EY helps clients create long-term value for all stakeholders. Enabled by data and technology, our services and solutions provide trust through assurance and help clients transform, grow and operate.
At EY, our purpose is building a better working world. The insights and services we provide help to create long-term value for clients, people and society, and to build trust in the capital markets.
How government leaders can seed a sustainable care economy
In this episode of the Government Insights podcast, host Kait Borsay discusses with her guests how government leaders can improve social care services and infrastructure to grow a sustainable care economy.
Care needs will grow exponentially in the coming years, with the International Labor Organization (ILO) estimating that public spending on universal long-term care needs would need to increase by US$3.1 trillion by 2035 to meet demand.
With government finances under strain, government leaders will need to activate other parts of society to fill the gap. This podcast will explore what government leaders can do to seed this important future growth market.
Implement a systems-thinking approach to unify sub-sectors of the care economy, enabling workforce mobility and streamlining funding mechanisms and the regulatory environment, to enhance productivity and quality of care
Foster community-led care systems by engaging with local populations to understand and meet their specific needs, ensuring care services are locally tailored, accessible and sustainable
Leverage technology and data to optimize care delivery by enabling self-managed care, improving workforce efficiency, and ensuring continuous innovation in care models that prioritize human connection and community participation
Teaser
Government Insights from EY-Parthenon.
Kait Borsay
Hello and welcome to Government Insights, a podcast series from EY-Parthenon for government leaders around the world. I'm your host, Kait Borsay, and we'll be looking at how governments can transform to strengthen services for their citizens.
In this episode, our topic is seeding a sustainable care economy. Joining us to share their insights and opinion on this subject are Kym Peake, Partner at EY Port Jackson Partners. Hello, Kym.
Kym Peak
Hi, Kait.
Borsay
And Emma Buchanan, Partner at Ernst & Young Services Pty Ltd, EY Strategy and Transactions. Hello, Emma.
Emma Buchanan
Hi, Kait.
Borsay
Kym, let's start with you. Can you define for us what the care economy encompasses and why it matters?
Peak
The care economy is so important to so many people's lives. It touches more than 8 billion people every year, and at its broadest, it really encompasses everything from childcare to health care to employment support and a social safety net, through to care and support of people with disability, older people and people who are returning from service, so veterans.
And if I think a little bit about your question about why we're so passionate about this industry, why we think it matters so much. Here in Australia it is the largest employer of any industry in the country. It represents about 15% of the whole workforce and it's forecast to grow faster than any other industry that we have in this country.
And for me, when we think about the care economy, we're talking about the supports that really help people to exercise rights, to have dignity and respect, but also to participate in social and economic life. But we're also talking about a sector that isn't just a big employer. It also enables every other industry to be productive and thrive.
Borsay
Emma, the World Economic Forum, argues that an effective care economy results in higher productivity, less inequality and less social expenditure. What are the challenges for a care economy?
Buchanan
Look, the first one to touch on is that demand for care is growing. The aging population is a global phenomenon. The proportion of the world's population over the age of 60 will almost double by 2050, and we're also seeing pretty significant increases in the prevalence of people living with a disability. And here in Australia it's almost one in five people that has a disability.
The other thing we know about the growth, which really makes it very tricky from a policy and a provider perspective, is that the growth isn't uniform. So, if you look across countries and then across regions within countries, the care needs of each region is different. And it's really made up based on the population and the communities that live in those particular regions. So, we have a really significant growth task, but it's very different and not uniform across countries as well.
There's also a real challenge around the financial sustainability of care systems around the world and getting the economics of care providers right is really, really critical to sustaining and attracting the right type of investment in the care sector. So, the efficiency and the productivity is really important, both from a value for money perspective for taxpayers, but also a quality of care perspective and making sure that these systems are sustainable. But the people that they serve can continue to access quality care now and into the future.
Borsay
And Emma, what are you hearing about how people want to receive that care?
Buchanan
We know a lot more now than what we did say 10 years ago about how people want to receive their care. And the overwhelming evidence and feedback that we're getting is that people want to receive their care in their family home. People want to stay in their family home and in the community as long as they can and avoid having to move into more formal supports. Now that's not always possible, but as much as it can be accommodated, we should look to evolve the caring economy so that we can keep people in their family home and keep them connected to their communities because that's what they want. They want to age in place and stay in their family home and receive the supports they need there.
Borsay
So what changes are needed to enable care systems to deliver well-being, growth and prosperity?
Buchanan
Yeah. Well, look Kait, at the risk of stating the obvious, one of the really important recognitions is that none of the challenges facing the care sector stand in isolation to each other. So, to give you an example, the care sector won’t grow if we don't have the right provider economics in place, and you can't have quality care without quality workforce.
So the first really big shift and enabler that we need is to have a much more stronger systems thinking approach to the care sector. When we talk about the care sector, we use the term, the care sector or the caring economy, but what we're actually talking about is a collection of sub sectors that includes the care that's provided to the aged, disability and veterans.
So typically these sectors have very different funding mechanisms, very different pricing arrangements, different regulatory environments and different governing requirements as well. And what this does is it creates unnecessary barriers and inefficiencies almost for carers to move across and between different care types.
So we need to be much more focused on asking ourselves questions around, why do these differences exist and should they be going forward. So a care sector that truly operates as one care sector, can be such a powerful catalyst for improving productivity and just creating the lift in quality that we need to see in the care sectors around the world as well.
And a really important part of this is strengthening the role of community in the care systems that we have at the moment. So we need care systems that reflect and respond to community needs and build trust and connections with the places and the people that they serve.
And there are absolutely pockets where this is happening and there are some really important “get rights” to making sure that we continue to kind of build on that and enable it going forward.
Borsay
What are those “get rights” then?
Buchanan
The first one would be information place-based planning. So if we don't have the right information, then we don't have ourselves set up to kind of understand what the care needs of particular communities are. So, we want to be able to zoom down on a geographical area and know what their care needs look like today, in 10 years’ time and in 20 years’ time, so we have that kind of foundational understanding of community care needs.
The second ‘get right’ and this is a really important one, is allowing better for multidisciplinary care. So, we know that when it comes to provider economics, that density really matters and travel time is really, really inefficient. We want our carers spending as little time as possible in the car and as much time as possible with the people that they care for.
Borsay
Let's continue with you on this, Kym, and look at how partnerships between government, business and communities are really important. From your perspective, how can “community-led” systems of care be achieved?
Peak
Well, I think we need to start with a completely different mindset and approach to how we both design and then steward these systems. So often I see as designing service systems for idealized markets and care recipients that actually result in ways of accessing and delivering supports that don't work particularly well in the real world. We end up layering processes and programs on to already pretty complicated and siloed services which makes it even more confusing for people to understand what they could access but also reduces the time available for great relational practice and multidisciplinary care. EY teams are advocates for approaches that ensure reforms are designed outcome first rather than solution first. Because we believe that population outcomes are a really powerful way for governments to describe what they want from a caring economy for individuals, society and the economy. But then to also provide a mechanism to encourage everyone who's contributing to that care economy to stay completely focused on not just whether a policy or program has been implemented well but whether it has actually had the intended effect. Delivering that kind of “outcomes first” approach to the sorts of challenges that Emma has outlined also depends on a really strong robust theory of change. The perspectives of people experiencing the care economy are critical to getting that theory of change right. As is a deep understanding of provider economics. But I also think there's an opportunity to more explicitly recognize the importance of both place and relationships for a well functioning care economy. Certainly, over my time in this sector, models of care and funding approaches have been reformed significantly to give the service user more choice and control to personalize supports for them and better translate evidence into practice. And I think these elements of reform are incredibly important and have been really positive. But I also think there's been an unintended devaluing of the community's role in a well functioning caring economy. I think provisioning care should be about the relationships and interactions between caregivers, recipients, and the broader community. And while personalization of services and supports is really important, I think we should also integrate the study of collective behavior and interactions among individuals groups and governments into the design and stewardship of care systems. Because I think it's when we combine that focus on place and relationships with evidence and personalization that we can actually design services and supports that work for people and reflect what care recipients are saying matters most to them.
Borsay
And Kym, what practical steps can government take to build more sustainable and connected local care systems?
Peak
The care economy can't grow, it can't deliver its objectives if we don't have a high-quality workforce. It represents about 11.5% of all employment and there's about another 475 million more formal care jobs that are going to be required by 2030 to meet global demand.
In fact, we know from Australian census data that most people who work as personal care workers in aged care, have actually come from other industries that have pretty similar demographic characteristics and employment characteristics. So, think about cleaning or clerical work, or retail and hospitality.
And so what we hear from personal care workers is that travel time, insufficient hours, what they hear from their colleagues, their peers and other members of their community about the value that's placed on care work as well as the low pay relative to the workload and responsibility and limited opportunities for career progression, all really wear away at them.
There's a bunch of stuff that can be done structurally to improve conditions and remove barriers to that career progression, but I suspect that that's never going to be enough. I do think that thinking about local workforces and local solutions to make jobs more attractive is absolutely at the heart of improving the stickiness, if you like, the reducing the attrition of people in these jobs.
Couple of things that we've found, we've seen, that are happening in pockets of Australia, is different providers kind of pooling together and creating joint employment models so that you can get enough hours close to where you live, even if it is with different employers.
And then the second thing that I just wanted to touch on in terms of what government can do to really enable the care economy to be at its best, is really to build the relationships between different parts of these sub sectors to drive innovation in models of care.
I think future models of care need to combine personal and clinical care with opportunities for social connection and participation.
And there's heaps of brilliant programs out there that are all about creating social networks, using technology to support community engagement. Because we know that there's nothing that is more debilitating to your health and well-being than feeling alone. Government has a really important role to play in supporting workforce development at a local level.
And they have a critical role to play in making sure that innovation in models of care lead to both multidisciplinary care, but also combining professional care with natural opportunities for people to participate in their community.
Borsay
Thanks, Kym, and I'm sure within innovation we can look at technology further as well.
Emma, let's talk to you about that and technology's role in helping government to build more sustainable and connected local care systems.
Buchanan
Technology and liberalizing data are really crucial to powering the relationships the provider economics and ultimately the outcomes of a caring economy. So just firstly on data, data is the lifeblood of good decision-making and the lifeblood of good systems stewardship. We can't make good decisions without good data and the way data is collected and stored and used is just fundamentally important to the functioning of the caring economy going forward, and governments around the world as well as providers of care and support around the world have a really important role to play in that. On technology there's been huge advancements in technology that is changing the way that care is delivered and changing the way that care providers run their businesses as well. And this is an area where we've seen huge advancements but it's also rapidly evolving so there's always more to be done. One really important area of technology advancement is the role of digital platforms and digital maturity of providers. So, look we know that when providers of care in the caring economy are more digitally mature, they're more likely to be using data analytics to support their business decisions. They're more likely to be having more sophisticated software that supports with the functioning of their businesses and things like rostering. We also know that they're probably finding it easier to meet a lot of their reporting requirements as well. And so, the governance around the care and support economy in particular in the caring economy does require quite a lot of reporting between government and providers and that reporting is really important to the overall functioning of the system, but how do we help providers do that as seamlessly as they as they can? And we also know that the more digitally mature providers are, the more likely they are to be better prepared for things such as cyber security. Another really important aspect of the role of technology and digital platforms is the role of electronic marketplaces and how they can support the matching of caregivers and care recipients. So electronic marketplaces have played a really important role in helping people find available caregivers. And that lets them exercise more choice and control over the type of care that they have, when it's received, and who it is that's coming into their family home to provide that care as well. And look the last one that I'm keen to touch on and this one is really powerful is the role of remote monitoring and assistive technologies. So, this is really powerful and important in terms of the impact it can have on the caring economy but also the broader health system. So, two obvious examples that get talked about quite often are the role of wearable devices and remote monitoring and the role of telehealth in providing care and support to people in their family home and delaying the transition into residential aged care and also delaying the need for them to move into hospitals or acute settings.
Borsay
That's really interesting. Okay, Emma and Kym, let's get some final thoughts then from both of you on developing the care economy. Emma.
Buchanan
Yeah, I'll make two really quick final thoughts.
So look the first one is the need for really careful market design. What we absolutely want to see is governments setting out a vision and a set of population outcomes of what they want to achieve for their caring economy. And that works best when all stakeholders are in the tent and agree to those outcomes and collaborate on their development. And then you've got everybody pulling in the same direction.
Then you can have really meaningful and really considered market design and really considered outcomes focused system thinking to help drive towards the future state and what you want your caring economy to look like.
And then the second observation and final thought I would make is, we are not talking about a small part of the economy here. And we're not talking about a small part of people's lives either. There's not anyone listening to this podcast whose lives wouldn't at some point touch the caring economy. And we absolutely want to make sure that the caring economy is as productive as it can be, as efficient as it can be and provides the highest quality care that it absolutely can. Whether that be for veterans to help them return to civilian life and their careers. Whether that's to help older people age well and with dignity, or whether that's to help people with disabilities live their best life. It's a really, really important part and it needs, like a lot of collective, concerted effort to get it right.
Borsay
And Kym.
Peak
Look, I completely agree with Emma's reflections on market design and stewardship. I would simply say that we know that care economy networks make care work. The free flow of ideas and relationships are just so important to unlocking possibilities.
And secondly, outcomes first approaches are the most effective way we know to promote rights, to align incentives to outcomes, and finally, to keep community at the heart of the care economy.
Borsay
Look, thank you so much for that. That's it for the episode. But it's been such an interesting conversation. Kym, thank you to you.
Peak
Thank you.
And Emma, thank you to you.
Buchanan
Thanks, Kait.
Borsay
Well do join us again soon when we'll continue to look at how governments can transform to strengthen services for their citizens. And please subscribe to this series so you won't miss an episode.
From me Kait Borsay, thanks for listening and bye for now.
Teaser
Government Insights from EY-Parthenon, back soon.
End of podcast.
Presenters
Kait Borsay
Journalist, author, TV presenter, Radio moderator at Times Radio
