MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: Back in 2012 the- back then, COAG, now National Cabinet, took a decision for the Commonwealth to take over responsibility for what used to be the Home and Community Care Program for over-65s. This was a program established in the early part of the Hawke Government to support older Australians living independently in their own home. You'll be familiar with services like Meals on Wheels, community transport, home modifications, a range of things like that, distinct from the sort of personal and nursing care that Australians, older Australians, receive in their own home as well. So that had been a program co-funded by the Commonwealth and states largely delivered through state arrangements through local councils and not-for-profit organisations like Meals on Wheels.
We decided in 2012 to set up two separate streams of support for older Australians living at home. The Home Care Program, which essentially bundled together a range of different programs that are developed over time, the community aged care packages, extended aged care at home, into a single stream of care at home delivering personal and nursing care services. That has grown very substantially over the last decade and a bit and, under Sam's leadership, has particularly grown in the last financial year and will grow very fast this financial year as the renamed Support at Home program.
There was a decision taken by the former government to merge these two programs, the Home Support Program and the Home Care Program. I have been pretty sceptical about that for some time because I think they deliver quite different services, drawing on quite different capabilities in the communities, and serving quite distinct needs on the part of older Australians. I was concerned that moving to a more individualised program type, of the type you see in Support at Home, also had the potential to undermine a lot of the social capital we see in our community through terrific organisations like Meals on Wheels that are block-funded and have delivered these services, in the case of Meals on Wheels, since the 1950s.
So we paused the decision that was taken by the former government to merge these two programs and have decided now as a government to retain the Home Support Program as a standalone program, and I'll hand to Sam to say a few words about that.
SAM RAE, MINISTER FOR AGED CARE AND SENIORS: Thanks, Mark. Over the last months we've been listening, and what we've heard is how much the CHSP means to older people, to their families, and to our communities. CHSP is the entry point for aged care services within our aged care system. More than 830,000 Australians rely on CHSP services. It's a little hand with cleaning the house, doing some shopping, Meals on Wheels importantly, transport, as well as maintaining social connectivity. Now, providers told us that they needed certainty, and importantly older people told us that they needed continuity of care, and that's what this announcement delivers today.
Many of these services are delivered by local government organisations, and the important part here is that contracts across the CHSP system will be extended through to 2029. Council contracts will be extended without interruption through to 2029 so that older people across our communities can have certainty about the sustainability of that delivery. It is older people's expectation and it is my expectation that councils will continue to deliver those services in accordance with their contracts.
More broadly, this announcement supports more than 1300 providers across the sector to continue to deliver these foundational supports. These providers are local and state governments, they’re not-for-profit organisations, and as Mark pointed out, they are community-based organisations who have significant components of community activity, including volunteer contribution. As Minister Butler said, we believe the CHSP should remain a standalone program separate from the Support at Home program. We'll begin consultation this year across the sector and importantly with older people to determine what the long-term future of the program looks like, including how block funding can continue, as well as the role for fair and equitable contributions, and how we can use early intervention services to take pressure off our aged care system overall. This is the latest step that our Government has taken to ensure that we've got an aged care system that continues to deliver on our promise of safe, dignified, and high-quality aged care for every Australian.
I'm happy to take some questions.
JOURNALIST: So is it your intention to keep them as separate programs in an ongoing basis before 2029?
RAE: Yes, it is.
JOURNALIST: You say that you've been listening to the community. What do you say to the older Australians who worry that algorithms are defying common sense when it comes to some of their aged care packages?
RAE: Andrew, your question pertains to the Integrated Assessment Tool. So the Integrated Assessment Tool is a component of the Single Assessment System, which was a key recommendation of the Royal Commission. And fundamentally, it's about getting more equitable and more efficient outcomes for older people in terms of their assessments. We've been able to drive assessment wait times down and improve accuracy. There are a number of improvements that we can make. We've continued to listen to older people as well as people who are working across the sector. Minister Butler and I have already announced some steps that we're taking, including the rapid review to the prioritisation mechanism, some other adjustments that we've made along the way, the MND priority pathway. I've made changes to the queuing rate. We'll continue to listen. We'll continue to take on board the advice that older people and their families give us, and we'll make whatever changes are necessary to get the best outcomes for older people.
JOURNALIST: But will you take algorithms out of the system?
RAE: Well, as I said, the IAT is a component of the Single Assessment System, which was a key recommendation of the Aged Care Royal Commission. We're getting fairer and more efficient outcomes by using this new assessment system. Fundamentally, that's the important part here. We're driving down assessment wait times for older people. We're getting fairer outcomes for them. We'll continue to refine the system as necessary to make sure that we get the best outcomes for older people.
JOURNALIST: In terms of the classification algorithm though, you're specifically not reviewing that, and the Royal Commission didn't recommend using an algorithm. We're hearing stories from people who are saying they want to be reassessed, why is it so damn hard to be reassessed? So why aren't you looking at that? Especially when there's such widespread support across Parliament for change too.
RAE: So median assessment wait times are now under a month. We want people to get reassessed as their circumstances change. At its worst, under the old system, sometimes people were waiting up to 10 months to get an assessment. The improvement that we've been able to deliver here for older people is very, very significant. We're going to continue to refine the system so we get the best outcomes for older people.
JOURNALIST: Why aren't you reviewing it? Why aren't you reviewing the classification?
RAE: We're doing a rapid review, which is going to deliver some of the outcomes of that. Our focus is on improving the prioritisation mechanism at this stage. But as I've said a number of times, we'll continue to listen to older people, take on board that advice, and make improvements where we think that's appropriate.
JOURNALIST: The lived experience of older Australians is that they're having horrible, horrific experiences at the hand of an unanswerable algorithm.
RAE: We conducted about a quarter of a million assessments in the first half of this year. There's already a process of review in place, and reviews were sought for less than half a percent of that very large number of assessments.
As I said, my focus is on listening and making the difficult decisions about where we can improve the entire assessment process so we get the best outcomes. The focus at this moment is about the prioritisation mechanism.
And I think we might have to go to this division.
[Press conference interrupted by parliamentary division]
[Ministers return]
JOURNALIST: Minister, what’s your reaction to news this morning of a new vaccine which could prevent melanoma?
BUTLER: This is incredibly exciting news, not just for Australia but for the whole world. But remember, melanoma tragically is Australia's national cancer. We have some of the worst rates in the world, but we also have some of the best researchers. And Professor Georgina Long, the former Australian of the Year who has been the lead investigator in this phase 3 clinical trial, is not just doing great things for our country but obviously achieving something that will be really significant for the whole world. She’ll be presenting the results, as I understand it, in the next several weeks at the international conference. But this is the first phase 3 trial to demonstrate the ability of an mRNA therapy in combination with Keytruda which is a well-known immunotherapy in the cancer area, to provide effective treatment for melanoma.
Now, this is incredibly exciting particularly for a country that lives in places that challenge of such significant melanoma rates as Australia does, but it’s a globally significant contribution to medical science.
JOURNALIST: Minister, can Australians be confident in this Zoladex alternative that’s going to be added to the PBS? And are you concerned that more big drug companies might go the way of AstraZeneca and pull their vaccines and medications from Australia because they’re concerned about low-cost base?
BUTLER: Yeah, I think we've been facing, as other countries have, quite a bit of disruption to the global medicines market after President Trump introduced his most favoured nation policy for medicines pricing. This is something we're engaging with industry about very closely, but also with patient groups who are bearing the brunt of some of the decisions that medicines companies are taking. Only a few weeks ago, we had to deal with the withdrawal of two very important drugs for multiple sclerosis, and put in place a process to preserve them on the PBS, which we have done to the relief of many, many MS patients who take those drugs. And I know just how distressing the potential withdrawal, or the scheduled withdrawal of Zoladex from the PBS has been for tens of thousands of women who use that treatment for breast cancer and for endometriosis in particular.
We've been working very hard to make sure that women don't go without an effective treatment. There is an alternative medicine that I understand is clinically basically an equivalent to Zoladex that’s been considered very urgently by the Pharmaceutical Benefits Advisory Committee called Triptorelin. It’s used in other parts of the world. The Breast Cancer Network of Australia, the key patient group in this area, has talked about this over the last several days and we're doing everything we can to make sure that all of those women have access to effective treatments.
JOURNALIST: Do you have any estimate for the cost of the extension to the budget of CHSP and will there be a corresponding decrease in the cost of the Support at Home programs?
BUTLER: Those updates will be provided in the usual way in the mid-year budget update in November or December through MYEFO.
JOURNALIST: Is this a cost saving measure, though?
BUTLER: No, this is not a decision that's motivated by a cost saving measure. What we’re going to have to do, and Sam's going to have to lead this work. is to reform this program as well, because it is quite clear that there is some level of overlap between the services provided under the Home Support Program, compared to Support at Home. There are some different services in co-contribution arrangements that will have to be sorted. I mean, that's why we’ve decided to extend the existing program for two years to allow Sam to lead the reform work that the Government has decided will be important to ensure there’s not duplication. And there is alignment on things like co-contributions.
JOURNALIST: Given your extension, do you expect that local councils and other providers that had left and no longer are providers, now will come back on and provide the service again?
RAE: For those that might have already left the program, we would very much like to add a second thought to that. For the many providers, both local government and the other types of providers across the sector – not-for-profits, community-based organisations – this gives them the certainty to continue providing. Their contracts will be extended without interruption through to 2029. They now know that the Government intends for the CHSP program to continue as a stand-alone program, and we can work, we can continue to collaborate with them about what the future, the long-term future of the program looks like.
JOURNALIST: You said you were going to begin consultation on making it long-term. When do you expect that to be completed?
RAE: We're going to begin consultation this year on what the long term settings of the program looks like. Minister Butler’s just talked about the interrelationship between the future of the CSHP and the future of Support at Home - how they operate in a complementary manner, and course how we ensure consistency between the two around things like contributions. So we're going to begin that work immediately. There are experts all across the sector, providers who deliver these services and, most importantly, older people who rely upon them. We're going to take the time to listen to that expert advice and work through the policy settings for the longer term.
JOURNALIST: Just on another matter. The Senate yesterday launched an inquiry into postpartum care, can I just get your response to that?
BUTLER: This is work that has been led by the Assistant Minister for Health, Rebecca White. We’ve moved closely with Senator Smith; also Katy Gallagher as the Minister for Women has been involved in developing the terms of reference for this. There is good engagement with other parties well. Our original intention was that this would be focused particularly on postpartum care, birth injuries, a range of other things associated with that area. There's been a lot of advocacy from Birth Trauma Australia, particularly in the last several weeks, which I think has been extraordinarily powerful and really builds a case for a deep look at this area of care to support those many, many women.
Now I understand the terms of reference have been expanded a little bit to deal with some associated issues. I can't say enough how important these Senate inquiries can be to build a case for reform. The big women's health package we delivered last term very much drew on through Senate inquiries - one into reproductive health, the other into perimenopause and menopause. The evidence given, the ideas that were canvassed in those reports were really formative as we developed that women’s health package.
Now, I don't want to pre-empt what this report might come up with, but I've got enormous faith in the people who are leading it - they’ve had a critical role in those last two reports. I think that it’s well beyond time, as Birth Trauma Australia has indicated, that we have a deep look at this area.
JOURNALIST: Minister, just on NDIS and Thriving Kids, Queensland says that the Commonwealth hasn't been able to answer basic questions about definitions, they can't answer what's going to happen to an eight-year-old who turns nine, et cetera. How are you going in your discussions the Queensland Government? Are you giving them the clarity that they need? And what else could you be giving Queensland to get the Minister to sign on to this?
BUTLER: I think what this means, again, is a recognition that this is a shared job. All of the jurisdictions have agreed that we need to work together on developing a definition of mild to moderate support needs. That work is being co-chaired by South Australia and the Commonwealth. It is not Commonwealth work. It is not a negotiation between the Commonwealth and Queensland, in particular. It is a collective work by all governments and it is, as I understand it, a draft definition ready to be provided within days to all jurisdictions. That was the subject of some discussion at the meeting of disability ministers last Friday.
I've seen some remarks by the Queensland Minister in the media that we haven't been sharing an update with them about what the scope of Thriving Kids might be. Quite some time ago we shared with all state governments the numbers of children we thought would be covered by the Thriving Kids programs, so that gives them the ability to think about scale of the programs that will be delivered at state level.
And as I said, this work on definitions has been going for a little while now, but it's not Commonwealth work, it's shared work. And I really want to thank South Australia for co-chairing that work with us, and it's pretty much ready to go. I think all other jurisdictions, Labor, Liberal alike - this is not a party political thing - every other jurisdiction has been able to get on with the work of developing their programs, finalising implementation plans. They know how much money they're getting from the Commonwealth to deliver their programs. It’s time that Queensland got on board too.
JOURNALIST: Just on the escalating option for the classification algorithm. Who's going to decide that a case meets extenuating circumstances? And do you expect it to be quite rare?
RAE: So, the escalation pathway that you're referring to, we announced that we'll pursue legislation to enable that. Now as I've said, of the quarter of a million assessment that were conducted in the first half of this year, we have about half a per cent that sought review. We accept that there is a small number of extenuating circumstances where the IAT doesn't necessarily provide the appropriate outcome. What we want to do is have another safeguard in place whereby those can be referred through this pathway to ensure that someone, such as the system governor, has the power to….
JOURNALIST: Will a bureaucrat or a clinical assessor decide that?
RAE: All of the assessment processes involve clinical assessment, so that won't change. So there will of course be clinical input into the way that these decisions are made. We're working through the detail of this right now. We would very much like for there to be a bipartisan approach to the way that we implement this. That has been the way that the aged care reforms have been implemented to this date to suit the needs of older people and to ensure sustainability of that reform program. I remain ambitious that we can get to a point where we get broad agreement around the Parliament about how to get the best outcomes for older people through this escalation pathway.