In the wake of the Covid-19 pandemic, vaccines are being developed around the world at unprecedented scale and speed. The reason scientists have been able to work at such an extraordinary pace? The system in which they work has specialist institutions to conduct research, ways of sharing knowledge between researchers, standardised processes to ensure effectiveness, and incentives to innovate – be that profit, research kudos – or both.
In other words, the pharmaceutical industry is set up to innovate.
When it comes to tackling social challenges, those R&D systems simply don’t exist
This structured approach is markedly different to the current approach to research and development in tackling social challenges, which lacks coordination, intentionality and resourcing. The recent interim report from the Royal Commission into Aged Care hits the nail on the head:
“Australia prides itself on being a clever, innovative and caring country. Why, then, has the Royal Commission found these qualities so signally lacking in our aged care system? We have uncovered an aged care system that is characterised by an absence of innovation and by rigid conformity. The system lacks transparency in communication, reporting and accountability.
It is not built around the people it is supposed to help and support, but around funding mechanisms, processes and procedures”.
Service providers are not at fault: innovation, intelligence and responsiveness have not been designed into the system. There’s little to no incentive to innovate, few resources to do it, and few structures to support it.
For example, the 2020 Productivity Commission found that “after decades of developing new policies and programs and modifying existing ones, we still know very little about their impact on Aboriginal and Torres Strait Islander people, or how outcomes could be improved”. These are services that can save lives, or destroy them – and yet we don’t know if they ‘work’, or make things worse. Can you imagine such a lackadaisical approach to vaccine development?
For greater social outcomes, we must organise as a system
Take Australia’s agricultural industry, for example. It competes in a global market with the help of a coordinated network of Rural Research and Development Corporations, part funded by government, part by industry. They commission research, support the application of new ideas, and provide training to farmers. While one egg producer competes against another in the supermarket, the Australian Egg Corporation Limited Corporation is raising the benchmark for performance across the board. Everyone wins.
Unfortunately, the approach to competition and collaboration can be quite different in NGO ‘markets’. For example, at TACSI, we’re currently working with NGOs to address addiction across a city. The services compete for contracts in a government quasi-market, which means they don’t share what they know about what works (or what doesn’t) with each other. Each believes they have the best service, but they can’t all be right.
Who does this market benefit? It’s not good for people living with addiction, because they can’t make the informed choice between the options, the way they might between eggs at a supermarket. It’s not good for the taxpayer because it doesn’t allow the most effective ‘value for money’ approaches to emerge. And it’s not good for mission driven providers because it prevents them from learning about what works best, for whom, when and how. Markets like this stifle innovation, and thwart value for money at their best. At their worst, they perpetuate harm and injustice.
A number of value-driven not-for-profit service providers pursue innovation because they believe in better outcomes, but the lack of formal incentives to innovate is remarkable. For the most part, finding a better way of doing things will not guarantee service providers a better bottom line, the take-up of their innovation, or status or recognition. Organisations engaging in innovation risk their bottom line, and risk developing new service models that work better, yet don’t fit tightly prescribed contracting guidelines.
We must look beyond our traditional views of R&D
We believe that through the development of R&D systems focused on tackling our biggest social issues we can make progress faster, bridge the gap between institutions and people, and we create systems and supports that are fit for now and the future.
The social sector could be saving more lives and increasing its productivity if research and development was built-in. Imagine if our systems championed outcomes, spread what works, incentivised innovation that discovered what works, provided technical and financial support for innovation, and supported people to train as innovators in their chosen field.
There are some things that social R&D can learn from agriculture, pharmaceuticals and other industries, but we cannot wholly transpose the approach from one sector to another. In a social R&D system, we will need to think carefully about how to coordinate innovation on intertwined issues, how to ensure ethical experimentation and how to put the views of the beneficiaries – people often marginalised by current systems – at the centre of decision making. Social R&D systems will also need to mesh with systems of social policy development. But these are considerations, not barriers to action.
Why we need to embrace a more mature approach to social R&D
There are four reasons why we should be embracing a more mature approach to research and development as part of reform:
Addressing the basics would lead to big improvements. Some of the very fundamental aspects of intelligent system design are missing from many social systems. Typically, they don’t incentivise meaningful outcomes, spread what works, or encourage experimentation with better alternatives.
The financial stakes and potential gains are significant. Social issues are costly, the Productivity Commission identified a $220bn annual cost associated with more mental health, that’s nearly four times the value of Australia’s agricultural industry, into which the government invests over $300m annually for innovation.
Systems need to be more person-centred. Putting people at the centre of research and development decision-making would lead to the emergence of systems that were genuinely person-centred in practice, not just in name.
We live in turbulent times. While we can’t predict what’s around the corner, we can prepare our systems to be adaptive and responsive to changing needs and norms.
Big reforms, like those expected in aged care and mental health, are our opportunity to set up our social systems for a smarter, more responsive, and more resilient future.
In 2021, we’ll be publishing a longer paper on the potential for social Research and Development systems, profiling in more detail what we can learn from agriculture and pharmaceuticals and imagining what a more mature approach to research and development would look like in mental health, aged care and home and housing.
This work builds on conversations with the Royal Commision into Aged Care and our joint submission to the Accelerating R&D in NSW review that was developed in partnership with Martin Stewrt-Weeks with thinking from RMIT, Monash Sustainable Development Institute, Centre for Social Impact, Geoff Mulgan, Uniting NSW & NT, Donkeywheel Foundation and Sydney Policy Lab.