When too much is barely enough: opinion

‘When too much sport is barely enough’ is a much loved satirical credo made famous by the Australian sports comedians Roy Slaven and HG Nelson as they send up obsessed Australian sports fanatics. Something eerily similar seems applicable to the eight volumes of the final report of the Royal Commission into Aged Care Quality and Safety. 

After waiting so long for the finished product, we see that the eight volume report is way too much. And yet, on so many crucial issues and questions, there is either nothing or what is said is not enough at all.  

One very fundamental example is the question of whether the aged care system should continue to develop as a market? Can it ever truly be driven by consumers? Is it possible that it could ever become either self-funded or self-regulating?  

In recent years, The Aged Care Roadmap (NACA, 2016) had set this out as the direction and intended outcome of policy reform. It was the shining new path for the future development of aged care in Australia. The goal was neatly summarised as ‘A consumer driven, market based, sustainable aged care system’.

Now, since the RC was called, there is no longer a roadmap showing the way forward. Nor has any plan been endorsed by government. After the long anticipation of the RC’s final report, it all seems to be such an anti-climax.

So, what happens next? Where to now?

Many of us had expected the media to have used the report forensically to hold the Commonwealth Government to account. Cleverly, the Prime Minister released the report before anyone in the press had the chance to read it. There really was no chance to ask questions then. So, once again, we’re waiting for answers to questions that have yet to be asked.

Since its release on 4 March, there has been an almost deafening silence from government and opposition. ‘Wait till the budget in May,’ we’ve been told.

Really? Is it likely there could possibly be a truly extensive ‘once in a generation’ response, a system redesign or perhaps the appointment of an implementation committee, on budget night? Even if there was such a response, would it be acceptable? Would it even be credible given the problems currently facing the prime minister and his government? 

Or will there be a cash splash of some sort? A brief acknowledgement of one or more of the most pressing issues. A quick palliative response intended to kill off any more extensive examination of the issues and options. 

Behind the scenes, beyond the mainstream media, however, various powerful alliances within the aged care industry have been organising.  Two clear blocs have emerged already, each manoeuvring to gain early advantage, defining the policy battlefields and preparing strategies to capture key positions.

The first and most prominent bloc is made up of the major service providers. It is The Australian Aged Care Collaboration (AACC), which claims to represent more than a thousand organisations that are responsible for around 70 per cent of the services delivered to 1.3 million Australians receiving care at home or in residential care facilities. Members include not-for-profit providers represented by ACSA as well as Anglicare, Catholic Care, Uniting Care and Baptist Care. LASA is also a member, representing a number of large and small for-profit private operators. AACC’s spokespersons are LASA CEO Sean Rooney and ACSA CEO Pat Sparrow. 

A key feature of their strategy is to apply political pressure to local members of parliament and political candidates, especially in marginal seats with an ageing demographic. It promotes the use of a popular public campaign based on petitions and other activities to pressure local members and candidates to support what they term ‘comprehensive reform of the aged care system’. 

Given that many of the key members of the collaboration have long opposed a major public enquiry, it is hard to see public support for reform being expressed through support of the platform developed by the industry associations. They are, after all, directly responsible for providing the care in question. In-turn they have also been, and will likely continue to be, the main direct recipients of public funding and any additional private contributions made by consumers or their families.

The second bloc to emerge claims to represent consumers. A ‘Joint Statement’, endorsed by twelve organisations that together wear the title of Aged Care ‘Consumer Organisations’, has been issued by COTA Australia.  Their spokesman is COTA Australia CEO, Ian Yates. 

As well as calling for specific and detailed actions on 10 areas of aged care in the May budget and subsequent years, the statement sets out a call for a new ‘governance structure’ for aged care in Australia. This looks something like a mini multi-coloured chess board, with 15 separate rectangles setting out different functions that are to be independent yet inter-related. The entire system looks like a complex board game which consumers will undoubtedly soon require additional help to understand and navigate.

Whether this really represents consumers or not remains a moot question. Unlike the providers’ tactics, the consumers’ political strategy is not clearly articulated. Instead, the strategy appears to lie in a belief in policy detail and an appeal to popular support from consumers as voters. Their interests, and direct importance, are not comparable to those of providers, but this does not rule them out.   

Of course, these aren’t the only positions being articulated. A host of other smaller groups, including the AMA, health care professionals and some trade unions, have also issued statements of various kinds, each with important and interesting things to say.  

But there are many voices missing. A crucial one is the organised representation of ordinary care workers and volunteers. So too are the policy positions of the major political parties.

So, this is the state of play in aged care at present: two powerful sets of players, led by powerful figures who have dominated much of the policy making over the past decade, seem set to battle it out behind the scenes with government. What the result will be, no-one knows. But unlike the Roy and HG show, the results really matter. However amusing it is, the show is not meant to just make us laugh.   

Michael Fine is Honorary Professor at Macquarie University Sydney.

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