MELISSA CLARKE, HOST: I'm joined by Sam Rae, who is the Federal Minister for Aged Care and Seniors. Sam Rae, thanks for joining me on Radio National Breakfast.
SAM RAE, MINISTER FOR AGED CARE AND SENIORS: Good morning, Mel. Thanks for having me.
HOST: So, can you talk me through the problem that you're trying to fix here?
RAE: Well, we're trying to fix the aged care system, Mel. There was a Royal Commission as everyone knows now, uncovered terrible, terrible things, horrific stories. And since we were elected in 2022, the Prime Minister's made very clear that this would be a key focus of our Government. And we've worked tirelessly ever since that point to build an aged care system that older Australians can rely upon.
Now, the assessment process for accessing care is a key component of that. And along with the new Aged Care Act and the Support at Home program that came into place in November last year, the new assessment framework was put into place as well. And along with that came the Integrated Assessment Tool, which you spoke about just there in the intro, and that has been something that we've been very clear about all the way through, would require ongoing refinement. As well as other parts of the assessment process. We've already made significant refinements. This is the latest refinement. This is about making sure that when there are a small number of people for whom the tool doesn't neatly capture their needs, there's an option, an escalation option, where the Secretary of the Department can make the necessary decisions to get them the care they need.
HOST: So the frustration for a lot of people had been that there was this assessment tool, that assessors came, worked person to person with someone, plugged the information in to check it against the assessment criteria, and that process was automated and wasn't a way to challenge that. So you're saying there will now be a pathway for people to challenge that assessment that is made through that automated process?
RAE: There's a bit of misunderstanding about this, Mel. So just if I could clear it up.
HOST: No please, do step through it.
RAE: Yeah, thank you. So we rely on highly qualified assessors, human assessors, just to be clear, to do all of the clinical assessments for older people. And that's usually done in an older person's home, often with a support person in place as well. That clinical data is collected, it's entered into the Integrated Assessment Tool, the IAT, as a holding place for that clinical data. There's then an automated component, which application of the Aged Care Rules, and this is where the confusion starts to lie – subjective clinical data collection and then objective application of the aged care rules against that clinical data. Once that process happens, it goes to a second human being, the assessor delegate, who then has to sign off on that. And if the older person is unhappy or a supporter of the older person is unhappy, they've got the option to refer that to a review process. We're creating an additional option here, where if in the assessment organisation's clinical view, the needs of the older person aren't appropriately catered for through the tool, then they have this option to escalate that to the System Governor, the Secretary of the Department.
HOST: So you're saying that's the person within the system, not the family members who would raise that?
RAE: Well, older people and their family members already have this option to seek a review and that will, of course, remain.
HOST: Through the Administrative Review Tribunal?
RAE: No, that would be way down the line. Within the initial assessment process, there's a review component. So they can already seek a review, the older person, or as I said, a supporter can seek a review through that review process.
This is another option where clinical judgement is applied. We think that this will apply to a very small number of assessments, but where the needs of that person aren't captured, and so there needs to be an escalation for that.
HOST: How do you trigger that additional clinical assessment?
RAE: Well, that's subject to some of the conversations we want to have over this winter break. Mel. We want to engage in good faith. A lot of the work that we've ...
HOST: So we don't know?
RAE: Well, I'll tell you my view in just a second. But I also want to be clear, I want to remain open-minded about some of these things. I want to hear from more people. We've always said that we want these reforms to be done on a bipartisan basis wherever possible or a non-partisan basis across the Parliament. But more importantly, I want to hear from older people. I want to hear from assessment organisations. I want to hear from supporters. So we're going to have ...
HOST: I thought you had been hearing from them. You've been getting a lot of complaints about this process.
RAE: I've been hearing, Mel.
HOST: But we don't have an answer yet. You're saying there'll be an additional clinical step, but how that's triggered is not clear. Like, do the families get to trigger that? Is that only people within the system who are looking? Is it certain conditions that trigger it?
RAE: My view Mel, subject to the discussions. As I said, I want to engage in good faith, but my view on this is that it'll be the assessment organisations, that they'll lean on their clinical judgement to understand where in a very small number of cases, the tool doesn't neatly capture the needs of a particular complex set of conditions, for example. The assessment organisation will lean on their clinical judgement, and they'll be able to initiate this escalation pathway.
HOST: So is that a clinician in one of the assessing organisations being a human overriding the automated assessment against the objective criteria? Is this the human making a different conclusion from what the automated process would have otherwise come to?
RAE: Sorry to be pedantic …
HOST: No, please do. This is clearly very detailed and I think the steps are not entirely clear.
RAE: That's really fair, Mel. And it's a complex system and we've tried to simplify it, because complex systems are obviously hard for older people and their families to understand, and that's a hindrance to their confidence in the system. That's why we're looking for options to simplify it wherever we can.
Nevertheless, the assessment is not an automated thing. The assessor, highly trained clinical assessors, always humans, they conduct the clinical assessment. The automated component is the application of the rules, and they have to be the same for everyone. That's how we get fairness and consistency in the system and, of course, it's how we brought wait times down.
HOST: That's the automated process, right?
RAE: That's the automated process.
HOST: So is this the bit that there will be another clinical point at which there can be an intervention?
RAE: Yes, at that point where the assessor organisation, the delegate is probably more appropriate in my view, where the clinical assessor delegate makes a decision that that process hasn't neatly captured the needs of a complex set of conditions, for example, interrelated conditions, comorbidities, circumstances where the tool doesn't capture that- we're talking about outliers here. Of the 260,000 …
HOST: So does that happen before the tool assesses the information? Or does the assessment tool be used and then that clinical assessor delegate then looks at the outcome and then steps in?
RAE: That's right, Mel, the latter of those two. So the clinical assessment occurs, the Aged Care Rules are applied against that clinical data, and then the assessor delegate would look at that and say, well, the clinical assessment inputs are right. They're satisfied with that, but they don't think that the framework is addressing that person's needs. So they can then initiate the escalation pathway to allow some discretion to be applied by the System Governor, who is the Secretary of the Department.
HOST: Now, you're saying this would only be in a few cases, but you're also not clear or haven't settled yet on what would be the triggers for it. So I don't know how you can say it could only be a few if you're not even saying what it might be that would assess that, because a clinical assessor delegate might see a lot of cases where they think this system isn't appropriate for the complexity and the specifics of this case.
RAE: That's a fair point, Mel, but we can also model what the likeliness of this is, and we can look at historical data around how assessors and assessment organisations have operated. We've been looking at that. We've also- it must be said, we've done 260,000 assessments between September and March. 260,000 in a six-month period. And of those, only half a percent sought review.
Now, some of those reviews were related to the clinical assessment itself, and the existing review process is the right pathway to address those issues. Some of them were related to this issue that we're raising today, where the tool doesn't neatly capture the needs of the person. So from that data set, we can extrapolate a likely number of cases where this will be the appropriate pathway.
HOST: How long is that likely to take, given many of these assessments are really time sensitive?
RAE: Well, obviously, we want this system to be working as quickly as possible. It's why we've brought those overall assessment times down. At their worst, people were waiting 10 months to get an aged care assessment. The median wait time is now consistently under a month. We want people to get assessed regularly as their needs change.
HOST: But is this an additional step that is going to mean that for some people in those complex or unusual circumstances, their cases take a little bit longer?
RAE: That's true. And we'll be seeking to make sure that that process happens as quickly as possible. The current review process is 90 days. So one would imagine- again, I want to be clear, I want to engage in good faith through this winter break of the Parliament so that we can get the legislation as much support across the aged care sector and with older people as we can before we bring it back to the Parliament in the next period. But my view is that it would be done by the assessor delegate organisation and it would be rapidly completed because it will be a relatively small number of cases overall.
HOST: What about people who've been through this process in the meantime? Is there an ability to go back if there are people who think they are one of these complex or unusual cases that haven't been able to have the opportunity of this clinical assessor delegate reviewing it a second time? Will they have the abilities? Will there be a retrospective element to this at all?
RAE: What we've built is an assessment [system] where people no longer have to wait for excessive periods of time to be assessed. We want people to be assessed regularly.
HOST: So you think if there's an issue, they need to be reassessed again?
RAE: Yes, and that's what we want. We want people to be reassessed regularly so that their care attribution meets their needs.
HOST: Just one more question. You talk about wanting to work collaboratively here and try and get as much support as possible, but these decisions and reviews seem to come only after the Government is dragged to these. I mean, we were on the precipice of the Senate voting on a Private Member's Bill to try and bring in a change just like this. The Coalition, the Greens and the crossbench seem to need to drag the Government to the edge of losing a vote in Parliament before you act. Why does it take that for the Government to respond to the very real and very loud concerns of people who are worried about this process?
RAE: Mel, I'm not going to weigh in on the politics of the Senate. It's not my natural habitat, I'm afraid. What I can tell you is that we've been listening to older people. We always said we would do that all the way through this process. I make regular changes to the way this system operates to get better outcomes. This is a point that we've been discussing publicly and I've been engaged with across the entire community for a period of time and made clear that I was giving this consideration. We're now at a point where we can take that next step, begin the discussions we want to have rapidly over the coming weeks and get the legislative pieces into place.
HOST: Sam Rae, thanks very much for talking me through your very complex portfolio. I appreciate it.
RAE: Thank you, Mel.