Market economics not the solution for human services

August 10, 2016

There is a well-known joke about a drunken man looking for a coin under a streetlight: he had dropped it elsewhere, in the dark, but was looking under the streetlight because he could see more clearly there.

In the same way, the thinking behind the Productivity Commission inquiry into increasing competition, contestability and informed user choice in human services is fundamentally flawed.

Using a contestable market to make the delivery of human services more effective and responsive is simply misdirected. The complexity and interconnectedness of human services — for individuals, community, and our whole society — is too challenging for market economics to properly address.

The consumer is given a lot of status and assumed power in the inquiry's terms of reference, because she or he gets to choose where their favour, or funding, is delivered. We are led to believe this will result in more appropriate, desirable, responsive services. But the problem is that consumers do not shape the products they consume, they simply choose between them.

The true value of such a consumer is as an income stream for the service provider. It might appear to be a convenient way of evaluating the allocation of resources but it's a step in the wrong direction for a society where the human services we deliver are — or ought to be — part of a larger, shared, social project which values the people using services as highly it does those producing them.

The best human services are the result of co-production. They may be a part of a community endeavour or an individual relationship between the person at the heart of the service and the people working with them. But defining someone simply as a consumer takes away any expectation that they will be a partner in the design and delivery of the service.

Such an approach also works against more expansive notions of collaboration between community organisations, service providers and public institutions. We are asking the service user to select from a menu of products that may or may not build on other community or social connections; feed into the ongoing wellbeing of other people; or add to or detract from the greater good of the wider society. We aren't giving them much of a chance to make a difference.

The implication that giving people consumer choice enhances their autonomy and respect, and improves the quality of the services they can get, is itself problematic.

 

"As consumers, we are trained to seek value for money. People now receiving consumer directed care are choosing not the most valuable or nourishing support, but the cheapest."

 

People do need to know that as individuals they are recognised, that they can connect to others around them, and that they can exert influence and control over how they interact with and access the services they need. But a consumer shapes the product only in as much as the product shapes her or him. As consumers, we are trained to seek value for money, getting the best bang for our buck. People now receiving consumer directed care, for example, are choosing not the most valuable or nourishing support, but the cheapest.

It is not a simple black and white issue. These models of consumer choice being introduced into aged and disability care are associated with many positive outcomes. Not least, that providers have had to change and develop their work and communication systems in order to seek out and pay attention to their customers' experiences. The change in culture that this shift requires is at times profound, although whether this requires a business imperative to bring it on, or whether it can come about without the reductionism described above, is an open question.

Many faith and community based social services, including Anglicare, are now looking at the power of a relational approach to caring for and working with people in their communities, rather than one that is in essence transactional. While such an approach is an obvious counterbalance to the dehumanising construction of service users as consumers, it is also a way to focus on the high quality, and the transformational possibilities, that such services offer.

For such agencies, compassion underpins much of their commitment to providing human services that can give an opportunity to all to flourish as active members of our society. And while the contract of consumer economics might conceivably assure people of essential services it can never require compassion from those providing the care or support.

There is another joke that is appropriate to this discussion. A traveller asks a farmer how to get to a distant town. The farmer suggests one set of directions and then changes her mind. She half suggests another, but stops. 'No,' she says 'if you want to go there, you wouldn't start from here.'

 

Read more at http://www.eurekastreet.com.au/article.aspx?aeid=49733#.V6zzH5h96Uk

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