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Of commissions and consortia: a new model for aged care

Introduction by Croakey: The Federal Opposition stepped up its push against the so-called privatisation of Australia’s Aged Care Assessment Teams (ACAT) this week, calling on the Morrison government to abandon plans to put the service out to tender.

Under a widely-criticised proposal floated at the end of last year, ACAT and the Regional Assessment Service (RAS) will be amalgamated into a single workforce and put out to tender. It has been so poorly received the chair of the Royal Commission into Aged Care Quality and Safety took the unusual step of issuing a statement to clarify the inquiry’s stance.

Opposition leader Anthony Albanese called on the Morrison government to “abandon its plans immediately” in a speech to the Queensland Media Club last week:

The first interaction the elderly and their families have with the aged care system is through an aged care assessment or ACAT.  It is the first step to getting a home care package or entering a residential aged care facility.

Our aged care system is broken – and this Government wants to make it worse by subjecting ACAT to the indifference of the market.

There is a role for the market. But markets have no conscience.”

Labor have started a petition calling for the move to be scrapped and have hammered the point in Parliament this week, with Federal Liberal MP Russell Broadbent also breaking ranks to criticise the plan.

In this piece for Croakey, Michele Smith, aged and community care executive manager for Brisbane North PHN, explores whether important nuance has been lost in the present ACAT debate, and presents an alternative model for the aged care sector.


Michele Smith writes:

Objections to proposed new aged care assessment arrangements overlook the fact that a highly successful non-government model already operates in Brisbane, with proven systems in place to manage conflict of interest concerns.

Under the new arrangements, Aged Care Assessment Teams (ACATs) and Regional Assessment Service (RAS) agencies will be combined from April 2021 to form a single assessment workforce.

A tender process will select a network of assessment organisations responsible for assessing eligibility for access to all government-funded aged care services.

Vocal opponents have branded this a privatisation of aged care assessment and say assessment agencies that are also service providers may be tempted to refer clients to their own services.

Yet, evidence to the contrary exists.

A role for PHNs

Brisbane North PHN leads the Partners 4 Health RAS, a consortium of seven not-for-profit community organisations providing assessment services for the Commonwealth Home Support Program across the Brisbane North, Brisbane South and Cabool aged care planning regions.

The PHN performs the role of the consortium backbone organisation. It is not a provider of home support services and remains entirely independent of the assessment process.

This aligns with the core business of Primary Health Networks, of which Brisbane North PHN is but one of 31 nationwide: That is to commission, rather than provide, regional healthcare services.

Consortium members provide the assessment service, overseen by a government-funded lead agency (the PHN) responsible for commissioning, service delivery coordination, governance and performance.

The PHN reviews all new clients and allocates assessments to these community organisations.

Responding to the client’s needs through the best use of each community organisation’s expertise and capacity to undertake a timely assessment, are the prime considerations in determining which organisation is allocated assessments.

In addition, the consortium’s governance model ensures oversight of community organisation assessment performance and referral outcomes to prevent conflict of interest.

Staff undertaking assessments do not provide other aged care services and are separated from organisational staff that do.

Assessors can also alert the consortium to failures in the aged and community care system. The consortium can then try to tackle these issues through a collective impact approach involving the wider sector.

Surveys help us to measure client satisfaction and the feedback tells us our service is highly valued.

Tailored services

In part, the consortium’s focus on providing tailored services to older people from culturally and linguistically diverse groups, including Indigenous Australians, can be credited for this result. But our performance statistics tell the rest of the story.

Since its inception in 2015, the Partners 4 Health RAS has consistently outperformed against all Australian Government key performance indicators that measure timeliness, quality and, more recently, the embedding of wellness and reablement approaches into assessments.

The beauty is that this consortium model is transferrable and can be scaled up as needed.

For example, working in partnership with Primary Health Networks, only organisations that are best placed to provide assessments will be selected for local consortia.

They may require specialist skills in providing culturally appropriate services, or services in particular geographical locations, or to people with special needs.

Within hospitals, existing ACATs may indeed be the most appropriate assessment partner for that setting, so Local Health Networks could be part of a consortium led by the local PHN.

But outside hospitals, where the majority of assessments take place, it would likely be community organisations that have the necessary local connections and knowledge for this task.

Ultimately though, we must be guided by a philosophy of consumer choice and adopt a commitment to streamlined business processes and service delivery.

The consortium model has proved itself effective and reliable at managing conflict of interest, actual and perceived, in the provision of aged care assessment services.

It is our view that this is the ideal model for the proposed single assessment workforce.

Michele Smith is executive manager, aged and community care, at Brisbane North PHN

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FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014