ACSA / IAHSA Joint International Conference, Perth Convention and Exhibition Centre
E & OE
Well thank you so much Geraldine Doogue.
And I’ve got to confess I’ve actually had a bit of a crush on Geraldine for some time.
Geraldine has the best voice on radio. I think Virginia Trioli has the best voice on TV, but always a delight to hear Geraldine.
And Geraldine very unkindly reminded me that I am the Manager of Government Business in the Senate. It’s something that I do try to forget in weeks when Parliament’s not sitting. Anyway that’s a particular joy.
And Geraldine’s right, I did spent some time as a reservist in the Australian Army Psychology Corps. But rest assured, the closest we ever got to a skirmish or going tactical was the odd bit of biffo with the Dental Corps.
But anyway, it’s fabulous to be with you and if I could acknowledge John Kelly, the CEO of ACSA, who does such a terrific job providing leadership in a time of change. Which I know is something which we’re all going through together.
Also Vaughan Harding, the Chair of ACSA, who again provides tremendous leadership to the sector.
And also great to have Katie Smith-Sloan here to bring an international perspective.
So thank you so much for the opportunity to be with you today.
Well, we’re here to focus on the challenge of ageing.
And in no way, shape or form–in saying that–do I want you to think I’m stating that as a negative. It’s a positive. It’s a fabulous thing that we as a community, as a society, are living longer, living better, living healthier, it’s something that we have collectively worked on together as an advanced Western society.
So if there’s got to be any challenge you want to have as a society, this is the challenge to have. So we should see it as unadulterated good news.
But we have a shared commitment to assist people who are living longer, who are facing challenges for reasons beyond their control, to have good lives.
And I know that for everyone here, what you do each day represents far more than a job to you personally. You know, that when you head to work, in what you do, you’re helping improve the quality of lives of other Australians. And can I, on behalf of the Government, thank you for that tremendous work that you do. It’s just so important for our community.
I have, as Geraldine mentioned, been asked today to speak on the subject of leadership and change.
It is a theme that’s been pretty relevant to my two years as the minister for aged care.
As you know, when I came into this portfolio, I was essentially in charge of implementing a series of changes which had been legislated by the previous government, that came into effect under my watch.
These focused primarily on two things:
- giving older Australians more choice in their care
- and the other important change was seeing individuals who’ve got a capacity to make a greater contribution to their care, to do so
The catalyst for these changes, as you know, was the Productivity Commission’s landmark report, Caring for Older Australians. When we were in Opposition we broadly supported that work, and the response of the previous government. Why did we do that as an Opposition? It’s not something Oppositions always do. We did, simply because the evidence in the Productivity Commission report was compelling. We knew that change was needed.
The PC did find that it was an extremely highly regulated aged care system. It didn’t always offer the choice that consumers were looking for. And that there were inequitable and inconsistent subsidy arrangements for users of aged care services.
And I think that we’ve collectively made some progress. I know that the changes in the middle of last year were a challenge for some providers and some consumers as well. But, can I say, I really greatly appreciate the goodwill that was brought to bear by providers through that period of change.
Most Australians, and this is one of the things pushing change, are increasingly wanting to live at home for as long as they possibly can. And older Australians are wanting to have a greater say in their care. A greater say, perhaps, than previous generations. And it’s the baby boomers who are certainly driving that change. And that desire for a greater say, providers are very much responding to.
Now leadership, in this area, means recognising that there’s really no such thing as the status quo in aged care. And as we go through these changes it also means that as a government, we’ve got to modify and adjust as we move along. Sometimes there will be unexpected consequences from the policy intent. And I think we’ve dealt with some of those along the way.
I know collaboration is a word that’s overused in public policy, but that is something we’ve seen between government and the stakeholders in this area. And it’s going to continue, let me promise you.
We have–just to demonstrate our commitment to collaboration–we’ve worked with over 30 advisory groups over recent times, covering workers and providers and consumers. We’ve had no end of discussion papers. And consultation on legislation. And a range of reviews for which input is welcome. Since I became minister we’ve had something in the order of 51 face-to-face sessions where we’ve briefed more than 7,000 people on the changes.
I know that good ideas are not the preserve of government. That the solutions that we find will come from the people in this room.
We do have an Aged Care Sector Committee, which was chaired by Peter Sheargold. Now chaired by the former Finance Secretary David Tune. And they’ve developed for us an overarching framework for change, which we’re calling the Statement of Principles.
And I’ll just quickly take you through what the four guiding principles are. And they are:
- Consumer choice at the centre
- That support by and for informal carers will remain a very important part of the aged care sector.
- The provision of formal aged care should be contestable, and innovative and responsive; and
- That the system is both affordable for individuals and sustainable for the taxpayer
The only way we will achieve this is through a partnership.
We are, I think, still a fair way off where I would ultimately like the sector to be.
But we have made an important paradigm shift together in terms of recognising the consumer-centric view that will be dominant in the sector.
We are moving away from a sector which is essentially, has been historically, controlled by providers. To one that really responds to and is driven by consumer desire.
We have, primarily, operated in a highly regulated aged care system, We are moving to one that is more open to competition. And that means there will be challenges for providers–the need for new service models, the need for new business models. That’s something you are all wrestling with.
And Geraldine has obviously picked that up from her time with you already. That it’s a period of constant change, a period of constant challenge. And I don’t want to underestimate, for a moment, the difficulty that can pose for providers.
We do have in this new paradigm though is an opportunity for providers to present and market those things which are unique and different and special about their offerings.
That as we change, as we have different business models, that’s not to say that those things which are fundamental and unique to service providers can’t remain. And can’t be something which are highlighted for the benefit of consumers.
In the Budget this year we have taken some additional important steps to achieving the vision that we have. And I’ll go through some of those briefly in a moment.
But I do want to emphasise that we’re very, very, very open to input and thoughts from the sector. We’re very open to adjusting our thinking as we go.
And I do welcome the opportunity to hear from providers. Over the last couple of days I’ve been in Busselton, Albany, Narrogin, Esperance and I’ll be in Geraldton this afternoon. Because I want to spend time, face to face, with providers, hearing from them. I have been finding over the last few days in these places, they say the boss is in Perth for the ACSA conference. That’s good because I like to visit when the boss is away, not really, not really. But I did want to highlight that for me there is no substitute to hearing from the providers at the place where they do their business.
We do in this new regime want to get away from unnecessary regulation. But of course, in doing so we need to maintain appropriate safeguards and standards particularly in a sector where we do have vulnerable people who we are dealing with. We have made some small steps in reducing regulation. We have already removed the duplicative building certification and also streamlined the process for higher accommodation charging. We are going to see more changes in terms of deregulation and that is an important role for the aged care sector committee. To continually look at those regulations, that don’t add value that only cause grief for providers.
What’s got to change, what is going to drive change, what is going to drive standards and quality isn’t regulation, it is ultimately going to be competition. And I think that competition is really driving a change in behaviour savvy providers can only benefit from the shift to consumer care and the flexibility that that will bring. And as you know from February 2017 we will have whole new approach to consumer directed care, a whole new approach to home care packages. I will touch on that in just a moment.
I mentioned that we did have in the budget a number of significant changes and I will just briefly take you through some of those if you haven’t had the opportunity to focus on those as yet. Because I appreciate, not everyone pours over budget announcements on the budget day. You are busy getting on with the work that you do.
I think one of the really important things we announced in the budget is an improvement in relation to restorative care. So that from 1 July next year we’ll have a new type of restorative care, to help a wider range of older people to regain independence and some function after they have had a setback. This will build on the success of the current transition care programme, but there is an important difference here. Unlike the current transition care program, restorative care will be available before the person is hospitalised. The new places will be allocated through a competitive process. We are very keen to expand the number of short-term restorative care places. The goal is to improve the capacity of older people to remain at home. So that’s an important one to look at.
My favourite budget measure is one related to Home Care Packages. At the moment, as you know, home care providers have to apply for Home Care Packages through the ACAR round. Obviously, there is an expense for providers to go through that process. Providers are not necessarily sure when they are successful, why they have been successful. And the same goes for when you are unsuccessful. It’s not necessarily clear to providers why they’ve been unsuccessful. So it is not terribly satisfactory from the point of view of providers.
For consumers it is not terribly satisfactory either. The consumer is assessed by an ACAT team. They have an eligibility for a Home Care Package. They then have to look for a Home Care Provider who happens to have a package and hope that they have a package at the level to which they are assessed one through four. So, it is a bit difficult to match providers with consumers in the current arrangements. So, from February 2017 home care packages will no longer attach to the provider, they will attached to the consumer. And I think that will be revolutionary in terms of the relationship between the consumers and providers. And something I’m particularly thrilled about is it means, at least for home care, that the current ACAR round will be the last ACAR round for home care. So, that gets me half way to my goal of eliminating the ACAR process altogether, including for residential aged care. Again, it is not a satisfactory process in residential aged care and I think there’s got to be a better way
We also announced in the budget that from the middle of 2018 we will integrate the Commonwealth Home Support Programme – the biggest part of which is HACC – and the Home Care Programme. So that we have one single at home care programme, which I think will eliminate some of the clunkiness between home support programme and home care and also reduce some of the perverse incentives that there are there, for people to remain in the HACC system where they might actually be better off in the home care system.
Quality is also something that we touched on in the budget. I think we are all keen to have a more sophisticated definition of quality. We should take safety as a bedrock, as a given. Quality really is what providers do above the basic safety standards. Quality is what providers do when they exceed the expectations of consumers. So we are fundamentally having a rethink about the issue of quality. We do have different arrangements at the moment in relation to home care and also residential care so we want to see if we can bring some greater consistency there because it can be difficult for providers who operate as both home care providers and aged care providers.
We are introducing quality indicators in residential aged care. The first three quality indicators are currently being piloted and there will be further indicators for quality of life or consumer experience which are being developed and these also will be piloted as well.
I have asked the Aged Care Quality Agency Advisory Council to work with consumers and providers to work on these more sophisticated definitions of quality. Advocacy, obviously will continue to be an important feature in this area as well. And we are currently having a review of advocacy arrangements to make sure they are fit for purpose. Because it’s been a while since advocacy services has been examined.
So, obviously, I have a very strong desire to see greater consumer choice in the sector here, it’s something the disability sector went through probably 10 years ago and is going through even more intensively through the introduction of the National Disability Insurance Scheme. I think there is opportunity for the aged care sector to learn, for aged care providers to learn from some of the experiences that disability providers have already gone through and are currently going through. So, I think that might be something that is profitable for providers who might not have a relationship with disability providers to develop those and to see if there are business lessons that can be learned from them as well.
The Aged Care Sector Committee, which I have mentioned, chaired by David Tune has been tasked with coming up a roadmap. I think we all have a fairly common view as to where we would ultimately like to get to as a sector, but we need do need a roadmap to get there and David Tune’s committee has been tasked with that. They are due to provide advice to me by the end of the year, but also, importantly NACCA is also doing work and providing good input into this area as well.
I would as I mentioned, ultimately love, love love, love to get rid of ACAR altogether in residential aged care as well. I recognise that in moving further towards Consumer Directed Care model in residential aged care, that has got to be balanced with the certainty that residential aged care providers need, given the long-term investments that they make. So, it is a matter of getting that balance right. But rest assured we are not going to rush headlong into anything in that regard that we have not worked through together with the sector. So I just want to make that clear.
One of the issues I just wanted to make a very very particular mention of is rural and remote Australia. I’ve constantly recognised and I’ve constantly flagged, as I’ve gone around. That the sorts of models that we may ultimately end up with in residential aged care that may work well in metropolitan areas might not necessarily work well in regional areas or particularly remote areas, in Home Care as well. That is something I want to keep a watching brief on. Because the dynamics are different, the challenges are different in rural and regional and remote areas. And we may well have to have a different model. And that is something that has been reinforced to me, as I say, in the Busselton and Esperance and Albany and Narrogin over the last few days, and no doubt will be in Geraldton this afternoon. So rest assured I’m not someone who will allow design elegance in policy to get in the way of practical outcomes on the ground. We have got to recognise that there are different operational realities for providers who are further away from metropolitan areas. So again, I very much welcome your thoughts and input into that area.
Ladies and gentlemen, I’ve thoroughly loved the the past two years that I have had as aged care minister. There has been a lot of change. There will be more change. But I am very excited about the prospect not just for consumers but for the industry itself. There is a tremendous opportunity here for us together, to shape the future of the sector. To shape the future of this industry. I know that there will be times of apprehension. And there will be times of challenge. But working together government – providers, consumers, staff in the aged care sector – we can I think build upon and improve what is already without a doubt a world-class aged care sector. But we can do better. I know we all want to do better. And I very much look forward to continuing working along on that task, on that challenge with you.