Policy made simple: key concepts and processes at COTA

Policy made simple

COUNCIL ON THE AGEING (AUSTRALIA)

POLICY MADE SIMPLE: KEY CONCEPTS, TERMS, IDEAS AND PROCESSES RELATED TO POLICY AND POLICY CHANGE

Written by Veronica Sheen, National Policy Officer
and first presented by Helen Scott in May 1999
to the HelpAge International Workshop on Practical Tools for Policy Development, Chiang Mai, Thailand, 3-5 May 1999

May 1999

1. Identification of issue
2. Scoping of issue
3. Analysis of current policy/programs
4. Policy development phase
5. Strategies for obtaining change
6. Evaluation and monitoring of outcomes

Summary
Common mistakes

1. IDENTIFICATION OF ISSUE THAT NEEDS TO BE ADDRESSED IN PUBLIC POLICY

Community care in Australia
Australian example: Older people with low care needs in Australia failing to get adequate preventive services to remain in their own homes.

Profile of typical older person with low care needs: eg a man or woman in their seventies on a full age pension, recently bereaved, doesn't drive anymore due to failing eyesight, no family close by, moderate but frail health and mild memory loss. Can continue living at home with household help twice a week and gardening once a month otherwise would need to go into residential care.

Issues will be identified through:

observation of service providers (this may be most likely scenario in developing countries)

families/community/older people contacting service providers or other agencies (eg through SIS about the problem)

specific research studies (eg Social Policy Reseach Centre study of community care)

2. SCOPING OF ISSUE

How widespread is the problem?

How severe is the problem?

Eg not widespread but very severe?

Not very severe (like homelessness) but can lead to more severe problems without prevention

What age group most likely to be affected? Other characteristics – male/female, non-English speaking, rural/remote?

In Australia, lack of low level assistance to older people to remain in their own homes is identified as a widespread but not a severe problem but one which can lead to severe problems because not enough prevention.

3. ANALYSIS OF CURRENT POLICY/PROGRAMS TO DEAL WITH THE PROBLEM

Key questions:

Is there a policy?

What is state of play with current policy?

What programs support the policy?

What are the problems with the policy?

What are the politics involved in getting changes to the policy?

Policy for community care

Current Australian Government policy:

to encourage older people to remain in their homes rather than go into institutional care which is expensive.

Program to support policy:

Home and Community Care (HACC) program which provides wide range of services to assist older people at home: eg housecleaning and gardening, basic home modifications, community transport, basic nursing care eg wound dressing, some allied health services

Problems identified with the policy

Resources from HACC being concentrated on very high need clients particularly clients being discharged from hospital who need intensive assistance at home

Resulting in cut backs on services for low care need clients or no access at all undermining the preventive purpose of HACC

Little access to HACC in rural areas and inadequate HACC funded community transport in rural/remote areas a particular problem

HACC losing its preventive aim – to help older people remain at home and prevent older people going into residential care

Demand for HACC services not keeping up with supply due to ageing population

User pays policy in HACC implemented a few years ago may be preventing access of older people on low incomes

Analysis of politics of the issue

What is the Government's stake in the issue?

What will be the main barriers to getting Government to address issue? Eg resource constraints, tight budgets, other priorities?

What is the Government's underlying philosophy/ideology? How does our policy issue fit with this?

How important is the issue to your organisation/ constituency?

COTA's assessment of the community care issue:

For Government it is an important issue because of the costs of residential care

Older people and their families want adequate community care and are concerned there is not enough

Government has a philosophy/ideology to promote independence and self-sufficiency so are likely to well-regard policy recommendations that fit with this. However such is not always the case. At the same time the Government has tight Budget parameters and doesn't want to spend any more money on social programs.

Assisting older people to remain at home is a key COTA and older person's priority policy area.

bi-partisan political support for this policy

4. POLICY DEVELOPMENT PHASE

What policy changes are needed so that low care need older people can get assistance they need to meet policy objectives?

What are the policy options?

more Government funding for HACC

greater share of HACC resources to go to low care need older people rather than high care need

change hospital early discharge policy

argue for new Government program that targets low care need older people

more user pays (this is the main option tried by the Government in recent years, doesn't seem to be expanding pool of funds and seems to be creating barriers to access)

COTA's preferred policy options:

More resources for HACC as problem partly related to ageing population and increased demand. Resource levels not keeping up.

Better resource allocation so low care need people get greater share of HACC resources involving changes in hospital early discharge practices with greater emphasis on rehabilitation and step down facilities prior to the person returning home so that more low care need older people obtain services.

Reduce Government reliance on user pays for HACC funding.

5. STRATEGIES FOR OBTAINING CHANGE OF GOVERNMENT POLICY AND TO GET OUR POLICIES ADOPTED

Three stage strategy

1. Obtaining Government recognition of problem

Provide strong evidence that problem exists – good research using solid research methodologies, evidence from service providers, number of phone calls/letters received on issue etc.

2. Develop realistic/possible recommendations/options that Government is likely to consider

Eg rather than asking for an additional $100 million for program in one year ask for:

incremental increases eg an additional $20 million over the next four years

a review of existing resource allocation with view to obtaining greater share of resources for low care need clients. Key questions for a review:

Are resources being used efficiently, effectively, equitably?

Should HACC be serving early hospital discharge patients?

Can pressure be placed on hospitals and health care system to provide better rehabilitation/step down facilities?

Are the policy objectives of HACC as a preventive program being met under present practices?

What is the role of user pays?

3. Advocacy processes

Budget submission
COTA develops a submission each year for the Federal budget – HACC is major area for policy recommendations.

Special reports
COTA may do a specific report on an issue it feels is important to older Australians. Articles in regular newsletters such as COTA's policy bulletin ReportAge, and member journal COTA News are another way of highlighting issues.

Submissions
In Australia special inquiries may be undertaken which provide an opportunity for airing of issues – Senate inquiries, Productivity Commission, Government evaluations.

Media strategy
Highlight issue through contact with media – speak to journalists; send out press releases; copies of reports, case studies etc.

Direct lobbying (face to face and letters) to Ministers, advisers and senior public servants about the issue
This is very important. COTA National Executive Director and other COTA representatives spends a lot of time in Canberra building relationships with Government to further aim.

Target backbenchers, Senators, Opposition
From time to time COTA writes to backbenchers so they will pressure their parliamentary leaders on an issue. In Australia, the Senate can have an important role in having the final say on policy outcomes. A change of Government may also provide an opportunity for obtaining policy change so it is important to influence the Opposition.

Community campaigns
Letter writing, visit to local MPs etc, holding a special meeting or conference on an issues and invite Ministers and other Government officials to attend and speak

Encourage older people to write to Minister/PM relating their specific experience of problem
This can be a very effective tool.

Representation on committees
The Government may establish a Committee to review particular policy issues. COTA is represented on a wide range of Government committees.

6. EVALAUTION AND MONITORING OF OUTCOMES

After a campaign on a public policy issue, it is important to assess how effective the campaign has been.

Key questions:

Has any change in policy been achieved?

Has the Government chosen to address the issue in a different way from your recommendations? Is this effective?

Is the Government more aware of the issue/problem?

Are there any reviews or inquiries in train?

Is there greater community awareness?

Do we need to rethink our policy recommendations?

Do the recommendations need to be less ambitious?

Does the strategy need to be redirected?

Is the community support for the issue as strong as it was in an earlier period, say one year ago?

Is the issue still important to older people?

What have been the main barriers to obtaining policy change?

COTA goes through this process of reassessment of its recommendations on a wide range of policies at least every year, in the process of preparing a submission to the Federal Budget.

As a result we may:

- change our priorities

- revise recommendations

- drop out some policy recommendations and some policy areas altogether

- put in others that better reflect current public policy debates

SUMMARY

Obtaining policy change can be a long process taking many years in some instances. Change is often most likely to occur incrementally by chipping away at an issue rather than getting major systems change.

It is important to keep in mind that radical system change can cause as many problems as it is designed to solve. An incremental approach may be best.

Some policies that you believe are important may never be adopted for a wide range of reasons: eg too expensive, lack of bi-partisan support, not culturally appropriate.

By carefully following a professional and clear-sighted process as outlined here, the possibilities of obtaining change is increased.

COMMON MISTAKES IN POLICY

Making recommendations that are wildly unrealistic and/or which are way beyond the underlying philosophy/ideology of the existing Government: It may be that you want the Government changed but in that case policy goes into the political realm which is outside our terms of reference here.

Getting the Government off-side so it will no longer talk to you or listen to you: Keeping lines of communication open is essential.

Having inadequate supporting evidence for your case: not doing your homework and background research thoroughly.

Presenting to the Government as overly emotive: this will put many people in Government off-side and rarely helps your case.

Not being consistent and not delivering clear messages: this may mean you are not clear about what your aims are.

Being seen as too strongly allied with the Opposition: try not to make your policies look as if they might be those of the opposing political party.

Not having a unified voice amongst your members
This may mean that you have not engaged your constituency adequately in the policy development process and they are unhappy with your approach or do not understand it.

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Council on the Ageing (Australia)
Level 2, 3 Bowen Crescent, Melbourne Vic 3004
Tel (03) 9820 2655 Fax (03) 9820 9886
email cota@cota.org.au