Crushing the human connection: Managerialism does not deliver good care

Oct 23, 2023
Doctor patient

Australia began its National Carers Week (15-21 October), poignantly, the very day after the nation voted ‘No’ to a way forward to giving Voice to their communities, which Aboriginal and Torres Strait Islander peoples had asked for in the Uluṟu Statement from the Heart.

This result continues a sad record of voters preferring paternalism and ‘don’t you worry about that, we know best’ approaches to running the country, which have marked our 235 years of derived, follow the leader, colonial history.

In the same vein, the release of the new Federal Government paper on the Care and Support Economy invites a response of acceptance and compliance, assuming people will buy its neoliberal and free market economics rhetoric.

The difference in this case is, the paper’s proposed approaches will directly affect virtually every citizen (rather than the 3% Australia’s First People comprise), and it promises more disempowerment in the most heartfelt aspects of our lives – caring for early childhood, mental health, ageing, disability, alcohol and other drugs, domestic and family violence. Things every one of us is directly impacted by. Welcome to the world that Aboriginal people experience every day.

The rationale and delivery system behind this paper dominates all Health & Human Services, and it flows from the same values that have run our nation as a derived and compliant penal colony culture for centuries – someone else knows best.

Added to the top down ‘we’re in charge’ administration of care services are two gifts of the modern era – Competitive, dog-eat-dog, free market delivery of care by private businesses and corporatised NGOs, in a confidential Tendering system (no one can know how decisions were made), and Managerialism as a method of ensuring compliance and maintaining a centralised surveillance and oversight process linked to all funding approvals.

While it may have been well intended, just as the Aged Care and Disability Royal Commissions were, the Care Economy report as it is currently worded will only result in more of the same – disempowered ‘consumers and carers.’

The framing of its value system and modes of delivery is all built around the ‘Medical (Clinical) Model,’ over any concept of care being best delivered in Relational Communities of Belonging, where different and diverse people can deliver care in ways that are relevant to their socio-economic and cultural contexts. Just as Aboriginal people like to do it.

Efficiency and Effectiveness, the economic rationalist smoke and mirrors concepts that have lured the unwary into submission for nearly 50 years, will always be ‘the bottom line,’ rather than focusing on Taking Time to Care.

Precise Measurement and Reporting linked to systems of Accreditation (and hence funding) will dominate, ahead of local Diverse Caring Relationships. And preset ‘Units of Care Delivered’ will rule the roost, above the Experience of Care and Caring in Different and Diverse communities being a matter of local delegation, discretion, design and delivery.

The same will go for Care Work and Pay, it won’t be linked to Quality of Life Outcomes for ‘the customers,’ or the staff, but to Units of Care Service that can be counted and ticked off against clinical accreditation standards.

So will the Education and Training of care staff, under the Taylorist, cookie-cutter, monkey-see monkey-do industrial Vocational Education and Training (VET) system, which is about to get a huge boost from Federal and State governments in the pursuit of ‘skilling up the nation.’ While well intentioned, this outdated model is very unsuited to the new world of work, but that will go unnoticed in Canberra.

Instead of acknowledging the workers’ own Life Experience and community cultural traditions and knowledge, this top down, preset, clinically determined system will continue unchallenged.

So the Care Economy paper will be discussed, and tweaks may be made to it around the edges. But at its core the Free Market Competition and Managerialist Surveillance Systems will crush out the Human Connection.

By my direct anecdotal experience working in the industry, the Regulatory Reporting and Compliance to so-called Standards of Care in these fields consumes 30-40% of care organisations’ time, resources and humanity. It stresses managers and staff, and keeps them all away from face-to-face relational care, in order to tick boxes.

The truth is, Relational Care takes Time and needs space in the schedule of each day’s work for Interacting between people. We are all Social Beings who need to share our Stories to feel an Identity and Purpose. Such Communities of Belonging don’t thrive on counting, measurement and competition for ‘Cost Effectiveness.’ And people don’t get well and stay well in environments like that.

Cookie-cutter programs applied across the board fail to acknowledge Local Contexts and Cultures. Humans need to feel trusted to take Locally Relevant steps and to be given Delegated Responsibility and Discretionary Decision-making Power over Budgeting, Planning and Delivery.

Something like what the Voice would have offered to Australia’s First Peoples.

In subsequent articles we will explore the implications of all this in more detail, in specific areas of care that are very close to all our lives.


For more on this topic, P&I recommends:

Our mutual obligations in a mutually dependent society


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