What's at risk in the proposed changes to the Australian Institute of Health and Welfare?

Several weeks ago we posted a piece from former Deputy Prime Minister Brian Howe, who was reflecting on his vision for the Australian Institute of Health and Welfare. Below, Richard Madden the former director of AIHW reflects on Brian's concerns, and what's at risk if AIHW were to lose its welfare functions.

Richard is a late addition to Power to Persuade 2014 Symposium, joining us for the afternoon session to discuss lessons on working across sectors to advance data collection and monitoring.

The 2014 Commonwealth Budget includes a proposal to merge the Australian Institute of Health and Welfare (AIHW) with a range of other health bodies into a Health Productivity and Performance Commission. This endangers AIHW’s independent data collection and reporting.

Australian health, community services and housing assistance systems are complex: they are delivered by three levels of government, a range of private professionals, companies and not-for-profits. They are funded by governments, insurers and individuals …so if we want reliable, consistent and timely data a lot of players need to agree to cooperate.

National data dictionaries were developed under National Information Agreements in the health, community services and housing sectors; these standards are now collected together in an online metadata registry (METEoR), the envy of statistical agencies in other federations. AIHW publishes a wide range of statistical series on a routine basis. Flagship publications Australia’s Health and Australia’s Welfare are required under the AIHW Act to be published every two years, and must be tabled in Parliament.

In short, for over 20 years, the AIHW has provided detailed information and descriptions of the Australian health, community services and housing assistance systems. Its reports are unbiased and provide a base for government policy making and community discussion. It is vital that the new administrative structure permit, and indeed require, this work to continue.

For health statistics, this could be achieved by requiring any new body to continue to carry out the health functions of the AIHW. But the reach of a new Health Productivity and Performance Commission will not extend to the AIHW’s community services and housing assistance functions.

So what is at risk? Australia’s Welfare 2013 provides an up to date briefing on each major area:

‘There are a range of significant data developments in progress in the children and young people sector. Several of these relate to the ongoing improvement of existing annual state/territory administrative data collections. Other projects reflect ongoing efforts to improve measurement in relation to long-term COAG National Partnership Agreements.’ (section 4.8). These developments cover early childhood education, care and child protection (including educational outcomes) data and youth justice.

‘The policy environment for providing support to people with disability has changed significantly... Major changes include the launch of (the National Disability Insurance Scheme), and new arrangements for HACC services for people with disability…There is a need to ensure the ability to provide a … national picture of services for all people with disability, irrespective of the funding source and service delivery setting…Until the full scheme is implemented, the vast majority of clients of specialist disability services will not be scheme participants and data on service provision will still be required. It will be important that data collection activities and systems across all services are broadly aligned and use consistent definitions so that comprehensive analysis of data about people with disability and the services they receive can continue’ (section 5.6). Up to now, an integrated disability statistics system across the NDIS, the ABS and AIHW remains unresolved, a significant flaw in the building of the NDIS.

The AIHW provides comprehensive data on ageing Australians, and services to support them in the community and in residential care (no longer part of the health portfolio). It reports on specific sub-populations such as Indigenous people and people born overseas. Section 6.8 reports plans to establish an independent and centralised National Aged Care Data Clearinghouse and develop recommendations for improving dementia data in Australia.

Homelessness information, based on comprehensive data, has been part of AIHW’s responsibilities since the mid 1990s. The Specialist Homelessness Services Collection demonstrates the impact of homelessness services, contrasted with the numbers of homeless people reported by the ABS. This information is particularly important given the continuing policy and funding challenges in this area.

Housing assistance policy is particularly uncoordinated nationally. AIHW brings together a comprehensive picture of housing assistance, including social housing and rent assistance, as well as information on demand for housing and overcrowding.

Australia’s Welfare also provides national reporting on community services workforce and expenditure. Last, it provides a comprehensive set of indicators of Australia’s welfare, covering healthy living, autonomy and participation and social cohesion.

All of the major social policy areas covered by AIHW are the subject of continuing program changes, and ongoing debate and proposals for further change. It is vital that there continue to be reliable and regular reports from an independent national statistical agency on the need for services and the services provided, across all government and private participants. In turn, these inform others reporting, such as COAG and the Productivity Commission.

The States and Territories (and NGOs) have great trust and confidence in the AIHW and have always been integrated in its governance. With most community services dependent on Commonwealth grants to the States, statistical reporting should not be managed by funding agencies, and not confused with their accountability requirements.

Ideally, AIHW can continue as it has in the past, with the same broad coverage of health and welfare. This can happen even if other health functions are added: AIHW in its early days assessed health technology changes, which did not clash with its statistical work. However, if a distinct Health Productivity and Performance Commission is established covering only health matters, then a separate agency should take over and continue the AIHW’s community services and housing functions. Absorption into the Department of Social Services would take away the independence that the AIHW has used to such good effect in building trust with all levels of government and the wide variety of (generally vulnerable) stakeholders.

What is at risk if the welfare functions of AIHW are lost? There would be no independent agency to monitor the effectiveness of new or future welfare policy, there would be limited knowledge of emerging areas of need: in short a less informed community.

The AIHW has an envied reputation across Australia and internationally. Let’s make sure reliable and trusted statistics continue.