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PC News - May 2017

Improving human services outcomes

The Commission has identified areas of human services delivery that would benefit from introducing greater competition, contestability and informed user choice.Doctors wearing surgical masks and gowns performing an operation on a patient in a hospital operating theater.

High-quality human services, such as health and education, underpin economic and social participation and contribute to the wellbeing of individuals and the community as a whole. The Commission is currently undertaking an inquiry to determine the circumstances where the outcomes for the users of human services, and the broader community, could be improved by the introduction of greater competition, contestability and informed user choice in the provision of those services. Many, but not all, human services are suited to this type of reform.

The Commission is undertaking its inquiry in two stages. The publication of the final study report in November 2016 marked the conclusion to the first stage, and set out the Commission's view on which services would be best suited to reform. The second stage is underway, and will make reform recommendations for the identified services. A draft report will be released in June 2017.

Why competition, contestability and informed user choice?

Well-designed reform, underpinned by strong government stewardship, could improve the quality of services, increase access to services, and help people have a greater say over the services they use and who provides them. Informed user choice places users at the heart of human services delivery and recognises that, with some exceptions, the service user is best-placed to make choices about the services that match their needs. Competition between multiple service providers for the custom of users can drive innovation and efficiencies. Where competition is not possible or desirable, governments' use of contestable processes to select and replace providers can achieve many of the benefits of effective competition.

The introduction of greater competition, contestability and choice does not preclude government provision of services.

Government stewardship is critical

Governments' stewardship role in the provision of human services is broader than overseeing the market. Stewardship includes identifying policy objectives and intended outcomes, designing models of service delivery, and helping to ensure that services are responsive to users, accountable to those who fund the services, equitable, efficient and high quality. Some recipients of human services can be vulnerable, with decisions often taken at times of stress. The development and implementation of consumer safeguards is an important aspect of the stewardship role and will be a key focus for the Commission.

What are the Commission's preliminary findings?

The Commission identified six priority areas where introducing greater competition, contestability and informed user choice could improve outcomes for people who use human services, and the community as a whole.

Social housing

Within the current social housing system, user choice is limited, and the suitability of an allocated property is often a question of timing and luck. There are long waiting lists to enter social housing, and some properties are poorly maintained and underutilised. In some overseas countries, efforts to improve users' choice of home have led to a range of benefits, including tenants being more likely to have stable accommodation and invest in the local community. Introducing greater contestability could also benefit tenants — most social housing properties are managed by government entities, yet on some indicators, including tenant satisfaction and property maintenance, community housing providers outperform public providers.

Public hospital services

Australian hospitals may often perform well against those in other countries but there is still scope for many to improve outcomes for patients, and to lower costs, by matching the practices of better-performing hospitals within Australia. Other countries have shown that user choice can benefit patients when they have access to useful consumer-oriented information on services, and referring practitioners support them in making decisions.

End-of-life care

While Australia's end-of-life care services are well regarded internationally, patient preferences are not always well satisfied — many Australians wish to die at home, supported by family, friends and effective care services, but often their wishes are not being met. In addition, access to high quality care is variable and services are often not as well integrated as they could be. A greater emphasis on user choice could help to better satisfy patient preferences regarding the setting, timing and availability of end-of-life care. As part of a wider suite of reforms, contestability and competition could play a role in promoting user choice.

Public dental services

Public dental services act as a safety net by providing access to basic dental care. Access continues to be a concern for certain populations, such as people living in remote areas who are more likely to suffer from poor oral health and to be hospitalised for potentially preventable dental conditions. More contestable delivery arrangements for public dental services that encourage known but not widely-adopted innovative and flexible service provision could improve oral health in communities not well serviced by the private sector. Introducing greater choice over the timing and location of treatment, and dental professional may also lead to fewer people delaying dental treatment until more painful and costly care becomes necessary.

Human services in remote Indigenous communities

Indigenous Australians living in remote areas are more likely to experience poor outcomes than other Australians. Inadequate access to human services is one factor that contributes to these poor outcomes. There is scope to improve outcomes over the long term through better design and implementation of policies to purchase services in remote Indigenous communities. Greater responsiveness to community needs through more community choice, place-based service models or greater community engagement could also improve outcomes. More stable policy settings and clearer lines of responsibility could increase governments' accountability for improving service outcomes for Indigenous Australians living in remote communities.

Commissioning family and community services

Family and community services include services for people experiencing homelessness, alcohol and other drug abuse, and family and domestic violence. Many services are contestable but better outcomes for service users could be achieved by taking a systematic approach to identifying community needs and prioritising services; funding services that are tailored to the needs of individuals; and taking an outcomes focus to performance monitoring and service evaluation.

Introducing Competition and Informed User Choice into Human Services: Identifying Sectors for Reform

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