As the average age in Australia rises,
as it will in all western societies over the next thirty
years, panic is growing amongst governments and welfare
services as to how existing systems and finances will
The reality is that our existing systems of social
provision and financing will not support the coming
"Silver Wave" in our population. These systems are not
oriented to regarding older people as a value-producing
segment of society. They are rooted in assumptions about
post-value creation retirement.
Nor are they oriented to understanding changing patterns
of relationships and responsibilities amongst citizens.
Our systems are built around cohorts of passive
recipients of services, not around
individuals, families and communities as active agents
who enter into relationships and incur responsibilities.
Nor are our existing systems oriented to comprehending
diversity and individuality. Institutionalised
arrangements may have become passe in mental health and
disability, but in aged care they are still in vogue.
One-size-fits-all ways of thinking will not accommodate
the generation of baby boomers.
Readers are invited to
comment on our selection of a ten point program for what
we call "self-directed and connected ageing". Our
assumption is that individuals want to retain as much
individual and social autonomy as possible as they age,
and self-direct, for as long as possible, their
preferred way of living.
Our assumption is also that individuals do best when
they are socially connected rather than isolated.
We also assume that governments and welfare systems are
not likely to get this,
without a lot of help. Without a strong exercise of
social leadership by citizens themselves in shaping a
public agenda for "self-directed and connected ageing",
government initiatives and social interventions will
fall well short of what is required.
Our ten point program is informed by several leading
examinations of ageing issues around the world. The
UK National Endowment for the Sciences, Technology and
program; the Helsinki Design Lab's work on ageing
Recipes for Systemic Reform
in Finland; and UK ResPublica's
Age of Opportunity are worth exploring.
We invite readers to use the online form below to send
in comments on this program. It is a draft, and it needs
your input. From this process, we would like to develop
a Strategy Group to explore ways of shaping the public
agenda on ageing in the coming few
years. Please indicate your interest if you would like
to participate in this work.
You will see too that this program contains a mix of
public policy initiatives and social innovations, with
an understanding that both are important, including the
relationship between them.
ten point program for self-directed and connected ageing
the last eighteen months, the Commonwealth
Government has established no fewer than eight new
national statutory authorities to administer health
Will they make any different to the consumer
experience of health care? No, says Jeffrey
Braithwaite, Director of the Australian Centre
for Health Innovation
at the University of NSW.
"Health restructuring is so pervasive, that
observers could be forgiven for thinking it is the
only change tool available. In the health sectors of
Britain, New Zealand, Canada, the USA and Australia
the activity seems virtually continuous. Primarily
it consists of regular mergers, altering the
responsibilities between central and peripheral
bodies, setting up new agencies that trigger
domino-like changes to the official responsibilities
of other agencies, constantly tweaking
organizational charts and re-orienting who reports
The evidence for this making a difference, let
alone demonstrably improving productivity or
outcomes, is surprisingly slender. This is the
case for both system-wide and
organizational-level restructuring... In truth,
there are no randomized trials, no longitudinal
studies of multiple restructuring events or time
series designs and little scientifically
acceptable cross-sectional work.
Anecdotally, one hears the groans of clinicians
when the next restructure is proposed or new body
announced. Usually management consultants or
government advisors are the proselytizers. Many
bedside clinicians look up into the far reaches of
hospital structures and see that, although new
organizational charts are released displaying new
boxes with novel titles and some trimming of old
positions, not a lot changes in terms of their own
work or responsibilities. Sure, the title of their
clinical directorate may alter because someone fuses
two or more together—or the name of a new national
body is publicized with fanfare, with a mandate to
enhance quality or safety or compliance with
regulations—but the professional arrangements that
deliver direct, local care to patients seem
Evidence challenging the
- Between 1999
and 2003 there were 2497 mergers
and acquisitions in the
healthcare industry of the USA,
yet the latest evidence suggests
that mergers induce less
competition and lead to
increases in prices of some 53%.
- A study of 20
teaching hospitals restructuring
their clinical directorates in
New South Wales and Victoria,
showed that efficiency gains
sought were not realized, and
that one structural type was as
efficient as any other.
- Case study
research into 25 National Health
Service trusts merged between
1996 and 2001 revealed that,
although mergers can realize
some benefits, there were
considerable negative effects
including: setbacks of at least
18 months in progress; problems
in fusing different
organizational cultures; no
better recruitment and retention
of clinical staff; and savings
below those forecasted.
- New Zealand
restructured its health services
in the 1990s along quasi-market,
competitive lines including a
purchaser-provider split, and
has now turned 180°,
re-instituting a public sector
All too often, regardless of good intentions,
restructuring is merely thinly-disguised public
relations, and spun as strategic, creative change
for the better. Those in authority, notably
ministers for health, move to change the
organizational chart, install a new agency, or
re-order some people's responsibilities at the apex
of the health system, and propose that reform has
been accomplished—until the next structural
‘transformation’ is identified. Sometimes the motive
is to configure like services with like more snugly
to achieve ‘strategic fit’. But often the purpose is
political, with intended outcomes ranging from
ridding the system of dead wood to ‘demonstrating’
something significant is being done, all in the
absence of tackling complex systems problems."
Jeffrey Braithwaite is Director of the Australian
Centre for Health Innovation at the University
CLICK HERE to read the full text of
Summit 2012 Reforming Public Services
Towards citizen-centred social policy and empowered
users of public services
Reform of public services has been a constant theme
amongst governments, policy officials, and service
delivery organisations for the last two decades.
Despite the constant talk, real change towards
citizen-centred social policy and empowered users of
public services is hard to find. What is more common
is a pattern of frequently restructured financing
arrangements for service delivery and re-badged
programs which have little impact on the experience
of users of services.
Summit over two days will review the progress, and
the stalemate, in reform of public services, and
explore prospects and strategies for reform in the
following areas of social policy:
Rural and regional affairs
Justice and community safety
The Summit has an interest in processes and models,
from Australia and overseas, that have broken
through the reform stalemate and generated
innovative thinking and practice, and new forms of
user participation in the design, ownership and
implementation of reform options.
The format of this Summit will involve a mix of
structured consensus-oriented deliberations,
informed by inputs from presenters in plenary and
concurrent sessions. The goal is to search for, and
progress, common understandings and approaches
through the course of the deliberations over the two
Call for Papers
Expressions of interest in presenting a paper or
workshop or display should be forwarded, in no more
than 300 words, by 31 December 2011, using
the form below or emailing
to submit an expression of interest in presenting
for more information.
Public Services Inside Out Putting co-production
preparation for the 2012 Reforming Public
Services Summit, we have made available for
download two excellent collections of case studies
from the UK on putting co-production into practice.
The first collection
Public Services Inside Out was produced
in 2010 by NESTA (National Endowment on
Sciences, Technology and the Arts., and the New
Economics Foundation. Here is the Executive
"This report is about real stories of reform, led by
people who work in and use public services. The
examples included in this report didn’t rely on
expensive consultants, troublesome IT systems, or
grand blueprints drawn up in Whitehall departments
and Westminster think tanks. They depended only on
the commitment and creativity of frontline workers
and members of the public who wanted better
In spite of this – or more likely because of it –
these examples represent a radical new approach to
public services. They embody what has come to be
known as ‘co-production’: public services that rest
on an equal and reciprocal relationship between
professionals, people using services, their families
and neighbours. They exist today not as promises in
pamphlets or manifestos, but as real services
serving real people more cheaply and more
effectively than traditional approaches.
This is public services inside out – innovation that
overturns the conventional passive relationship
between the ‘users’ of services and those who serve
them. As we enter a period in which cuts and savings
will be made from on high, these examples point to
the possibility of a different approach: better,
cheaper services created from the ground up by those
who know public services the best.
This is the second of three reports on co-production
from a partnership between nef (the new economics
foundation) and NESTA. The first report, The
Challenge of Co-production, published in
December 2009, identified the problems in
trying to reform public services from the centre. It
pointed to the exhaustion of improvement efforts
through a so-called ‘New Public Management’ of
seemingly endless institutional re-wiring, targets
and ‘efficiencies’ – especially in the face of
long-term challenges such as an ageing population
and a rise in debilitating health conditions.
... From family nurse partnerships to parent-run
nurseries, community-led justice to patient-led
recovery from brain injuries, the examples here
demonstrate six main themes. These include
recognising people as assets and building on their
existing capabilities, establishing mutual
responsibilities between professionals and the
public, and supporting people to support each other.
... But the fundamental and provocative issue
underlying all of these barriers is that
co-production is sometimes blocked because it takes
seriously the current political rhetoric about
‘devolving power’ and ‘empowering communities’ –
because it challenges the costly but conventional
model of public services as a ‘product’ that is
delivered to a ‘customer’ from on high, and instead
devolves power, choice and control to frontline
professionals and the public."
to read the full report.
New Economics Foundation
Empowerment and Inclusion
The second collection of case studies was
produced by the New Economics Foundation in 2011. It
is titled Creating stronger
and more inclusive communities which value
everyone's right to contribute.
to read the full report.
Putting Citizens First - Without Any Citizens!
Zealand School of Government is a public
sector management school which offers post-graduate
courses for public servants in public
Like government agencies everywhere, it monitors the constantly changing fashions
in public administration, importing ideas and
practices from abroad that it believes the next
generation of bureaucrats should know about. It has
picked up the idea of co-production of public
services from overseas literature, and given it a
local twist. The local twist is that the "co" part,
the part that involves citizens, is optional.
In July, ANZSOG held its annual conference titled
Putting Citizens First
examining "Citizen-Centric Service Delivery".
With a registration fee of $2,990 for two days, this
event attracted public servants from around the
country eager to explore ways of putting citizens
first. Of course, there were no citizens present,
speaking or listening. Every contributor was a
public servant or public sector management
consultant. It was Putting
Citizens First without any citizens.
Allan Fels is the Dean of ANZSOG
[photo above]. When asked how it is possible
to hold a conference titled
Putting Citizens First
"Citizen-Centric Service Delivery"
without any citizens, Alan Fels responded
by saying "The conference is for public
administrators to explore ways of engaging with
citizens". When asked whether it might be useful to
involve citizens in a kind of dialogue, particularly
citizens who are active in working towards
"Citizen-Centric Service Delivery" in fields such
health or disability or indigenous affairs, he
replied "The conference is for public administrators
to explore ways of engaging with citizens".
It is doubtful that even George Orwell could
anticipate anything quite so Orwellian. The gap
between Australia's bureaucratic class and the
general public is so vast that public servants can,
seemingly with a straight face, allocate $2,990 of
taxpayers money to themselves, each, to discuss
"co-production with the public" without any member
of the public being part of the discussion.
A new public agenda on Reforming Public Services
that involves citizens is long overdue in Australia.
To this end, a Summit
on Reforming Public
Services will be held in March 2012.
Members of the public (citizens, users of services,
residents and taxpayers) are invited to be part of
CLICK HERE for the Summit flyer.
Vern Hughes Social Impact Bonds in NSW
The NSW Government announced on 5 September 2011 that it is to trial a tender process for private investors in foster care and prisoner post-release programs, whereby investors may make a return on their investments if they yield budget savings for the Government.
This announcement is the direct result of lobbying by the Centre for Social Impact (CSI) with financial support from JB Were and the Macquarie Group. The financial interest of large finance houses in pushing public policy arrangements such as this comes as no surprise. The Macquarie Group has three decades experience behind it in overseeing for-profit private investment in public programs. Known as the "millionaire's factory", the Macquarie Group has made its mega-bucks by designing infrastructure projects (tolled bridges and tunnels are its specialty) that screw consumers. It uses its philanthropic foundation to mask its rapacious corporate greed.
Having invested profitably in public infrastructure, why should the Macquarie Group not spread its tentacles into foster care and prisoner post-release programs?
Social Impact Bonds have been highly controversial in the UK. but have been introduced by the NSW Government with virtually no public debate. Innovative ideas in foster care, or disability, or mental health, that arise from users of services, or parents and carers, or residents, rarely get the ear of governments, despite years, indeed decades, of trying. If an innovative idea comes from a charity or service provider, it will be considered more favourably. But if it comes from private investors, then, apparently, all you need to do is ask.
The thinking behind Social Impact Bonds is that private sector investors can weave positive social impacts if they are offered incentives to apply their financial investment “expertise” to communities, through a “payment for results” framework. The deep flaw in this thinking is the naive assumption that social goals (in this case, reduced demand for foster care and lower re-offending rates among former prisoners) can be orchestrated by programs and investors if the incentives are right. This is not the case. Social relationships are the key to reduced demand for foster care and lower re-offending rates, and the people who might make these relationships happen are not private investors. They are people in civil society - family and friends, neighbours and communities, mentors and teachers.
Many such people have worked tirelessly for decades to get governments to recognise that managerial approaches in foster care do not work. But governments have relentlessly persisted with failed programs .... until a proposal for private investment with a return for budget savings comes along. It is offensive that private returns from budget savings should flow into the likes of the "millionaires factory" when individuals and groups have been calling for radical change in foster care for years, with no expectation of any financial reward.
That governments have listened to ivory tower academics and investors on a topic of such sensitivity and complexity as foster care, and not listened to voices in civil society who are immersed in the relationships that potentially make a difference, is contemptuous of those individuals, families and communities.
The assumption that positive social impacts can be leveraged by getting the incentives right for investors to make profitable returns is a further triumph for shallow managerial thinking on the part of governments and public policy academics, for whom social well-being can apparently be adjusted upwards or downwards by manipulating this or that program lever or amending this or that set of incentives. This assumption is fundamentally wrong.
Further details of this CSI intervention with the NSW Government are available at Social Impact Bonds
Vern Hughes is Director of the Centre for Civil Society
John Milbank Christian social thought and civil
John Milbank is a leading
writer on civil society, social theory, theology and
politics in the UK, whose work underpins the emerging
'third way' in British politics based on a stronger
civil society. Here he comments on the
forgotten tradition of Christian social thought and
its affinity with alternatives to the "bankruptcy of both liberal left and neo-liberal right".
"There has been
a new surge in the importance of charities and
voluntary welfare activism, plus a great rise in the
number of social enterprises, not-for-profit
organisations and hybrid businesses which combine
for-profit and not for-profit activities.
Now some of the reasons that
can be given for the growth of this "third sector"
can accurately be called cynical. Businesses can try
to imbue even charity with a capitalist logic, or
find that charitable involvement is good for their
image and ultimately for profit. Meanwhile
governments can find that they can supply services
more cheaply and more efficiently, yet without
surrendering bureaucratic control, by turning to the
assistance of voluntary agencies.
Yet even such cynical intent
would not change the fact that this is giving a new
public opportunity to genuine motives of social
purpose and the pursuit of interpersonal aid.
Moreover, the "cynical"
explanation is insufficient: more crucial is the
manifest failure of both state and market to meet
some of our most fundamental human needs. This is
because both institutions think and operate in
materialistic, instrumentalist terms that cannot
supply the currency of tacit trust and unwritten
tradition that is required in order for any social
formation to operate.
Given that neither state nor
market are able to supply various crucial local
needs, we are seeing a natural return to mutual
collaboration in order to make up for this lack -
anything from voluntary-aided independent schools
taking supposedly "impossible' students to
cooperatives committed to keeping old bicycles in
constant repair and renewed circulation.
It would be sheer ideological
dogmatism - whether of the Right or of the Left - to
suppose that this kind of development is an
aberration: a sign that there isn't enough "genuine"
capitalist enterprise on the one hand, or that the
state is abrogating its responsibilities on the
On the contrary, there are
inherent limits to any system's attempts to dispense
with the role of trust and reciprocal assistance.
Central planning cannot assess people's various
local and changing needs, while the pursuit of
profit leaves many genuine needs and demands totally
In addition, we should welcome
the rise of the third sector because it vastly
increases the instance of genuine, spontaneous and
participatory democracy in operation. By contrast,
the overwhelming evidence is that merely
representative democracy has reduced the ordinary
person's real decision-making power which can only
come about through neighbourly collaboration.
Fixation on the ballot-box
means that governments are increasingly able to
manipulate the choices of individuals in a vulgar Benthamite manner that is supposed to increase their
passive, consumerist "happiness." The population is
in turn bought off with "welfare" which blinds them
to the injustices of the workplace and releases them
from any active thought as to what the pursuit of
true education, true health and true care for others
might really involve.
Participatory democracy, in
the realms both of welfare and of co-operative and
stakeholder enterprise, was in the British past (as
elsewhere in Europe and the Americas and
Australasia) almost entirely tied up with the
practice of religion.
Frank Prochaska, in his
Christian Social Service in Modern Britain: the
has shown how, in Victorian Britain, this religious
philanthropy was neither sporadic nor condescending.
Rather it was all-pervasive and often done by the
working class for the working class.
It allowed intimate and
collaborative relationships between donors and
beneficiaries; it guarded against loneliness; it
ensured an holistic union of body and spirit when it
came to schooling and nursing; it rendered domestic
labour communal and collaborative and it encouraged
far more communication across class boundaries than
However, all this activity was
in considerable measure intended to ameliorate the
perceived evils of the market. Eventually,
Christians in Britain came to realise that voluntary
provision was not enough to protect against its
ravages, especially after church infrastructure was
decimated by two world wars.
Ironically, it was the
religious tradition of welfare which itself played a
big role, through the influence of William Temple
and others, in erecting the welfare state which
quite quickly destroyed this tradition and the moral
energies which it had nurtured.
There are many important
tensions around this event: the architects of the
welfare state like William Beveridge and Clement
Attlee meant it to be more mutualist than it has
turned out to be; others wished that it had taken a
different form, involving a systematic collaboration
between voluntary and state agencies.
Indeed, there has always been
a debate within Anglicanism between the statist
Temple-tradition on the one hand, and the
"Christendom" perspective of John Neville Figgis
though to V.C. Demant and T.S. Eliot - deriving
variously from the Oxford Movement, Radical Tory
evangelicalism, non-statist Christian socialism and
Catholic distributism - on the other...
To some degree, given the
anarchy of the market and the sheer fluidity of
modern life, the state takeover of welfare has been
inevitable. However, it is equally true that this
takeover has run into endlessly more problems, and
that it has not halted a capitalist slide into
is something now rather pathetic about erstwhile
radicals who think that the most "leftwing" thing to
do is to try to shore up crumbling state enterprises
that are in themselves merely flimsy defences
against the rapacities of unconstrained
It may seem as if state
provision is more stable than voluntary mutualism.
Yet in reality, state provision is completely
subject to the vagaries of national fortune and the
preparedness of tax-payers to pay.
The spurious idea of a "right"
to welfare, to healthcare or to education allows us
to forget that we are, in fact, dependent on the
sense of duty of others and that these others
require society, including us, to provide them in
turn with resources if they are to be able to carry
out these duties.
There is more genuine
stability in well-established traditions of constant
voluntary activity, if these are rooted in religious
societies which have a comprehensive concern with
the whole of human life - and so are, for this
reason, themselves genuine "polities."
But of course there is the
problem both of gaps and of coordination. It is for
this reason that the state has a genuine role and
that increasingly we are seeing hybrid arrangements.
One can fear, with Prochaska,
that if much of the money for charities comes from
state provision that they will fall under
bureaucratic control. But on the other hand, if the
state is itself relying on voluntary contributions,
and on a more "hands-on" voluntary approach, then
the influence can go in the other direction.
... To imagine that the state
and not the Church is the proper supplier of mercy,
education and health is, quite simply, a form of
practical atheism, of sheer disbelief.
For what are the real
motivations of the state after all (at least, after
it has cast-off any lingering odour of British
Hegelianism)? Surely they are to secure its economic
and military might, combined with the desire to keep
the populace in order through a neo-pagan deployment
of bread and circuses?
It is, by contrast, only
religion that is likely to care for the person
as person - as someone possessed of an immortal
spirit who is therefore "more" than any collectivist
whole and who is to be considered an agent of duty
as well as a recipient of rights."
John Milbank is
Professor of Religion, Politics and Ethics at the
University of Nottingham. He is the author of many
books, including the highly influential
Theology and Social Theory: Beyond Secular Reason
(Wiley-Blackwell, 2nd edition, 2005) and
The Future of Love: Essays in Political Theology
(Cascade Books, 2009).
to read the full text of this article.
Coalition Formation meeting 28 November 2011
emerging social enterprise sector in Australia
is large and diverse but lacks a peer-generated
leadership and a public voice.
towards the formation of a public voice for
social enterprise in Australia first began in
The UK and Scottish Social Enterprise Coalitions
provided initial models for a leadership voice
and common development tool. These models have
been assessed and reworked to reflect Australian
A formation meeting for the Australian Social
Enterprise Coalition will be held on Monday 28
November 2011 in Melbourne (10am to 1pm).
Membership of the Coalition is open to all
social enterprises who meet the eligibility
criteria (below). There is no cost.
To join the
Coalition, complete this online
to RSVP to attend the formation meeting on 28
Statement of Purpose
1. A social
enterprise is a market-based business for a
social purpose. It may be for-profit or
enterprises have a long history in Australia,
but lack a peer-generated leadership, a public
voice, and shared tools for strategic
development and innovation.
3. The Social
Enterprise Coalition will be a leadership
vehicle and voice for social enterprises in
Australia. Its governing body will be a
Leadership Council comprising representatives
from the main streams of social enterprise in
a. cooperatives and mutuals
b. for-profits with a
c. community sector ventures for a
d. indigenous businesses and social
e. rural community businesses and
f. environmental businesses and
g. consumer empowerment businesses
Coalition will be a leadership vehicle and
public voice, not a provider of services or
member benefits. It will speak to governments
and the general public on the value of social
enterprise and engage them in the growth and
development of the social enterprise sector.
Coalition will advocate for major regulatory
reform to create a favourable operating
environment for social enterprise.
Coalition will advocate for a key role for
social enterprise in the reform of service
delivery in health, education, community
services, housing, indigenous affairs, rural
affairs and environmental innovation.
7. The Coalition will advocate for a key role
for social enterprise in reform of the
Australian economy, in diversifying ownership,
dispersing assets more broadly, and enhancing
competition in all sectors.
the Coalition, complete this online
RSVP to attend the formation meeting on 28 November.
Colin writes: "Numerous enquiries
into and reviews of aspects of the work of Not-for-Profit organisations, or those of them known as
'charities', have gone on over the past 10 years and more. Never has so much effort
produced so little change! But perhaps that is no bad thing because much
of it started in the wrong place (mainly 'regulation'), and then headed in
questionable directions (such as strengthening links between government
and the sector via compacts)."
Colin argues that these reviews
should begin with function and identity. He puts forward four features of organisations that should
characterise entities in the third sector:
voluntary; independent; not-for-profit;
and Not self-serving in aims and values;
and then asks how Australian NGOs