Don’t underestimate the power of representation

Myself and Prof. Janine O’Flynn from the University of Melbourne recently recorded a podcast for Wiley Society in honour of International Women’s Day on March 8th.  In this we talk about out experiences as women in academia and how societies and associations can help to improve gender parity in research fields.

 

You can find the full recording here.

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Why the Jacquie Lambie Network’s Tasmanian health plan doesn’t add up

 

Helen Dickinson, UNSW

The polls are predicting a hung parliament in Tasmania’s March 3 election. So it’s not surprising that key political players are starting to jockey for position. The Jacqui Lambie Network (JLN) has stepped into this fray, demanding control of the health ministry in return for providing a guarantee of confidence and support to a minority government.

“Enough is enough,” the JLN campaign page says, explaining that:

“… despite heroic efforts by our doctors, nurses and other health professionals the Tasmanian health system is in permanent crisis. It has been mismanaged by successive Labor and Liberal administrations for well over a decade and beyond.”

The JLN has a “plan to fix” this situation, but it is short on detail and unlikely to improve the health system or outcomes for Tasmanians over the longer term.




Read more:
Tasmanian election likely to be close, while Labor continues to lead federally


 

The state of the Tasmanian health system

Health is an important topic of debate in Tasmania, given the state experiences some of the poorest health outcomes in the country. Tasmania suffers from high rates of chronic disease, obesity and smoking, poor nutrition, and low physical activity levels.

Many of these indicators will come as no surprise, given Tasmania struggles with high unemployment in some areas and low economic growth relative to other states and territories. Although there has been some improvement in recent years, entrenched poverty remains a problem for the island state.

The JLN makes a number of criticisms of the Tasmanian health system including: long waiting times for surgery, a lack of “properly funded and clinically staffed” hospital beds and a health system that is uncoordinated and mismanaged.

It contests that elective surgery waiting lists are “out of control”, with “Tasmanians often waiting four times longer than our counterparts across the Bass Strait”.

The JLN plan to ‘fix’ health

The plan for addressing these issues is vague, at best. The first stage is to employ the services of Aspen Medical, a private firm, which will “review” the health system and recommend ways to speed up hospital admissions and reduce waiting lists for surgery.

Aspen Medical describes itself as a “global provider of guaranteed, innovative and tailored health care solutions across a diverse range of sectors”. It has provided services nationally and internationally under contract to various levels of the Australian government, among other clients.

Further, at a time when governments are again under pressure for using too many consultants, this might not seem like an obvious choice to “save” the health system.




Read more:
Public hospital blame game – here’s how we got into this funding mess


 

Following the scoping study to identify the problems in the system, in the medium term, the JLN says there will be “a special intervention by Aspen or a comparable company”.

Over the longer term, a feasibility and benefit study into a new public and private health centre will be completed, with the aim of building a new hospital located on a greenfield site in a central location on the North-West Coast.

 

Will this work?

It’s unlikely to make a difference. Both the starting point and the solutions offered aren’t quite right.

The state of the Tasmanian health system is not as dire as Lambie and colleagues make out. While it is true that Tasmania has traditionally performed badly in terms of waiting times for surgery, successive improvement plans have had some impact.

Recent figures on the performance of public hospitals show that in 2017, 90% of those on the waiting list were seen within 300 days, down from 450 days the year before.

More than half of those on the waiting list were treated within 41 days in 2017, down from 60 the previous year and only a few days above the national average of 38 days.

This is not to say that there is no further room for improvement. But the process of turnaround seems to be in place. Hard working clinical professionals should be supported to continue these gains, rather than simply just abandoning wholesale the approaches adopted.




Read more:
Infographic: a snapshot of hospitals in Australia


 

Debates have rumbled on for years about the lack of hospital beds in Tasmania and whether the health system is underfunded. It may be true that there is a need to increase capacity of hospital beds in the state. But this alone will not deal with the health system’s challenges.

Building a new hospital may alleviate some of the pressures that Tasmania faces; although the idea that there is an “ideal” site to situate a hospital is fanciful at best and will likely encounter challenges of those who live close to a hospital at present.

But the more worrying part of this plan relates to the fact that it treats hospitals as the most important part of the health care delivery infrastructure. Much of the international literature on health systems suggests a need to move away from hospital-centric models of service delivery.

As developed nations encounter growing numbers of people with chronic and complex illness, we need to enhance community and primary care to most effectively and efficiently serve this population’s health needs. This is even more pressing in contexts of socioeconomic disadvantage. Investing in preventative care is a way to improve patient outcomes and, over the longer term, slow growth in health funding increases.

The evidence shows that Tasmania spends significantly less than other states on public health interventions. By simply focusing on waiting times and hospital admissions, the JLN is missing an important part of the health system. In effect, this plan is seeking to treat the symptoms and not the cause.




Read more:
Focus on prevention to control the growing health budget


 

Helen Dickinson, Associate Professor, Public Service Research Group, UNSW

This article was originally published on The Conversation. Read the original article.

‘You don’t know what you’ve got ‘til it’s gone’: The implications of expanding the use of robots in care services

This post originally appeared on the blog of the Australian and New Zealand School of Government, you can find this here

Paro with a dementia patient

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, the team of researchers explores some of the long-term implications for governments from the rise of robots.

The rise in number of citizens needing government-provided care services and advances in technology make it inevitable that robots will play a far greater role in care services, including services most of us will access at some point in our lives (e.g. education and health) and those that only a small proportion of the population will access (e.g. disability services or prison).

Since at least the 1970s, many countries have experienced significant changes in relation to care services. Groups needing care services are increasing in numbers, becoming older, have greater levels of disability and chronic illness and higher expectations about the quality of services that should be delivered. At the same time, care services are finding it increasingly difficult to recruit appropriate workforces.

Horizon-scanners and futurists have told us for some time that robots will play a larger part in our everyday lives and will replace some of us in our current jobs. For all the attention that these kinds of predictions have gained in the media, many of us have not seen quite the dramatic changes promised. However, a combination of forces including technological development, pressures for governments to contain costs and rising public expectations mean that we will likely see greater use of robots across many more facets of public services in the coming years. Our research examines the implications of this for the delivery of care services and the role that government should play in stewarding these innovations.

Robots are already here

Robots already have a number of applications in the provision of care services broadly defined. Applications include manual tasks such as transporting goods, meals, linens (e.g. Robocart), conducting surgery (e.g. ZEUS), dispensing medication (e.g. CONSIS), checking on residents of residential homes and sensing for fall hazards (e.g. SAM), providing rehabilitation (e.g. Hand of Hope), as learning tools in the classroom (e.g. NAOPepper), as a virtual assistant for the National Disability Insurance Scheme (Nadia) and also for social interaction (e.g. ZorabotPAROMathilda).

Advancements in Artificial Intelligence mean that many new care applications will take on more advanced roles which aim to combine the execution of particular tasks along with social functions, where these technologies learn about individuals from previous interactions. One of the first tasks of our research project is to develop a typology of robots in care services that can provide a way of differentiating between these different technologies and their functions.   

Can machines really care?

Some of the developments in care robotics will undoubtedly drive efficiencies, improve some services and outcomes for those using these. However, others may bring unanticipated or unintended consequences. As MIT Professor Sherry Turkle argues, we need to consider the human value of different care activities and whether it maintains this value if it is carried out by a machine. There is a risk that if we do not suitably consider what tasks are being substituted by technology then we could inadvertently lose some of the value in the delivery system.

As an example of these issues, the greatest recent expansion of applications in aged care is in the social domain, seeking to reduce social isolation. Robots such as Matilda are being used to engage people with dementia, through play, dancing, and making Skype calls to family members. Some of these robots have sensors so they can detect aspects of individuals’ emotions and daily schedules and use this data to interact with people in a way that is perceived as consistent with the act of caring. Other robots, such as ElliQ, aim to serve monitoring, communication and well-being purposes, that aim to keep older people living independently for longer and as a means of maintaining engagement with their family and friends.

In these applications, we believe there is a need to investigate a number of these factors in more detail. One facet of this might be the implications of surveillance in private/public geographies of care. Although it may seem a helpful development to be able to monitor people in their homes, what are some of the implications for privacy and security? Moreover, does surveillance equate to care that might be provided in situ?

There is a substantial literature arguing that care is a reciprocal activity, not simply something that is done to a person, so what might be lost if care is carried out by a machine? Additionally, we need to consider the embodied experience of touch and expression of care, and what the trade-offs are in safety and security for the cared-for in the different iterations of these arrangements.

Working to protect the rights of vulnerable groups

Many of these applications seem helpful ways to prevent social isolation in aged care and disability services, yet in other spaces there have been significant concerns expressed surrounding their application. In the US, similar technology that is being used in nursing homes to connect older people to families and friends has been rolled out to an estimated 600 prisons across the country, where in-person visits have either been significantly restricted or stopped entirely, in favor of video calls.

While the prisons cite security concerns, experts and public alike have deemed it inhumane and counter-productive. There are important differences in the prison and nursing home examples (although both constitute different forms of care). In the latter families and friends do not just Skype but physically inhabit an avatar in the same room and this is intended to supplement and not replace face-to-face contact.     

Yet there are also worrying similarities, in both public framing and recipient demographics. Both groups are psychologically and physically vulnerable, and prone to social exclusion. Both groups are likely to be in need of training or therapy programs which can be mediated digitally or in-person. And while both technologies are presented to the public as a way of increasing family connection, they’re sold to the purchasers (prison and nursing home administrators, or government departments) as cost-saving measures.

There might be nothing new in this, but it means that there is an important balance to be maintained in stewarding these technologies to ensure that we can open additional avenues for social inclusion and communication, without decreasing or offering an excuse to multiply the barriers in front of physical interaction. This is where governments play an important role as stewards of technologies, developing guidelines, recommendations, and legal baselines. Our project will be a step in supporting this endeavor.

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

Image credit: The Toronto Star