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.
A lot of the human & societal problems that public services try to address are ultimately due to relationship difficulties, and these are in turn often related to sex/gender, which I discuss in sub-pages on Domestic Violence & Suicide and Gay & Transgender issues.
Also attached here is my schematic of a cohesive, integrated strategy to address the problems of an ageing population (which I did on my own initiative 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 2016-20, so I'm releasing it proactively here in accordance with GIPA). It refers to integrated, person-centred services, as discussed below, along with other policies on my web site covering superannuation reforms and transport & land planning to support affordable housing and "Inclusive Housing Communities".
A further sub-page offers a hypothesis on the cause of cancer (which may guide research for a cure), whilst elsewhere I write about the nature of autism.
Private sector delivery of "public services"?
- example: what is "public education"?
With the UK announcing an intention in 2016 to "privatise" all schools, and the 2010 "Gonski" needs-based funding reforms being gradually 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, corruption, 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. However, it does require government to be competent at managing contracts and regulating the private sector, which isn't always so, in which case the risks of entering a large outsourcing contract could outweigh the benefits.
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). Conversely, private schools that don't provide this same comprehensive & equitable service ought not to get the same level of funding as public education providers (yet they currently do, and these funding inequities seemed set to worsen beyond 2020 as the Federal Government continued to demolish the Gonski funding model, even after Commonwealth and State funding for private schools increased at nearly five times the rate of public school funding over the decade to 2019-20, and still at twice the rate over 2012-2021).
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 subjecting 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.
Another common aspect of debate in public services revolves around the advantages of choice and competition vs collaboration for delivering improved efficiency and effectiveness. The reality is that both approaches have merit, which is what leads to the idea of competitive-collaborative networks (adopting the principle of "Co-opetition", although I haven't actually read this book).
These concepts could be applied to education and health/social services, as described below:
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 (comprised of 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.
This approach achieves economies-of-scale through large networks whilst maintaining devolved local-school governance (management & accountability mechanisms). This balanced approach is important because with many hundreds of schools and the limitations of bureaucratic oversight, it's not realistic to expect all school Principals to make good decisions.
(Note that systems with objectives that are hard to precisely measure - like teaching quality - require more devolved governance like this so they can use subjective judgments to complement centralised performance monitoring and direction.)
The election of local school board members, and in turn, the choice of School-Support Network, would give all parents a choice over the most important aspect of the education their children receive - the approach to teaching, rather than the building design & location - in contrast to the flawed approach of choosing which physical school to attend, which is only a practical option available to the lucky (& mostly wealthy) few, and can create a vicious circle of decline for unpopular schools (especially when classroom dynamics suffer as they become deserted by all the smarter, better-behaved and more wealthy kids, who benefit from better support at home).
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 closing small, local schools.
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 (apparently put forward by the former 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 be a tragedy not 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 incrementally refine funding formulas and/or increase total funding in future if it's affordable). Similar arguments apply to higher education - see adjacent/following section on "Modernising Universities".
Modernising Universities
Once the centres of free-thinking and new technology, the world of academia is now, in some areas, failing to keep up with, let alone lead a society & economy that's going through an information revolution. With a growing need for widespread higher-education and life-long learning for the majority of the population, calls for more funding to support old ways of doing things will simply not cut it. As with schools, far greater gains can be achieved through reforms than through any realistic funding increases, not least through greater use of 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). In some respects it seems university degrees have become an expensive badge of honour for being good enough to get in, 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 not only help to promote commercialisation of research (with practical benefit for the community), but also - with supplementary commercial revenues reducing overall funding volatility - 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.
Academics have been forced by current funding & employment systems to focus on publishing quantity rather than quality in academic journals ("publish or perish"), which were once the sole way of spreading publicly-funded information across the global research community, but have now become a money-making rort for oligopolies that restrict access only to the "elite" world of academic institutions that pay them. This is no longer acceptable for taxpayer-funded research when the internet enables global publishing for free. Effectively challenging the current system of journals will, however, require internet-systems that enable rating of publishing quality (in place of the current journal "peer review" system, which often operates on a "you scratch my back and I'll scratch yours" basis) - which the likes of Facebook would be well-suited to develop (with a more-sophisticated system of ranking "likes" that can be weighted according to the credibility rating of the reviewer, which could itself be determined by weighted community ratings).
Person-centred human services
(see also my attached article from 2018, which is also on GAP's forum)
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. Also the nature of much of GPs work - substantially involving psychological and musculoskeletal issues - suggests other professionals could provide more appropriate services, especially via triage in a multi-disciplinary centre.
GPs need to be supported and guided by a range of specialists, with all services coordinated to meet a patient's needs. In many cases, pharmacies will be better suited to provide what customers need - with the right funding incentives and disruptive innovation, pharmacies working with employers and Workcover insurance & regulation may do a better job providing the preventative "primary health" services that GPs often fail to provide, especially to help people stay in/get back to work quickly after injuries and psychological trauma (thus avoiding larger costs to society & other parts of government).
The efficiency and effectiveness of social/health service spending could be improved by integrated networks offering a flexible range of "joined-up" services focussed on individual client needs (rather than being isolated, program-focussed services). Services could be optimally customised & coordinated with the help of competitive Primary Health Networks (PHNs), which could contract for all health, social/affordable housing and other family-support services (including for child protection & DV) — similarly to flexible, individualised NDIS funding packages. (But note that getting the details right is critical and we should be careful not to casually discard the mostly-effective State-based public health management demonstrated in the Covid-19 pandemic, especially given the disgraceful national management by a gaslighting PM and his mediocre replacement, as well as the similarly lying, incompetent, indifferent & narcissistic UK clown and anti-science, reality-denying US President Trump).
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).
Government funding would flow through these networks, following consumers' choices (as the Productivity Commission recommends) - in particular their choice of insurer-backed PHN, with more informed choices facilitated by regulation of different tiers of cover (bronze, silver or gold, with bronze being effectively the minimum level of Medicare, fully funded by the government). Government funding guidance for the long term should be relatively stable (as per my proposed budgeting reforms), so that health service agencies have clear accountability to manage costs and incentives to invest in cost-saving efficiency initiatives. 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 the ownership of actual service-delivery providers).
Note however that whilst these reform directions may be conceptually logical & appealing, they are complicated to deliver in practice - potentially resulting in very bad outcomes (as has happened in aged care) - so they should not be rushed. In fact, a certain level of mistakes, learning and continual improvement are inevitable, so problems along the way should not necessarily be treated as a reason to abandon the strategy.
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 producing & delivering services (so-called "pro-sumers").
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 economies of scale).
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):
