Yet Another Royal Commission

The Prime Minister’s announcement that there is to be a Royal Commission into the Aged Care sector caught me a little by surprise. After all, as Mr Morrison (who also wears hats as Minister for Health and Minister for Senior Australians and Aged Care) was careful to point out in his media release, there has already been a review into quality in aged care initiated by his predecessor Ken Wyatt. What follows is from the PM’s media release:

We have already taken steps to improve the system [after the public outcry about the Oakden aged facility in South Australia]. In 2017 we commissioned the Review of National Aged Care Quality Regulatory Processes.

We have worked through the 2017 Legislated Review of Aged Care, and responded in the 2018 Budget with the More Choices for a Longer Life package that encouraged active ageing and provided an extra $1.6 billion for home care.

We have legislated for new Aged Care Quality Standards, the first upgrade of standards in 20 years, and introduced a Bill to create the Aged Care Quality and Safety Commission, supported by $106 million to support better facilities, care and standards in aged care.

When I became Prime Minister just over three weeks ago, I was advised that as a result of the increased audit work we had commissioned as a Government to deal with this problem, the Department of Health has closed almost one aged care service per month since Oakden, with an increasing number under sanction to improve their care.

Putting in place clear requirements for better standards and providing the resources and powers to police those standards will always shine a light on the problems that exist. That is the whole point. These findings demonstrate the effectiveness of the measures we have been taking.

All this sounds good. Why, then, do we need a Royal Commission? Aha!From the Prime Minister again: If you want to deal with a problem, you have to be fair dinkum about understanding the full extent of it. Whether there is a crisis in aged care or not is to be determined. That is the point of holding a Royal Commission. It is not to pre-determine outcomes.

I don’t know about the next average citizen, but there seems to me to be a real disconnect between the work the Government has already done, and what the Royal Commission is proposed to do. The Government seems to have been pretty fair dinkum already. The terms of reference follow, but I would have thought the measures since 2017  outlined by the Prime Minister should have covered them all.

  • The quality of care provided to older Australians, and the extent of substandard care;
  • The challenge of providing care to Australians with disabilities living in residential aged care, particularly younger people with disabilities;
  • The challenge of supporting the increasing number of Australians suffering dementia and addressing their care needs as they age;
  • The future challenges and opportunities for delivering aged care services in the context of changing demographics, including in remote, rural and regional Australia;
  • Any other matters that the Royal Commission considers necessary.

 So why are we doing this? My guess is that it gets the issue of the quality and availability of aged care off the table in the run-up to the next elections. I can’t see any binding public policy reason for it. Because of my own connections with Dementia Australia and like bodies I was asked to comment on the Terms of Reference. The turnaround time was three days! I looked at the ToR, and thought there was nothing sensible I could add to them. But the request did at least produce this essay!

Anyone who has any familiarity with the Aged Care sector will know that it exemplifies the great Australian belief in  ‘diversity’. There is real excellence and some abysmal stuff. Television news clips show ‘carers’ beating up frail and defenceless patients. A friend of ours, a freelance nurse, told us that she had been attacked with fists by a patient. The patient then said something like ‘I’ve got a camera trained on you. You’ll be out of here in no time!’ More (frail) beating with fists. Yes the patient has a dementia of some kind. Nor would I say this experience was typical. But it’s always useful to stand back, and get some kind of overall view. Another friend visited her father every day for the last few years of his life to ensure that he ate the food that was provided to him, that he had his medications, and that everything was being done to look after him well. She had no particular complaint to make, but she felt that her daily visits really did mean that her father was looked after.

A correspondent to The Canberra Times, the day after the announcement, pointed out that the answers to the problems facing the sector were plain and straightforward. Carers needed to be paid properly, to be trained properly, to have the same status and conditions as nurses in hospitals, there should be an activities co-ordinator in every facility, as indeed there should be a nurse on duty each night. And more of the same. Yes, all that is true. But it can’t be done in a flash. The money involved will be large indeed. Where is it to come from? Elsewhere in the health and social welfare budgets, or from new taxation? If the latter, how could it be protected from other hands reaching into the total government expenditure pot?

What I fear the most is a Kevin-like visionary pronouncement like those heralding the NBN and the NDIS, full of promise and hope and relatively devoid of implementation. We have trouble now finding nurses for our hospitals, as I know from having spent some time in them over the last few months. Where are we going to find the RNs to staff the nursing homes? Let’s look at salaries. Very generally, a starting RN can expect an annual salary of around $65,000. Nursing-home carers aren’t even dignified, in most scales, with annual salaries, but only hourly rates of pay, and the national range is from $38 per hour to $55. In Canberra, the average hourly rate-range is $19 to $34, but these rates include people who come to your homes as well as those who work in facilities. No doubt the Royal Commissioner will get access to the fine details of pay and conditions.

All in all, the letter-writer had it right on the nail, and didn’t even have to spell out that this would take a great deal of time. Even then, there would be some sort of gap in pay and conditions, unless you loaded nursing-home conditions to compensate workers for the sheer onerous duties that can come in the middle of the night in such places, where the carer has little or no support from colleagues.

I have no great expectations of the outcome of the Royal Commission, and its report may well gather dust somewhere if there is a change of government. But can I beg that the whole ‘attack’ on the aged-care quality system is seen as a careful and incremental business, not as ‘announcement’? It is announcements, not real policy, that seem to drive the business of governments these days.

Two quickies that deserve a mention.

(i) The Prime Minister has said that we need a holiday that marks our respect for Aboriginal history and culture. If his idea it is to be implemented without being  written into the Constitution, I could happily support it. Canberra has such a public holiday already. Predictably, the PM’s idea has been seen as a sell-out by parts of the Aboriginal community, but it might pass the pub test for the rest of us.

(ii) Michelle Guthrie’s departure as the Managing Director of the ABC is causing ructions, not least from her. It’s hard to be sure of the causes, and the present Chairman is not providing any. But an interesting statistic drawn from The Canberra Times (25 September 2018, page 5) quoting research given to ‘an industry conference’ in 2016, is that the average ABC televiewer is 66, the oldest of the channel populations, while its share of radio listeners follows much the same trend. The ABC is losing its audiences, just as newspapers are. We, who talk about it, and watch/listen to it, and like books, we are falling off the perch. Ms Guthrie wanted to turn that around by pitching the ABC to the younger demographics. Maybe she did. No one’s saying. But I think it’s a lost cause. She wasn’t fired, I think, for trying to bring back some dispassionate news reporting about global warming, President Trump or the myriad of what I would call ‘me too’ appeals coming generally from the Left.












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