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Guest Column: Grattan Institute
SMOKE AND MIRRORS
THE GOVERNMENT’S RESPONSE TO THE AGED CARE ROYAL COMMISSION MIGHT LOOK GOOD ON ITS SURFACE, BUT LACKS SUBSTANCE UNDERNEATH, SAYS THE GRATTAN INSTITUTE
The Royal Commission into Aged Care Quality and Safety called for major reform of Australia’s aged care system. Business-as-usual is no longer acceptable. But does the Government’s response deliver what’s needed?
Bold rhetoric, with little substance
The Federal Government’s bold rhetoric appears to accept that significant reform is needed. The Prime Minister’s Press Club address in February 2021 said the Government would deliver ‘step-change reform’ in aged care. In his Federal Budget response, the Minister for Health and Aged Care, said that the Government was delivering a ‘once in a generation reform to aged care to deliver respect, care and dignity to our older senior Australians’. And the Government said they had accepted 126 of the 148 recommendations of the Royal Commission—either in full or in principle—noting that 25 were specific to the individual Commissioners.
This all sounds very rosy. But looking beyond the slogans, it is hard to find many structural mechanisms that will actually deliver the changes needed. Sifting through the fine print, the Government often appears to adopt only the theme of the Royal Commission recommendations, rather than the specifics. In many cases, where it has ‘accepted’ the recommendation, the Government ignores the mechanisms proposed by the Commissioners. In its Budget response, the Government’s investment, while significant, is only about half of what the Royal Commission called for. In a sleight of hand, the Government calculated the investment over five years rather than the conventional four-year forward estimates or the more important steadystate incremental annual spend. The Government committed to an additional $2.5 billion for more Home Care Packages per year when fully implemented, and about $2.4 billion more for residential care per year when fully implemented. The total steady state increment is about $5.5 billion from 2023-24 and beyond—not enough to create a needs-driven, rights-based system, called for by the Royal Commission and the Grattan Institute.
This lack of commitment undermines the potential for achieving the transformative change needed, and as called for by the Royal Commission. Without transformative change, we may end up again where we started: a system in crisis.
Immediate fixes are a start, but not enough
The Budget includes funding for 80,000 extra Home Care Packages over two years. But the Government has not explicitly promised to clear the waiting list and bring waiting times down to 30 days, as the Royal Commission called for.
The Budget has some good news for people in residential aged care. The Basic Daily Fee (for services including food) will be increased by $10 per resident per day, as called for by
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the Royal Commission. And there’s more funding for better staffing, with mandates for an average of at least 200 minutes of care for every resident every day (40 minutes of which must be by a nurse) by 2023.
The Budget also provides additional once-off funding for training of the aged-care workforce. But the Government has not gone far enough. It stopped short of guaranteeing that every staff member providing care for older Australians will be trained to a minimum Certificate III level, and that all residential aged care facilities will have a registered nurse on site 24 hours a day. And there is no commitment to lift staff wages.
Much is still uncertain, with structural reforms yet to be determined
The Government has committed to a new Aged Care Act, to be legislated by mid-2023. Many of the reform recommendations, including improved provider regulations, have been lumped under this proposal, for further consideration.
Although the Government has committed to designing a new home care program and a single assessment process for both home care and residential care, much of the detail is yet to be nutted out. Crucially, it is not clear that better governance and accountability will guide the reform process. Instead, $260 million is being pumped into the Aged Care Quality and Safety Commission, which the Royal Commission found had demonstrably failed.
There is no clear step-up in accountability of providers. While some transparency will be provided through public reporting of staffing hours and star ratings to compare provider performance, clear transparency measures will be needed to ensure it is being spent on services.
The good news from the budget is that the journey has begun. The Government has made a substantial down payment to allow development of a new aged care system. We must all now take steps to ensure that more ambitious reforms are made, otherwise older Australians will remain exposed and vulnerable to poor care, and putting the sector’s social licence, once again, at risk.
Stephen Duckett and Anika Stobart are co-authors of a recent Grattan Institute report: The next steps for aged
care: forging a clear path after the Royal Commission,
released in April 2021.
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