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 investigated 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 consolidations, 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 services would be to give clients the choice to decide 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 objective 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 deliver social services?
Changing client outcomes for the better
Research consistently highlights the benefits to clients who are provided with greater choice and control. One of the single biggest 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 Australia noted in their final report, Disability and Support Care (2011), that:
“Self-directed care is typically associated with greater satisfaction levels, perceptions of greater power and control over life decisions, without adverse effects on health.”
In addition, the Commission examined 27 American studies into self-directed funding spanning the last 25 years (the ‘Disability and Support Care Inquiry’). The evaluations consistently found that self-directed funding 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 recent study undertaken on behalf of the Department of Health in Australia (Provider and consumer research regarding recent and future changes in home care, 2017) that noted benefits in terms of:
- allowing individuals to control the type and nature of care they receive;
- flexibility for consumers, due to the portability of funding;
- better supply of care and reduced waiting times;
- increased quality of service and value for money due to competitive forces in the market; and
- access to a greater range, and more affordable services.
Can it really be done in Canada?
The change agenda in Human and Social Services across Canada presents the perfect opportunity to move towards a new way of providing services to those most vulnerable in the country and empowering people to control their support.
It is not an easy transition and the implementation 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 undertaken independently of the service provider – it is important to remove any potential conflict of interest between the service provider and the funding package provided to a client.
3. A flexible and strong regulatory framework for service providers – the government 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 emphasized enough, as moving to this approach demands transparency of information 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, it must 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 BC Choices for Support in Independent Living, the Alberta Self-Managed Care Program, or the Ontario 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.
About the Author
Martin Joyce is a Partner at KPMG in Canada where he heads up the National Human and Social Services Advisory 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 organizations. 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. Get in touch by emailing him at firstname.lastname@example.org.
All views expressed here are the author’s own.