Reforms to Human Services

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• This inquiry is about finding ways to put the people who use human services at the heart of service provision. This matters because everyone will use human services in their lifetime and change is needed to enable people to have a stronger voice in shaping the services they receive, and who provides them.
• In the study report for this inquiry, the Commission identified six services for which the introduction of greater user choice, competition and contestability would improve outcomes for the people who receive them. These services are: end-of-life care services; social housing; family and community services; services in remote Indigenous communities; patient choice over referred health services; and public dental services. This final inquiry report sets out tailored reforms for those six services. There is no one-size-fits-all competition solution.
• Users should have choice over the human services they access and who provides them, unless there are sound reasons otherwise. Choice empowers users of human services to have greater control over their lives and generates incentives for providers to be more responsive to their needs.
  • Competition and contestability are means to this end and should only be pursued when they improve the effectiveness of service provision.
• A stronger focus on users, better service planning and improved coordination across services and levels of government is needed. Governments should focus on the capabilities and attributes of service providers when designing service arrangements and selecting providers — not simply the form of an organisation.
• Each year, tens of thousands of people who are approaching the end of life are cared for and die in a place that does not fully reflect their choices or meet their needs. Reforms are needed to significantly expand community-based palliative care services and to improve the standard of end-of-life care in residential aged care facilities.
• The social housing system is broken. A single system of financial assistance that is portable across rental markets for private and social housing should be established. This would provide people with more choice over the home they live in and improve equity. Tenancy support services should also be portable across private and social housing.
• Family and community services are not effective at meeting the needs of people experiencing hardship. Practical changes to system planning, provider selection, and contract management would sharpen focus on improving outcomes for people who use these services.
• Current approaches to commissioning human services in remote Indigenous communities are not working. Governments should improve commissioning arrangements and should be more responsive to local needs. This would make services more effective and would lay the foundation for more place-based approaches in the future.
• Patients should have greater choice over which healthcare provider they go to when given a referral or diagnostic request by their general practitioner. A simple legislative change would help. More patient choice would empower patients to choose options that better match their preferences. Public information is needed to support choice and encourage self-improvement by providers.
• Public dental patients have little choice in who provides their care and most services are focused on urgent needs. Long-term reform is needed to introduce a consumer-directed care scheme. This would enhance patient choice and promote a greater focus on preventive care.

• Preliminaries: Cover, Copyright and publication detail, Letter of transmittal, Terms of reference, Contents, Acknowledgments and Abbreviations
• Overview including key points
• Recommendations
• Chapter 1 The Commission’s approach
• 1.1 What the inquiry is about
• 1.2 The roles of government
• 1.3 The objective of reform
• 1.4 Introducing greater informed user choice, competition and contestability
• 1.5 Assessing reform options
• Chapter 2 Government stewardship
• 2.1 Governments’ role as stewards
• 2.2 Design
• 2.3 Delivery
• 2.4 Improvement
• Chapter 3 End-of-life care in Australia
• 3.1 What is end-of-life care?
• 3.2 Some end-of-life care is excellent
• 3.3 Too many Australians miss out on high-quality end-of-life care
• 3.4 Poor stewardship is hindering better end-of-life care
• Chapter 4 Reforms to end-of-life care
• 4.1 Improving acute care at the end of life
• 4.2 Enabling more people to be supported to die at home if they wish
• 4.3 Supporting end-of-life care in residential aged care
• 4.4 Advance care planning
• 4.5 Effective stewardship of end-of-life care
• Chapter 5 Social housing in Australia
• 5.1 The role of social housing
• 5.2 The broader housing market
• 5.3 Towards a better social housing system
• Chapter 6 Choice and equity in social housing: a single system of financial support
• 6.1 The importance of choice
• 6.2 Unlocking choice: A single system of financial assistance
• 6.3 Designing a single system of financial assistance
• 6.4 Transitioning to a single system of financial assistance
• 6.5 Enabling greater choice within social housing
• Chapter 7 A better social housing system: improving user focus
• 7.1 Improving government stewardship
• 7.2 Increasing contestability of tenancy management
• 7.3 Creating a more even playing field for providers
• 7.4 Improving services for users
• Chapter 8 Commissioning family and community services
• 8.1 Context and scope
• 8.2 Problems with the current arrangements
• 8.3 Reform directions
• Chapter 9 Human services in remote Indigenous communities
• 9.1 The opportunity for reform
• 9.2 Lessons from previous reforms
• 9.3 Toward a better model of service provision
• 9.4 Improvements to commissioning practices
• 9.5 Longer-term directions for service provision in remote Indigenous communities
• Chapter 10 Patient choice
• 10.1 Introduction
• 10.2 Referral pathways
• 10.3 Giving patients greater choice
• 10.4 Key benefits and costs of the reforms
• Chapter 11 Information to support patient choice and provider self-improvement
• 11.1 Introduction
• 11.2 What information would support choice, provider self-improvement and contestability?
• 11.3 How well does current reporting support choice, provider self-improvement and contestability?
• 11.4 Proposed reforms
• Chapter 12 Reforms to underpin more effective provision of public dental services
• 12.1 The potential avoidable costs of oral disease
• 12.2 Establishing the basis for improvement
• Chapter 13 User choice and contestability in public dental services
• 13.1 Giving users choice through consumer-directed care
• 13.2 A better way to pay for public dental services
• 13.3 Better targeting high-risk children under the Child Dental Benefit Schedule
• 13.4 Allocating funding to patients
• 13.5 Improving contestability within public dental services
• 13.6 The reform pathway
• Appendix A Public consultation
• References