The 20th Century has seen a succession of ideologies resulting in rebellions, wars, migrations and vast upheavals. This has flowed over into the 21st century and the world is once again in an ideological crisis with millions dying and many more millions of helpless refugees.
Ideological developments in western democracies during the latter part of the 20th century have led to a hierarchical social structure based on markets and a political system closely tied to them. This has hollowed out local communities and undermined civil society. It is threatening our democracy.
While noisy and vituperative the political system has lost touch with the community. It is paralysed and ineffective leaving citizens disempowered and disillusioned. An unstable market system swings wildly between boom and bust putting the lives and welfare of vast numbers of citizens under pressure. Aged care in western countries is a part of this and it is trapped within it.
There is hope for the 21st Century. The majority of the public is largely unaware that this situation has stimulated analysis and a multitude of ideas and experiments since the turn of the century. These seek to resolve the impasse and find a way out, not by taking sides in politics but by creating a society that can handle the situation and deal with ideology. This web page looks at these 21st century ideas and concludes that the proposed aged care hub is positioned within this broad movement and creates a structure that should enable aged care to find its way out.
Summary of this page
This web page starts by summarising the legacy of the 20th century in the first slider. After that it examines the thrust of new 21st century thinking by giving examples and providing links into this broad field. In an attempt to address the problems, this new movement focuses on community engagement, participation and control across the breadth and depth of our society.
The Centre for Welfare Reform has made a major theoretical contribution to this debate. Its ideas are directed specifically to disadvantaged, impaired and marginalised groups in our society. They are consequently particularly relevant for aged care.
Another group is critical of the manner in which government and large corporate groups have adopted the mantra of innovation to promote their ideas, ideas that are more in their interests that those of the community. They believe that true innovation comes from within an engaged community. The proposed hub would hopefully create the sort of interactive melting pot within which innovations that benefit the community will be generated.
The Debris of the 20th century littering the 21st
An insightful article in The Australian on New Years Day at the turn of the century written by a young author wrote optimistically about the potential of the 21st century as it moved away from the vast upheavals of the 20th century. She used the phrase above to express her fear that we would struggle and might be unable to escape the legacy of our 20th century ways.
There has indeed been some very active and innovative 21st century thinking and that thinking seeks to confront and address the sad legacy of the 20th century. It is acutely aware of problems created there by a series of ideologies that imposed their ideas on others.
At the heart of current problems are:
- the failure of current democracies to deal with ideologies that develop within them,
- the dominance of powerful groups with sufficient resources to control the sources of information,
- the ability of ideologies and powerful groups to use modern media to selectively present information to the public in ways that control the way they think, and
- a political process that is no longer representative as it is not drawn from the community.
- a focus on economic well-being at the expense of social well-being
Professional politicians who form groups with prior agendas are marketed to the public like any other commodity. Elected politicians and government are no longer representative of the people. Government “by the people for the people” has become an illusionary catchphrase.
(Added Dec 2015) Sociologist and social critic, Eva Cox, has written a article for The Conversation in which she indicates that “evidence is emerging of continuing damage to social stability and cohesion” and that “Time may be running out for political agendas that offer material rewards but not social well-being”. It is a criticism of current policies and their consequences.
- Social stability is the missing link underpinning economic growth by Eva Cox The Conversation 1 September 2015
A diverse and still uncoordinated 21st century movement broadly seeks to find ways of giving effect to the sort of democracy claimed in that catchphrase. In many ways and often unconsciously it seeks to make the essential idea of democracy, one that originated in ancient Athens, real for the 21st century.
The debris of the 20th century is exposed in the assessments and criticisms on the page "Politics is Broken" also in Part 4.
This web page examines the broad movement that is seeking to find a way out of the 20th century impasse.
Some possible examples (Added December 2015)
Stephen Duckett is an economist and veteran health administrator holding controlling administrative positions in Australia and in Canada where he was criticised and ultimately fired after being involved in a controversy. He has played a major role in both forming and applying health policy in Australia and Canada.
Duckett has recently written an interesting article for The Conversation in which he documents the enormous changes that have occurred in health care and the difficulties in restructuring the system to meet these. He stresses the importance of technology for data collection and future policy indicating that “21st-century governments will need to keep a firmer hand on the innovation rudder than they have in the past; encouraging system innovation alongside treatment innovation”.
I have no problem with any of this but Duckett has been and I think is still very much part of the top-down legacy of the late 20th century and its debris, a century that has been trapped by a narrow belief system. Duckett has not suggested political and social changes that will tap into the extensive resources of the professions and the community to produce the sort of government that has the resources and breadth to address these issues. A 21st century Health system will be one where all sectors of society including community and professional providers of care will have input into the policy decisions that are made. They will not be locked into the policy of the particular elected government, whose role will be to facilitate the democratic process guiding it to sensible and practical decisions.. Innovative ideas will be welcomed from all sections of society and be discussed within the community
The 21st century will hopefully be the century of participatory democracy and see the resurgence of citizenship and civil society. We will I hope have a system that is restructured around citizens and professionals working together and then coming to government with ideas to meet these challenges. But this web site is about changing aged care. I don’t want to start redesigning health care here but I see the two as closely integrated.
- A 21st-century health system means seamless care and ongoing reform The Conversation 7 October 2015
Another interesting example of 20th century thinking is an article about the recent Productivity Commission report into homes, criticisms of which I have commented on elsewhere. The article blames the lack of awareness of aged care reforms on a failure to communicate effectively when this was in fact a failure to involve the community in the process at any stage during the development and in the subsequent operation of the services. The article then goes on to promote the PCs recommendations to government - in effect making the same mistake all over again. It is the community they need to engage. The failure to truly engage the community is illustrated by the negative response to their recommendations about downsizing. The opportunity was there but citizens did not avail themselves of the opportunity - a reflection of the extent to which we have disengaged from politics and government.
- Government communication on aged care reforms needs improvement: PC Australian Ageing Agenda 2 December 2015
The Open Government Movement
The Open government movement can be seen as a global partnership between civil society and governments - an agreement to work together in the pursuit of a more truly democratic world.
The Open government movement has been simmering for some time. Australia embraced the ideas enthusiastically becoming a part of this global movement in 2007. In 2008 it started reforming its FOI laws. It was invited to join an international body as a founding member in 2011. It agreed to make the changes and set in place the processes needed for Australia to join as a founding member by 2013. The way in which it turned its back on this and reverted to 20th century thinking is discussed on the web page “Politics is broken”.
Australia stands out as one of the very few of the early participants that have not made progress to joining. It seems that deadlines are approaching. The Turnbull government has hurriedly commenced the process of community consultation but this has been very low key and there has been very little publicity. It seems to be doing the bare minimum.
This may be because we have a government where a majority of the party are conservative neo-liberals who have been forced to elect a more liberal and progressive prime minister to appease the electorate and have some hope of re-election. But this prime minister and his supporters, if they do genuinely want to be more open and progressive, are constrained in what they can do by the lack of support in their party.
The reluctance is reflected by the preliminary choice of two “grand challenges” to focus on, which will allow a 20th century top-down approach in order to get membership. These are “Improving Public Services” and “More Effectively Managing Public Resources”. “Participation” and “Accountability” would be more suited to 21st century thinking but both would lead to a loss of government control and a bottom-up move into the 21st century. This government is not looking at this because its members know the community do not support many of its policies.
Participation is described on the government’s web site as “Mobilisation of citizens on government policies or programs to provide input or feedback and make contributions that lead to more responsive, innovative and effective governance.”
Participation is the key paradigm behind almost all 21st century thinking and initiatives and in my view is the single most important change needed. Aged care and the multiple other market failures attest to this. It is the key component of the underlying agreement to work together with civil society. It is integral to the restoration of citizenship as a responsibility. It goes beyond simply voting and looking after our own interests, to playing an active part in structuring and running our communities. The proposed community aged care hub is an initiative within this paradigm.
In my contribution on the government's web site asking for ideas I suggested that “Participation” should be the first of the “grand challenges” and that “Improving Public Services” be second. “Improving Public Services” is important because the structure and culture of our public services is a major obstruction to open government and unless radically changed would frustrate attempts at participation.
Two other grand challenges on the list “Transparency” and "Accountability", both of which were abandoned by the Abbott government would be integral to participation so would become part of that. Provided there was a genuine willingness to embrace partnerships these would follow automatically.
I urge all of those Australians who read this to explore the issues and then go to the two web sites asking for contributions. Have your say.
This government is not showing much enthusiasm for moving us into the 21st century. We have to do that by participating and making what we want absolutely clear - so clear that there is no alternative.
Government Web sites
- Open Government Partnership – Australia November 2015
Asking for Comment
- OGP Australia National Action Plan: Background
- OGP Australia National Action Plan: Consultation
- OGP Australia Consultation Stage 1: Preparation, Framework and History
Blog Web sites for information
- Open and Shut Blog
- PM Turnbull on the road-an opportunity to stand with the Open Government Partnership 11 November 2015
- Australia, Open Government Partnership and Declaration of Open Government 18 November 2015
- Government senators claim strong FOI record-don't mention the bill to abolish the Australian Information Commissioner 30 November 2015
- The Australian Government - Can we afford it? The author of this blog, Steve Davies, is an ardent advocate of open government and participatory democracy. He is an active contributor to the government OGP web page discussion. He has been a particularly strong critic of our public service and its culture.
- The paranoia that will 'shut' government by Steve Davies Sydney Morning Herald 8 March 2012
- Aged care - Are you next? Steve Davies realises how the things that he writes about impact on aged care and has been talking to Aged Care Crisis. Here he writes specifically about aged care.
International Web sites
The Long Road that got us here 30 Nov 2015
21st Century thinking
The broad focus of this diverse global 21st century movement is to find ways of involving a truly representative selection of citizens including, when needed, a random selection of those with expertise. They would play a vital role in every sector of government and in those community activities that need to be protected from groups with special interests. They see citizens as engaged in, controlling and managing their society at every level – a rejuvenation of a responsible civil society - a new ideal and a new goal.
Developments and pilot studies in this broad movement have flourished since the turn of the century. Participants in these global developments in Australia include organizations like 21st Century Dialogue, New Democracy Foundation and Mosaic Lab. They each have a number of examples on their web sites where genuine citizen engagement has made important contributions.
The wide-ranging projects use terms like participatory democracy, Citizens juries (community decision making tribunals), deliberative democracy, generative democracy, community governance, crowdsourcing, citizen’s senate, electronic town hall, co-design, etc.
A group of citizens without any prior ideological commitments drawn from diverse backgrounds are supplied with all the information available and then given as much time as they need to come up with a recommendation that will be implemented. They engage in robust discussion working through the issues and coming to a consensus view. To be successful its is essential that there be a genuine commitment by the politicians to implement all or most of the recommendations made. Citizens Juries can be used at all levels of government.
- Citizen juries - leadership for a new democracy ABC Radio National, 9 Jun 2015
An example of a very successful project was the 10 year financial plan adopted by Melbourne City Council
- 10 Year financial plan 2015-2025
- Melbourne citizens' jury success offers fresh hope for democratic renewal ABC Sunday Extra Friday 3 Jul 2015
Bodies that have been involved in similar projects of various sorts include:
- Melbourne City Council
- Victoria Council of Social Services,
- New South Wales Independent Local Government Review Panel,
- The Local Government Association of South Australia’s Expert Panel,
- Council on the Future,
- Local Government New Zealand,
- Marion City Council in South Australia,
- Mitchell Shire in Victoria and
- The Australian Centre of Excellence for Local Government.
Participatory Democracy - democratising democracy
The New Democracy Foundation is a group supported by large numbers of past and some present politicians from all parties. On its web site there are links to papers proposing many different ways of moving towards the Athenian citizen’s model of democracy - one where citizens themselves and not trained politicians have decision making powers. The ideas on its web site include
- A Citizens Senate: A random group of citizens would be stratified for age and income to match census data on the makeup of the society it governs. It would either replace our senate or be a third house.
- The Electronic Townhall: This proposal would select one fiftieth of the voting age population each year and engage them in discussion and subsequently in online voting. This citizens voice would constitute an additional house in the parliament.
- Demarchy: This idea is based on a network of numerous decision making groups. Each group deals with a specific function (i.e. transport, land use, parks) in a given area – so it's not a "generalist" system. Groups are created by randomly selecting from a sector with the required expertise.
- Sortition: A scientific method for selecting a group of people that will look like society as a whole. It seeks to address the problem of money in politics. Another model seeks to divide the activities of lawmaking among several randomly selected groups with different functions and different characteristics.
- The popular branch: proposes a randomly selected 3rd house of parliament, the popular house.
- Consensus conferences: Bring together lay people and experts to debate and resolve issues
Crowdsourcing is a very broad process in which opinion, assistance or funding is sought from a large number of people. Governments are now using crowdsourcing to reach out and leverage citizen knowledge and energy and so tap into the talent base in the community.
- Crowdsourced policymaking - The motivations, expectations and profile of the crowd. audio of lecture by Tanja Aitamurto Swinburne Institute Seminar Series
- Crowdsourcing for Democracy: A New Era in Policy-Making by Tanja Aitamurto Publication of the Committee for the Future | 1/2012 Parliament of Finland
Breadth of this movement
These schemes and proposals cover a broad range of citizenship projects addressing issues in international trade, government (national to local) and a number of other sectors like science - even self-advocacy where disadvantaged groups form associations. Information and communication technology are integral to many projects.
- Beyond Trade: Getting Economic Integration Right: ANU Centre for European Studies Policy Notes Issue 1, 2015
- BUILDING AUSTRALIA THROUGH CITIZEN SCIENCE OCCASIONAL PAPER SERIES ISSUE 11 July 1015 Australian government : Office of the Chief Scientist
- Self-advocacy and inclusion: a summary of the study 'What can be learned from speaking up over the years' Christine Bigby, Living with Disability Research Centre (LaTrobe) published on Australian Policy Online 21 July 2015
- ICT, open government and civil society John Restakis, Daniel Araya, Maria José Calderon, Robin Murray Journal of Peer Production ISSN: 2213-5316 July 14, 2015
- DEMOCRATISING THE DATA REVOLUTION: A DISCUSSION PAPER by J Gray for Open Knowledge July 2015 - this paper, which is part of the “Open Data Movement” looks at the enormous potential for an informed civil society. Not only will information be available but there will be new ways of analysing it. New forms of measurement will be developed. The paper raises issues and links to a discussion forum.
Studies have looked at the sort of engagement that has been successful, particularly when providing services or introducing them in situations when support from communities is required. They have compared projects that have succeeded, and ones that have failed. A key to success was direct and close engagement with the community and their direct involvement in designing and running their services.
The Medical Journal of Australia published a good article examining these issues. It is online but only available to subscribers.
- Partnering with consumers: national standards and lessons from other countries Stephen D Gill and Melinda Gill. Med J Aust 2015; 203 (3): 134-136.
It was important that the community’s concerns be given priority over those of the service provider. It was essential that control was handed over to the community so that they engaged, learned about, identified with, innovated and in doing so came to “own” the service. The key to success was the willingness to accept the noisy discussion and then trust the community by handing control of the service over to them.
One of the main reasons for failure was an unwillingness or inability to build relationships with the community and trust them. In many failed examples, community engagement was with selected individuals and not with the entire community. It became tokenistic - a self-serving illusion.
A good example of success in Australia is Aboriginal Health, a blight on Australia, one where millions of dollars have been wasted in well meaning projects over the years. Since responsibility for their health has been handed to local communities, there have been dramatic improvements. This experience has been replicated in overseas studies.
- Planning, Implementation and Effectiveness in Indigenous Health Reform The Lowitja Institute July 2015
What may not work?
It is interesting to compare this with a strong criticism of the "The Empowered Communities: empowered peoples design report". The criticism comes from The Australian National University (ANU). The report proposes a new model of Indigenous empowerment and development in Australia.
This report is the culmination of work funded by a A$5000000 grant to the Empowered Communities network in early 2014 from the Department of the Prime Minister and Cabinet.
This is in line with the new paternalism approach where governments and policy makers empower themselves to nudge, sanction and discipline Indigenous agency to make the ‘right choice’ towards economic development. The report presents Empowered Communities as the only group that understands empowerment, with everyone else needing to opt in. Leadership thus becomes about assimilating Indigenous people into the report’s version of modernity, overlooking alternative models of Indigenous development.
Source: Empowered communities: Review of the empowered communities design report Centre for Aboriginal Economic Policy Research ANU College of Arts & Social Sciences CAEPR Topical Issue No. 1/2015 by E. Klein
The author of the report is critical of the way development and empowerment are equated with economic development and empowerment to the exclusion of other forms of development and empowerment. The criticisms assert that examples of similar economic development strategies have in fact not worked as well as claimed and have had downsides because of this. They consider that community discussion was inadequate and only a small proportion of the community was engaged.
Anyone who did not opt into the conditions the report specified, would be excluded. The comminities' own concerns and priorities might not have been considered.
In other words, the data has been cherry-picked to support the government’s agenda and views. Described as “innovation”, I would argue that this seems to be the government appropriating the term for what it wants to do, something that will actually stifle innovation from within the community because that would come from those who are not a part of this. (See the slider "The Dragonfly Collection" below)
Do these criticisms apply to CDC: While the sectors are different much of what is said could equally well be applied to the manner in which the government and NACA have introduced Community Directed Care (CDC) and probably also the proposed Quality Indicators (QIs).
An aged care example:
An excellent research project for the Blue Mountains Council was done by researchers. It engaged the community in multiple discussion sessions in order to determine the resilience and capacity of the community to cope with crises and look after itself. It focused on vulnerable groups including the aged who needed help. It found that “In emergency situations most people are assisted by family, neighbours and friends. For other assistance may be much harder to find”.
In other situations, the study “demonstrates that vulnerable people typically relate to various community services and Non Government Organisations (NGOs) in the first instance, rather than friends, neighbours or family”.
The report considered that it was “imperative that existing community services and NGOs are maintained and resourced appropriately within the Local Government Area. To support enhanced approaches to accessing and supporting vulnerable people within the community, Neighbourhood Centres need greater recognition as trust builders with vulnerable residents”.
The report was critical of the “MyAgedCare.gov.au” website stating “This approach, whilst plausible in theory, will create a number of issues for our most vulnerable - namely the potential loss of local community connection and engagement with local service providers as their essential point of contact”. The report describes what others have called a “hollowing out of the community”.
This report in my view, highlights the problems created by the provision of services within preconceived ideological frameworks and by excluding rather than embracing the community in making policy. This is well illustrated in aged care by the close relationship between NACA and the government.
Aged Care Crisis is also critical of the “MyAgedCare” website. We consider it to be out of touch with the community and of little value.
- Community Connections Vulnerability and Resilience in the Blue Mountains Project Report for Blue Mountains City Council
The Centre for Welfare Reform in the UK has led the way in developing concepts with a sound thoeretical basis that underpin the application of the principle of community and consumer participation. It has been a driving force in developing, applying and testing the concept of citizenship in the provision of services to the disabled, the aged and the marginalized. Key to their activities has been the assertion of the rights of the disadvantaged as citizens through a process they call “personalisation”, driven and organised by supportive community participation. The next slider examines their contribution.
Bringing this together
This new focus represents a shift from a leader dominated belief driven society, to one driven by analysis, assessment and broad discussion – a community dominated focus.
Integral to this is a new sense of citizenship focussing on both the right of citizens to participate and be heard and their responsibility as citizens to engage and participate in the affairs of the community and of the nation.
Late 20th century philosophy was underpinned by a belief that self-interest was the dominant driving force in our psyche and that this could be harnessed and used to drive beneficial change. Individuals defined themselves and their identity by competing for money and status, mostly in a marketplace context.
In the enthusiasm, believers ignored the fact that we are social animals and our social selves languished. The aim is to restore a balance between self-interested individuality on one hand and social beings with responsibilities for others and the world on the other.
To counter the attitudes that resulted from an inward looking self-interested focus on competition and personal advancement, the focus has shifted to engagement and participation in the society we all live in. Civil society is seen to be in need of revitalisation. The digital revolution has opened up new ways of engaging and accomplishing this. The process in federal politics is in its infancy, but it is moving ahead in the community.
The Centre for Welfare Reform (UK)
This centre in the UK has several interesting papers, based on more recent ideas and with a different way of looking at things. What they are saying is current and widely relevant. This can also be looked at within a general framework for addressing our current problems by rebuilding civil society around issues locally, spreading nationally and then globalising it - a bottom up process built on real ongoing experience.
I am putting some links to relevant articles here as they should inform discussion. If you are serious about looking at where aged care could go then I urge you to look at some of them. In Part 5: Background of Community Aged Care Hub I analyse and criticise our aged care system from within my frame of analysis and find it seriously dysfunctional.
I show how the hub I propose would address this. I had already written the pages criticising our aged care system when I learned about the centre and looked at its web site. I think that, while there are differences in emphasis, what I am suggesting is congruent and meshes well with what Duffy and his colleagues are saying. The hub is intended to provide a forum in which the community can engage in ideas like this, and then play a key role in implementing them.
Designing NDIS: by Simon Duffy. In this early 2013 article Duffy, the director of the centre is strongly supportive of Australia's National Disability Insurance Scheme but very critical of the way it was being implemented at the time. Some of what he says is relevant to the way we do things and to aged care, particularly the introduction of Consumer Directed Care.
Community Sourcing and Social Care: by Chris Yapp and Chris Howells from the centre. "This new (2013) report offers an alternative to privatisation and the hollowing out of local government". Instead the authors propose that commissioners work with and support local communities.
Joining Up Community Involvement: by Gabriel Chanan and Colin Mille. This paper acknowledges that privatisation discourages community and user involvement. It examines the important role of government in working with and rebuilding communities.
Citizenship Council: a slide show by Simon Duffy: "The future for local councils is to radically rethink their role. It no longer makes sense to simply serve central government, this has led to cuts that target local government and the on-going failure of the system to transfer more power to local communities. Instead councils need to start focusing on promoting citizenship, family and community".
Positively Local: John Gillespie, with Susanne Hughes 2011: "In the fourth joint policy paper with the University of Birmingham, John Gillespie argues that communities are best served when government and local services begin to believe in them, when they look for and help unleash capacity, rather than assuming that failure is endemic. Positive change begins with positive thinking".
The authors argue that communities are best served when government and local services begin to believe in them. They suggest that "If privatisation was the key focus of the 1980s - - - then personalisation could be the key focus of the early twenty-first century". Personalisation is the process which the centre promotes to give people and their communities the power and resources they need to reclaim their identities as effective citizens. In referring to the disabled they claim that "The model support residents to reclaim their capacity to direct change for themselves".
Community Engagement: by Kate Fulton and Claire Winfield 2011. What is required is a process of real community engagement in order to identify and support their involvement. I quote "This discussion paper aims to explore and support the development of community organisations and support services as an intrinsic element of the community model of support."
The article promotes the idea of Community Brokerage which they indicate will enable the following:
- Starts by assuming and encouraging the capacity of citizens and families by enabling access to a wide information network
- Facilitates the early use of peer support for everyone
- Ensures access to community supports from organisations and associations within their community
- Enables citizens to work with support services directly and to explore with them what options are available
- Puts in place sufficient professional advisors, such as social workers or other specialists, so that everyone can get the help they need
They also state that "It is important to remember that the community-based support system to brokerage starts with the assumption that people can plan and organise things for themselves if we keep the process simple to navigate and access."
Dying with Dignity: by Simon Duffy 2011. In writing about aged care in the UK, Duffy is saying what many of us feel about the system in Australia. He indicates that "Anyone who has anything to do with the care of the elderly or the chronically sick in community settings knows that all is not well in the UK. - - - and it is those patients that are due care at the end of life, that best reveal the flaws in the current system".
He goes on to say "The idea of personalisation - although it began with disabled people - is well fitted to offer insight into the kinds of systems that will help achieve these twin goals of palliative care and to enable the development of a competent system". He stresses that often it is how funding is used rather than the level of care that is important.
Travelling Hopefully: by Simon Duffy 2013. There has been no publicity about what South Australia has been doing and most of us are unaware of it. Simon Duffy has been out there helping them set up the NDIS. This is his advice on how to do it.
In his introduction he says "South Australia has firmly committed itself to shifting power to its citizens with disabilities. It has decided to reform its systems of funding for support and make increasing use of self-directed support." Remarkably there has been little, if anything about this in the Australian media.
The Centre for Social Welfare, its theories and its practices, grew from Social Work and more specifically, disability care, but the insights are applicable to any marginalised group. The aged are vulnerable to the same marginalisation and are equally in need. Citizenship Theory is a new approach to social justice for those society tends to marginalise.
What Duffy says in his article on Citizenship Theory (link on quote below) seems to have particular relevance for aged care in Australia because current government policies are based on competitive market forces. These create strong pressures that fan "the human tendency to exploit the disadvantages of others" and provide no effective means of monitoring or preventing this.
Citizenship matters because we are different. The very fact that we are different makes us vulnerable to prejudice, exclusion and segregation, as the history of disability shows. But a commitment to citizenship gives us the chance to fight the human tendency to exploit the disadvantages of others. This will never be simply a matter of changing a law or of reorganising services. We will need to be constantly alert to the possibility that others are being cut-out of community.
Source: Citizenship Theory - Personalisation & Social Justice (p13) by Simon Duffy The Centre for Social Welfare 2010
Part 5: Background of Community Aged Care Hub of these web pages deals very specifically with how and why this exploitation happens. The proposed hub creates a mechanism for addressing this and a structure within which these ideas of citizenship and personalisation can be debated and implemented in aged care.
November 2015: Simon Duffy has kindly pointed me to some additional material that has implications for the criticisms I have made and for the proposal for an aged care hub.
We're Getting Older - Don't Panic, Don't Panic!! On his own blog Simon Duffy argues that the crisis in aged care is created by government policies, policies that are increasing the problems. He indicates that “there is almost no social change, even social progress, which cannot be turned into a crisis if it's handled in the wrong way”. He points out that “There is an army of community capacity potentially available to any community (unless its working too hard) and this capacity is probably over 20 times greater than what is spent on social care”.
He indicates that “If we focused on our immense community capacity available then there would be no sense of crisis. However community capacity is undermined by a series of negative factors that are driven by Government policy and by the interests of the powerful:”
The full article is an interesting approach.
Citizenship in an Ageing Society: This is a paper based on an oration given by Duffy to the Australian Association of Gerontology Conference in Adelaide in 2014.
In this paper he is critical of current policies, their impact on citizenship and consequently on social services. In our societies citizenship has come to have a very restricted meaning. He argues that “True citizenship will be reflected in our socio-economic arrangements, in the distribution of rights and duties and in the wider political decision-making processes; in other words, in our democratic systems” He claims that “This is very relevant to the challenge we face in an ageing society”. He expresses some concern about the idea of “Consumer Directed Care” because consumers are not citizens and this concept does not embody the idea of citizenship.
The Relational Basis of Empowerment by Karl Nunkoosing and Mark Haydon-Laurelut Published in the “The Need for Roots” series. The Centre for Social Welfare.
This interesting paper by two psychologists goes to the heart of our being by stressing the importance of community and relationships. It examines service cultures and characterises those cultures as Empowerment, Protection, Control and Punishment on the basis of the relationships they build and the personal stories that are built there. They explain how these impact identity and the quality of life of the disabled and how current practices and reforms fail because of the cultures that are formed.
While the classification may look a little arbitrary it leads on to an important discussion of empowerment, citizenship, social capital and the building of life stories through social action and involvement/contributing in the community. It looks at how developing community and relationships leads to empowering cultures that lead to a good life. The life stories developed are critical. The article explains why personalisation has not always worked and comments that when services are provided by for-profit entities people are seen primarily as financial investments.
Duffy referenced this in the previous paper about the aged. While it is about the disabled the content can equally be applied to the aged. It needs to be read to be understood.
Consumer Directed Care: Because of the way our establishment thinks in Australia the process of self directed care has been handed over to the market. The illusion of choice has been used to sell it to the public. In the process citizens - the community - have been excluded and their participation limited. This is what Duffy is critical of. His inclusive approach to the aged through citizenship is very different. It is more efficient and better value for money to treat people like citizens, than as service users.
The approach to aged care as a citizenship issue is something the proposed hub will be in a position to explore and develop. Duffy sees citizenship as something where “making things better is everyone's business” and that is a situation that the proposed hub is intended to create.
Customers and Citizens: A provider of care services asked Simon Duffy a number of key questions about leadership and the provision of services to customers. Simon’s answers, which he has published on his blog under this title, are revealing of how asking the wrong questions frames issues within the wrong perspectives and leads to the wrong outcomes. Once you start thinking in terms of citizenship you frame things in very different ways to those both our major political parties and our market establishment are doing. You get different outcomes.
This is what has happened in Consumer Directed Care (CDC) and much else in aged care. I am writing about CDC in more detail on another web site. CDC is a good idea misapplied and badly structured. This is because it has been created within a pattern of ideas and words that compromise its intention.
Leadership: Duffy’s criticism of the way leadership was conceived as a top-down process when he responded to the questions in "Customers and Citizens" was music to my ears. I have long felt that powerful leaders driving their ideas from positions of power are antidemocratic. They dare not foster critical debate if they want to succeed. This would expose the flaws in their reasoning. Instead they seek to frustrate it.
They avoid sober debate and informed opinion, both in parliament and outside it. Policy making is distorted and so readily becomes harmful for citizens. Our political leaders are prime examples. Abbott must be the only leader who has successfully made the country ungovernable for the entire period while in opposition and then did the same when in power himself.
In my view good leaders should have a broad grasp of issues. They should be integrators and facilitators guiding and facilitating the development of policy. They should be low key and allow issues to take centre stage as the depths of community knowledge and interest is harvested to contribute to the debate. Politician’s role’s should be to modulate and guide true debate to a sensible conclusion. Abbott, with his captain's picks, has been an extreme example. Turnbull is better but is still being pushed into this role by his colleagues and an anxious community.
It is a measure of the instability of our society and of the community angst that politicians fan that we embrace powerful assertive leaders and turn to them for solutions. We expect them to make decisions for us. Not surprisingly these decisions are often those that they want and not the ones we would make.
In a civil society the community involves itself in the affairs of the nation. It is central to the debate. This interest in issues leads to exploration, study, competence and confidence. If our community were knowlegeable and confident in our views we would not tolerate dysfunctional leadership.
While they come from different perspectives there is some synergy between what Duffy is saying and our Eva Cox’s ideas. They are expressed in her ABC Boyer lectures “A Civil Society”. She explains how society builds “social capital” (contrasted with financial capital) as it engages with the issues of the day.
COTA is a community organisation working with industry and government. It has adopted the top-down model to drive its proposals for CDC. It has excluded rather than engaged fully with other seniors organisations. Its public discussion has been tokenistic.
The proposed Community Aged Care Hubs are conceived and structured as a bottom-up community system learning from and around real world experience and feeding this up into an integrating and evaluating central system.
There is a large collection of pdfs, books, ebooks, audio files, movie files, innovations, human stories and Powerpoint presentations on The Centre for Welfare Reform web site. Those who want to explore this area in greater depth and understand what Duffy and others are arguing for might like to explore some of the thoughts about the concepts of Citizenship and Personalisation, including where and why they have sometimes failed.
Canada is doing something and not just talking
While Australia is barely talking and the UK is experimenting communities in Canada are getting on with the job of changing society themselves. They have set up an institute to do that. They are focusing on training their communities to empower them. They are getting support from businesses and governments. It is not that Australia does not have active and effective community organisdations but the level of intergration, education and support in Canada is interesting.
Tamarack, an institute for community engagement, focuses on education and training in order to support local communities in engaging with the complex issues that societies confront. They are seeking to rebuild communities. There is a great deal of resource information on their web site.
The Learning Centre, established in 2003, is designed to create a fluid, creative system of documenting community building activity and delivering this learning to organizations. The centre has a threefold purpose: to broadly disseminate knowledge gathered through research and practical experience; to help communities increase their power through learning; and to generate knowledge about community engagement so as to advance the field. Learn more about the Learning Centre here.
Source: About Tamarack Tamarack web page
One such is the British Columbia Association of Community Response Networks, a community project to address adult abuse and neglect. They have assembled a team of 17 team leaders and mentors across the state. Once again there is a focus on learning and building in local communities to make them effective.
It is recognized that offering support to adults who may be abused or neglected, and having access to some new legal tools, is only part of what will make a difference in peoples' lives. As well there is a need for increased coordination at the community level, not only of responses to individuals who are abused or neglected, but also coordination in terms of working towards prevention over time. Community Response Networks are the vehicles for achieving increased coordination of community responses to abuse and neglect. Today, there are CRNs established or under development all over British Columbia.
CRNs provide a foundation for the community, as a whole, to work together as a team on an equal playing field, sharing power and responsibility.
CRNs around the province are reaching out to the community to establish a network of community agencies, local businesses, government agencies, (Health Authorities, Community Living BC) to provide help for adults experiencing or at risk of experiencing abuse, neglect and self neglect. Working together as a CRN, people and their communities are making a difference.
Source: What is CRN CRN web site Jan 2016
The proposed community aged care hub was conceived quite separately from these 21st century ideas but was a response to the same forces. It can be seen to lie within the same pattern of thinking. It gives form and substance to these same ideas of participatory democracy, community engagement, community control, citizenship and civil society in aged care.
Implementation of grand political ideas at the federal level can take many years and much discussion. It will start at the top and then seek to work its way down, perhaps replicating any mistakes made. Citizen movements like this are much better if they start at the bottom, hone their ideas in everyday activities, learn their lessons and then spread the insights into government itself. If it works it becomes a fete accompli.
Good government supports and facilitates ideas like this, tests them out, monitors them and learns from them. It listens to and follows the community. Good leaders in a democracy are facilitators that engage the community in developing and debating idea, and in the affairs of the country, then give form and structure to the community's ideas. They don't seek to impose their own ideas.=