Commissioner Lynelle Briggs has suggested the National Health Reform Agreement currently being negotiated between the Commonwealth and the States and Territories could contain a commitment for the two sides to set down the roles for the provision of outreach and primary care services into aged care facilities – before the Royal Commission makes its recommendations in its Final Report in November 2020, during a panel discussion with State health officials.
For one-and-three-quarters-of-an hour, Senior Counsel Assisting Richard Knowles had led the panel: Terry Symonds (pictured above right), the Deputy Secretary in the Health and Wellbeing Division in the Victorian Department of Health and Human Services; Ross Smith (pictured below right), the Deputy Secretary in Tasmania’s Department of Health; Michael De’ath (pictured below left), the Director-General of the ACT Health Directorate; and Dr Maggie Jamieson (pictured above left), the Deputy Chief Executive for Health Policy and Strategy in the Northern Territory Department of Health – through the same set of propositions that Counsel Assisting tested the previous day on the other State health officials.
Like the previous panel, the group was all in favour of providers being responsible for health care services – and the Commonwealth ‘kicking the bucket’ to make it happen.
The panel backed the idea raised by Professors Leonard Gray and Leon Flicker the previous day that there is a need for an agreement to set out the roles of the Commonwealth and States and Territories in relation to outreach and primary care services into aged care facilities under the Agreement.
However, they pointed out the Agreement has what Mr Symonds termed a “long gestation period” i.e. it takes a long time for the Commonwealth and States and Territories to actually agree on the terms – which could hold up any reforms in this area.
“I would not want to see this work held up, including that … processes and it may or may not be for the Commission to direct how expedient a process,” Mr De’ath said.
This led Commissioner Lynelle Briggs to cut in and reassure the panel – suggesting the Commissioners may not wait to seek a commitment from the Government to reform this area.
“We were told yesterday by the Secretary of the Department of Health in the Commonwealth that the next National Health Reform Agreement is moving along very swiftly and indeed likely to be finalised before we complete our work here,” she stated. “Is it possible within those agreements to provide additional schedules or items over time, or in those circumstances, is it therefore necessary to have an additional reform agreement?”
“If I could,” Mr Symonds said, “the National Health Reform Agreement does foreshadow and require other processes in various ways, business rules and schedules and other things. So, if I understand the question, there’s no barrier to the National Health Reform Agreement including a high-level commitment to do that work. And develop such a schedule or agreement that would then be attached in some way to the National Health Reform Agreement. I can’t think of any reason why that wouldn’t be practical to do that.”
“Thank you,” said the Commissioner.
The group also supported the Counsel Assisting’s proposition for a national rollout of hospital-led outreach programs into residential care, but highlighted a number of challenges including access in regional areas, availability of allied health staff and the need for agreement on costs between the Commonwealth and the States and Territories.
Mr Smith was wary of endorsing the rollout, saying it shouldn’t be a single model.
“I think we need a suite of things to be able to adapt them to local conditions and local patient circumstance,” he said.
Mr Symonds added that while the funding wouldn’t need to be changed to support such a model, there would need to be consensus between the various stakeholders around what care would be required and the costs of services.
This would likely require an increase in funding from the Commonwealth so the budgets matched up, he said.
“There are caps on the Commonwealth contribution to State funded services and various jurisdictions are already at or close to their cap. If the price is to rise for this particular service to incentivise a certain model of care, if the budget does not increase accordingly, or the cap does not increase accordingly, then we will fund more of a higher price procedure at the expense of something else and that will create other tensions in the system.”
The panel also agreed aged care providers should be responsible for providing health care services to residents including taking residents to external appointments and offering telehealth services and consulting rooms and equipment for visiting GPs – and this role should be clearly marked out to providers.
To make that point, Mr Symonds pulled out a copy of the Quality of Care Principles to quote its line that health care services should “be provided for all care recipients who need them”.
“I would share with you that when I raised this with a colleague who works for a private aged care provider during the week, they pointed out to me that there are words on the page that include services by nurses, for example, acting within their scope of practice and if they don’t have sufficiently qualified nurses they can’t provide the services that are in here. They also pointed out the words that: **Services may include. Not ‘must include’ and so that – it occurs to me that people are reading this page in different ways,” he said.
“We read this as a good guide to the services that should be provided but private aged care providers might read this as an optional list.”
Sounds like providers could have their exact responsibilities spelled out to them – a plus and a minus.