of these "layers" of people and the huge number of "hoops" (read meetings) we as family members\advocates of PWD will have to go to to get support from birth to death would pay formany services/programs our family members are not getting now. In most cases our family member has been in this system since birth why are we having to go to all these people to get services?? What has been learned from all the money spent on MEETINGS? ("There is no money for service at this time, try again in a year")? I think it is about time you have a board of family\advocates, with authority to act, as the final decision makers in all the disputes arising from any decision regarding services made by professionals and not supported by the family\advocate. Although some PWD are non verbal most have some way to communicate they are not happy. I feel this board of parents should also review all cases each year to ensure non verbal people with disabilities are content with the service they are receiving. The Ministry can appoint these parents to enable them to meet and support these PWD who have no one other than the Ministry to speak for them. I know many Ministry employees do care about PWD unfortunately some see it only as a job. All PWD deserve caring, committed support and the government should have a board that is autonomous in reporting on the service for our most vulnerable citizens. The money should follow the PWD from birth to death. You will eliminate many meetings and save time, money and stress on the PWD, their family, and the Ministry. It should not be so complicated. We know our family member(s), their needs, their strengths, their vulnerability, let us full fill our commitment to them and stop throwing up road blocks in our way! Remember we are committed for life! I would appreciate answers to these questions and feedback on my comments and recommendations. Calvin's - Mother and Advocate, Cheryl Baker ______________________________________________________________________
I have read the 28-page document "Transforming Community Living Services in British Columbia" dated January 6, 2005. Comments:- 1. The service delivery proposed seems top-heavy, with many bureaucrats involved in an array of executive functions that don't necessarily transform directly to services. 2. Service plans have to go from the facilitator to operations analyst and back to facilitator, back and forth several times between these officers. How can this ensure timely delivery of services? 3. How many operations analysts are there? Presumably one for each of the Community Living Centres. There needs to be clear definition of how the OA in each Centre interfaces with the other "bureaucrats" and the facilitator, and the time element involved. The OA seems to have awesome responsibility (and responsibilities) and I am concerned that the requirement to go back and forth between the facilitator so frequently will cause a backlog of paperwork, because that's what this system of "delivery" amounts to, and hence delay in delivery of services. 4. There needs to be some clear delineation of expected time frames for service delivery. Speedy and efficient approval of individual service plans needs to be guaranteed for the "transformation" of service delivery to work. 5. I do not see a specific planning protocol for crisis intervention or other contingency for emergencies. 6. The report was vague in specifying from a family or self-advocate's position the availability of services. It said a facilitator helps to develop an individual service plan (with the help of an OA), but what exactly can be included in the plan? It would help to list all possible services, in a general sense if need be, so that families/individuals can formulate a plan before going to a facilitator, and save time. Shortening the processing time for service planning and development will make the bureaucrats more available to serve more people and improve efficiency. The time element is crucial.
Cathy Liddle (parent, North Vancouver). ______________________________________________________________________
Hello, Thank you for conducting this process. After reviewing the new service model for clbc I have the following concerns/questions: * Model is top heavy hierarchy. Recommend unilateral model to support family and individual input and decision making. * Facilitators duties are very limited compared to current social work role. Does less responsibility mean less money for position performed primarily by women? What are their intentions, wage roll back to support hierarchy with all the responsibilities? * How does monitoring contracts/resources from afar equate to safety for individuals? Many hands on tasks performed by social workers now administrative functions? * Where is the protection for consumers at the local level? Who do they report abuses to? Where will consumers requiring counselling, assistance with problem solving etc., etc., go for this support and who will they talk to? Many social workers currently fill this role particularly those who do not have access to counselling because The Interior Health Authority refuses referrals from our consumers with mental illness because they are developmentally delayed first-this is discrimination by the way. Will the consumers be required to contact Victoria or some crisis line?? What if the individual does not know how to use a telephone will they ask the person who is taking advantage of them to call? What about the individuals who require trusting someone before opening up to them or those who become weary of the phone voice. Who will ensure that licensed facilities report abuses because we know they don't all the time. These kinds of things can't be performed from head office. * I wonder how busy facilitator's will really be without access to individualized funding. Where will all the need for planning come from? If we unbundle services in Salmon Arm they will fall apart and others will suffer. * I don't understand how a top heavy bureacracy equates into more accountability-more red tape, more people to say no to consumers? * Where does Health Services for Community Living come in? If we are responsible for facilitating planning who will case manage, who gets these people involved? Lynn Cvitko, MSW Children and Adult Community Living Services ______________________________________________________________________ Thank you for sharing the Coalition's concerns regarding the proposed CLBC Service Model, and thank you for your hard work in advocating for individualized funding on behalf of all individuals and their families. As a service provider, we also share your concerns. With due respect for all the hard work that many members of the community have put into this change I would like to offer the following comments: It appears that this Service Model has moved away from the original purpose which was to provide individualized funding so that people would have the option of moving toward smaller, flexible (and cost effective services) - if that was their wish. It is also difficult to understand from this Service Model how the "end services" will be delivered to individuals and families and who will be responsible for delivering the services. In addition, it is unclear how separate "new funding" will be identified for individualized funding in a time of cuts to services. This Service Model appears to focus on the "structure" of the organization, while loosing its focus on individuals. As an advocate for the people we support (and their families), we are particularly concerned with the Principle Statement: "These remain the essential elements shaping CLBC, with the caveat that families will always be actively involved in planning and decisions ......but "they may not always be the final decision makers". There will continue to be constraints related to the capacity of the system to respond and the specific accountabilities of CLUB and its Board." I hope you will find this feedback helpful and thank you for providing an opportunity for the public to comment on this important change. Name withheld by request BACK TO Staying True to the Vision - A Response to Transforming Community Living Services in BC - Jan 06, 05 |
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