Breakfast Seminar

“I wouldn’t for a second presume to tell you how to run things in the UK – just talk about how some things could perhaps be addressed a little differently,” Jason Howie told Care Conversation delegates.

In Australia, the most recent of several rounds of reforms had put the social care sector at a crossroads, he said. “The government has fundamentally changed the way our industry operates, and we’re probably a little ahead of you in terms of the social services space in that there are fewer stakeholders in Australia.” The government had also pulled the responsibilities for aged care and disability services into the same central department, a treasury-driven reform that aimed to reduce inefficiencies. “There had been a lot of competing agendas and differing levels of competence across state governments,” he said. 

His organisation, KinCare, focused on domiciliary care, with a staff of 2,000 delivering services to 17,000 people a year. “So it’s quite a large operation, and certainly the challenges we face have changed over the years. For as long as I’ve been at KinCare there have been reports saying that a more market-driven approach was needed in the sector. So if we’re not prepared for the reform programme that’s just hit us, we can’t say we weren’t warned. However we’ve been very fortunate in that there’s been a fair bit of consistency around what needs to happen in terms of the competition agenda.”

Where reform had been most successful, it had been a multi-staged approach, he said. The federal government, through frustration with progress at state government level, had introduced a number of reforms, which eventually led to a consumer-directed care model requiring more time to be spent with each customer to understand their needs. This business model “had some things going for it” but there were practical problems with implementation, and in February 2017 a major change was introduced that allowed customers to choose for themselves which accredited provider they wanted to use.

“That completely changes the equation,” he stated. “The customer experience becomes paramount in terms of deciding the winners and losers across the industry. Now more than ever we’re also in the hospitality game – we’re not just there to deliver services, we’re there to deliver an experience. I can’t over-state how big the change has been across our organisation and across some of the more forward-thinking organisations. Every organisation is either going to have to address this or lose their relevance in the market place.”

It was this that would drive competition across the industry in the coming years, he stressed, something that could present enormous opportunities. “In Australia, whatever the sector, we tend to consolidate down to a small number of major players.”

In terms of relevance to the UK, while Australian providers had controlled the funding under the old model there had now been a complete change in the way business cases were formulated for investment. “Suddenly there’s a significant return on investment for delivering good customer outcomes. We have a body that’s similar to your local authorities that go out and make assessments, but services are only purchased hour by hour and that’s not driving innovation. It means each part of the system is incentivised to drive up the number of hours, and in the effort to save the number of cents per customer you lose sight of the main game.”

The biggest challenge in the UK was that every local authority was purchasing services on a regional basis, he said. “We’ve got a smaller system that makes it easier to manage things. If I were operating in the UK I’d be concentrating on the opportunities that exist in the Care Act in terms of self-managed funds – putting purchasing power in the hands of customers rather than local authorities, which gives the capacity to deliver better margins. You’ll almost certainly find that – with better use of things like IT and monitoring – more hours are being delivered than need to be.”

While Australia’s National Disability Insurance Scheme had been set up with the aim of allowing customers to manage their own funds, there had been a great deal of complexity in attempting to roll this model out to the aged care sector, he explained. “We do have a number of challenges in the industry, and it’s still very early days in terms of the reform programme.”

The marketplace was moving slowly as it was still controlled by the government, he said – “for all their good intentions it’s as though they’re driving with the handbrake on”. A key example was the lawyer-drafted process for customers to move into the funding programme. “The letters people receive are almost incomprehensible, and the information on the website is also confusing. The government themselves are learning as they go, which makes the marketplace difficult to navigate. You can’t have a functioning marketplace without information.”

KinCare was fortunate in that, as a national organisation, it received good intelligence, he said. “But we still have some really significant challenges in Australia. We can only hope that, step-by-step, the government sorts out its processes, and that results will continue to improve. It’s an incredibly challenging and chaotic environment, but it’s also incredibly interesting and exciting.”