Following the Review of Commonwealth aged care advocacy services, the Australian Government announced consultation on the draft National Aged Care Advocacy Framework (the Framework). The feedback form questions are detailed below, along with our responses (submitted on 28 Oct 2016).
QUESTION 1. Is the purpose of the Framework clear?
There are issues of concern that are not clear:
1 (a) Lack of consumer participation: Failure to publish submissions so that the views of those with experience making contributions are not available to the community who are to be the recipients. Public debate and the ability to advance discussion by the community are stifled.
1 (b) Data collection: It is far from clear who will collect, access and control the data that is proposed to be collected. Whilst data is intended for government and for service improvement, it is critically important that data be transparently collected and assessed and that this data be publicly available to researchers, community (civil society) and those engaging in advocacy. It is not clear that this will happen.
1 (c) Increased assistance and protection: As the report indicates, the marketisation of aged care will result in a greatly increased need for assistance and protection. This data is likely to expose the serious deficiencies in government policy. NACAP is funded by government and its funding will be at risk if its reports challenge policy. Both NACAP and government will be at risk of confirmation bias and tempted into massaging data or even indulging in outright censorship.
1 (d) Funding of advocacy services: The allocation and funding of advocacy services is consequently critically important and should not lend itself to becoming a tool for securing compliance and crushing criticism. There should be no conflicts of interest created for them. Close links with government aged care departments as advised is worrying when we consider that government also funds NACAP. If this cooperation was directed through a community controlled service (of which advocacy was a part) working with government, this risk would be markedly reduced. Closer cooperation with an autonomous system of independent advocacy would be important.
1 (e) Quality and transparency of data: A good example of how easily data reporting can be distorted is the previously “independent” Accreditation Agency which since 2014 has become the government run Quality Agency. Data has been reported out in a way that creates the impression that there are many fewer failures than actually occurred and where the manner of reporting conceals information that reveals major differences in performance between different sorts of providers - a finding that challenges government policy.
There is clear international as well as local evidence that profit driven enterprises indulge in greater cost cutting and as a consequence have fewer less qualified staff and a greater number of failures in care. It is therefore critically important that to inform policy the structure of the provider should be included in all data collected so that problems can be identified early and policy adjusted.
While much is made of cooperation, there is a danger that this data may become another silo. Integration at a central level may help financial or broad analyses, but in in a sector where ideology plays so large a role, the way this is integrated will be at high risk of confirmation bias.
1 (f) Partnering with the community: In our submission we advocated an integrated local service for managing aged care in which advocacy would be included. Data collection locally would explore why situations arise and integrate that with other information being collected so that a much broader understanding is developed. When brought together it would give a far deeper insight into how services are being provided.
The community, family members, those receiving care and providers would all benefit immediately as adjustments to services would follow. When collated it would give NACAP, government and systemic advocacy from the community a far broader view of the services being provided. Many problems that individual advocates encounter will be a consequence of systemic problems needing systemic advocacy. Our approach would identify where they were and then work closely with systemic advocates.
QUESTION 2. Is the proposed process for the design and development of the Framework sufficient?
No. The intentions are good but we have some reservations.
2 (a) Risk of becoming irrelevant: While flexibility is a prime objective there is a real danger that, like the funding, complaints and accreditation systems, this will become complex, centrally structured and controlled, process driven, and so inflexible and often impersonal. This approach has not served the community or aged citizens needing care well. Many are disillusioned and very critical of all three services.
2 (b) Choice as a mantra: We are concerned by the strong focus on choice. Despite attempts to demedicalise and pretend that aged care is not about health, most elderly have a multitude of health issues and their frailty is a direct result of tissue degeneration of one sort or another which health practitioners seek to hold at bay. For example, no health professional will agree to provide treatment that is not beneficial even if a patient chooses it. The emphasis should be on guiding and helping people so that they make the sort of decisions that are in their best interests.
The mantra of choice for choices sake is an advertising strategy adopted in the marketplace and has been used to con the vulnerable into buying services that they may not need, may not be beneficial for them, or may be downright harmful. The prominence it receives gives the marketing of snake oil a legitimacy it does not deserve.
QUESTION 3. Does the proposed content of the Framework include key elements that will support the future delivery of nationally consistent advocacy services?
No. There are funding risks.
3 (a) Risks in funding system: Government funding is high risk funding which can be withdrawn for ideological reasons or in order to divert funding to more popular projects that will win votes. A far more stable service can be provided by involving and including far more community volunteers to provide advocacy. They provide a resource that will take up the slack when politicians abandon advocacy and will recruit their friends when there is a need.
3 (b) Risks that the system will be overwhelmed: We have studied market failure in vulnerable sectors and we think it likely that if advocacy is provided in sufficient quantity to hold profit pressures in check and to all those who would benefit from it then the need for advocacy will increase dramatically and the system may not be able to cope. But without a local trusted contact many will not access the system.
It would not be difficult to build a strategy that would support and encourage the formation of local government and community structures and then progressively delegate these services and responsibility to them as these groups develop skills and confidence.
3 (c) A better and fairer way: We believe that a broad strategy of community involvement could be included in the framework in order to encourage politicians, bureaucrats and citizens to start thinking about something better than the present system. This is failing far too often and is proving far too costly. Advocacy would be better provided by people closer to the bedside. There would be a larger number of people with diverse skills – a resource to drive innovation.
QUESTION 4. Are there any other comments?