Urgent rethink needed in funding and provision of community care

Governments must move to invest in community provision of care, writes David Crosbie.

Australia is wasting billions of dollars in care costs. Charities play a critical role in preventing this waste, but under-resourcing of charities forces many people into more expensive options. If governments are seriously committed to reducing costs and improving community wellbeing, investing in community provision of care is one of the best investments they can make.

It is difficult to find a human services system in Australia that is not struggling to adequately meet demand. Aged care, disability, drug treatment, mental health, housing, employment and training, family support, youth engagement, are just some of the areas where more investment in community-based organisations would significantly improve productivity and wellbeing in Australia.

Invariably when human services are unable to support people at a community level, it is our acute services, hospitals and prisons, that are forced to accommodate people who would be much better off in alternative settings.

While there are variations across Australia, prison beds generally cost on average around $400 a day or $150,000 a year. The average hospital bed costs are even more expensive – at least $200,000 a year. Pressure to meet ever increasing costs in these systems presents one of the biggest government budget dilemmas. And yet, with foresight and appropriate targeted investment, these costs can be significantly reduced.

Aged care is an obvious example. If we cannot provide treatment and support for elderly people in their homes, if nursing home beds and respite care are not readily available, how many elderly people end up in hospital beds that are not suitable to their needs?

We know that more specialist supported housing options would reduce the number of hospital beds inappropriately occupied by people living with a disability.

How many hospital or mental health beds are occupied by people who simply need appropriate treatment for their drug dependence?

And how many people needing treatment for their drug dependence or mental health issues or dealing with a disability end up not in hospital, but in prison beds?

When it comes to accessing mental health treatment in Australia, finding appropriate less intensive community counselling and support options is, at best difficult, and in many communities almost impossible. All too often the choice faced by people seeking mental health treatment is either a specialist mental health bed in an intensive and expensive setting, or joining a waiting list to see a psychiatrist or psychologist. Peer-led community mental health treatment options that have proved so successful in New Zealand are just one example of how properly resourced community options can save money, provide more appropriate services and achieve better outcomes for less cost.

The Queensland government have this week announced they are looking at building more youth prison beds. No-one seriously believes more prison beds will reduce youth crime. Again, we know that investment in community engagement of youth in education, housing, employment and training achieves a real reduction in criminal activity.

None of the above is controversial. These arguments are well known by anyone who has spent time examining any of these systems. And yet we go on repeating the failures of the past, spending more and more on the ambulances at the bottom of the cliff and not investing in guard rails and safety nets that would reduce the need for acute care.

There are many reasons why this pattern of failed government investment repeats, mostly to do with politics, vested interests, system change and distributed versus specific benefit.

It is not in the interest of a Minister responsible for prisons to reduce the size of their budget and give more to health. The victim of youth crime is more likely to be interested in seeing the perpetrator punished than supporting community youth engagement programs, or drug treatment programs to reduce drug related crime.

No Health Minister can afford to cut hospital funding to invest in community options. Health costs rise by around 7 per cent a year even with no new programs or services. Seeking more health investment in community-based options is a big political ask. This is especially true when you consider the power of acute services to provide compelling stories of life and death.

A new hi-tech humidicrib that would have saved the life of a grieving family’s premature baby might cost as much as the annual funding for a community program working with mothers to be. The community program could make a difference in the health and wellbeing of hundreds of mothers and their babies, reduce post-natal depression, promote better early childhood development, even save lives, but all these benefits will often be nonspecific and distributed. Who knows which mother or child might have suffered without the program? The grieving family of a premature child can point to their tragic loss and demand something very specific.

This is one of the many challenges for human service charities – not just to show that their programs can deliver savings and provide real benefit to the community, but that funding the program will be beneficial to governments and Ministers at an economic and political level.

In the lead up to our two biggest state elections in NSW and Victoria, some charities are already actively building support for the programs and services they know can strengthen their communities. Charities that can demonstrate both effectiveness and strong backing across communities are much more likely to convince major political parties that increasing spending on community level programs is politically a good idea.

It is tough to undermine the orthodoxy around prioritising acute care spending over less expensive and more effective community care, but elections provide a window of opportunity for shifts in what is possible. Charities should actively pursue this opportunity to achieve change over the coming months, not only in their own interests, but in the interests of all Australians.