The Department’s Secretary Glenys Beauchamp PSM (pictured above) has rejected Senior Counsel Assisting Peter Gray QC’s use of the Australian Institute of Health and Welfare (AIHW) figure as the Counsel Assisting continued to criticise the DoH for not collecting the data required to identify residents in need of primary care.
For just under two hours, the Senior Counsel’s attention was squarely focused on the Secretary despite the presence of the Commonwealth’s Chief Medical Officer, Professor Brendan Murphy (pictured second from the bottom), and the Deputy Secretary for Health Financing, Penny Shakespeare (pictured bottom), who seemed to be solely present to act in a supportive role.
Like her previous outings before the Royal Commission, the Secretary was again on the defensive – and proving she has mastered the bureaucratic art of evading the question.
Mr Gray wasn’t deterred however, making the point that the Department lacks data on the underlying need for GP services in residential care – which could be much higher than what the available data shows.
Bringing up strategic action 9 from the 2018 Aged Care Workforce Taskforce Report which recommended strengthening the interface between aged care and primary/acute care, he noted that the performance and quality framework for the Primary Health Networks (PHNs) only measures two indicators related to aged care – the rate of Medicare Benefits Schedule (MBS) services provided by primary care providers in residential aged care facilities and the rate of people age 75 and over with a GP health assessment – which were both simply marked ‘met’.
“I suggest that that in itself doesn’t tell one anything about the underlying need in the primary health network for MBS services to be provided to people in residential aged care facilities. It’s simply a gross measure of whether there’s an increase in the services that are actually provided,” he said.
Mr Gray then pointed to GenWise GP and aged care consultant Troye Wallett’s evidence from Monday that their survey of 96 facilities found 92 had an urgent or immediate need for GPs.
Ms Beauchamp agreed the indicators needed more work – but denied access to GPs is an issue in residential care, arguing there has been an increase in GP services going into residential care based on the MBS data.
“We have about 50 per cent or 54 per cent of the 37,000 GPs that are providing services in residential aged care facilities. So, on the basis of the evidence that I’ve presented in my witness statement, access to GPs in a global sense doesn’t seem to be an issue,” she stated, adding: “That doesn’t mean there aren’t urgent and hotspots that might emerge at particular points in time or, indeed, in particular areas.”
Mr Gray (pictured above) however noted the data also shows only 4,500 GPs provided enough services in residential care in a year – 200 consultations or around four a week – to trigger a practice incentive payment.
“I’m suggesting is that there’s a huge disparity between the 54 per cent of GPs who are defined by having provided at least one service and those GPs who are actually regularly visiting,” he argued. “That’s the first point. If I’m right about my figure of 4,500 GPs, there are only 4,500 GPs who provide more than 200 services … annually, then you would accept that there are, really, very few GPs regularly visiting facilities? Do you agree with that?”
Ms Beauchamp deferred to Professor Murphy and Ms Shakespeare, but not before adding that seeing a GP once a fortnight was a level of service most others in the community don’t receive.
“Well, just stopping you there, those people who are seeing a GP, on average – this is just an average, seeing them, say, once a fortnight – but there are nine per cent of people in facilities who never see a GP for the whole financial year,” Mr Gray said, pointing to the AIHW figure he raised in his opening address.
“If I could clarify, the nine per cent I thought was those that are accessing MBS services,” Ms Beauchamp replied. “And, of course, even on the example you gave earlier and knowing that a residential aged care service has a salaried GP, a salaried GP may not be accessing MBS revenue. So, there are a number of services provided by GPs and by other specialists that do not show up in the MBS system.”
Ms Shakespeare added that GPs who are paid a salary by providers or are funded through the Department of Veterans Affairs would be ineligible for Medicare services, which could account for the 9% figure.
“Counsel, can I just say I think it’s inconceivable that anyone of 12 months in a residential aged care facility would not be seeing a primary care practitioner,” Prof Murphy also tacked on. “And the other group of people in state-run residential aged care, where often there are salaried junior medical staff who wouldn’t be claiming Medicare as well – we will do that further work. It is inconceivable that people would not be seeing a doctor over a 12-month period. That has to be a data that we will explore with the AIHW.” (If that is correct, why wasn’t the Government’s data accurate in the first place then?)
Ms Beauchamp also wouldn’t take on board Mr Gray’s proposition that the Government should work with the sector, professional and consumer groups to introduced a new funding model to improve access to health care for those in residential care or receiving home care, saying funding needs to be supplemented, not necessarily changed.
“I would like to see not primary care treated separately from access to other State-based services; so what is the funding model we want for that continuity of care you spoke about that’s going to meet, I guess, the patient or resident journey through the health system and aged care system,” she said. “So some of the things that the previous panel did speak about, and we’re negotiating in the health reform agreement, is joint commissioning and joint funding of particular health care services, and then having the data to support it and in terms of performance, putting some performance expectations around that as well.”
The deadline for the Agreement was clearly of keen interest to the Commissioners – and their own deadline.
“We’re very conscious that throughout this Royal Commission governments, normal government business procedures, and we might be making recommendations on changes to these areas,” Commissioner Lynelle Briggs commented. “If our recommendations are to be considered within the context of the health agreement, when would they need to be made public?”
Ms Beauchamp, ever the bureaucrat, gave a roundabout response that didn’t actually answer the question.
“Thanks, Commissioner, in terms of process, we’re in the process of finalising through health ministers the Health Reform Agreement and we only met as officials last Friday. But I think some of the principles that have been raised already in the interim report, is certainly something that all the chief executives are cognisant of. For example, those interface issues where there are big risks, they absolutely will be picked up in the health care agreement. Specific reference to aged care will also be made. I think the improvement in the health performance framework and data sharing is a commitment that’s consistent with the Commission’s findings. In terms of the funding arrangements that the Commission may touch on and has started to touch on now, we need to look at what we need to do, particularly in terms of block funding arrangements because if we are looking at blended models of care and funding, there’s much flexibility within the Health Reform Agreement to do that. And the onus is on us as CEOs to look at how do we actually measure that performance and how do we fund it. But there’s certainly a commitment to do that. And we do focus on aged care at most of our senior officials’ meetings.”
The Commissioner wanted a more definitive answer however.
“So finally, when do you expect decisions to be taken at senior Ministers’ level?” she asked again.
“In terms of – the Health Care Agreement is to apply from 1 July 2020, I think,” Ms Beauchamp responded. “Whilst it needs to go through our health Ministers and it will, it also needs to be agreed by all what we call Premiers and Prime Minister departments and treasurers to make sure, because it’s quite significant, as you know, in terms of funding, so we expect to have an agreement in place early next year and that’s me saying that, but, of course, it’s got to get through all the jurisdictional approvals and certainly our approvals at the Commonwealth level as well.”
The Royal Commission’s recommendations are not due until November 2020 – almost five months after this date.
Will the Commissioners wait for their Final Report to have their say on these issues then – or could they release a paper with their views earlier?
We will find out in the New Year.
