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Community Affairs References Committee
23/02/2017
Future of Australia's aged-care sector workforce

BRIDGES, Ms Tamra, General Manager, Blue Care, UnitingCare Queensland

ROBERTS, Mr Peter Bruce, Chief Executive Officer, Warrina Innisfail

WEBBY, Mrs Glenys, Director, Service Reform, Blue Care, UnitingCare Queensland

CHAIR: Welcome. Thank you for coming. I have a short official bit that we need to do before we get going. I understand information on parliamentary privilege has been provided to you. I would like to invite whoever wants to to make an opening statement, and then we will ask you some questions.

Mrs Webby : I am going to start, and then Tamra will tell you about our Indigenous services. Blue Care is one of Queensland's, and in fact one of Australia's, largest providers of aged-care services. We have an integrated service model across residential, community and retirement living, and across Queensland we are in over 260 communities. So we have quite a significant presence across regional and remote services of the state. We are also with ARRCS, our Northern Territory counterpart, one of the largest providers, if not the largest provider, of Indigenous aged-care services. We are going to start today with Tamra telling you about our Indigenous services in the Queensland sphere.

Ms Bridges : Blue Care Indigenous Services manage a range of residential aged-care services specifically for first nations people. They are in various remote and urban locations. The key points that I wish to share today are a reflection of the strategies that we have used to successfully overcome the key workforce issues in both Aboriginal and Torres Strait Islander discrete communities and the urban settings like Townsville and Cairns.

Each of these strategies, however, impacted through aged-care funding cuts, may implicate our specialised workforce in the future. One is around creating the space for Aboriginal and Torres Strait Islander people to step into. The key strategy is providing a space that honours and empowers our first nations people. This is demonstrated through authentic and genuine relationships established with first nations residents but also through relationships with local key elders, traditional owners and community members. Our experience is that, as key people in the organisation, as we create the relationships and we show a genuine and curious commitment to building strong relationships, local people automatically want to be part of it.

To ensure success, there needs to be an intentional strategy from the organisation to invest and employ Aboriginal and Torres Strait Islander people in these areas. So this strategy also aligns with the national agenda for reconciliation and our collective responsibility as a nation. As an aside, recruitment strategies need to be flexible in this sense and support Aboriginal people to enter the workforce. This includes utilising informal networks, such as the Murri grapevine in Queensland. It also needs to be acknowledged that Aboriginal people are experts in caring for their elders and, since they are the experts, space needs to be provided for them to take that position.

Another intentional strategy that we have is maximising the spread of employment. Operating our services in discrete or very regional communities has some advantages. While the population and therefore the staffing pool is much smaller usually, it is less transient than the metropolitan areas. Often the services are one-of-a-kind in the centre, and so good relationships with local people often mean that we end up with a very secure pool of staff. This is complemented by considering employing a maximum number of people. Instead of reduced full-time jobs, we spread the hours across a community. This has advantages as, obviously, we have large pools of skilled staff to backfill staff as required, but it also considers the complexity around having different family groups employed in regional areas, so we have greater roster resilience at times of traditional celebration or community grieving. This is another one of the strategies that is put at risk through the funding cuts to aged care.

The third intentional strategy we have is creating leadership opportunities at all levels, so we create a space that empowers and encourages Aboriginal and Torres Strait Islander people to take ownership by showing commitment to mentoring and succession planning, so first nations people are able to step into leadership roles. We are very aware of: ‘Yes, we need to employ Aboriginal and Torres Strait Islander people.' However, they are not just our personal carers and our cleaners; each of them has a succession plan through to leadership, so we have Aboriginal managers in all of our services for the Blue Care Indigenous services.

We also have succession planning into clinical roles. We have an overexpectation that all non-Indigenous staff mentor Indigenous people into their roles and ideally do themselves out of a job. A strategy like this, obviously, requires significant organisational investment. It requires additional training and additional support staff to ensure that all of our service managers and Aboriginal staff are adequately supported and retained. In the long-term, our results have shown that we have a highly-skilled group of local workers who want to stay in the workforce and they continue to develop at higher levels throughout our organisation.

As an aside to that, it is important that the organisation adopts an understanding of the complexities of roles for people within the community. So often we have Aboriginal and Torres Strait Islander people in management roles but they are not purely the service manager or the nurse; they are also a brother, a sister, a knowledge holder, an elder by right so they have different community obligations. So organisations need to put in different sorts of support structures to be able to honour that and to support their staff.

Valuing and encouraging traditional healing methods—in a lot of our services, we actively utilise traditional healing methods, because first nations people have been successfully caring for their people for hundreds of years before aged-care facilities were built. We recognise in our services that these are useful practices which create a greater sense of empowerment for Aboriginal staff, and people want to be a part of something that is a bit different. We see this through our strong and committed workforce. Examples of this include traditional dancing and songs, specifically for healing purposes, and the use of bush medicine and healing touch. These methods remain unfunded and are absorbed operationally by the organisation, so I guess aged-care funding schemes need to have a look at how these kinds of really useful interventions can be funded.

The last key thing that we do is we utilise remote clinical monitoring systems, so a key challenge, obviously, as you have heard this morning, is retaining and attracting qualified clinical staff. As a strategy to address this in the past, we have used remote clinical monitoring systems, so this reduces the number of clinical staff that need to be on site but provides a comprehensive clinical oversight of each resident in conjunction with the people who are on the ground, who are usually the relatives of the elders that they are caring for.

The remote system involves monthly site visits and weekly virtual monitoring sessions. If there is a gap in clinical staffing at the service and we need to have an agency staff step in, it also provides continuity and ensuring that clinical standards are maintained. As our pool of local and qualified staff develop within the organisation, we can reduce the external clinical monitoring without compromising our clinical care that is provided.

CHAIR: Did you have anything to add?

Mrs Webby : I think the only thing I would want to add to that is that, from a rural and remote perspective, rather than an Indigenous one, there are obviously many of the same issues around recruitment and retention. In particular, there is the need for us to be creative about using technology and developing new roles or roles differently, which I do not think we have explored enough really through our service models and what the impact of that is on our workforce.

The second factor is the need for permeability—and this is mentioned in the UnitingCare Australia submission—where, in small towns, the market is not going to be there to have sustainable and viable numerous services. That also applies across disability, aged care and health. So more flexibility around staffing and workforce across those different services and between state and Commonwealth, I think, is really a necessity in funding models.

The third factor is that the cultural change issues that come around ACFI changes and consumer direction care for the workforce are absolutely significant. It is so much more difficult to do that in the regional and remote areas than in the commercial south-east corner, and we notice that acutely. So it is more resources to get information to people to get that change to happen. The cultural change issues, I think, are quite significant for us in that workforce sense.

Mr Roberts : Firstly, I would like to say thank you very much for the opportunity to address the committee and I should acknowledge our Senator Ian McDonald, who was a visitor to Warrina; I appreciate his ongoing support. Clearly, I am not going to be able to introduce to you any startling, exciting new national statistics, coming from a local one-operator, community based, not-for-profit organisation, but I hope that I might be able to add some understanding of the issues and the problems that are faced by rural and regional operators in the aged-care industry.

I will give you a little bit of background to our organisation. Warrina, placed in Innisfail, is about an hour's drive south of Cairns. It has 190 beds, so it is quite large by community standards. We have 248 employees. We have income of around the $16 million mark; wages—76 to 78 per cent of our income. So we are juggling with 22c in the dollar to pay all of the other bills, as is common in these locations.

We have some differences compared to our representative groups: the lasses and the axes. We have a turnover of staff that is generally in the eight to nine per cent. People stay for a considerable amount of time, but finding those people is a serious and ongoing challenge as is being able to get suitably qualified staff—RNs, ENs and so forth.

I would like to make the point that aged care in a lot of these communities is much more than just one local industry. It is imperative to the ongoing survival, to some degree, of those communities. I note that in most rural and regional communities we have already lost the 18- to 30-age group. They have left school, gone off to do their studies and build a career and so forth. Our grave fear is that we may also lose the 70-plus age group because they have to be five hours drive away in a suitable facility away from family and away from the community in general.

Aged care is a significant economic contributor to a lot of our rural and regional areas not only in wages but also in all of the food supplies, the bread supplies and the fuel supplies, and the access to tradespeople. I think I pay a quarter of a million dollars a year in rates to the local council. All of that is a significant part of keeping these communities alive and functioning. I think it is sometimes overlooked because we just look at how we get the appropriate number of RNs. A failure in that industry in rural Australia is going to have an incredibly big impact right across the board.

In the last 18 months, our organisation has spent $800,000 in refurbishment, and a million dollars as a result of the Quakers Hill fire in putting in sprinkler systems to meet mandatory directions. We are hoping to develop another 64-bed facility and knock down 25 or 26 of old stock. That is another $18 million. A place like Innisfail probably has not seen $18 billion worth of investment into a building activity in the last two decades. It certainly plays an important role.

We also have a number of items that cause us anxiety. We are seriously concerned about what consumer-directed care in a residential facility might look like and how it might impact on the organisation in terms of its flexibility and capacity to continue to operate. We have some concerns about enforced staff ratios. We have opportunities at the moment to be flexible—where we can move staff where our greatest care needs are. I instance the number of times where we may well bring in significant numbers of staff where we are having problems in the behavioural dementia area and run fairly lean in some of those others where there is no current need.

I flag the concerns that are shared by many of my colleagues in the general funding styles that are applied. I particularly instance the importance now of RADs and their impact in the rural and regional areas. I flag the stats that we have had a look at that suggest the median house price in Brisbane might be half a million dollars and the median house price in Sydney might be $800,000 or $900,000. I can tell you that the median house price in Innisfail is $182,000. So to be able to compete and meet the requirements of the legislation and provide the quality of care that not only we want but our raison d'etre demands as a community-based organisation, it almost impossible for us to put in RADs of $300,000, $350,000 or $400,000, but our needs are the same.

We have concerns obviously about the availability of bed licences and how they are distributed, and the impact that that has on our capacity and ongoing ability to attract and maintain staff. We have issues with technology and how that might roll out and how important it is, but also how behind we seem to be in the rural areas and the limited capacity of an organisation outside of the major capital cities to attract people.

Right now we have been successful and somewhat reliant on 457 visas—we have had six quality staff who have contributed significantly to our organisation and are still there—and we would certainly be hoping that that would continue and, in fact, be made even easier. I suppose that is the snapshot of our interests and concerns. Obviously we are battling to maintain the highest level of care that we possibly can. But I also think that in rural and regional areas we are blessed with some incredible and dedicated staff that do deliver high-quality service.

Senator POLLEY: I thought we would start with the easy question first—and, Mr Roberts, you touched on it—and that is the change to the CDC, which is only four days away. What effect is that going to have not only on service providers but on your consumers? The other issue that comes with this is: what have the implications been for your organisations, in terms of attracting and retaining staff, of the cuts to the Aged Care Workforce Fund?

Mr Roberts : I can duck your first question to a large degree because we do not operate in the home care environment. We are super anxious about what CDC is going to mean in the residential environment. I might add that we work very closely with the local Blue Care operators and are seeing that they have been impacted, as of two days ago. I am not convinced that what CDC is going to mean in residential care has been sufficiently articulated for us to really understand it. It just causes nerves.

Senator POLLEY: What about when the Aged Care Workforce Fund was cut?

Mr Roberts : To be honest it has had a minimal impact on our organisation. Obviously any cuts have an impact, but I would have to say that it has been minimal.

Senator POLLEY: Mrs Webby, do you have any comments?

Mrs Webby : First of all, from a consumer direction care perspective, we have, in the past, been on the record raising some quite considerable concerns about the notion of consumer direction in regional and remote areas. We have a concern about it being travelled directed care rather than consumer directed care. We have many examples of where people live just outside of town—not very far at all—and just getting people to the household takes up quite a significant amount of time that would ideally be allocated to their package.

What that essentially then means is that they need to reorganise the way they would choose to have that care provided. It may not really be how they would like it to be—and I guess, ultimately, they choose where they live—but, instead of having regular shorter visits, they have to have longer term visits to maximise the use of the travel that occurs.

I think the other issue that is there, which is the issue that Mr Roberts has already raised, is around the increased costs for local communities. We are all impacted by the increased cost of fuel and the increased cost of all the things that support the service, which then impact on that package and are not really adequately covered by the viability allowance. So we still have a gap between what the real cost of service is to our regional and remote communities, even with all those special allowances, and what the funding is.

I think the other issue around consumer direction is the notion that in some communities—maybe in regional towns such as Cairns and Townsville et cetera but not in more remote ones like Innisfail—the changes to consumer direction, as of February, will bring more people into the marketplace. I do not think that is simply realistic. In fact, we have examples that we have seen under the disability work where we have been in town doing aged care and disability services but a choice has been made to bring competition in and both organisations almost are on the very edge of viability. It does not really serve the purpose of the community to have two organisations that are barely able to stand up. It would be much better for us to deal with that issue that I mentioned earlier around how we service communities with a blended funding model and with a good public and not-for-profit service there that can provide a range of different options for people. I think they are the models that we need to look at, which also need to be supported by an appropriate workforce.

Senator POLLEY: What do you see as the role of the federal government in developing the workforce strategy for this sector? What role does the federal government have insofar as training and skilling up and helping to develop a career path for those people working in the sector?

Mrs Webby : I think the federal government has a role in terms of doing exactly what it is doing—engaging with the sector, because it is a partnership responsibility. In the current climate where we have significant reform happening and there is obviously a huge increase in demand as well, with a decreasing workforce, there are a range of issues that I think from a federal government perspective we need some leadership on in partnership with the sector.

The sorts of things that I think the federal government can do is to support the processes that have already been mentioned around how we deal with immigration to help boost our workforce numbers and to look at ways that the systems and processes can be simplified. We have a range of things, even in our industrial arena, that are challenges for us in the current environment as we move into this consumer direction. It is really very much around getting the issues on the table and being able to look at how the transformation of what we currently have needs to move to something that will be more sustainable in future.

The other area that I think is huge is leadership around technology. Our workers will need to be trained to work in different models. We will need different funding mechanisms to support that, which I do not think we have explored to the degree that we could have. It is really around setting policy, looking for the barriers and the issues that we can remove and then looking for innovation and providing an opportunity for people to play in new and different spaces, creating new models.

Senator POLLEY: Ms Bridges, in your opening comments you referred to the engagement that you have with Aboriginal and Torres Strait Islanders within your workforce and that you have given them a career path and an opportunity for advancement. Can you elaborate on that? Say I am an Aboriginal woman coming to work for you as a career, can you step me through what the career path and opportunities are?

Ms Bridges : In a residential aged-care facility it begins with gaining entry level qualifications, but it is the same as in a mainstream setting where you have meaningful performance appraisals and work with the goals of the employee to ensure they have opportunities. In Blue Care we have a broader range of opportunities than some smaller providers. We also have a broader range of services so we can give staff opportunities across our different services—so from Thursday Island down to Cherbourg. It depends if they want to follow pathways around clinical roles like registered nursing. We have an Indigenous graduate program. If it is more around management and following the management pathway we have an organisational management development program. We have really careful succession planning. We identify those individuals early. We have quite a lot of examples, but here in Townsville we have a residential aged-care facility called Shalom Elders Village. Our service manager started with us seven years ago as an administration trainee. He has progressed through the different pathways to now be the service manager at that site. It is not a manual process. It is really building the relationships, knowing the staff and helping to work with them to secure those positions.

Senator POLLEY: We have had evidence to the committee, not just today, but in other hearings around the country that there is a gap between being able to provide the training and the expectation that people would need to do that training in their own time, and there is no adequate funding available to ensure that you have that ongoing trading. The other component around that is the expectations on carers and professionals working in the sector. They are dealing with people who are living with dementia. We have a multicultural society but we do not have any requirements to have bilingual people working in the sector, and those people should be acknowledged for the extra skills that they bring. Do you have any comments?

Ms Bridges : Absolutely. In relation to your first comment it is really a job of the organisation to prioritise that training investment. It is the job of the managers at the service but it is also my job and then the broader executive of Blue Care to invest in that to ensure that it does work. We find that we have a reduced need for ongoing training and development of staff because our retention rate is quite good. We support our staff by ensuring that they can attend training in work time and we pay them for that time. We look for any incentives possible to cover the costs of training such as accessing things like the Job Creation Package and other government initiatives.

As far as the memory support services in our Indigenous-specific services, we adopt, like I said in my opening statement, a range of different approaches and many of them come from our staff who have different portfolios. A member of the cleaning staff at one of the facilities has a particular gift in doing traditional song and dance, so that is incorporated into the roster. She is not purely a cleaner, no-one is purely in their role, they also bring everything that they have to the service. That is recognised in the workforce culture and that is how we operate.

Senator POLLEY: Thank you. Mrs Webby, you look like you want to make some comment.

Mrs Webby : I wanted to make a comment around your comment on training. We have accessed the workforce training fund in the past, but less so now. The point that I wanted to make around this is that we are under increasing pressure as there is more competition in the market place as it becomes unregulated. We are dealing with the value proposition, which is price related, as well as the changes around funding under ACFI. As an organisation all of the things that you would like to do to support your staff become a whole lot more difficult when the funding envelope is changing considerably. With that, which speaks to the dementia side of things, you have an increasing number of people coming in with dementia, we want to change the culture of the service, so there is quite a lot of work that you actually do need to do in that space.

I think the tension that exists in the environment at the moment with the reform that is happening, with the increasing needs of people and the changing funding envelope, puts a whole heap of pressure on services to keep that quality of service that we so aspire to do. The notion of staff ratio and things like that is a really interesting one because there is no guarantee that, even if you have staff ratios in place, the quality of care is maintained. It is in fact training and a range of other mechanisms that really will deal with that. They are the things that we are challenged to do. I think the support at the national level to provide good access for regional and remote services to that, because it costs us more, is really important.

Senator POLLEY: Thank you that. Mr Roberts do you have any comments.

Mr Roberts : I would certainly support that. We have a fairly high retention rate, and I believe that a significant part of that is our prioritising of training. It is vitally important. We have relationships with James Cook University and we have relationships with a number of training organisations that put staff in, and without that I do not believe we would be able to maintain the staff the way that we do. The funding envelope keeps getting tighter and it puts more pressure on one's capacity to meet those needs but, at this stage, we have seen that as a major priority.

Senator POLLEY: Would you be one of the bigger employers in your town?

Mr Roberts : We would be the biggest employer in Innisfail outside of the local council, which operates over the whole region. In Innisfail itself we would be the biggest employer.

Senator IAN MACDONALD: I will carry that on, because I have the same question. You would source most of your cleaning, laundry and food from the local community?

Mr Roberts : Correct; from the local community. I would have to extend that, and extend that as far as Cairns for some of the vegetable supplies and so forth, but our local Brumby's provides our bread under contract; our local electrician is the one who comes out and does all of our work; we put out our meat contract once every 12 months and that is supplied by one of the local butchers. So the short answer is yes.

Senator IAN MACDONALD: Your qualified staff—nurses and that in one category and then your cleaning support, clerical, kitchen staff—is it easier to keep and maintain the second group that I mentioned; that is, the non-technically qualified staff, than it is the nurses? Do you have any solutions for that?

Mr Roberts : It is increasingly difficult to find appropriately qualified nursing staff that are registered nurses or, to a lesser degree, enrolled nurses. Our staff that are AINs and PCs and hospitality staff and kitchen staff and so forth are all coming from the local community, within 50 kilometres. To date we have been able to fill almost all positions in a relatively short period of time. Increasingly, though, it is becoming difficult to get RNs and ENs. I might add that we are somewhat selective; not every qualified person is an appropriate worker to operate in an aged care facility, and we endeavour to make sure that there is some degree of match.

Senator IAN MACDONALD: I will ask Mrs Webby this later, but have you any thoughts that you might be able to suggest to the committee, who could then suggest to the government—accepting that you run your own thing and you run it better locally than government ever would—on whether there is anything we can do to assist, particularly in the training area? I would not mind passing across you, because we have had this conversation privately about red tape and how all different levels of government give you different instructions to do the same thing, and often they are contrary. But, first of all, is there any magic wand solution?

Mr Roberts : I cannot think of any magic wand solution. It is an ongoing challenge to make sure that there is appropriate funding there. There needs to be a close look taken at the quality of the training to make sure that that is consistent across the industry, because there is a degree of mobility amongst the workers.

Senator IAN MACDONALD: Do you train your own, or do you get—

Mr Roberts : We bring in a lot of trainers.

Senator IAN MACDONALD: From where?

Mr Roberts : From Brisbane, Sydney. We enrol a lot of organisations with a subscription to the aged care channel, and that training is being provided on call regularly for staff to attend. We bring in significant numbers of experts in the dementia area, because the people working there need a lot of support and understanding, and we recognise that to help them we have to make sure they are as well-trained as they can be. All of our nursing staff would either be a Cert III or more. We see that as critically important.

Senator IAN MACDONALD: What percentage are with 457 visas?

Mr Roberts : Half a dozen.

Senator IAN MACDONALD: Have you ever heard of physicians' assistants? I will ask Mrs Webby the same question. We have just had someone in, and my simple and not very accurate description is that they are somewhere in the middle, between a registered nurse and a GP. They do a lot of clinical work. They are not quite doctors, and there is a suggestion they might be useful. Do you have much problem getting your local GPs into the home to deal with patients?

Mr Roberts : It is a challenge, absolutely.

Senator IAN MACDONALD: Mrs Webby, I would ask you the same things and I want to ask you another question. You are based where?

Mrs Webby : I am based in Brisbane.

Senator IAN MACDONALD: Blue Care has homes everywhere.

Mrs Webby : Yes, that is right.

Senator IAN MACDONALD: Could you comment on the differences between the challenges in a country area, like you have and like Moorina, and the bigger city ones, like Brisbane? Are there different challenges and how do you cope with them? And if you could recall some of the questions I asked Mr Roberts as well that would save time.

Mrs Webby : Yes. There definitely is a difference in the workforces, in terms of their access to things—to training and the frequency with which people move around. We would say that we will probably see more movement between our facilities in the southeast corner, but we do have—certainly in the Indigenous services—very long-term staff that stay for long periods of time. In our regional areas though, like Mr Roberts has said, we do struggle to get professional staff. We are looking at different models, such as this remote clinical monitoring that Tamra has talked about. That is not quite the same issue for our south-east-corner spaces. We may do it there because it offers us competitive advantage and gives us a different opportunity in the service model, but we would be doing it for a very different reason. We have been driven here to develop different models because access to staff is not there. So there is absolutely a difference.

There is the access to things like leadership training. I think leadership is a core training need that we have across the sector but it is particularly an issue in regional and remote areas. I would also say that when I talk about leadership I am not talking just about management. I think we really need clinical leadership. You referred to the physician's assistant role. There is a role called the nurse practitioner as well. Having their involvement—or across. We have a residential facility in your location as well. We could be sharing a nurse practitioner, for example. That would bridge that gap between the GPs. So there are new roles that are just becoming available, that we do need to fund some pilot projects in regional and remote areas and work together more to actually see how we can bridge some of those gaps. Leadership training is a core need.

The other issue that has been touched on around training is access. If you are flying people in and out that is a costly process and it means that the staff have access today but not access after that. The leadership on-site would help that, but I think we also need to be able to use technology better. We run RAS services, regional assessment teams—the new community based assessment process—in Queensland, in the regional and remote areas. That training was all done from a Canberra base. We had to fly people to Canberra for eight days, I think it was, to start with. There was no way we could do that in any regional or remote kind of process. I think we do need to spend some time trying to get equity of access to training.

Senator IAN MACDONALD: Can I interpose there. So it costs you much more to send people from North Queensland to Canberra than it does for someone in, say, Sydney?

Mrs Webby : That is right, exactly. And the third issue is the consistency of the message. Where we do not have strong models and a good evidence base—it is the partnering with the unis to get the evidence base, to then get the training delivered and translated into practice, and then the right support to evaluate and measure at the end. What I think is missing is an end-to-end training model that has a consistent approach to things, around the core factors of concern at the moment, like dementia and what consumer direction means for people. We have not even had the proper discussion on consumer direction in residential, as Mr Roberts said, but it will be a need in the future. I think that we do not tie that end-to-end process up enough to ensure that what we train gets delivered in practice and that the loop is closed off to make sure that the training is upgraded again and consistently delivered. There is lots of scope for us to have some improvement, across the country, really.

Mr Roberts : Can I add a little support to that and use a very minor example? One of our peak bodies, LASA Queensland—we are a member of that organisation—regularly runs some training, in this case to update management. Two days or a week ago I received an invitation to head down to a managers update session. It will run from seven o'clock till 10 o'clock in the morning in Brisbane and it will at least give us an opportunity to catch up. That is pretty good if you live in the south-east corner, because you drive there and spend three hours. But, for us to attend that free session, it requires two airfares down to Brisbane and back at $250 an airfare; at least one night's accommodation, because you cannot get there by seven o'clock in the morning unless you go the night before; and a day and a half out of the office. That is very typical. We are desperate for quality technology to help us address those sorts of issues, and at this stage it is just not there.

Senator WATT: Mrs Webby, these are probably questions for you. I want to return to the issue Senator Polley raised about the introduction of consumer-directed care. That is obviously a very big change for the industry generally. Did I hear you correctly earlier when you said that you were not particularly convinced by the argument that consumer-directed care is going to generate more providers in the market? You are not convinced that argument is correct?

Mrs Webby : I think it will absolutely produce more providers in the market in the south-east corner where there is a large volume and good opportunity for people to very efficiently and effectively provide services to a captive audience. To some extent that may also occur in some of the bigger regional towns, so the eastern corridor: Cairns, Mackay, Rockhampton and so on. But I very much doubt that we are going to see a whole heap of new providers in Mount Isa, Charleville, Cloncurry or Longreach. In fact there are probably some people who currently provide there who will be seriously considering whether they can stay in that area. I think that is a significant issue for us to consider and to monitor over time to see what that impact is. The government, to some extent, has a responsibility for stewardship of making sure that access to services is secure for all Australians. While we all agree with and aspire to consumer direction as a wonderful opportunity, I think it does have some challenges for some of those smaller regional and remote areas.

Senator WATT: I realise that Blue Care is the biggest provider in Queensland of aged-care services, so I suppose this question is Queensland-wide rather than just for SEQ or rural and remote areas. What kind of concerns do you have about the impact the introduction of consumer-directed care may have on your workforce management going forward?

Mrs Webby : Clearly, we expect that consumers are going to be wanting choice and control, which is really what it is all about. For us that means they will want to have an involvement in choosing or matching the support worker that is going to work with them. They will want services delivered when and how they like, so we will need to be a whole heap more flexible. Currently, we work and are funded under conditions that are pretty well nine to five—not always, but six to six or six to seven. People will want services at all sorts of different times of the day, and we will only have a limited number of workers. We will not be able to shower everybody at seven, if that is what they want. So it is potentially going to bring casualisation the workforce as we try to get more flexibility. It is going to also raise questions around things like training. Because as people want to pay less, they will be saying, 'How much do we want to pay for training?' As providers, we will also have that same issue about funding we have talked about. I think there are a range of things around choice and flexibility. The third issue really is about our staff needing to become much more customer-focused than what they have traditionally been as well. They have been very person-centred, but this is a shift again, so there is a training issue.

Senator WATT: Where is Blue Care at in terms of coming up with a strategy to deal with the introduction of CDC, in terms of workforce management?

Mrs Webby : We have certainly been working on this for some time, and we have developed our Blue Care tailor-made service model, which has been developed and co-created with our clients and the communities in which they live. That training has all been rolled out across the organisation. We have, as part of that, had some quite significant discussions at the union level and in the Fair Work Commission about the different models we would like to put in place.

We have also been heavily engaged in re-looking at different roles and looking at how technology might support this and therefore what impact that has on the workforce. We are trying to do some innovative pilot studies around that. We have a project in south-west Queensland with a regional and remote focus looking at care technology with Telstra Health that is seeking to provide services using videoconferencing and other things.

We have been working on a range of different issues to position us better for both the shortages in staff we expect with the increase in demand and also the changing consumer expectation that we expect will come with consumer direction.

Senator WATT: You have mentioned that you think it is a likely consequence of this model that you are going to need increased casualisation or an increased casual workforce. Is that right?

Mrs Webby : We will need people to be working shorter, more flexible hours, and, at the moment, the only mechanism industrially that we have to do that is casualisation. It is not our preference, because we would in fact like to be able to give people security of employment. Ideally, our clients would also want consistency of staff members. So there is a tension between that that we have yet to resolve. When I referred earlier to the industrial system or the paradigms that we currently work in needing to shift to something different, it is a piece of work that I think we as a whole sector and the unions as well need to have more conversation around.

Senator WATT: Have you thought yet about what the likely impact will be on the wages you can afford to pay and those kinds of things?

Mrs Webby : Yes, that is absolutely a key factor in that process. The not-for-profits that currently have EBAs in place have generated those. Certainly ours has very much been around valuing our employees over time. We are one of the higher payers in the sector and we have been proud to be that, but that will put us under significant pressure in this new environment. How we manage that going forward is certainly going to be a challenge, whereas there are new entrants coming in using different business models without the same restrictions in place that have a much different playing field in which to operate. We do have that factor that we have to deal with as a sector as well.

Senator WATT: Are you far advanced yet about working out what your position is likely to be in terms of wages going forward?

Mrs Webby : No, that is a work in progress.

Senator WATT: So it depends on what happens in the rollout and what new competitors there will be?

Mrs Webby : I think we are very clear that the roles we have now will not be the roles we will continue to have in the future. For example, we often have people who go in and do domestic assistance and others who go in and do personal care, with one person doing lifestyle services. So roles will change and then rates of pay et cetera will need to change according to that. We will absolutely have less professional supervision of some of those front-line lifestyle workers because we will not be able to afford to do it. The nurse will only come in when and if there is a specific nursing need to be addressed, whereas up until now we have actually had a team of people—more people going in than one—and the nurse has been there as a member of that team. The workforce will look different.

Senator WATT: Have you done any modelling or forecasting about your revenue and how that is likely to change due to the introduction of CDC?

Mrs Webby : Yes. We have done modelling. The space we are entering into is one that we have modelled, but we really cannot predict how consumers are going to behave and we also cannot predict how our competition will behave. While we have done and continue to do work in that space to get ready and to look at our price and how to bring efficiency through into our offering, there are a lot of unknowns in that for us—and we are no different to any other organisation out there. It is a punt at this point in time.

Senator WATT: Within reason in terms of commercial-in-confidence information, could we request information that you have about the modelling of the likely impact of revenue and wages for your staff? I am very concerned about what the impact of this is going to mean in terms of employee wages and conditions, and as the largest provider in Queensland it sounds like there are some legitimate concerns about that. Could I put on notice a request—

Mrs Webby : We can have another conversation around that as a commercial-in-confidence discussion.

CHAIR: Yes. We can accept that in confidence, if that is what you need.

Senator WATT: I am happy with that.

CHAIR: It is an on-notice question, I hope.

Senator IAN MACDONALD: Just a clarification: you said new entrants do not have the same restrictions as you have, Mrs Webby. Could you elaborate on what the restrictions are that you have that they do not?

Mrs Webby : I am referring to the 'uberisation'—for want of a better way of putting it—of the aged-care workforce.

Senator IAN MACDONALD: The what?

Mrs Webby : The uberisation. In fact the new entrants coming in and starting as new start-ups are using different business models for which we would have significant transformation. One would say if you cannot get with it you should get out, but it is clearly easier for a start-up to come in and build up. Some of the business models are around the self-employment of a group of people who register on a website and self-employed staff who can cut their price differently and are not subject to the EBA arrangements that we have got. They obviously have a different opportunity in the workforce arena and in the sector to those that have been established for some time and have more formal industrial arrangements in place. It is a lot more difficult for us to have that degree of flexibility while respecting the processes we have in place with our existing employees.

CHAIR: I am going to have to cut this short. I am sorry.

Senator IAN MACDONALD: Greater contractual flexibility for you would address that, though, wouldn't it?

Mrs Webby : Yes.

CHAIR: Thank you very much for your evidence today. We will be in contact about the additional information that was requested.