PATRICIA KARVELAS, HOST: Minister, welcome to the program.
SAM RAE, MINISTER RAE: FORAGED CARE AND SENIORS: Thanks for having me, PK.
KARVELAS: This report says the use of automation in the aged care system lacks safeguards, it's led to unfair outcomes for elderly patients. Why not just scrap it?
RAE: Well, the old system that we had prior to November 1 last year wasn't working for older people, it wasn't working for our community, PK. A single assessment system with a tool to support fair assessments was a key recommendation of the Aged Care Royal Commission, and that's what we have sought to implement through this process.
Of course, we are getting fairer outcomes, more efficient outcomes, and more accurate outcomes, but, as the report outlines we admit freely that it's not always getting it right. It's why, since it was implemented in November, we've already made a number of changes throughout the process. We’ve changed the queuing rates to make sure that people are getting the care they need at the most appropriate time. We've implemented the MND pathway. Last sitting week we legislated a pathway for escalation for people. And there's an independent review to come as well.
KARVELAS: Okay. But on the algorithm, the report says that it's been rolled out without any meaningful risk assessment. Do you accept the characterisation of this report?
RAE: Well as I said, this is about getting fairer outcomes for older people.
KARVELAS: Not fairer, according to this report.
RAE: Well, I think the recommendations that we see in this report are constructive recommendations, many of them the Government has already put into motion prior to the report being published. And the Department has, at least in principle, accepted some of those other recommendations along the way as well. So, this is about an iterative process to making sure that we do have an assessment system that is fair, that is getting the best possible outcomes for older Australians.
KARVELAS: But the most significant course, which hasn't been adopted by the Government, is the one calling for a human override. Why won't you accept it?
RAE: To be fair, PK, that's what the escalation pathway that we announced some time ago, and indeed was legislated in the parliament last sitting week, that's what it provides for. It provides for in circumstances where people's complex conditions can't be appropriately assessed using the IAT - that those can be escalated and there can be an alternate clinically informed approach to determining the best care for those folks.
KARVELAS: But that's not this recommendation. It’s for a broader human override, and you haven't accepted that recommendation.
RAE: I think it's consistent - principally consistent. I think the recommendation imagines some version where the IAT may not be the most appropriate or getting the most appropriate outcomes and that those circumstances need to be escalated, and that's what we have provided for. It's what we announced some time ago, it's what we've legislated in the Parliament, and it's what we're implementing on January 11.
KARVELAS: So, this recommendation is quite clear that it wants a broader human override. It doesn't trust the system itself - it says it's failed too many people. So are you looking at making further changes? Because out of the 10 recommendations six have been accepted by the Government but the other two, including that human override, have not been accepted.
RAE: The recommendation points to an assessor delegate providing override. We're building a pathway where a delegate of the department can accept the assessor's advice that the IAT not be the appropriate method for determining the care, and that be the override option.
KARVELAS: Okay, explain what that means in English. I'm saying this very respectfully, I'm not trying to be rude, but I don't know what that means. What does that look like? Doesn't everyone get a right for an override?
RAE: Unfortunately, this is a really complicated system. We're on track to see about [half] a million assessments go through the system this year. So the volume of assessments in a system where we know demand is going through the roof is very, very high. It's why we need a standardised approach - to make sure that no matter who does your assessment or what they have done, everybody can get a fair assessment. It's a clinical assessment. A person comes in, it's always done by a human being, and then that data goes through the standardised process to determine the care.
We acknowledge that in some cases it's not getting it right. In those cases, those are the ones that need to be escalated, that's why we've put in place this escalation pathway. So it's an alternate route, if you like, for…
KARVELAS: But if it doesn't cover everyone, you're still going to have the potential for flaws.
RAE: I think what we need to realise is that we're trying to build an assessment system that does meet the needs of people more broadly. We're seeing that. We've seen significant improvements from the old system. But we have to be careful here. We have to find a space in this discourse where we can say, this is what's working and this is what’s not. There's always opportunities for improvement. We can't keep throwing the baby out with the bathwater. We've seen waiting times coming down. We're seeing more accurate assessments occurring. We're seeing better outcomes for older people. We want to keep improving that system, and that's what the Government's approach is all about.
KARVELAS: The Ombudsman's investigation also found the rollout itself undermined public confidence. Do you worry about what this has done for Australia's faith in the aged care system?
RAE: This is a generational reform program that we're on, PK. And there's no doubt, and we've always been upfront about this, there are going to be really significant challenges along the way. And we can look back to the Royal Commission, those harrowing stories that came out of the Royal Commission process. But the work of rebuilding Australia's aged care system from a place that was pretty dire, in the context of this ageing population, this unprecedented demand, this is not going to be done overnight. This is going to be years and years of work.
KARVELAS: Sure, but I think it's fair to say that when the Albanese Government was elected in 2022, one of your chief promises was to fix the aged care system and to denounce the Morrison government's management of aged care. There are more people dying waiting for aged care places in their own homes now - that's been reported very recently. Do you accept that promise that Labor made has not been upheld?
RAE: First and foremost, let's be very frank, it is a tragedy when any older Australian passes away while for the care that they need. It's why this reform program is so important. We have to recognise the steps forward that we're taking.
Safety and quality within the aged care sector has never been as high as it is right now. At the end of this financial year, we'll have three times the amount of people receiving Support at Home as was received under the Home Care Packages Program just in 2020. So we're seeing explosive demand. We're seeing the Government responding, the sector responding to meet that demand. As well as, quite rightly, elevated and evolved expectations from our community about what high-quality, dignified aged care looks like. We've got to stay the path here. We've got to keep making these improvements for older people and for our community.
KARVELAS: But the problem is if older people aren't experiencing them as improvements, increases in deaths waiting - not just the global number of how many extra packages are being offered but the actual people waiting - and then algorithms with no human oversight more broadly, you can understand why people are frustrated.
RAE: I just think we need to get the details right. There has always been human oversight throughout the assessment process. That has never been in question. What we're talking about here is an escalation pathway so there can be human override, and the two are importantly different. Nevertheless, people's experience is absolutely the test that I certainly think…
KARVELAS: Do you accept that on that test, there's a problem here?
RAE: What we've seen is, through our investments, we've seen wait times for home care coming down across the board. That's how people experience this system. They need to be able to get the care they need when they need it.
KARVELAS: The experts say that should all happen in 30 days. Can you achieve that?
RAE: There are varying views on a whole range of these matters, PK, and there's varying levels of expertise that are self-appointed and those that actually have some, to put to this challenge. Nevertheless, what we've seen is wait times coming down for Support at Home across the board.
KARVELAS: What do you think is reasonable?
RAE: They've dropped by months just over the last few months. So now what we're seeing is people who are urgent priority within the system, they always receive their packages of care under a month, PK. People who are high priority are just over a month. And then, in those other priority categories, we're seeing them coming down by months.
In the assessment system, once upon a time, people were waiting as much as 10 months to get an assessment. The median wait time for an assessment now is under a month and has consistently been so since November.
KARVELAS: I started the interview by mentioning that you hadn't adopted all the recommendations. Is that it - set and forget? Or are you going to look at those other recommendations?
RAE: No. To be really clear, PK, this is a pathway of constant improvement. As I said, these are generational reforms and changes.
KARVELAS: So why was there a resistance to the others?
RAE: To the other recommendations?
KARVELAS: Yes.
RAE: I'm not sure quite what you're referring to there.
KARVELAS: But they weren't all adopted. Why?
RAE: Well, we've already put in place a number of the recommendations that came out of the report, and the Department has accepted, at least in principle, the others along the way as well. So there's no question about the intention here to meet the ambition that the Ombudsman's report. We've got to do it in a way that has older people front and foremost rather than letting it get caught up in the bureaucracy of government. It’s why we’ve already made these changes along the way.
Now, the Ombudsman's report was clearly written at a time before some of these changes were implemented, so I'm sure he will be glad to see that we're heading in the right direction. And nevertheless, as I said, the Department continues to work on those others, and the Government will give them all consideration so we get the best outcome.
KARVELAS: The Government's been stymied over the changes you want to make to the private health insurance rebates for over-65s. But for the states are also actually pushing back on this, they say that this decision will basically lead to more ramping in public hospitals. Do you accept that if older people give up their health insurance because they're going to be out of pocket, that you're actually going to put more pressure on the public health system?
RAE: I think Minister Butler has spoken rather eloquently to this challenge. This was a very difficult decision for us to make. And what we had to do was to weigh, in the context of difficult budgetary constraints, where that money was best spent in the interests of older Australians. Now, of the $3 billion odd that are saved through the PHI changes, that is entirely reinvested in Australia's aged care system. About $1 billion of it is spent on funding adjustments to Support at Home so that older folks can get showers and personal care in their own homes.
KARVELAS: But it's like taking from one part of aged care and giving to another, if you want to look at it like that. Why do you have to do it that way?
RAE: Well, we do have to balance the budget, PK. Of course, we need to make responsible decisions about how we use taxpayer money. That's always the approach that our Government takes. So, as I said, we gave this very deep consideration. That's the sensible approach. And we made a decision based on how we thought that money could be best spent to help and support older Australians. And in the context of a huge demand pressure on our aged care system, it was determined that was the best place for this money to be…
KARVELAS: Do you accept though that it will lead to more old people turning up at public hospitals?
RAE: What I absolutely accept, PK, is that it gives us the opportunity to avoid older people going to hospital. Because if we can provide better preventative care through things like in-home care, these investments in personal hygiene, and showering and wound care that we're making, as well as the investments that we're making in the residential care sector to try and ensure that we have enough supply to meet that future demand. By getting people the care early, we can avoid their health situations deteriorating and needing to present at hospitals in the first place.
KARVELAS: Today, of course, the Parliament's focused on the Helen Haines tragedy and how to respond. Angus Taylor says that robust debate should always be protected. Do you agree with that? Or do you think robust debate is leading to antisocial behaviour?
RAE: I suppose, PK, that this probably depends on your definition of robust. I do believe in robust debate as a key tenet of our democracy. I think it's an important part of being Australian and having such a stable system of government here in our country. You're right, the tone here in the Parliament today is sombre, but I also think that there is a degree of quiet resolve amongst colleagues across the political divide - people who are reflecting on these terrible circumstances. And of course, all of our thoughts with Helen and her family. We do want to see robust debate. Helen herself is a participant in robust political debate, but she has always conducted herself in a respectful manner, and that is the way that our Parliament should operate as well.
KARVELAS: Thanks for coming in.
RAE: Thank you for having me.