The ableism elephant in the academy

A new paper I am involved in has just been published by Disability and Society and written with a bunch of amazing scholars at the University of Sydney. In this paper we explore issues of ableism within universities. We argue that little attention has been paid to how we can support people with disability to develop their careers as researchers. I have written previously about issues relating to gender in academia and I think that this is an area that is even more neglected.

When we reviewed the literature we found that there is little attention paid to this issue in terms of research.  So in plotting a way forward we draw on personal testimonies of four of the authors who are researchers and who have experienced career challenges in part at least because of their disability.  In the paper we develop a series of recommendations in terms of how universities might better support individuals with disability within the academy.

The abstract for the paper is below and the full version can be found here.

The academy should be a welcoming environment for people with disability. Across Australia, however, there is a current shortage of programmes supporting people with disability to develop their careers as researchers. This article critically investigates current practice and experiences concerning universities and the employment and career development of people with disability as advised by the literature, and how this practice aligns with the lived experiences of several of our authors. Our review of the literature utilising Scopus, PsycINFO and ProQuest databases found a deficiency of research attention on this topic, with only 16 relevant articles identified. This paucity of literary evidence has been augmented in the article by personal stories shared by four of its authors. By focusing on evidence-based measures with potential to support disability employment and career pathways throughout universities in Australia and elsewhere, this article challenges leaders to address ableism and to advance a more inclusive academy.

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What is the Medicare rebate freeze and what does it mean for you?

The Conversation
Helen Dickinson, UNSW

On the weekend, Opposition Leader Bill Shorten said he would end the Medicare freeze in his first 50 days as prime minister if Labor won the election.

Every day Morrison’s Medicare freeze stays in place is another day that families are paying higher out-of-pocket costs to visit the doctor. If I’m elected prime minister, I won’t waste any time stopping Morrison’s cuts to Medicare.

Health issues always feature strongly in election debates, but what is the Medicare rebate freeze and how does it affect what you pay when you see a GP?

How Medicare works

Medicare is our public health insurance system and funds a range of services such as GP visits, blood tests, X-rays and consultations with other medical specialists.

The Medicare Benefits Schedule (MBS) lists the services the Australian government will provide a Medicare rebate for. Medicare rebates don’t cover the full cost of medical services and are typically paid as a percentage of the Medicare schedule fee.




Read more:
Explainer: what is Medicare and how does it work?


GPs who bulk bill agree to charge the Medicare schedule fee and are directly reimbursed by government.

Those who don’t bulk bill are free to set their own prices for services. Patients pay for their treatment and receive a rebate from Medicare.

There is often a gap between what patients pay for services and the amount that Medicare reimburses (A$37 for a GP consultation, for example). This gap is known as an out-of-pocket expense, as the patient is required to make up the difference out of his or her own pocket.

Under an indexing process, the Medicare Benefits Schedule fees are raised according to the Department of Finance’s Wage Cost Index, a combination of indices relating to wage levels and the Consumer Price Index.

Organisations such as the Australian Medical Association (AMA) have long argued this process is inadequate and Medicare schedule fees have not kept up with “real” increases in costs to medical practitioners of delivering services.

The rebate freeze compounds this financial challenge by continuing to keep prices at what the AMA and others argue are “unsustainable levels”.

How did the freeze begin?

Although the Coalition is largely associated with this issue, Labor first introduced the Medicare rebate freeze. The freeze was introduced as a “temporary” measure in 2013, as part of a A$664 million budget savings plan.

The AMA, the Coalition and others loudly criticised the then government for the freeze.

However, on being elected to office in 2014, the Coalition froze the rebate after the failure of a number of proposed health policies. The rebate was frozen initially for four years, starting in July 2014, and extended in the 2016 federal budget to 2020.




Read more:
Rebate freeze will set GPs back $11 per general patient consultation, but they’re likely to charge them more


Although the freeze was to be in place across the board until 2020, since 2017 there has been a phased lifting of the freeze for GP bulk-billing incentive payments (July 2017), standard GP consultations and other specialist consultations (July 2018), medical procedures (due July 2019) and targeted diagnostic imaging services (from July 2020).

What impact has the freeze had?

The freeze means those medical professionals who have not seen it lifted are reimbursed the same for delivering health services today as they were in 2014.

Professionals are paying more for their practices, staff, medical products, utilities and just about anything else that goes into running a medical service. But the amount paid remains static.

Those who have had indexing return to their services have seen only a limited rise in their value – A$0.55 for a GP consultation, for example.

In the run-up to the 2016 federal election, Labor made a similar promise and told voters they needed to “save Medicare” from the government’s plans to privatise the system.

This tactic was dubbed the “Mediscare” campaign. Some saw it as being highly effective in driving a swing towards Labor in the last election.




Read more:
Labor’s ‘Mediscare’ campaign capitalised on Coalition history of hostility towards Medicare


Last month the shadow health minister, Catherine King, blamed the Coalition for the freeze and argued this had driven up out-of-pocket costs for both GP and specialist visits, leading to more than 1 million people delaying or avoiding medical care.

There are a number of reports of GP practices and specialist services halting bulk-billing and patients having to pay higher out-of-pocket costs.

Yet the data on bulk-billing show bulk-billing rates have not fallen. In fact, the latest data show bulk-billing at an all-time high at 86.1%.




Read more:
FactCheck: are bulk-billing rates falling, or at record levels?


Some commentators argue these figures are misleading as they are calculated on services and not patients and so may be an indication of the increasing number of health services that use the MBS.

GP groups have welcomed the lifting of the Medicare freeze, but argue the indexation rates still fail to reflect the genuine value of general practice.

For those in areas such as diagnostic testing, the freeze is argued to have a profound impact. The Australian Sonographers Association argues that for ultrasound alone the average out-of-pocket cost for patients has increased by 117%.

Many experts argue that just giving a little more funding to GP services will not improve the quality of the Australian health care system and far more fundamental issues need attention if we are to see significant reform.

Helen Dickinson, Professor, Public Service Research, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Implementing the Australian National Disability Insurance Scheme: implications for policy and practice

Although our project ‘Choice, control and the NDIS‘ completed some time ago, we are now starting to see some of the academic outputs follow.  Just published is a paper by based on this data and other review data.  In the paper we focus on the implementation of the scheme, some of the challenges that have emerged so far and implications for policy and practice.  Below is the abstract and the paper can be accessed without a pay wall here.

Australia is immersed in its largest reform of disability services in a generation – the staged rollout of the National Disability Insurance Scheme (NDIS). Enacted swiftly to capitalize on rare bipartisan political and public support, the $AU22billion scheme promises to design and deliver disability services differently, with emphasis on service user choice and control. However, the scheme’s rollout is outpacing the readiness of service users, service providers and the agency charged with implementing it to achieve its stated aims, threatening to derail it. Research suggests issues arising in the implementation of the scheme can be attributed in part to the design of the policy and, in part, to how it is translated into practice, both making scant reference to lessons from comparable reforms. Reflecting on the implications of these findings for policy and practice, we explore a range of challenges that arise when embarking on large scale reform in an environment of tight timelines, high expectations, extant policy silences, competing priorities, and jurisdictional ambiguities. This paper adds to the growing body of literature on the NDIS by bringing in the views of participants, and elaborating on implementation challenges posed by its governance structure, system architecture, and administrative structures.

Expanding the role of social science in conservation through an engagement with philosophy, methodology, and methods

One of the very exciting things about working in an inter-disciplinary research group – as we do at the Public Service Research Group – is having the chance to work in areas that I know very little about.  Recently I have been working with a couple of different teams in the space of ecology and conservation and a publication on this work has just come out.

This first work builds on a special issue that explored the use of   “qualitative methods” for conservation. We welcome the intention of that special issue and argue that the collection makes many important contributions. Yet, the articles presented a limited perspective on the field, with a focus on objectivist and instrumental methods, omitting discussion of some broader philosophical and methodological considerations crucial to social science research. Consequently, the Special Feature risks narrowing the scope of social science research and, potentially, reducing its quality and usefulness. In this article, we sought to build on the strengths of the articles of the Special Feature by drawing in a discussion on social science research philosophy, methodology, and methods.

We start with a brief discussion on the value of thinking about data as being qualitative (i.e., text, image, or numeric) or quantitative (i.e., numeric), not methods or research. Thinking about methods as qualitative can obscure many important aspects of research design by implying that “qualitative methods” somehow embody a particular set of assumptions or principles. Researchers can bring similar, or very different, sets of assumptions to their research design, irrespective of whether they collect qualitative or quantitative data.

We clarify broad concepts, including philosophy, methodology, and methods, explaining their role in social science research design. Doing so provides us with an opportunity to examine some of the terms used across the articles of the Special Feature (e.g., bias), revealing that they are used in ways that could be interpreted as being inconsistent with their use in a number of applications of social science.

We provide worked examples of how social science research can be designed to collect qualitative data that not only understands decision‐making processes, but also the unique social–ecological contexts in which it takes place. These examples demonstrate the importance of coherence between philosophy, methodology, and methods in research design, and the importance of reflexivity throughout the research process.

We conclude with encouragement for conservation social scientists to explore a wider range of qualitative research approaches, providing guidance for the selection and application of social science methods for ecology and conservation.

The full text can be found via this link and is available open access (ie free!).

Special issue: Gender, power and use of evidence in policy

Building on work that Gemma Carey and myself have previously done on the role for feminist theory in public policy, for this special issue we had the great privilege to work with Eva Cox on a special issue of the Australian Journal of Public Administration.  Titled gender, power and use of evidence in policy, we sought to bring a gender analysis and/or feminist lens to a diverse range of policy and public administration literature, ‘slanting’ how we perceive and understand them.

In 2015, Gemma and I curated an online special issue for the Australian Journal of Public Administration in which we surveyed research published in the journal archive relating to issues of gender and feminism. We found that two major silences exist in public administration concerning gender. The first is the place of women and gender equity within public service workforces. The second silence is the role that feminist theories could play in tackling contemporary public management challenges.  We argued that there are particular contributions that feminist theories could make in relation to topics such as collaboration, boundary-spanning and skill requirements for future public sector workers. From this work, we conceived a special issue dedicated to addressing these silences.

In 2016 we put out a call for papers to address this space. We challenged authors to not just consider gender in their work but also adopt and explore how a feminist approach might enhance work in their various domains of policy work. While feminist policy is not a new idea, we believe this collection provides a much-needed foray into the practical application of feminism across a breadth of policy work.  Reflecting a parallel process, we took a feminist approach to putting together this special issue. Rather than the traditional blind peer review process, all three editors reviewed each paper multiple times – working with authors to craft their research. The aim of this was to usurp the traditional authoritarian review process with a more constructive and collaborative practice. In doing so, we provided a robust peer-review process that paralleled the theoretical approaches reflective in the work included in this special issue.

The special issue includes any array of great papers including:

Ultimately we recognise that this is a long-term project. Like policy itself, change is often frustrating incremental when it comes to both the way we think about women and more broadly altering the paradigms in which we operate.

The NDIS and its impact on service providers

A few years back I was lucky enough to be part of  team who were funded to do some work exploring the impact that the NDIS is having on service providers.  The work was funded by the Australia and New Zealand School of Government and reported a little bit ago, but now the journal articles from this project are starting to emerge.

The first is in Health and Social Care in the Community and the abstract appears below:

As governments worldwide turn to personalised budgets and market‐based solutions for the distribution of care services, the care sector is challenged to adapt to new ways of working. The Australian National Disability Insurance Scheme (NDIS) is an example of a personalised funding scheme that began full implementation in July 2016. It is presented as providing greater choice and control for people with lifelong disability in Australia. It is argued that the changes to the disability care sector that result from the NDIS will have profound impacts for the care sector and also the quality of care and well‐being of individuals with a disability. Once established, the NDIS will join similar schemes in the UK and Europe as one of the most extensive public service markets in the world in terms of numbers of clients, geographical spread, and potential for service innovation. This paper reports on a network analysis of service provider adaptation in two locations—providing early insight into the implementation challenges facing the NDIS and the reconstruction of the disability service market. It demonstrates that organisations are facing challenges in adapting to the new market context and seek advice about adaptation from a stratified set of sources.

You can find the full article here.

Before replacing a carer with a robot, we need to assess the pros and cons

File 20181108 74778 1gcepvk.jpg?ixlib=rb 1.1
A number of Australian nursing homes use Paro, a therapeutic robot that looks and sounds like a baby harp seal, to interact with residents with dementia. Angela Ostafichuk/Shutterstock

Helen Dickinson, UNSW and Catherine Smith, University of Melbourne

If you have seen science fiction television series such as Humans or Westworld, you might be imagining a near future where intelligent, humanoid robots play an important role in meeting the needs of people, including caring for children or older relatives.

The reality is that current technologies in this sector are not yet very humanoid, but nonetheless, a range of robots are being used in our care services including disability, aged care, education, and health.

Our new research, published today by the Australia and New Zealand School of Government, finds that governments need to carefully plan for the inevitable expansion of these technologies to safeguard vulnerable people.

Care crisis and the rise of robots

Australia, like a number of other advanced liberal democracies, is anticipating a future with an older population, with a more complex mix of chronic illness and disease. A number of care organisations already operate under tight fiscal constraints and report challenges recruiting enough qualified staff.


Read more: Robots in health care could lead to a doctorless hospital


In the future, fewer numbers in the working-age population and increased numbers of retirees will compound this problem. If we then add to this equation the fact consumer expectations are increasing, it starts to look like future care services are facing a somewhat perfect storm.

Robots are increasingly becoming a feature of our care services, capable of fulfilling a number of roles from manual tasks through to social interaction. Their wider use has been heralded as an important tool in dealing with our impending care crisis. Countries such as Japan see robots playing a key role in filling their workforce gaps in care services.

A number of Australian residential aged care facilities are using Paro, a therapeutic robot that looks and sounds like a baby harp seal. Paro interacts by moving its head, heavily-lashed wide eyes and flippers, making sounds and responding to particular forms of touch on its furry coat.

Paro has been used extensively in aged care in the United States, Europe and parts of Asia, typically among people living with dementia.

Nao is an interactive companion robot developed in a humanoid form but standing just 58cm tall in height.

Nao acts as a little friend. By Veselin Borishev

Nao has gone through a number of different iterations and has been used for a variety of different applications worldwide, including to help children engaged in paediatric rehabilitation and in various educational and research institutes.


Read more: Robots can help young patients engage in rehab


The double-edged sword of technology

Robots are capable of enhancing productivity and improving quality and safety. But there is a potential for misuse or unintended consequences.

Concerns have been expressed about the use of robots potentially reducing privacy, exposing people to data hacking, or even inflicting physical harm.

We also lack evidence about the potential long-term implications of human-machine interactions.


Read more: We need robots that can improvise, but it’s not easy to teach them right from wrong


Our research explored the roles robots should and, even more critically, should not play in care delivery. We also investigated the role of government as a steward in shaping this framework through interviews with 35 policy, health care and academic experts from across Australia and New Zealand.

We found that despite these technologies already being in use in aged care facilities, schools and hospitals, government agencies don’t typically think strategically about their use and often aren’t aware of the risks and potential unintended consequences.

This means the sector is largely being driven by the interests of technology suppliers. Providers in some cases are purchasing these technologies to differentiate them in the market, but are also not always engaging in critical analysis.

Our study participants identified that robots were “leveraged” as something new and attractive to keep young people interested in learning, or as “a conversation starter” with prospective families exploring aged care providers.

Robots can help draw in potential clients. PaO_STUDIO/Shutterstock

But there are significant risks as the technologies become more developed. Drawing on research in other emerging technologies, our participants raised concerns about addiction and reliance on the robot. What would happen if the robot broke or became obsolete, and who would be responsible if a robot caused harm?

As artificial intelligence develops, robots will develop different levels of capabilities for “knowing” the human they are caring for. This raises concerns about potential hacking and security issues. On the flip side, it raises questions of inequity if different levels of care available at different price points.

Participants were also concerned about the unintended consequences of robot relationships on human relationships. Families may feel that the robot proxy is sufficient companionship, for instance, and leave their aged relative socially isolated.

What should governments do?

Government has an important role to play by regulating the rapidly developing market.

We suggest a responsive regulatory approach, which relies on the sector to self- and peer-regulate, and to escalate issues as they arise for subsequent regulation. Such engagement will require education, behaviour change, and a variety of regulatory measures that go beyond formal rules.


Read more: Asimov’s Laws won’t stop robots harming humans so we’ve developed a better solution


Government has an important role in helping providers understand the different technologies available and their evidence base. Care providers often struggle to access good evidence about technologies and their effectiveness. As such, they’re largely being informed by the market, rather than high quality evidence.

Many of the stakeholders we spoke to for our research also see a role for government in helping generate an evidence base that’s accessible to providers. This is particularly important where technologies may have been tested, but in a different national context.

Many respondents called for establishment of industry standards to protect against data and privacy threats, and the loss of jobs.

Finally, governments have a responsibility to ensure vulnerable people aren’t exploited or harmed by technologies. And they must also ensure robots don’t replace human care and lead to greater social isolation.

Are robots an answer to the ‘care crisis’?

This piece first appeared on the ANZSOG blog

An ANZSOG-funded research project is exploring the increasing use of robots in care services to replace or complement the roles of humans. In this article, researchers explore how the growth of robots in care services is changing how we think about care, and what we need to do to ensure that the ethics of care are maintained. The full report is expected to be published in the near future.

By Catherine Smith, Helen Dickinson, Gemma Carey & Nicole Carey

It is well-established within policy and practice circles that we are facing an impending crisis of care.

Australia, like a number of other advanced liberal democracies, is anticipating a future with an older population, with a more complex mix of chronic illness and disease. A number of care organisations already operate under tight fiscal constraints and report challenges in recruiting sufficient numbers of appropriately qualified staff. In the future, fewer numbers in the working-age population and increased numbers of retirees will compound this problem. If we then add to this equation the fact that consumer expectations are increasing, then it starts to look like future care services are facing somewhat of a perfect storm.

Robots are increasingly becoming a feature of our care services, capable of fulfilling a number of roles from manual tasks through to social interaction. Their wider use has been heralded as an important tool in dealing with our impending care crisis.

We have recently completed an ANZSOG-funded research project exploring the roles robots should play in care settings, with particular attention to what this tells us in terms of definition of care. In our research we explored how robots are currently being used across a range of care services (health, disability, education and aged care) and areas where they will likely develop further in the future. We found that care is not a simple concept but a complex and relational set of practices which has important implications for policy.

One thing that we were interested in exploring with interviewees is: if robots are an answer to the care crisis, then what is it that we mean by care? Care is one of those terms that we all use regularly, but don’t often stop to define precisely what it is that we mean. So what activities do we think robots might undertake and what are the implications?

What is care?

Typically, when public services think about designing care services they inevitably pull together a series of different activities (e.g. cleaning, washing, feeding and supporting other practical needs in day-to-day living) that comprise those services. Indeed, if we think back to when care services were first outsourced from local governments, this was often done by individuals observing workers and listing the different activities that they undertook.

In our research, although care was defined in terms of different sets of activities, there are other facets that are also thought to be crucial, namely, care being a relational and responsive activity.

Participants aligned the concepts of robots and care with a definition of care that largely focused on the relational aspect of care service practices. Most people reasoned that humans and human interaction is essential to care relationships, and robots would not be able to replace this.

However, in the care of people with needs associated with autism and dementia the non-human qualities of a robot are seen to be a strength in relational care. In both situations, participants identified that robots are able to undertake repetitive tasks without experiencing the monotony and potential boredom of a human. Robots were described in these scenarios as having no emotional baggage, being patient and unable to get angry.

This was seen as an opportunity to remove a potential stressor from the relationship between the primary carer and those being cared for, and as an augmentation of their care relationship, not a replacement. It was identified as an opportunity to provide the carer with the additional time to address other activities.

Robots are identified as a way to combat loneliness and isolation but with a caveat of concern that they could also generate further isolation if their ‘company’ is used to replace human contact. In most cases, the robot is conceptualised as facilitating relationships. Some participants saw that they provided a conversation piece and relational bridge for the cared for and other people in their wider community, such as peers or family members from other generations.

Care is therefore seen as something that is defined in terms of a relationship, and where responsiveness to the needs of the cared-for is elemental to success. An element which arises in much of the care literature is one of reciprocity, where there is a synergy that develops in such a relationship. The role of the cared-for and the carer can be fluid, with the cared-for strengthened by the value they can bring to the relationship, and the reward that is felt in the giving of care.

Concerns of this nature arose particularly in discussions of ‘Paro’ – a robotic seal that responds with sound and movement to the touch of another. The robot is soft to touch and invites actions of nurture. This was identified as particularly useful for people with conditions such as dementia and autism, where its primary use was settling erratic behaviour. The opportunity to provide for responsiveness and reciprocity was otherwise largely unexplored beyond general discussions around the importance of empathy and the need for human carers to achieve it.

Ethics of care and implications for policy and practice

Describing care as a responsive, relational activity is very much in-line with a way of conceptualising this practice as consistent with an ‘ethics of care’ perspective.

In care ethics, care involves bestowing value on the cared for and activity that provides for their needs. Tronto identified that good care comes about when both of these dimensions – caring about and caring for – are present. Care is oriented toward particular beliefs, including concern and the ability to discern the risks of interference over the risks of inaction; interpretation of the responsibilities in each situation as opposed to aligning to a rigid set of rights; and responsiveness aligned with the setting and the individual. Privacy, dignity and agency are all of particular concern in the provision of care in services as a result of these orientations.

If we define care practice in terms of ethics, then accountability of the relationships of care goes beyond the cared for and the carer. It also includes those who have determined the ethical systems that guide robot behaviour, and therefore expands the care relationship into opaque and impersonal elements that require consideration. This has important implications in terms of policy and practice. If we replace some or part of a care process with a robot, it may have far-reaching implications.

We therefore need to carefully consider how robot technologies fit within models of care. Without this there is a danger that we will not use these tools to their full effect, or will create unanticipated consequences.

Members of the research team:

  • Helen Dickinson, Public Service Research Group, University of New South Wales, Canberra
  • Nicole Carey, Self-Organizing Systems Research Group, Harvard University
  • Catherine Smith, Youth Research Centre, University of Melbourne
  • Gemma Carey, Centre for Social Impact, University of New South Wales

Developing and recruiting the future public servant workforce

A few times a year the good people over at Power to Persuade turn over the blog to the Public Service Research Group for a week.  Over that week we run a number of pieces based on work that we are doing across the group.  In the recent PSRG week one of the pieces that ran was based on a chapter that I wrote with colleagues at PSRG on the development and recruitment of the public service workforce.  This chapter comes from the book I was involved in editing on the future of the public service, published by Springer.

In this piece we delve into issues of development and recruitment employing a social learning framework.  We outline four distinct elements to this approach that we argue can serve as a framework for building workforce capability and supporting change within the public service.

The piece can be found here and if you go to the site you can also find the other great pieces from PSRG colleagues.

 

New book: Public Service workforce of the future

It has been a number of years in the making but our (me, Catherine Needham, Catherine Mangan & Helen Sullivan) edited book Reimagining the Future Public Service Workforce has just been published by Springer.   This book investigates the professional needs and training requirements of an ever-changing public service workforce in Australia and the United Kingdom. It explores the nature of future roles, the types of skills and competencies that will be required and how organisations might recruit, train and develop public servants for these roles.

The book draws on leading international research and practitioners also make recommendations for how local organisations can equip future public servants with the skills and professional capacities for these shifting professional demands, and the skillsets they will require.

Drawing on ideas that have been developed in the Australian and UK context, the book delves into the major themes involved in re-imagining the public service workforce and the various forms of capacities and capabilities that this entails. It then explores delivery of this future vision, and its implications in terms of development, recruitment and strategy.

Stay tuned for news of a book launch!