Human Services

This page proposes approaches to the structure & governance of more efficient & effective government-funded "human services", focussed on improving people's health, education and general welfare.
It also includes sub-pages with background thoughts on Domestic Violence & Suicide (covering gender issues especially) and Gay & Group Parenting,
plus attached at the bottom of this page is my schematic of a cohesive, integrated strategy to address the problems of an ageing population (which I did to help NSW FACS & non-government stakeholders think about the issue, but which seems not to have influenced anything in the updated NSW Ageing Strategy 2016-20so I'm releasing it proactively here in accordance with GIPA).


Private sector delivery of "public services"?
- example: what is "public education"?
With the UK "privatising" all schools, and the "Gonski" needs-based funding reforms being implemented & refined for all private and public schools in Australia, it's worth defining what we mean by "public education", so that national debate is not dragged down into a simplistic but ill-defined or misdirected "for or against public education" debate.

Defining public education by who owns the assets is rather absurd, given that the majority of costs and the effectiveness of education is overwhelmingly determined by teachers, and no-one owns them!  Even school physical assets (e.g. buildings, sports facilities/equipment, computers) may also be leased or accessed on a contracted use basis, and hence could be "privately" owned even with "public education" provided by State-owned schools, especially if the private sector offers expertise & innovation in classroom design.

Although the motivations within public or private sectors can differ, the differences are not as clear cut as is often claimed.  Yes, private businesses are generally motivated by money, because they have to be to survive, but they're still comprised of people, who funnily enough have similar motivations & failings to people in the public sector (e.g. greed, sloth, risk aversion & the occasional bursts of altruism, compassion & psycho-obsessions!).  The problem of aligning contracts, monitoring mechanisms and management & employee incentives to what society wants can be just as challenging in the public as private sector (my thoughts on "Capitalist Co-ops" have some relevance to this issue) so although the effective outsourcing of public services does require a more sophisticated approach to procurement / commissioning, which may seem an extra burden, it is really just making the problem more transparent.  The positive aspect of it is that it forces government to think about what it actually wants and contract specifically for that, rather than simply employing a lot of public servants and assuming they'll automatically deliver what's wanted in the most optimal way.

Public education also can't be defined as "not for profit", since many private schools don't distribute dividends to shareholders (and even if they did, this is only a return on capital invested or a form of interest paid on funds borrowed, with a premium paid for the extra risk of equity funds compared to interest paid on debt).
It can't even be defined as a school that gives free education to all local children without discrimination, since some State-owned schools are selective according to academic ability.

I think the origin of 'public education' was that it made education freely available to the whole public, so no child can be denied an education.  
Accordingly I suggest a public education provider should be defined as:
An organisation that provides free (or very nearly free) education of very similar standard to any child that lives in the organisation's defined service area.
This means an organisation can still be considered a public education provider (and qualify for "public education funding") if it provides academically-selective schools or classes, as long as it also has other schools or classes with a similar quality of education available to anyone else in the same defined local service area (noting that the selective schools will have teaching that is customised to higher academic ability, but this doesn't make it better than other teaching customised to the differing needs of students in other classes and schools).

With this definition, there becomes the opportunity to think about new governance models for education, and similarly also for health & other "social purpose" providers....

Choice with 'co-opetition' networks
Physical capacity limits and school selection criteria mean we can't all choose which school building to send our kids to, nor is this desirable, because of its tendency to divide society, as well as subject children to grueling commutes when they could be out playing.  However, we could all have a choice over their school’s teaching leadership - which is far more important for their education.
One approach for improving education in this way, and other human services, is the idea of competitive-collaborative networks (which adopts the concept of "Coopetition" , although I haven't actually read this book), such as:
  • Competitive "School Support Networks" helping schools deliver better quality teaching:
    • Competing School Support Networks would serve those schools that choose them (through local school boards with elected parents, teachers & Department of Education representatives), by helping to transfer best-practice teaching knowledge (especially using technology) across all member-network schools (since teaching leadership & teacher quality are the most important factors affecting student outcomes), as well as supporting them with business admin & knowledge systems and innovative delivery of services outside of standard school hours.
      (Note systems with objectives that are hard to precisely measure, like teaching quality, require more devolved governance like this (management & accountability mechanisms), so they can use subjective judgements to complement centralised performance monitoring.)
    • Connected networks of local schools, such as the successful Sydney Secondary College (comprising Balmain, Leichhardt & Blackwattle Bay campuses), have the potential to deliver the same education benefits as larger schools, through economies of scale and the sharing of knowledge and resources, but without the problems of school closures.
    • The School Support Networks would largely replace and reverse the accountability of former bureaucratic district/regional education system offices that local schools report to.  Senior teachers (e.g. heads of faculty) could also be employed by these School Support Networks (which could be private businesses), whilst more junior teachers could remain employed by and only teach in their one local school.
    • These recently proposed education system reforms (labelled as coming from the new NSW Education Minister, Rob Stokes), seem similar in concept.
    • Yes money is important, but within the realistic bounds of affordable funding levels (which the original "Gonski" funding probably wasn't), I agree that it would have been a tragedy not to grab the chance to finally settle a fair way of allocating available funds to schools (with negotiated refinements to "Gonski 2.0"), so we can focus on the even more critical issue of developing an industry structure and governance that will make the most effective possible use of the available resources (& of course people can still seek to increase total funding in future if it's affordable).
      (And on a similar vein in higher-education, the government would do much better focussing on supporting quality on-the-job & on-line education (instead of, or at least before increasing student fees), which can enable much better learning at vastly lower cost than out-dated and inefficient university courses - which the likes of Ernst & Young no longer seek from recruits because there's “no evidence” they support achievement in later life, and for many people are just not worth the cost It seems uni degrees have become an expensive badge of honour for course entry, which aren't worth so much now that so many people have them!  Thankfully some universities are embarking on the changes required.
      Furthermore, since researchers don't always make the best teachers, university funding should be fundamentally reviewed, with research grants probably best separated out and contested by public or private organisations, which could then provide more secure employment, and hence attract better researchers than under the current situation where individual research academics have no job security because they have to apply for new grants every few years.)
  • Joined-up, targeted, person-centred human services - customised & optimised for clients by competitive Primary Health Networks (PHNs) contracting for all health, social/affordable housing & family-support services (including for child protection & DV) - as per the attached blog, which is also on GAP's forum.
    Important components should include government funding aligned to health outcomes (rather than activity, such as GP visits), health insurers (providing the analytics and incentives for effective & well-targeted services to manage long-term costs) and a regulator to protect customers from greedy/poorly regulated insurers (who damaged the USA's managed-healthcare experience by simply limiting access to services to reduce costs).
    • As medical technology advances at an accelerating rate, it is ludicrous that we still expect individual GPs to have sufficient knowledge to provide the best diagnosis and treatment for every health problem.  
      GPs need to be supported and guided by a range of specialists, which could be coordinated by PHNs.  In many cases, pharmacies will be better suited to provide what customers need (expect disruption there).  They, working with employers via Workcover, may do a better job providing the primary health services that GPs fail to provide, especially to help people stay in/get back to work quickly after injuries and psychological trauma.
    • Government funding would flow through these networks, following consumers' choices (as the Productivity Commission recommends).  The value-proposition of competing networks would derive from how easily they help consumers get the services that they need and want (more so than in the IP of actual service delivery models).
See these links, which are consistent with this direction of reform:

Co-design is another growing trend, where consumers become actively involved in designing and maybe even delivering services.  Co-design improves service design, making it better suited to customer needs, and it also promotes trust in suppliers, which could be further promoted through co-ownership, or "Capitalist Co-ops" - a co-operative business ownership and governance model that could overcome the "distance" and distrust often present with major publicly listed corporations, which sometimes seem to pursue shareholder value at customers’ expense (but are needed to support the roll-out of successful pilot projects with the economies of scale that's required to improve the effectiveness of national social spending).

Competing social-service networks - accountable to end users who choose which network serves them - have the potential to support innovation by smaller component members, whilst delivering the benefits of scale and collaboration within the network.  These networks would be dynamic entities, with constantly changing composition and no fixed, monopoly geographic boundaries (although they may have some geographic focus, at least initially):


https://sites.google.com/site/drdavidcthorp/human-services/GP.jpg?attredirects=0


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David Thorp,
2 Apr 2017, 04:04
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David Thorp,
23 Feb 2018, 00:12
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