Insight 1: Community demand and expectations are growing

Community demand for human services is expected to increase due to an ageing population, an increase in chronic illness and a reduction in informal care, as care givers return to the workforce. The expectation that services will be high quality, equitable and easily accessible is also growing in Australia.

Australia’s ageing population is driving demand for care and support services

One of the most significant trends shaping Australia’s future is an ageing population, driven by increasing life expectancies and declining fertility rates.⁴⁰ As a population, Australia is ageing at a rapid rate, a trend kick-started in the early 2010s when the baby boomer generation started to reach the age of 65 (see Figure 5).⁴¹ The number of Australians aged over 65 years is projected to grow to by 6.1% over the next 40 years, with almost half of that growth projected to be among those Australians aged over 85 years. Older Australians are expected to represent 23.4% of Australia’s population by 2063.⁴² Australia’s ageing population is a driver of increasing demand for human services, including aged care and health services.

Figure 5. The proportional age structure of Australia’s population⁴³

The needs of an ageing population vary across Australian communities and the human services requirements are diverse.

The age structure for Aboriginal and Torres Strait Islander people is younger than that of non-Indigenous Australians, due to higher fertility rates and lower life expectancy.⁴⁴ While the population of Aboriginal and Torres Strait Islander people is also gradually ageing, it is at a slower rate than non-Indigenous Australians.⁴⁵ Over 15 years, between 2016 to 2031, the proportion of Aboriginal and Torres Strait Islander people over the age of 50 is projected to increase from 16 to 20%.⁴⁶ The needs and experiences of older Aboriginal and Torres Strait Islander people are unique, with cultural connection an important aspect of wellbeing and Elders’ significant role in community (providing cultural wisdom and support).⁴⁷ It is important for many older Aboriginal and Torres Strait Islander people to be able to receive support in-place, in community, and from a culturally competent provider.

As Australians live longer, the number of years that Australians live in ill-health is expected to rise.⁴⁸ Older Australians, in particular, are likely to experience multiple, overlapping health conditions as their life expectancy increases. In 2022, approximately 94% of Australians over the age of 85 lived with a chronic condition, contributing to growing demands for human services.⁴⁹ As age is a common and unavoidable risk factor for many chronic conditions, there will be increasing pressures for the treatment and management of ill-health in Australia in the long-term.⁵⁰

The Australian government estimates that approximately 40% of the projected increase in government expenditure over the next 40 years will be attributable to demographic ageing.⁵¹

Increase in chronic illness is also driving demand for human services

Advances in medicine have dramatically decreased mortality rates from infectious diseases, meaning that chronic conditions are now the leading cause of ill-health.⁵² In 2022, 61 % of Australians were living with at least one chronic condition and 38% of Australians were living with 2 or more chronic conditions.⁵³

Chronic conditions are generally characterised by their long-lasting and persistent effects. Once present, symptoms often persist through a person’s life and require long-term management, including support from healthcare and other professionals.⁵⁴

Mental illness is increasing, particularly among younger Australians. As the onset of most mental disorders begins during the transition to adulthood, the impact of mental illness across Australians’ lives can be profound.⁵⁵

Dementia and chronic liver disease are among the other fastest growing chronic conditions.⁵⁶ Should the prevalence of many chronic conditions continues to rise, Australians will require more services to support the treatment and management of their conditions.⁵⁷

It is estimated that 38% of the total burden of disease in Australia is preventable by reducing exposure to various behavioural, metabolic, dietary and environmental risk factors.⁵⁸ Preventative measures which strengthen health determinants are the most effective way to reduce the risk of Australians developing chronic conditions.⁵⁹ Strengthening determinants of health likewise support those already managing
chronic conditions by easing symptoms and work to improve the lives of Australians.⁶⁰

The return to work of informal care givers is increasing the demand for formal care

In the decade between 2012 and 2022, the care workforce grew by 65%, compared to a 53% growth in the overall Australian workforce.⁶¹ This trend is projected to continue, with the care and support workforce expected to double by 2050.⁶²

The growth in the care sector is, in part, a result of the transition from informal to formal care, particularly as women’s participation in the workforce has increased.⁶³ This shift has resulted in greater demand for government human services, such as childcare, paid parental leave, aged care, disability and carers support.⁶⁴

During consultation, Australian community members reported feeling time poor and overwhelmed with the pressures of managing multiple responsibilities. Some adults reported caring for ageing parents at the same time as caring for young children. The lack of synchronicity between school times and work times was mentioned by some survey respondents and workshop participants as a stressor for families with young children, with families struggling to find meaningful family time around other obligations.

Expectations for personalised, integrated and accessible services are growing

Australians’ expectations for high quality human services are growing.⁶⁵ The quality of human services is very closely related to concepts of equity and access.⁶⁶ Community service providers noted the growing community expectations around ‘universal minimal government service guarantees’ – the minimum standards for the amount, quality, and accessibility of services provided by government. Government providers noted the increase in requests for highly individualised services as opposed to services provided in small and medium group settings. For example, in seeking NDIS and family services, people were increasingly asking for a 1:1 service resulting in wait lists and others missing out.

During the consultation, we asked Australians about the extent to which they want services to be universal or personalised to meet the specific needs of different people. Most respondents (59%) expressed satisfaction with the breadth of current human service offerings. People experiencing marginalisation and disadvantage expressed higher rates of dissatisfaction with the accessibility and availability of human services and were seeking more integrated and personalised human services.⁶⁷

Currently, over half (58%) of Australians trust public services and the majority (68%) of Australians are satisfied with the public services they accessed in 2024.⁶⁸ Life satisfaction, age, location, gender and major life events, experiences of hardship, vulnerability, marginalisation and inequality are all negatively associated with trust, based on multiple years of surveying.⁶⁹

Community service providers identified ‘market failure’ in regional and remote Australia due to limited providers, a lack of scale, the high cost of service delivery and access challenges associated with long distances. Insufficient or ‘thin’ markets do not exist solely in rural and remote contexts; they also result from a shortage of providers who can meet specific cultural or material needs of communities, including for First Nations people, homeless, LGBTQIA+, or culturally and linguistically diverse Australians.⁷⁰

Service providers also raised the challenge of unmet demand when services are capped. The demand for services, particularly in aged care, can exceed the funding or places available resulting in long waiting lists and forced rationing.

Insight 2: Expenditure on human services is projected to grow

Human services expenditure, in particular for health, aged care and NDIS, is forecast to be the major spending pressure for the Australian Government over the medium and long term.⁷¹

Government spending on human services will need to be targeted and effective in delivering outcomes to Australians who need it most to ensure the long-term sustainability of the Australian Government’s budget.⁷²

Long-term projections show human services as the major budget pressures

The Intergenerational Report identifies health, aged care and the NDIS as the top three long-term spending pressures for the Australian Government (see Figure 6).⁷³ NDIS payments are expected to grow fastest over the next decade, while health and aged care are expected to grow most quickly towards the end of the 40 year projection period, as the population ages.⁷⁴ In contrast, spending on the Australian Government age and services pension is projected to decrease from 2.3% of GDP in 2022-23 to 2% of GDP in 2062-63, in contrast to most OECD nations.⁷⁵ The decrease reflects the shift towards superannuation being the main source of retirement income and means testing of the age pension to support those most in need.

Figure 6. The top five spending pressures and projected increase as per cent of GDP to 2062-63⁷⁶

Government expenditure on human services workforces has risen in recent years to address historical under-provision or under-valuation of these services. For example, the Australian Government is investing in wage increases for aged-care nurses and childcare workers. The increasing demand for welfare workers is also expected to continue in aged care, disability, early childhood education and care services.⁷⁷

Outsourcing of human service delivery is not delivering the efficiencies anticipated

The Australian Government outsources the provision of some human services by contracting private sector and not-for-profit providers. The trend to outsource human service delivery and introduce market discipline aimed to increase efficiency, bring in competition and empower service users to choose between providers to best meet their needs.⁷⁸ The Productivity Commission found that not-for-profit organisations were the major providers in most human service areas across Australian governments and that there were around 20,000 non-profit organisations in the human services sector that relied on government for their main source of funding.⁷⁹

Evaluations of the market-based model show that it can work well for Australians who have straightforward and quantifiable needs. However, as shown in Table 2, Australians with more complex or nuanced needs can see poorer outcomes.⁸⁰ During consultation, many experts raised concerns that the market-based model for delivery of human services was not achieving the efficiencies anticipated. The lack of market incentives for contracted providers to work on the most complex cases was also raised during consultation.

Table 2: Efficiency savings through outsourcing by type of human services

Insight 3: Complexity is impacting access to services

Access to human services is being impacted by complexity in the system and fragmentation in service delivery. Additional barriers such as stigma, shame and physical distance are also impacting access to services.

For Australians with complex needs, First Nations people, victim-survivors, young people (aged 18 to 24), migrants and communities in regional and remote Australia the challenges of access to services are often compounded.

Complexity in the system is a barrier to accessing human services

System complexity is often the result of outsourcing, competition, fragmentation and unnecessary process in the provision of human services.⁸¹

During the consultation, Australian community leaders and community organisations consistently raised concerns about complexity in the system. A third (32%) of young people (aged 18 to 24) surveyed highlighted difficulties in navigating government human services, describing the systems as overly complex and inaccessible. Australians who experience multiple, overlapping and complex issues report the human services system is increasingly challenging to navigate.⁸²

The most recent annual trust in Australian public services report found that one in five people who accessed government services reported dissatisfaction, with the top concerns being complex system processes and challenges with access to services.⁸³

To address the complexity, there has been increased investment in professional system navigators to support those trying to access human services. For example, the Aged Care System Navigator and the Australian Cancer Nursing and Navigation program are 2 large-scale system navigators (see case studies below for further details).

Siloed service provision is exacerbating fragmentation across the system

During the consultation, Australians highlighted the disconnect between services, the lack of a singular entry point, and the circularity of systems as common barriers encountered in seeking to access government services. The separate organisational lenses also create a siloed view of needs, which does not always account for people’s holistic circumstances and results in service providers appearing insensitive to people’s lived realities.

Government silos were frequently referenced as preventing the provision of comprehensive care that addressed the multidimensional needs of Australians. Silos were identified between government departments as well as between levels of government. The burden of having to engage with multiple departments, led to people experiencing navigation fatigue or simply ‘falling through the cracks’. Community members reported meeting numerous ‘dead ends’, not knowing where to go to next, or becoming frustrated by constantly needing to re-explain oneself and one’s circumstances.

Legislative barriers also prevent data sharing, for example between Centrelink and Medicare, and prevent a ‘tell us once’ approach. This means service users have to repeat information and details of their situation to multiple human service providers.

Siloing was described as existing within agencies as well as between agencies, with hierarchies compounding fragmentation and complicating access. Regional operational staff reported feeling disempowered to make decisions or innovate and not supported to share decision-making with the community.

Beyond the silos, there is also complexity created by the inconsistency in the fundamentals for each service. Some services are means-tested (targeted to those with the highest need) and some are universal (provided to all). Experience from one service area can lead to expectations of another service.

Other barriers such as stigma, shame and distance are blocking access to services

Common barriers to access that were raised during community consultation include stigmatisation and shame, fears for safety, caring responsibilities, lack of transport options and unsuitable opening hours. Victim-survivors of family and domestic violence reported encountering additional structural barriers such as child support decisions, challenges to attending court dates and seeking legal advice/representation.

These challenges are also contextually defined, taking on different forms when encountered by migrants and refugees, those who face language barriers, those with low levels of literacy, Aboriginal and Torres Strait Islander peoples, people with disability, partners of veterans or law enforcement officers, LGBTQIA+ people, or people living in regional and remote areas.

Aboriginal and Torres Strait Islander peoples often experience significant barriers to accessing healthcare. In 2018-19, 30% of Aboriginal and Torres Strait Islander people (243,700 people) reported that they needed to but did not see a health care provider on at least one occasion in the previous 12 months. Those who did not see a healthcare professional reported that competing priorities, cost and service availability were the main barriers impacting access (36%, 34% and 33% of respondents, respectively). In addition, 23% of respondents reported a dislike of available services, including because of fear and embarrassment, creating barriers to access.⁸⁹

Around 7 million people (or 28% of Australians) live in rural and remote areas, where access to services is limited by distance, lack of public transport and limited availability of service options.⁹⁰ Some common barriers experienced by rural and remote communities shared through this consultation were around cost, workforce challenges, lack of infrastructure and lower levels of trust in government. Migration from cities into regions is likely to continue over the next decade due to factors such as the high cost of living in major cities and growing demand for clean energy workforce.⁹¹

While many Australians experience disadvantage at some point in their lives, for most, it is temporary. Entrenched disadvantage, however, affects a small but significant proportion of the Australian population. Entrenched disadvantage is multidimensional: a combination of poverty, deprivation and social exclusion. There are around 700,000 Australians currently experiencing persistent and recurrent poverty, indicative of entrenched disadvantage.⁹² Whilst Australia has relatively high income mobility, people at either end of the income distribution are more likely to remain there, contributing to enduring entrenched disadvantage and divides. Entrenched disadvantage can be a self-reinforcing cycle that passes from one generation to the next, with studies showing that children raised in welfare-dependent families are significantly more likely to rely on social security in adulthood.⁹³ No single human service is likely to offer adequate support for those experiencing entrenched disadvantage. Place-based partnerships can be an effective method to identify and address areas of entrenched disadvantage in Australia’s communities; see case study below on The entrenched disadvantage package.