RAFAEL EPSTEIN, HOST: To talk about a lot of the issues, a lot of people waiting on lists for far too long, we’re joined by Sam Rae. He’s the Aged Care Minister in Anthony Albanese’s Federal Government. He’s also an MP for the seat of Hawke right here on the edge of Melbourne. Sam Rae, good morning.
SAM RAE, MINISTER FOR AGED CARE AND SENIORS: Good morning, Raf. Thanks for having me.
EPSTEIN: I just wanted to start with a lot of the feedback we get. I was really struck recently – one of our callers described the system as cruel, and that was really around the complexity. But maybe I'll start with a different caller. Sue rang us from Northcote. She's waiting for a knee replacement, then she broke her leg. She needed a wheelchair, and she had to pay for it herself. Just have a listen to this.
[Excerpt]
CALLER: In order to get a wheelchair, I needed to be assessed. In order to be assessed, I had to wait two weeks for an appointment, whilst I needed the wheelchair now. So I actually bought one. I was lucky that I had enough money to buy one. I can't get that refunded because it was done without their approval, which is ridiculous.
[End of excerpt]
EPSTEIN: So let's start there, Minister. She's on Support at Home, but she's not getting the help she needs. She sort of had to dip into her own pocket. Why is that happening?
RAE: Raf, let's be upfront about this right from the get-go. These are really distressing moments in people's lives. They're under a lot of pressure, often facing health challenges such as Sue just spoke about there. I think the thing that I would really want you and your listeners to understand is how acute that emotional challenge is, and how much I think about that for people every single day.
In regards to the circumstances, I'm obviously not across Sue's specific case, but the way these things normally work when people are talking about getting an assessment for urgent support is, you'd imagine that in a circumstance where someone had broken a leg, they would be getting assessed for that support within the hospital system. The wait times, the median wait times for assessments in hospitals is under a day. So really happy for you to pass along Sue’s details so that I can follow up with her directly.
EPSTEIN: Can I interrupt, Minister? Immediate care isn't the issue. It's I need this thing at home. People don't find that system easy to navigate. Why? is this- if she's already in your system, in your new system, why is that system not providing the wheelchair?
RAE: Well, people need to get assessed according to their needs, Raf, and part of that is about making sure that we've got a fair distribution of our aged care resources in accordance with people's needs. And of course, part of that is also making sure that when we're spending taxpayer dollars, that are very precious taxpayer dollars, especially in days like today when we know our budgets are under pressure, we need to make sure that they are going to the right people at the right time. Now, what I've just heard there from that call with Sue, that sounds like a really good example of where someone needs urgent assistance. And I would have hoped and expected that she would be assessed within the hospital system within the day, and we could get that support to her quickly. But as I said, really happy for you to pass along those details.
In terms of the broader challenge here, we've got unprecedented demand for aged care services. And if we take a step back here for a second, Raf, we're only twelve months into what is supposed to be a multi-year, generational reform of our aged care system. But we've got to look where we started. The aged care system was broken, and I think people have forgotten that, and I'm glad that people are starting to forget that. But this was a system that was failing older people, was failing our communities. We saw that laid bare in the Royal Commission. It's why this reform program is so important. So we're trying to rebuild the aged care system at the same time as an ageing population is driving unprecedented demand upon it.
EPSTEIN: You've said unprecedented demand. I think people understand that. There's more of us. We're getting older. But the wait times and the number of people waiting are significant. There's something- last figures I've seen reported by the ABC, there's a total of about 150,000 people waiting for all or some of their funding. A lot of those lists are getting longer, not shorter. Why?
RAE: Well, can I just correct a couple of things there, Raf. There's about 100,000 people on the waitlist right now for Support at Home, and the wait times, which I think personally are the more important part of this, because the waitlist is one thing. That's not how people experience the system. How they experience the system is the time that they personally have to wait to receive their care.
EPSTEIN: They’re waiting like 10 months.
RAE: Well, that's not right, Raf. Wait times have been falling across the board.
EPSTEIN: Is the average not 10 months?
RAE: No, absolutely not. We have seen wait times falling by many months just over the last 12 months. And people who are assessed as urgent priority, they receive their packages of care within a month, always. People who are high priority …
EPSTEIN: There’s a whole lot of people who aren’t classified as urgent. So I'm just talking- just to talk about a 10 month average for a moment, that came up in the Senate inquiry very recently. That's last month. That is not the average for the full list?
RAE: No, that's outdated. Quite outdated data now, Raf.
EPSTEIN: So what's the average now?
RAE: We are seeing the longest wait times in Support at Home be between six and eight months. So just within one year, they've fallen by multiple months, and we're going to keep driving those wait times down. Again, I'm not satisfied with where we're at here, Raf, but we are seeing improvement. We've got to be careful not to throw the baby out with the bathwater while we continue to make the changes to ensure that we've got a system that works for older people.
EPSTEIN: So let's just follow up on some of those numbers. If you've just joined us, it's 09:13am. Sam Rae is with you, the Aged Care Minister. This new system's been in for just over a year now.
Minister, I mentioned 150,000 waiting. That includes the figure in March was 53,000 people getting essentially some form of interim funding. It isn't only interim funding, but the 50,000 people in March getting some of the money, not all of the money. Has that number gone up or down?
RAE: We use interim funding, Raf, to make sure that people can get access to the services they need sooner than they would otherwise be able to. And again, this system has tripled in size since 2020. With so many new people coming on, we're having to make those hard decisions to ensure that people aren't left languishing without any funding support. So, we bring on 60 per cent of their funding as soon as we possibly can, in order that they can access that funding earlier…
EPSTEIN: So they’re getting something and not nothing.
RAE: Correct.
EPSTEIN: But has that number grown since March, the 53,000?
RAE: The number continues to grow because we're seeing such high demand in the system. Now, as at the end of June, that number dropped to zero. We had no people on interim funding, but it will continue to grow again throughout the year because we're trying to get that early support to people as soon as we can.
EPSTEIN: There's some money allocated in the budget for aged care. Something else that came out in the Senate Inquiry is there's something like $1.5 billion that wasn't spent. So both residential aged care and aged care in the home, supported home. What happens to that $1.5 billion? Is that a saving in the mid-year budget statement at the end of the year, MYEFO, or does that $1.5 billion stay and is it spent on aged care?
RAE: Well, I think what we need to understand is that the aged care budget is growing very, very rapidly, Raf. This year, depending on how you cut it, it's roughly $44 billion of investment in aged care, and just in the budget a few months ago, we topped it up with another $3.7 billion of additional investment. The amount that is residual there that you're referring to, that was caused by part of the delays in the transition in terms of people adjusting to the new system, the sector responding to the new system, largely driven by workforce challenges - because, as you know, we find it really hard to find to find these amazing workers to come into the system. There's been some delays there. There's also been some changes in the way the residential care system works in residential aged care homes.
We don't foresee there being any long-term savings around the aged care budget. In fact, we're continuing to make investments, and we've done that at pretty much most of the budget processes since we were elected. The budget in the aged care system has grown by more than 40 per cent since we were elected in 2022.
EPSTEIN: So, just to pass that, savings sometimes described by your opponents as cuts, but that $1.5 billion that wasn't spent, and you explain some reasons for that, goes back into the pool, it doesn't get taken away from your portfolio?
RAE: Well, again, I think what we need to do is be sensible about this, not worry so much about the accounting tricks of government, but understand about the investment…
EPSTEIN: Forgive me, Minister. They're not tricks, but I mean, I haven't even started on the intense political pressure your Treasurer is under to save money. So- and I'm not saying I understand how governments move money around. There's clearly a 1.5 billion that wasn't spent. You've presented what sound like some very reasonable reasons why it wasn't spent. I just want to know if that gets spent in aged care or not?
RAE: We have to make decisions in the context of the budget, Raf. I can't presuppose what the budget process will do in terms of the aged care budget next time around. What I can tell you is that we've got a few opposition members quibbling about what is ultimately a relatively modest portion, although an important portion of the overall aged care budget. But we injected another 3.7 billion dollars into the aged care budget just last budget.
Foreseeably, Raf, let’s be frank about this, I don’t want to be disrespectful about the Budget processes that we go through with the Prime Minister and the Treasurer, but demand in the aged care system is driving constant growth in the aged care budget. I don't think Jim Chalmers or anyone else will be looking to the aged care budget as the source for any savings in the short term.
EPSTEIN: Just a final, but really important thing to talk to you about, as the Aged Care Minister, and I guess this goes back to where I started. People find the system cruel. Just that- it's just not an easy system to use. There's an algorithm that's part of the assessment. There's been an Ombudsman's report. We spoke to the ombudsman about it. Has the algorithm made things better or worse?
RAE: The Single Assessment System, which is the broader system to which you're referring here, of which the Integrated Assessment Tool, which has the algorithm built into it, that was a key recommendation of the Royal Commission. And I want to say two things here about this because they're both important. The situation has improved significantly from where we were. The assessment system was failing people, and yet, Raf, it can still improve further. Too often in politics, people want to speak in absolute terms. Something either works or it doesn't work. Everyone's either a genius or an idiot. This is a system that is improving, and so we need to keep making sure that it stays on track. There are parts of it working-
EPSTEIN: Has the algorithm made things better or worse?
RAE: That approach is definitely improving the fairness of the system to make sure that people across the country are getting fairer outcomes. The wait times for assessments have fallen. At their worst, people were waiting up to about 10 months to get assessed. The median wait time is now consistently under one month. We've shortened the wait times. We're getting fairer outcomes for people, and we're making sure that those precious taxpayer dollars are being spent where they need to be spent. All that said…
EPSTEIN: But you haven't followed all of the Ombudsman's recommendations, and if I can just inject this into the conversation, the Ombudsman says the algorithm was unreasonable, and unfair, and undermined public confidence. So, in the context of that- that's what the ombudsman's saying. Do you think the algorithm has made the system better or worse?
RAE: Well, again, firstly, we're taking heed of all of the ombudsman's recommendations and acting upon them. So, I just want to clear the air on that.
EPSTEIN: You're following all of the recommendations.
RAE: Yes, we are following all of the recommendations. We've already put in place an escalation pathway to deal with the first of the Ombudsman's two recommendations, so that where the automated system can't achieve a fair outcome for people, that can be escalated to another clinical process for determining the appropriate level of care for those people. And the Department has taken all of the other recommendations; has either accepted them or accepted them in principle, and is acting upon them. Coming back to your fundamental question, this is significantly improved from where it was. We're getting fairer outcomes, we're getting faster outcomes, and we're getting more accurate outcomes. And yet, I want it to improve still. It's why we're going through a review of the algorithms that underpin the single assessment system and the IAT to make sure that they are fit for purpose and they're getting the best outcomes for older people.
EPSTEIN: Are you effectively weighing up a choice between letting people die without help, or blowing the budget?
RAE: No, this is about dignity. This is about human dignity as much as it is anything else, Raf. And I think what we all saw through the Royal Commission was…
EPSTEIN: Well, I'm sure you just- just on that word dignity, Minister, I won’t read out the texts but a lot of people don’t feel like it’s very dignified.
RAE: This is part of the challenge that we face, Raf. We've got this huge level of demand. You talked about it. In fact, it's roughly 800 per cent from where it was 15 years ago, just to give you some understanding of what that looks like, and the system has tripled. The home care system has tripled over the last five or six years. We're now seeing nearly one and a half million Australians being cared for in some part of the aged care system. We've got to make responsible decisions about how we fund that, and we've got to make fair decisions about how we distribute those resources.
EPSTEIN: I appreciate your time this morning, Sam Rae. A lot of people have got a lot invested in this system, so thanks again.
RAE: Thank you so much, Raf.
EPSTEIN: Oh, actually, no. I'm going to ask you another question. Forgive me. That's bad radio craft.
RAE: I could have just hung up there and got away, you realise.
EPSTEIN: You could have. I just remembered where your seat is. The suburbs in the seat of Hawke, in Melbourne's northwest, there's a tonne of people wanting to vote One Nation there, and potentially kick out a lot of long-serving Labor members. Do you think within your seat, you'll have a One Nation state MP?
RAE: Raf, it’s obviously a pretty tough election for the Victorian Government. I'm not a member of the Victorian Government, but I've got regard for the work that they are all doing. They’re running a very strong campaign at the moment. I think, to speak frankly, people are under a lot of pressure. We’ve seen wars internationally driving inflation around the world. We’ve just seen the American election play out along those lines. It’s going to be a challenging election. I don’t know what the outcome is going to be, but I know that my colleagues are putting their best foot forward about how they plan to continue to represent working people out here in Melbourne’s outer west.
EPSTEIN: OK. You’ve been generous with your time. Thanks a lot.
RAE: Thank you so much.