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When will 'power to the people' be the dominant service-delivery paradigm?

By Vern Hughes - posted Wednesday, 8 October 2003


It is now generally accepted in the human services that the old service delivery paradigm (standardised programs organised in government silos and delivered by contracted suppliers) has delivered fragmented, provider-driven outcomes which contribute little to social capital formation, community participation or end-user empowerment.

At an intellectual level, it is difficult to find any defenders of this old paradigm in education, welfare, health care, Indigenous policy, community services or family support.

At the political level, it is another story. The political and policy debate in these areas is stuck firmly within the old paradigm. Despite recent discussion around the concepts of social capital, community building and the state of voluntarism, political debate in social policy areas in Australia remains stuck circa 1972. In education, health and welfare, politicians are still able to get away with promising more schools, more doctors, more nurses, more police, as if the volume of spending in these areas is the primary determinant of good policy. It's not, of course.

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In economic policy, it is generally agreed that the standard of economic debate in Australia increased dramatically through the 1980s during a period of bipartisan support for economic reform. Both sides carefully explained to the public why the old economic policy settlement no longer worked. We accepted that governments could no longer buy economic security for us: it had to be found in the world of competitiveness, markets and export earnings.

So why is the social policy debate stuck in 1972? Why are governments and oppositions still arguing that social security can be delivered by government spending initiatives when they've accepted that economic security can't be bought in this way?

Why do state politicians still argue that pouring more money into public hospitals will relieve waiting lists when the demand for health care is growing exponentially?

Why do governments of all persuasions still try to argue that the drift from public to private education will be curtailed by more public sector spending on schools?

The one exception to this rule is Aboriginal affairs. Largely through the work of Noel Pearson and Richard Ah Mat in Cape York, there is an emerging acceptance that Indigenous disadvantage cannot by alleviated by throwing money at it. Pearson's argument that the condition of "passive welfare" has been generated by the very service delivery paradigm intended to "help" blacks, is now contested by only a few.

But the same service-delivery paradigm in areas of white male welfare dependence or disability services or stress-ridden public schools or over-crowded public hospitals has barely begun to attract the same critical public scrutiny or policy renovation. The key features of the paradigm are present in all these settings: a plethora of agencies dispense services to disconnected, passive and disempowered "clients" using resources allocated by governments for which the agencies are accountable not to their "clients" but to their funders.

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The key relationship in this paradigm is that between public funder and agency. The end-users or consumers are external to this financial relationship. References to consumers as "stakeholders" does not alter their exclusion from this key financial relationship.

There are many micro-level innovations emerging around the country that are challenging this service-delivery paradigm. Three examples, from different parts of the continent, are breaking new ground and inspiring others to follow.

Person by Person is an initiative of families of children with severe disabilities in Melbourne. Being sick of standardised services for their children, these families have successfully negotiated (on a pilot basis) with the Department of Human Services to have their service entitlements cashed out and administered by a budget-holder of their choice. The families in small groups select and appoint a Support Co-ordinator for their children: the Support Co-ordinator purchases a mix of services chosen by the family (which may be education, home help, day care, singing lessons, respite care) with the budget-holder administering the financial allocations and acting as the employer on behalf of the family. They call this model "family governance".

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Article edited by John Carrigan.
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About the Author

Vern Hughes is Secretary of the National Federation of Parents Families and Carers and Director of the Centre for Civil Society and has been Australia's leading advocate for civil society over a 20-year period. He has been a writer, practitioner and networker in social enterprise, church, community, disability and co-operative movements. He is a former Executive Officer of South Kingsville Health Services Co-operative (Australia's only community-owned primary health care centre), a former Director of Hotham Mission in the Uniting Church, the founder of the Social Entrepreneurs Network, and a former Director of the Co-operative Federation of Victoria. He is also a writer and columnist on civil society, social policy and political reform issues.

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