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Community Affairs References Committee
Future of Australia's aged-care sector workforce

GELLE, Ms Roxanne, Industry Adviser, Occupational Therapy Australia

O'REILY, Ms Nicole, Board Director, Occupational Therapy Australia

Committee met at 08:29

CHAIR ( Senator Siewert ): I declare open this public hearing and welcome everyone here today. We acknowledge the traditional owners of the land on which we meet and pay our respects to elders past and present. This is the fourth public hearing for the committee's inquiry into the future of Australia's aged-care sector workforce, and I thank everyone who has made a submission to this inquiry. Before the committee starts taking evidence, I remind all present here today that in giving evidence to the committee witnesses are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to the committee and such action may be treated as a contempt by the Senate. It is also a contempt to provide false or misleading evidence to the committee. We prefer all our evidence to be given in public, but under the Senate's resolutions witnesses have the right to request to be heard in a private session. It is important that witnesses give the committee notice if they would like to do that, because we have preparation that we need to do.

I welcome representatives from Occupational Therapy Australia. I understand that information about parliamentary privilege and the protection of witnesses and evidence has been provided to you. Thank you for your submission. I invite either or both of you to make an opening statement and then we will ask you some questions.

Ms O'Reily : Thank you for the opportunity to appear before you today. I am joined by Roxanne Gelle. She is an occupational therapist; she is currently a frontline manager of occupational therapists—among other allied health professionals—within an aged-care service; she is a representative of Occupational Therapy Australia on the National Aged Care Alliance; and she is an aged-care industry adviser for Occupational Therapy Australia. We have both had experience in regional, rural and remote service provision.

Occupational Therapy Australia is the professional association and peak representative body for occupational therapists in Australia. As of June 2016, there were over 18,000 registered occupational therapists working in Australia, many of whom work in the aged-care sector. Occupational Therapy Australia understands that the significant reforms to the structures, funding and delivery of aged-care services fits within a broader Commonwealth policy shift towards individualised funding and consumer-led services in health and community care.

The future of Australia's aged-care workforce is an area of particular interest to occupational therapists and Occupational Therapy Australia. Our submission focused on the needs of the professional aged-care workforce—particularly that of the occupational therapy workforce. As a profession, occupational therapy focuses on placing the client and their occupations at the centre of assessment, planning and service provision. Occupational therapists seek to assist our aged-care clients to design and implement their own person-centred plans based on their aspirational goals. This could include addressing their general health and wellbeing as well as issues related to ageing. Occupational therapists could work with our aged-care clients to help them get out to the shops or other locations that they wish to go to. Occupational therapists can undertake driving assessments to ensure safety while driving and, if necessary, look at alternative modes of transport to help aged-care clients access community. We can also help clients to stay safe at home through undertaking falls prevention and home modification activities.

There are, however, many challenges facing the future of the aged-care workforce, as outlined in our submission. Firstly, ensuring there is a future aged-care workforce. As outlined in our submission, a recent study by the University of South Australia showed undergraduates in allied health disciplines do not see aged care as their preferred postgraduate career pathway. This is a big problem. We need a cross-community campaign to promote working in aged care as a career of choice that provides opportunity and reward. We need to attract new graduates and established occupational therapists and support the retention of the current quality aged-care workforce. Occupational Therapy Australia also believes there is a significant opportunity for professional staff to build capacity in the nonprofessional staff with the care they provide, and this is a key recommendation of our recent submission to another Senate community affairs inquiry on enhancing social inclusion for young people in residential care facilities.

Secondly, the recent reforms within home care have raised questions about the clinical governance measures that will be put in place to ensure that innovative, evidence-based professional standards like supervision requirements are supported and upheld in aged care. The Commonwealth government needs to invest in ensuring quality safeguards are there to protect consumers. A quality and safeguards framework similar to that currently being developed for the NDIS should be developed for the broad aged-care services across the home and community, with input from providers, consumers and carers, to ensure national consistency of standards.

Thirdly, Occupational Therapy Australia supports a coordinated, team-based interdisciplinary approach to aged-care service delivery, where possible. However, it is evident that this approach is declining in some aged-care services as a result of cuts to the Aged Care Funding Instrument and increased competition between the different services involved in providing aged care.

Finally, Occupational Therapy Australia believes there are significant challenges facing the provision of a workforce in rural and remote settings. As with most policies, implementation in a rural and remote setting may not achieve the same outcomes or may not be possible due to workforce, population and facility issues. In this time of implementation of reform, Occupational Therapy Australia would seek to have the Commonwealth monitor and evaluate the policies and how they work in rural and remote locations to ensure equity. Additionally, Occupational Therapy Australia believes the Commonwealth should increase funding for telehealth in rural and remote areas to address the issues of the RAS—the regional assessment service—being unable to assess clients face-to-face because of travel requirements.

We would like to thank you, again, for the opportunity to be here today. Occupational Therapy Australia is thrilled that the work of this committee has recommenced after the election and we believe planning and resourcing for Australia's future aged-care workforce must be a policy and budget priority for the government. We look forward to answering your questions.

CHAIR: Do you want to add anything at this stage, Ms Gelle?

Ms Gelle : No, I will focus on the questions, thanks.

Senator POLLEY: Thank you very much for coming and giving evidence today. What is the crucial issue in relation to the workforce? Is it attracting people to work in a remote area? What is the age of your workforce? Can you outline to us the sorts of challenges that you see generally around the workforce issue which you have not already elaborated on?

Ms O'Reily : Do you want me to focus on rural and remote as opposed to general aged care?

Senator POLLEY: Start with general aged care and then talk about remote areas, because I think they are distinctly different challenges.

Ms O'Reily : I might ask Roxanne to respond to the challenges around the general workforce, and then I can add in around rural and remote.

Ms Gelle : I am just speaking on behalf of occupational therapists. In terms of attracting people to the aged-care workforce, often our positions are solo, where somebody is working in an isolated situation and does not have the team or the collegial support of occupational therapists in their teams, so, therefore, attracting the young workforce that we need for the future can be difficult, because they tend to go into the health environments of hospitals and into other more connected environments. In aged care, we tend to work across a very broad range of health issues and functional decline that requires really quite an extensive level of expertise and support, in terms of delivering those sorts of services. Obviously, attracting people to that area of work can be difficult, as it is not seen as a high-flying area of work and it is not as sexy as some of the other industries that occupational therapists work in.

Senator DUNIAM: We heard that word a lot in Western Australia, it is fair to say. I thought we had banned it!

Senator POLLEY: We are changing the perception, because we are saying we are putting the sexiness back into it.

Ms Gelle : We have to look at the fact that there are many healthy, active ageing people in our communities. Helping them to really engage in their communities is a really rewarding part of our work in enabling them to remain living at home because a lot of people are choosing to do that and to not go into institutional or aged-care facilities. That is very positive.

Ms O'Reily : To some extent, the challenge is around providing the clinical and supervisory structures within a workforce where there are a lot of sole positions. In large institutions such as hospitals or health centres. you can start at a graduate level and have the support of level 2s, level 3s and level 4s inside a clinical structure, which provides a level of support and safety for new graduates. A lot of the positions that are within aged care can be solo OT positions within a multidisciplinary team or even just solo positions that link into a team through an employment structure but may not be a part of it. They might be subcontracted or they might be a visiting service to another service. I think there is a need to look at that clinical and supervisory structure not only inside organisations but also inside the system as a whole.

In terms of rural and remote, one of the interesting challenges is that there are quite a number of programs that might actually attract people to work in rural and remote locations, but those people who have grown up in rural and remote locations are not actually eligible for them. The programs are about attracting someone who has grown up in the city, done their uni in the city, to come out to a rural and remote location and relocate. There is an incentive for that. But the same does not necessarily apply to someone who grows up in a rural or regional place to do their training there and then stay. There is a bit of a challenge in what you do about attracting to versus retaining in your community and in whether or not there is a need to think about what that looks like.

Senator POLLEY: What sort of incentives would you like to see to encourage this? I was at a visitor facility yesterday, and they said the same thing. If you can find locals—people who have lived in Darwin for some time—you have a better chance of holding them in that position. If a person grows up in Darwin or somewhere else more remote than Darwin, what sort of incentives do you suggest to retain them?

Ms O'Reily : I am not sure that Occupational Therapy Australia have a position on what those incentives need to look like. I think probably work needs to be done to explore what will work. I live in Darwin The challenge for occupational therapists in Darwin is that you cannot train locally. There is no uni course in the Northern Territory. You can do an undergraduate degree here that has a pathway to a masters-entry occupational therapy course, but you have to go interstate to do that. Those are the sorts of challenges. Even if you grow up locally, you have to go away to do some allied health courses—not all; some are offered here. Then the challenge is, during that process, you get a bit of attrition. Some come back; some do not.

Senator POLLEY: I am interested because it peaks my interest: telehealth. How can we do telehealth better in areas like we are today?

Ms O'Reily : I think it is probably about making it much more accessible. The experience in the Northern Territory—if I can focus on that—is that you also need to make sure you have someone who can help you bridge the gap culturally. In terms of the Aboriginal and Torres Strait Islander population, you need not only the clinical supervision and mechanisms for support but someone who can support the cultural interface between a therapist and the people who they are working with. I think there is probably a need to look at that. It is about making sure that that is funded and supported through quality frameworks, standards and that sort of thing.

Senator POLLEY: In your submission, you touched on the challenges, which I think are also our national challenges. These include the demand for workers, whether it is in the aged-care sector or whether it is in the disability sector. Can you draw a picture for us of the challenges that you see from your professionals?

Ms O'Reily : In terms of just—

Senator POLLEY: In terms of being able to work between the two and in having enough workers.

Ms O'Reily : I do not think I have quite understood the question. I am sorry, Senator.

Senator POLLEY: What we are hearing in relation to the aged-care workforce is that there is a real issue around being able to transition between the NDIS and the aged-care sector. Is that something that your organisation finds challenging or does it not affect you?

Ms Gelle : I can answer a little bit about that in terms of the staff feeling that they are skilled in delivering services to younger people and to people with disabilities, and they tend to focus on that. But at times they do not see the relevance or have the desire to move that skill into the aged-care population, and, in effect, there are a lot of those skills that are quite applicable across the range of ages. In terms of the challenges, it is the systems in terms of interacting with the systems—the type of payment systems and the funding system. The systems are different, although we are now moving more towards an individualised-type of funding for both aged care and for disability. We have an ageing workforce as well and I would think that they have a lot more issues in terms of the use of technology. When you are going back to Telehealth, it certainly needs to be simplified. The usage of it needs further training, explanation and giving staff the opportunity to trial it to see how it works before they are interacting with a client. In setting up, those systems are quite challenging in terms of having somebody at both ends who can interact and teach people how to use them. That is really important because that can lead to the success or the failure of the process. We really need to have good expertise in using the actual technology because the actual interaction can be quite similar to sitting face to face with somebody.

Senator POLLEY: What would be the average age of your workforce?

Ms Gelle : I service provide in the Ipswich area of Queensland and West Moreton. I guess our average age would be about 45.

Ms O'Reily : I would be happy to take that question on notice to get you the data for occupational therapy across Australia.

Senator POLLEY: That would be great. We have had evidence and through travelling it is pretty obvious to me that as young health professionals are training at university if they have exposure by working with an aged-care provider then there is a better outcome and perhaps it is more likely that it will be the sort of challenge that they will want to enter into. Does your organisation have any ongoing relationships with any of the universities and the larger aged-care providers?

Ms O'Reily : That is probably more of an issue for the universities and the aged-care providers. They manage the field-work component of occupational therapy students. Occupational Therapy Australia is a member of the World Federation of Occupational Therapists. Under the AHPRA registration for occupational therapy, our university courses need to meet the WFOT standards for education. That requires a thousand hours of field work across two or four years of training depending on whether you are doing your masters or your undergraduate course. There is quite a lot of opportunity for occupational therapy students to be exposed to a range of occupational therapy work scenarios and, generally, there is a bit of a plan around making sure that students get opportunities across multiples of those. It is rare that a student would go through a uni course and only focus and go to one sector, whether that be aged care, paediatrics or hospitals and those sorts of things. Through that mechanism, Occupational Therapy Australia as an organisation is involved in ANZSCO—I am sorry, I am not going to know what that acronym stands for. It is about the heads of the occupational therapy schools. So all of the heads of occupational therapy schools across Australia and New Zealand meet. Occupational Therapy Australia, through our CEO, is involved in at. We have conversations about these sorts of issues at that point. How can we develop fieldwork? The challenge for the occupational therapy profession in providing fieldwork is that with the increasing individualised funding, some of what we are losing is those large institutions, because the funding might well go to smaller companies or organisations. It becomes a bit more of a challenge to place students in those areas because they actually cost money. You do not get the full efficacy out of a staff member in that time when they have a student.

Ms Gelle : We do offer student placements at our place and we are very supportive of having students with us to attract them to come to our work environment.

Senator POLLEY: In your submission you suggest that older Australians are not receiving the down-the-road health services they need. What evidence is there of that, and is that something that would be of concern in relation to the challenges for those people with the amount of time that they are able to give to an individual? Are they being pressed for time and therefore not delivering the best outcomes?

Ms O'Reily : This is probably a bit of a system issue. I will give you a fairly brief answer now but I would like to take that on notice to give you a more comprehensive answer. What we have found is that the systems and structures for funding and assessment do not necessarily provide occupational therapists with the best opportunity to become engaged in services for people who are ageing. You have an example of the development of a minigolf course in an aged-care facility.

Ms Gelle : It enables people to become engaged in an activity that is increasing mobility and fun aspects and is a way of helping with their pain management, because they are actually involved in something that is related to occupation and recreation. I guess we are looking at the idea that that does reduce reliance on medication and other sorts of treatment modalities that are utilised in the pain management field.

Ms O'Reily : The challenge with that is that it is very difficult to fund minigolf as a treatment modality under the funding, when actually the therapeutic outcomes of that activity are related to that sort of outcome.

Senator POLLEY: It addresses the pain management as well as their mental health.

Ms O'Reily : Absolutely.

Senator DUNIAM: Just going back to the issue of telehealth, I think implied in what has been said here is that it is not utilised as much as it could be, or there are hurdles. Do you know what the current usage rate is, in rough terms, of those who could be using it?

Ms O'Reily : I do not have that information available, but we can certainly look to find something to get to you, if you are happy for us to take that question on notice.

Senator DUNIAM: That would be handy, in terms of answering that question that I suppose has been asked to hear about how much extra funding is required to actually make that system here in the Northern Territory.

CHAIR: We would be interested to hear of any experience you have had in the really remote areas. That would be useful.

Senator DUNIAM: In relation to the hurdles being faced, you talked about the cultural interface. Can you explain that a little more?

Ms O'Reily : The experience with providing any form of care and support—I will focus on Aboriginal and Torres Strait Islanders, as that is where my experience has been, but you could also apply it to people who have migrated from other countries—is that the interaction is one thing from a clinical perspective, but there are a range of cultural issues that people need to be aware of. There are language barriers. If I digress from Occupational Therapy Australia to talk about my work here in the Territory, I have seen a video where there is an old white gentleman who is in hospital and sitting on a hospital bed and a range of Aboriginal staff come in and start talking in their local language around him and then say, 'Okay, we are going to do that' and then walk out of the room. You get the sense of the fact that you have not actually understood what it is that the clinical activity is that is going to happen to you.

There is a need to have either a translator or some sort of cultural interface that helps you maximise the outcome of your clinical intervention. That is required face to face, but also on a telehealth system. The issue with telehealth is that it is not just about having the TV and the video camera at both ends; it is also about having the staff at both ends who can engage and work together. If you are out in a remote location with an Aboriginal person you may actually need two staff if you need clinical staff and a cultural person. All of that takes money and funding in some sort of way, or it will take those two people away from another service that they are doing if it is not new money.

The challenge with that is whether the outcomes and benefits you get are worth that investment. So it is a bit about making sure that the investment is there for the outcomes. It is about making sure that if we are going to introduce telehealth then it is done in a way that is going to get the outcomes so that people do keep using it, because it could be very easy for someone to go, 'Well, the person on the end has not understood what I have done and they have not done it and it has not worked.' The client can disconnect and the clinician can disconnect.

Ms Gelle : You cannot replace the face-to-face contact. Using telehealth is more of a follow-up. The client's interaction with the environment is so important in terms of providing a quality service to them and enabling them to live independently within their home. A lot of our work is about their home environment and their access to different local services and those sorts of things. Telehealth has its limitations, but it is certainly very good for follow-up and for different sorts of interactions.

Senator DUNIAM: I was about to come to that. At the beginning there we talked about attracting more people into the workforce you are representing here today in this community and the difficulty attached to that. Then we talked about telehealth. They are not competing priorities; they are complementary, in your view.

Ms Gelle : Absolutely.

Senator DUNIAM: One service would not replace the other. You talked about a follow-up in the form of telehealth.

Ms Gelle : Yes.

Senator DUNIAM: The information you provide on notice will be incredibly useful in terms of fleshing out this issue a bit more, so I look forward to receiving that. Getting back to education and training opportunities in the Northern Territory, you said that you have to leave Darwin to train. Where do you end up going?

Ms O'Reily : To any university.

Senator DUNIAM: Anywhere in Australia?

Ms O'Reily : You could end up anywhere. That is unique to the Northern Territory and Tasmania. They are the two states and territories that do not have an occupational therapy course within their geographic boundary.

Senator DUNIAM: Following on from a few of the questions that Senator Polley raised, in relation to opportunities for training to be done here, is there the demand? I presume there is the demand for that sort of training here in Darwin.

Ms O'Reily : There is a range of work happening at universities. I would probably direct you either to the universities, and we can take it on notice—

Senator DUNIAM: From your perspective. It is certainly something that I and the committee can follow-up with the universities, but from your perspective, if there is anything that you would like to add—

Ms O'Reily : There are certainly a number of occupational therapy students doing their undergraduate science degrees here. Whether or not there is the demand to make operating an occupational therapy school up here viable, I am not sure.

Senator DUNIAM: There is a critical mass question. That is one you will not be able to answer. That is fine. In the OTA submission, in the recommendations, it talks about a government-funded community campaign to tackle ageism. Is that another way of referring to the need to destigmatise the industry? So it is not about the age of people working in it; it is about a general perception issue?

Ms O'Reily : It is around the general perception, I guess. One of the challenges that we have talked about is the difficulty in attracting the workforce there. Part of that difficulty is that ageing is not necessarily seen positively by the community in general. We all are a bit worried about getting old and those sorts of things, so we have this more general issue around the idea of positive ageing and then the idea around supporting positive ageing as community services and health services et cetera.

Ms Gelle : We were aware that there is a lot media about NDIS, but it is not as well done in the aged care field, where there are probably four or five times the number of people who will be ageing compared to those in the NDIS, so it is proportional in terms of that media type of advertising of that area.

Ms O'Reily : There is a lot of focus on the NDIS and attracting the workforce there, and that is going to affect maybe 500,000 people. But the ageing system is going to deal with millions, and we do not see the same level of media and work around attracting people into that space.

Senator DUNIAM: Going to the second recommendation there, that undergraduate students of aged-care disciplines should complete assessments to determine if a career in aged care is right for them. Has it been the experience that people undertake their studies and then embark on a job pathway in this industry and then find out that it is not for them and move on to another industry? Is that what that refers to?

Ms O'Reily : It probably refers to the fact that people probably start somewhere other than the aged-care sector and then come into the aged-care sector later. They do not necessarily do what I call grow up in aged care. They will grow up somewhere else as a professional, then they might move across to aged care. In terms of the rural and remote workforce, they cover a wide range of services, so as a clinician in a country area you might cover the hospital, paediatric, aged care, disability, education in on—

Senator DUNIAM: Which you can understand.

Ms O'Reily : Or you might job share as a private practitioner for part of it and public employment for the other part of that role. It is about making sure that we encourage students to experience that aged-care domain and look at what the opportunities and rewards are there and help them understand how that can fit them for their career.

Senator DUNIAM: Having read that, and coming from the last hearing in Perth, it was put to the committee by some witnesses that the industry was more of a stepping stone industry, where they would start out in training or work and then move on to something else because remuneration or the chance for career progression was better in another industry. I read that and thought that maybe that is part of it, but you are talking about it the other way.

Ms O'Reily : The experience of occupational therapy as a profession in this space is that often people will start somewhere else where there is that clinical and supervisory structure and then move. Occupational therapy as a profession has a wide range of areas that people can work in, and people do often do a little bit in a few different places, find their passion and go with the passion.

Senator DUNIAM: Referring back to the way things operate, you talked about people working across a broad spectrum of different sectors. I guess that to a degree that is the nature of the beast in remote communities—

Ms O'Reily : In rural and remote.

Senator DUNIAM: In an ideal world I am sure it would be nice to step away from that and have people focused on things.

Ms O'Reily : There is probably value in having a local person. If you are going to step away from that you are going to decrease the ability to create full-time work in each of those areas. People pull together a full-time role.

Senator DUNIAM: That make sense.

Ms O'Reily : That is how they do it. If you start specialising, then you actually end up not having the critical mass to create a full-time position, and then you end up moving into maybe a hub-and-spoke-type service from a larger regional centre and out and that sort of thing. So there are pros and cons to both models, and different communities will use them at different times, depending on who is living there at the particular time and what skills and capacity they have.

Senator DUNIAM: That make sense.

Ms Gelle : From a clinician's point of view: I started off as a generalist in a hospital situation and went into neurology, orthopaedics, paediatrics, extended care and burns and had a very broad range of skills and experience. I have really utilised that through the whole career, because in aged care you really do need a generalist's perspective and an ability to draw upon quite a number of different areas of clinical expertise to work with clients, because there are a whole range of different chronic conditions—visual impairment and all sorts of different things—that you will be working with. You need to be resourceful. Having that grounding is really important. It is a pathway that can be quite positive for people coming into the aged-care sector.

CHAIR: I just want to go back to the issue of incentives, because it is one of the recommendations of the submission. I know that we touched on it—Senator Polley asked a question on it. I am just looking at what could be the types of incentives and whether you have looked at that specifically up here.

Ms O'Reily : At Occupational Therapy Australia, we have not looked at that. We have not canvassed our members and sought that information. We certainly could look to see if we have got anything available and provide that on notice if we have got anything specific from any of our previous member surveys. They do go nationally, so we would need to be aware of that. But I guess there is a need to look at both the incentive for the aged-care workforce—because, if we are having trouble attracting them, we need to think about how we attract into that space—and then the incentive for rural and remote, which overlaps but it may also be independent, depending on what a position or a role looks like in a rural or remote location. I guess we would also expect that the Rural Health Commissioner would have some role to play in the rural and remote incentives work when that is established. We have also looked at the issue of attracting not only workforce but actually service providers into rural and remote as well. The challenge with the incentives is that there are multiple layers to look at, and we can certainly look to our members to find out what sorts of incentives they would look for for working as therapists. But the other incentives are probably more ones that we would suggest are explored, because they would not be necessarily our place to talk to.

CHAIR: I want to ask a broader question—and obviously I will be asking Sarah this next up—and that is: in terms of the involvement of OTs in aged care, how extensive do you find that is? We get quite a lot of information—and you touched on it—around funding not being available, around funding being tight, in aged care. How extensively are your services used in aged care, both in community care and residential care?

Ms O'Reily : I might start an answer then and then move to Roxanne. As you would expect with most professions, occupational therapists will work across the wide range of aged-care, from policy through to senior management, management and then into the clinical space. We have therapists across a wide spectrum of roles. In terms of the clinical space, I think Roxanne will have experience and be able to talk to that.

Ms Gelle : There is a huge demand for OTs to provide services in aged care. We have long waiting lists in terms of provision of services. It is a profession that is really quite valued by people who receive our services, because we are actually working towards somebody remaining to live at home and to help them to access the life they want to live, to do the things that they used to do and to be involved and self-reliant. So when we do engage with people they really value our service. So we do find that we are in quite a lot of demand, and trying to service that can be challenging in terms of the amount of time we have, because we have to share it across a lot of different disciplines and services. So I would say that OTs are very valued in the area.

Ms O'Reily : I think some of the challenge comes in that occupational therapy is not a very easy tick-a-box type profession. We do not walk in, work with a client and then walk out going: tick, we have managed pain; tick, we have done this; tick, we have done that. It is a bit more iterative than that. The challenge is when you are funded to deal with pain management—like the example before, a physio might use ultrasound or might use massage and they will achieve that—and our approach might be to go, 'Okay, so you have a bit of pain; those things are going to work well in dealing with your pain now; let's think about how we can get you moving in an activity that you enjoy and like that will extend that pain-free period or the reduction in pain that you have had from that modality.' So it is a little bit difficult. It is a little bit hard to measure it and, therefore, it is difficult to map back to funding.

CHAIR: Thank you.

Senator POLLEY: In relation to the My Aged Care portal, what is your experience with it?

Ms Gelle : Look, 12 months ago I would have said that we had some significant difficulties. But over the past six months the Department of Health and MAC seem to have improved significantly. The IT systems have had some significant upgrades that have been beneficial both in terms of the client accessing the MAC and the service provider utilising it. We have found that the knowledge of how to use the system and the process is much more internalised, and we have much better experiences. Of course, that does not take away the fact that there still remain some problems. Really, I can see that the main problems are to do with handling and servicing people with more complex needs. So it is very much going well with the middle type of need that is for entering into the service, but we still need to work on those more complex types of client need.

Senator POLLEY: The only other issue, if we could just touch on it, is I take it from your submission that you would suggest that there needs to be more training around the CALD and LGBTIQ communities. Can you elaborate a little more and either give us some evidence of what you have observed or just your general view that this perhaps is not covered off as well it could be?

Ms O'Reily : I guess it is about the learning and experience. This recommendation is not only about the occupational therapy workforce but also the broader workforce. There are distinct challenges and issues for people who have faced challenges or difficulties across their lifespan. Particular types of thinking, working and approaches need to be considered when working with those different groups, whether it be CALD, ATSI or whichever group. So it is a bit about making sure that people are well skilled in that and understand that—and also understand their own skills and capacity and know when to seek support, refer on or use another staff member within their agency to help them with a client. So it is probably in that wide range of training. This is just another area where we need to acknowledge that there is a specialist knowledge and skill set that people need to develop in order to meet the clients' needs.

CHAIR: Thank you very much. We started early, so we will finish on time. Thank you for your time. The committee secretary will be in contact about the questions on notice.