It takes real courage to speak truth to power. Frank and fearless advice may be a public service aspiration, but all too often it is clothed in easy-to-misunderstand bureaucratese.
So when a statutory officer decides to use plain, clear language to call out fundamental flaws in the legislation she is charged with overseeing, it is important to pause and really listen.
That is what Natalie Siegel-Brown did in her first report to the parliament as the inspector general of aged care.
The human rights lawyer, former public guardian and productivity commissioner says she is thrilled that the new Aged Care Act is couched in never-before-seen language, respecting the human rights of older Australians and codifying these rights in law. But she worries about the yawning gap between promise and delivery, that the low-hanging fruit of the old system may have been lopped but the structural flaws remain in place and may even be exacerbated.
Siegel-Brown declared “despite the volume and pace of reform, a number of actions that would have seeded transformational change have not yet been delivered. Other actions are not actively being considered, and indeed the manner of implementation in some areas may bring about unintended consequences.”
The second part of the report details the responses to each of the 148 recommendations but, as the first part of the report demonstrates, this misses the “transformational, whole-of-system change called for by the Royal Commission”.
We should all be grateful that the person charged with overseeing the delivery of the aged care reforms recommended by the royal commission is a straight-talking Queenslander. We should urge the government to pay serious attention and respond meaningfully to her report to the parliament.
But until this becomes a real political problem – which it will as more people age and the services fail to keep up – that seems unlikely. Shortly after Siegel-Brown’s report was tabled, rather than responding to her cautionary concerns, the minister for aged care, Sam Rae, put out a media release reporting on a survey showing high levels of satisfaction with the system. Spin over substance.
Four years ago, the eight volumes of the aged care royal commission demonstrated in excruciating detail that the privatised system introduced by John Howard in 1997 was failing to meet the needs of older Australians and their families, workers in the system and even the companies seeking an investment opportunity.
It argued that what was needed was timely entitlement to aged care. Instead, the government, with the support of the opposition, opted to ration care, aim for three-month waiting periods, increase individual costs exponentially, increase compliance and not address the special needs of Aboriginal and Torres Strait Islander people or people with disabilities who lose NDIS support when they turn 65.
This endangers lives and even undermines the much-vaunted quest for improved productivity – every aged person who does not have access to adequate care will rely (if they are lucky) on a family member who can stop work to be there for them.
With 4.2 million people over 65 and an estimated 433,300 living with dementia, there are countless stories that illustrate the urgency of the need; nearly 5,000 died last year waiting for the letter from My Aged Care offering a package.
A foretaste of the political potency of this issue became clear a week before the inspector general’s report was tabled.
After weeks of niggling media reports and a Senate inquiry, the government announced that it would make 20,000 home care packages available before 1 November when the new, more costly system begins. Rae declared the political compromise that was needed to ensure the passage of the new Aged Care Act was a “huge win” for older Australians.
Not everyone saw it that way.
Most of the reporting considered that the government had “caved in”, “bowed to pressure”, “been dragged kicking and screaming” and “suffered a defeat”.
No doubt, for those lucky 20,000 and their families and carers who had been waiting for months for some support, it was a ray of hope. Whether that hope materialises will depend on where they live, whether they can find and afford the workers they need and whether they have the cognitive ability to navigate the complex aged care system.
Meanwhile 88,000 others who have also been deemed eligible for support to continue living at home will have to wait well into next year. The 121,000 waiting for an assessment will have to wait even longer with thousands queueing behind them. The announcement offered nothing to the thousands of people waiting in public hospitals for a bed in residential aged care.
In New South Wales alone, more than 1,000 people are in public hospitals, unable to return home unless, as doctors are wont to say, “you have a lot of servants to look after you”.
The home care packages on offer do not begin to address the needs of those who need 24-hour care, but in the past four years only 6,500 new residential beds have been built, waiting lists are now years long, with homes refusing to even take the names of those in need.
Some health officials call these people “bed blockers”, and state governments are quick to use their presence to demand more commonwealth support. But even using this language highlights once again the gap between the human rights of older Australians and the practical realities of a system that has known the demographics for decades but failed to do enough.
Siegel-Brown does not think the problem is intractable, but says the courage to change and implement a paradigm shift – not just dress up a broken model – is needed. We have been warned.
