First glimpse of the Departments’ thoughts on the Royal Commission

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The Commonwealth Departments have offered “in principle” support for the majority of the Counsel Assisting’s 124 recommendations – but say the Royal Commission must show benefits for a separate aged care agency in its response to the Counsel Assisting’s final submissions.

The Royal Commission has published 387 public responses to Counsel Assisting’s Final Submissions, which were invited in October 2020 following the Commission’s Final Hearing – including the response from the Department of Health and the Aged Care Quality and safety Commission (ACQSC).

The 11-page submission is accompanied by 69 pages of responses to each of the 124 recommendations.

It’s the first real insight into what the bureaucrats think of the proposed recommendations – and what they will support – and not support – when the Royal Commission makes its final recommendations.

Bureaucrats offer in principle support for majority of recommendations, but…

Critically, the Commonwealth Departments indicate support or “in principle” support for the majority of the recommendations.

But they also tell us that the bureaucrats are unwilling to let aged care fall outside of their oversight – and they do not want the States and Territories to have more power.

The major point is that the Departments do not appear to support an independent aged care commission to oversee the sector – a point raised by Commissioner Lynelle Briggs AO in the final hearing – saying that they need to see costings to know the benefits will outweigh the risk and time to set up.

No backing for mandatory staffing ratios or separately funded health care

The Commonwealth also joins the Counsel Assisting in rejecting the nurses’ case for mandated staffing ratios – instead they back a case-mixed tool.

The proposed Aged Care Pricing Authority (ACPA) also gets a knock on the head, with the Commonwealth arguing for Government to determine prices.

They also push firmly for medical services delivered into residential care not to be funded separately, stating that all Australians should have equal access to health care.

Support for an enforceable duty for aged care providers – with civil penalties

The Departments do back an enforceable duty of care for providers – with civil penalties – but caution against allowing individuals the right to claim for damages.

Critically, they also label the Counsel Assisting’s five-year timeline “challenging” particularly around the home care wait list, workforce, provider readiness, legislation and IT – suggesting a longer timeline would be preferred.

Department says individuals should not have right to private compensation

The recommendations they do not support include:

  • APHRA handling a personal care worker registration scheme or training development program
  • Funding for a dedicated Aged Care Research Council (they prefer to support existing research bodies)
  • New Medicare Benefits Schedule (MBS) items for mental health and allied health services
  • Annual Residential Medication Management Reviews (the Commonwealth prefers a model based on clinical need)
  • Amendments to the MBS so only a geriatrician or psychiatrist can prescribe antipsychotics
  • The new Aged Care Pricing Authority to determine prices (they want the Government to set the prices with advice from the authority)
  • Nominal co-payments from consumers for social supports, assistive technologies and home modifications
  • Fees for respite care
  • Nominal co-payments for domestic assistance at home
  • Non-pensioners being required to pay the full cost of their ordinary costs of living i.e. accommodation without exceptions for people in financial hardship
  • That the means tested daily care fee should be repealed
  • That individuals have a right of private action for losses or damages when a provider breaches its duty of care

Commonwealth delivers warning on provider culture

The written submissions also contain a warning about provider culture – that it is “driven by the personal values of the staff and leadership of the governing board of the provider.”

Essentially, providers need to drive reforms among their workforce to deliver safe and quality care – not just the Government.

So, what does this mean for the final recommendations? While the Commonwealth submissions don’t reflect the views of Scott Morrison and his Cabinet, they do showcase the views of those behind the scenes who actually make the system run.

It is likely then that these submissions will be echoed in the Government’s response to the Royal Commission’s Final Report.

That means a “revamped” Department of Health and Ageing, an enforceable duty of care with civil penalties, new staffing and pricing models and more could all be on the cards.

Watch this space then – the Royal Commission’s Final Report will be handed to the Governor-General David Hurley next Friday.

Pictured: Commissioners, the Honourable Tony Pagone QC and Lynelle Briggs AO, with the Governor-General, His Excellency, General the Honourable David Hurley AC DSC (Retd).