Reforms to Human Services Inquiry Report – Arts & Humanities Assignment Help

Assignment Task


The Australian Government’s 2015 Competition Policy Review recommended that governments should, wherever possible, put user choice at the heart of human services
delivery. In its response to the Review, the Australian Government asked the Commission to undertake this inquiry to examine policy options that apply the principles of informed user choice, competition and contestability to the provision of human services. Desirable though they may be, applying these principles has proven to be neither simple nor without cost.

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Why reforms to human services matter
This inquiry is about finding ways to put the people who use human services at the heart of service provision. This matters because everyone will access human services in their lifetime, including children, the elderly, people facing hardship or harm, and people who require treatment for acute or chronic health conditions. People who use human services can lose their autonomy, and with it their dignity, if they have too little control over decisions that affect them. Reforms to the way human services are provided are needed to enable and support people and their families to have a stronger voice in shaping the services they receive, and who provides them.

Human services are essential for the wellbeing of individuals and their families, and underpin economic and social participation. Ensuring that everyone, regardless of their means or circumstances, has access to a minimum level of high-quality human services promotes equity and social cohesion, which in turn contributes to the welfare of the community as a whole.

The number of services provided each year in Australia is considerable, for example, there were more than 10 million admissions to public and private hospitals in 2015. Other services, such as homelessness services and social housing, are each used by hundreds of thousands of people every year. Public and private expenditure on human services is significant — over $300 billion in 2014-15 — with demand for services projected to grow as more people live longer, incomes grow and technological advances increase the types of services that can improve a person’s quality of life.

Introducing greater user choice, competition and contestability

The Commission’s task in this inquiry is to recommend reforms using the policy ‘tools’ set out in the inquiry terms of reference — the introduction of greater informed user choice, competition and contestability — to improve the effectiveness of human services. In doing so, the Commission’s objective is to improve outcomes for the users of those services and the welfare of the community. Not all areas of human services are amenable to the mechanisms we have considered. In the study report for this inquiry, the Commission found reform could offer the greatest improvements in outcomes for people who use:
• end-of-life care services
• social housing
• family and community services
• services in remote Indigenous communities
• public hospitals for elective care following a referral from their general practitioner
• public dental services.

In making its final recommendations to improve the effectiveness of these six services, the Commission has assessed whether: the likely benefits to the community of its proposed reforms would be expected to outweigh the costs; the incentives of providers and users would be aligned; and government objectives would be achieved.
The Commission also considered five attributes of effective service delivery in its assessment of the potential costs and benefits of reform options.
• Quality: whether the reform option would lead to incentives for providers to offer high-quality services to users.
• Equity: who would be affected by the reform option and how.
• Efficiency: whether the reform option would lead to incentives for providers to reduce the costs of providing services while still maintaining quality, and for users to select the services that best meet their needs.
• Responsiveness: whether the reform option would result in service providers being more responsive to the needs of service users.
• Accountability: whether the reform option would result in service providers being more accountable to those who fund the services (taxpayers and users).
Each of the services the Commission has proposed for reform is different — in the type and number of users, their capacity and willingness to make choices, the setting and circumstances under which services are accessed, and the share of the cost of service provision that is paid for by users and by governments. The starting point for reform also differs across the services. In some cases, improving service effectiveness through the application of competition principles would require major reform. In others, particularly those that currently operate well, service effectiveness can be improved with relatively minor reforms to introduce greater choice and competition. The Commission has tailored its proposed reforms to the unique circumstances of each service.

Informed user choice empowers people
Informed choice can improve outcomes for users because it:
• empowers people to have greater control over their lives
• enables people to make decisions that best meet their needs and preferences
• generates incentives for providers to be more responsive to users’ needs and drives innovation and efficiencies in service delivery.

The Commission’s starting point is that users should have choice over the human services they access and who provides them, unless there are clear reasons otherwise. These reasons include a lack of capacity to exercise informed choice and the inability of an agent to exercise choice on a user’s behalf, or when decisions must be taken during a crisis, such as a medical emergency. Providing choice can also be expensive for governments, and the benefits of introducing greater choice need to be considered against its costs.

A common theme in submissions was a strong desire for people to have choice and the empowerment that comes with it. In its submission to this inquiry, Alzheimer’s Australia stated:

Alzheimer’s Australia is strongly supportive of the principle of user choice in human services.
For people living with dementia, their families and carers, having a say in their everyday lives is a basic desire and underpins a sense of purpose and wellbeing. Many people living with dementia have expressed a desire to feel that they are participating in decision making regarding their care but also recognise that their ability to do so can be impacted by their diagnosis: capacity to make informed decisions may change from day to day or may decline rapidly.
Not everyone shares this view. A small number of inquiry participants considered that user choice should not be increased, pointing out that recipients of human services may not possess full knowledge of their preferences, have the capacity to act on their preferences, or have access to information that is necessary to make decisions.
The Commission recognises that there are circumstances where user choice is not desirable.
If not the user, someone — the government or the provider — will be making a choice as to which services a person should receive and who should provide them. In these cases, it is critical that the best interests of users, rather than governments or providers, remain at the heart of service provision. Yet even when user choice is not desirable, a focus on users can be achieved through other approaches, such as increasing ‘user voice’ and co-design so a person’s (or community’s) preferences are taken into account when others make decisions on their behalf.

A staged implementation
Taken together, the Commission’s recommendations represent a long-term and systemic reform pathway for public dental services.
The Commission’s reforms should be implemented in a staged manner, starting with reforms to improve the stewardship of the system. Following the development of outcome measures, governments should improve their commissioning processes and examine opportunities for introducing greater contestability in public dental services. These reforms on their own would improve the effectiveness of public dental services in Australia.
Once the outcome measures are in use, the consumer-directed care scheme should be developed and trialled at a range of test sites. Results from the test sites should inform a staged rollout process.

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