Life Matters

Last week I had the pleasure of going on the program Life Matters on Radio National to discuss the NDIS.  I was part of a panel brought together to discuss the roll out of the NDIS, some of the successes to date and some of the challenges now and in the future.  I was joined on the panel by two wonderful people – Leah van Poppel of the Youth Affairs Council of Victoria and Kevin Stone of the Victorian Advocacy League for Individuals with Disability.

We had a great discussion of the NDIS and its impacts on disabled people that involved research, advocacy and consumer perspectives.  You can catch the version of the discussion here.

 

 

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Launch of the Centre of Research Excellence in Disability and Health

I have written before about the fact that I have the great pleasure to be involved in an NHMRC-fundedCentre of Research Excellence in Disability and Health (CRE-DH).  This is the first of its kind internationally and is Australia’s new national research centre to improve the health of people with disabilities.

Last week we had our public launch with a debate titled ‘what makes us healthy’.  The event was hosted by Julie McCrossin, and guest speakers included the Disability Discrimination Commissioner Alastair McEwin, performer Emily Dash, and journalist and appearance activist Carly Findlay, speaking about their personal experiences of health and happiness.  It was a great launch and if you missed it there is a great write up of the event and the centre’s approach on the Power to Persuade site written by Celia Green and Zoe Aitken and you can find this here.  Croakey also republished this piece with pictures of the event and some tweets from the audience here.

Co-lead for the CRE-DH, Professor Anne Kavanagh was busy in the run up to the event writing pieces for the Australian on Pauline Hanson’s suggestion that children with disabilities should be excluded from mainstream schools, link for this is here.  Anne also did a piece for Pursuit on the new CRE-DH, which can be found here.

If you are looking for a research role there is a postdoctoral fellow in health inequities being advertised by the University of Sydney and you can find the advert here.  Stay tuned for more updates about this exciting initiative.

Victorian Parliamentary library video

We have been doing a lot of promotion of the research we did funded by the Melbourne Social Equity Institute into the National Disability Insurance Scheme of late.  One of the things we had the chance to do was to present at the Victorian Parliamentary Library. Myself and two of the community researchers presented the findings and took questions from an audience including a number of MPs from the Victorian government.  Other community researchers joined us in the audience and took part in the discussion that followed.

In addition to having a wonderfully beautiful library, the librarians are very adept with knowledge translation via social media and have produced a short video clip on our research.  You can find this here (if you can bear to look at my face for a few minutes).

The NDIS costs are on track, but that doesn’t mean all participants are getting the support they need

File 20170615 25017 19byiw2
Many people who are dissatisfied with the scheme have reported they couldn’t find care providers to deliver their funded and approved plans.
from shutterstock.com

Helen Dickinson, UNSW

The National Disability Insurance Scheme (NDIS) is “on track in terms of costs”, according to a position paper released by the Productivity Commission this week. The report further stated that:

if implemented well, it will substantially improve the well-being of people with disability and Australians more generally.

But the Commission’s paper also expressed some significant concerns at the speed the scheme is being rolled out, and that this could undermine its overall effectiveness. The report highlighted a number of areas that are proving challenging for those accessing the scheme. It noted that such barriers to access are, in fact, contributing to keeping the costs on track.

Where the NDIS is succeeding

Rarely a day has gone by in recent months without a news story about the perceived failings of the NDIS. The scheme has been reported as “plagued with problems” and concerns aired about a potential “cost blowout” .

As a result, the government asked the Productivity Commission to undertake an independent review into the overall costs of the scheme, its value for money and long-term sustainability. The full report is due by September.

The current position paper goes to great lengths to acknowledge the size of the challenge in delivering the NDIS. It argues that the

scale, pace and nature of the changes it is driving are unprecedented in Australia.

When fully implemented, the scheme will involve the delivery of individualised support to 475,000 people at a cost of A$22 billion per year.

There is no doubt the NDIS is complex, but the Commission finds that there is “extraordinary” commitment to the success and sustainability of the scheme. It notes that making the scheme work is not simply the job of the National Disability Insurance Agency (NDIA), but also that of government, participants, families and carers, providers and the community.

Based on the data collected, the Commission finds NDIS costs are broadly on track with the modelling of the NDIA. A greater number of children are entering the scheme than expected, leading to some cost pressures, but the report notes the NDIA is putting initiatives in place to help deal with these challenges.

The report also finds benefits of the NDIS becoming apparent, with many, but not all, NDIS participants receiving more disability support than previously and having more choice and control.

Problems with the scheme

Many people who are dissatisfied with the scheme have reported they couldn’t find care providers to deliver their funded and approved plans. This kind of under-utilisation of services is a factor contributing to keeping costs on track. Such findings are in line with recent independent research into consumer experiences of the scheme.

Overall the report finds there is insufficient flexibility in the NDIA’s operational budget and that money could be spent more in a way that reflects the insurance principles of the scheme, such as greater amounts of funding being invested in prevention and early intervention services.

The process of care planning needs greater attention. Pressure on the NDIA to get numbers of people on to the scheme means that the quality of the care planning processes have been decreased in some cases. This has caused “confusion for many participants about planning processes” and has resulted in poor outcomes for them.

There is a significant challenge in relation to the disability care workforce. The Commission estimates that one in five new jobs created in Australia in the next few years will need to be in the disability care sector. The report notes that current approaches to generating greater numbers of workers and providers are insufficient.

A range of responses required to address these include a more targeted approach to skilled migration, better market management, and allowing formal and informal carers to provide paid care and better price monitoring and regulation.

The interface between the NDIS and other disability and mainstream services has also proved problematic. There is a lack of clarity in terms of where the responsibilities of different levels of government lie and who should be providing which services. Some people with a disability have lost access to supports they used to get as state government disability services close down.

Need for political will

The Commission describes the roll-out to the full scheme as “highly ambitious” and expresses concern it risks not being implemented as intended. Indeed the speed of the NDIS roll-out is described as having “put the scheme’s success and financial sustainability at risk”.

The report concludes that if the scheme is to achieve its objectives there needs to be a

better balance between participant intake, the quality of plans, participant outcomes, and financial sustainability.

The NDIS is taking a number of steps to deal with these issues but the Commission “is unable to form a judgement on whether such a refocus can be achieved while also meeting the roll-out timetable”.

The ConversationWhat all of this means is that we will need to see some enormous political will to enable the scheme to be supported to reach its full potential. This will likely involve some slowing of the timetable for implementation and some difficult work to deal with a number of the areas that have been identified as problematic. Whether the government has an appetite to see this through remains to be seen.

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

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

More journal articles on the NDIS

This week two articles on the National Disability Insurance Scheme have made it to early view with Social Policy and Administration.  Both deal with important aspects of the scheme drawing on data collected with a variety of different stakeholders from across the system.

The first with Catherine Needham, compares the introduction of individualized budget policies for people with disabilities in Australia and England. Data is drawn from semi-structured interviews undertaken in Australia with politicians, policymakers, providers, disability rights groups and care planners, along with analysis of policy documents. This data is compared to the authors’ earlier research from England on the personalization narrative. We argue that the National Disability Insurance Scheme (NDIS) currently being introduced in Australia deploys an insurance storyline, emphasizing riskpooling and the minimizing of future liabilities. This contrasts with the dominant storyline in England in which attention has focused on the right to choice and control for a minority of the population. This difference can be explained by the different financial context: the NDIS needed to build public and political support for a large increase in funding for disability services, whereas in England the reforms have been designed as cost-neutral. Tensions in the English narrative have been about the extent to which personalization reforms empower the individual as a consumer, with purchasing power, or as a citizen with democratic rights. We conclude that Australia’s approach can be characterized as a form of social investment, evoking tensions between the citizenship of people with disabilities now and the future worker-citizen.

The second is with colleagues at the Public Service Research Centre on the topic of market stewardship in the NDIS.  We argue that personalized care and market-based approaches to public service provision have gained prominence in a range of Organisation for Economic Co-operation and Development countries. Australia has recently joined this trend, launching a complex and expansive programme of individualized care funding for disability through the National Disability Insurance Scheme. Public sector markets (i.e. where governments either directly fund a market by way of competitive tendering, or through personal budgets) have been embraced by actors at different points of the political spectrum and for a range of reasons, including efficacy and efficiency gains, empowerment of citizens and efforts to cater for diversity. Despite the growing dominance of public sector markets and individualized funding, many questions about the role and responsibility of governments in managing and regulating these markets remain unanswered. In this article we outline different roles governments might assume in the creation and management of public sector markets, based on the types of risks governments are willing to take responsibility for. We argue that to fulfil the social contract between government and citizens, governments need to ensure that markets are properly stewarded and embedded in broader social safety nets. This, we contend, can ensure citizens receive the gains of market models while being protected from market failures or market-produced inequities.

Our research into the NDIS continues and expect more papers to follow.

 

Launch of the Public Service Research Group

Yesterday evening saw the launch of the Public Service Research Group which I lead.  The press release associated with the launch is copied below.

UNSW Canberra’s School Of Business launches the Public Service Research Group (PSRG)

FOR IMMEDIATE RELEASE: Bringing together a wealth of public service experience and expertise across a broad range of disciplines and methodologies, the Public Service Research Group – launched on May 16 – uses a fresh approach to gain new insights into effective public service implementation and evaluation.

“People tend to focus on the design of policy and assume if you get that right, everything will be okay,” explains PSRG Director, Associate Professor Helen Dickinson. “We know that’s not the case and we’re more interested in the messy side of policy and public service, such as what happens around implementation, or when things don’t quite go to plan.”

Partnering with organisational clients, integral to the group’s research is that there will be a practical benefit for those who work in public service.

“We put a lot of effort into knowledge translation and making evidence more useful to practice,” says Dickinson.

Consisting of around 20 academics across the School of Government Business with backgrounds ranging from political science to health, systems theory, project management, economics, accountancy, HR, environmental studies, geography, public management, public administration and industrial relations, the PSRG has recently recruited eight experienced career researchers. The PSRG also works with an expert network of both national and international associates to ensure they have the best range of skill sets for any task at hand.

The PSRG’s inter-disciplinary, inter-methodological approach sets it apart from other research groups of its kind, with Dickinson highlighting its relevance given the changing face of modern public service.

“The reality of public services today is they’re designed and delivered by more than just the public sector,” she says. “There’s been a big expansion of contracting out services into private and not-for-profit community organisations and there’s a greater expectation that different groups and people have a say in policy-making processes. We think it’s extremely important to bring together those different sectors in the works we do, because that’s the nature of contemporary government.”

This collaborative approach also allows the PSRG to “work closely with clients to solve real issues they’re dealing with, rather than take a cookie cutter approach to research and problem solving,” explains Dickinson.

While working across a broad range of issues, the Group’s research will centralise around three themes, led by internationally renowned academics. The first, led by Dr Gemma Carey, focuses on large scale systems change and reform, the second, led by Dickinson, looks at diversity, equity and inclusion, while the third, led by Professor Deborah Blackman, focuses on public service capability.

“Those three themes, which were developed to address ongoing public service issues, encapsulate what we do, providing a practical framework for us to build on,” says Dickinson.

For interviews or further information, please contact PSRGinfo@unsw.edu.au

 

More on the NDIS and accountability

A few years ago myself, Helen Sullivan and Catherine Needham wrote a paper that speculated on what some of the challenges might be for the NDIS in terms of issues of accountability.  In this we argued that the individual funding component of the NDIS poses a number of interesting questions about accountability. The paper considered a number of accountability dilemmas and provided evidence from different national settings to illustrate how these accountabilities may manifest in an Australian context. The paper concluded by setting out a framework of accountability bringing together these different dilemmas to think about provision of care as a whole.

In recent months we have been collecting significant amounts of data with individuals in Federal and State government exploring the tensions and challenges that have arisen as the NDIS is rolled out across the country.  Over the next few months a number of new papers will come out that present this data.

In one of the first contributions myself, Eleanor Malbon and Gemma Carey revisited the paper outlined above to examine whether these types of accountability dilemmas are being realised in the early implementation of the NDIS.  In the paper we outline accountability dilemmas in relation to: care outcomes, the spending of public money, care workers, and advocacy and market function. We argue that examining these accountability dilemmas reveals differences in underpinning assumptions within the design and on-going implementation of the NDIS, suggesting a plurality of logics within the scheme, which are in tension with one another.

The contribution of this paper is to set out the accountability dilemmas, analyse them according to their underpinning logics, and present the NDIS as having potential to be a hybrid institution. How these dilemmas will be settled is crucial to the implementation and ultimate operation of the scheme.  No doubt this will be an issue that we revisit at a number of times over the following months.

NDIS hiccups are expected, as with any large scale reform

Here is a piece I wrote recently for the Conversation on the NDIS.

<p>Disability services were widely recognised to be in a <a href=”http://www.pc.gov.au/inquiries/current/ndis-costs/issues/ndis-costs-issues.pdf”>parlous state</a> and there was bipartisan support for the development of a national scheme that would address their identified inadequacies. In recent months, this enthusiasm and excitement has been replaced by a more critical discourse. National rollout of the scheme began last year, but already there have been reports of the NDIS being “<a href=”http://www.abc.net.au/news/2017-03-12/ndis-rollout-plagued-with-problems-foi-documents-reveal/8346892″>plagued with problems</a>”.</p>

<p>However, one of the problems with judging success and failure is that they often look the same part way through. We shouldn’t be surprised that such a huge reform process is encountering challenges in the implementation process and these issues don’t mean that the NDIS is failing overall.</p>

<h2>Problems with the scheme</h2>

<p>The <a href=”https://www.ndis.gov.au/participant-portal-user-guide”>online portal</a> that facilitates payments to providers received extensive <a href=”http://www.abc.net.au/news/2016-08-10/ndis-providers-entering-their-eighth-week-without-payment/7711754″>critical attention</a> for delays and technical glitches. In November 2016, the NDIS was criticised for <a href=”http://www.abc.net.au/news/2016-11-14/ndis-struggling-to-meet-target-quarterly-report-shows/8022196″>struggling to meet enrolment targets</a>. From July to September 2016, only 7,440 people were enrolled in the scheme instead of the targeted 20,264.</p>

<p>This problem was rectified in the next three months, when 26,000 people signed up to the scheme. But in return, there was <a href=”http://www.abc.net.au/news/2017-03-03/ndis-enrolments-surging-despite-difficulties-accessing-plans/8321232″>criticism</a&gt; this had been at the expense of the <a href=”http://www.theage.com.au/victoria/its-like-a-fiveyearold-wrote-it-disability-advocates-slam-ndis-care-plans-20161026-gsbsdm.html”>quality of the planning process</a>. </p>

<p>Then came concerns about a <a href=”http://www.abc.net.au/news/2017-01-20/national-disability-insurance-scheme-government-announces-review/8198574″>potential cost blowout</a> due to the increased prevalence of autism, debates over <a href=”http://www.abc.net.au/news/2015-05-31/ndis-confusion-victoria-state-federal-government-agreement/6506840″>state and federal responsibilities</a> and reported <a href=”http://www.abc.net.au/news/2017-02-25/ndis-report-warns-major-cities-not-prepared-for-implementation/8303276″>workforce shortages</a>. Due to this, the Productivity Commission was asked to undertake an <a href=”http://www.abc.net.au/news/2017-01-20/national-disability-insurance-scheme-government-announces-review/8198574″>independent review</a> into the overall costs of the scheme, its value for money and long-term sustainability.</p>

<p>Recently we have seen extensive reporting on the failures of the scheme and concerns that the various pressures on it might be <a href=”http://www.theaustralian.com.au/opinion/editorials/time-to-make-the-ndis-workable-and-affordable/news-story/f4575a0570ce875249c3526b2cc7768c”>overwhelming</a&gt;. There also seems to be agreement from some quarters that the implementation of the NDIS is <a href=”http://www.theaustralian.com.au/news/inquirer/monster-that-ate-the-national-disability-insurance-scheme/news-story/92b7c5e7b5719290741966c9b1983500″>failing</a&gt;.</p>

<p>By 2020 the NDIS is expected to have around 460,000 participants at a cost of A$22 billion. It should empower people with disability and their families and support individuals to participate more fully in society and the economy.</p>

<p>Such a process involves massive changes to several areas. These include who delivers services and how; power relationships between people with disability, their families and service providers; and the involvement of people with disability in Australian economic and social life.</p>

<p>This vast reform is being implemented at <a href=”https://theconversation.com/four-lessons-the-ndis-must-heed-to-avoid-a-pink-batts-disaster-35385″>break-neck speed</a>. Different levels of government are rushing to divest themselves of the provision of disability services, create a market for disability services and individualise services all at the same time. </p>

<h2>Historical comparisons</h2>

<p>England embarked on a similar reform process a few decades ago – although over far greater timescales. This started with the creation of a market for disability services in the 1980s, the introduction of direct payments in the late 1990s and the expansion of individual funding to all groups around <a href=”http://pf7d7vi404s1dxh27mla5569.wpengine.netdna-cdn.com/files/2011/10/UKDPfinal.pdf”>a decade later</a>. </p>

<p>Although these initiatives were developed over a period of nearly a quarter of a century, they still encountered a number of implementation challenges as they have been <a href=”https://pure.york.ac.uk/portal/en/publications/the-evaluation-of-the-individual-budgets-pilot-projects-ibsen(1ac4b7b7-fc13-4d85-9153-50d784a616ee)/export.html”>rolled out</a>. These include different levels of take up of these options across disability and age groups, reports of inadequate budgets and challenges in planning processes. </p>

<p>In some ways, the comparison to the English experience of implementing individual budgets is not a good one. In England, support for disability services remains focused around a small group of individuals. The development of the NDIS as a major new funding initiative required extensive support and as a result emphasised the potential benefits for the whole population. </p>

<p>The <a href=”http://www.everyaustraliancounts.com.au/”>Every Australian Counts</a> campaign argued people with disabilities should be treated as full citizens and made an appeal to universality. It argued that the NDIS was needed for “peace of mind” in the sense that everyone could be at risk of disability either directly or through a family member.</p>

<p>Many <a href=”https://www.ndis.gov.au/chair-speech-reducing-inequality”>have described the NDIS</a> as the largest social policy reform since Medicare.
So Medicare might be a better comparison than the disability reforms in England, and Medicare’s history is instructive in terms of the time it takes to achieve large-scale reform. Although today Medicare is relatively settled in the policy context and supported by the public, its history is more <a href=”https://theconversation.com/explainer-what-is-medicare-and-how-does-it-work-22523″>contentious</a&gt;. </p>

<p>Medicare started in 1984, but an earlier version, Medibank, was introduced in 1975 after extensive political debate that even led to the <a href=”https://www.whitlam.org/gough_whitlam/achievements/healthandsocialsecurity”>double dissolution</a> of Parliament in 1974. </p>

<p>Medibank was abolished in 1981 and only reintroduced after a significant increase in those without health insurance. Other similar large-scale reform processes follow similar patterns. Change doesn’t come quickly and we need to be patient.</p>

<h2>Lessons to learn</h2>

<p>We are less than a year on from the roll-out of the NDIS nationally. Given the size and scale of this reform agenda we can’t expect to see change emerge overnight. Some of the current commentary around the scheme goes too far in making definitive statements about success and failure. We should expect some challenges to arise as the NDIS is implemented and this doesn’t mean that the idea is fundamentally flawed. </p>

<p>But having patience doesn’t mean ignoring these problems either. The government needs to ensure appropriate mechanisms are put in place to learn from issues as they arise. The scheme is certainly in need of <a href=”http://www.theage.com.au/comment/cuts-to-the-22-billion-ndis-behemoth-would-cost-more-in-the-long-run-20170408-gvgy8k.html”>refinement</a&gt;, but we should not abandon this altogether given life prospects for those with disability are significantly worse than for the general population, and <a href=”https://theconversation.com/is-australia-ready-to-give-people-with-disability-real-choice-and-control-over-services-50312″>well below</a> those of other comparable nations.</p>

<p><span><a href=”https://theconversation.com/profiles/helen-dickinson-113022″>Helen Dickinson</a>, Associate Professor, Public Service Research Group, <em><a href=”http://theconversation.com/institutions/unsw-1414″>UNSW</a></em></span></p&gt;

<p>This article was originally published on <a href=”http://theconversation.com”>The Conversation</a>. Read the <a href=”https://theconversation.com/ndis-hiccups-are-expected-as-with-any-large-scale-social-reform-75693″>original article</a>.</p>

New tools for thinking about policy implementation

In a recent blog post over at Power to Persuade, myself, Gemma Carey and Sue Olney wrote about drawing on feminist theory for new ideas on how policy actors can navigate and influence the dynamic and increasingly complex policy implementation environment. This is copied below and is based on a longer academic article published in Evidence & Policy.  

 

We know that policies are only as good as their implementation, but this phase of the policy process is continually overlooked with sometimes catastrophic results (think Pink Batts). Implementation does not simply involve the spread of best practice or the adoption of particular tools and techniques, but is a much more complex process involving a range of different actors. Yet, policy implementation research has traditionally been highly rationalist in its thinking, portraying this process in a largely linear fashion.

Implementation of almost any policy now requires actions and engagement across multiple organisational domains with government, public, private and community partners. What this means is that implementation requires significant work across a range of boundaries- professional, organisational, sectoral, cultural, and knowledge-based. Yet this work is largely ignored within the literature and rarely documented comprehensively in practice.

In a recent paper we looked to feminist theory for new ideas about how to work across boundaries and across multiple domains to address policy implementation challenges. Table 1 shows how feminist theories offer an alternative to three recent waves of policy implementation/public management approaches – public administration, new public management and new public governance.

Table 1: Approaches to policy implementation

Table 1: Approaches to policy implementation

 

Post-structural feminist theories help us to more deeply interrogate what boundaries are and how they operate. O’Flynn (2016) recently noted that much attention to the ‘boundary issue’ has focused on how to create collaboration and consensus. However, some boundaries may be coercive (for example, forcing individuals to conform to particular cultures and norms) and some boundary crossing practices may be disruptive (altering given ways of working).  Cross-boundary working may not always create additional value, efficacy or effectiveness as is suggested in the literature. We need to acknowledge these differences and develop competencies to navigate different forms of boundaries and their effects. Here, feminist perspectives draw attention to the importance of positionality.

Positionality refers to the concept that all ideas are inherently developed in response to others – there is no such thing as neutral or objective ideas.  Knowledge becomes valid when it includes a specific position with regard to context “because changing contextual and relational factors are crucial for defining identities and our knowledge in any given situation [2]. Cross-boundary working means working with individuals or groups with different positionalities. It should also mean that those groups articulate their contextual differences; that is, the contexts from which they speak and, in turn, the limitations of what they can ‘speak to’ (i.e. the claims they can lay to truth). This becomes important for negotiating power differentials between groups involved in policy implementation. Positionality helps to acknowledge the partiality of any one group’s knowledge and, in turn, can help to mediate any damaging effects of boundary work.

Feminist theorists also bring to the fore concepts of social performance and performativity [3]. When we think about social actions, such as collaboration or negotiation over policy implementation, we embody particular cultural and historical possibilities. At the same time, we also enact those possibilities. In other words, when working across boundaries we do so from a set of historically-conditioned presuppositions which shape how we act/perform. In paying attention to these performances, we can understand how actors ‘construct relationships and erect boundaries’ in between themselves and others, and the ways in which they are shaped by the histories of particular individuals and groups, for example past experiences of collaboration or of other actors. This sheds light on why certain dynamics emerge within policy networks.

Why is cross boundary working important?

The complexity of contemporary public policy issues, combined with changing citizen expectations and increasingly outsourced service delivery, has shifted the goalposts for public sector managers. Kay and Daugbjerg [4] argue that new public governance involves working both within a plural state with multiple actors delivering services and a pluralist state where multiple processes inform policy-making, requiring focus not only on interorganisational relationships but “interpretation of the policy instruments literature as a key driver of observed governance processes” [4]. This means that all policy work, whether design or implementation, involves working across departmental, organisational and sectoral boundaries. Despite this, boundary working is regarded as one of (if not the most) challenging aspects of contemporary policy ‘work’.

The fact that it is so challenging may make people resistant to embracing cross-boundary working. More specifically, the negotiation and persuasion involved in working across boundaries is rarely captured in measures of success for policy-makers or implementers, occurring instead in a ‘black box’ leading to achievement of specified outcomes in specified timeframes. Time spent negotiating trust, values and meaning within institutional and environmental contexts, as well as between individual policy actors, is not typically factored into the increasingly market-driven delivery of public services, despite evidence that it can reduce friction that might otherwise occur in implementation [4,8].

Feminist theories can enable deeper analysis of why different actors need to be brought together to solve problems. As noted above, groups have different and partial knowledge of policy problems. Accessing this different knowledge is the gain that offsets the heightened complexity of working across boundaries, although the extent to which this has been achieved in practice is variable [7]. Moreover, post-structural feminism also highlights the ways in which the diverse groups drawn into the policy process can and should challenge authoritative ways of working on the basis of positionality. It demonstrates that authoritative ways of working, while powerful, are partial and need to be challenged. For those occupying more marginal positions, embracing this fact provides a greater authority to speak and challenge dominant paradigms and ways of working. It is not enough to simply remove barriers to participation; there is also a need for measures to empower individuals through education and economic benefit to question and reform the political-administrative system.

Importantly, poststructuralist feminist theories and ways of working have de-centred notions of authority (i.e. single ways of knowing or doing) [9,10]. Recognising that de-centred power can be productive allows for and enables a great diversity of perspectives, as well as assisting to negotiate diverse perspectives. When we consider that much policy work now involves working across organisational, institutional and sectoral boundaries, a plurality of meanings is both unavoidable and one of the chief advantages promoted within discourses of new public governance 11.  The question then becomes one of how best to secure the gains of this plurality, which brings us to our third question.

What does implementation in contested spaces involve?

We argue that feminist perspectives offer insights into the types of skills and knowledge required to navigate cross-boundary working. We focus on two factors in particular: language and the desire for unified frameworks.

Common language is often said to be a barrier to effective cross-boundary working [12,13]. While not denying that differences in language can make policy implementation more challenging, feminism has shown that arguing for a common language is not innocent, nor neutral [14]. Rather, it is riddled with presuppositions which may in actual fact hinder progress. When we allow different languages (and discourses) to exist, and also actively encourage an awareness of this, we give policy actors greater choice. As Weedon [14] suggests, “the lack of discursive unity and uniformity … means that the individuals [or groups implicated in implementation] have available to them, at least potentially, the discursive means to resist the implications of” policies or ways of working. Put more simply, in allowing different languages to co-exist we give groups greater opportunity to define their own roles in policy – to articulate their own positionality and subjectivities.

A feminist approach to implementation could lead the field to more effectively embrace a multiplicity of voices, subjectivities and ways of knowing and doing. In particular, these include more emotive ways of working. Increasingly, public administration is realising the need for ‘soft skills’ for working effectively within policy networks. These include brokering and coordination skills, as well as a willingness to undertake the emotional labour of working in a highly relational environment [15,16]. Emotions have, in the past, been seen as barriers to the type of rational, impartial decision-making which ought to govern policy processes [15,17]. However, working in contested relational spaces is emotive – particularly when we consider the different positionalities and subjectivities at play.

Recently we have seen successive waves of attempts to capture the same challenges of cross boundary working (that is the different positionalities, languages and knowledges of different actors) [18,19]. These have included popular terms like co-design and co-production, which dominate the policy landscape but gloss over the intricacies of cross-boundary practices including issues of power, context and performivity. Rather than common frameworks, feminist perspectives suggest that we pay more attention to what is gained through diversity and difference and allow space to explore differences in knowledge, experience, context and power. Arguably, it is here that the value of cross-boundary working lies – a richness that will be missed if we seek only consensus, collaborative and commonalities. To do this, we need to listen, question the experiences and perspectives of others, value difference and diversity and recognise that our own knowledge is always partial [20].

References:

1. Dickinson H, Sullivan H. Collaboration as cultural performance: agency and efficacy. In: Carey G, Landvogt K, Barraket J, editors. Creating and Implementing Public Policy: Cross-sectoral debates. New York: Routledge; 2016.

2. Maher FA, Tetreault MK. Frames of Positionality: Constructing Meaningful Dialogues about Gender and Race. Anthropological Quarterly. 1993 Jul;66(3):118.

3. Butler J. Performative Acts and Gender Constitution: An Essay in Phenomenology and Feminist Theory. Theatre Journal. 1988 Dec;40(4):519.

4. Kay A, Daugbjerg C. De-institutionalising governance? Instrument diversity and feedback dynamics. Asia Pacific Journal of Public Administration. 2015 Oct 2;37(4):236–46.

5. Colebatch H. Beyond the Policy Cycle: The policy process in Australia. New South Wales: Allen and Unwin; 2006.

6. Kelman S. The Transformation of Government in the Decade Ahead. In: Kettl DF, Kelman S, editors. Reflections on 21st century government management [Internet]. IBM Center for the Business of Government; 2007 [cited 2014 Aug 21]. p. 33–63. Available from: http://faculty.cbpp.uaa.alaska.edu/afgjp/PADM610/Reflections%20on%2021st%20Century%20Management.pdf

7. O’Flynn J. Crossing boundaries: The fundamental questions in public management. In: O’Flynn J, Blackman D, Halligan D, editors. Crossing Boundaries in Public Management and Policy: The International Experience. London: Routledge; 2014. p. 11–44.

8. deLeon P, deLeon D. What ever happened to policy implementation? Journal of Public Administration Research and Theory. 2002;12(4):467–92.

9. Gavey N. Feminist Poststructuralism and Discourse Analysis. Psychology of Women Quarterly. 1989;13:459–75.

10. St. Pierre EA. Poststructural feminism in education: An overview. International journal of qualitative studies in education. 2000;13(5):477–515.

11. Osborne S, editor. The New Public Governance. New York: Routledge; 2010.

12. Bammer G, Michaux A, Sanson A. Bridging the “know-do” gap knowledge brokering to improve child wellbeing [Internet]. Acton, A.C.T.: ANU E Press; 2010 [cited 2014 Jun 19]. Available from: http://press.anu.edu.au?p=681

13. Wiseman J. Lost in translation: knowledge, policy, politics and power. In: Carey G, Landvogt K, Barraket J, editors. Designing and implementing cross-sectoral public policy: contemporary debates. Routledge; 2015.

14. Weedon C. Feminist practice and poststructuralist theory. Oxford: Blackwell; 1987.

15. Dickinson H, Sullivan H. Imagining the 21st century public service workforce. Melbourne: School of Government, University of Melbourne [Internet]. 2014 [cited 2015 Jun 16]; Available from: http://www.birmingham.ac.uk/Documents/college-social-sciences/public-service-academy/imagining-the-21st-century-public-service-workforce.pdf

16. Newman J. Working the spaces of power: activism, neoliberalism and gendered labour. London: Bloomsbury; 2012.

17. Dickinson H, Sullivan H. Towards A General Theory Of Collaborative Performance. Public Administration. 2014 Mar;92(1):161–77.

18. Carey G, Dickinson H. Gender in Public Administration: Looking Back and Moving Forward: Gender in Public Administration. Australian Journal of Public Administration. 2015 Dec;74(4):509–15.

19. Rhodes RAW. “Genre Blurring” and Public Administration: What Can We Learn from Ethnography?: Genre Blurring and Public Administration. Australian Journal of Public Administration. 2014 Sep;73(3):317–30.

20. Atwood M, Pedler M, Pritchard S, Wilkinson D. Leading Change: A guide to whole of systems working. Bristol, UK: The Polity Press; 2003.

Integrated care and the NDIS

The Journal of Integrated Care has recently published a special issue on Integrated Care in Australasia.  This issue features papers on topics such as: Why understanding what matters to the patient mattersPeople-centred integration in a refugee primary care service: A complex adaptive systems perspectiveSpace, time and demographic change: A geographical approach to integrating health and social careIntegrated care in practice – the South Eastern Sydney experience; and, The theory and practice of integrative health care governance: The case of New Zealand’s alliances.  Also featured in this paper is a piece by myself and Gemma Carey on Managing care integration during the implementation of large-scale reforms: The case of the Australian National Disability Insurance Scheme.

Gemma and I are currently involved in a number of different projects examining different aspects of the National Disability Insurance Scheme as it is implemented across the country (some of these I have written about before and others are coming soon).  One of the themes that has been discussed across many of these different research projects is where the boundaries lie between the offer from the National Disability Insurance Scheme and what is the responsibility of mainstream services.  Most of those who are eligible for individual funding packages under the NDIS will likely access a number of mainstream services in addition.  Yet, our research indicates that a number of discussions and debates are arising around where precisely these boundaries should lie and who should be responsible for funding which aspects of these services.  In our paper we flesh out the facets of these debates in more detail and reflect on how similar some of these issues are to those that have played out in other contexts (e.g. the UK).  In the coming weeks I will report more on consumer experiences of these boundaries from another research project I am involved in.  Those interested in education may also wish to take a look at this article from academics at Deakin University who have also identified similar challenges in terms of boundary-patrolling between the NDIS and education.

If you are interested in the special edition and would like to head to Sydney for the launch this will take place on the 24th February 9.30-12.30 at Sydney Hospital.  This event will feature a keynote address by Dr Robin Miller on international perspective on integrated care.   Robin is a Senior Fellow and Director of Evaluation at the Health Services Management Centre, a Senior Associate of the International Foundation for Integrated Care and a co-editor of the Journal of Integrated Care. This will be followed by a presentation by Professor Joanne Travaglia on reflections on integration in Australasia. Jo is Professor of Health Services Management, Faculty of Health at the University of Technology, Sydney.  If you would like to attend please RSVP your attendance to Daniel.Shaw@health.nsw.gov.au by COB Monday 20th February 2017.