PDF printable version of LASA-WA Congress Speech (PDF 313 KB)
19 November 2015
Thank you for inviting me to be with you today.
And let me say from the outset how pleased I am to be part of the move to bring responsibility for aged care back to the health portfolio.
Aged care has come home. It is back where it belongs as part of an integrated health system.
I know that the connection between aged care and health has been highlighted time and time again in ongoing consultations with both sectors over past months.
The move restores that connection and, importantly, also gives aged care a seat at the Cabinet table.
It certainly makes sense. So many of the issues that are important to older Australians – chronic disease, palliative care, dementia, infection control, wound management – they’re all health issues. And the programmes and policies around them are all administered by the Department of Health.
So, when moves were made to bring responsibility for aged care back to the Health portfolio, I was also very happy to put my hand up as the new Assistant Minister for Health, with a focus on aged care.
I believe that we can support older Australians – and their carers – better with aged care in the portfolio that includes health.
There is no doubt that bringing aged care back to Health will add value.
We know aged care plays an important role in the overall health system. Better integration will benefit all Australians, particularly those over the age of 65.
Of course, aged care is not all about health. And certainly the Government has some major ambitions in terms of ageing and aged care that go beyond health. These include choice and flexibility for older people, with changes to home care packages to allow consumers to direct the government to fund their provider of choice.
We’re also looking to reform residential care, balancing a market-based approach with the needs of people in rural and regional Australia – a complex financing issue, but one that the Government is prepared to tackle because it is so important to people who choose to live beyond the big cities.
That we are looking at changes in these areas is a reflection of the Government’s recognition that issues around our ageing population have implications across a range of areas, including financing.
It also demonstrates the fact that reform of the aged care sector, driven by former Minister Mitch Fifield and the Department of Services, will continue. There will be no drop in momentum.
When there is a change of Minister, people inevitably wonder whether existing policies and initiatives will continue or be subject to change by the new broom, if I can put it that way.
I want to take the opportunity today to put clearly on the record that the aged care changes announced in the 2015 Budget will continue and the day to day business of delivering quality aged care will also continue.
With my Ministerial colleagues – Sussan Ley and Fiona Nash – we will implement, monitor and tweak as need be.
But overall, it’s business as usual. A new Minister in aged care does not mean a new direction in aged care. That’s because the direction we are on is the right direction.
This is a time of significant change for the way we approach aged care in Australia.
The demographics demand it. You know this better than I do.
The key point for Government and industry is that Australia’s rapidly ageing population is characterised by longevity, diversity and a desire for independence.
The current generation of older Australians want to have a much greater role in decisions about their care – and this will accelerate as the baby boomers begin to need services.
This is the challenge we face as a society – how best to support this diverse demographic, giving them the choice and control they seek while making sure that the Australian taxpayer can afford it.
The current reforms take us quite some way along that track but – as the industry agrees – there is still more to be done.
Aged care reforms
So on that note, I want to speak briefly about some of the current Budget initiatives which are all in various stages of development and implementation.
There is a lot going on – and I want to thank the industry for taking up the Government’s invitation to be engaged in their development. We asked for feedback on key policy and implementation decisions – and we got it.
You are also helping us to get the design of the Short Term Restorative Care programme right. Supporting people to regain maximum independence after a hospital stay or avoiding going into hospital altogether is incredibly important work – and your contribution has been of great value.
Developmental work on other 2015 Budget changes, including developing a single quality framework and private market provision of accreditation services, is well under way. I expect you’ll be able to further engage with the Department more on these over the coming months.
And, excitingly, from 1 January next year, the new independent Aged Care Complaints Commissioner will start operations. This change will give people confidence that any complaints they have will be independently managed and addressed. As it separates the management of complaints from the department’s role in funding and compliance, it should also give the sector greater confidence.
In addition to these developing reforms, we are already busy implementing system changes to better support older Australians.
I am aware that the department and the industry are in the process of bedding down a series of changes to information and assessments for consumers.
My Aged Care is now the entry point to aged care services and from 1 July this year that included undertaking assessments.
This was a significant change and, inevitably, some clients, assessors and service providers faced unexpected challenges.
The department has been responsive to these operational challenges and has continued to work with our delivery partners to ensure systems and processes reach a steady operational state as quickly as possible.
While it’s not yet operating perfectly, I understand that it has improved and referrals are now flowing – though I know there are other issues that still need to be addressed.
The Government is committed to continuing to develop and improve My Aged Care.
And I thank you for working with us to that end. Consumers need to be able to find the services that are going to deliver on what they need – which is what My Aged Care is about.
I am also aware of the work being done to develop and deliver the best possible dementia support in aged care services.
The Health portfolio is now responsible for both the health related elements – such as research – and the care for older Australians living with dementia.
An estimated 340,000 Australians live with dementia and an estimated 1.2 million people are involved in caring for them.
Government is tackling dementia on the medical research front. We have boosted dementia research with an additional $200 million allocated through the National Health and Medical Research Council.
As part of this funding, we have established a new National Institute for Dementia Research. This institute will prioritise and coordinate dementia research across Australia, and promote collaboration internationally.
Care of people with dementia is absolutely core business for all aged care services with approximately 50 per cent of all aged care residents having dementia.
The new Severe Behaviour Response Teams commenced in every state and territory on Monday 2nd November. There was an open competitive process for the delivery of the SBRT and HammondCare were selected as the national service provider for this programme.
This mobile workforce of multidisciplinary experts support residential care services, delivering care to people with the most severe dementia related behaviours.
The teams assesses residents exhibiting extreme behaviours, help care staff in resolving the immediate crisis, develop a care plan, and provide follow up assistance as needed.
The idea for the teams came from the 2014 Ministerial Dementia Forum – another example of Government/industry collaboration.
I want to mention one other really important piece of work.
The work of the Aged Care Financing Authority will be critical in understanding the issues affecting the financial performance of rural and remote providers.
ACFA’s earlier report on factors affecting the financial performance of residential care providers highlighted the importance of strong and strategic governance and leadership on the success of organisations.
But there wasn’t enough information on rural and remote services to draw any firm conclusions. That’s why the Government has tasked ACFA to look more closely at this issue.
This study will include both residential and home care providers. The study will include a large scale data collection exercise as well as a series of one-on-one meetings with rural and regional providers all over the country. Interested parties have already been able to make a submission to the ACFA to put their views and share their experiences.
I urge all rural and remote aged care providers to work with ACFA. A collaborative approach will give us a better evidence base for policies that will work for Australians living outside main population centres.
We have always known that one size doesn’t fit all and that providing services in metropolitan areas is different than in rural towns or areas with remote or indigenous communities.
This study should help Government and the industry to think about how aged care services are best delivered in rural and remote areas.
One of the things you sometimes see in rural and remote areas is a greater integration of all health and human services on the ground.
The Multi-Purpose Service Model – which I know providers have been raising questions about and which will be looked at as part of ACFA’s work – was originally designed with that intent.
I said at the start of my remarks that integration is one of the real opportunities we have before us with aged care returning to the Health – and I want to come back to that theme.
Over the past nine months, The Government has been speaking with health professionals, touring innovative medical facilities and listening to the concerns of patients. Indeed, consultation has been one of the hallmarks of the Coalition Government approach.
As I said earlier, one of the key themes that has been highlighted right through these consultations has been the connection between health and aged care.
Minister Ley has visited many facilities and has been impressed with the innovative models of care she has seen – especially those that link primary care with residential care.
Reforms under this Government have the potential to transform health care – and in particular, primary care – and, might I also add, aged care, in coming years.
These will help define our health system for the 21st century. These initiatives include, but are not limited to, the crucial areas of –
- primary care
- mental health
- digital health; and
- the PBS and pharmacy
It is one of the Government’s top priorities to rebuild primary health care, and a critical part of this is reforming Medicare through –
- new Primary Health Care Advisory Group;
- the most comprehensive review ever undertaken of the MBS – we have looked at safety and quality, and now we are looking at appropriateness; and
- improving Medicare compliance.
One of the fundamental flaws in our health system is in its inability to focus on prevention and early intervention, to reduce the need for expensive health treatment. It wasn’t originally designed to deal with chronic diseases, including mental illness, which together are now the major cause of our burden of disease.
We are changing this, and modernising the system. But it has many moving parts to consider.
The Advisory Group has been looking at new ways to:
- fund and deliver primary care, particularly for people with chronic and complex conditions; and
- mend a fragmented system, and shift from individual transactions to one that considers a person’s whole health care needs.
The heart of the system, Medicare, is built on a fee-for-service payment – with no incentives or rewards for keeping people healthy.
There’s also little incentive for health professionals to work together because they get paid for each visit – irrespective of who else is treating the patient.
Currently in Australia, around one in six people see more than three health professionals for the same health condition.
Integration of care is an essential element in this because patients with one or more chronic and complex health conditions usually require services from a variety of health care professionals.
Most of these people had a GP, specialist or other health professional helping to organise this care.
It’s clear that fee-for-service is not the best option for those people or their health professionals. Submissions and feedback to the Advisory Group have revealed strong support for new funding models.
So it should be relatively easy for Australian consumers and doctors to adopt a new approach.
Already, nearly two thirds of Australians have had the same doctor for the last five years, and almost all people over the age of 65 – the biggest age group for chronic illness – can nominate a regular doctor or place of care.
GPs need their roles spelt out more clearly in relation to holistic care for these patients.
We need to give GPs a financial incentive to plan and coordinate this care.
And we need make it as easy as possible for them.
The second part of Medicare reform is reviewing the MBS.
We are considering whether services listed on the schedule up to 30 years ago are out of date – whether they should be replaced – and whether they are being used appropriately.
The review is also considering a new framework to make it easier for doctors to comply with Medicare legislation and regulation.
There are 5700 items on the schedule and very few of them have ever been reviewed. The use of some items varies hugely between regions and between doctors.
I am confident the Primary Health Care Advisory Group’s work will result in a better way to deliver care – and a better way to pay for it.
I am also confident that the Review will, over time, give us an MBS that better reflects current best practice, is both clinically and cost-effective and works better for doctors and better for patients.
Clearly, these reforms to primary health care will have wide ranging implications for older Australians. They’ll be better able to get the right care in the right place at the right time. And they’ll be better served by Medicare.
Mental health is another area where true integration of care is much needed and long overdue.
The aim is to replace current fragmented and duplicated services with a genuinely national mental health approach, focused on the needs of people with mental illness.
We need to stop people being shunted from the GP to the ED and back again. We need to stop people from falling through the cracks in the system.
I expect the Government will be making a major announcement in this space very shortly. Certainly our improvements in mental health care delivery will have major ramifications for older Australians.
Primary Health Networks
The new Primary Health Networks are a major step forward for integrating care and improving access to the services that communities need.
They will also be heavily involved in the improvements to mental health care. The 31 new networks have now started operating.
PHNs will be truly outcome-focused – with less administration and more emphasis on frontline services that actually benefit patients.
They will genuinely understand the health care needs of their local community.
They’ll help to end fragmented care – including ensuring better integration between primary and acute care services.
In particular, they will help to end the merry go round for patients with chronic or complex conditions – who end up going down wrong paths, or no paths at all, giving up because it’s all too hard or too expensive
I see the task of PHNs as three-fold.
Firstly, they will increase efficiency and effectiveness of medical services for patients, particularly those who are very unwell.
Secondly, the networks will improve coordination of care so patients receive the right care in the right place at the right time.
Thirdly, they will tailor local strategies to local needs. This will help reduce avoidable emergency department presentations and hospital admissions.
PHNs will develop collaborative relationships with GPs, primary health care providers and hospitals, with their boundaries aligned with local hospital networks. This will allow for better planning, and better management of resources.
There will be variations in how PHNs operate to meet local community needs – one size does not and will not fit all. Again we will see differences in operations between metropolitan PHNs and rural and regional PHNs – and that’s as it should be because areas and markets differ and consumer choices differ too.
Part of this variation may also be the role PHNs could potentially play in aged care. We want to explore what this could be and the circumstances where it makes sense to have them involved.
The bottom line is better care and improved health outcomes for older Australians.
One of the challenges for PHNs is the need to develop an understanding of the health care needs of communities through analysis and planning, addressing service gaps, while also getting value for money.
Because most PHNs have only a limited role in delivering services, one of the key ways they will achieve these objectives is to become commissioning organisations over time.
With the establishment of PHNs, commissioning is set to become a stronger feature of this nation’s health system.
When we talk about commissioning, we include a range of elements such as assessing and planning for local community needs, co-ordinating and linking services at the coalface right through to contracting service provision.
Commissioning will give PHNs the flexibility to stimulate public and private health care solutions by commissioning health and medical/clinical services for local groups most in needs. This will include, for example, patients with complex chronic conditions or mental illness.
The Government is laying the groundwork for information technology to have a more prominent place in primary health care.
Digital health is being rebooted, including a new name for an individual electronic health record – My Health Record.
The way consumers sign up to the digital health system is also likely to change. There will be trials next year – involving up to a million people.
Smarter use of data, information and communication can greatly help with better integration and coordination of care.
A digital health record is one of the most important systemic changes we can make in this regard.
A national digital record system will allow doctors, nurses, pharmacists and other healthcare providers across the country to instantly access the information they need to treat their patients.
Under a national digital record system that works properly, all members of the patient’s care team could exchange information and results, and stay up-to-date with the patient’s progress.
This will result in holistic care – where the whole care is much greater than the sum of the parts.
Equally important, it will allow consumers to become partners in their own care.
Having access to their own health information will support consumer participation, self-management and informed choices about their care.
We know many consumers want to be engaged and empowered in their own health management. This may be even more so for the first of the baby boomers now entering aged care.
The Government is also supporting a wider role for pharmacy in primary health care. This will enable pharmacy to be an important link in the integrated care chain.
For so many Australians, including older Australians, pharmacy is their touch point in the health care system.
People ‘ask their pharmacist’ much more than they go to see the GP – some estimate as much as 12 times more in a year – not just for prescriptions, but for advice across a range of health, lifestyle, risk and related factors. The pharmacist helps people with pain management, with worming tablets, with colds and flu medications.
By drawing upon their special link with the Australian health consumer, and better utilising their skills, expertise, and presence in the community, there is real opportunity for pharmacy, working with other professions, to help shape the wider primary health care agenda, including improved integrated care.
Clearly, pharmacy can offer so much more as an integrated health care destination.
That’s why, in negotiating the recent Pharmaceutical Benefits Scheme Access and Sustainability Package and, within it, the Sixth Community Pharmacy Agreement, the Government doubled the investment in primary care services to $1.26 billion to enhance their role in the primary care space.
Federation White Paper
The Reform of the Federation White Paper is a further opportunity to rethink how the system works and how services are funded and delivered.
The White Paper, which the Government is developing in consultation with the states and territories, is expected to be released next year.
Health is a key area within the White Paper.
At the Council of Australian Governments Retreat in July, the leaders decided to concentrate on two options.
The first option hinges on a new way of funding hospital care. Instead of funding the states and territories, the Commonwealth would provide what’s been called a ‘hospital benefit’ – think of it as being like a token, or a voucher given to the patient.
The other proposal being seriously considered would make the Commonwealth, states and territories jointly responsible for funding individualised care packages for patients with, or at risk of, developing, chronic or complex conditions. All governments would contribute to a pool of funding for coordinated care for people with high-cost chronic conditions who are frequent users of hospital systems.
Whichever way the Government goes, these would have significant impacts on the health system and aged care systems.
The Government’s health reform agenda is a big one. None of this is simple. Some of it will challenge long-held norms.
But there’s a great deal of goodwill and optimism. There’s a genuine focus on constructive collaboration, about taking the next steps. This, in turn, is generating real momentum to move towards a more integrated, coordinated and patient-centric system.
The reforms all have one thing in common. They will inform real action on the ground. They will improve frontline services and make a real difference to people’s daily lives.
A binding feature across these reform areas is the central focus on the individual – what they need and want to live healthy and independent lives.
As well, they are not exercises in isolation. They all fit together in the wider health care environment.
As does aged care reform. I’m excited to be continuing Mitch Fifield’s work in implementing and driving reform across the aged care portfolio.
Next month, the Government will receive an aged care roadmap from the Aged Care Sector Committee. This will provide future directions for aged care in this country.
The committee is investigating and prioritising what more needs to be done to build on the reforms made to date.
Importantly, it embraces the Aged Care Statement of Principles that:
- Consumer choice is at the centre of quality aged care.
- Support for informal carers remains a major part of aged care.
- The provision of aged care is contestable, innovative and responsive.
- The system is both affordable for all and sustainable.
The roadmap will also take into account work already done to implement reforms to date, questions raised from the sector and work being done by the Aged Care Financing Authority.
It will be a robust plan that will influence government aged care policy for many years to come.
Our aged care system needs to support those who need it now, but it also must be ready for the next generation of Australians.
The roadmap will set the path forward.
I’m looking forward to working with all of you in delivering a consumer-led, sustainable market based aged care system for older Australians.
Finally I’d like to thank each and every one of you for the work that you do in supporting ageing Australians.