Increase choice in human services, Productivity Commission urges

By David Donaldson

March 27, 2018

Giving users of human services like public housing and end-of-life care greater ability to choose will lead to better service quality, the Productivity Commission says in a report.

“Everyone will use human services in their lifetime and change is needed to enable people to have a stronger voice in shaping the services they receive, and who provides them,” says the commission.

The paper follows an initial study report in 2016 that identified which policy areas the inquiry would take as its focus. It outlines specific recommendations for reforming six areas:

  • 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.

“Users should have choice over the human services they access and who provides them, unless there are sound reasons otherwise,” says the report, released on Monday.

“Choice empowers users of human services to have greater control over their lives and generates incentives for providers to be more responsive to their needs.

“Competition and contestability are means to this end and should only be pursued when they improve the effectiveness of service provision.

“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.”

Market rent for public housing

Some of the recommendations will no doubt be controversial. In public housing, for example, the PC points out that many who are eligible for public housing are in the private rental market, and that people with similar levels of need receive differing levels of assistance depending on whether they live in social or private housing. One impact of this is that some who want to move out of public housing cannot afford to, because rental assistance payments won’t cover the gap, exacerbating the up to 10-year wait to get a public housing place.

To counter this problem, the commission recommends making government assistance to public, social and private tenants with low incomes more similar. This would include charging public housing tenants market rental rates and extending Commonwealth rent assistance to public housing tenants, who are now not eligible. People on low incomes in the private rental market should also be given access to support services currently reserved for public housing tenants, it says.

The commission wants government to make social housing management contestable, and allow organisations from the non-profit and private sectors to compete on equal footing.

Not enough people get quality end-of-life care

Although Australia has high quality end-of-life care, many are unable to access it.

Service availability varies widely according to patients’ diagnosis, age and location. Up to 70% of Australians would prefer to die at home, but few do so, says the commission.

Greater access to community-based palliative care would give people more options for managing end-of-life care, rather than hospital being the default, as it currently is for many. The PC wants state and territory governments to substantially increase the availability of community-based palliative care. More clinically qualified staff in aged care would help, too. These reforms would help reduce hospital admissions, and could even save money overall.

Consumers and their families also need more information to help them select aged care facilities that deliver high-quality end-of-life care, it argues.

Governments across Australia need to cooperate more on end-of-life care so that patients receive integrated services across different settings and jurisdictions, the commission recommends.

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