Why the delay in implementing much-needed reforms to the aged care sector?
Croakey columnist Charles Maskell-Knight looks at Aged Care Minister Anika Wells’ announcement this week that the Government has accepted all recommendations of the Capability Review of the Aged Care Quality and Safety Commission.
While this seems like progress, the real story is one of interminable delay.
Charles Maskell-Knight writes:
I sometimes wish that I had studied German rather than French at high school. I’m sure if I had, I would have learned the German compound word for “astonishment at egregious levels of government delay”.
That is what I felt on 3 June when Aged Care Minister Anika Wells announced that the Government had accepted all the recommendations of the Capability Review of the Aged Care Quality and Safety Commission (ACQSC) carried out by David Tune AO.
The ACQSC is responsible for regulating thousands of providers delivering aged care to hundreds of thousands of physically and/or cognitively impaired older people. Its mission is to ensure that these people receive safe care that meets quality standards.
The Aged Care Royal Commission received submissions and heard evidence that the ACQSC was not performing well.
Its recommendation 104 was that the Government should commission an independent review of the ACQSC’s capabilities by 1 May 2021; and that the recommendations of the review should be implemented by 1 January 2022:
to provide the resources that are necessary for the [ACQSC] to engage and develop a skilled and dedicated compliance and enforcement workforce, with the regulatory and investigative skills, clinical knowledge, assessment skills, and enforcement skills required for it to meet its regulatory mandate.”
The Morrison Government responded that “a capability review … will be undertaken in 2023” – i.e. beginning 12 months after the Royal Commission recommended that the findings should be implemented.
Following the change of government in May 2022, new Aged Care Minister Anika Wells announced on 28 July 2022 that the Government would proceed with a capability review to “consider whether the [ACQSC] has the appropriate resources, workforce, necessary regulatory and investigatory skills, clinical knowledge, assessment skills and enforcement skills, to meet its regulatory responsibilities and keep older Australians safe”.
The review was to report “in the first half” of 2023.
In mid-October 2022 Wells announced the appointment of David Tune AO as the independent reviewer.
Tune’s report was provided to the Government on 31 March 2023, but it was not until 20 April that Wells announced she had received it. She said “we are carefully considering the report and working our way through the recommendations. The full report will be released with the Government’s response in due course”.
It took another three months until Wells released the report on 21 July 2023, when she said:
I welcome the practical and constructive recommendations from Mr Tune, and will be carefully considering each of them as a matter of priority. As a first step, I have directed the department to establish a senior level Steering Group (Recommendation 2.1) to advise Government on prioritisation and implementation of the recommendations.”
(The final Government response reveals that the Steering Group did not meet until September 2023.)
Now, after 10 more months of additional careful consideration, Wells has announced that the Government will be accepting all the recommendations.
In her media release she says that “we’ve already made substantial progress in delivering on these recommendations”, and lists a number of areas where action is already under way.
Where is the urgency?
The introduction to the Government response goes further, claiming that six recommendations have already been implemented.
However, this is not as impressive as it sounds. One of the six is the recommendation that the Department “consider expanding the range of reviewable decisions under the new Aged Care Act”. The response claims that “this recommendation was delivered in December 2023”.
As the target date for the new Aged Care Act is now July 2025, one can only assume that the delivery means that the Department had completed its consideration of the issue.
Another recommendation “delivered in December 2023” is that “no new functions should be added to the Commission before the commencement of the new Aged Care Act”. Given the new Aged Care Act has not yet commenced – and will not for some time – it is nonsense to claim that the recommendation was delivered last December.
Some of the recommendations that the Government claims to have accepted have not actually been accepted in full. For example, the capability review recommended that the ACQSC should have four Deputy Commissioners at the SES Band 2 level. The Government response indicates funding was provided in the 2024 Budget for two Deputy Commissioners at the SES Band 2 level.
The most disappointing aspect of the delayed Government response is that it appears to have delayed action on important initiatives that could have proceeded far more quickly.
For example, an important contributor to the ACQSC’s performance issues has been its difficulty in maintaining a workforce with the knowledge and expertise to deliver on its mandate. The capability review recommended that the ACQSC should “develop a detailed, holistic and thorough Strategic Workforce Plan that identifies skills gaps and focusses on all aspects of the employee lifecycle”.
The Government response indicates that this will be completed in September 2024, 18 months after it was recommended.
Similarly, a new Regulatory Strategy as recommended by the capability review will only be delivered in July this year.
The ACQSC is crucial to ensuring that older Australians receiving aged care are safe and being looked after properly, and that the $80 million a day the Government is spending on aged care subsidies is being spent appropriately.
It should have all the resources it needs to do the job. It should not have to wait over 14 months while the Minister carefully considers recommendations about how it can do a better job.
I saw a media article recently describing Wells as a rising star of the Albanese Government. Her performance on this issue is not consistent with that assessment. She comes across as a dim outer planet, not a rising star.
• 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. He is a member of Croakey Health Media. Follow on X/Twitter at @CharlesAndrewMK.
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