Ideas are the lifeblood of our movement. Policy conversations need to be encouraged, not muted, at all levels of the Party. The policy snapshots that follow are designed to stimulate discussion in our Party.
01>> RANDOMISED POLICY TRIALS
ANDREW LEIGH MP
In politics, there are few hotter potatoes than drug laws. So when the NSW Labor Government in 1999 was faced with a suggestion that it deal with drug offenders through a “Drug Court”, there were plenty of vocal opponents. To deal with the challenge, the Government did something that was both smart policy and clever politics: it set up a randomised trial.
Like a randomised medical trial, offenders were assigned to the treatment or control groups by the toss of a coin, making the two groups basically identical at the outset. A couple of years later, it was clear that those who went through the Drug Court were much less likely to reoffend than people who went through the traditional judicial process.
Internationally, randomised trials of early childhood intervention, job training, housing vouchers, health insurance and microcredit have produced similarly valuable results. Farmers have used randomised evaluations for centuries, while medical randomised trials date back to James Lind’s 1747 experiment showing that citrus fruits cure scurvy.
We should not lightly dismiss ethical concerns about randomised policy trials, but they are often overplayed. Many government policies are surely ineffective, and some may even be harming the people they were intended to help. Part of the reason is that we mostly use low-quality evaluations rather than randomised policy trials.
Like other forms of evaluation, randomised trials have their limitations. But my best estimate is that less than 1 percent of all government evaluations are randomised trials (excluding health and traffic evaluations, the proportion is probably less than 0.1 percent). Given that you can’t get a new pharmaceutical approved in Australia without a randomised drug trial, it seems odd that hardly any policies are subject to randomised trials. One option would be to learn from the US, where federal legislation sometimes sets aside funding for states to conduct randomised evaluations.
What we need in Australian policy today is not more ideologues, convinced that their prescriptions are the answer, but modest reformers willing to try new solutions, and discover whether they actually deliver results. As Labor Party members, we must always remember that what defines us is the light on the hill, not a particular path up the mountain. As US judge Learned Hand famously said, ‘The spirit of liberty is the spirit which is not too sure that it is right’.
02>> PERFORMANCE PAY FOR DOCTORS, NURSES AND HOSPITAL STAFF
Australia’s health workforce – our doctors, nurses and allied health staff – have a dirty habit. A lot of them don’t bother to wash their hands. It’s a habit that’s putting lives at risk. Now the time has come to incentivise our health workforce to do the right thing with a performance bonus.
Consider the fact that across Australia every year one in 30 patients develop an infection when they are in hospital. This costs the health system, and taxpayers, almost two million bed days annually, with approximately 1,500 deaths. That’s not far off our national road toll. Think of the resources that go into cutting the road toll. We won’t ever stop all infections, as germs have been around longer than we have, but we can sure do better. We are all taught at a young age to wash our hands to kill germs. Doctors, nurses and allied health staff know that too. The problem is, it is estimated only 43 percent of doctors and 67 percent of nurses in NSW actually practice hand hygiene as recommended by the World Health Organisation. That’s right – less than half of our doctors clean their hands according to best practice when visiting patients in wards. The rest don’t do it enough, or don’t do it at all. That’s not good enough when plenty of evidence proves the heightened risk of transmitting infections in a hospital. Health Departments have had programs in place for years to promote hand hygiene, with mixed success and stubbornly variable compliance rates.
Our doctors, nurses and allied health professionals are among the best in the world. They all work hard and are time poor, and whilst washing or disinfecting hands may be annoying, it can save lives. It is time to consider a way of rewarding those health workers that follow best practice. At the moment staff who follow the guidelines are paid the same as those who don’t. In an ideal world,we wouldn’t need to reward good behaviour in such a way. But the status quo is not working. If hospital managers could have found a way to ensure 100 percent compliance, they would have.
Such a change need not be expensive because the pay bonus need not be large to achieve the desired change in behaviour. There are approximately 8,500 doctors, 40,000 nurses and midwives and 8,000 allied health professionals working in the NSW public health system. Therefore a $1,000 per annum bonus, payable to those who follow the NSW Health hand hygiene guidelines, with compliance audits and transparent monitoring, would cost $56.5 million annually if all staff complied. Performance pay could be trialled in one Local Health District first to determine whether it can lead to effective behaviour change.
Performance pay is being introduced for Australia’s best teachers. This was a bold and controversial reform in the Labor tradition to promote better education. There is no reason why we can’t take the same approach to Australia’s best doctors and nurses and continue Labor’s proud record in health policy. Of course there are many other aspects that make a good doctor and nurse, but this could be one measurable small step in the right direction to better patient care.
Oh, and next time you are next visiting a family member or friend in hospital, and a doctor or nurse comes to shake your hand, don’t forget to ask them if they’ve washed first!
03>> GET INVOLVED IN THE COMMUNITY
Each Labor Party member should be an active member of at least one community organisation. I understand the pressures of balancing work and family dominate our lives. We have precious little spare time. But Labor was built from the ground up. Our ideals and our goals came from a community without a voice. Our success derived not just from Labor policy but also the promotion and prosecution of that policy in the community.
My father was an active member of the Maroubra Surf Life Saving Club. On my 13th birthday he took me to join the surf club. I remain an active member to this day. I later also worked with the Eastern Suburbs Police and Community Youth Club (PCYC).
In becoming active in these community organisations I not only formed relationships with more people in my community, I also gained an ongoing appreciation of their issues, their struggles and their aspirations. These people are never shy in letting you know their opinions and they are a pretty good policy thermometer.
There was a time when every member of an ALP branch also served in their local community, sporting and religious associations. Some still do, but the numbers are ever diminishing.
This is also due to the growing culture of self-interest that has permeated through our Party. While working within politics is a rewarding experience, it is all too often the only experience our members gain.
Young Labor members are amongst our most active. The organisation of enthusiastic and energetic party members promoting progressive policies is an extraordinary tool for promoting our cause. However, our young members need to recognise the potential for personal growth and learning, which comes as a result of active community participation.
The potential to learn from the experiences of community activism is limitless. I have always said that the best management course I ever did was being in charge of 15 lifesavers on patrol at Maroubra, especially when the surf was up and the “North Maroubra express” – a well known local rip – was ferrying its usual quota of swimmers out to sea, or the dark blues and greys in the sky heralded the arrival of a menacing southerly.
It’s through my involvement with the management of SLSCs and PCYCs, that I was inspired to greater heights of community activism that led me to a career in politics. The more who participate in community organisations, the more prosperous our communities will be. PCYCs work with kids who have often come from broken homes or tough financial circumstances to keep them from going off the rails, and to help them get back on track if they do.
Police Youth case managers work with “at risk” youths, managing issues such as school attendance, peer group choice, employment options, identifying interests and activities to support new directions in their life. This work makes a real difference.
Community organisations are like a family and they show pride when one of their own succeeds. Five past presidents of my surf club were present when I made my first speech to parliament.
Community involvement and activism can play a vital role in communicating with those of our community who rely on Labor for a better life.
04>> MODERNISING MICRO-FINANCINGTO DEVELOP ENTREPRENEURSHIP
IN WESTERN SYDNEY AND RURAL NSW
As a progressive social democratic party, NSW Labor needs to find innovative ways to assist the urban and rural poor to make the break from long term and inter-generational poverty.
Effective and well designed micro-financing projects have successfully enabled impoverished people to engage in self-employment projects that allow them to generate an income and, in many cases, begin to build wealth and exit poverty. A modernised model of micro-financing will assist the poor in urban and rural NSW break the poverty cycle.
Micro-financing is the extension of small loans to those in poverty and is designed to spur entrepreneurship. Individuals with a history of long term unemployment or inter-generational poverty lack collateral, steady employment and a verifiable credit history, and therefore cannot meet even the most minimal qualifications to gain access to traditional credit. Microcredit emphasises trust building, which can enable micro-entrepreneurship, so generating employment and helping people to help themselves during enterprise initiation and during difficult times.
Microcredit programs have the potential to transform power relationships and empower the poor – both men and women – improving the standard of living by raising awareness, aiding decision making, and reducing poverty among beneficiaries. Evidence demonstrates a positive impact on enterprise and household income, asset accumulation, household consumption, and a positive influence on social welfare indicators (education, expenditure on health and nutrition).
This concept of micro-lending is usually thought of as being only useful in developing nations. However, microcredit projects have been effective in the US, where 37 million people (12.6 percent) live below the poverty line. Due to the increasing rates of success of micro-finance recipients, a number of significant US banks have recently announced plans to award multi-million dollar grants to nonprofits to use in backing microloan programs. A number of non-banking organisations have been able to provide US$117 million in microloans, and have seen a repayment rate over 90 percent. Other developed countries in which the micro-loan model has gained impetus include Israel, Russia and the Ukraine.
However, there are lessons that can be learned from examples where micro-financing has failed in developed countries, for example, in Canada; rural Nova Scotia and urban Toronto and Vancouver. These failed for a variety of reasons – including difficulties in reaching the target market, the high risk profile of clients, their general distaste for the joint liability requirement, and high overhead costs – and made micro-finance lending unviable without subsidies. However, debates have continued about whether the required subsidies may be justified as an alternative to other subsidies targeted to the entrepreneurial poor.
In NSW we need to seriously consider introducing a modernised model of micro-financing to assist in providing a platform for entrepreneurship among low-income earners. We need to develop an integrated package of services rather than just handing out money. When access to credit is combined with other services, such as additional financial services (voluntary savings facilities, non-productive loan facilities, insurance), enterprise development (production-oriented and management training, marketing support) and welfare-related services (literacy and health services, gender and social awareness training) we provide a real alternative for those Australians attempting to break with the cycle of poverty.
05>> COMMUNITY RE-ENVISIONEDANNA MINNS
In 2010, Time Magazine listed it as one of the 10 ideas that will change the world, Fast Company Magazine estimated a portion of this idea to be worth $100 billion, and venture capital investment in this idea is booming … and yet the idea is thousands of years old.
What is this idea? It is called “collaborative consumption”, and the idea is simply to share.
We all have so much stuff. As a society, we are very focused on individual getting and spending, and as a result of all this consumption we have an enormous amount of stuff, most of which we use very rarely. This creates waste, which in turn impacts on the environment and is costly to our economy.
Collaborative consumption is about letting people enjoy their stuff, but in a different way. It is an old fashioned concept of community made new again through the internet and social media. The way villages once interacted by swapping, trading, lending, renting, bartering and gifting has been re-envisioned, and on a global scale. We’re sharing again!
Communicating with people on the internet through social media websites has become mainstream, through the global phenomenons of Facebook, Twitter and YouTube. An online global community has emerged and it has encouraged increased communication between strangers. A new social currency has emerged that is built on one’s online reputation, rather than credit history. The communication between people globally is evolving whereby people are starting to share their stuff with each other.
Ebay is the grandfather of the sharing economy. It has allowed people to get rid of their pre-loved stuff. In doing so, extended the useful life of their things and has reduced waste. People can also gift their unwanted things away on Freecycle, as well as trade or swap for other people’s things, including books, DVDs and baby clothes, through a plethora of swapping websites.
Apart from the redistribution of stuff, with the growth of the sharing economy, people can now have access to all the things they enjoy without having any of the burdens of ownership. It makes sense to rent your neighbour’s power drill (www.openshed.com.au) when you consider that the drill is used on average for 12-13 minutes in the lifetime of the drill, or neighbour’s car (www.drivemycarrentals.com.au) when the average car sits idle for 23 hours a day. Bike sharing has become so popular that it is the fastest growing form of transportation in the world. Entrepreneurs are creating services for people to rent and borrow formal dresses, maternity dresses, handbags, sports equipment, artworks and all manner of things that you don’t need to own to get enjoyment from.
Sharing has now even extended into people’s lifestyles. Through innovative websites people can share their time, skills and money. People can share their homes with travellers (www.airbnb.com), gardens with green thumbs who would like a space to grow vegetables or plants (www.landshareaustralia.com.au), as well as the skills they have in anything from playing poker to making cupcakes with people in their local community (www.skillshare.com).
One of the most exciting and dynamic creations in this new sharing economy is crowd funding, which is a collaborative way to raise money. This concept involves the funding of projects using mostly small contributions from a large community of people.
The collaborative website www.kickstarter.com in the United States has already funded over 10,000 creative projects in art, film, publishing, music and other endeavours, with contributions from over one million supporters. A similar website, www.pozible.com, has emerged in Australia, and it has already collaboratively raised over one million dollars for a range of creative projects. The opportunity for artists, researchers, entrepreneurs and social campaigners to raise funding and support for their favourite projects through crowd funding, will have a huge and transformative impact on their ability to realise their dreams as well as the traditional systems of funding these projects.
Funding for the arts community is just the tip of the iceberg for what crowd funding can achieve. It creates enormous potential for centre-left governments and political parties around the globe, who have a never ending call to reduce taxes and expenditure, to use the collaborative consumption marketplace to realise projects and funding goals. The global movement to share is fostering a stronger sense of community, and in this process we can rediscover the collective good.
06>> USING MEDICAL RECORDSFOR SOCIAL NETWORKINGBETTINA McMAHON
Unlike in the 1970s, when doctors managed our healthcare, today we take more responsibility for our own health and treatment of any illness we have. However, we need new tools and information to help us understand what is going on, recruit providers into our care team, and share information about ourselves to our care team.
The Commonwealth Government has funded a ‘personally controlled electronic health record’ that will bring together health information from IT systems across the health sector, which will be available to all Australians who want one by July 2012. The system will liberate data currently locked away in IT systems of hospitals, doctors, pathology labs etc, and make it available to the right people at the right place and time.
At this stage, the program focuses on information sharing between a person and their care team. However, there is great potential to use the data unlocked to enable people with similar health conditions to network with each other.
All of us will experience significant, sometimes life changing, healthcare events at some point in our lives. Whether it be having a baby, managing a mental illness, or dealing with a chronic or end of life condition, these events not only take a physical toll but can also be emotionally taxing. The fear and anxiety when coming to terms with many of these events is helped by connecting with other people going through the same thing.
Support groups have effectively met this need for many years. Being able to connect with another person who is in the same situation as you can be deeply comforting when nobody else you know has gone through what you are experiencing.
However, support groups have traditionally been limited by geography (like mothers’ groups that meet face to face) or require the involvement of an external organisation (like cancer support groups that form connections between people).
The way that Australians have embraced social networking technology shows that we love connecting online. Sometimes social networking is used as a supplement to “real world” relationships, and sometimes we form relationships with people we will never meet. While it might be fashionable to criticise online relationships as being superficial, the reality is that many of us rely on our mobile phones and computers to get the intimacy we crave in a world that demands so much of our time that we are unable to meet in person.
Imagine logging on to your electronic health record, reviewing the results of your latest pathology test result to monitor your diabetes and seeing a pop-up “There are 17 other people with Type 2 diabetes online – click here to chat”. No need to contact a diabetes support group. No need to have awkward face-to-face group meetings. If you’re feeling OK then you ignore the message, but if you want to talk to someone, that support is just a click away.
Using a person’s medical records to create social networking links would undoubtedly give privacy advocates an aneurism. Getting their support to share online medical records with healthcare providers is hard enough. But if we can use medical data to help people connect online, and that provides comfort to someone who is sick and isolated, it is a fight worth having.