Game Changing Report for Human Service Provision

Recommendations made by the Productivity Commission into human services provision could prove to be a “game changer” according to the social sector.

The Productivity Commission released its latest draft report on Friday, examining competition, user choice and the role of government stewardship in the areas of health care, end-of-life care, social housing, family and community services and services in remote Indigenous communities.

The report, Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services, found that robust government oversight was essential to unlock the potential benefits of user choice and competition in human services.

According to the commission the aim was to find ways to put the people who use human services at the heart of service provision.

“Taken collectively, these changes put in prospect improved wellbeing for all Australians,” productivity commissioner Stephen King said.

Community Council Australia CEO David Crosbie told Pro Bono News it was one of the most important reports into human services provision in Australia.

“If its recommendations are adopted, it will be a game changer,” Crosbie said.

“CCA will be consulting members and preparing a CCA submission in response to this draft report.

“The report is clearly focused on performance and outcomes measures for government and for providers, as well as shifting to a stronger model of consumer choice in critical areas like health.”

Crosbie said he expected CCA members would strongly support key recommendations including:

• the default government contract length in the provision of family and community services should be seven years
• the default government contract length in the provision of Indigenous programs should be 10 years
• referrals to specialists by GPs will specify the specialty service required, but not name any one specialist provider – thereby giving the choice of specialist to patients
• more consumer supportive information will be available to allow for greater choice in health services including hospitals
• end of life care will be better monitored with better access to palliative care
• the opening up of social housing to more providers and reform of rent assistance.

“There are several areas of concern in the report, and areas where the report probably does not go far enough in seeking reform to existing government practice, but it is certainly offering some important new ideas and solutions to ongoing issues for service providers within the NFP sector,” Crosbie said.

Among the recommendations the report, which builds on a 2016 Human Services Study, called for a move to a single model of housing assistance across both social and private rental markets.

Productivity Commission’s social policy commissioner Richard Spencer said Australia’s social housing system was “broken, unfair and failing those in need”.

“People in the community who need the security of social housing can wait 10 years or more for a place to become available,” Spencer said.

King said an overhaul was needed to create “a fairer, more flexible system so people who are eligible for housing assistance have greater choice over where they live”.

“This means people can move closer to the services they use such as schools and be closer to where they work or want to work,” King said.

“We are also recommending, as have many before us, a well overdue increase to Commonwealth Rent Assistance. An increase of about 15 per cent is needed to catch up with rises in rental prices.

“Rent assistance should also be indexed to rental prices so that the rental affordability gap does not worsen for Australians most in need.”

The report also identified widespread changes were needed to end-of-life care in Australia.

Spencer said there need to be “vast improvements in end-of-life care services both in homes and residential aged care facilities”.

“We see far too many people stuck on a ‘medical conveyor belt’ at the end of their lives instead of getting the care they want, where they want,” he said.

“About 70 per cent of Australians would prefer to be cared for and to die at home, but don’t because they can’t access community-based palliative care. Instead people receive care and die in a place that is not of their choosing.”

The report identified a lack of palliative care in aged care facilities.

“Four out of five residents of aged care facilities die there. But many often make traumatic and costly trips to hospital to receive end-of-life care that could have been provided in surroundings that are by now familiar to them,” Spencer said.

Palliative Care Australia CEO Liz Callaghan said they welcomed the recommendations.

“We are very pleased that the Productivity Commission has formally acknowledged that few people in Australia are able to access high quality community-based palliative care, and that ‘without significant policy reform, tens of thousands will die in a way, and in a place, that does not reflect their values or their choices’,” Callaghan said.

“PCA wholeheartedly endorses the Commission’s recommendation that State and Territory governments will need to ‘substantially increase the availability of community-based palliative care and while most people would prefer to die at home or in a community setting, it is very important that end-of-life care in the acute hospital setting is also of high quality and patients are supported to share in decision making.”

Callaghan commended the commission for acknowledging that residential aged care services were “ill-equipped” to meet end-of-life care needs and that more staff were required to lead and coordinate end-of-life care for aged care residents.

“We stand ready to assist all levels of government in the careful planning and stewardship that the commission has identified as essential to this expansion,” she said.

The full report can be found here and submissions will accepted until Friday 14 July.

The final report will be handed to the Australian government in October 2017.