Predictions for 2020: Community services
Tuesday, 18th February 2020 at 8:34 am
A report released in the latter part of last year could lead to a tipping point of sorts for the not-for-profit sector in 2020, as the implications of this start to play out and we ask questions more critical about the pros and cons of markets in human services, writes Doug Taylor.
In late 2019 a report was released with potentially huge implications for the Australian community. The report was a consultation paper from the Aged Care Royal Commission. It suggested, in a few lines that were likely missed by most people, that government is too focused on “market forces” and that these markets aren’t delivering for all Australians.
The consultation paper said: “The direction of current reforms puts too much faith in market forces and consumer choice as the primary driver of improvement in the aged care system… Market forces have an important role to play but are not delivering equitable outcomes in all parts of the country or for all groups.”
It goes on to say, “framing the policy discussion around ‘markets’ and describing older people needing aged care services as ‘consumers’ also reduces the issue to one of transactions rather than relationships or care”.
These are big claims and have significant implications across the human services landscape. Over the last 20 years government has been creating markets in various policy areas, based on principles of choice, competition and improved efficiencies. These reforms are not limited to aged care but are widely evident in employment, vocational education, early learning and disability sectors.
This is all underscored by the royal commissions into the children’s, disability and aged care sectors of recent years. I expect (and hope) that in 2020 we will take a step back and ask questions more critical about the pros and cons of markets in human services and find a better balance between the efficiency and effectiveness.
Of course, there are very real benefits to these reforms that should be celebrated. Most critically, consumer directed care. This gives the individual the ability to choose who provides their service and the way in which the service is delivered. This has been transformational for people who have for too long been asked to accept whatever they get. And it also allows those who can afford it, to make contributions to services which can focus already stretched government spending on those that need it most. But of course, not all people need these types of services nor can act with the same level of agency as a customer.
Moreover, people who experience some form of social or economic exclusion need holistic support and meaningful relationships, not just transactions. The challenges they face are multi-faceted – for example a person could be living with job insecurity, mental health issues, a disability or family breakdown. These people can fall through the gaps and not have opportunities to access joined up services that help them step out of the cycle of disadvantage.
A benefit of competition for the sector is that organisations have been clearer on the value they create for people, reduced their overheads and operating costs and improved employee productivity. The limitation is that the people we serve need organisations to work together whilst also competing at the same time!
Another adverse impact of these new markets has been reducing the social mission of many not for profits. Marketisation has meant they have become too focused on simply being organisations contracted by government to provide services. It has meant many have become less focused on the importance of measuring their social outcomes, investing in social innovation, building relationships, community development and advocacy, which we know are all vital for genuine social change.
The reality is these areas of human services can never be pure markets. We know that without adequate government mitigations or incentives, “thin markets” are naturally created because servicing some people (like culturally and linguistically diverse, Aboriginal or highly disadvantaged communities) and working in some geographies (rural and remote in particular) incurs extra costs and can’t be judged on commercial success. This has been a feature of the critiques of the aged care and disability sectors.
So, in 2020 I hope that we as a community use the opportunity of the aged care and disability royal commissions to assess the pros and cons of market-based approaches in human services. There’s too much at stake for the people we serve.
This article is part of a series of 2020 predictions from experts across the social sector.