It recently came to light that the federal government has paid more than $66 million to the consulting firm McKinsey & Company since 2016, with $33.5 million paid in 2021-22 alone. While this is notable, it isn’t necessarily surprising: firms like McKinsey, KPMG, Deloitte, and Ernst and Young have played a significant role in federal and provincial policy-making for many years now. That being said, it’s a fact that isn’t widely understood among the Canadian public.
In response to the news about McKinsey, journalist Paul Wells has suggested that we should be asking more questions about how our taxpayer dollars are being used for these types of contracts, and about what the tangible results are for people.
In Ontario, developmental service organizations have become very familiar with KPMG, the consulting firm that is leading a government-commissioned study that aims to understand the per-unit costs of the services these organizations provide. KPMG also presumably performed the related scoping research that was first commissioned by the provincial government in 2019, and played a role in the development of the Journey to Belonging strategy itself.
KPMG’s role is important to understand because Journey to Belonging strongly reflects a model, called ‘commissioning in human services,’ that the firm has helped implement around the world. According to KPMG, ‘commissioning in human services’ is an approach that positions government as an overseer of markets for social services. At its most basic, commissioning is centred around ‘service users’ (a KPMG term) planning for and purchasing health and social services. The language that KPMG uses to describe the model is strikingly similar to language contained in Journey to Belonging, as shown by a few examples:
|KPMG, “Unleashing Value”
|Journey to Belonging: Choice and Inclusion
|“The influence of technology on many of our lives means that people – especially younger generations – expect to be able to interact with government in the same way they interact with other service providers, such as banks, retailers, or couriers.”
|“Our plan will focus on modernizing services, making them more user-friendly and improving the service experience for people and their families.”
|“This trend is accelerated by moves towards giving people direct purchasing power and, consequently, more choice over which services they receive. As new delivery models are developed, service users will need to be able to choose between, and distinguish, services based on price and value.”
|“Moving towards a funding approach that gives people greater choice and control over their supports will play an important role in promoting service quality. Individualized funding can encourage service providers to innovate and provide high quality services that deliver the best possible outcomes for people.”
|“Moving to a person-centered model means providers are no longer able to rely on secure, recurrent funding from governments, but are instead required to attract users in an increasingly competitive market.”
|“Implementing an evidence-based funding model will allow us to make funding decisions based on the current needs of people, instead of historic arrangements.” “Our plan will… promote healthy competition among providers and reward innovators.”
|“While a government may no longer directly deliver services, it must monitor and manage the performance of service providers to ensure targets are met and identify and manage risks. Its role becomes one of oversight, providing essential assurance to service users that service quality will be maintained.”
|“We also want to be able to measure how well different parts of the system are performing in order to improve the quality of services for people. To help achieve this, we will introduce a performance measurement approach to measure outcomes for people and get feedback on their service experience.”
In his reflections on the federal government’s recent payments to McKinsey & Company, Paul Wells worries about “the contracting-out of complex problems to private firms that charge a premium; are never around when problems arise later; often produce work of questionable quality; and are too often exempt from even the minimal transparency and accountability that’s expected of work done in-house by the regular public service.”
Should we have concerns about the apparent influence of KPMG on Journey to Belonging? Should we be worried about what happens to the strategy – which aims to completely change the way developmental services are funded – when KPMG’s work is done and they move on to other contracts?
KPMG has offered advice on their own model that gives us a few reasons to be troubled. The firm has said that “the realization of outcomes and benefits expected from commissioning are not easily achieved.” In particular, they note that “if the market is not ready for a new approach, imposing a commissioning framework is likely to fail.” Additionally, they point to the model’s “potential to destabilize the pool of providers, especially where a few major providers supply a range of interdependent services, or where present provision is a poor match for population needs.” Perhaps most strikingly, the firm has written:
“Providers may not have the capacity or capability to respond to the new approach, or may be unable to provide services in the innovative way that the commissioner expects. This can lead to a complex commissioning arrangement that ultimately sees no change in service delivery but a substantial increase in administrative costs, or worse, a lack of provider engagement with the commissioner, rendering the whole process ineffective and wasteful.”
In other words, there is no guarantee that the main objective of Journey to Belonging – changing the way service agencies are funded – will actually lead to improvements in the system.
In this day and age, the provincial government’s use of KPMG to develop a new strategy for developmental services is not unusual. However, in light of the recent news about McKinsey, it will be important to listen to what is likely to be a growing critique of this approach. It is also important to understand that Journey to Belonging is part of a global trend in human services, rather than a tailored response to the specific needs and realities of people who have intellectual and developmental disabilities in Ontario.
Journey to Belonging is still in an early stage, and it is incredibly important that we get it right. It is crucial that people, families, and organizations continue to have input into its evolution, and that the provincial government takes corrective action when necessary. Understanding where the strategy came from, and where it is going, will allow all stakeholders to be clear about what the strategy means for people who have intellectual and developmental disabilities in Ontario, and to provide relevant direction and feedback.