OHS--AND RISK--IN DISABILITY SERVICES

1. OHS--AND RISK--IN DISABILITY SERVICES SOME FINDINGS FROM AN ARC STUDY ON RISK AND COMMUNITY SERVICES David Green La Trobe University

2. ARC RESEARCH PARTNERS • La Trobe University –Social Work and Politics • Department of Human Services • Office of the Public Advocate …….AND 24 COMMUNITY SERVICES AND PUBLIC AGENCIES

3. WHY STUDY RISK? • Risk and risk taking are important in all our lives • In the C21 we are all much more conscious of risk in our lives • Taking risks and avoiding risks are key factors in disability services and in OHS

4. RISK IS CONTENTIOUS WHOSE RISK IS IT ANYWAY? U.K. Disability Rights Commission campaign on the rights of people with disabilities to make decisions about risk Deciding about risk is about the way we define our lives BUT WE CANNOT TAKE RISKS WHICH JEOPARDISE THE RIGHTS AND SAFETY OF OTHER PEOPLE

5. OBJECTIVES OF ARC PROJECT • 1. To document the history of contemporary risk management in the Australian context, from the identification of risk as a major imperative for public and private organizations in the late 1980’s. This historical account will focus on the development of risk policies and practices at national and state levels. • 2. To describe the processes by which the practices and technologies of risk management have been taken up and translated into the practices of community service organizations. This part of the project will focus on Victoria.

6. OBJECTIVES OF ARC PROJECT • 3. To test the contention that there are dysfunctional interactions between the values, objectives and practices of community services and the values, objectives and practices of risk management, and to define the nature of these dysfunctions, and their impacts on services, professionals and service users. • 4. To examine the ways community services, professionals and service users have adopted and adapted risk management to service goals and ideals.

7. STAGE ONE IN-DEPTH INTERVIEWS WITH 24 CEO’s OR EQUIVALENTS FROM….. • five multi-sector providers (such as homeless services, municipal councils), • six mental health, • six disability • five aged care. (Among these are one local government council, and two government agencies and three public health network services. Ten agencies were either rural based or had rural branches)

8. STAGE TWO IN-DEPTH INTERVIEWS WITH …. • Program managers (24) • Front-line staff (40+) • Patients or clients (40+) From the same 24 organisations

9. SNAPSHOTS FROM THE FINDINGS OF STAGE 1 A CHANGING PICTURE OF RISK IN COMMUNITY SERVICES

10. EVERY CEO REPORTED VERY SIGNIFICANT INCREASES IN RISKS AND RISK ISSUES OVER LAST DECADE A changing profile of risk across community services

11. MAJOR RISKS REPORTED • RISKS TO CLIENTS AND RISKS TO WORKERS • RISKS TO COMMUNITY • GOVERNANCE – the legal security of the organisation • FINANCIAL ACCOUNTABLILITY • BUSINESS RISKS—contracts, funding arrangements, service agreements and regulation • QUALITY—Quality assurance, Auditing, Registration and Accreditation • PREPARING FOR DISASTER--Y2K , technological breakdown, epidemics, transport crisis etc (not all agencies on this issue) • REPUTATION--managing the organisation’s public profile in a climate of increased accountability and exposure

12. ALL CEO’S REPORTED MAJOR CHANGES IN THEIR UNDERSTANDING ABOUT THE SCOPE & NATURE OF RISK OVER THE PAST DECADE RISKS TO CSO’s HAVE INCREASED AS A RESULT OF MANY CHANGES TO POLICY AND OPERATIONS For example contracting practices, person centred planning, client choice, profile of client needs etc

13. A MAJORITY OF CEO’S REPORTED INCREASED COMPLEXITY IN THE NEEDS & PROBLEMS OF CLIENTS. Co-morbidities, dual diagnosis, dual disability etc Non-institutionalisation and its consequences—early discharge from acute care, ageing in place, community care, etc. Fragmentation of services experienced as considerable business and service complexity Increasingly complex behaviours adding to client, patient, worker and community risk

14. SOME CEO’S REPORTED MAJOR INCREASES IN RISKS ARISING FROM CONTRACTING AND PARTNERSHIPS The contracting CSO incurs liabilities for the care and standards of their sub-contractors, and effectively has to monitor hundreds of individually packaged arrangements There is no state-wide licensing or regulation of many of these businesses and effectively the contracting CSO has to be a regulator

15. ACROSS THE 24 ORGANISATIONS THERE WERE MAJOR DIFFERENCES IN CAPACITY TO RESPOND TO RISK The risks faced by small to medium community service agencies are the same or greater than those experienced by large public agencies--yet their capacity to respond is variable and/or weak. This issue according to CEO’s is not recognised by government AND the direction of public policy is towards increasing risk regulation requirements in general and specific ways.

16. MOST CEO’S INTERVIEWED REPORTED INCREASING RISKS FROM SHORTAGE OF SKILLED WORKERS THE COMBINED EFFECTS OF …….. Growth in community services Increasing competition between providers Inadequate, poor quality and poorly regulated training programs at sub-tertiary levels Low pay and remuneration rates for community services now having to provide increasingly complex services for patients and clients passed on from the ‘clinical’ services with different funding and salary rates

17. ALL CEO’s INDICATED INCREASED COMMITMENT TO OHS Improved performance generally Better training for OHS Strong financial incentives New OHS issues emerging strong commitment to not impacting on client opportunities

18. SOME EMERGING ISSUES RISK AND CHOICE RISK AND PERFECTION RISK AND TRUST

19. KEY POSSIBLE FUTURE DEVELOPMENTS Public policy for risk, person centred planning and OHS Supporting CSO’s to manage risk Sorting out the problems of contracting, sub-contracting and devolving risk Confronting policy issues about disability and risk