A recent report by the Productivity Commission, examines the role of competition and contestability in achieving efficiencies in human services. The Productivity Commission points towards well established markets for childcare, schools, optometries, GP (Medicare) and allied health professionals which demonstrates the benefits of competition. The report acknowledges that competition or contestability may not be suitable in all areas of human services and one must be cautious when applying the principles of competition.
What distinguishes this report is that, it places consumers of human services and user choice at the heart of all its recommendations. A common and important factor across all areas of human services addressed in the report was empowering consumers of human services through better availability of information and providing them with choices where feasible. If a consumer can make an informed choice about providers of human services then that will put competitive pressure on providers to improve quality of human services. For example, in the UK data on patient based outcomes and other evaluation outcomes are publicly available. This not only helps patients choose hospitals or specialists based on these data but also puts competitive pressure on providers to improve their services.
The report covers six areas of human services: end of life care, social housing, commissioning family and community services, human services in remote indigenous communities, patient choice and provision of dental services. The Commission acknowledges that there is no one size fits all solution to the complex problems that exists in these areas. Some areas might benefit from increased competition and contestability while for others a staged implementation based on subsequent evaluations might work better. For example, when it comes to commissioning family and community services, an outcome focused approach which uses outcomes rather than outputs for government activities such as funding providers, provider performance management, service evaluation, program design, service delivery is more effective.
The Commission notes that government’s role in regular monitoring and regulating certain human services is important for the long run success of reforms to human services. The report emphasized that the role of government should be to provide better stewardship not service provision. It is also important that Federal, State and Territory and Local Governments clarify any overlap in policies related to provision of human services.
The report recommends increasing the scope of community based palliative care and to better equip residential aged care facilities to be able to provide end of life palliative care. Australians must have the right to choose where they wish to die, as many prefer to depart from their loved ones in the comfort of their home. This would also be less expensive than hospital care and would free up hospital services overall. What is required is an integrated system of medical, nursing and personal care. It is worth mentioning in this regard that The Bushland Health Group employs a nurse practitioner to integrate palliative care into its residential aged care facilities. This model of care recently won a National Innovation and Excellence in Aged Care award from the Australian Aged Care Quality Agency.
In the past the focus of government was capital creation through private public partnerships. However, there is a pronounced shift in consumer’s preferences towards services and the role of government should not be limited to formulating how to meet this increased demand for services, but to explore how increased demand for human services can fuel growth in other sectors of the economy.
For instance, the demand for palliative care for end of life is going to increase as the baby boomers reach end of life. The demand for these services can be met through targeted migration. Facilitating migrants who are skilled in geriatric and palliative care, can help ease the pressures on end of life care and enable consumers of these services to choose. And in certain parts of Australia increased migration can foster economic growth through increased job creation and increased economic activity.
Further, the report points towards greater availability of data to empower consumers of human services. Technology plays a very important role in a data driven economy. A brief paper by Deloitte talks about changes and emerging trends in technology in human service delivery. Investment in innovation and artificial intelligence that can use these data in meaningful ways will increase productivity of workers which in turn will contribute to economic growth. Technological innovations such as affordable smart home technology enables sensor-based reporting on signs of illness or cognitive degeneration, creating options for senior citizens to remain in their homes and maintain independence. Investment in research and development can help provide integrated care for consumers of end of life care without leaving the comfort of their home.
In case of social housing provision the report recommended that the system should be made equitable by allowing consumers of public housing be eligible for Commonwealth Rent Assistance. Consumers should be offered the choice between public and private housing and provided with tenancy assistance in areas where there are affordability issues. Empowering consumers in this way will not only prevent underutilisation of public housing but also put pressure on providers of social housing to maintain quality of these services.
Consumers of social housing are usually from a low socio economic background and the report states that they would require assistance from other human service providers such as health, youth services, financial advisors, community and family support to keep their tenancy secure. Victorian Tenancy Plus (VTP) program which is an individual case based program for social housing, and HASI in NSW which is a partnership between health, housing and tenancy support services are some of the current available schemes. HASI aims to provide people who have mental health problems with stable housing integrated with clinical and psychosocial rehabilitation services.
Again what is required is reliable data collection and a free flow of client information across various providers of services to enable effective case handling. A person who is in need of social housing may experience unemployment, depression, the possibility of family violence, drug abuse and is obviously at risk of homelessness. So keeping information in silos and trying to solve problems in isolation of separate silos won’t eliminate problems. On the contrary better access to data and taking a holistic approach can provide more effective solutions. More programs like HASI and VTP and an increase in the number of providers who can operate with this holistic approach can in the long run lower social costs borne by governments.
Technology can play a major role in how workers are trained to operate across the sector. According to Deloitte, artificial intelligence and simulation-based training will play an increasingly important role in preparing case workers to handle difficult situations. Customer and geospatial analytics can enable better understanding of impact and be used to predict client needs. Case workers are now able to connect more frequently with clients using free videoconferencing software. Wearable devices and that detect changes in biometrics and can predict if wearers are likely to engage in risky behaviours may allow personalised multimedia drug interventions in real time, and alert case workers when in-person interventions are required.
Investment in innovation and technology that are aligned with provision of human services can open up a whole new sector in the economy which can have far reaching implications for Australia. Training people to work in data analytics in conjunction with emotional intelligence will create new jobs in the future to meet increasing demand for human services. Governments will need to formulate policies that are more tailored towards regional needs and place based as opposed to one size fits all federal policies. They will also need to be mindful of key policy and implementation challenges, such as how to ensure protection of individuals’ privacy in an environment of increased data sharing. Use of competitive approaches to deliver human services is not new to Australia and evidence from employment services, aged care and disability services shows that unless implemented with caution it can defeat its purpose of effective and efficient delivery of human services and lead to poor social and economic outcomes.