Structural Reform Needed – Not Patches

26 September, 2018

Aged Care Crisis (ACC) welcomes the establishment of a Royal Commission into aged care.  ACC have been deeply concerned by the direction that aged care has taken over the last 20 years, have critically examined what has been happening and made many critical submissions to inquiries and reviews.  

ABC 4 Corners 2 part special "Who Cares" exposed the problems in care, staffing, and weak regulation. It revealed how the sector is characterised by opacity and the refusal to collect and analyse the sort of data about staffing and failures in care, which would have told us what was happening.  

It revealed whistleblowers having to take matters into their own hands after their warnings were not acted on.  It exposed deliberate and systematic attempts to cover up abuse and the lengths in which the government were complicit when faced with serious failures.

The failures in both care and staffing at the coalface and government regulation point to deep structural and conceptual problems within the sector.  This is congruent with our own assessment.

Extensive problems have recently been identified in the banks, who have invested heavily in and been mentors to the sector.  Over the last several years there have been revelations of exploitative practices in almost every sector where customers, staff or the financial system are vulnerable.  Aged care is by far the most vulnerable sector. This suggests that aged care is not unique and that structural problems need attention.  

While staffing is critical and requires urgent attention, the Terms of Reference must examine the structure of the system, the concepts on which it is based, its impact on the social dynamics within the sector and the consequences of all this.  These are matters that have been neglected by all previous inquiries.

The Minister's new Aged Care Quality and Safety Commission does little more than move the pieces around. These proposals are all set within essentially the same overall framework.  They are underpinned by the same thinking. They are temporizing measures that attempt to control the manifestations of the structural problems without addressing the core problems in policy that gave rise to them.

We have proposed the following Terms Of Reference in our submission and will be pressing for their adoption at the roundtable discussions with the Minister Ken Wyatt in Sydney this Thursday:  

1.     Evaluation of structural issues in the aged care sector that might have led to past and present instances of failures in care.  This should determine whether current structure and management practices are congruent with community values and with our knowledge of the behaviour of individuals, communities, society and market entities.

2.     Evaluation of past and present policies including the Living Longer Living Better reforms and the Aged Care Roadmap to assess their effectiveness in the light of the ongoing problems in care, current and past research and the known behaviour of individuals, communities, society and market entities.

3.     Evaluation of potential changes that would address any issues identified in these areas as well as any potential problems that need to be managed.

4.     Examine the role of whistleblowers in the sector with attention to receiving the support they need, their protection and to suitable recompense when they suffer as a consequence of speaking out. 

We have also made the following interim recommendations in our submission to the Royal Commission's Terms of Reference:

Recommendation 1:  Further implementation of the current reforms should be put on hold until the Commission has reported.

Recommendation 2:  That urgent steps be taken to improve staffing by transparent disclosure[1] by setting recommended minimum safe levels with recommended increases based on acuity, then addressing Vocational training to bring standards of training back to those that existed prior to the removal of training from the TAFE's.

Recommendation 3:  Accept the Accreditations Agency's forceful assertions in 2011, when it was an independent agency.  In its submission to the Productivity Commission[2] "Caring for Older Australians" it emphasised its position in a heading "Is the accreditation body a regulator? – No".  It maintained that accreditation and regulation are incompatible and "inherently contradictory". 

The Quality Agency has been accrediting and NOT regulating.  A separate independent regulator directly responsible to the community should be appointed.

[1] as proposed by a Bill from The Hon Rebeckha Sharkie

[2] Accreditation Agency's response to the Productivity Commission's Draft Report - Caring for Older Australians Mar 2011