Canadian Government Executive - Volume 24 - Issue 04

July/August 2018 // Canadian Government Executive / 47 PERSPECTIVE Everyone wants to change, become more efficient, and drive better value – all code for greater cost savings. But one important global trend in social services delivery that is only just starting to be investigat- ed in Canada is that of providing greater choice and control to the client. True transformation in the sector For all the talk of back office consolida- tions, digital transformations, reducing fragmentation, and better client journeys, it is greater choice and control through the use of client direct funding, that can be effective on a number of levels, even if difficult to implement. One way to truly transform social servic- es would be to give clients the choice to de- cide who they receive a service from, how they receive that service, and when they receive that service – in other words, a new paradigm of funding, with the ultimate ob- jective of giving people greater flexibility and control over their wellbeing. But does providing client choice and control actually work? Can it transform a person’s life and also provide systemic change to the way we fundamentally de- liver social services? Changing client outcomes for the better Research consistently highlights the ben- efits to clients who are provided greater choice and control. One of the single big- gest human service reforms has been the implementation of the National Disability Insurance Scheme (NDIS) in Australia – a $22 billion reform to how disability services are funded and delivered across the country. The Productivity Commission in Aus- tralia noted in their final report in 2011, “Disability Care and Support,” that: “Self- directed care is typically associated with greater satisfaction levels, perceptions of greater power and control over life deci- sions, without adverse effects on health.” In addition, the Commission examined 27 American studies into self-directed funding spanning the last 25 years. The evaluations consistently found that self-directed fund- ing provides significant benefits to people with disability and their families. Positive results were found for those with physical, intellectual, and mental health disabilities, and for the non-elderly and elderly. Positive findings were also outlined in a 2017 study undertaken on behalf of the De- partment of Health in Australia (“Provider and consumer research regarding recent and future changes in home care”) that noted benefits in terms of: • allowing individuals to control the type and nature of care they receive; • flexibility for consumers, due to the por- tability of funding; • better supply of care and reduced wait- ing times; • increased quality of service and value for money due to competitive forces in the market; • access to a greater range, and more af- fordable services. Can it really be done in Canada? The change agenda in Human and Social Services across Canada presents the per- fect opportunity to move towards a new way of providing services to those most vulnerable in the country and empower- ing people to control their support. It is not an easy transition and the imple- mentation will be difficult, but there are five non-negotiables to set these types of transformation on the right path, including: 1. A detailed understanding of the client cohort and their needs, and demand for services – getting a single source of truth is critical to make this approach work. 2. Planning and assessment must be un- dertaken independently of the service provider – it is important to remove any potential conflict of interest be- tween the service provider and the funding package provided to a client. 3. A flexible and strong regulatory frame- work for service providers – the gov- ernment needs to become a “system steward” under this approach, and they must ensure confidence in the system for both the user and provider. 4. Be transparent, be transparent, be transparent – this cannot be empha- sized enough, as moving to this ap- proach demands transparency of in- formation and access to data to ensure the system is fully aligned. 5. Funding is based on need – not on some predetermined annual amount based on an outdated funding model. By providing the client with greater choice and control, the level of funding must be sufficient to meet their needs, allow for new service providers to enter the system, and ensure the use of innovative (and high quality) service delivery mechanisms. There is no doubt that we are seeing an appetite for these types of reforms here in Canada. In fact, there are already examples of direct client funding occurring across the country – consider British Colombia’s Choice for Support in Independent Liv- ing, Alberta’s Self-Managed Care program, or Ontario’s Passport program. However, a more systemic and integrated approach is required, rather than a piecemeal approach. Modernization is but only one brave decision-maker away. M artin J oyce is a Partner at KPMG in Canada where he heads up the National Human and Social Services Advi- sory Practice. A senior executive with experience across Non-Government, Government, and Commercial sectors, he is highly skilled at leading teams and building growth agendas for orga- nizations. This includes three years in the Not for Profit sector in Australia, 11 years at KPMG in Australia as a Management Consultant, and two years in the KPMG Corporate Finance team with a focus on private equity. BY MARTIN JOYCE by gi v ing cl ients greater choice, cont rol , and f lex ibi l i ty INNOVATING SOCIAL SERVICES IN CANADA “Integration, transformation, and modernization” have become the prevalent buzzwords in the Canadian Human Services sector.