The Community Hub: I am advocating a system that is structured around a partnership with government and providers. It is closely aligned with government policy for partnerships with consumer and community. It seeks to implement those policies in aged care. The standards required for partnerships in health care were set out in 2012 by the Australian Commission on Safety and Quality in Health Care. The approach adopted in this document is problematic. The proposed hub addresses those problems
Under the proposal for a hub, communities will assume responsibility and will control those activities that have failed repeatedly in aged care. They should also be involved in the central administration of the aged care system. The intention is to entrench total transparency by putting those who need to know in charge of information. It aims to make the community, not government, the main customer to whom providers are accountable.
The community would have the power to force providers and government to take account of their views and what they want. It creates a forum where the benefits that the market is capable of bringing are evaluated, tested, measured and adjusted to be sure that they work and do not impair the service provided. Illogical ideas can't flourish. Science and common sense can replace practices imposed by illogical ideological belief.
On ABC 7.30 report on 12th March 2015 well known physician and writer, Dr Karen Hitchcock, speaking about ageing and ageism said "I think we need to start from an ethical perspective of what we want our community to be, and then from that, imagine our society and then find ways to create it and fund it, rather than starting from an economic position."
At present our society does it in the reverse direction. The proposed hub creates a context within which this can occur starting in aged care. It also creates the power base needed to force market and politicians to examine and consider the community's ideas and views.
The objective: What is envisaged is not something where participants are at each others throats, or community regulators are walking around policing, looking for misconduct. They will be collecting information for everyone to look at and discuss and will be contributing thoughts and ideas. Trust and trustworthiness are essential in a sector like this and care will suffer if that is not what happens.
The intention is to develop a cooperative venture where parties are on the same page, with all of the information, all focused on doing something constructive together, all dependent on one another. By making for-profit and not-for-profit services part of a wider community enterprise we bring them back into the community and out of the silo that they are now a part of.
Those providers who are serving the community will not have anything to fear, and will gain help and support. Those that maintain a silo mentality will find themselves out in the cold and will have a tough time if they don't sort themselves and their community values out.
Government: I am not suggesting that government should disengage, but that they should be joint partners in this, supplying training, supervision, mentoring, coordinating and back up where needed. Because funding comes from taxes controlled by government, they need the information that the communities will collect, as much if not more than the community customer does. They pay and so are joint customers, with the right to representation on the hubs. They need to feel the pulse of the community, and respond.
I do not believe that this will harm commercial enterprises that build good relationships with their community customer by providing good service and value for money. Market theory tells us that a functioning market selects for those that do so and dispenses with those who don't.
Communities are likely to support local managers in their efforts to get more resources from corporate owners. If there is a genuine need for increased funding, or the service provided justifies greater rewards, then the community is likely to support and lobby on behalf of the providers. But they can only be expected to do so if they are in possession of all the information they need, including how the money is being spent. Commercial in confidence in vulnerable sectors is an anachronism and should be abolished. In vulnerable markets full transparency is essential.
Politics: the good, bad and illogical
We have in western countries and in Australia, political systems where no one dare admit even to themselves, let alone to the public, that they are wrong and have made some terrible and illogical mistakes. As a consequence everyone in the country suffers and no one does anything about it.
But worse still, because they can't (or won't) acknowledge their mistakes, they keep repeating them and making the situation worse. This is bad for the country and puts our future at risk.
This is something else our communities need to fix, but for now just lets concentrate on fixing aged care. In doing so we can show how much failures in other sectors are a consequence of politician's inability to see the mistakes they have made unfolding in front of them and do something about it. As we learn to take more responsibility for our country ourselves we will turn to politics and make it work too.
Politicians need to take off their blinkers and understand the consequences for others. They will not do so in this high pressure system where their minds are totally focussed on their own political future. They are too engrossed to carefully and thoughtfully listening to criticisms and govern the country the way citizens expect them to. There is no room to reflect constructively and to challenge themselves. We need to work with them and take them and the process of governing into a participatory model of government -- into the 21st century.
A Civil Society: Sociologist Eva Cox in her ABC Boyer lectures suggested that in a "civil society" people involved in activities communicate freely and so build "social capital" sorting out issues themselves. In such a society laws and regulations would rest lightly and be seldom needed. No one has tried that yet! Its what we would like to achieve for our society. Aged care would be a good place to start.
We do need regulation and we do need to have processes in place that tell us all what is happening. It's called democracy. Those who are negligently harmed do need full access to the law. We need to recognize when culturopathic ideas are forming and confront them before they retreat behind cultural barriers, where they become polarized and implacable.
While each participant would recognize the balance of power created by the hub, they would not want to use it except when all else fails. I have focused on power structures, and independent oversight, not because I want to regulate and punish but because they need to be there to keep us on track, so that we seldom need to do so.
Where to next
In Part 4: Debating other ideas I will be looking at what has happened in some other countries, at criticms of our political system, at what others are doing and talking about in aged care and at emerging ideas about organising what we do in society that are relevant for aged care and how it could oiperate. There is so much information in the links that if you follow them you could drift away. I suggest you just skim through it without following the links to gain perspective then return to explore and follow your interests in more depth after reading Part 5.
In Part 5: Background of Community Aged Care Hub I look critically at what is happening in aged care from several diifferent points of view to illuminate other aspects of this failed market and show how the aged care hub would fit into and address the problems when seen in that way. You may prefer to read that first and then return to Part 4.