Choice and control in disability services

Choice and control are words that are used a lot in relation to the new National Disability Insurance Scheme (NDIS).  Australia’s disability services have traditionally been underfunded and found to be lacking in comparison to those in a number of other countries.  The NDIS promises profound shifts in these services and to put control in the hands of individuals with disabilities.

However, meanings of choice and control are not as straight forward as they might appear.  We might have a wealth of choice and yet none of those choices may be things that we want.  We might have control over spend of, say, care budgets but lack offerings that we would want to choose.  While these sound like good concepts (and I believe should be afforded to people accessing disability services) we need to ensure that they are effectively supported if they are to be realised.

This process requires more than just greater critical thinking about the concepts of choice and control, or even getting more adept at better market management.  There is a great deal of political courage involved in facilitating an outcomes-focus.  If we are truly to afford individuals control over the spend of their individual budgets then we will need a shift in the way that we see welfare services.  Rather than considering these services to be a ‘gift’ and focus on input equity as many systems traditionally have; we need to turn our attention to outcome equity.  This means that sometimes people will spend public money in very different ways than in traditional services.

Today I published a piece in the Conversation reflecting on these issues in relation to disability services in Australia.  Drawing on evidence from other countries that have rolled out similar sorts of systems and their experience to date I reflect on whether Australia is ready for a similar sort of system.  The piece can be read in full here.

 

Bridging the gap between the creation and application of knowledge

The Office of the Chief Scientist recently published a report on knowledge creation and application in the context of entrepreneurship.  It argues that knowledge is ‘the foundation of the highgrowth industries of the future’ (pg. iv).  Given that Australia is currently going through somewhat of a transition in terms of the structure of its economy then this is an important issue for the country.

To some degree Australia is well placed for this future in terms of its share of the world’s top 1 per cent cited research papers in STEM (Science, Technology, Engineering and Maths) areas.  But overall the country is far more weak at bridging the gap between the creation of this knowledge and its application.  Australia places ninth for the quality of scientific institutions and only 72nd on Innovation Efficiency (output innovation relative to input in terms of the Global Innovation Index.  No Australia Universities place in Reuters’ ranking of top 100 innovative universities.  Fewer than one in two Australian businesses report innovative activity of any kind.

This report is not an anomaly and other studies reveal similar patterns.  For example, the OECD ranks Australia last in terms of relationships between universities and businesses.  During a debate at the Melbourne Institute conference last week, the Prime Minister Malcolm Turnbull noted that other countries with similar academic cultures are ‘well ahead’ on industry engagement with university research.

Such a state of affairs is depressing for those with an interest in innovation and entrepreneurship, but also offers a huge opportunity to advance this agenda.  It seems that in driving this agenda there are two things that are agreed upon.  The first is that the journey from knowledge creation to its implementation is not straight forward.  This process involves navigating a whole series of different organisations, interests and values.  The second point that is agreed on is that universities are central to this process.

The recent introduction of Advanced Health Research and Translation Centres to Australia may be one way these activities may be improved in the context of health care.  Modelled on experiences in the UK, Canada and the US, these centres bring together universities, health organisations and clinical professionals to focus on producing high quality research and mobilising this into practice.  At the University of Melbourne we have a project seeking to evaluate these organisational arrangements as they develop and you should see a report from us on this soon.

The Victorian Health Network is another innovation that seeks to support the mobilisation of knowledge, particularly in relation to systems improvement.  We believe that knowledge is best mobilised where it is socialised between different actors within a system.  By bringing together senior individuals from across the health system with an internationally renowned speaker, we believe this affords the system the opportunity to learn from the best and to think about how it mobilises this knowledge into practice.

The first VHN event takes place next week and we have just a few places left.  We will be hearing from David Albury on the topic of ‘Health Innovation: From buzzword to disciplined action’.  If you are interested in attending then drop us a line to find out more.