Introduction by Croakey: The Albanese Government introduced a new bill last week to improve “transparency and accountability across the aged care sector” by giving the Inspector-General of Aged Care Bill the “necessary powers to investigate systemic issues across the aged care system”.
It has been two years since the Royal Commission into Aged Care Quality and Safety’s final report was released.
In a statement on the anniversary of the report’s release, Minister for Aged Care and Sport Anika Wells said:
The Royal Commission told us all that we must do better, be better, and this Government is not wasting a single day.
These are not new problems, but we are giving new energy to fixing them and we have already directly addressed 37 Royal Commission recommendations – that is, four times more than what those opposite did in 17 months.”
However, overall progress on implementing the recommendations of the Royal Commission “has been less than ideal”, according to aged care policy experts Charles Maskell-Knight and Dr Sarah Russell.
As the 1 July deadline looms for the recommended implementation of a new Aged Care Act, bold changes and active engagement with aged care lobby groups are among actions that “would lead to a more successful implementation of the reforms recommended by the Royal Commission”, they write below.
Charles Maskell-Knight and Sarah Russell write:
It is now over two years since the Aged Care Royal Commission final report was released by then Prime Minister Scott Morrison.
At a hastily arranged media conference at Kirribilli House, journalists were given half an hour and one volume (out of eight) of the Commission’s final report to prepare to ask questions.
Although the Prime Minister promised that “there will be plenty of opportunities to ask many questions; this isn’t the only day I’ll be standing before you on this”, he did not front any other media conferences on the issue before losing office.
The Federal Government released a response to the Royal Commission’s recommendations as part of the May 2021 Budget. It was full of “accepts in principle” and “sector consultation” – both phrases experienced observers understand as meaning “not any time soon, if ever”.
Even when the Government ostensibly “accepted” recommendations, such as that relating to increased residential care time, it delayed the timing, and was silent on the second of the two increases the Royal Commission recommended.
During the 2022 election campaign the Labor Party made a number of aged care commitments, including implementing both recommended increases in care time, albeit slower than the Royal Commission intended. After winning government Labor has proceeded with legislation and other steps to deliver on its promises.
Less than ideal implementation
However, as Charles Maskell-Knight has written on Croakey before, implementation of the Royal Commission’s recommendations has been less than ideal.
The aged care star ratings are a joke. As long as a nursing home has avoided regulatory action for a year, it can fail to meet the care time targets, and do badly on quality measures and consumer experience, but still receive three stars denoting “an acceptable level of care”.
More frequent financial reporting on the sector is all very well, but unless the reporting deals with the profit-shifting related-party transactions the reports still don’t provide an accurate view of the financial health of the sector.
The bill touted as delivering on the new Government’s commitment to greater transparency laid the groundwork for better reporting by government, but it failed to deliver on the Royal Commission’s recommendation to remove the blanket ban on members of the public obtaining information about a provider through Freedom of Information.
It is difficult to track progress on implementation of the Royal Commission’s recommendations because the Government is not publishing any kind of tracking information.
The Royal Commission addressed the implementation issue when it recommended that the Inspector-General of Aged Care should “report… directly to the Parliament at least every six months on the implementation of the recommendations” (Recommendation 148).
While the Government has now established the Inspector-General administratively, pending passage of legislation this year, there have so far been no reports on implementation. The Department of Health states that the interim Inspector-General will be “considering opportunities to report to Parliament, including on the implementation of Royal Commission recommendations”.
However, the exposure draft of the legislation to establish the Inspector-General does not include six-monthly reporting among the Inspector-General’s functions. It looks as if this will be another recommendation that is simply ignored by government.
Why has it gone wrong?
Why has the Government delivered such a patchy response to the Royal Commission’s recommendations?
We think there are several underlying – and interrelated – causes.
First, implementation is being driven by the same department which oversaw the system as it declined over the last two decades. In 2013 the Australian Public Service Commission undertook a capability review of the Department of Health, which observed that “a majority of external stakeholders…reported they have experienced the department as increasingly insular and often outwardly defensive”.
“[They] commented on the difficulty in interacting with the department compared to other APS policy departments, which were seen as much more open”.
A member of the review team told departmental staff that other departments referred to Health as “fortress Woden”.
While some improvements were made under Secretary Martin Bowles (appointed in late 2013), after his departure in 2017 the Department seems to have reverted to its old ways. It is hard for an organisation with a culture of secrecy and defensiveness to embrace a reform agenda including transparency and openness, and so far it has failed to do so.
Secondly, the Department ignores many voices in the aged care policy area. It has a long-standing practice of targeted consultation on aged care reforms with COTA, National Seniors Australia, and Older Persons Advocacy Network (OPAN), all organisations that receive government funding.
There is a large number of voluntary aged care advocacy groups, including Aged Care Crisis, Elder Care Watch, Aged Care Matters, Stop Elder Abuse, Aged Care Reform Now. Representatives of these voluntary groups spend hours upon hours talking with residents of aged care homes, recipients of in-home care, family members and staff.
They have also spent years writing to, and meeting with, MPs, making submissions to enquiries, including the Royal Commission and attending round tables.
Yet, when the Government decides to “consult” with consumers, it approaches only the chosen few.
When Ken Wyatt was the Minister for Aged Care (2017-2019), he valued the “frank and fearless” views of an independent advocate. After reading Dr Sarah Russell’s research on families’ experiences of aged care homes, he asked her whether she could do similar research with recipients of home care packages and those who access the Commonwealth Home Support Program.
When Russell approached the Department to submit a detailed proposal for consumer research on home care, she was told that the Department’s consumer research was undertaken only by COTA and National Seniors Australia. While intervention by the Minister’s office eventually led to Russell being commissioned to carry out the research, the Department resisted release of the final report.
And finally, despite – or possibly because of – the number of voluntary aged care advocacy groups, there is not a strong, well-resourced body with policy expertise advocating for an aged care reform agenda.
The three major older persons’ groups have much wider policy interests than aged care, including income and employment, housing, health, digital inclusion, and aged discrimination. These are all important issues, but aged care policy advocacy (as distinct from individual advocacy) often seems to take a back seat to other priorities.
For example, COTA’s response to the release of the residential aged care star ratings could have been written by the Department’s media team: “increased transparency and accountability will help older Australians navigate a complex system and drive improvements over time”.
There was no evidence of any critical assessment of a system that claimed 90 percent of homes were providing an acceptable level of care.
It appears to us that there are a number of actions that would lead to a more successful implementation of the reforms recommended by the Royal Commission.
First, the Federal Government – Ministers and the Department – needs to accept that fundamental change to the aged care sector is required. Rather than make the minimum changes necessary to look as though reform is happening, they should be bold.
If they need inspiration, they should read the terrible stories in the Royal Commission’s interim report of the abuse and neglect that the current system enables.
Minister for Aged Care Anika Wells recently tweeted
Don’t tell us, Minister, show us.
Second, the Government – both the Minister and the Department – should actively engage with the broad range of aged care specific lobby groups in designing policy. Senator Janet Rice, the Greens spokesperson on aged care, recently convened such a meeting to discuss the new Aged Care Act.
So far, the Government has shied away from interaction with groups outside the (government-funded) mainstream older Australian lobby groups. Talking to the same people that have influenced government policy for the last two decades will not throw up ideas for change. Talking to outsiders might.
Third, the plethora of aged care voluntary groups and activists should get together to consider forming an umbrella organisation to monitor and influence aged care policy. Sharing resources and expertise should enable an effective voice to government to advocate for real policy reform, rather than the Claytons efforts we have seen so far.
We will be contacting the various groups to suggest that they should combine to form an Aged Care Action Network. This article will be posted on the Aged Care Matters Facebook page, and we welcome discussion and ideas on how such an inclusive, focussed aged care policy lobby group could operate.
About the authors
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20.
Dr Sarah Russell is the principal of Research Matters, a consultancy working in public health, mental health and aged care. In 2016 she founded Aged Care Matters, a community of people who are passionate about improving aged care services.
See Croakey’s extensive archive of articles on aged care reform.
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