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The power of persuasion

While talk continues of ways the industry can more effectively lobby government, guest reporter Jim Toohey speaks to two former federal ageing ministers for their perspectives on aged care politics, peak bodies and the push for change.

Where can one find a reliable, independent, expert view on the aged industry – especially from the political perspective?

We thought that the opinions of two former aged care ministers, now long departed from politics, might provide a unique perspective.

We therefore approached former Labor Premier and Federal Minister for Human Services and Health Carmen Lawrence (March 1994 to March 1996) and former Liberal State Minister and Federal Minister for Ageing Santo Santoro (January 2006 to March 2007) and asked them about their impressions of the industry, how effectively it lobbied and what advice they would give to peak bodies looking for change.

JIM TOOHEY: How did you feel about your elevation to the ministry? Were your impressions of the industry prior to your appointment favourable or otherwise?

CARMEN LAWRENCE: As I came into federal politics from the Western Australian State Government where I had held the positions of Premier and Treasurer, I had no special perspective on how the portfolio was viewed at the federal level.

However, because of this background, I was particularly interested in the implications of aged care policy for public hospitals.

I saw the aged care sector as an important part of the larger health care portfolio and I believed it was important as a federal minister to work closely with state governments.

In addition, local federal members have ongoing dealings with providers and are a conduit for their special pleadings which were consistently relayed to me.

I was very mindful of the pressure from the wider community to explore different models of care – nursing homes had a very negative image in the minds of the community.

SANTO SANTORO: I felt privileged by the opportunity to serve people who I later in my Ministry described as our nation builders – the elderly. I knew I was taking on responsibility for a sector under severe funding and bureaucratic stress.

I knew it would be challenging for me as it had been for very capable predecessors, however because of the Prime Minister’s expressed confidence, I felt confident that I could achieve significant things. I had considerable experience of the sector via private work with various providers including at actual facility level, before I entered the Senate.

This prepared me somewhat in terms of understanding problems confronting the sector – particularly funding – but nowhere near to the extent I eventually came to appreciate as minister.

JT: In your dealings with the industry, what were your lasting impressions of its effectiveness in putting its case to government?

CL: I was struck by the very different approach of the not-for-profit and for-profit organisations. Not-for-profits seemed to have a more genuine concern and sharper focus on resident well being and highlighted that in their representations.

However, both sides were as likely to raise concerns regarding insufficient funding.

I recall in particular some high profile for-profit providers publicly proclaiming the profitability of the sector which didn’t assist their special pleadings via other channels about insufficient funding. Many organisations adopted an unduly confrontational approach revealing narrow sectional interest, rather than genuine policy concerns. I felt much of the criticism of the government’s policies were ideologically driven and sometimes politically motivated.

SS: I believed then and now that the fragmentation between for-profits and not-for-profits compromised and diluted the sector’s effectiveness. There were often inconsistent messages from the different peak bodies – even on issues where there was 100 per cent commonality on the agreed problem. A singular and consistently expressed message to government was often not possible because of this fragmentation when it should have been relatively straightforward.

JT: Did your department share the industry’s views about the major challenges for the future and how they should best be dealt with?

CL: I brought in an outsider to run the department because I wanted a fresh perspective rather than the traditional department view.

My overall perception was that the department had insufficient specialist analytical skills and was thus more likely to be captured by fads and fashions. I also developed substantial direct communication links with providers and their representative bodies.

I think it’s fair to say that the department had a more sceptical view of sector pleadings than the politicians.

That’s not to say that these pleadings did not contain some elements of truth – it is a minister’s role to sift out the truth from spin.

As a politician, it’s important not to leave yourself open to criticism that you have been hoodwinked or captured by special interests.

I didn’t feel that the department had any undue influence on policy – I relied equally on specialists in my office as I did on departmental advice.

SS: I found the department to be made up of people who were highly knowledgeable of the sector and who had very strong personal views and policy ideas as to where the sector should be heading – including policy frameworks and imperatives. It was obvious from an early time that that often the personal opinions of influential department leaders and consequently the departmental corporate views, did not always correspond with those expressed by industry leaders including those not represented by peak bodies.

I therefore constantly sought to expose these Departmental leaders to the opinions of industry participants so their views could be challenged by those with a deep and practical understanding of the issues such as Warren Hogan, Henry Ergas and Jim Carlton. These people also well appreciated the rigidities of the department.

JT: What advice would you give to the aged care industry in respect of improving its capacity to properly advance its case?

CL: I would suggest that before coming to government with suggested policy changes, the sector asks itself and is clear on what exactly it is trying to achieve.

What are the precise goals – could we do better within the existing framework rather than embark on further reform? Reform is not necessarily a guarantee of improvement.

Ensure that the articulated goals are actually an improvement on the existing arrangements.

For example, it was assumed that improving standards meant moving to single room en-suite accommodation. I really have to question if that was actually necessary. Why was it assumed that to improve standards of care the sector had to provide predominantly single rooms and en-suites?

I understand that some providers may have gone out of business trying to meet this standard or withdrawn from the sector because of the cost.

Is it really in elderly resident’s interests to spend their few remaining years isolated and alone?

I question whether the rigid application of this policy was really in the interest of residents especially those suffering from dementia.

Finally, try to view the problems from the perspective of the community, politicians and the wider health care sector. Avoid narrowly focused interests and be prepared to look outside Australia for different models.

There seemed to be a reluctance to do this as I recall.

SS: If I were advising an aged care representative organisation, I would firstly urge the employment of leadership who demonstrated a genuine understanding of the complexities of the sector and also possessed a sense of diplomacy coupled with the courage to employ non-diplomatic tools to get the message across if required.

It is vital that industry leaders have the respect of their peers and are recognised as such by decision makers in both the political and bureaucratic arm of government.

In their approach to government, they should be polite and pleasant and posses a broad outlook encompassing other stakeholder perspectives. If they can achieve this, it will engender trust with the Minister and other relevant ministers without compromising the capacity to deliver a strong message when necessary.

Finally, I would suggest any new incumbent immediately upon appointment undertake a listening and consultative tour with all stakeholders so that key issues and messages were clear, shared and able to be communicated simply to government and the community as much as possible without jargon. The complexity of the funding and regulatory system sometimes defies even the comprehension of the most dedicated and intelligent politician.

JT: What advice would you give any future aged care incumbent about dealing with aged care providers?

CL: I would express my concern that there are too many for-profits and not enough not-for-profits – the balance is getting out of kilter. Again, I have a concern that many good not-for-profits have left the sector because of the cost of new buildings.

I would counsel aged care ministers to focus on the state of play now – not to speculate too much about what residents will want in the future. They should actively consider different models rather than the existing approach.

Don’t assume that the baby boomers will be as driven by standards of accommodation as we expect – they won’t want to be in aged care facilities at all and there is no need for them to be.

I would urge them to focus on reducing the percentage of the population in aged care facilities.

The key consideration should always be quality of life for existing residents.

Ministers need to treat the sector with respect and courtesy but to question the underlying assumptions behind their representations.

SS: Approach the issues which the industry brings to you with an open mind.

Don’t be captured by any particular provider/person/representative.

Spend the most time talking to the most important stakeholder – residents and their representatives. Don’t forget to hear all perspectives however – including carers, employees and providers.

Where the department advice differs strongly from industry, convene small but relevant forums of all sides and have the issues debated – letting all sides contribute. However, make up your own mind as to who is right and act accordingly. Fight hard to elevate the ministry into cabinet for the social, demographic and economic implications of the future are too significant to be denied cabinet ranking and recognition.

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