Kia ora, koutou. Thank you for joining us today. My name is Adri Isbister and although I can't see you, I'm very pleased to be able to engage with you all today. Before we start our session, I just want to introduce Dr. Ashley Bloomfield He's our Director General. And Toni Atkinson, our Group Manager, Disability Support Services. Ashley.

Well, kia ora, koutou. Thanks very much, Adri. And thank you to all of you for joining the korero today. I just wanted to make a couple of comments to start with before I have to head off to another meeting. And first of all, just to let you know that I personally am very committed to and interested in the work that the team is doing with the providers and, indeed, right across the disability support sector. So one of the things I did explicitly in taking on this role and through my initial reorganization was to establish a standalone disability directorate. And that was with intent and purpose to make sure we did have the right focus on disability support services.

So what the discussion is about today is really to respond to some of the questions that have been raised in response to the letter you've received regarding cost pressure funding for this year. The intent of the letter was to be clear and to provide you with certainty, but that's not the end of the discussion. That is the start of the discussion, and really just another step in the work with you.

And I do want to just underscore our commitment to continuing to work with the provider sector and with the range of stakeholders across the disability sector. And just to underscore our commitment to ensuring financial and service sustainability in the sector. And while the additional $72 million the government has voted for disability support is significant, we understand that there are still a number of ongoing pressures, including for providers. And I should also say that that $72 million was in addition to a further $60 million that the government put aside right at the end of the last financial year, and it came through the budget as well.

So I want to leave you with a really clear impression that, as a Ministry, we are very committed to financial sustainability of the provider sector and of the wider sector, and I can also pass on that our ministers are also very committed to that. We will work with you to make sure they get very good advice about how we can ensure a sustainable investment pathway forward. So I'm going to hand back to Adri now, and I look forward to hearing the outcome of a discussion today. Kia ora, koutou.

Thank you, Ashley. Toni. (WHISPERS) You'll have to introduce yourself.

Morning, everybody. I'm Toni Atkinson, and I'm the Great Manager for Disability Support Services here at the Ministry of Health, and I've been in the role for just coming up to seven years next month.

Thanks, Toni. As you know, I'm not new to the disability sector, although, I am new to this position in the Ministry. And it's a real privilege to be leading this directorate through the next iteration of how best we will work with disabled people, providers, and the wider community to deliver support services. I'm very familiar with the NGO sector as well as corporate health sector and, most recently, as a CEO of a DHB. I am also a person with lived experience of disability through my young grandson, James.

You may be aware, as Ashley mentioned, that the disability directorate was reformed and the Ministry in October 2018. And that decision to bring disability functions across the Ministry back into its own directorate was a very heartening moment for me. What the creation of a disability directorate has done has given the sector the level of importance that it needs. So I'd just like to pretty much ditto what Ashley has said. We are focused on delivering and developing a future strategy that makes the sector sustainable.

Toni and I are going to discuss the next steps for the directorate and our communities with you all today. Before we start our conversation, we wanted to let you know that live streaming is a new way for the Ministry to engage with people. So if there are technical glitches, please bear with us. We also want to outline some terms of engagement before we start. This forum is for providers of disability supports and services, so we will not address any questions or comments that fall outside of the scope at this time. We will answer as many questions from providers that we can. And to those of you who sent questions in advance, thank you. There are many of them.

This livestream will be available to view on our website when we finish. We apologize that we were unable to secure a sign language interpreter for the session, but we will ensure that is accessible afterwards.

You have, as Ashley mentioned, received a letter a couple of weeks ago outlining the Ministry's decision regarding price increases for this financial year, aside from pay equity. And we acknowledge that this news is disappointing. And we want to take this opportunity to provide some context about why we've made this decision and what it means for you as providers, as well as our disability community.

We are committed to ensuring disabled people and whanau have the opportunity to live the lives they choose in New Zealand with access to the services and support they require from DSS services. Through DSS funding, disability providers currently support approximately 37,000 disabled people in New Zealand. So handing across to Toni, what does the DSS landscape look like?

Thanks, Adri. Well, I think it's important to acknowledge that between us, both us in our funding role and you as providers, we deliver supports and services across a range of services and types of services that provide delivery of essential support needs to disabled people. So the funding means that nearly 8,000 people have someone to help them get up in the morning and shower through their personal cares, and we have over 9,000 people who have help with cleaning and laundry.

Nearly 16,000 caregivers have support to take a break from their caring responsibilities and 7,500 people have 24/7 support to live in their community through a residential provider. We also have some bespoke services, such as behavior support where over 2000 people a year can access the behavior support service. And things like cochlear implants-- 86 adults and children every year receive a cochlear implant that enables them to hear.

In addition to those ongoing services and supports, about 75,000 people of all ages get the equipment they need to remain independent. Our priority is ensuring that people continue to access these important supports and services.

So as you can see, more people are accessing Disability Support Services than ever before. And we are heartened to see that more disabled people are able to access these services. To give some context to the numbers, in the last five years, the numbers accessing services has grown by approximately 3%. In comparison, the general population has grown by 1.5%.

And Adri, just to add to that, the biggest growth that we've seen is the number of people accessing supports related to ASD-- the autism spectrum disorder. So that group, I think we've seen about a 24% increase in numbers since 2013-14 when we confirmed the eligibility for ASD.

And that is really important, that, because they are people that do need services. But it does actually mean that costs have increased significantly. So for example, over six years, total costs for community care supports have increased by approximately 40%. Total costs for residential care has increased by approximately 15%. And total costs for environmental support has increased by approximately 35%.

Costs have increased for a range of reasons, including availability of new equipment and technology, and legislation changes, including pay equity and in-between travel, and health and safety requirements. These changes are important, and we are proud that we are building a future where disabled people can get the support that they need. The Ministry of Health has managed this in different ways over the years, and Toni will give you some detail about how that has occurred.

So what we're experiencing is a system that has seen growing pressures over a number of years. And I think it would be fair to say that for the last four years, Disability Support Services has been looking at a forecast overspending each financial year. In the earlier years, that forecast overspend was much more easily manageable, because it was around the $20 to $30 million mark. But certainly last year, and Ashley alluded to some of the additional funding that's come in, the growth that we're seeing has put a much greater pressure on what we're able to do in terms of managing against our appropriation.

So in previous years, the Ministry shifted funding from elsewhere in the health budget to meeting the shortfall, but this isn't possible anymore. We need to ensure that the Ministry is allocating its funds across the health and disability sector in a way that's both equitable and sustainable. And we need to ensure that funding is allocated in accordance with government priorities. We know that cost pressures for Disability Support Services will continue, and this means we need to look at how we can manage this pressure into the future while continuing to deliver support and services for disabled people and their whanau.

We want to be really clear that we are not cutting services in support. We don't want disabled people and their whanau having to worry about losing out on the supports and services they currently access, so our priority is making sure disabled people can continue to access those supports. But we can't do this alone. Adri, what can providers do to work with us on this?

So, as I mentioned before, our opportunity is to work with you to build a sustainable future for everyone who accesses and delivers Disability Support Services within the funding that we have. You work at the front line. You know what works well for our communities. And we are looking to you for your solutions and ideas about how we best work together to resolve this challenge. So we will be hosting regional forums starting as soon as August and September this year, and we want to listen.

In these forums, some of the topics we will explore include, how we manage contracts and agreements with your organizations, how can our contracts with you give you more flexibility, how can we make it easier for you to add value. We also want to shift our approach in contracting to commissioning for better outcomes for disabled people and whanau. Toni will briefly discuss some of the projects we currently have underway that will also guide our future direction.

So you will be aware that the Ministry is currently working on a number of projects to manage the financial pressure and enhance the value of services. Key to that is rethinking how we work as a sector to deliver services for disabled people and their whanau. There will be changes as we seize opportunities to work better and smarter to deliver services within the funding available, but I just want to emphasize that no decisions on what those changes are have been made as yet.

So we want to work with you collectively and individually to understand the short- and longer-term issues and pressures you are facing, and how you see the sector developing and adapting over time. The more information we have, the more we'll be able to provide insights and advice for the government about the future of disability support sector and funding arrangements.

With your help, we can inform the government's priorities next financial year and beyond. So we're really in the early stages of looking at how we can better fund the range of home and community support services, for example. And we started a piece of work on home and community support that looks to some of the work that's happening in the aged care sector and perhaps leveraging off some of that development work in that space.

You also know we've been working on a new residential pricing model so that we can better understand the cost pressures that are driving cost increases in the residential sector. And we've got analysts who are working on that model and looking forward to the information that the residential providers are delivering to us at moment that means we can move forward and land that residential pricing work.

But what we need to do is look at different ways of contracting and pricing services to give providers the flexibility to focus on outcomes for people with a disability, rather on things like the hours of service delivery. We also need to mention the trial going on in the MidCentral region of a new disability support system and approach. And it was co-designed with disabled people and their families and whanau, which we hope will help us to develop a better operating model for Disability Support Services that is equitable, sustainable, and provides those better outcomes for disabled people in the future.

The evaluation of the program and its success will start to be undertaken towards the end of 2020. And at that point, we'll be able to build on some of those learnings. So the prototype is underpinned by the Enabling Good Lives principles, and they include things like self-determination and person-centered supports. And those principles will help guide any future changes to our models of care or any changes to our funding arrangements.

Adri you will be doing a roadshow later in the year to meet with providers, disabled people, and their whanau.

Yes. That's a-- a big part of these forums is to sense check where are we're heading. As I mentioned, we're going to be holding a number of forums for providers and separate forums for disabled people and whanau. In these forums, we'll be sharing our initial thinking for redesigning services and ask you to work with us to identify, design, and roll out systems and services that will work well for you in our disability community within the funding we have available.

We are aiming to meet with you as soon as August or September this year, and we'll keep you updated as we play in these forums. And as I mentioned before, I have already engaged with a number of you, and I do want to thank you for the welcome that you have extended to me. I've also had a few providers contact me individually with solutions and ideas that they wish to trial. So thank you for reaching out. I'm encouraging all of you to reach out and share your ideas. I've heard many of you have innovative ways of providing services around New Zealand and new ways of working across the sector, and we want to hear more about these. And I look forward to exploring them further in our upcoming forums with you.

We will continue to work closely with disabled people, their families and whanau, in the disability sector to ensure that we are heading in the right direction and making informed decisions. Co-designing solutions is the priority for us. In addition, we may be able to find solutions by working across agencies. Many of you already do this, and we will continue engaging with MSD, education, and Ora Tamariki-- and mental health. And we acknowledge that many government agencies play a role in supporting people with a disability. And a key role of the new directorate will be to work with our government colleagues to ensure a cost-effective delivery of better outcomes.

A number of you have sent us questions in advance and we will start to answer some of these now. Toni, one of the questions was, when the government says it was fully funding DSS, why can't the Ministry give pay increases?

Well, Adri, that's the $64 million question. So what we're experiencing is a symptom of a system that's been under pressure for a number of years. And that means much of the funding provided for '19-'20 has already been absorbed by meeting the growth and demand for '18-'19. So Ashley did a little bit about the funding that came in to Disability Support Services in the '18-'19 year. The total amount we spent that year was $1,358,000,000, and that included, as Ashley said, $60 million from budget '19, plus an additional $28 million from re-prioritization from within the Ministry of Health. So that's money that was allocated to other Ministry of Health priorities that has been moved into the disability support sector to manage that growth and cost pressure.

But that funding, both the $60 million and the $28 million last year, was one-off funding for the year. So that means that money can't be included in the money going forward. We did, as Ashley said, receive an extra $72 million in the budget, and that brings the budget for '19-'20 to slightly less than the spend in '18-'19. So that means we starting from a base which already assumes that our spend for '19-'20 is going to be at the same level as the '18-'19. It doesn't allow us any money for additional investment, or any money to invest in anything other than the things that are required to do under legislation, such as pay equity.

So, Toni, another question that did come on was that, in addition to that question, does no price increase include pay equity?

Adri, the providers know, and we know, that the pay equity area is pretty tricky to understand. So there's money that's come in from a pay equity appropriation, and there's money that DSS has had to fund from its own appropriation to pay for some of the cost. This year, in '19-'20, the pay equity appropriation is going to be devolved to funders, which means Disability Support Services is going to get a lump sum of their pay equity money. However, that money is in addition to money that we have to find from our current appropriation to provide the full funding around the pay equity commitment.

So where did this money come from previously?

So previously, the Ministry had unspent funding from other areas in the Ministry, as I said, to meet that shortfall. But that's no longer possible. And we need to ensure the Ministry is allocating its funds across the health and disability sector in a way that's equitable and sustainable. We also need to ensure that the funding is allocated in accordance with government priorities.

So, Toni, why weren't providers told about this earlier? That's one of the questions that's come through.

And, Adri, we've had a few providers contacting us saying, look, we didn't find out until very recently that we weren't having price increases. And we understand that some of you would have made commitments for your budgets for the '19-'20 year to your boards around what your '19-'20 financial year looks like. So budget '19 came out at the end of May, which is later than usual, and that only left us a month to do our own analysis to learn the budget and identify where the priorities would have to be. So we'll endeavor to keep you informed with as much notice as we can going forward if there are any changes to funding.

Adri, why do you think providers miss out when other areas have got more, such as mental health?

And it's certainly a question that I've been asked personally in the last little while as well. So investment in the wider budget package is really important. Disabled people also have health needs, including mental health. And the investment in mental health will make a difference to the lives of disabled people in New Zealand. Disabled people will not miss out on access to support and services. We are not cutting services. Toni, just another question that came through is, is the Ministry asking for more money? And if the funding wasn't enough, why didn't we ask for more?

Thanks, Adri. And look, I can understand to providers that it would seem that that seems to be one of the solutions. But I guess what I'd say is that we want to work with you as providers to understand the short- and longer-term issues and the pressures you're facing. And see how the sector's developing and adapting over time. The more information we have-- and we have a team of analysts working hard upstairs trying to understand where those pressures are-- the more we'll be able to provide insights and advice to government about the future of disability support sector and funding arrangements. So with your help in identifying those cost pressures and providing us with information, we can inform the government's priorities for next financial year and beyond.

Adri, one of the questions providers have asked us, how does the Ministry expect provides to deliver services without any more funding?

It's certainly a question that I've been asked personally as well. So whilst we acknowledge that it's good to be able to meet demand pressures and employer obligations, particularly under pay equity and minimum wage, the issue of general price uplift and pressure on other provider costs remains outstanding. So we'll continue working together to build a sustainable future for providers and people who access disability supports and services.

As I mentioned before, we've already been contacted by a number of providers who have innovative ideas about possible changes that could lead to better outcomes for disabled people with less funding. Things like the way in which we contract with people, flexible funding in the contracts, bulk funding-- we've been talking about a whole lot of different things for making things easier for you as providers. But we want to harness these good ideas and use them more widely across the sector to support our plans for long-term sustainability. We also have a range of supports available to you, so please contact your contract relationships manager.

Some providers have asked about cuts to services. And the government has made it really clear that there will not be cuts to people's support. The disabled people, their families and whanau, do not have to worry that a funding shortfall about losing out on the supports and services that they need. We will ensure that disabled people and their whanau will continue to access these very important services.

So, Toni, another question that's come through is, why do we keep sharing different numbers?

Yeah. So it's really hard to manage and understand the peaks and troughs and drivers of the change in spend when you're trying to manage nearly $1.5 billion of money. What happens in the Ministry is that we start with an appropriation, but that appropriation can change during the year. So that's our budget. But also cost pressures change, and we're constantly analyzing and trying to understand what's happening in the sector.

We also get legislative changes, such as pay equity, sleepover, in-between travel which can impact on the funding. Some of those changes don't come in at the beginning of the year and, therefore, things can change during the year. But we will try and keep you informed about our financial position as we go through the year.

So another question that has come through is, if DSS runs out of money, what happens?

So when I talked about the position that we're starting the year on, that money has nearly all been committed on people whos current funding levels and support packages. And as Adri said, we're not going to be able to reduce those, and we're not intending to reduce those. So we have to continue to fund disabled people and whanau at the level of current supports that they're eligible for and has been allocated through the NES. What we can do is look at some of the areas that we fund and that money goes that is not directly impacting on people's essential needs and figure out ways to manage the growth that we're seeing in some of those areas and how we can do those better.

Adri, providers have asked what is the Ministry doing to get out of the hole?

Well, as you know, the directorate was reformed in October 2018. And this provides a focused team within the Ministry and elevates the level of importance it has within the Ministry. We're also going through a change process to ensure that we're set up to build a sustainable disability system. We want to work with providers to build this system for everyone who accesses and delivers disability support services.

The Ministry is currently working on a number of projects. And I think Toni spoke about some of those projects to manage the financial pressure and to enhance the value of services, such as rethinking how we work as a sector to deliver services. We are looking at different ways of contracting so you can have more flexibility and enhance outcomes for people. There will be changes as we seize opportunities to work together. And we want to work better and smarter to deliver services within the funding available. But no decisions have been made. The Ministry of Health will continue to work with disabled people, their whanau, and providers to look at new ways of offering support that both meets people's needs and is sustainable.

One of the questions in terms of the sustainability into the future is, what's happening with the RPM, the residential pricing model?

Well, as I said earlier, we work on the RPM has been continuing, and we have a dedicated team of analysts who are supporting the DSS story and working to understand and present our data in an informative way. We've asked our residential providers to give us some information about client numbers in houses so we can do a stocktake of where our current 7,500 clients are. And that'll help us to identify the significant costs of residential and how it's impacting on residential providers in a more consistent way. And then this information will form the basis of a new way of funding residential services. So we'll continue to keep you updated as the work on the residential pricing model continues.

Adri, what's the Ministry for pricing to make savings? How will this translate to disabled people?

In the first instance, as you all know, the government has made it very clear that there will be no cuts to services to disabled people for the support that they need. No decisions have been made on changes to the funding and delivery of Disability Support Services. The Ministry of Health is continuing to prepare advice on options to ensure that we have a system there is fair, equitable, consistent, and sustainable. We will continue to involve disabled people and their whanau and providers in our decision-making processes.

We're also working with the workforce through a number of working groups. And we're working right across the sector, including government and the Office of Disability Issues, to ensure that we're building that future. We know that a number of you are already doing this. We also know how important it is that government agencies are working together so that we can create cross-sector solutions.

Another question that did come through is, does the Ministry, Toni, talk to disabled people before making decisions?

Well, Adri, the [INAUDIBLE] government's made a commitment to involving disabled people in the decision-making and some of the policy decisions around the disability sector. So it's important, because we can't deliver meaningful services for disabled people and their whanau without the support and their involvement. So we continue working with disabled people as well as whanau and providers to look at new ways of offering support that both meets people's needs and is sustainable into the future.

So Disability Support Services have a number of regular forums and opportunities for disabled people to engage with us. One of those is our consumer consortium, and they provide us with advice. They for three days every six months, so twice a year. And we also have a Maori leadership and advisory group and the Pasifika advisory group who we meet regularly throughout the year and provide us with advice on some of the work that we're doing. We adhere to the disability strategy of Nothing About Us Without Us and the Enabling Good Lives principles.

Adri, is system transformation still the direction? I know a lot of providers are interested to know what our long-term strategy is and how system transformation feeds into that.

Yeah, and that's a really good question. And as Toni mentioned before, we are trialing a new disability support system approach in the MidCentral region, co-designed with disabled people and their families and whanau, which we hope will help us develop a better operating model for Disability Support Services that is equitable, sustainable, and provides better outcomes for disabled people. Right now, we're still in the pilot phase, which means we're testing and adapting this prototype. It has been going for less than a year, so it is early days. But we believe that key learnings from this prototype will help design a new disability support system for the future that better meets people's needs and continues to be sustainable.

This prototype is focused on the Enabling Good Lives principles, which are driving change and how support is delivered and designed. These principles will continue to drive our future direction, how is this rolled out, and to what extent is still to be decided. And I know that many providers have said to me that the EGL principles are what drives their way of service innovation and delivery. So I've been really heartened by that.

But, Toni, one of the questions that I have noted has come through is on the OIA process. So why did providers need to use the OIA process to getting information from us?

Well, Adri, we're really happy to share information that we have with the sector. And providers and other people don't necessarily have to use the OIA process to get information. We try and publish information on what we're seeing in terms of our demographics regularly, and we have a new demographic report that's due to come out within the next couple of months. And that provides a lot of information about the people who are accessing our supports and services. So we're really committed to being open and transparent, and we're currently reviewing how we share information so everyone can understand what's happening and what it means for them. We also have a lot of information contained on our website so, for people who want information, particularly data, you can go to our website and have a look at some of the reports that are available.

So we've had some more questions come in. One is, why has there been no inclusion in the funding for cost pressure increases or any increases to compensate for the DHB Nurses MECA for government legislative pay equity, associated relativity increases for other roles in community disability care? Gosh, that's a bit of a mouthful [LAUGHS].

It certainly is. Yeah. And I totally appreciate, and I've heard feedback on relativity. And I think that we have covered this, but we do want to hear from you regarding your ideas about how we might do that better.

Another question that has come through is, how do we plan to target the service, as this is a volumes game? So if funding is not forthcoming, then how will client numbers be managed by the Ministry of Health? Could that mean waiting lists? Could it means user pays or testing the user pays system? So that kind of question has just come through as well, Toni.

So I think we've seen a couple of times already this morning that we're not intending to cut services and supports for people with disabilities. And we can't do anything about the eligibility criteria. People who are eligible will always get access to a needs assessment from the NES. So we can't do anything in terms of the volume--

Yeah.

--of services people are getting. And we want to just remind people that we're not going to be cutting services. So we can't manage client numbers through eligibility criteria, but what we can do is look at different ways of funding those essential support needs.

So what would your suggestion be to counter the extreme costs providers face and delivering care on, say, public holidays?

So I understand that some of the costs around the support staff and the workforce are increasing, and that the pressure's been exacerbated by some of the recent settlements, such as pay equity and in-between travel. But I would say that the costs that providers face for delivering supports on a public holiday has been a long-standing pressure. Let's just-- we acknowledge that it has been exacerbated, so I guess all we can say to provide is to manage this in the same way that you've done, whilst we acknowledge that it has been additional pressure through those recent settlements.

OK. So how do we, as a Ministry, have a role in the sustainability of the sector? And if so, how? And if not, why? It's a question that's being asked.

And, Adri--

Yeah.

--you've clearly articulated to us in the disability directorate our role in the sustainability of the sector and how we want to work together as a directorate to ensure that long-term sustainability. One of the projects that we didn't mention earlier is the project that we've started on our strategic planning. So that certainly is looking into the future around how we can make the services and supports in the sector more sustainable. So I think, Adri, when you do your big lesson, you're going to talk a little bit to the sector about what that strategic planning looks like.

Yeah. Now I know Toni spoke about things-- so data, information on our website. And we have been doing a huge amount of work on looking at what is actually driving some of this. And one of the questions that's come through is, what percentage increases in funding has occurred in the last five years, excluding pay equity and IBT funding, that has been due to legislative requirements?

So, Adri, that was a question that came in pretty late, so I don't have those numbers to hand.

Yeah.

What I can say is that the percentage increase in funding for price increases has been different every year. And so we go through a process once we get our budget through the budget process and understand what our appropriation is of looking at, first, client growth and their pressures and the commitments we've already made to disabled people in the sector about their level of support. Then we look at any legislative commitments we might have, and we talked a little bit about pay equity, in-between travel, and also minimum wage commitment, so we have to put funding aside for that.

Then any funding that's left over after all of those commitments will be a portion to provide us full price increases, but also some of it might be used to look at investments in the future and how we can look at funding things now that will make a big difference to those cost pressures going forward. But what I can say in the last five years is that for very few of those years have we had much funding available after we've made our commitments to look at price increases and providers.

Yep. And we've also stated within this conversation today that we'd like to see innovation and technology advancements in the sector. So one of the questions is, where do we propose the funding will come from to manage this?

And, Adri, I know this is one of the areas that you're quite keen on-- innovation and technology.

Yeah, yeah. So yeah. Certainly I am really keen to look at what is coming through from the sector, and as I said, I've heard about a lot of that kind of technology that's happening at the moment in terms of logistics for home base support service provision, et cetera. And systems transformation is looking at ways that they can invest daily to make savings through this technology as well.

But one of the other questions that came through was, a few years ago in central TAS and it's certainly something as a new person, I wasn't aware of-- conducted a costing model for service delivery. And would we be prepared to revisit the costing model to support what the realities of the cost of delivering services are?

Absolutely. And I think one of the points that you've been making all along is that good ideas about how we make the sector sustainable can come from anywhere, so we are quite happy to make contact with TAS

Yeah.

--and look at any work they've done in this space.

Yeah. And the other question was about individualized funding and what we think the role of individualized funding might be in the future? And do we see this increasing?

So there has been a significant increase in individualized funding over recent years. Partially because of the publicity around personal budgets. But also as services have changed and new services have become available-- but also as other services have not-- people have made choices about how they want to manage their disability support funding. And so more people are taking up individualized funding and personal budgets. But I think the international evidence in this space is that it sort of peaks at around 30%. So while we expect it still to grow-- and we're not quite sure what the impact will be on system transformation-- there will always be a portion of the population who don't want to move to a personal budget-type model.

OK. So we're about getting close to closing this forum, but the very last question that came through was, does the Ministry plan to support the standardized service specification? And do we anticipate this will lead to standardized funding? As the Ministry of Health would be at the lowest end of the funding spectrum currently, can we advise why this is?

So in the service specification space, I mentioned earlier the project that we have underway in the home and community support services area to build on the work that's happening in the aged care sector. And one of the important parts of that will be looking at and revisiting the service specifications. We're very aware that in Disability Support Services many of our service specs aren't up to date and not necessarily fit for purpose. So we're going through a process, having a look at those service specifications and modernizing them and updating them for the changes in the future direction.

Thank you, Toni. Thank you, the people that are out there that I can't see. But again, I acknowledge the pressure that providers continue to face in 2019-20. And my key message is that we can create a sustainable sector without input from some of the most knowledgeable people in need-- that we can't-- I'm sorry. And that's you, our providers. And that is together. And while we continue to analyze our data to better tell the story about our cost pressures, we cannot rely only on additional funding to address current funding. We need to think about the longer-term strategy, learn from systems transformation, and look at ways to redesign our funding models of care to address the likely ongoing growth in cost pressures.

We have also tried a new way of engaging with you today through this livestream process, which is kind of scary, but we're happy to be doing this. But we can't get your feedback on how well this has worked. Please feel free to send Toni or me your feedback, and we'll be in contact with you again in the next couple of weeks about more opportunities to talk and discuss and to build solutions together. Thank you for your time. I look forward to meeting you all at our upcoming forums in the very near future. Thank you.

Thanks.