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What might the health sector learn from the challenges for social services reform?

Some of the questions surrounding plans for social services reform in Victoria will no doubt ring bells for those involved in reform efforts elsewhere – whether in other jurisdictions or sectors.

Thanks to Dr Gemma Carey from the Centre of Excellence in Intervention and Prevention Science and Dr Pauline McLoughlin from the LightHouse Foundation for exploring some of the challenges for reformers hoping to tackle ‘top-down’ relationships, service silos, overly complex funding arrangements and legacies of mistrust.

No doubt these are familiar challenges for many of those working in the health sector….

***

Victorian Service Sector Reforms. Back to the future?

Gemma Carey and Pauline McLoughlin write:

The Victorian Government recently launched the ‘Service Sector Reform: A Roadmap for Community and Human Services Reform’, lead by Dr Peter Shergold.

The goal has been to identify how the Victorian government and community organisations could work better together and improve the way social services are funded and delivered. These services address important social determinants of health, such as housing, employment, emergency assistance and social support.

Following consultations with community service providers, the ‘roadmap’ suggests that social services can be delivered more effectively through:

  • Better partnerships between government and community organisations
  • More collaboration between community organisations
  • Reducing ‘red tape’
  • Streamlining services
  • Designing services around people, and
  • A greater focus on individual outcomes (rather than ‘outputs’).

At the heart of these recommendations is a plan to create ‘joined up government’. This means that organisations are not only better linked with government, but also with each other. The goal is to change ‘top-down’ relationships between government and organisations.

This collaborative work will be supported by more integration between government departments, where, for example, the departments responsible for housing and transport coordinate and collaborate on policy.

This overhaul comes in response to fragmented service ‘silos’ and overly complex funding arrangements across the community sector. Shergold’s consultation process also found widespread distrust between the community sector and government.

While attempts to improve services and their outcomes are welcome, the question is whether this reform is likely to be effective? And if so, how will we know?

Back in 2007, the previous federal government rolled out a similar, major “joined-up” reform, known as the Social Inclusion Agenda. Running between 2007 and 2013, it targeted social services and the relationships between government and the community sector.

The Social Inclusion Agenda was supported by a number of initiatives aimed at improving relationships with the community sector, including establishing a Not-For-Profit Reform Council to cut down red tape and a National Third Sector Compact which outlined new principles for cross-sectoral relationships.

While the ideas put forward by Shergold seem promising, there is a striking resemblance to the Social Inclusion Agenda. For example, the National Compact promised ‘true collaboration’ and ‘productive partnerships’, reducing red tape, ‘improving the consistency of financial arrangements’ and ‘funding and procurement processes’.

Also like the Service Sector Reform, the Social Inclusion Agenda aimed to streamline services and shape them around the needs of clients (through what was called a ‘no wrong door’ approach). There was a focus on increasing integration, collaboration and partnership between organisations.

Under the Social Inclusion Agenda, there were some wins. These included drawing national attention to issues of poverty, and improving policy through new research efforts that focused on preventing disadvantage. Yet as a whole, the government struggled to implement its vision.

As Peter Shergold himself recently stated at a forum in Melbourne (quoting Noel Pearson), ‘you can only judge a policy by the manner in which it is delivered’. In other words, it’s one thing to design a policy, it’s another to implement it.

This is concerning for the Service Sector Reform, as these two initiatives not only offer the same solutions, they appear to be taking the same approach to implementation. In both, a cross-departmental and cross-sectoral working group guides implementation.

In practice, these groups have been found to limit, rather than encourage, collaboration. They create new organisational enclaves and silos: new teams and structures that are not well integrated into other government departments. This means that the main government departments continue to carry the weight of implementation, while these new teams generate great ideas without the capacity to get things done.

These type of cross-sectoral and interdepartmental working groups began under the Blair Government in the UK. Since then, they have become a ‘must have’ item for joined-up government initiatives. But the evidence simply does not support their use.

A major criticism of the working group approach is that it reinforces existing power relationships between government, government departments, and organisations or bodies that have long-standing lobbying power in the community sector.

For smaller organisations, it can be difficult to navigate the system and to influence decision makers. This means that there is less openness to new and innovative practices, and serious barriers for smaller organisations to get involved.

Given that mistrust in the community sector is such an issue, equity is crucial. Smaller organisations that are innovative need opportunities to develop relationships so they have a seat at the table in the decision-making processes that affect them at the ‘pointy end’ of reform.

To be effective, the ‘roadmap’ laid out for the Service Sector Reforms also needs to have better ‘infrastructure’ for implementation. This might include formalised accountability arrangements between inter-departmental groups and the rest of government, or incentive mechanisms to encourage integration across government and between government and other sectors. This can help address the gap between the ‘ideas’ and the ‘practice’.

The strongest lesson to emerge from the research on joined-up government is that it needs multiple interventions and flexibility. This means that new administrative bodies and mechanisms can be added, removed or refined as ‘joining up’ progresses. We need to be careful not to develop a one-size fits all approach.

One of the key things that government can do in the first instance is support relationships and conversations with the community sector, and reward collaborations that can demonstrate positive outcomes for people.

The aim is to avoid simply creating new bureaucracies, and rather to actively bring the community sector to the decision-making table.

 

 

 

 

Comments 1

  1. GP Rural says:

    So much talk, same challenges, same system failures, same power imbalances – need strong political leadership, a single level of health funding and governance (abolish state health systems), focus on Australians and their Health not the people paid to deliver it…

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PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2018 conferences
#6rrhss
#ACEM18