$86 million for aged care research in past decade compared to $1.8 billion for neurological disease, panel tells Royal Commission – Counsel Assisting pushes for dedicated research centre

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Only 10 to 15% of aged care research projects put forward to the National Health and Medical Research Council (NHMRC) have received grants over the last four funding schemes, a panel into translating aged care research into practice has heard in the final session of the Royal Commission’s second workshop.

Over 75 minutes, Senior Counsel Assisting Peter Rozen QC quizzed the panel – Professor Alison Kitson, the Vice President and Executive Dean of the College of Nursing and Health Sciences at Flinders University, and the Foundational Director & Knowledge Translation lead for Flinders’ Caring Futures Institute; Professor Steven Wesselingh (pictured above right), the Executive Director of the South Australian Health and Medical Research Institute, and Chair of the National Health and Medical Research Council Research Committee; Professor Briony Dow (pictured below), the Director of the National Ageing Research Institute Ltd; Julianne Parkinson (pictured above left), the Chief Executive Officer of the Global Centre for Modern Ageing; and Dr Judy Lowthian (pictured further below), Principal Research Fellow and Head of Research at the Bolton Clarke Research Institute – around the idea of a dedicated centre for ageing research and innovation.

This Government-funded centre would have a governing board that would set a national research and development strategy for the sector and allocate funding – basically a carbon copy of the Aged Centre for Growth and Translational research proposed under strategic action 12 from the 2018 Aged Care Workforce Taskforce report led by Professor John Pollaers.

The panel’s members were enthusiastic in their support, but the session quickly began to feel more like a pitch for the job.

Prof Dow – who is currently working on three projects for the Royal Commission including a study of quality of life for aged care residents, home care clients and respite users’ experience of care, and models of integrated care that combine health, social care and housing – said NARI would be able to take on the role.

Prof Wesselingh – who was previously the Dean of Medicine at Monash University and is an infectious diseases physician – argued that the NHMRC was the obvious candidate.

“I think that an initiative, a strategically directed initiative into issues around ageing and aged care and aged care quality could be something that NHMRC could easily take on and has taken on in other areas,” he said. “And would achieve, I think, the highest quality outcomes.”

And as always, the discussion came back to funding – or the lack of it.

The Senior Counsel suggested that a dedicated amount of the NHMRC’s funding could be allocated to aged care – which clearly unimpressed the other members of the panel.

“I’m not actually sure that it’s the right organisation to fund aged care research because of the reasons I’ve just given because I think it’s a different type of research that we want, this outcomes focused research, priority driven by the aged care sector,” Prof Dow argued. “Although I do take Professor Wesselingh’s point about having the structures for peer review, which are very helpful if you can guide the criteria for peer review which is what’s happened in the dementia research area.”

The panel were also less keen on a separate funding body for the research centre.

“I don’t think we need a new funding body with you,” Dr Lothian stated. “I just think the priorities need to be set by this centre by the people who know what’s needed, know who is needed to conduct the research and how it’s needed to be conducted and then government can delegate the funds accordingly to those priorities and perhaps NHMRC could administer it, I’m not sure, I don’t know I want them peer reviewing. They have great peer reviewers, but they are not great peer reviewers for the type of research we are conducting.”

Prof Wesselingh added that separate funding could prove counterproductive.

“It’s quite hard to develop that level of skill in peer review and coordination required and the buy in from the Australian research community which is very much invested in the NHMRC, to achieve the quality the NHMRC does,” he said.

Unsurprisingly, the Commissioners were sceptical that just throwing money at the NHMRC was the right approach – and would result in more research.

“So, Professor there are three ways I think you can deal with the problem, in what you have been saying,” Commissioner Tony Pagone summed up. “One is that we create a new funding body which has at its task aged care issues. Another is to create a centre of excellence which might be doing the research. The third seems to be that we give you a whole heap of money. I take it that’s your preferred option?”

“Yes,” the Prof replied a bit bashfully. “I mean the money doesn’t come to me. NHMRC is a statutory body but yes I think your third option is the evidence.”

“How does that then solve the problem of the money that is given to you being used for the things that we might think it should be used for?” Commissioner Pagone asked.

“So, there are examples where NHMRC receives clear direction and moneys to obtain a particular outcome and that might be in PIFAS contamination for example,” Prof Wesselingh explained. “So NHMRC can take strategic direction and utilise the money for a given area.”

The Commissioner was still unconvinced however that this would provide the leadership that would be required to guide any research strategy.

“So, doesn’t that really dodge the point of the question which is should there be somebody directing the kind of research and your third option doesn’t seem to deal with where the direction is coming from,” he questioned.

“No,” disagreed Prof Wesselingh. “No, I think that through NHMRC through research committee and I think the dementia initiative [which saw $200 million allocated to the NHMRC for dementia research]is a good example, structures were formed that then looked at the needs in dementia research and the areas that required the most input and where also we should be looking at the areas where the biggest impact can be made. Those questions were asked in the dementia initiative.”

As always, Commissioner Lynelle Briggs showed that she has a grasp on the underlying issues – there is a lack of funding for aged care research, but the sector also lacks the leadership capability to drive research forward.

“It depends, doesn’t it?” she stated. “There’s various sorts of research and we have just heard earlier on that there has been quite a lot of clinical work around dementia. I get that. And there may well be other forms of clinical work that might have a home in the right place. I’m just wondering, is the real dilemma, there are many dilemmas here but there’s clearly been a shortfall of funding overall. And that’s causing part of the problem because people are fighting over a smaller cake and we’re working with an historical basis for allocation. When we fully understand that the aged care sector is growing out of sight and is desperately underfunded and unsupported without the capability across the board to do the work.”

It would seem the Commissioners face a dual problem in getting their recommendations moving – where will the funding come from? And who will be behind the wheel?