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Failings In Ministry Stewardship Of High And Complex Framework

The Ministry of Health needs to urgently improve its oversight of services for people with an intellectual disability and high and complex needs, says Chief Ombudsman Peter Boshier.

Mr Boshier today released Oversight, his investigation report into the Ministry of Health’s oversight of the High and Complex Framework.

"The Framework is a network of hospital and community services for people with an intellectual disability in secure or supervised care. As steward, or kaitiaki, of New Zealand’s health and disability system, the Ministry is responsible for ensuring the Framework can deliver the services it’s designed to", Mr Boshier says.

"My finding is that the Ministry has not fully met these kaitiaki responsibilities".

"The majority of Framework service users enter care through the criminal justice system. Others have high and complex mental health and other needs that cannot be met by mainstream services.

"This is a very small group of people, around 200 to 250, who need intensive and specialised care and rehabilitation services that support them to live good, balanced lives with as much independence as possible", he says.

"My investigation found that Framework services were not always achieving this."

"Problems had built up over the years, especially capacity problems. The Ministry of Health didn’t do what was needed to address these problems, and stop them getting bigger", Mr Boshier says.

"This meant people needing Framework services were not always able to be placed in suitable accommodation. In some cases, court proceedings were being deferred, and some people were spending longer in prison while waiting for a hospital placement", he says.

Some of the people using Framework services have not had the opportunities they should have to live in an environment that is as unrestrictive as possible, to develop their capabilities and strengths, or to move into the community, even where community care may be a much better option for them", Mr Boshier says.

"At worst, I found some people’s experiences have been traumatising, and have impacted negatively on their wellbeing", he says.

"The DHBs providing Framework services raised their concerns with the Ministry. But the Ministry didn’t do enough to plan, monitor, act, or develop a long-term, strategic response", Mr Boshier says.

"The Ministry’s performance in this area appears to have been inconsistent with New Zealand’s obligations under the Disability Convention, to protect and promote the rights of people with disabilities, and prevent breaches of their rights", Mr Boshier says.

"My opinion is that in failing to meet its stewardship responsibilities, the Ministry acted unreasonably. I’ve made substantial recommendations for immediate action".

"I’m encouraged by recent signs that the Ministry is taking a more proactive response to its planning and monitoring responsibilities. I have asked for regular reporting on progress, and will receive my first formal report in September’, he says.

Notes for Editors

The High and Complex Framework provides residential, care, rehabilitation, and vocational services to around 200 to 250 people at a time.

During the period of the investigation (2015-2020), The Ministry of Health purchased around 66 hospital beds from five DHBs for secure hospital Framework services; and around 200 beds from seven NGOs for secure and supervised community accommodation and services.

Framework service users are people with an intellectual disability who:

-have been referred through the Courts under the Intellectual Disability (Compulsory Care and Rehabilitation) Act; or

-have not been charged with any criminal offending, and have been referred under the Mental Health (Compulsory Assessment and Treatment) Act 1992; or

-have not been charged with any criminal offending, but have high and complex needs that can’t be met in the community; these are civil clients.

While the facilities and services are provided by DHBs and NGOs, the Ministry is steward of the Framework, with responsibility for its overall operation and effectiveness.

The Ministry’s role as steward is to plan, act, monitor, and advise to ensure the Framework provides the best possible care, rehabilitation, quality of life, and independence.

Investigative activity included: reviewing Ministry information; interviewing Ministry staff; visiting the five DHBs that provide secure hospital care under the Framework, and reviewing DHB records; reviewing international conventions and domestic law; and examining the experiences of selected service users, whose case studies are included in the report.

This is the second investigative report into the Ministry of Health’s administrative practice for intellectual disability services. Last year the Chief Ombudsman published Off the Record, about the Ministry’s collection and use of information following the deaths of people with intellectual disability in residential care. The Chief Ombudsman found significant gaps in Ministry practice.

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