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Brendan Murphy, Secretary of the Department of Health. Photo: NCA NewsWire/Martin Ollman

Aged care system needs ‘fundamental reset’: Murphy

Secretary of the Department of Health Brendan Murphy believes the aged care system needs a “fundamental reset”.

Murphy, who was Australia’s chief health officer when COVID-19 hit Australia, was responding to a question posed to him at the Royal Commission into Aged Care Quality and Safety on Friday about whether the Department of Health believes the aged care provision ratio should remain in place.

“At the moment the Government’s focus has been very much on meeting the demand for home care packages… but I think we clearly accept that the system does need significant redesign, including in the costing and funding and transparency of that system.”

When asked whether the department says the aged care provision ratio should be scrapped in favour of an uncapped system, Murphy said it agreed that the program should be demand driven.

“In fact, it is demand driven in residential care at the moment, and we are endeavouring, with frequent releases of home care packages, to meet the demand for home care. So essentially, Government is supporting that general direction.”

Murphy, along with first assistant secretary at the Department Nick Hartland, who was also speaking at the commission, said the provision ratio could be maintained as a forecasting tool rather than operating a cap.

The conversation later turned to the financial pressures faced by the aged care sector.

Murphy acknowledged that the system was under financial pressure at the moment but added he wasn’t sure whether there was clear evidence that there has been pressure put on service delivery. Still, he said the level of indexation needed to be addressed.

In response, counsel assisting Peter Gray brought up an uptick in adverse regulatory outcomes in 2017-18. Murphy said: “…you cannot conclude that increased action by the regulator and increased outcomes necessarily reflect the deterioration in quality of care.

“Often that can just be a reflection of improved regulatory oversight and improved regulatory action.”

When pushed by Gray on the matter Murphy added: “I don’t think we’ve got any evidence to support the contention that care quality has declined because of financial pressures. We have evidence that prudentially there have been pressures across the sector but we don’t have evidence that there has been a decline in quality of care.”

As the questioning turned back to home care packages, Murphy said the Department strongly supports the idea that home care packages should be more generous and enable people to stay in their home with increasing levels of frailty.

On the idea that the amount of funding that should be available to a person for care at home should have a connection with the care component of the funding they would have been assessed to receive in a residential setting, Murphy said: “The idea you would somehow link a dollar amount to what would be otherwise a residential aged care assessment process, it might have some technical complexities in it, but I think the general approach we are perfectly happy looking at a much broader range of home care packages that would allow people to stay in their home.

“So whether you would need to then do a full residential style of assessment for someone in home care to determine their dollar amount might be a bit tricky … but I think in general the direction is something we support.”

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  1. Rosemary Oates RN RMN RGerN DNA

    Professor Murphy is absolutely right when he says that the aged care system needs a “fundamental reset” !!!!!!!!

    Government can throw all the buckets of money at the system but nothing will happen until it is recognised that the real need is for complete & detailed accounting to the Government by each Aged Care Facility owner / operator as to HOW the money is spent.

    This together with well defined staff skills required to actually deliver the care tailored to each individual resident’s needs.

    These requirements were in place prior to the changes to the Aged Care Act 199,7 when the element of ‘trust’ was instituted. This whole area needs to be revisited & revamped to provide a system, which will provide the necessary care for an ageing population with complex care needs now & into the future …..

    • Great comment Rosemary.
      Funding approaches and the removal of a division between costs of care and accommodation left the field open for residential aged care organisations to change the balance of spending. This situation has remained unchallenged by either major political party. Over time staff skill mix was reduced and quality of clinical care diminished at the same time as resident dependency and complexity of care increased. This was further obscured by the almost exclusive focus on creating a home-like environment, extremely important for the residents and families as the RAC is a home, but this can not be at the expense of the reason for admission i.e. complex health and support needs. Things have been out of balance for a long time in aged care and the result of these and other policies is what we see coming up in the Royal Commission (let alone all of the other previous reviews). I have great respect for Brendan Murphy and the excellent work in his role however he sounds a bit Trumpesque when stating ” Often that can just be a reflection of improved regulatory oversight and improved regulatory action”. That’s a bit like ‘we’re doing more testing, so more people are being diagnosed, so don’t worry about wearing a mask’ to paraphrase the POTUS. It’s about time the regulatory processes were improved, clearly you could shoot cannonballs and not hit a thing through the old one.

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