Purpose People with intellectual disability have a low rate of employment in Australia and internationally. Their low employment rate is set within a context of limited employment choices. Further, the most common types of work currently undertaken by people with intellectual disability – open and sheltered employment – have limitations and may not be suitable for everyone. Expanding the employment choices available represents an important way forward, but evidence is needed to guide the expansion. This paper aims to contribute to the evidence required by comparing people with intellectual disability’s experience and outcomes in open and sheltered employment to their experience and outcomes working in social enterprises, which is becoming an important alternative employment option for this group. Design/methodology/approach The paper uses the qualitative accounts of 51 people with intellectual disability to compare experiences and outcomes in open, sheltered and social enterprise employment in Australia. Findings The paper finds that social enterprises combine some of the benefits of open and sheltered employment and thus expand employment choice. However, the level of business/market development and opportunities for employment in social enterprises are currently limited and require further development and scale to enable social enterprises to be an option for more people with intellectual disability. Policy implications are drawn out for expanding employment choice, in particular through social enterprise employment, for people with intellectual disability. Originality/value The paper offers the first three-way comparison of open, sheltered and social enterprise employment for people with intellectual disability, contributing to both the disability employment and social enterprise literature.

Objective To explain how the Primary Health Network commissioning model works, and factors likely to affect its success. Methods The study focuses on the delivery of primary healthcare services by one Primary Health Network (PHN) in Australia. The qualitative case study is informed by a desk top review, interviews (n = 49) and observations with key stakeholders involved in commissioning and delivering primary healthcare services in the region. Results The study provides several insights about the PHN model. First, conceptually, the PHN commissioning model is well suited to identifying and meeting local primary healthcare priorities, bringing together a range of stakeholders involved in healthcare provision. Second, although primary healthcare services are difficult to specify and measure, PHN staff use their content knowledge and experience, and relationships with providers and the community, to design services that meet the needs of consumers. Third, the success of this model may be undermined by short funding cycles and short lead-times, a focus on national rather than local priorities, and continual reductions in operational funding. This may result in more procedural forms of contract management, which may mean that changes in service need, provision and quality go unnoticed. Conclusions This study shows that although clever in design, the PHN model may not meet its full potential. Given continual changes to the model, including funding, further independent research should be undertaken to understand how PHNs adjust and whether services continue to meet the needs of the local community.

Human services, such as social supports and health care, have low contractibility; services are difficult to specify and measure, and difficult to manage when delivered by a third party. Services can and do fail, resulting in the inefficient use of public resources and potential harm to clients. This article develops a conceptual framing using transaction cost economics (TCE) theory to understand why human services are difficult to contract, and management control theory to understand how services might be managed. This identifies a potential tension between how low contractible services are managed when probity requirements are high. This is explored using a qualitative case study of an intermediary model of outsourcing, focusing on one of 31 Primary Health Networks tasked to commission primary health care under contract to the Australian Government. This study explains how design choices, making use of controls available in different organisational contexts across the intermediary model, overcame the tension between low contractibility and probity. This study adds to our understanding of the TCE characteristic of probity. A greater understanding of why this intermediary modelThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

No abstract