Exciting news about JHOM

I am lucky enough to have a couple of editorial roles with journals, one with the Journal of Health Organisation and Management (JHOM) and the other with the Australian Journal of Public Administration (AJPA).

We recently got the very exciting news that JHOM has been accepted into the Social Sciences Citation Index and will get an impact factor.  This is exciting news as having an impact factor is one of the ways that academics (and research excellence exercises) determine the relative merit of publications.  JHOM was submitted for review about four years ago now so it has been a long journey and we are really happy with the outcome.

The press release can be found below and if you are interested in submitting a piece to JHOM then I am happy for you to get in touch with me directly.

Press release

As contributor to Journal of Health Organization and Management (JHOM), we are delighted to let you know that the journal has been accepted into Clarivate Analytics (formerly Thomson Reuters) Social Sciences Citation index (SSCI). This decision reflects the increasing quality and impact of the journal and the dedication of the editorial team, led by co-editors Helen Dickinson, University of New South Wales, Australia, and Suzanne Robinson, Curtin University, Australia.

 

SSCI is a key database within Clarivate Analytics Web of Science™ Core Collection and covers content in the social sciences discipline. Inclusion in the SSCI means that the Journal will receive an impact factor, the first one will released in Summer 2017.

 

To celebrate this exciting news, the latest issue of JHOM (Vol 31 issue 2) will be available on free access from 19th May- 18th June 2017. Please follow this link to the free access: http://bit.ly/2qw2hHZ

 

The editors are currently welcoming submissions to the journal. Inclusion in SSCI will provide greater discoverability for authors published, so now is an ideal time to submit your work. To submit to the journal, please use the online submission system: http://mc.manuscriptcentral.com/JHOM.

 

For queries, please contact the Editors, Helen Dickinson, h.dickinson@adfa.edu.au, Suzanne Robinson,  suzanne.robinson@curtin.edu.au, or the Publisher, Wendy Alderton, walderton@emeraldgroup.com.

 

Feel free to forward this exciting news to your peers and colleagues.

 

Finally, I would like to take this opportunity to thank you very much for your valuable contribution to the quality of the journal and your continuous support.

 

With very best wishes,

 

Emma Leverton

 

 

 

 

Emma Leverton, MA

Publishing Editor | Health and Social Care | Emerald Publishing

Tel: +44 (0) 1274 785157

eleverton@emeraldgroup.com | www.emeraldpublishing.com | www.emeraldinsight.com   

 

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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

 

Budget 2017 sees Medicare rebate freeze slowly lifted and more funding for the NDIS: experts respond

File 20170509 11018 1upkul9
The future of the NDIS is seemingly secured in this federal budget.
from shutterstock.com

Stephen Duckett, Grattan Institute; Chris Del Mar; Elizabeth Savage, University of Technology Sydney; Helen Dickinson, UNSW, and Michael Woods, University of Technology Sydney

As expected, the government has announced a progressive lifting of the Medicare rebate freeze. Together with removing the bulk-billing incentive for diagnostic imaging and pathology services, as well as an increase in the PBS co-payment and related changes, this will cost a total of A$2.2 billion over the forward estimates.

Other announcements include:

  • From July 1, 2019, an increase in the Medicare levy from 2% to 2.5% of taxable income, with the extra half a percent directed towards the NDIS
  • $1.2 billion for new and amended listings on the PBS, including more than $510 million for a new medicine for patients with chronic heart failure
  • a A$2.8 billion increase in hospitals funding over forward estimates
  • $115 million for mental health, including funding for rural tele-health psychological services, mental health research and suicide prevention
  • $1.4 billion for health research, including $65.9 million this year to help research into children’s cancer.

All up, these commitments equate to A$10 billion.

Medicare rebate freeze

Stephen Duckett, Health Program Director, Grattan Institute

As foreshadowed in pre-budget leaks, the government is slowly unthawing the Medicare rebate freeze, but at a snail’s pace. At a cost of A$1 billion over the forward estimates, indexation for Medicare items will be introduced in four stages, starting with bulk-billing incentives from July 1, 2017.

General practitioners and specialists will wait another year – until July 1, 2018 – for indexation to start up again for consultations, which make up the vast bulk of general practice revenue. Indexation for specialist and allied health consultations is slated to start from July 1, 2019.

Certain diagnostic imaging items (such as x-rays) will be the last cab off the rank. Indexation will start up again from July 1, 2020.

There is no mention of reintroducing indexation for pathology items. This may be due to the recognition that there is money to be saved in pathology.

Regardless of the reaction of medical lobby groups, it is too early to tell whether this glacially slow reintroduction of indexation will be enough to keep bulk-billing rates at their current levels. Practice costs and income expectations of staff have not increased dramatically over the freeze period as the Consumer Price Index has been moving slowly. But each additional day of a freeze means costs and revenues fall further out of alignment.

The jury will be out for a while on whether reintroduction of indexation is enough to restore the Coalition’s tarnished Medicare credentials with voters.

Certainly, the slow phase-in may attract cynicism, with a legitimate perception the government is doing the minimum necessary and at the slowest pace to ensure the issue is off the agenda before a 2019 election.

There is no sign in the budget that the government has sought any trade-offs from the medical profession in exchange for the reintroduction of indexation, so we will have to wait to put in place better foundations for primary care reform.

National Disability Insurance Scheme (NDIS)

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

Since its inception, a number of bitter political battles have been fought over how the National Disability Insurance Scheme should be funded. Many have been nervous the current Productivity Commission review of the costs of the scheme could lead to a scaling back of the NDIS before it is fully operational.

The NDIS operates under a complex funding arrangement split between federal, state and territory governments. Until now it has been unclear where the federal component of this commitment will come from, and a significant gap was emerging from the middle of 2019.

Today’s budget promises to fill this funding gap, in part through an increase by half a percentage point in the Medicare levy from 2% to 2.5% of taxable income. Of the revenue raised, one-fifth will be directed into the NDIS Savings Fund (a special account that will ensure federal cost commitments are met).

A commitment has also been made to provide funding to establish an independent NDIS quality and safeguards commission to oversee the delivery of quality and safe services for all NDIS participants.

This will have three core functions: regulation and registration of providers; complaints handling; and reviewing and reporting on restrictive practices. While such an agency will be welcomed by many, the devil will be in the detail as to whether it is possible to deliver this in practice.

Generic Medicines

Chris Del Mar, Professor of Public Health, Bond University

The government is set to save A$1.8 billion over five years by extending or increasing the price reduction for medicines listed on the Pharmaceutical Benefits Scheme (PBS).

This will be achieved in part by encouraging doctors to prescribe generic medicines that name the active ingredient (as in “90 octane petrol”) rather than the brand name (as in “BP” or “Shell”). This has the effect of pharmaceutical companies selling the drug that is cheapest.

It doesn’t work for drugs still under patent (which allows only pharmaceutical companies holding the patent to negotiate a price, compensating them for the drug development costs). But when drugs come off patent, any other pharmaceutical company can manufacture the generic drug for the best price.

Some doctors worry different brands might have different effects, but there are very few examples of patients being harmed by this. Australia’s Therapeutic Drugs Administration (TGA) makes sure drugs are manufactured to tight standards.

However, many patients know their medications by the brand name rather than the generic name. This same problem can happen right now (when patients are prescribed the same drug with two or more different names when they are prescribed by GPs, hospitals, or specialists).

Doctors are already alert to ensuring that different drugs names do not confuse patients – the danger is that they take the same drug twice, thinking they are different drugs.

Aged care

Michael Woods, Professor of Health Economics, University of Technology Sydney

The government has held the line on restraining growth in funding to residential aged care providers in this budget by implementing its pre-announced indexation freeze for the year, and a partial freeze in 2018-19.

The freeze was in response to concerns some providers were wrongly over-claiming payments under the Aged Care Funding Instrument (ACFI). The instrument determines the level of funding the government pays to providers to care for their residents.

The government has stopped publishing its annual target number of ACFI audits, so any proposed changes in compliance activity are now unknown.

The long-awaited consolidation of the Home Care Packages (which aim to help ageing Australians remain at home for as long as they need) and entry-level support through the Commonwealth Home Support Program has been put off for another two years, until at least 2020-21. This will be disappointing to consumers as a more seamless set of support services will improve their ability to remain in the community.

A welcome initiative is the additional A$8.3 million for more home-based palliative care services, although this extra support is budgeted to end in 2019-20.

Overall, the biggest unanswered issue facing the government in aged care is the need to develop an evidence-based and sustainable funding regime for residential care. To date we have seen short-term budget fixes and the commissioning of opaque rushed research reports.

The health minister needs to step back and establish a proper policy review process that undertakes sound research and consults widely. The review needs to establish a set of core funding principles and model options that address the varying incentives of residents, providers and taxpayers. It needs to adopt the one that transparently empowers consumers, provides market competition and results in long-term sustainability and certainty.

An inequitable budget

Elizabeth Savage, Professor of Health Economics, University of Technology Sydney

The budget has increased the Medicare levy (from 2.0% to 2.5%). It also has removed of the 2% budget repair levy, which benefits individuals with taxable incomes above A$180,000.

In 2014-15, only 3% of taxpayers had taxable incomes above $180,000. By contrast, the Medicare levy increase affects almost all taxpayers. This is a tax increase designed to generate revenue to fund the NDIS. The Medicare levy is essentially a flat tax, except for those at the lowest end of the distribution of taxable income.

Revenue could have been raised more equitably by increasing marginal income tax rates for higher earners (including making the budget repair levy permanent) or lowering upper tax thresholds.

What’s missing from the budget?

The 30% subsidy for private health insurance was introduced in 1999, and cost the budget A$2.1 billion in 2000-01. This cost has grown steadily and was estimated in the 2016-17 budget to be about A$7 billion for 2017-18. Despite high population coverage, consumers question whether private health insurance provides value for money.

There is abundant evidence the subsidy is an ineffective and costly policy, but it seems the politics keep reform of the subsidy in the too-hard basket.

From the budget speech and budget papers, it is not clear that there is any reform of the pricing of prostheses for private hospital patients. The Prostheses Listing Authority, the government regulator, sets minimum benefits for prostheses for private hospital inpatients.

The levels set are far higher than both prices in comparable overseas countries and those paid by public sector hospitals in Australia. Private hospitals are major beneficiaries when the regulated minimum benefits exceed the negotiated prices paid to suppliers.

Private health insurance premium increases are being driven by hospital benefits, of which 14.4% are for prostheses. In 2015, insurers paid out almost A$2 billion in hospital benefits for prostheses.

The previous health minister, Sussan Ley, raised prostheses reform as a priority, noting that insurers pay $26,000 more for a specific pacemaker for a private patient than a public patient ($43,000 compared with $17,000). It appears from early documentation that this problem has not been prioritised in this budget.

Stephen Duckett, Director, Health Program, Grattan Institute; Chris Del Mar, Professor of Public Health; Elizabeth Savage, Professor of Health Economics, University of Technology Sydney; Helen Dickinson, Associate Professor, Public Service Research Group, UNSW, and Michael Woods, Professor of Health Economics, University of Technology Sydney

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

Getting the NDIS “on track”

Of late there have been a number of critical reports about progress in terms of the National Disability Insurance Scheme (NDIS).  I wrote about some of these issues in a piece for the Conversation recently arguing that we might expect to see some challenges in the process of such a large scale reform.

Over the last few weeks there have been even more calls for the NDIS to make changes in order that it get back on trajectory.  National Disability Services – Australia’s peak body for disability provider services – released a paper called “How to get the NDIS on track” which details recommendations on the way forward for the NDIS.

While agreeing with the overall direction of travel the paper argues that the current reforms are placing pressure on a number of stakeholders and in particular service providers.  The paper makes a number of proposals about what can be done to improve the current system.  Many of these, perhaps unsurprisingly given the nature of this organisation, relate to pricing and the involvement of providers in care processes.  Others relate to the improvement of participant planning – which is a key point that we will report at the launch of our research into consumer experiences of the NDIS in a few weeks time (you can book a ticket to this event here).

You can hear me commenting on the report and the progress of the NDIS on the Wire in a piece on the NDS report and disability advocate responses to this.

This week Every Australian Counts – the original campaign for the NDIS and an organisation now committed to sharing information and views on the scheme – released a ‘report card‘ based on feedback from more than 2,100 supporters.  Although many are positive about the NDIS and the impact that this has had on disability services, there are a number of concerns particularly in relation to planning processes and the types of information available.

A particular challenge for the NDIS will be the observation that ‘people waiting for the NDIS are more likely to say that they NDIS is not living up to expectations, than people who are actually in the NDIS’.  This is also an issue that the National Health Service in England faces, where patients typically report higher levels of satisfaction than those in the general population.  This has led to continual challenges for these services and something that the NDIS will need to be mindful of given the likely political battles ahead.

 

 

 

 

 

 

 

 

Evaluating outcomes in health and social care

Back in 2008 I wrote a book called Evaluating outcomes in health and social care, which was part of a 5 book series called ‘Better Partnership Working‘ aimed at students and practitioners working in and around health and social care environments.  This particular book focused on reviewing the evidence for collaborative working and provided an overview of the different approaches used in evaluating joint working arrangements.

Last year Janine O’Flynn and I revised and updated the initial book and published a 2nd edition of the text.  We updated the evidence base and expanded this to take more an international perspective on the issues.

The reviews have started filtering through for this text (and for the broader series) and I will share these here as they emerge.  The first is from Emma Miller at the University of Strathclyde and who has worked extensively in the evaluation of collaboration and health and social care outcomes.  Her review of the book can be found here and in this she provides a very helpful overview of the content for those who might be interested in this text.

 

 

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>

Robo-debt, Centrelink and collaborative working

There is a story that has featured fairly prominently in the Australian media of late that hits many of research interests.  The story focuses on Centrelink, which is a program that sits within the Department of Human Services and delivers a range of different government payments and services for those who are unemployed, people with disabilities, carers, parents, Indigenous Australians and others.  The majority of Centrelink’s work is in relation to disbursing social security payments.

Last year an automated debt recovery system (the snappily titled Online Compliance Intervention) was designed with the aim of recovering $4.5 million in welfare debt every day.  This computer program compares data gathered from other government agencies (e.g. the Australian Tax Office) and compares it to what has been reported to Centrelink.  The aim here is to work out where people have been overpaid benefits and then to work to reclaim these.

In the past the same kind of system was used but referrals were passed to a Centrelink officer who would investigate before sending out a letter asking for more information about any discrepancies.  Between July and December of last year 170,000 compliance notices were automatically sent out, where previously only about 20,000 a year were issued.

The problem came about because many people reported not receiving these letters (some went to old addresses or they did not check their MyGov account) and then they were contacted by private debt collectors who work for the department.  Essentially if you don’t respond to one of these letters in 21 days and provide more information, this is assumed to be evidence of an overpayment and the process is started to reclaim monies owed.

 

Although the offical figures aren’t known, it has been suggested that about 20 per cent of those receiving these notifications are in error.  By the nature of the work that Centrelink do, this typically means that these are individuals and families in the lowest socio-economic groups that are being pursued wrongfully for debts that they don’t owe.  In some cases people were being asked for information (such as payslips) going back to 2012 and were having to pay back debts they did not owe because they couldn’t prove that they didn’t owe this money.

As this story hit the news it gained the moniker of ‘robo-debt’ and there were a number of stories initially that blamed the robots for incorrectly calculating figures.  Stories tended to talk about decisions being made that would not have got past “human” quality control such as the fact that robots calculate fortnightly income by dividing the annual income by 26 or they don’t pick up on mis-spellings of employer names and other egregious flaws that resulted in people being inappropriately pursued for debt.

I’ve been getting interested in the use of robots in public services of late (more to follow soon) and here were the robots being blamed for poor people being pursued for money they didn’t owe.  What seems to be fairly well established now is that the robots weren’t to blame for this outcome – they were just doing what they had been programmed to do.  What had been changed is that the quality control had been removed and the algorithms that were used to identify debts had not been revisited given what we know about the number of cases that were initially identified in the old system and which were actually followed up.  The processes of communication with those being pursued for debts was in practice more problematic than the initial process of identification and had led to the distress of many of those caught up in this process.

The final bit of the story that has come out more recently is even more interesting with respect to what has gone wrong.  In a recent ABC news story, Henry Belot found that there was no formal briefing on this issue between the Department of Social Services (DSS) and the Department of Human Services (DHS).  Broadly speaking the DSS has responsibility for developing policy relating the debt recovery policy, which DHS then leads on the implementation of.  So the department that developed the policy didn’t formally brief the department that implemented it.

 

 

 

 

 

 

What this shows is the importance of developing policy with those that implement it and the challenges that arise when you don’t do this.  This is a stark illustration of the policy implementation gap, which is a key theme of the new research group that I head – the Public Service Research Group at UNSW.  This example further demonstrates the importance of collaborative working and what happens when different agencies don’t work together.  You can find more analysis on this and expert commentary on this from me and others in Henry’s piece which is here.

 

Labor’s Health Policy Summit

A few weeks ago I was one of a number of people invited to attend the Labor National Health Summit.  This event was held to help shape Labor’s health policy agenda heading into the next Federal election.

With colleagues from the Centre of Research Excellence in Health and Disability, I wrote some reflections on the event and what the discussions mean particularly for people with Disability for the good people over at Croakey.  You can find out our take on this here.

 

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.