Oakden: What has Quality got to do with it? Holden’s Versus Oakden – Michael O’Neil and Andreas Cebulla

It was the first economist Adam Smith who wrote that “economic life is deeply embedded in social life; that social relationships come first.  Trust, cooperation and social relationships are the foundations (or glue) of non-market relationships and behaviours and of product and consumer markets, contracts, and property rights.  Hence, trust in government, our civic institutions and public services matter.

So take for example the concept of trust in product markets.  Trust in the final product of our car manufacturer’s matters and on balance manufacturers fulfilled that trust with better consumer products, safer products and a commitment to improve safety and even repair defects (e.g. witness the airbag recall).  Improvements in quality and the finished product were evident to all, regularly promoted, evaluated and written about.

However, think about our relationship with products, product purchases and product markets.  When you last bought a new television set, a range of kitchen appliance or a motor vehicle it is almost certain that you did not pay much attention to the qualifications of the labour force in the company that produced the product; you did not much think about the quality of labour services, the management practices or the production technologies involved in the manufacture of these goods.  Perhaps you were reassured and have come to accept that business standards, consumer protections and government regulation were in themselves a guarantee of the product.

However, this is not the case with human services.

It is likely that when the time came for you to enrol your child in child care or pre-school that you visited the site, your spoke with staff, they explained the quality (and cost) of the services that were available at the centre and the individualised attention your child would receive.  The service provider may even have outlined the number and qualifications of staff.  When the time came to select a primary school or to make a decision about private or public education it is almost certain that you visited various schools to inform your decision.

Similarly, if you have been faced with a decision to place an older family member or relative into aged care, nursing accommodation or disability care the decision is not taken lightly.  The needs of the individual are first sought, that they are happy with the accommodation/location and you would almost certainly have taken advice, inspected the premises and services and discussed the needs of the older relative with the provider.

That is to say, when we think about aged care, disability care, education, health services, even tourism and community services the QUALITY of the service provided is pre-eminent because it involves a human dimension.  The quality of the service is dependent on, inter alia, staff skills and training, and qualifications, management practices, the physical facilities and related support services.  Proof of the quality of service might be displayed on the wall with certificates of accreditation or awards of some nature.

In human services you care about quality and ultimately decisions are made on a direct and involved assessment of quality.

This is the real challenge that the report on the abuses that occurred at the Oakden Older Persons Mental Health facility in Adelaide present and they will not be adequately addressed by placing video cameras on the walls of service providers.

The challenge for the provision of human services are twofold:

The first challenge is one of demand.  The private sector is the key player here under direction, funding and regulation of government.  We are witnessing a rapid and sustained increase in employment in human services and the household sector as a response to, inter alia, our ageing population and changes in the composition of that population, the commitment to improving services for those with a disability and the de-institutionalisation of care.  In some human service occupations this has given rise to skill shortages and the search for higher rates of labour productivity.

The second challenge is for government.  The reality is that the provision of human services is labour intensive and costly, so that they place an ever increasing burden on the Commonwealth and State Government budgets.  In addition, there is upward pressure on government to do more and so that they face an ever increasing wage bill.  Hence, the imperative to find new ways to deliver services.  Government faces a dilemma – it must address the demand for increased services, it must set standards of service and it must regulate/accredit all the while balancing quality of service and the need to reduce costs.

What is the way out of this dilemma? – the dilemma of rising costs and higher service demands.  Ultimately it is the non-government sector (NGOs) and business that can help government design more efficient service delivery models and achieve productivity gains.

Structural changes in the economy along with demographic changes and longevity of life are evident in the growth of employment across the full range of human services.  The quality of human services matter and quality of service or the absence of quality is more visible than in other spheres of the economy.

Oakden is a warning that needs to be responded to appropriately.  What is required?  More highly skilled staff with access to training, improvements in staff and resource management, greater transparency and accountability of all service providers, efforts to control what can easily become government over–reach and greater service provision by the non-government sector including private providers accompanied by better regulation, accreditation and supervision by government.  Service markets need to be contestable.  Penalties for maladministration should be sufficient to impact and penalise providers, including the threat of withdrawal of contract.

In human services the highest quality matters. you are reassured of the above when you catch an airline.

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