NADA submission to: Grants Management Improvement Program Taskforce Submission Process

Transcription

1 NADA submission to: Grants Management Improvement Program Taskforce Submission Process September 2012 The Network of Alcohol and Drug Agencies (NADA) is the peak organisation for the non government drug and alcohol sector in NSW. NADA s goal is to support non government drug and alcohol organisations in NSW to reduce the alcohol and drug related harm to individuals, families and the community. PO Box 2345, Strawberry Hills NSW 2012 p. (02) f. (02) w. NADA Submission to NSW Ministry of Health GMIP 1

2 INTRODUCTION This submission responds to questions raised in the NSW Health grants Management Improvement Taskforce Discussion Paper for Consultation. This paper outlines the background to the Grants Management Improvement Program (GMIP) initiated by the NSW Ministry of Health and the subsequent development of the GMIP Taskforce and its consultations process. The consultation paper forms the basis for discussions at the various public forums that were held by the Taskforce as well as outlining the main questions for the submissions to the overall GMIP review process. This submission from NADA will directly address the six key questions of the discussion paper. NADA has also been directly involved in the Taskforce process through the involvement of the NADA CEO as a Taskforce member. NADA has broken down the six questions into three topic areas that the questions fall under: 1. Grants Administration 2. Relationships with Peak organisations 3. Outsourcing of government delivered services to the NGO sector About NADA The Network of Alcohol and other Drug Agencies (NADA) is the peak organisation for the non government drug and alcohol sector in NSW, and is primarily funded through NSW Health. NADA has approximately 100 members providing drug and alcohol health promotion, early intervention, treatment, and after-care programs. These organisations are diverse in their philosophy and approach to drug and alcohol service delivery and structure. NADA s goal is to support non government drug and alcohol agencies in NSW to reduce the alcohol and drug related harm to individuals, families and the community. The NADA program consists of sector representation and advocacy, workforce development, information/data management, governance and management support and a range of capacity development initiatives. NADA is governed by a Board of Directors primarily elected from the NADA membership and holds accreditation with the Australian Council on Health Care Standards (ACHS) until Further information about NADA and its programs is available on the NADA website at PREPARATION OF THIS SUBMISSION NADA Submission to NSW Ministry of Health GMIP 2

3 NADA welcomes the opportunity to provide input into the GMIP Discussion Paper and consultations process. The comments provided in this submission have been prepared by NADA staff on behalf of the NADA membership. Input was also sought from the NADA Board of Directors. NADA would be happy to discuss any of the comments made in this submission further with the NSW Ministry of Health staff. SUMMARY OF NADA SUBMISSION NADA advocates the following key points which will be discussed in further detail in subsequent sections of this submission: RESPONSE TO THE QUESTIONS RAISED IN THE DISCUSSION PAPER TOPIC ONE: GRANTS ADMINISTRATION Question 1: How clearly does your NGO understand what NSW Health is seeking from you regarding the funding it allocates to your NGO? NADA contends that due to the historical nature of the grant program, there has been no real planned, strategic goal for the program and the majority of the NGOs that receive funding have done so on a series of submissions (begging and pleading) for funding support for their service. These original grants were made by Ministers after some level of departmental support as a contribution to the service. Subsequent to those original funding grants, most drug and alcohol NGOs have also bid for recent (last ten years or so) specific treatment service grants. (examples include Drug Summit grants for specific types of treatment service delivery, MERIT drug diversion funding for treatment places in D&A NGOs and the most recent Drug and Alcohol Treatment grants (DATS) funding) these later grant funding programs differ from the original grant contributions in that they were for specific pieces of service delivery (residential rehabilitation beds, detoxification episodes, case management services and the like). On top of this funding, most D&A NGOs have also applied to the Commonwealth department of health for drug and alcohol grants through their various grant programs and a range of other state and federal departments for grants related to drug and alcohol service delivery. In a 2005 funding review of drug and alcohol residential rehabilitation services conducted by NADA Submission to NSW Ministry of Health GMIP 3

4 NSW Health then Centre for Drug and Alcohol, it was found that the funding contribution by NSW Health to these services overall operating costs was about 25%, with the remainder coming from the commonwealth health department (approx 30%) and fundraising and client contributions. So, given the above, what NSW Health is seeking from the drug and alcohol NGOs they fund is based upon old and not updated original performance reporting requirements, interspersed with newer specific bits of performance information related to specific service grants. The overall picture of what kind of service delivery the organisations is therefore not well captured under this regime, and there is often a big difference between what the organisations report to funding agencies under the contract requirements and the overall picture they paint in their annual reports. In terms of the way in which performance information is used, NADA believes that the culture of compliance has dominated the requirements for and use of performance information. That is, performance information is generally only used as a means to ensure the NGO is not misappropriating funds or not delivering the service that is being (partly) funded. There also has been no coordination between the reporting requirements of various different funding contracts that make up the totality of the funding from Health. This also means that agencies are reporting against numerous contracts for the same overall service for example, residential rehabilitation. Finally, NGOs have been managed in a contract sense by Local Health Districts (LHDs) (formerly Area Health Services) but they have never really been managed as an integral part of the drug and alcohol service mix of the LHD. This has been in part due to the lack of human and financial resources devoted to managing the NGO grant program at the LHD level and through a culture that viewed NGOs as separate to public health drug and alcohol structures. The central health department also contributed to this culture by viewing the NGO component of the drug and alcohol program as a side show not owned and managed by public health units. The net effects of these factors have led to an NGO drug and alcohol program that has not been managed as a core component of the overall state-wide drug and alcohol service system. This has not been conducive to strategic and effective performance management of the NGO part of the drug health program and hence has led to a gross underutilisation nof the performance information generated by the sector. Question 2: In what ways do you think the process and interactions between your NGO and NSW Health can be improved? NADA Submission to NSW Ministry of Health GMIP 4

5 NADA believes that a formal integration of NGO providers into LHD strategic planning processes needs to be mandated and practiced as an essential element of service planning at the local level. The management staff of drug and alcohol NGOs should be incorporated into the senior staff planning and review structures at the LHD level. This should also be reflected by stated policy at the level of the Ministries Mental Health and Drug and Alcohol Office. The Ministries NGO Advisory Committee should also develop clear policy guidelines for the inclusion of program related NGOs (like drug and alcohol and mental health) into these LHD program planning processes. NADA further argues that relevant NGO service provision data be included in the LHDs performance reporting processes and publications and that joint branding of program delivery by public health and NGOs be considered. Question 3: Do you feel your NGO receives adequate feedback from NSW Health regarding its annual reports As we have stated in the response to question 1 NADA believes that due to the uncoordinated, compliance driven and non strategic way that performance information is collected from NGOs, there is generally no feedback on the richness, the outcomes or the appropriateness of the performance data provided. NADA has received regular feedback from its members over the past decade that indicates that the LHD never reads its annual reports, let alone feedback on the way the service has performed over the years. In relation to the annual reporting NADA provides to the central office bureaucrats, we have had a similar experience to our members. While one direct contract manager from the Mental Health and Drug and Alcohol Office (MHDAO) may be aware of the detail of the NADA annual performance report, MHDAO as a whole has no real idea of the breadth and depth of the NADA performance report as the data is not shared across the Office or used in any meaningful was for example in the strategic planning that MHDAO conducts from time to time. Question 4: How does your NGO measure the impact of its services on its client groups? How do you report those impacts to NSW Health and disseminate them more widely? NADA will answer these questions more broadly on behalf of the sector. NADA has been promoting the use of the results Based Accountability planning framework and is working in partnership with the Mental Health and Drug and Alcohol Office (MHDAO) on this project with the aim of improving performance management in line with recommendations of the NSW Ministry of Health NGO Program Review, and to the satisfaction of both the funder NADA Submission to NSW Ministry of Health GMIP 5

6 (NSW Ministry of Health/Local Health Districts) and the fund receivers (drug and alcohol NGOs). Reviewing and amending current performance management of NSW Ministry of Health funds provided to non government organisations for the provision of drug and alcohol services will support improved program development, reporting and evaluation. Current performance management arrangements do not allow for whole of program or whole of organisation evaluation. Current performance indicators do not clearly align to broader drug and alcohol or health outcome endeavours. A move away from reporting on process and small activities to outcome reporting would be welcomed by all parties. Performance monitoring proposed by NADA The review of the NSW Ministry of Health NGO Program provides the drug and alcohol sector an opportunity to improve performance monitoring of government funded activities and programs to answer the questions of: - How much did we do? - How well did we do it? - Is anyone better off or has anything improved? These questions and their answers go to the heart of good outcome performance monitoring. Performance measuring The following descriptions used for performance measuring have been adapted from the Results Based Accountability model 1 and should be used to inform the development of performance measures that form part of NSW Ministry of Health drug and alcohol grant programs. Results or outcomes Results or outcomes are conditions of well being. Indicators Indicators are measures which help to quantify the achievement of a result or outcome. Performance measures Performance measures are measures of how well a program, organisation or service system is working. Performance measures have three types: NADA Submission to NSW Ministry of Health GMIP 6

7 - How much did we do? A measure related to effort (always numbers). For example: No.of clients treated for alcohol problems or the no. of group sessions provided - How well did we do it? A measure related to the quality of what was done. For example: % of clients admitted within 2 days of contact or % staff with qualifications or quality improvement program accreditation. - Is anyone better off? A measure related to the effect on skills/knowledge, attitude/opinion, behaviour and circumstance. For example: % of clients with improved health outcomes. NADAs Proposed Outcomes and Performance Measures It is proposed that performance measures be defined within three main domains of drug and alcohol service delivery: health promotion and prevention; treatment and extended care; and harm reduction. Each service delivery domain contains intervention types with expected outcomes minimum performance measures, and specific performance measures for population and/or location and/or service delivery types. Additional optional performance measures may be reported under agreement between NSW Ministry of Health MHDAO and the individual NGO in receipt of funding. Definition of performance measure terms Performance measures Performance measures are measures of how well a program, organisation or service system is working and include how much, how well and is anyone better off types measures. Service delivery domains Intervention type Broad categories that capture the range of drug and alcohol service delivery. Specific intervention types related to the service delivery domains Expected outcomes Outcomes that are expected from the intervention provided. Minimum performance measures Performance measures that must be reported against for each intervention type. There may be identical minimum performance NADA Submission to NSW Ministry of Health GMIP 7

8 measures applied across a number of intervention types. Specific performance measures Optional performance measures Performance measures that must be reported against and are related to specific populations, services provided or service location. For example: parents with children, residential pharmacotherapy, outreach counselling, family intervention. Performance measures that capture activity not related to the funding provided but which MHDAO and the NGO agree to collect and provide. NADA argues that it is only through this kind of performance management system that meaningful and valuable performance data will be collected and used by the NGO sector and government funders. TOPIC TWO: RELATIONSHIPS WITH PEAK ORGANISATIONS Question 1: Does your NGO have any direct relationship with Peak NGO in your field, and if so, what is your relationship with that peak organisation. Do you feel this is a valuable relationship and what benefit, if any, do you derive from it? Role of a peak body In reviewing literature that discusses Australian peak bodies in the health and community services sector, core roles and responsibilities are generally described as: - Policy development and advice - Sector advocacy and representation - Information dissemination - Sector consultation and coordination - Promoting and facilitating partnerships - Sector capacity building - Research. NADA undertakes all of these roles, with the exception of community education, and is widely recognised for the work it has done. The role of peak bodies has gained attention through a number of reviews and agreements such as Working Together for NSW, the Compact between the NSW Government and the non government organisation (NGO) sector, and the recently completed review of the NSW Health NGO Grant Program. The Productivity Commission Research Report Contribution of the Not-for-Profit Sector (2010) highlights the role not-for-profits (NFPs) play in influencing public policy through advocacy. Peak bodies can facilitate contribution from a wide sector NADA Submission to NSW Ministry of Health GMIP 8

9 that has on the ground knowledge and experience, thus providing analysis and expertise on what may or may not work, what the current issues are and how to best implement policy change. Additionally, peak bodies support organisations to undertake activities and provide the services for which they are funded by government to do. Capacity building may be described as actions that support organisations to become stronger, more responsive and effective service delivery organisations. Sustained capacity building requires an enduring relationship of trust, communication and united sense of purpose. Peak bodies are able to develop those relationships with members and are therefore ideally placed to deliver capacity building initiatives. Considering the above points and the increasing role and development of the non government sector in the delivery of drug and alcohol services in NSW, NADA believes it essential that a revised and more sustainable agreement be developed with NSW Health that formalises core functions undertaken by the peak body. Role of NADA Over the last decade, NADA has taken a more comprehensive and direct support role with its membership in meeting its goal, to support non government drug and alcohol organisations in NSW to reduce the alcohol and drug related harm to individuals, families and the community. 2 The enhanced role of NADA has been supported by an increase in government interest and funding towards the sector. NADA has developed a strategic plan that directly supports members, the drug and alcohol sector, stakeholders, and ultimately clients and community. The NADA Strategic Plan is available from the NADA website, with the strategic plan for the period being finalised now. NADA s Program Services have developed into the broad categories of sector, organisational and workforce development; supporting members to strengthen their governance, management and clinical service delivery, particularly in response to emerging trends, and government policy and legislative changes. Through project funding, NADA has been able to engage the sector in key service delivery issues and promote practice change in line with NSW Health directives. In fact, NADA and members have in some cases been able to develop and lead unique initiatives that have contributed to the drug and alcohol program, for example, the Family and Carer Program and the recent Aboriginal Drug and Alcohol Traineeship Program. Obviously, direct service delivery work is of critical importance, however policy, expert advice, advocacy, information exchange and capacity building is also important in achieving good health and welfare outcomes with clients and communities. NADA is ideally placed to continue those roles, as direct service delivery organisations do not always have capacity to 2 NADA Strategic Plan NADA Submission to NSW Ministry of Health GMIP 9

10 engage or lead policy, expert advice, advocacy, information exchange and capacity building work, particularly in drawing together the bigger picture or representative views. This work supports the broader NSW Health drug and alcohol program by contributing to planning, communicating directions and practice, and developing partnerships with government and other service providers. In the past two years, NADA has invested significant resources in providing expert advice to NSW Health and other government policy, program and position development. This advice is harnessed from the knowledge and experience of the non government drug and alcohol sector and provides a unique and important perspective. A list of some formal submissions provided by NADA in recent years is available at Appendix B. The sustainability of NADA continuing this activity to the depth and competence it has in recent years is questionable without a more secure funding base. Additionally, the Productivity Commission (2010) recommends governments review their support for sector development and strengthen strategic focus, including on: - developing the sustainable use of intermediaries providing support services to the sector, including in information technology - improving knowledge of, and the capacity to meet, the governance requirements for not-for-profits organisations boards and management - building skills in evaluation and risk management, with a priority for those not-forprofit organisations engaged in delivery of government funded services. (Recommendation 9.2). NADA has consistently demonstrated it is an effective intermediary for the development and delivery of support services and capacity building with the sector. Relationship with MHDAO MHDAO and NADA have developed an effective working relationship, particularly since the NSW Drug Summit in This relationship is evidenced in a number of ways: - NADA membership of the NSW Health Drug and Alcohol Program Council and related Subcommittees - NADA membership of specific MHDAO committees/advisory groups, e.g. Drug and Alcohol Plan Advisory Group, Comorbidity Guidelines Advisory Group - Joint project development, e.g. NGO performance management review - Resource development, e.g. Residential Rehabilitation Guidelines - Project funding, e.g. Family and Carer Program, Research Grants - MHDAO involvement in NADA projects, grant selection panels and staff recruitment selection panels - Sector development grants provided to NADA, e.g. quality improvement support funding for members. NADA plays a critical role in the relationship between NSW Health and the non government drug and alcohol sector. NADA creates and accesses opportunities, often not available to government departments, for tapping into the richness and diversity of the NGO sector, NADA Submission to NSW Ministry of Health GMIP 10

11 galvanising sector support around key human service and health issues. As NADA is independent of NSW Health, objective, frank and fearless advice can be provided. Relationship with the sector As a member based organisation, NADA works with and for its members. The organisation is governed primarily by member representatives, ensuring the sectors needs are effectively identified and responded to. A number of other governance and management arrangements are in place to ensure NADA s relationship with the non government drug and alcohol sector is maintained and effective for both parties. Such arrangements include Board subcommittees with member and non member participation; project specific advisory groups; issue specific consultations, forums and workshops; regular cycle of visits to members; and an open door practice for member feedback. Formalised policies and procedures ensure good member management. In the past two years, NADA has extensively reviewed that way it communicates with members. This has led to targeted information dissemination strategies and focused consultations. Examples of specific member communications include: O O O O NADA website - primary tool for distributing outgoing information to a broad audience, contains information about NADA s goal, governance, membership, activities, current projects and news items. Members post positions vacant free of charge on the NADA website. NADA Advocate bi-monthly digital newsletter with a primary target audience of NADA members and stakeholders, highlights policy and operational issues, discusses issues relevant to the sector, profiles member organisations, NADA Board and staff, promotes NADA activities, and promotes NADA partnerships. Member Update - primary tool for distributing outgoing information to NADA members, particularly senior staff, provides brief information on relevant events and resources, workforce development opportunities, NADA projects, policy and activity highlights, other organisations events, and available grants. Distributed fortnightly, the items in the Member Update link to the NADA website and other sources for more detail. Project specific updates - updates targeting a sub group of NADA members, such as specific grant recipients or organisations participating in a NADA pilot project. These updates provide information on specific subject areas and link to further sources of information. The 2009 NADA Member Feedback Survey (Appendix C) indicated that general information and support by NADA staff was one of the most beneficial activities of the organisation as a whole. The highest rating activity/role overall was providing timely responses to requests for information and providing expert advice and information. NADA Submission to NSW Ministry of Health GMIP 11

12 It is important to note that all NGOs funded by NSW Health for the delivery of drug and alcohol services are NADA members. Relationship with stakeholders Building networks and information exchange opportunities is one of NADA s current outcome areas (Outcome Area 3). This is seen as vital for a strong and effective drug and alcohol program in NSW. As previously indicated NADA participates in numerous committees/advisory groups as well as entering into memorandums of understanding (MOUs) with partner organisations. These activities ensure connection with current issues and shared knowledge and program implementation. Feedback from the 2009 NADA Stakeholder Feedback Survey rated NADA as either very effective or effective in developing and maintaining partnerships. Quality improvement accreditation In July 2010 NADA received full accreditation for four years through the Australian Council on Healthcare Standards (ACHS). This achievement demonstrates NADA s commitment to providing quality services for its members and stakeholders. It also shows that the governance and management practices of the organisation meet all risk, safety and human resource requirements. TOPIC THREE: OUTSOURCING TO NGOS Question 1: Are there services currently delivered by the public health service which you feel could be more effectively delivered by your NGO? Is do, what are they and why do you think your NGO would be best placed to deliver those services? NADA believes that in terms of the drug and alcohol program, that all out of hospital drug and alcohol services, can and should be provided by specialist NGO drug and alcohol services. These include detoxification; community based counselling day programs, assessment and referral, residential rehabilitation programs, Magistrates Early Referral into Treatment (MERIT) and health promotion and community development programs. These programs are all currently being partially or wholly provided by drug and alcohol specialist NGOs in NSW. We believe that these services are better provided by specialist NGOs as they have the track record and are more efficient and effective in providing access to highly marginalised clients NADA Submission to NSW Ministry of Health GMIP 12

13 CONCLUSION who have high and complex needs and are often not well managed by public health units across the state. NGOs also have a better record on engaging communities of marginalised people and offer a user friendly model of client engagement and management. NGOs also have a strong history of client advocacy and are well placed to fight for the rights of marginalised and stigmatised people. The NGO drug and alcohol sector in NSW is a well managed, accredited and professional grouping of organisations who have developed robust service delivery models and respond rapidly to change. NADA believes that the outcomes off this NGO grant program review must see the redevelopment of the grants management system in NSW and also lead to the expansion of the sector in terms of the scope and range of service it delivers on behalf of government to the people of NSW. NADA is confident that the drug and alcohol specialist NGO sector is ready for this change and development phase and is working towards this outcome through its involvement in the review process. NADA CONTACT DETAILS Larry Pierce Chief Executive Officer Network of Alcohol and Drug Agencies PO Box 2345 Strawberry Hills NSW 2012 Ph. (02) NADA Submission to NSW Ministry of Health GMIP 13