Unfinished business: Experts gather to dissect structural reform

At Macquarie University's first aged care policy forum of 2021, a coalition of experts, industry leaders and stakeholders met to set the agenda of what reforms are needed to drive the sector forward.

The presenters met with over 100 members of the public via Zoom to highlight the shortfalls of the royal commission and to reach common ground for future action.

Anita Westera, a senior researcher at the Australian Health Services Research Institute, said the government’s response to reform is welcomed, however she noted that “the devil will be in the detail.”

Her research drew attention to the lack of oversight and accountability in the broader aged care system.

“Individualised funding sounds wonderful, but it shifts the risk from governments and providers onto the individual," said Westera.

“We also have a social responsibility to ensure that we provide appropriate services for those who need it, and there are great risks associated with quality and safety predominantly coming from a highly casualised workforce.”

She said the government had missed the opportunity to strengthen existing infrastructure in the sector in its $17.7 billion dollar budget response.

Annika Stobart from the Grattan Institute argued that the government funding lacked enough depth to trigger fundamental reform.

She said that the royal commission had made 148 recommendations, but the federal government had only accepted 125 in principle.

One of the largest issues also blocking change, Stobart said, was the competitive nature of the market. 

“Where is the incentive to come together and collaborate?” she said. 

“This cultural requirement for people to do that in health, in aged care, we don’t have that imperative.”

All the speakers agreed that the workforce is one of the most pressing issues putting staff and elderly people at risk. 

New interim chief executive of ACSA, Paul Sadler, emphasised the need for a set industry plan to guide broader changes for organisations and workers.

He noted that his comments were from a personal capacity.

“We have seen attempts to introduce more standards in the past, and aged care homes end up closing, so you have to tread carefully,” he said.

“If we’re going to achieve substantial change, you need a properly articulated plan of how that is going to happen.”

Sadler mentioned the government’s failure to address the worker's union claim for a 25 per cent increase with the fair work commission, leaving aged care employers as “the meat in the sandwich”.

“You cannot expect providers to change their ways if they are systematically underfunded,” he said. 

Dr Bob Davidson, an honorary research fellow at the Macquarie School of Social Sciences, said that transparency was still an overriding concern.

He said that rebuilding trust in the community would require collaboration. 

“This is a complex issue where there are no easy answers,” said Davidson.

“We’ve gradually got to find the common core and work towards finding some consensus there.”

Macquarie University Professor Michael Fine, who led the event, said that the flow of opinions expressed by the attendees during the speeches spoke to the weight of the public’s support.

​​“We cannot run aged care as a sort of afterthought, that nobody talks about or doesn’t get mentioned in elections and doesn’t get treated as a serious priority in our society,” he said.

“We would like to see everybody getting in and understanding what they think aged care should be about and how we can run it.”

As part of a bi-monthly seminar series moving into 2022, Macquarie University will host two forums later this year on workforce planning and system design.

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