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PC News - June 2018

Reforming human services

Increasing competition and informed user choice in the provision of human services can improve outcomes for users and for the community as a whole.

The Commission’s final inquiry report on reforms to human services was released by the Australian Government in March 2018. In a previous study report for the inquiry1, the Commission identified six services for which the introduction of greater user choice, competition and contestability would improve outcomes. These services are end-of-life care services, social housing, family and community services, services in remote Indigenous communities, patient choice over referred health services, and public dental services. The final inquiry report sets out tailored reforms for these six services.

The Commission considers users should have choice over the human services they access and who provides them, unless there are sound reasons otherwise. A stronger focus on users, better service planning and improved coordination across services and levels of government is needed. Governments should focus on the capabilities and attributes of service providers when designing service arrangements and selecting providers – not simply the form of an organisation. There is no one-size fits all competition solution.

The Commission’s recommendations aim to put the people who use human services at the heart of service provision. Change is needed to give people a stronger voice in shaping the services they receive, and who provides them.

End-of-life care services

Each year, tens of thousands of people who are approaching the end of life are cared for and die in a place that does not fully reflect their choices or meet their needs. Reforms are needed to significantly expand community-based palliative care services and to improve the standard of end-of-life care in residential aged care facilities.

Public dental services

Public dental patients have little choice in who provides their care and most services are focused on urgent needs. Long-term reform is needed to introduce a consumer-directed care scheme. This would enhance patient choice, and promote a greater focus on preventive care.

Referred patient services

A combination of rules and common practices limit patients’ choice of healthcare provider when they receive a referral or diagnostic request from a GP. These barriers should be removed. Patients differ in their needs and preferences, and providers differ in their locations, performance, waiting times and  out-of-pocket charges. All patients should be given the opportunity to choose the provider that best meets their needs. Better public information is needed to support choice, and encourage self-improvement by providers.

Services in remote Indigenous communities

Current approaches to commissioning human services in remote Indigenous communities are not working. Governments should improve commissioning arrangements and should be more responsive to local needs. This would make services more effective and would lay the foundation for more place-based approaches in the future.

Family and community services

Governments fund family and community services – such as services for homelessness and family and domestic violence – to assist people at risk of hardship or harm. These services are not delivering the best possible outcomes for people who use them, their families or for the governments that fund them. Practical changes to system planning, provider selection, and contract management would sharpen focus on improving outcomes for service users.

Social housing

The social housing system is broken. A single system of financial assistance, which is portable across rental markets for private and social housing, should be established. This would provide people with more choice over the home they live in and improve equity. Tenancy support services should also be portable across private and social housing.

Reforming human services: caring for people at the end of life

  • Many people approaching the end of life cannot access the type of care that aligns with their needs and preferences. Service availability varies widely according to patients’ diagnosis, age and location. Many patients undergo avoidable, or unwanted, hospital admissions, often associated with confusion, and a loss of dignity and control. Few people who would like to die at home are able to do so. The Commission found that a number of reforms could provide significant benefits for those requiring end-of-life care2.

    More community-based palliative care should be available

    Many people approaching death have a medical condition that is amenable to palliative care, and have family and friends who are able to care for them at home. However, the demand for end-of-life care in the community (community-based palliative care) far outstrips availability, particularly for those with illnesses other than cancer. Better meeting this demand will require State and Territory Governments to substantially increase the availability of community-based palliative care, and to fund that increase. While offering service users a choice of provider should be the long-term goal of governments, the first priority should be better meeting demand.

    Residential aged care should be better equipped to meet end-of-life care needs

    All aspects of end-of-life care should be core business for residential aged care facilities. Under current arrangements, many people do not get the clinical care they need at the end of life. Intensive nursing and other end-of-life care services are only funded in the last week or days of life, and are not available to those with pre-existing high health care needs. Two main reforms are needed to address this. First, residents require greater access to services delivered by clinically qualified staff. Second, consumers and their families need more information to help them select aged care facilities that deliver high quality end-of-life care.

    Advanced care planning should be encouraged

    Aligning care to people’s preferences is critical to the effectiveness of end-of-life services. Preparing an advance care plan (ACP) means people can have a real choice in the care they receive, even if they can no longer communicate that choice. Despite efforts to promote advance care planning, less than 15 per cent of Australians have an ACP. Reforms are needed to provide more opportunity for people to develop a high quality advanced care plan.

    Stewardship of end-of-life care services should be improved

    State and Territory Governments are primarily responsible for end-of-life care in public hospitals and in people’s homes. The Australian Government is primarily responsible for  end-of-life care in residential aged care and general practice. Coordination between these services is often poor.

    Collaborative reform is needed to improve the effectiveness of end-of-life care. The Australian, State and Territory Governments should, through the Council of Australian Governments (COAG) Health Council, ensure that there is cross jurisdiction co-operation to:

    • plan, fund and deliver end of life care so that patients receive integrated services across different settings and jurisdictions
    • set standards for end-of-life care in each of the settings in which it is provided
    • monitor and evaluate end-of-life care services.

Footnotes

  1. Productivity Commission Introducing Competition and Informed User Choice into Human Services: Identifying Sectors for Reform , Study Report, December 2016. Return to Footnote 1 in the text
  2. End-of-life care refers to the physical, spiritual and psychosocial services provided by health professionals and ancillary staff to people who are likely to die within the next 12 months. Return to Footnote 2 in the text

Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services

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