Digital disruption in social care: friend or foe?

The role of web-based platforms or digital reform is playing a key role in the personalisation of social care for older people, people with disability in Australia. The emergence of web-based information platforms (designed by government and some providers), digital intermediaries (web-based services connecting service users with potential support workers) as well as on-line discussion forums are changing the relationship between people who use social care, the disability and aged care services and the government. However, the roll out of web-based platforms including My Aged Care and the National Disability Insurance Scheme (NDIS) My Place Provider and Participant Portals raises questions about the government’s awareness of the transformation required by all actors in the social care system to implement such significant reforms.

Digital disruption in social care

The idea of ‘disruptive technology’ or ‘disruptive innovation’ was developed by Christensen (1997)[1]. These terms are used to describe how technology can disrupt the status quo, leading to the development of new products and services that change industries or markets. For example, the emergence of Uber and Airbnb are examples of digital disruption that have disrupted the transport and hotel industries across western countries.  Often referred to as digital intermediaries, these services connect people to services via on-line platforms and tend to have lower transactional costs than existing services.

In social care, examples of digital disruption may include the development of digital platforms to hire staff, service users sharing skills and knowledge via social media as well as web-based access and funding platforms such as My Aged Care, The Carer Gateway and the NDIS My Place Provider and Participant Portals. The emergence of digital intermediaries, that is, digital platforms that connect people using social care with staff (for example Better Caring[2] and Hire Up[3]) may disrupt the front-line worker market in social care. Rather than work for a provider, support workers work as sole traders, managing their own work and relationships through the on-line platforms and the connections with people with disability. Similarly, the emergence of on-line social care user groups on social media provides opportunities to share experiences and lessons in making the system work for them. Additionally, web-based portals (such as My Aged Care, the Carer Gateway and the NDIS My Place Provider and Participant Portals) have disrupted providers and service users.  People using social care have to learn how to navigate these systems as do providers who have had to transform their business processes, systems and skills of staff to accommodate changing systems.  

Empowering people who use social care

The rise of individualised funding in social care could see an increasing role for digital on-line platforms that provide access to information and resources for people using social care. The emergence of on-line marketplaces where older people, people with disability and their allies search for support workers may empower people using social care. These business models are designed to provide flexibility and choice, where people can pick who supports them and at what times. However, there are questions about how workers are vetted on these platforms, particularly from service providers. Furthermore, some research has identified the potential of professional deskilling and a reduction in pay and conditions for support workers in individualised funding systems of social care[4]. These debates highlight important questions about how people choose who supports them, as well as the mechanisms to ensure that support workers are appropriately qualified and paid in a deregulated market.

People are also connecting via social media sharing insights about how to make the social care system work for them. Some users of social care have created on-line petitions[5] to highlight inequities in the social care system providing a voice to express issues and concerns. While social media can be a friend of people who use social care, it can also be a foe if people don’t have access to the internet. Despite Australia being seen as an early adopter of smartphones, there are still people who struggle to get access to the internet. It is important that the government considers strategies to promote access to the internet. Furthermore, it is important to consider that some people prefer face to face contact rather than connecting via web-based platforms or social media.

Provider experiences of My Aged Care and NDIS My Place Provider and Participant Portals

The roll out of My Aged Care and the NDIS My Place Provider and Participant Portals pose serious questions about the understanding of the depth of transformation needed in using on-line technology in social care in Australia. The roll out of My Aged Care from 1 July 2015 across NSW, Queensland and South Australia posed many challenges for all stakeholders across the aged care system. The number of older people and their carers who contacted My Aged Care far exceeded expectations.  Many older people and their allies potentially missed out on accessing information and support because of significant delays. Furthermore, many providers reported receiving incomplete referrals from the My Aged Care contact centre which delayed providing support to older people and their allies. Additionally, access issues for Culturally and Linguistically Diverse (CALD) people and Aboriginal people were underplayed in the design of My Aged Care. While My Aged Care has responded to some of these issues and concerns, more in-depth testing of the system could have reduced the level of disruption experienced by the sector.

Similar experiences have been reported with the implementation of the NDIS My Place Provider Portal from 1 July 2016. Providers have struggled to upload information for payment including bulk uploads.  Significant delays and issues with the portal meant that providers were not paid[6]. The government had to step in and make emergency payments to providers to ensure that staff continued to be paid. For small organisations with limited cash flow, issues with the NDIA provider portal has posed a serious risk for their financial survival and without the emergency funding from the government, many providers would not have been able to meet their existing liabilities. The review of the business case and process for the development of the NDIS My Place Portal identified serious issues with the service delivery operating model, sector engagement and resourcing to implement the changes[7].

The experiences of the roll out of My Aged Care and the NDIA My Place Provider Portal highlight the importance of planning, consultation and appropriate change management strategies in implementing reforms.  Some issues could have been addressed if there had been adequate testing of the portals, as well as more time and resources for stakeholders to implement proposed changes. The political imperative to progress with the reform agenda appeared to override concerns about the sector readiness for change.

Digital Disruption -Friend or Foe?

The emergence of on-line platforms has the potential to provide information to people who use social care services in Australia. However, the design of web-based platforms needs to involve the people who will use the system and not just by technocrats. There should be careful planning and consideration of operating models, and what change management strategies need to be put in place including appropriate time frames and resourcing to support all stakeholders to implement changes.

The reforms currently being implemented for older people and people with disability and their allies across Australia could easily have been derailed because of poor system design and implementation plans. The lessons from the rollout of My Aged Care and the NDIS My Place Provider Portal clearly highlight the importance of time, engagement and appropriate resourcing to ensure that digital changes are implemented in an effective manner.