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Public, private or in-between? Staff-led mutuals may be future of aged and disability care

Julian Le Grand

Published: December 7 2017 - 12:15AM

I have devoted the past 40 years to thinking and writing about public policy. I have been fortunate enough to advise governments, community organisations and – for several years – worked with British prime minister Tony Blair on health and social policy.

Throughout this period, how Australia grappled with, and often resolved, major social policy challenges has always been of interest. Not just to me, but to anyone working at the centre of the British government in Whitehall, the European Commission in Brussels, or any of the world's major universities. Medicare and compulsory superannuation might not be perfect, but many experts consider them as two of the best examples of how to fund and administer a world-class public health system, and how to provide adequate income post-retirement.

And now the implementation of the national disability insurance scheme has the potential to demonstrate new ways of providing high-quality care for those who need it.

Social policy – how a society seeks to care for and support its members – is in the news. The Victorian and NSW parliaments have debated and come to their respective decisions on voluntary assisted dying. About 80 per cent of Australians who had the opportunity to cast a vote indicating their view on marriage equality, did so.

Although I am no expert on Australian policy debates, both issues are clearly important in principle and to those affected. Yet both only affect a comparatively small number of people. Less than 10 per cent of the population identifies as homosexual, and it is estimated that only about 400 people a year may have their decisions affected by the Victorian Voluntary Assisted Dying Bill's proposed changes.

These issues, like many, are considered in crude "yes or no" terms. But when it comes to social policy challenges that are likely to affect all of us, it is rarely, if ever, that simple.

It may be in our nature to deny our health vulnerability at some time in our, or in our loved ones', lives. But as more of us live longer, decisions about how we, or those close to us, will be supported and cared for, and by what kinds of organisation, are unavoidable. We may wish to avoid these questions, but these decisions must still be made. In the British election earlier this year, how social care would be paid for suddenly became one of the campaign's main issues.

In Australia, as in Britain and much of Europe, how human services are administered has been a question of public versus private provision. Proponents of markets see the problem of overblown, inefficient bureaucracies. Proponents of public health and social-care provision view the profit motive as an unethical and potentially exploitative way of providing care and support.

Much of my work has examined such positions to better understand what sorts of systems and organisations can genuinely provide higher-quality care. If the aim is for higher quality, greater user and worker well-being, more community involvement, enhanced accountability at an efficient price, then often the most effective providers are neither government agencies nor private organisations. They are a hybrid of both.

One such hybrid is the public service mutual: employee-led organisations that deliver public services, managed by entrepreneurial staff, endorsed and financed by government. They mix some of the best aspects of public and private provision. Mutual organisations involve employees as members and owners of social enterprises focused on providing care.

Evidence from Britain shows they can be an innovative and highly successful way to transform health and social care. People needing care want greater choice, but they also want diversity among the services on offer. Many don't want to feel their vulnerability is boosting the margin of a for-profit business; they are also reluctant to entrust their care to the mercies of a large government bureaucracy. In contrast, they trust the professionals and others providing care in a mutual: a trust well placed, for there is evidence from across the world that mutuals of all kinds deliver higher quality of service and greater user satisfaction – as well as lower production costs and generally higher productivity.

The more those working for the mutual service provider care about their organisation's future, the higher quality the care they provide. This makes more than intuitive sense; the data supports it.

When it comes to health and aged care, this means a mutual responsibility for achieving social and economic benefits being built into the organisation's culture and purpose. Mutuals not only honour a strong public service ethos, they also benefit staff. Employee-owned mutuals demonstrate higher morale, lower staff turnover and much lower sickness rates.

All the evidence shows these "hybrid" organisations have the potential to provide highly effective care services.

I'm unqualified to judge whether mutuals offer an opportunity for Australia to again demonstrate its capacity for social-policy innovation. But it seems very well placed to do so.

Australia has an ageing population and, as the NDIS matures, people with disabilities will need new models of care and support. And with the Productivity Commission recently completing its inquiry into human services, which is likely to encourage more diversity of provision, it may be that, in a few years, Australia's support for mutuals will herald another example of the country's record of social-policy success.

Sir Julian Le Grand is professor of social policy at the London School of Economics and Political Science. He is in Australia this week as a guest of the Business Council of Cooperatives and Mutuals.

This story was found at: http://www.canberratimes.com.au/comment/public-private-or-inbetween-staffled-mutuals-may-be-future-of-aged-and-disability-care-20171206-gzzrqw.html