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Community Affairs Legislation Committee
24/10/2018
Estimates
HEALTH PORTFOLIO
Department of Health

Department of Health

[09:06]

CHAIR: I now welcome Senator the Hon. Nigel Scullion, representing the Minister for Health, and officers of the Department of Health. Minister, do you wish to make an opening statement?

Senator Scullion: Thank you. This is my first appearance on behalf of the health minister for Senate estimates. I'm looking forward to you being really gentle with me. In exchange for that, of course, I'll comply with your rulings. We don't actually have an opening statement.

CHAIR: Thank you.

Senator WATT: Welcome, Minister. We're looking forward to having you.

CHAIR: I intend to keep the time limits, so senators are reminded to contain your questions within that time, and other questions can be put on notice.

Senator POLLEY: Thank you very much, and welcome. My question goes to the 2016-17 budget. Can the department confirm that, on page 101 of Budget Paper No. 2, there was a revision of the ACFI and that there was an efficiency made to the tune of $1.2 billion to the ACFI?

Ms Beauchamp : Senator, are you asking questions in relation to outcome 6?

Senator POLLEY: Yes, I'm doing that here just in terms of ACFI.

Senator WATT: I thought this might come up. We're not intending to pursue a large number of aged-care matters in cross-portfolio. We'll do that in outcome 6. The reason Senator Polley is raising this one is that it's more about the budget of the department overall, including aged care. So it won't be a long process, but we thought this was the appropriate place to ask this particular set of questions.

Ms Beauchamp : Okay.

Dr McCarthy : As I think we've discussed in previous estimates, the government did, over a combination of a MYEFO and a budget, introduce measures to reduce unplanned growth in the Aged Care Funding Instrument. But as we've discussed before, Senator, the net effect of the measures was an increase in aged-care funding overall.

Senator POLLEY: I'm trying to understand where that $1.2 billion has gone.

Dr McCarthy : That was a moderation in unplanned growth. The government increased—made an upwards estimates variation and then introduced a measure to reduce the unplanned growth. The net effect was an increase in funding to aged care.

Senator POLLEY: Can you confirm that the $1.2 billion was taken out of ACFI—that was removed?

Ms Beauchamp : It's probably worth looking at what has actually happened in terms of investment into aged care over the period. I think there's been—

Senator POLLEY: Well, no, that's not my question. That's not my question. I'm sorry.

Ms Beauchamp : Sorry, I hadn't finished.

Senator POLLEY: The question was: the $1.2 billion was taken out of ACFI—

Senator Scullion: Madam Chair, if we can just give the officer an opportunity to get the first sentence out, I think would be really helpful in terms of the process.

Senator POLLEY: Well, it's also helpful if they answer the question that I've put to them rather than talking about other budgetary—

Senator Scullion: I'm sorry, but if you just allow at least a sentence to come out, perhaps you'll get to the information required.

Ms Beauchamp : Senator, I was putting it in context of what Senator Watt had said, in terms of the overall departmental funding as it related to aged care. If you have a look at the aged-care budget over the forward estimates and from as early as the budget that you referred to, I think you'll find that annual funding has increased each year, and over the forward estimates it will increase by $5 billion.

Senator POLLEY: Can I—

Ms Beauchamp : I just wanted to mention that there have been a number of commentators—independent commentators—who have said there has actually been both a real increase and a nominal increase in the aged care budget since 2012-13.

Senator POLLEY: I have a copy of the budget papers. On page 101 it says:

The Government will achieve efficiencies of $1.2 billion over four years through changes to the scoring matrix of the Aged Care Funding Instrument (ACFI) that determines the level of funding paid to aged care providers.

That's in the budget papers. You're obviously not going to answer my question in so far as this is what the budget papers have to say. It's here in black and white. Can you then explain to me what the term 'efficiencies' means as far as the budget is concerned.

Ms Beauchamp : I think Dr McCarthy has mentioned a moderation in growth, but on the other side of the equation there's been quite a substantial investment into aged care as well.

Senator POLLEY: That's still not answering the question in relation to that money that was taken out of ACFI. Was it spent somewhere else in aged care, did that go into the health budget or did it go into the health budget? What program did that go in to?

Ms Beauchamp : As you would appreciate, the budget process consists of lots of ones and offs, and then the government decides how to invest and reprioritise funding across a number of portfolios. I just wanted to put into context that funding has actually increased both in the Health portfolio and including the Aged Care portfolio. Decisions are made on budgets, MYEFOs and whole lots of processes from year to year.

Senator POLLEY: Was the money, that $1.2 billion, invested in the home care support program, or the home care packages?

Ms Beauchamp : You're assuming a direct hypothecation model, whereas the government decides how to reprioritise, how to spend the money that's been appropriated to all the portfolios. There would be, as Dr McCarthy said, some areas of growth restraint that we've looked at that has been reinvested into aged care. There have been quite substantial amounts invested into aged care since that budget decision. I'm happy to go through some of those measures.

Senator WATT: We've very much heard what you've said about funding to aged care overall. Senator Polley and the opposition are keen to just focus on the efficiencies that were made with the ACFI in that particular year, 2016-17, when Mr Morrison was the Treasurer. We're keen to understand where that money went. I think what you've said is that some of it might have gone to aged care, but government makes decisions about where it puts money, and some of it may have gone to other portfolios as well. Is that a correct understanding?

Ms Beauchamp : In budget deliberations the government decides how to prioritise the money. What I would like to confirm is that that moderation of growth on ACFI has been more than offset by increases in expenditure on aged care since that time.

Senator WATT: You have said that, and you keep talking about moderating growth, but if you look at that budget paper—

Senator POLLEY: Which I'm happy to table.

Senator WATT: they've each got minus symbols in front of the dollar figures. 2016-17 has a minus or reduction of $119 million. 2017-18 has a reduction of $229.6 million. 2018-19 has a reduction of $339.5 million. 2019-20 has a reduction of $463.8 million. You might want to describe it as moderating growth, but with minus signs in front of every one of those figures, we're talking about reductions of funding to the ACFI.

Ms Beauchamp : But on the other side of the equation, you haven't gone through all of the plusses.

Senator WATT: Sure, and that's a fair point. But we're looking at the ACFI. What I've said is correct. If we're looking at the ACFI, year on year, funding for the ACFI was reduced. That's correct.

Dr McCarthy : There were upwards variations made to the Aged Care Funding Instrument. The net effect of the measures taken, the efficiencies, was increased funding through the Aged Care Funding Instrument.

Senator WATT: Can you point to us, in those budget papers, which aged-care programs received funding as a result of the redirection of funding from the ACFI? It may not be possible to do that because the money goes from here into general budget holdings for the government, which might then go to health, to aged care or to education. That's fine if that's the answer; we're just trying to work out what the answer is.

Senator Scullion: In general terms, that doesn't happen. It does happen from time to time. I know in my own portfolio, usually in a fairly small matter, you can shift it, for example, from one organisation to the other. Then it actually shows a cut and then a plus, and you have to find that. But it's very rare that we would hypothecate efficiencies into a particular area. As you would no doubt be aware, ACFI, the Aged Care Funding Instrument, is something that's been used efficiently and effectively by your own government to ensure that the money we pay to residential aged-care facilities actually ends up going to the people in need, and not necessarily to the facilities. That's exactly what happens. So the notion of this as a cut has been pretty reasonably scotched. There's no way that you can say that there is no hypothecation of funds, so we say these are efficiency dividends from ACFI, because we're not paying people anymore for services they don't provide. So that does go back into the general health fund revenue. But it's really important to note that because we have far more money being spent every year in aged care, that's where some of those funds no doubt can be appreciated.

Senator WATT: So I think we're in agreement. This funding isn't hypothecated, so it's not possible to say that the money went from ACFI into other aged-care services; it may have gone partly there, but it may have gone to other portfolios as well.

Senator Scullion: Given there's a significant increase across aged-care services, to the tune of a billion dollars every year for the last five years, where that actual dollar came from, I'm not sure we can ever really find out in the context of the budget. But the most important thing is that, if people want to think that those efficiencies have been rechurned into, certainly the numbers are there to support that. I think the most important figure for everybody is that we have, in fact, increased the aged-care budget by over a billion dollars a year for every year that we've been in office.

Ms Beauchamp : Senator, could I also just add that the budget paper—now I've got a copy of it—from two years ago did say that funding would be redirected to fund health policy priorities.

Senator POLLEY: What we were asking was: has that gone to home care packages?

Ms Beauchamp : It would have gone to a number of measures, including aged-care measures.

Senator WATT: But also potentially to other matters in the Health portfolio, whether it be hospitals, PBS—

Senator POLLEY: Or other portfolios.

Ms Beauchamp : Well, it says the health policy initiatives in the budget papers two years ago.

Senator WATT: Not just aged care.

Ms Beauchamp : But I think, still, the bottom line is that there has been additional funding going into aged care since the budget you referred to.

Senator POLLEY: Can I ask, then, whether the sector was consulted before this cut was made?

Ms Beauchamp : I'd have to take that on notice. It was two years ago.

Senator Scullion: Even so, Senator, can I say: you don't consult someone on a compliance regime. We say, as you did—remember, in exactly the same position in 2012, in the same budget papers as you're looking, in the same line item, there's minus $1.6 billion. You cited significantly higher than historic rates of growth in 2012 under exactly the same circumstance. I can remember—in fact, I think it was Julia Gillard who said, 'People are claiming levels of money we don't think they're entitled to, and they may be unhappy the gig is up.' They were talking to the ACFI. It's not about, 'Look, we're going to consult with the aged-care sector.' The aged-care sector know that there are some dodgy dealers within their sector.

Senator POLLEY: Well, then you deal with those dodgy dealers.

Senator Scullion: If you could just let me finish, Senator. The vast majority of the aged-care sector believes that the Aged Care Funding Instrument is a useful instrument to ensure that not only the payments are made but compliance can be made around. As you'd know, even in the last quarter, 39 per cent of invoices have been questioned. So, we're in the business. Now, that's not an efficiency dividend; that's a compliance system. It's not a matter that you'll discuss at length with industry: 'Do you think this is a good compliance system or not?' They've known that that has been the case. And, yes, industry have been involved in the set-up of the policy around ACFI, and they broadly agree. Now, there were some who didn't agree, who are non-compliant, but the rest of them would agree and have been consulted on those matters.

Dr McCarthy : If I can just support the senator's comments. We don't consult on compliance, per se, but, at the time that we were aware that the claims were well above what was planned, there were discussions in fora like the Aged Care Sector Committee about this issue and what might be done about it.

Senator SIEWERT: Can I just jump in on that one? My recollection is that there were some significant negotiations with providers after this announcement was made, and that, in fact, some changes were negotiated with how these cuts would be made. Is that—

Dr McCarthy : Senator, I wouldn't necessarily use the word 'negotiation'.

Senator SIEWERT: Discussions with providers about the changes, and, in fact, some alternatives—the money was still saved, but some alternatives?

Dr McCarthy : That's correct, Senator.

Senator SIEWERT: Are you able to tell us now what they were?

Dr McCarthy : I might ask my colleague Mr Murray to help us out on that. There were some changes made relating to indexation versus some of the changes that were going to be made to the scoring instrument.

Mr Murray : Yes, that's right. After the announcement in the budget, there was discussion with the sector about how to implement those changes. What that involved was discussion around whether it was better to proceed with some of the changes that had been announced of the ACFI tool itself, some of the detail of the changes of the questions in the ACFI tool; or whether the sector would prefer and think it a better outcome to have a greater focus on the indexation and slowing the indexation rather than making some of the direct changes to the ACFI tool. After that discussion, in the following MYEFO, in December of that year, the government announced a revised package of measures which relied more on the indexation approach rather than the direct changes to the tool.

Senator SIEWERT: I'm conscious of the time. Are you able to table those revised measures this morning? We've got a number of hours now where we're going to be talking about aged care. Are you able to—

Mr Murray : Yes. There was a media release and an announcement at the time of exactly what those changes were. I'm happy to get them and provide that to you.

Senator SIEWERT: That would be useful. The point being here is that that money came directly out of the care component—ACFI is about the care that each resident receives. That's the point that's trying to be made, that money has come out of the direct hands-on care to other areas in Health.

Dr McCarthy : Senator, the funding to direct care increased year on year as a result of the net effect of the upwards estimates variations and the efficiencies that we've explained. The net effect was more funding for direct care year on year.

Senator SIEWERT: But, if you hadn't changed it, that would have kept going.

Senator Scullion: But, Senator, the actual number in the budget was an approximation of how much we would have thought that the payments that would be made would be made. One in three of the claims audited in 2017-18 were judged to be incorrect. We set aside a number we thought would be right based on previous history. But now, because we've had an increase in auditing, we've found those to be incorrect, and the actual number is lower. You might like to call that a save. It's the actual amount that was actually needed to be provided.

Senator SIEWERT: And you only, when you're auditing—

Senator Scullion: That was a lower number than anticipated.

Senator SIEWERT: You're only pulling in those high outliers when you're auditing. We had this argument at the time. You're saying that one in three implies that everybody is audited and that one in three were a problem.

Senator Scullion: No.

Senator SIEWERT: That's the way it sounds when you go to the media to say that.

Senator Scullion: That isn't the way it is. Instead of doing 20,000 compliances, which was the original number you're talking about, we're now down to 7,000, but it's in a much tighter area. Like in every auditing process, the function of auditing should be a function of compliance. For those who are continuing compliance, we're not. We're focusing very much on those with a history of non-compliance.

Senator SIEWERT: Which is why the outcomes are relatively higher than if you audited absolutely everybody to that degree. That's the point, that one in three makes it sound like it is a much—it's a skewed figure in terms of the whole number of providers that are out there.

Senator Scullion: No. Every provider comes under compliance regimes, Senator.

Senator SIEWERT: They're not audited like this.

Senator Scullion: The important thing is, you're saying, 'Well, why is this number lower than we anticipated?' It's because we anticipated a high amount historically. Just like running any business, we're making sure that the invoices we pay on are correct and accurate. We put a lot of effort into that. That's why we have the capacity. It's like running any business or running any economy. We're good at it and we make sure we're not paying for things that people within the aged-care sector aren't getting.

Senator DEAN SMITH: Secretary, ACFI revisions are not uncommon, are they?

Dr McCarthy : That's correct, Senator.

Senator DEAN SMITH: When was the last time there was an ACFI revision?

Dr McCarthy : 2012.

Senator DEAN SMITH: Under the Gillard government?

Dr McCarthy : Correct, Senator.

Senator DEAN SMITH: Secretary, in your earlier evidence, you mentioned that there had been some third-party commentary in regard to the level of aged-care funding under the coalition. You mentioned it in the broad. Could you be more specific in terms of where that third-party commentary is?

Ms Beauchamp : I think there has been a lot of commentary around the increase. Some commentators have said there hasn't been an increase in aged-care funding. I think there have been two independent assessments of what has actually happened in both real and nominal terms over the last few years. One was by Peter Whitford, which was reported in The Conversation, and the other one was an ABC Fact Check that put to bed that there has actually been a billion dollar increase in aged-care funding over the forward estimates building on past expenditure. I think they're important in terms of correcting the record of other commentators, particularly in the media. The other thing I'd like to say, responding to Senator Siewert, is that there has been a six per cent increase in growth. When you look at the average care subsidy over the period, it's gone from $53,100 in 2012-13 to $66,000 in 2017-18. I think they're significant care figures if you're looking at direct care subsidy per consumer.

Senator DEAN SMITH: Thank you. It's also not uncommon for residential aged-care funding to be redirected to other sources of aged-care funding, is it? I've got the 2010-11 budget paper document here, where it says: 'The government'—so, the government at the time in 2010-11. A little bit difficult to keep up; it was either Kevin Rudd or Julia Gillard—

Senator POLLEY: It's a bit like Abbott, Turnbull, Morrison—you want to go there, do you?

Senator DEAN SMITH: I'm not arguing with that.

Senator POLLEY: Anything to churn up time.

Senator DEAN SMITH: No need for cheap political points; it's Wednesday morning. The document says:

The Government will redirect funding of $247.7 million over four years from high-level residential aged care to high-level community aged care—

A redirection initiative under the previous Labor government. A similar document says:

The Government will ensure additional high-level community aged care places are made available by temporarily adjusting the balance between high-level community aged care and high-level residential aged care.

…   …   …

This measure will provide savings of $211.7 million over five years from 2010-11, due to the lower costs associated with delivering care at home.

Senator POLLEY: The money was staying in aged care. That's the difference. You've taken the money out of aged care and given it to other groups.

Senator DEAN SMITH: These are not uncommon decisions for government to make.

Ms Beauchamp : Based on what you're reading, which I don't have in front of me, yes.

Senator POLLEY: Which confirms that that money stayed in aged care, unlike the current government's.

Senator DI NATALE: I have my standard questions on health expenditure. Could you provide me the latest figures: total health expenditure, percentage increase over the last year and where those increases have occurred.

Senator Scullion: You've taken them a bit by surprise by asking a budget question.

Senator DI NATALE: Why's that?

Senator Scullion: I was joking.

Senator DI NATALE: Right, you mean a serious question?

Senator Scullion: Yes.

Mr Yannopoulos : Just forward estimates, this year and forward?

Senator DI NATALE: Yes please.

Mr Yannopoulos : For health overall: $78.825 billion.

Senator DI NATALE: How does that compare to the previous year?

Mr Yannopoulos : $76.039 billion; 2019-20, $80.416 billion; 2020-21, $82.48 billion; 2021-22, $85.41 billion

Senator DI NATALE: You have seen close to a $2 billion increase, and it looks like that trend is set to continue. What areas have grown?

Mr Yannopoulos : I'll need to go through. Each program has grown.

Senator DI NATALE: Is there an area that stands out or is it proportionate across all of them?

Mr Yannopoulos : The MBS has grown probably the most, looking at this table: 2018-19, $24.728 billion.

Senator DI NATALE: Which was an increase of?

Mr Yannopoulos : Just on $800 million from $23.976 billion in 2017-18. In 2019-20—

Senator DI NATALE: I don't need the forwards; I'm interested to see what has happened over the last year.

Mr Yannopoulos : Just in the relative year?

Senator DI NATALE: Yes. Any other bits?

Mr Yannopoulos : Hospitals in 2017-18, $19.936 billion, has gone up to $21.189 billion.

Senator DI NATALE: That almost accounts for the total increase.

Mr Yannopoulos : Yes. There's just one more that I think I should call out, given the previous conversation, which is aged care. In 2017-18 it was $18.086 billion and in 2018-19, $19.764 billion.

Senator DI NATALE: What's the total cost of the private health insurance rebate now?

Mr Yannopoulos : Budgeted for this year: $6,405 billion; last year, $6.276 billion.

Senator DI NATALE: Over the forwards?

Mr Yannopoulos : Going up to $6.546 billion in 2019-20, $6.710 billion in 2020-21 and $6.877 in 2021-22, growing 2½ per cent on average by my calculation.

Senator DI NATALE: I don't know how you allocate total funding for preventative programs looking specifically at alcohol, obesity and tobacco.

Mr Yannopoulos : I have some numbers that break down 'other': preventative health and chronic disease supports in 2017-18, $374 million; 2018-19, $399 million; 2019-20, $394 million; 2020-21, $392 million; and 2021-22, $383 million.

Senator DI NATALE: Why is that projected to decrease?

Mr Yannopoulos : I'd have to take that on notice—I don't know—or we could deal with it later today.

Senator DI NATALE: I'll perhaps interrogate that in the relevant outcome.

Mr Yannopoulos : I suspect it's savings at some point.

Senator DI NATALE: I have some additional cannabis questions, but it would probably be unfair to—

Ms Beauchamp : To add to what Mr Yannopolous said about preventative health, some of that is included in primary care, MBS and some of the other mainstream programs. We'll get a more definitive figure later.

Senator DI NATALE: Yes, I understand that probably includes primary health networks and so on, does it?

Ms Beauchamp : Yes, that's correct.

Senator Scullion: We'll take those questions on notice and try to have the answers back shortly.

Senator DI NATALE: I have some stuff on medicinal cannabis, but I will wait for the right program.

Ms Beauchamp : Late at night.

Senator SIEWERT: I have a couple of questions about where I should ask different things. Should the remuneration of GPs providing care in aged-care facilities be in outcome 6 or one of the other outcomes?

Ms Beauchamp : That's outcome 4.

Senator SIEWERT: MRIs and their locations?

Ms Beauchamp : Outcome 4.

Senator SIEWERT: I thought so. Indexation issues for mental health and practice incentive program?

Ms Beauchamp : That's outcome 2.

CHAIR: Senator Watt, we have about 10 minutes on this portfolio and then we will move onto the next.

Senator WATT: In the past we haven't strictly enforced these time brackets, within reason.

CHAIR: I intend to as the chair.

Senator WATT: That is the first I've heard of that. May we have a little bit of a discussion on that? I don't think I will need much more than 10 minutes.

CHAIR: That's it. You've got it.

Senator WATT: We might have a talk about that at some point.

CHAIR: Yes, but for now you have 10 minutes.

Senator WATT: Moving onto a different topic, which has cross-portfolio aspects to it, I turn to the dispute on the reconciliation of public hospital funding for 2016-17. Can I confirm that this dispute is between the Commonwealth on the one hand and all states and territories on the other?

Ms Beauchamp : We probably should take that in another outcome, but the dispute is not with the Commonwealth; it's with the independent funding bodies.

Senator WATT: But it's the Commonwealth who all the states and territories are seeking some change from.

Ms Beauchamp : Can we raise that under the hospital outcome?

Senator WATT: The reason I'm doing it now is that it does have impacts on the department's overall budget. This is one of only two matters that we intend to raise in cross-portfolio.

Senator Scullion: Is this National Health Reform? The title helps; there's lots of negotiation going on.

Senator WATT: Yes, the National Health Reform agreement.

Senator Scullion: My understanding is that the coalition have signed a new heads of agreement with five states and territories on the delivery of public hospital services. New South Wales, Western Australia, South Australia, Tasmania and the Australian Capital Territory have already signed. That's a 2020 national health—

Senator WATT: My understanding is that is for future funding.

Senator Scullion: That's correct.

Senator WATT: But the dispute is about past funding.

Senator Scullion: Sorry, can you ask that question again?

Senator WATT: I think you are talking about the future agreement, 2020 to 2025; what I'm focusing on is the existing agreement and a dispute over past funding.

Senator Scullion: Sorry, I'll let the department answer that—same heading; different matter.

Senator WATT: You are familiar, Ms Beauchamp, with the dispute I'm talking about?

Ms Beauchamp : Yes, I am.

Senator WATT: It is the case that all of the states and territories, including state Liberal governments such as New South Wales, South Australia and Tasmania, are united in their opposition to the Commonwealth's position.

Ms Beauchamp : The Treasurer made a determination on reconciliation based on the advice of the independent bodies and the administrator.

Senator WATT: Which Treasurer was that? There have been a few.

Senator Scullion: They've all been good, though.

Senator WATT: You reckon? Why do they keep getting replaced?

Senator Scullion: It was the most recent Treasurer.

Senator WATT: As in Mr Morrison?

Ms Beauchamp : Mr Frydenberg.

Senator WATT: We have all the states on one side, regardless of Liberal, Labor or whatever, and the Commonwealth on the other side.

Ms Edwards : The situation we have is a mechanism under the national reform agreement currently in place which requires the Treasurer to make a determination about the final payment for hospital funding in a year. The Commonwealth makes payments through the funding pool during the year in advance on the basis of estimates, then at the end of the year, on the advice of the pricing authority and the administrator, the Treasurer makes a final determination to do ons and offs. So that's what we're talking about.

Senator WATT: Sure. I understand the role of those independent agencies, but it is a fact that all of the states and territories don't agree with the decision that has been put forward.

Senator Scullion: But the decision by those independent agencies—

Senator WATT: Which is acted upon by the Treasurer.

Senator Scullion: But the independent agencies have made that recommendation.

Senator WATT: Sure.

Senator Scullion: And so it's the jurisdictions who are united against the two independent umpires' decisions. They're the recipients of the funds and that is unremarkable. But the Treasurer follows the advice of two independent agencies, which he is doing in this case.

Senator WATT: Okay.

Ms Edwards : I would just add that I'm not sure whether it's the case exactly that they're united. The states have expressed views about the way the pricing authority and the administrator have calculated the very complex way we do pricing. Some of them have written letters to the minister and some of them have raised issues in ministerial councils. So there is an ongoing discussion and a whole series of consultative forums going on. At the moment where we've landed is that the Treasurer has made a determination and the states have been discussing that among health ministers and have some issues with the technicalities of how it was put together.

Senator WATT: You've made a lot of references to these independent bodies. Are you aware of the concerns that the states have raised about the supposed independence of those bodies?

Ms Edwards : You might have to describe further what you mean. Certainly I haven't in those terms.

Senator WATT: My understanding is that the states are so concerned about the independence of those bodies that they're considering voting to sack board members of those bodies, to the extent that they're able to under the health agreements. Are you aware of that?

Ms Edwards : I'm aware of a draft paper—and I don't know whether it went anywhere near ministers or not—which was talking about the deputy chair of one of the bodies. I'm not aware of any move to do anything about the administration. In fact, the administrator was very recently appointed in a process which consulted very heavily with states and territories and took their nominations. The administrator was unanimously appointed at a health ministers' meeting. I think it was the one in Alice Springs in July. So that is a very recent appointment which, as far as I'm aware, the states were wholly in agreement on. The pricing authority board changes over from time to time. We have been having discussions about how we might seek nominations from states about replacement members. I am aware that states have been worried about the methodology and the way the technical and very complex mathematical actuarial-type arrangements have been made and how those have flowed through. Continuing discussions have been happening about that, including a well-established working group with all the states about how we deal with these issues in the new agreement. So it is a complex, ongoing discussion.

Senator WATT: Okay.

Ms Beauchamp : Senator, can I just add to that? At the most recent Commonwealth Health Ministers Meeting, all jurisdictions, including the Commonwealth, met with the independent bodies. There was no discussion or agreement about sacking any of them. So I just wanted to put that on the record. There may have been some discussions at officer level in the states about what measures could be taken, but certainly at the last Commonwealth Health Ministers Meeting there was no agreement or discussion about sacking any members of the independent—

Senator WATT: Okay, maybe not at ministerial level. At that most recent meeting of the state, territory and Commonwealth health ministers, the COAG Health Council agreed to invoke section 23 of the National Health Reform Agreement and refer this dispute to COAG if it is not resolved by this Friday, 26 October. Can you give us any previous examples of section 23 being invoked?

Ms Beauchamp : Could I just first correct something. It wasn't COAG that agreed; it was the states and territories that invoked that clause.

Senator WATT: Okay. So all the states and territories agreed to refer the dispute to COAG, if it's not resolved by this Friday. Has that ever happened before?

Ms Edwards : Not that I'm aware of.

Ms Beauchamp : I'd have to take it on notice.

Ms Edwards : But clause 23 is a reasonably new agreement, so it's not as though we have decades—

Senator WATT: Sure, but there would be similar clauses in previous agreements.

Ms Edwards : I'm not aware of any, but we will take that on notice.

Senator WATT: Our research is that this would be the first time that a dispute has had to be referred to COAG because it hasn't been able to be resolved among ministers.

Ms Beauchamp : We'll take that on notice.

Senator Scullion: Just in the context of people who might be following this, they may not understand the notion of reconciliation. It's not unlike the previous discussion around ACFI. In 2016-17, for example, you would say, 'This is what we would anticipate.' In one year we had a 78 per cent increase in skin rashes, constipation went up 67 per cent, resistance to antibiotics and penicillin went up a massive 161 per cent, trouble initiating and maintaining sleep went up 134 per cent and the list goes on. These are conditions you would expect to remain stable. So the reason the Labor Party put in the independent process in 2011-12 was to ensure that, when we see increases like that, they check whether those are real increases, and, when they aren't, they say, 'We're not going to pay you something that you haven't provided a service for.' I can understand that the states and territories are, in the vernacular, a bit narky about that and will do everything that they can. But I really think that this was an independent process set up by you and has been supported by governments since that time. I think it is, in fact, a process that's working well.

Ms Edwards : Can I just add to that, Minister, that the independent body has actually been called to appear later today and they will be able to explain in very great technical detail exactly how those apparent growths were then treated and how the actual situation was determined. The minister is obviously steeped in it, but I'm certainly not across it enough in the details. I suggest you might want to have a full explanation of exactly how the back-casting issue that's provided for in A40 of the agreement applies to things like apparent growth, which might turn out to be simply coding differences and so on. Those very great complexities can be discussed by the independent bodies that are conferred with the role of working through that.

Senator WATT: Sure. I will have a discussion about that.

Senator Scullion: Senator, you're saying, 'They didn't like this person,' or, 'They were going to sack someone,' or, 'They didn't like what was going on.' I'm not sure if you can provide, not necessarily now, the reasons why. Was it malfeasance, or was it that they didn't like the process or the technical detail? I'm not sure, but—

Senator WATT: Okay. I'll see what I can find out.

Senator Scullion: Thank you.

Senator DEAN SMITH: I can't help but be reminded of Paul Keating's 1993 comment about how unwise it is to get between state governments and a bucket of money. But, in all seriousness, which government proposed the independent model?

Senator Scullion: I think my recollection is that it was the Labor government, in 2011-12.

Senator DEAN SMITH: And who nominated the current administrator? Ms Edwards, you did say that everyone came to an agreement on the current administrator.

Ms Edwards : The previous administrator's term came to an end. There was a process in train that the Commonwealth ran. The previous administrator decided not to reapply. The Commonwealth came up with a possible candidate and took that candidate to the states. There was a view, at least among a majority of states, that they weren't a good candidate, so we withdrew that nomination.

After that, I took on a process where we canvassed for nominations across all of the states and territories. We convened another panel, which involved two states, myself and the head of the safety and quality commission. Then we had a roundtable discussion about the merits of the various candidates. A consensus view was arrived at, after which I rang back all of the states' very senior officials—secretaries or equivalent, or deputy secretaries—to say to them: 'You put up'—so-and-so. 'We're actually thinking about going with this other person. What do you think?' I spoke to all of the states who had that view and also to some external referees in relation to the person who'd been nominated by a state and whom we thought was a good idea. Then it went into a private session, I believe, amongst all the state ministers, and there was, as I understand it, complete agreement that the person who is now the administrator should be appointed.

Senator DEAN SMITH: Thank you.

Senator WATT: In terms of the money that we're talking about here, the states say that the Commonwealth is making changes retrospectively and reducing funding for hospital services they delivered in 2016-17. Are they wrong?

Ms Edwards : That's not the way we would characterise it.

Senator WATT: I figured that.

Ms Edwards : As we mentioned before, what we're talking about is a reconciliation process. Large amounts of money are paid out during the year. Obviously, states want the money during the year. At the end of the year, a reconciliation is done to check actual activity—what services are really provided to people in hospitals—and then that data is all reconciled. What you end up having are relatively minor ons and offs—we hope. At the end of the day, what happened in this reconciliation was that an additional $307 million was paid out to states and territories as the final payment for the year. For some states that meant a bit more, and for some states it meant a bit less. Those payments are then made during the next year—either small amounts or relatively modest amounts held back or payments made. That happens every year so that the payments catch up. Nobody is ever required to pay anything back. That's the fundamental process.

Senator WATT: Victoria says that it's owed $201 million, Queensland says it's owed $79 million, and presumably the other states also say that they're owed tens of millions or more.

Ms Edwards : I think states say that, on their analysis of the data, there was growth in hospital activity which should have been paid for. Then the advice from the independent bodies is that when you apply backcasting methodology—which, as I say, they should explain to you in technical detail later today—it means that the growth was actually a certain amount. That advice was provided to the Treasurer, and he paid out exactly in accordance with that advice to reflect what the bodies have come at, in this very complex area, as being the actual services provided to people.

Senator WATT: Okay.

Ms Beauchamp : Senator, could I just add, it's probably worth looking at some—

Senator WATT: Can I just make a point? With the greatest of respect, we've got limited time, and lot of the answers are getting pretty long. If we can try and keep them as concise as possible. Please go ahead.

Ms Beauchamp : I was just going to say it would be worth tabling the growth figures of funding to public hospitals from the Commonwealth compared to the growth rates of each of the states and territories. Funding from the Commonwealth has been quite substantial where the growth rate from the states and territories has been much smaller. I think we've got those details on the record through questions on notice. I think the growth from the Commonwealth funding certainly outstrips the states and territories.

Senator WATT: Sure, okay. The dispute we've been talking about is over 2016-17 funding, but there was a similar dispute over funding in 2015-16, and that dispute arose after the then Treasurer, Mr Morrison, directed the umpires to audit 2015-16 funding. To your knowledge, did Mr Morrison as Treasurer do the same for 2016-17?

Ms Edwards : The process that happened in 2015-16 did not happen in 2016-17, no. There was no request to the bodies to investigate the apparently excessive growth.

Senator WATT: Right, so the actions Mr Morrison took as the Treasurer in 2015-16 were not repeated by whoever the Treasurer was—

Ms Edwards : The Treasurer wrote to the Minister for Health, from memory—this is back beyond my current folder—and asked them to look at that apparently extremely high growth, which didn't seem to be justified. That did not happen in 2016-17. I'm sorry if my answers are getting long, but this is a very complex area.

Senator WATT: My understanding is that the administrator or the pricing authority considered a range of options to resolve its dispute, including one option that would be prospective so that it would start in 2018-19. Is there a reason that wasn't adopted by the Commonwealth?

Ms Edwards : The Independent Hospital Pricing Authority provides advice to the administrator, who provides it to the Treasurer, who adopted that advice. I think you'd actually have to talk to the pricing authority about what was the nature of its advice and to the administrator about whether he did or didn't take it.

Senator WATT: So the department wasn't involved in that?

Ms Edwards : No. We were aware the discussions were going on, as were all states and territories invited to consultations, but no. I think there was notice of the advice given as it happened, but we did not have any specific role in that. IHPA gave advice to the administrator and the administrator gave advice to the Treasurer, there was consultation along the way with the Commonwealth and all the states, and then the Treasurer made a decision which was entirely based on the advice of the administrator.

Senator WATT: It was widely reported that the cancelled COAG meeting in October would have discussed health funding. Would that have included this issue?

Ms Edwards : I'm not aware of any proposal to—well, you'd have to address those issues to PM&C in relation to what might have been on the agenda—

Senator WATT: You're not aware?

Ms Edwards : As far as I'm aware, I didn't see any specific agenda that went to this issue, no.

Senator WATT: Okay. Last one here: if the COAG Health Council does refer this issue to COAG on Friday, when will COAG discuss it?

Ms Edwards : That would be a matter for different portfolios. We don't have any—

Senator WATT: You don't know?

Ms Edwards : No.

Senator WATT: Just one quick thing on another topic before I hand over to Senator Singh. Minister, have you been asked to provide advice on policy concessions or spending commitments that could be made to members of the House crossbench? I'm asking you here as a representative of the health minister.

Senator Scullion: I understand that, and you'd understand that I'll have to take that on notice, Senator, but if we can find an answer to that question today, we will.

Senator WATT: Okay.

Senator Scullion: Can I just take that on notice?

Senator WATT: Sure. What about in your own portfolio, where you might have more knowledge?

Senator Scullion: What the question again? in regard to my—?

Senator WATT: I was asking about Health, which you will take on notice. In your own portfolio, have you been—

Senator DEAN SMITH: No, this is not Indigenous Affairs. That's Friday.

Senator WATT: Okay. I just thought it might be an opportunity for the minister to clarify.

CHAIR: I think, Senator Watt, now we can move to the—

Senator WATT: Secretary, have you been asked to provide advice to government on policy concessions or spending commitments that could be made to members of the House crossbench?

Ms Beauchamp : No, I have not.

Senator SINGH: How many national action plans has the current health minister announced?

Ms Beauchamp : We can get the officers up here, but I think that's in the order of 11 or 12.

Senator SINGH: While we're getting a confirmation on whether it's 11 or 12, I just want to run through some of them that have been announced by the current minister, because I haven't quite found 11 or 12. So maybe we can find the missing ones. I've got a national action plan for osteoporosis.

Ms Beauchamp : Yes. I'll wait for the officer to get here, but some of those plans have also involved states and territories and are being developed through the COAG process as well.

Senator SINGH: Yes, I'm just trying to get the right number on how many there are. I think I've got ten that I've been able to identify, so maybe if there's 12 you can identify the missing two. So, I've got a national action plan for osteoporosis, a national action plan for endometriosis, a national action plan for chronic pain management, a national action plan for inflammatory bowel disease, a national action plan for macular disease, a national action plan for arthritis, a national action plan for kidney disease, a national action plan for children's health, a national action plan for childhood heart disease, and a national action plan for lung conditions. What are the ones I've missed?

Dr Studdert : I believe that women's health and men's health are also there, and cardiovascular and stroke disease. The relevant officers that can go through those and explain them in some detail will be here for outcome 2 this afternoon, and will be happy to talk you through this.

[09:58]

CHAIR: We now move to outcome 6, ageing and aged care.

Senator POLLEY: I'd just like go back and talk about some issues. In parliament last month, the minister said that funding for ACFI expenditure has continued to increase against claims across all three domains. I'd just like to put some evidence before you. Firstly, there is the Ansell report, where there is confirmation that there was an effect of the 2017 ACFI changes on residential funding. This report states that there was a cut of $6,655, or 11 per cent, per resident per year as a direct result of the budget measures across the complex healthcare domain. This can be further evidenced by the fact sheet, Changes to residential aged care funding arrangements - budget 2016-17 whereby changes to ACFI would be implemented in two stages. Do you want me to read out those stages? The ACFI monitoring report in April of this year also supports the occurrence of this cut with a negative growth of the complex healthcare domain of minus 2.4 per cent. Isn't it clear that the complex healthcare domain was cut in the 2016 financial year, or are you saying that there has been an increase over the last year?

Dr McCarthy : As we've already discussed, funding for aged care, including the care component, has increased year on year. We do monitor the ACFI claims, and that's done by the report that you suggest. There can be variability over time in those claims, and we monitor that closely. But, overall, as we've discussed, there have been increases year on year to aged-care funding.

Senator POLLEY: Are you saying to us that the minister's statement, when we believe it was clearly wrong when it comes to complex healthcare domains—are you saying that there's no substance to that?

Dr McCarthy : Sorry, can you repeat the question?

Senator POLLEY: In the report it states that there's been minus 2.4 per cent growth—a decrease in the growth. Was the minister right, or was he clearly wrong, when it comes to the complex healthcare domain?

Dr McCarthy : The minister was referring to an increase overall in funding for the three domains collectively. There has been some variability in relation to one of the domains—

Senator POLLEY: What's that?

Dr McCarthy : but, overall, care funding has increased. It may be helpful to know that, of course, the funding that flows through the Aged Care Funding Instrument assessment flows to the facility as a total pool. It's assessed per resident, but the facilities use a total pool, and, of course, that total pool has increased year on year.

Senator POLLEY: But the minister actually said that every domain had increased, and the department's report clearly states and shows that it was a minus. So, I'm still confused.

Mr Murray : The complex healthcare average payment in 2015-16, before these changes, was $18,900. That was the average payment. In 2017, it was $19,100. So that domain has increased over that time period.

Senator POLLEY: Over the three domains?

Mr Murray : Over the three domains it has increased.

Senator POLLEY: We just had evidence that there is one domain that didn't.

Mr Murray : For complex health care, which is the domain I think you were talking about, the average ACFI payment in 2015-16 was $18,900. The average payment for complex health care in 2017-18 was $19,100. So that has increased.

Senator POLLEY: And what is it now?

Mr Murray : That was the 2017-18 figure. It would be slightly above that moving into the 2018-19 year, but that was 2017-18.

Senator WATT: So why does the department's own ACFI monitoring report in April 2018 show negative growth of the complex healthcare domain of minus 2.4 per cent?

Mr Murray : There were movements in the domain over that period, and that's what's sort of identified in the report. But if you look at what the situation was prior to the changes and what the situation is after the changes, there has been growth in that domain.

Senator WATT: But there were cuts along the way.

Mr Murray : There were movements in the pattern along the way. What often happens with these changes is that we'll see providers bring forward claims, for example, so that brings you forward to a higher peak before the changes take effect. Then the changes take effect, but after a while they move back into the positive.

Senator POLLEY: Perhaps we can move on to the royal commission into aged care. Can the department give us an update as to when the hearings are going to start?

Ms Beauchamp : The royal commission will not be the responsibility of the department. The royal commission will be managed under the Attorney-General's Department, so any hearings and any questions about the mechanics of the royal commission should be directed to them.

Senator POLLEY: Can we go back, then, to see whether you can confirm when the department gave advice to the government about a need for a royal commission? What date was that advice given?

Ms Beauchamp : These decisions are made by government primarily through the cabinet process, so I am not in a position to answer questions that relate to cabinet and government decision-making processes.

Senator POLLEY: Did you give advice to the government on whether there needs to be—

Ms Beauchamp : We give advice on a range of matters and we would have given advice on this matter.

Senator POLLEY: When was that advice given?

Ms Beauchamp : I'm not in a position to give you that date, because it was part of a government decision-making process.

Senator POLLEY: I'm not asking you to outline the advice, but surely you can tell us when that advice was given? It is kind of pertinent to the royal commission being established, particularly just prior to the ABC report.

Ms Beauchamp : It was given before the government announced the royal commission.

Senator POLLEY: Come on!

Senator WATT: One of the most basic questions we can ask at an estimates hearing is when departments provided advice to government. Can we not get into games about 'We can't tell you because it went to cabinet.' We can ask you the date that you provided advice to government. That is allowed.

Senator POLLEY: It is fair and reasonable.

Senator Scullion: I'm sorry, the convention is that anything to do with advice to cabinet, whether it's a date or whatever—

Senator POLLEY: That is not true.

Senator Scullion: No, I'm sorry—

Senator POLLEY: That is not true. You are misleading the committee. Many times I have asked for advice about the date and I've been given the date when that advice was given. And I think it's pretty pertinent to calling a royal commission into aged care when you have been in government for five years, and you've failed.

Senator Scullion: Any advice to cabinet, whether it is the date of advice to cabinet, is not something that the officers are required to give—

Senator WATT: We haven't asked for the date of advice to cabinet. We have asked for the date of advice to government. They are different.

Senator POLLEY: That's right.

Ms Beauchamp : Advice to government comes from a number of sources and not just from our portfolio.

Senator WATT: We are asking about your portfolio.

Ms Beauchamp : I just wanted to suggest that we don't provide advice at one go. We provide advice on an ongoing basis. It can be across a period, it can be a number of advices—

Senator WATT: When did you first provide advice to the government about the need for a royal commission?

Ms Beauchamp : I would have to take that on notice.

Senator POLLEY: Really! It is the biggest thing that has happening in aged care since we were in government, when we established the platform for the reform. We are now having a royal commission into aged care—you keep telling us at every estimates how there is more and more money going into it—and you can't tell us when you gave advice to the government on calling a royal commission.

Ms Beauchamp : I am suggesting that advice to government on a royal commission matter comes from a number of sources—

Senator POLLEY: It does. But we are talking about your responsibility as secretary to this department.

Senator WATT: You are the primary department.

Ms Beauchamp : Senator Watt asked what advice there had been to government. We provide advice to ministers responsible in this portfolio on a number of issues and we would have provided advice on the royal commission, at various stages, to our ministers.

Senator POLLEY: So, you're not prepared to put a date as to when you gave advice to the government that there was a need for royal commission. Or, did you not in fact give advice about calling a royal commission—that this was done by the Prime Minister himself?

Ms Beauchamp : I suggested to Senator Watt that I will take that on notice. Is it advice to our ministers.

Senator WATT: Dr McCarthy is the deputy secretary in charge of ageing. Is there anything she can add here?

Dr McCarthy : Only that occasionally over the years there have been calls from members of the sector for inquiries—a royal commission. So, in terms of when you first provided any advice, over the years there have been calls going back quite some time.

Senator POLLEY: Can I put this in context. Just two weeks prior to the airing of the Four Corners program, the Minister for Senior Australians and Aged Care said that there was no need for a royal commission. Can you then explain to us why the minister changed his mind, what advice was given and when was that advice was given?

Dr McCarthy : Minister Wyatt has addressed that publicly.

Senator POLLEY: Can you advise us?

Ms Beauchamp : I don't think it's our place to add any further comments to what Minister Wyatt has said publicly.

Senator POLLEY: I just want to again talk about what the minister said in question time on 18 September. I quote:

The information from the Australian Aged Care Quality Agency provided detail on the number of complaints, which has risen significantly, but they also raised an issue that was absolutely important. That issue was the serious risks found. In the first year, there were only two. In the second year, there were 22. In the third year, there were 61.

At that time, the Minister for Senior Australians and Aged Care said that the Australian Quality Care Agency report was confidential. Given this report was so vital to the decision being made about why the Minister for Senior Australians and Aged Care spoke with the Prime Minister, can the department or you, Minister, please identify this report? What is the report called? And can the department provide a copy of this report?

Senator Scullion: I'm not sure, Senator, whether it's actually a report. I do know, as you said, that there are findings of serious risk against service providers that have risen by 177 per cent over the past year. We would know that within the department, simply as part of our numbers, but I don't think this would be necessarily part of an actual report as such. Referrals to the Australian Aged Care Quality Agency have gone up by 188 per cent over the past year and non-compliance notices are up 185 per cent. We use royal commissions for different things, but, where there is a systemic issue and it appears to be a systemic problem—that's why we've called the royal commission that will look at the whole aged-care sector. But I'm not aware of any particular report—

Senator POLLEY: Can I ask the department, then—

Dr McCarthy : Can I just clarify? Was that a precis of what Minister Wyatt said in the parliament?

Senator POLLEY: That was a quote direct from him in parliament.

Dr McCarthy : Referring to a report?

Senator WATT: Yes.

Senator POLLEY: Yes.

Senator WATT: Is there someone here from the Australian Aged Care Quality Agency?

Dr McCarthy : There is. Mr Ryan has just come to the table.

Senator WATT: Are you able to shed light on this—that the minister referred to detail that your agency provided on the number of complaints? Which report is he talking about?

Mr N Ryan : I would have to look carefully at what you're quoting, Senator. Certainly, findings of serious risk have increased over recent years. We took a very fresh look at the principles and the requirement every time we found non-compliance across all 44 outcomes. Principle 2.62 requires us to test whether one or more residents were placed at serious risk to their health, safety and wellbeing.

Senator POLLEY: We are aware of that.

Mr N Ryan : So, given the clarity and the requirement of the principles and given our greater focus on risk—

Senator WATT: Mr Ryan, we haven't got a lot of time. What was the report?

Dr McCarthy : Senator, we may be able to help you. My colleague, Ms Jolly, can speak to the issue that Senator Polley is referring to in relation to a report. I think it's a combination of information.

Ms Jolly : Senator, there are three, I guess, streams of information that come together to provide our overall regulatory data, some of which is data from the quality agency that you've heard about, which is released in their annual report. There is also data that the Complaints Commissioner releases in their annual report, and the department collects data on mandatory reporting and compulsory reporting that comes through to the department. Much of that data sits in the ROACA report, which is released periodically.

Senator POLLEY: When was that last reported?

Ms Jolly : The next one is due shortly. The last one was this time last year.

Senator POLLEY: This time last year?

Dr McCarthy : On the Aged Care Act.

Ms Jolly : It's a report on the Aged Care Act.

Senator POLLEY: That was from last year. All those annual reports have been available for some considerable time. There was no specific report, then, that was provided in recent times to the minister for him to make those statements and to call for the royal commission. Is that right?

Ms Beauchamp : Sorry, Senator, we did provide that advice and that information to the minister.

Senator WATT: When?

Ms Beauchamp : I'd have to take on notice exactly when because it would have been from a combination of data that Mr Ryan has spoken about and information that we had.

Senator POLLEY: Did the department brief or provide any advice to the minister about the need for a royal commission before he was interviewed for the Four Corners program around the middle of August 2018?

Ms Beauchamp : Again, I'll take that on notice.

Senator POLLEY: Was the advice for a royal commission into aged care? Could you provide the date that that advice was given to which minister: the Minister for Health or the minister for aged care or both?

Ms Beauchamp : I'll take that on notice for specific dates.

Senator POLLEY: You can't tell us?

Ms Beauchamp : We provide information and advice—

Senator POLLEY: This is pretty significant.

Senator Scullion: Before—

Senator POLLEY: Again, I'm sorry, but can I just finish my question before—

Senator Scullion: There are two questions that I just want to—

Senator POLLEY: Yes, but I haven't finished asking my question, Minister.

Senator Scullion: I think that's the problem.

Senator POLLEY: The questions are very pertinent to the fact that, after five years of this government, they've called a royal commission into their own failures. Surely the department would have been prepared for these questions in coming before us today and could provide the date on which that advice was given.

Senator Scullion: When you ask a question and you say 'giving advice about the royal commission' or 'giving advice about reports', they are completely separate matters.

Senator WATT: Yes, we're talking about the need for a royal commission—

Senator Scullion: Yes, that's right.

Senator WATT: not about certain stakeholders who said there needed to be one.

Senator Scullion: I understand that, Senator. But it's very difficult for my officers to answer when asked the question, 'Did you give advice about a royal commission?' That's separate. If the question is 'Did you provide the report just referred to?', yes, they can provide that answer. But most of this, as I understand it, was provided in the context of information.

Senator WATT: Yes. Let's cut through all that. What we're focusing on here is advice that the department provided to either the Minister for Aged Care or the Minister for Health about the need for a royal commission.

Ms Beauchamp : We provide a range of advice on a number of matters. We would have provided advice on royal commission issues. I'll take on notice when I or the department provided that advice to both our ministers.

Senator POLLEY: So you can't then confirm whether that advice was given in mid-August, prior to the minister being interviewed on the Four Corners program?

Ms Beauchamp : As I mentioned, we provide advice to our ministers, both oral and written, every day. I think it's probably unreasonable to expect that there was one piece of advice that either went to either minister or that we provided to government. Government makes these decisions on the basis of advice from a number of different sources, including our ministers in the Health portfolio, the Prime Minister & Cabinet portfolio, the Attorney-General's portfolio, the Treasury portfolio and a range of other portfolios.

Senator POLLEY: And you're prepared to table the reports which you made the basis of your advice to the minister?

Ms Beauchamp : I'll take on notice the exact sources of that information, but I think, as Ms Jolly said, it's from publicly available information through annual reports. I'll see what we can provide, yes.

Mr N Ryan : Findings of serious risk are always published decision by decision. We provide regular reporting to government.

Senator POLLEY: Yes, I can appreciate that. We've got very limited time. So, if I can keep moving through, that would be appreciated.

Senator WATT: The reason we're asking, Mr Ryan, is that, in the minister's comments in question time, he referred to information that had come from your agency that was confidential—

Senator POLLEY: Yes.

Senator WATT: as opposed to the published data that you're talking about.

Mr N Ryan : I can't answer with regard to a specific piece of advice. What I can say is that some of the elements of statutory findings that we made are protected under the act, but the finding itself is made public.

Senator WATT: Forget about dates of advice and that kind of thing; let's simplify it. Did the department ever provide advice to the minister recommending the establishment of a royal commission?

Ms Beauchamp : I'm not going to say what the content of the advice was, but we provided advice in relation to issues on the royal commission.

Senator WATT: I think we're very clear on that.

Senator POLLEY: We know in the last two financial years that the Australian Aged Care Quality Agency reported a near tripling of concerns that accreditation standards for the aged-care facilities were not being met. Given the minister is responsible for overseeing the agency, what advice did he receive about the type of poor care and treatment in the lead-up to the Four Corners program? If you could give us the date of the time of that advice, that would be really good.

Ms Beauchamp : Sorry, Senator, but can I just clarify? Are you seeking advice from the quality agency?

Senator POLLEY: From the department. Secretary, if you can't give that advice maybe Mr Ryan can. It's open to the department whether you answer it or whether the agency does.

Ms Beauchamp : We have provided advice on compliance matters to both Minister Hunt and Minister Wyatt, yes.

Senator POLLEY: Okay, can you tell me when that advice was given?

Ms Beauchamp : We provide advice on a range of issues ongoing, and certainly on compliance matters we do provide advice regularly to Minister Hunt and Minister Wyatt.

Senator WATT: Ms Beauchamp, you described this advice as being about compliance matters. What we're focusing on here is the data from the quality agency that reported a near tripling of concerns that accreditation standards for aged-care facilities were not being met. So, on that specifically, was the minister provided advice either by the department or by the agency?

Mr N Ryan : We provide advice to the minister on an ongoing basis. We always brief via the department. As it were, we don't have a separate point of channel; we always brief via min services. We provide regular advice. I meet with the minister on a regular basis—

Senator WATT: Mr Ryan—

Senator POLLEY: How regularly?

Senator WATT: For the benefit of everyone who's appearing here today, you can assume that we understand that agencies and departments provide advice to ministers on a range of matters at various times. We're not interested in that. We are asking very focused questions, and that's what we want answers to. So, did your agency or, Ms Beauchamp, did your department advise the minister at any time about the increasing concerns and reports that accreditation standards for aged-care facilities were not being met—that specifically?

Ms Beauchamp : Yes.

Senator WATT: Yes—thank you.

Senator Scullion: And can I say the minister is very much aware—he was behind the increase in policing inspections which pre-dated the increase in findings of serious risk against the service providers. It was actually the minister who instigated the policing and inspections—

Senator WATT: Sure, and this advice that was provided to the minister about the increasing number of complaints and concerns—were there numerous pieces of such advice, or it just happened once?

Mr N Ryan : No, they're regular. If I can also advise: under section 30 of our Act, the Australian Aged Care Quality Advisory Council receive updates six times a year. They write following every meeting—if not every meeting, almost every meeting—and provide a full report to the minister which would include where regulatory performance of the industry is up to. We provide written advice and often we will provide advice on particular outcomes where there are inquiries or matters of concern. There's regular reporting.

Senator WATT: And this advice that was provided by the agency and the department about the increasing number of complaints and concerns was provided to the minister prior to the Four Corners story—because it happens on a regular basis?

Mr N Ryan : It happens on a regular basis. There would be—

Senator WATT: Including before the Four Corners story?

Senator Scullion: His entire time as minister pre-dates the Four Corners story.

Senator WATT: Yes, so it included advice provided before Four Corners—we're just trying to get a sequence here.

Senator Scullion: I understand.

Senator WATT: That's correct, Ms Beauchamp?

Ms Beauchamp : That's correct.

CHAIR: Senator Hinch just needs eight minutes, and then we'll come back to you.

Senator POLLEY: Hang on!

Senator SIEWERT: Some of us have been sitting here all morning and have a whole lot of questions.

CHAIR: He requested—

Senator SIEWERT: I haven't even had a chance to ask any questions here.

Senator POLLEY: I've got three more questions—

CHAIR: We'll come back to you. Senator Hinch.

Senator POLLEY: Sorry—

CHAIR: He needs to go.

Senator POLLEY: Sorry, Chair, but this is not the way that we normally proceed. At least we have the opportunity—

Senator SIEWERT: Do you want to ask your questions?

Senator POLLEY: to continue our questions. I've got three more questions.

CHAIR: Senator Hinch, do you want to ask your questions, and then we'll come back?

Senator HINCH: Madam Secretary, back in May, we discussed the nursing and care levels in various places, and I said at the time: 'Does the department concede there is a crisis in the number of nurses and carers?'

Senator POLLEY: This is not even in the right area.

Senator HINCH: And Dr Stoddart said, 'I don't think we'd be accepting that. We want to look at the workforce in a holistic way.'

Senator POLLEY: I'm sorry, Chair: this is not even in the area that we're dealing with at the moment. That's a workforce issue. It comes on later in the day.

CHAIR: In outcome 6?

Senator HINCH: Alright, I'll hold back; I'll wait.

CHAIR: Okay, good. Senator Polley.

Senator POLLEY: Thank you. In relation to the royal commission, why wasn't residential retirement village living part of the royal commission's terms of reference; and can the department confirm if it advised against including retirement village living?

Dr McCarthy : Senator, the royal commission, as the Prime Minister has said, has an area of focus, which is the delivery of aged-care services in any setting in which that may occur. So, any delivery of an aged-care service in a retirement living context is part of the royal commission's terms of reference. But retirement living per se—

Senator POLLEY: Isn't.

Dr McCarthy : is much broader than the area of focus, which is the delivery of aged-care services.

Senator POLLEY: How many submissions were made in relation to including retirement villages to be considered to be part of the royal commission?

Dr McCarthy : I have some aggregate figures in relation to the very large number of submissions that were received on the terms of reference. I don't have that breakdown.

Senator POLLEY: Can you take that on notice and provide it to us?

Dr McCarthy : I can take it on notice.

Senator POLLEY: In relation to the royal commission and the government—and we've known for some time that there are issues in relation to the increase in noncompliance—what else in terms of advice have you given to the department that needs to continue to be focused on?

Dr McCarthy : As the secretary has indicated, we provide advice on an ongoing basis on the full range of issues as they relate to aged care—funding, policy, quality, compliance. There's an ongoing flow of advice to the minister on the full range of issues as they relate to aged care.

Senator POLLEY: Just to be very clear, did you provide advice against the retirement village living being included in the terms of reference?

Dr McCarthy : As I think Ms Beauchamp's indicated, we have provided advice in relation to the royal commission.

Senator POLLEY: I'll defer to Senator Siewert.

Senator SIEWERT: In terms of the royal commission, I appreciate, as you said earlier, it's the A-G's, but when we were looking at the Royal Commission into Institutional Responses to Child Sexual Abuse, there was a lot of support for witnesses through the process. Have you given consideration to what support is available for witnesses? Obviously, a lot of the witnesses will be elderly, although, of course, there will be family. What sort of supports are witnesses and participants expected to receive?

Ms Beauchamp : Details on support are yet to be worked out, but we've certainly raised it as a key issue in supporting witnesses that may be called and staff that may be called—frontline investigators and aged-care staff as well. So we've given a lot of thought to it and have raised, in the context of establishing the royal commission, that this will be an area where we need to make sure that people feel well supported to come forward.

Dr McCarthy : Indeed, there's a specific term of reference, so the commissioners have been asked in the letters patent to have regard to the need to establish as they see fit appropriate arrangements for evidence and information to be shared by people about their experiences, including people receiving aged-care services, their families, carers and others who provide care and support, recognising that some people will need special support to share their experiences. So it's been raised directly with the commissioners.

Senator SIEWERT: I understand that, but that requires resources and commitment and support through the agencies. What level of commitment is there in terms of resources that have been allocated? Which agencies will be doing that? Whether it's Health or A-G's who are going to be providing some resources, how is that going to work? And what's the time line for decision-making in terms of 'where to from here'?

Ms Beauchamp : That support and effort and resources and funding required are still under consideration by government.

Senator SIEWERT: What's the time line for the decision?

Ms Beauchamp : Really, it's the establishment of the commission. It's up to the commissioners how they want to manage the process, but we'll be putting in place arrangements as soon as possible to meet the needs of the commission time frame. I'm sorry I can't be more definitive, but we've just got to make sure that we're there supporting people to come forward when asked for by the commission.

Senator SIEWERT: I'll come back to that in a second. Have you already had members of the community ringing and asking what the process is, whether they're going to get support, and how that's going to be delivered?

Ms Beauchamp : As part of the consultation process on the terms of reference, we did provide an avenue for comments to be referred to the commission—

Senator SIEWERT: I understand that. I'm sorry if I haven't been really clear. What I mean is: since the terms of reference were announced and the commissioners were announced, have you had people—whether they're individuals, families, or, in fact, organisations—ringing and asking you specifically how they participate and what sorts of resources are available?

Ms Beauchamp : I'm not personally aware, but a number has been set up under the royal commission website. And, of course, we've got a number of portals through My Aged Care and others where—I haven't got the details, but I'm sure people would be referred to the website if they requested information on the royal commission.

Senator SIEWERT: Could you perhaps take on notice how many people are contacting you?

Senator Scullion: So that's the number of people wishing to have additional support to access the royal commission?

Senator SIEWERT: There'll be some broader questions such as, 'How do I go about engaging with the royal commission?' which people are more likely to come to you about rather than to think to go to A-G's.

Ms Beauchamp : Indeed, and that's why I've made reference to the process around consultation on the terms of reference, because we did ask in that process whether people would like to register an interest to be kept informed on the royal commission but also to make sure that there was an avenue for them to go to if they did seek further info. But we'll—

Senator SIEWERT: Perhaps you can take that on notice.

Ms Beauchamp : I'll take on notice the numbers.

Senator SIEWERT: I'll broaden it out. You publicly released the number of people. It's 5,000, which is a lot, so it shows a deep interest. Can you advise how many of those have already asked to be kept informed but also how many have there been since then? Ms Lamb, it looks like you've got some information.

Ms Lamb : We've had a significant number of contacts from people—something like a 30 per cent increase in our workload since the royal commission was announced. We're taking them as complaints and contacts and inquiries, and we're already turning our minds to how, as we go into the new commission, we can be available to deal with any concerns and complaints that arise out of the royal commission as part of the support network.

Senator Scullion: I'm entirely trying to be helpful. She's asking about what sorts of support and what levels of support people are going to get to access the commission. I do understand what you're saying, Senator, and we can take that particular matter on notice: how many and what plans we have for supporting those people. Is that—

Senator SIEWERT: Yes, you could, but I've got an addition to that and I just wanted to ask Ms Lamb: do you need more resources? A 30 per cent increase is a very significant increase. Do you need more resources?

Ms Lamb : It comes on top of significant increases in the last 2½ years, and we are in active discussions with both the department and, through them, I know, with government, and I'm hopeful the resources will be there. It's not like I have had any reason to doubt previously.

Senator SIEWERT: Can I go back to the issue, then, of time lines. Obviously, this is pretty critical, and, Secretary, you didn't tell me before: what is the time line for the decision-making on these resources, given that, as Ms Lamb has just articulated, the commission is already dealing with a very increased workload?

Ms Beauchamp : The time line has been announced in terms of the commission process itself.

Senator SIEWERT: I'm talking specifically about—

Ms Beauchamp : But there will be consultation, I'm sure, through Attorney-General's, and I'm probably not the right person to ask, but the Attorney-General's Department will be talking to the commissioners in terms of the requirements to support witnesses coming forward and, indeed, people who are going to be working on the royal commission.

Senator SIEWERT: There's obviously support to participate in the commission, but counselling is also likely to be necessary for witnesses and their families. Is that going to be part of the package?

Ms Beauchamp : And I think those sorts of discussions would be happening with the commissioners and the Attorney-General's Department.

Senator SIEWERT: I'll come back to the issue of the complaints commission and the new commission. Is Health going to be providing any of those resources or are you participating in those discussions with A-G's with the expectation that the funding comes through A-G's.

Ms Beauchamp : The government is yet to make a decision on the allocation of funding for the royal commission, and we're in discussion across governments and across portfolios on the level of funding required.

Senator SIEWERT: Let's go back to the commission and the beginning, and then it will swap over. In terms of the level of funding to deal with the workload that's coming in right now, when is that likely to be resolved?

Ms Beauchamp : That'll be considered in that context. We are very cognisant of the fact that there has been not only an increase in compliance activity, which the government's responded to in terms of additional resources for compliance, but we want to make sure that people have the right avenues to raise any concerns coming through the aged care portal and other areas that we administer. I don't know exactly the sorts of support people we'll need, because it'll need to be considered on a case-by-case basis, but I think those things are to be assessed with the commissioners and attorney-generals.

Senator SIEWERT: In terms of the terms of reference, you'll be aware that a number of us were very strongly advocating for a much broader remit in terms of violence and abuse against people with disability. However, the terms of reference did go some way towards that in terms of young people and older people with disability. If a person with a disability brings an issue to the commission, are they going to be turned away? If a person with a disability who's not yet aged 65 comes to the commission, will they be turned away?

Dr McCarthy : I don't think we can speak for the commissioners.

Senator SIEWERT: Is it your expectation that they would be under the terms of reference?

Senator Scullion: Perhaps I can just quote the terms of reference on this particular element. The royal commission includes:

… the interface with other services accessed by people receiving aged care services, including primary health care services, acute care and disability services…

So we all know it will deal with issues that I know you're concerned about young people with a disability in the aged care sector. That will be captured anyway. As I said, the terms of reference include the interface with other services like those disability services.

Senator SIEWERT: So you are saying that they can? That's your interpretation?

Senator Scullion: That is what the terms of reference actually says. It includes the interface with other services accessed by people receiving aged care services. So it captures young people living in an aged care facility.

Senator SIEWERT: I get that.

Senator Scullion: And it says, 'including primary health care services, acute care and disability services'.

Senator SIEWERT: That's about young people. I'm talking about people that aren't considered—

Senator Scullion: I'm assuming that's the reference. That's what it says now. I'm not sure what level of interpretation that's open to, but I think that specifically says that it's the interface with other services accessed by people receiving aged care services. That would be that demographic.

Senator SIEWERT: But that still takes you into that over-65 bracket, if they're accessing aged care, with special exceptions.

Dr McCarthy : To add to the minister's comment, the letters patent also include provision for the commissioners to make referrals of issues as necessary to other relevant authorities.

Senator SIEWERT: I take your point, but it doesn't actually—they'll be referred on, potentially, is what you are saying.

Dr McCarthy : I would not want to pre-empt any decision a commissioner might make, but as the minister has pointed out and as I've pointed out, there are—

Senator Scullion: To be quite clear, this is a royal commission into the aged care sector. It is not into the disability sector. But where they interface in areas that we know well about and Senator Steele-John has championed, it's within the aged care sector and services that are across or affected by the aged care sector. That is the quarantined area of the very focus of this royal commission.

Senator SIEWERT: Can I just double-check one more question to take on notice? Senator Polley may have covered this point, but I'll just double-check in case I missed it. In terms of what you are taking on notice about the advice that was given, are you taking on notice the timing of that advice?

Ms Beauchamp : I'm not taking on notice the content of that advice.

Senator SIEWERT: I understand. We'd like you to! We might as well ask you, just in case.

Ms Beauchamp : I think the question was when we provided advice.

Senator SIEWERT: Yes, the timing, Can I also ask the timing of when advice was sought of your agency from the PM?

Ms Beauchamp : That probably would have come not through us directly, but our ministers. We provide and support our ministers in broader government decision-making processes. As I mentioned, the Prime Minister would have sought advice from a range of sources.

Senator SIEWERT: What I'm asking is when the Prime Minister sought advice the timing of that advice from the minister? Or when the Minister for Health asked and when the minister for seniors.

Ms Beauchamp : I just want to reiterate that the government decision-making process is through cabinet, where these discussions, which I'm not privy to, might or might not occur between ministers and the Prime Minister. I'd have to take on notice what I could provide and what I know about. But of course I may not know about those sorts of conversations or advice.

Senator SIEWERT: I understand what you've just said. What I'd like you to look for is when the Prime Minister asked for specific advice about the possibility of a royal commission.

Ms Beauchamp : I could take that on notice.

Senator SIEWERT: I'm asking you to take it on notice.

Ms Beauchamp : I can't necessarily satisfy you.

Senator SIEWERT: I heard everything you said, but it doesn't stop me asking.

Senator Scullion: It may be the case that he did not specifically ask this department for advice. That will be part of the answer.

Senator SIEWERT: That's what I'm trying to find out.

Senator Scullion: I'm just trying to clarify. I'm trying to be helpful.

Senator POLLEY: I'd like to move on to home care services, so 6.2.

Senator HINCH: My question is royal commission associated. On the royal commission question, going back to May, I quoted Mount Alexander Hospital had ten nurses for 153 aged care residents. Bupa Ballarat had two nurses for 144. We then discussed nurses and carers. I asked, did the department think there was a crisis in the number of nurses and carers. Dr Studdert said, 'I don't think we would be accepting that.' Now term (f) of the terms of reference, speaking of how best to deliver aged care services in a sustainable way, says that one of the things is 'investment in the aged care workforce'. Do you now accept that the royal commission was needed back in May and that workforce and ratios of nurses and carers will be looked at?

Ms Beauchamp : Nurses only constitute part of the workforce in aged care. You're looking at a range of skills, expertise and requirements, depending on both acuity of the resident in aged care services but also the workforce required in supporting people at home. There has been an independent study done on workforce issues for aged care, and quite significant developments have happened since May around the workforce. But the workforce more broadly will be looked at. Anything that impacts on the quality and safety of people receiving aged care services from the Commonwealth, including the quality and capability of the workforce, will be looked at.

Senator HINCH: In the Four Corners program, when the question of ratios and numbers came up, Sean Rooney, the CEO of Leading Age Services, said 'Ratios are very blunt instrument to deliver person-centred flexible care to a growing set of needs.' He said, 'I don't believe there should. The international literature supports that.' Are you aware of an international literature that supports no need for ratios?

Ms Beauchamp : I would have to ask my staff that, technically.

Dr McCarthy : We're aware that this is a matter of considerable debate within the aged care sector. Some parts of the sector strongly support the notion of ratios. Other parts of the sector don't. I think it's fair to say that that question is not settled.

Senator HINCH: While I have his name, Mr Rooney, up there talking about sustainability of care et cetera, the point has been made that some of the aged care centres were providing four minutes a day for a resident to be got out of bed, showered, dressed, hair done, teeth cleaned occasionally et cetera. When he was asked, 'Is five to six minutes to get somebody out of bed, showered and dressed for breakfast, is that acceptable?' he says, 'It depends on who the person is. Everybody is different.' I would like to know what the department's reaction is to that. I can't do it in four minutes, never mind being in an aged care centre.

Ms Beauchamp : I can't make any judgements. You would have to look at the needs of the individual consumer. From the department's perspective that would be a priority, to ensure safety and quality of care.

Senator HINCH: You will be aware that in Victoria they've now mandated some of the better quality of numbers. I'll leave that one alone, because it's obviously going to be part of the royal commission to be looked at. Back in May I also talked about the quality and the cost of food. There was a university study saying it was $6 or $6.08 a day. I think I made the point that the last time I was in jail we got $9 a day for food plus as many free litres of milk as you wanted. Talking about that, Mr Rooney pleaded ignorance of the $6-a-day figure, but he also said, 'These meals are being prepared for people who have a low nutrition requirement.' Surely people at aged care centres have the same nutritional requirements as a young person. Is that your department's attitude as well?

Dr McCarthy : We can't speak for Mr Rooney, but Mr Ryan can certainly speak on the considerable attention that is paid to the issue of nutrition in both the standards and in the monitoring of the standards. I know Mr Ryan has spoken about this before.

Mr N Ryan : The research which you're discussing is the Lantern project out of Bond University in Queensland. Dr Cherie Hugo led that research. Her research showed that the provision of food was just under $6.10 a day of food—not necessarily preparation of food. It's established by nutritionists that older people have a lower nutritional need because their digestion slows down. We are deeply concerned by the research as it's shown. It's certainly the requirement that there's sufficient food and hydration and nutrition for every resident. That is absolutely paramount. It's an area that we focus on very carefully. We find areas of non-compliance around that, and where we find it we call it. I note that food is an area for the royal commission to look at. We think that there is some innovative work in the industry, which the royal commission might showcase in terms of not just nutrition but the mealtime experience, the broader process of not just getting nutrients in, but the celebration of the meal and so forth. Certainly we're very concerned that every resident receives adequate nutrition and hydration relative to their needs.

Senator HINCH: I'm sure the department, the same way as many senators here, would get emails and photographs of the quality of some of the food that's being served up to people—some that's mush, party pies for dinner et cetera. Is that your experience as well?

Ms Lamb : We also receive that material through complaints. I assure the senator that we certainly look into those to ensure that the people involved are receiving adequate nutrition and proper food for their needs.

Senator HINCH: So you are saying that the royal commission will look at that very, very seriously?

Ms Lamb : I can't speak for the royal commission, but I'm certainly saying that people have complained.

Senator HINCH: It is on the agenda.

Dr McCarthy : In the letters patent there is a very long list of what constitutes quality, including nutrition.

Senator Scullion: That will be included by the royal commission, but as Commissioner Lamb was indicating, she gets a number of these complaints and responds to those complaints every time to ensure that the correct amount of nutrition and hydration is available to that particular person.

Senator HINCH: I have one more question which moves off the topic a little bit. I want to talk about the new policy in some healthcare centres. Japara is one of them. In Japara healthcare staff have been told not to check in on residents overnight—presumably to make sure they're still breathing or they haven't fallen out of bed—because 'this is not a valid reason to check'. Last year a resident in a for-profit nursing home—not run by Japara—her name is Barbara Pell, fell out of bed, broke her forearm, stripping skin—what they call 'degloving', apparently. She was left for almost an hour until staff came in and found her that morning. Japara's new policy, which they call 'respecting night time for residents—etiquette guidelines', is saying that even though they're increasing bed numbers, that is not a valid reason to check on people during the night. What's the department's reaction to that?

Dr McCarthy : I think you may have raised the Japara policy at the last estimates, if I remember correctly. I think my colleague, Ms Laffan, may have spoken, not specifically in relation to a particular provider, but about the need for providers to balance clinical care needs and residents' privacy and dignity. So I think the department's view would be that, in relation to every individual in the aged-care facility, the provider needs to balance a range of factors, depending on their individual needs.

Senator HINCH: This is why there's the understandable opposition to CCTV cameras in people's rooms, because you have to look after people's privacy as well. I do realise that some facilities have sensor mats alongside the bed. In the case of Ms Bell, that didn't work. Is that a general thing these days? If somebody does fall out of bed—

Dr McCarthy : I think it varies across facilities. Some use technology to a high degree, others less so.

Mr N Ryan : With regard to Japara, we have met with that provider based on that information that was in the media. We've worked closely with them so that they understand that their requirement is for appropriate care around the clock. Of course, it's a question if a resident is asleep and there's no particular need to go in frequently, but they have an obligation—and they acknowledge their obligation—that adequate care and services are provided in a timely fashion.

Senator HINCH: Am I right in saying that, if you're in aged care in your own home, it's legal to have a protective rail to stop you falling out of bed, but in most aged-care centres that's not allowed because it's regarded as restraining or restrictive? Are you aware of that?

Ms Lamb : With all of these things, it's really very much a matter of assessing an individual's need. If we get a complaint from someone who's concerned about something that's happened in any of these areas, it's about looking at what that individual needs and whether that home is providing what that person needs, which is what they are supposed to do.

Dr McCarthy : And, indeed, that they're providing that in direct consultation with the person concerned, their families and representatives.

Senator HINCH: What's the department's attitude to the new system of care that's coming in of graded aged-care facilities? In airlines you have a gold pass, a silver pass, a platinum pass et cetera. Some aged-care centres are now bringing in, or thinking of bringing in, where you'll virtually have platinum care, gold-pass care or basic residential care.

Dr McCarthy : I think you might be referring to the bundling—

Senator HINCH: Of packages.

Dr McCarthy : of services in relation to the amount—

Senator HINCH: In relation to the quality of care—how much care you get, probably the quality of your room or size of your room et cetera. I have been told by people in the industry that it's like the airline system; you get a silver card or a gold card.

Dr McCarthy : We might be talking about a few different things.

Ms Lamb : We receive a number of complaints from people who come to us saying that they are concerned about being charged additional fees for additional services. It's a matter, again, of establishing whether or not they're being charged for things that they do or don't want or they can or can't use. Again, it's about working it through on an individual basis. But you are right—there are some facilities which are offering a different level of services in return for additional payments.

Dr McCarthy : That is separate to quality-of-care issues. All providers are required to provide the level of care that the resident needs, as assessed by the facility. That's what I meant when I said we're talking about a couple of different things.

Senator HINCH: I get where you are coming from. That's fine.

Senator POLLEY: Just to finalise questions on the royal commission, in relation to our quest to get the dates when that advice was given to the ministers, can we have that today, please?

Ms Beauchamp : No, I don't think so, because I would have to go back and look at written advice, verbal advice and when I met with ministers. As I said, these things happen over a long time frame. I'd need to have a look at various pieces of advices to see what the dates were.

Senator POLLEY: Okay. Can we move on to home care packages, please. Can the department confirm how many of the 14,000 home care packages will roll out in this current financial year—that's 2018-19?

Dr McCarthy : It's 8,700 this financial year.

Senator POLLEY: Excellent. Can the department confirm how many of the 14,000 home care packages will roll out in the next financial year—that's 2019-20?

Dr McCarthy : We do have that. We've got a colleague coming to the table.

Senator POLLEY: While we're waiting—because time is of the essence—can we know how many of the 14,000 home care packages have rolled out since 1 July this year?

Mr Haslam : Next financial year, approximately 5½ thousand of the 14,000 high-care packages will be rolled out, with the remainder over the following two years for the forward estimates.

Senator POLLEY: How many were rolled out since 1 July this year?

Mr Haslam : Those additional home care packages form part of the overall growth in high-level home care packages. They're released throughout the year, so I can't give you exactly how many right now, at this point in time. However, that figure is throughout the year.

Dr McCarthy : I think what Mr Haslam is saying is that the new packages were added to an existing number that was already going to be rolled out.

Senator POLLEY: Yes, but you would know, having had 14,000 over the time. From 1 July until now, you should be able to give a figure of how many of those 14,000 have been rolled out currently.

Ms Buffinton : On the 8,700 high-level packages this year, we can take on notice at this point in time exactly how many, but I'm just letting you know that it has been proportioned across. We do a weekly release, and they've been fairly evenly proportioned across the year.

Senator POLLEY: So how many are you rolling out weekly?

Ms Buffinton : More broadly and, say, in recent weeks, we've been offering about 2,300 packages of all level types. What you're asking for is the subset of the new packages and how many of those are being rolled out. That's the part that I will need to take on notice.

Senator POLLEY: If you could, I would appreciate that. If you could get those figures to us today, that would be even better.

Senator WATT: Could I just clarify the figures that Mr Haslam gave us? I might be misreading this, but what we were told was that 8,700 of the 14,000 will be rolled out this financial year and about 5½ thousand would be rolled out next financial year, with more to come in the following financial years. My maths tells me that's already more than 14,000, just over those two years. Is there something I'm missing here?

Mr Haslam : Effectively, with the bulk of those packages, there is only a small number in addition to those 14,000 that are in the last two financial years. I'll come back to you with the exact figure, but what I can say, just to confirm what Ms Buffinton said earlier, is that they're part of the overall growth and that they comprise growth that is, I think, over 80 per cent in higher level packages over the forward estimates, from 2017-18 figures.

Dr McCarthy : And, of course, the 14,000 were on top of an additional 6,000 in the MYEFO previous to the budget.

Senator POLLEY: Yes.

Ms Buffinton : My quick calculation is that it was actually about 13,700 in the first two years. The point of that is so that we can get them into the system early and get the benefit. Although it's through the forward estimates, it's in the first two years when the bulk of the additional packages are being rolled out.

Senator POLLEY: Right. Can we be provided with the levels of packages for each year across the forward estimates, in total?

Dr McCarthy : Sorry, I didn't quite hear what you were asking, Senator?

Senator POLLEY: Can the department provide the levels of packages for each year across the forward estimates?

Dr McCarthy : We can. I think Ms Buffinton has the information out.

Senator POLLEY: Do you want to table those for us?

Ms Buffinton : Whichever you'd prefer.

Senator POLLEY: If you could table those for us, that would be good. Can the department confirm that there was no additional money allocated to fund the 14,000 home care packages?

Ms Buffinton : Sorry, what was that question, please?

Senator POLLEY: Can you confirm that there was no additional money allocated to fund the 14,000 home care packages?

Dr McCarthy : I think we discussed this in some detail at the previous estimates hearing. As the secretary and my colleagues explained, as a result of a policy decision to combine the residential care and home care appropriations, funding was able to be allocated to home care packages that would otherwise have been lost to aged care.

Senator POLLEY: Can you confirm that the 14,000 home care packages were funded entirely by a more than 26,000 reduction in projected residential care places between 2017-18 and 2020-21, as supported by the Macquarie University analysis of the 2018-19 budget?

Dr McCarthy : As I think we've discussed before, the home care packages were funded using funds that would otherwise have been lost to aged care. For example, fewer aged-care facilities were coming online in the time that providers had indicated to us that they would come online. So that is funding that would never have flowed to—

Senator POLLEY: So you disagree with—

Dr McCarthy : the aged-care system, because under the demand-driven appropriation it wouldn't have been used. That funding, instead of being lost to aged care was then, through a policy decision, made available to be used more flexibly—in this case for home care packages.

Senator POLLEY: So you disagree with Macquarie University's analysis?

Dr McCarthy : I don't have the Macquarie University's analysis in front of me, but I'm stating the way in which it occurred.

Senator WATT: The money came from residential aged care—

Senator POLLEY: Aged care.

Senator WATT: The money was moved from residential aged care into home care packages.

Dr McCarthy : And, as I think we explained before, it was funding that would not otherwise have been used.

Senator WATT: We understand that. But that is correct: the money was moved from residential aged care into home care?

Senator POLLEY: Into home care packages.

Dr McCarthy : The appropriations were combined in order for them to be used more flexibly.

Senator POLLEY: So, the answer is yes.

CHAIR: We now adjourn for a tea break and we'll convene back here at 11.16 am.

Proceedings suspended from 11 : 01 to 11 : 16

CHAIR: It is time to get back to it. Senator Polley, you have the call.

Senator POLLEY: Can the department explain if the 14,000 home care packages announced in the budget are enough to keep up with the current demand?

Dr McCarthy : We know that home care is and always has been very popular. We also know that we only now understand the level of demand. We only now understand how many people are waiting because of changes that were made in February 2017 to establish a national queue.

Ms Beauchamp : Senator, can I also add something on the previous question you asked about the rollout of each of the level 1, 2, 3 and 4 over the forward estimates. We've actually found a question on notice from the last estimates, SQ18-000555, that gives you a breakdown between June 2018 and June 2022 on the number of places being rolled out between level 1, 2, 3 and 4 for each of those years.

Senator POLLEY: Thank you for that. Can the department confirm if you've been undertaking any work in relation to rolling out a level 5 home care package?

Ms Beauchamp : That was an issue that was canvassed in Mr Tune's review, the Legislated Review of Aged Care. We are not considering it. There are no plans to roll out a level 5 package at the moment. The focus is on the very significant increases that are being made to the number of home care packages, including at those higher levels.

Senator POLLEY: Can you confirm, then, if there are any other interventions being undertaken by the department to address the home care package wait list?

Ms Buffinton : One of the things that we've done is that we have engaged with providers, and we're also seeking to communicate with consumers as we write out with offers. As Dr McCarthy mentioned, we are genuinely learning about the queue. One of the things we know about the queue is that people might be on, for example, a level 2 interim home care package and their assessment is for level 4, but, given their informal care arrangements and so forth, they are actually feeling satisfied with a level 2 at the moment. What we are doing is asking providers to engage in a conversation with consumers and discuss their care needs so that, if an offer of a level 3 comes forward—which is at the moment an automatic upgrade—if somebody feels that they're actually quite comfortable with that level 2, they can let us know that and they will still keep their position in the queue so that, as soon as they say they need a level 3, they can come back and not lose their place in the queue. But we're not offering them a level of care that they don't currently require.

Senator POLLEY: It's a good segue into an email that we had on behalf of an aged woman, just out of hospital—her heart valve was worn out. She has been waiting since early 2017 for the aged care package level 3 and is more in need now, having had trouble with, as I'm aware, inexperienced staff at My Aged Care in getting them to call the authorised person. The question from aged care to us is, 'What do I want to have done?' This woman is 99.5 years old, and is possibly in the final months of her life. Her doctor wants her to be granted her wish to die at home, and she needs some care to keep her comfortable. Her family is spending alternate nights with her, and paying for a morning and evening nurse and meals. What does the department, and what does this government, say to a woman who's almost 100 and who has been waiting since early 2017 for a level 3 package? They're the faces of real people, and I can talk about others who have been in contact with my office.

Ms Beauchamp : We can take the details and get that information. Of course, we do get lots of approaches in the department and through our aged care portal in terms of how we can help people who have been assessed for a certain level with other supports and care. A lot of people that are waiting for higher-level packages are already in receipt of the Commonwealth Home Support Program or a lower-level package and the like. But, if we can take the details, we try to endeavour to meet the needs of that particular individual. If they're frail, obviously, and requiring special needs, then we'd look at that.

Dr McCarthy : It sounds like, for the person you're speaking about there, their circumstances have changed. So they would qualify for a reassessment. That person's GP, for example, can cause that to occur.

Senator POLLEY: Sorry, I just want to clarify this: they've already been assessed as needing level 3 care, which is significant care, and they've been waiting for that since 2017. We're now in October 2018. Even if they have a reassessment now and it says that they need level 4, I doubt very much that they're going to get that level 4 assessment delivered.

Dr McCarthy : There are two parts to this.

Ms Buffinton : The first thing is that we would encourage anybody who is assessed for a level 3, as we've discussed before, to take a level 2, because that gets them the connection to home care. If their circumstances change, as Dr McCarthy was outlining—so it sounds like there is a level 3 at a medium priority in place there—and the ACAT does an assessment and is of the opinion that their circumstances have changed, there may be an upgrade to a high priority, in which case she would be offered a package much sooner.

Senator POLLEY: I have spoken before about other constituents and their families who have been in crisis. This family is obviously still in crisis. When a 94-year-old gentleman is told that he could have to wait—this is from your department—12 to 18 months for his level 4 package, it's really not acceptable. If we're talking about trying to keep people out of acute hospitals, which cost governments far more money than supporting people at home, can you tell me what the current waitlist is now? We keep having delays in that information coming out to us. Can you give me the current waitlist numbers of people in Australia? The most recent figure we have, which is a couple of months out of date, is 121,000 Australians. How many are on that list now?

Ms Buffinton : That's publicly available—that's the data report that's been released. As at 30 June, it is 121,487.

Senator POLLEY: But you would know how many are currently on that waiting list. It would have increased since then. What's that figure?

Dr McCarthy : Those reports are issued on a regular basis.

Senator POLLEY: No, they're regularly late.

Dr McCarthy : Those reports are issued on a regular basis, after very significant analysis and checking. We provide regular reports, making the data available after it's been validated through a very thorough process.

Senator POLLEY: But the last two reports have been significantly delayed—we're talking months—in being made public. Are you saying you don't know what the figure is, as the department that has the responsibility for monitoring these waitlists? Or is it that you just don't want to tell us?

Senator Scullion: There's a regular reporting of this—

Senator POLLEY: It's late, Minister, and you know that.

Senator Scullion: and you can imagine the complexity day to day, week by week, as somebody moves from a level 2 package to a level 3 package, and then someone moves to take that second level 2 package. What we've agreed is to publicly report on those processes regularly, and the last report—and that's what we've agreed to do—was in June of this year.

Senator POLLEY: When was that released, Minister? When were the figures for June released? In September. That's three months late. If I can move on, because I don't want to waste time—

Senator Scullion: It's very difficult to write down the figures of 30 June on that date. We've said it's on that date. So you have to work out exactly what that date was, because of the complexities I just indicated.

Senator POLLEY: But not three months. It doesn't take three months.

Senator Scullion: Well, it did take three months to make sure that—

Senator POLLEY: That's because you didn't want to release them before the by-election, for political reasons.

Senator Scullion: No, that's not the case. It was nothing to do with the by-election. That is just in your mind. It is a fantasy that we would operate around such a thing.

Senator POLLEY: You're wasting time. Can I just clarify: you're suggesting that the woman who I highlighted here, who's 99.5 years old—almost 100—should accept a level 2 package?

Ms Beauchamp : I can confirm that, if we can get the details, we can look at what sort of support she can be provided. Obviously, when people are looking at packages, there may be some other wraparound services we can look at. I think it would be good to get the details. If someone is in crisis and either needs to be reassessed or needs services immediately, then, of course, we're going to be looking at how we provide that. On the waiting list: the waiting list is only a new thing that's been put forward over the last couple of years. We do need to do further analysis and understand what we're talking about, because half the people on the waiting list are on the waiting list but also in receipt of some sort of package. Also, I think—

Senator POLLEY: We are aware of that.

Ms Beauchamp : there are about three-quarters who receive the Commonwealth Home Support Program. It's not as if people are waiting to get something, but—

Senator WATT: But they're not getting the care they need.

Senator POLLEY: That's right. A significant—

Senator Scullion: That may not be true if you factor in—

Senator POLLEY: number of those 121,000 older Australians who need level 4 packages are living with dementia as well as other ageing issues. We're well aware that some people get a certain amount. But there's a huge amount of people, out of that 121,000, who don't get anything.

Senator Scullion: That's not true.

Senator POLLEY: Sorry, Minister, it is true.

Senator Scullion: You have just said a majority, or a huge number of people, of the 121,000 are getting nothing. That isn't true. If you factor in the $5.5 billion—

Senator POLLEY: There are 54,000 who aren't getting anything.

Senator Scullion: Let me answer.

Senator POLLEY: There are 54,000 who aren't getting any home care package at all.

Senator Scullion: How many?

Senator POLLEY: There are 54,000 of them who don't get any assistance at all from the home care package. They're your figures.

Senator Scullion: So $5.5 billion in addition to those packages ensures that people can stay at home longer, because that's their choice.

Senator POLLEY: Well, you tell a 99-year-old woman who needs a level 4 package that she should wait.

Senator Scullion: No, no.

Senator POLLEY: That's what you're saying, Minister.

Senator Scullion: That is not what we've said.

Senator POLLEY: That's what your government is saying to her.

Senator Scullion: No, we have not said that at all. We have said, 'Let's provide that information to the department.' I've given an undertaking to the secretary: let's get hold of that information and let's contact them—

Senator POLLEY: She's 99 and been waiting since 2017. She's 99!

Senator Scullion: The issue is not about chronology. That's been accepted. It's about a needs basis. Some people at 95 are doing quite well and don't require any services. Let's have a look at the service provision that's been provided. As the department has indicated, we'll ensure that that's looked at.

Senator POLLEY: If you're not prepared to give us the figures about the current waiting list, can we move on to—

Ms Beauchamp : Those are public.

Senator Scullion: We've just provided those. They're public, Senator Polley. We haven't refused, as you just asserted, to provide those.

Senator POLLEY: They are out of date, and I still believe the department should be able to give us that figure.

Senator Scullion: If I provide you some figures on that today, they will be out of date. We all acknowledge that.

Senator WATT: When will the next report be released?

Senator Scullion: They have been released on 30 June, and I think—when is the next release planned?

Senator POLLEY: When is the next report going to be released?

Ms Buffinton : We aim to have that report out sometime in the period of two months after the end of the month. So the end of September figures will be out at some point by the end of November.

Senator WATT: But the most recent figures are as at 30 June, correct?

Ms Buffinton : Yes, and there are quarterly data reports, so the 30 September data report—

Senator WATT: So we should have, by now, had the figures from 31 July, because two months have elapsed.

Ms Buffinton : No, it's quarterly data.

Senator Scullion: It's a quarterly account.

Senator WATT: Okay; I take that back.

Senator POLLEY: So are you anticipating that those figures will be announced on time, rather than delayed like the last two have been? Is that the intention of the department?

Ms Beauchamp : We'll do our best endeavours to make sure that we can get the report out in a timely manner.

Senator POLLEY: Okay. Who made the decision to announce the latest quarter of data on the eve of the grand final weekend?

Senator Scullion: We don't take sporting events into consideration with the release of our data.

Senator POLLEY: Oh, come on!

Senator SIEWERT: You don't take into account when you release these things? Pull the other one!

Senator Scullion: I'm just stating as a fact that this government does not take into account sporting events around the release of its data.

Senator POLLEY: Who made the decision to announce it on the eve of the grand final?

Senator Scullion: Nobody made a decision to announce anything on the eve of the grand final, as I just indicated.

Senator POLLEY: Who made the decision to make the announcement?

Senator Scullion: I've just made it very clear that we have not made a decision to announce anything in the context of a sporting event. That's very clear; you don't need anything further on the matter.

Senator POLLEY: Who made the decision to announce the data on a day which happened to be the eve of one of the biggest sporting events in this country?

Ms Beauchamp : The minister announced the release of that information. It would have ultimately been the minister's decision.

Senator POLLEY: How long had the minister had the data before he announced it on the eve of the grand final?

Ms Beauchamp : I'd have to take that on notice because, as Ms Buffinton said, there is a lot of analysis and work that needs to be done to better understand what is actually in that report.

Senator Scullion: In this great sporting nation, Senator Polley, you will not find a date that doesn't somehow intersect with a sporting event of note.

Senator POLLEY: In taking that on notice, would you be able to come back to us after the lunch break?

Ms Beauchamp : Sure.

Senator POLLEY: And can you also provide the dates of when the data was provided to the minister's office for the last three releases of data—that's December 2017, March 2018 and June 2018. That data was released, at all times, three months late on the eve of the grand final. Can I ask why there isn't some consistency in the approach the department has? Why is there that delay of three months from when the data is given to the department and to the minister? Why does it take three months to then make that public, and are there any processes being put in place to ensure that that data is released in a timely manner?

Dr McCarthy : As I think we've explained, it's a very complex dataset that requires a lot of analysis and checking and validation before it's made public.

Senator Scullion: We don't actually know what that is on the date we're reporting it on. It takes us time to work out that moment and date, and to work out the exact data so that we can report on that day.

Senator POLLEY: That's why it will be very pertinent to have the date on which the minister received the information for those three times—December 2017, March 2018 and June 2018. I understand it's his decision when he makes that announcement, so he would've decided to make the latest data available to the Australian people on the eve of the grand final.

Senator Scullion: We'll take that on notice, but I don't think we'll be able to provide the three sporting events, because they don't exist.

Senator POLLEY: Can I then talk about the Commonwealth Home Support Program and the government's decision to expend money on a campaign. Can the department confirm there was $8.2 million included in the 2017-18 budget for a communications campaign to support the package of reforms in the 2018-19 budget?

Dr McCarthy : That was a communications campaign relating to an entire budget package, More Choices for a Longer Life. That package was a cross-portfolio package, demonstrating from a whole-of-government, whole-of-nation perspective the importance of policy responses to an ageing population. That campaign was designed to raise people's awareness about the need to plan for a longer life. The package, as you may be aware, had a range of measures, not only aged-care measures, although they were very significant, including a very large increase in the number of home care packages, but also measures relating to jobs, skills, financial planning, combatting elder abuse and so on. So it was a campaign in relation to a very significant budget package relating to healthy ageing.

Senator POLLEY: The funding, as I understand it, went to advertising for home care packages via print, digital and television. Is that correct? And wasn't it the single biggest advertising spend in the 2018-19 budget?

Dr McCarthy : I think, as we may have said at the last estimates, the Department of Finance is better able to comment than we are on relativities between spending on campaigns. But the campaign was in relation to the entire package; it wasn't just in relation to that single home care packages measure.

Senator POLLEY: Who made the decision to roll out the advertising campaign to promote the 14,000 home care packages, when the waiting list was already growing?

Dr McCarthy : The decision to advertise a very significant package relating to better ageing was a decision of government through the budget process.

Senator POLLEY: Did the department provide information and advice to the minister in relation to the funding of this campaign?

Ms Beauchamp : Yes, we did.

Senator POLLEY: Were these funds from the health budget?

Ms Beauchamp : They were funds allocated in the budget context, and, as Dr McCarthy said, it wasn't just advertising home care packages; it was around jobs and skills, financial literacy, health checks, and aged-care services. So there was quite a large package in the last budget—

Senator POLLEY: And that came out of the health budget?

Dr McCarthy : It was a measure in the Department of Health's budget.

Senator WATT: Can I ask about the advice that was provided to the minister about this advertising campaign. Did the minister request that advice and say: 'I'm keen to run an advertising program. Can you please provide me with some advice on what that might look like'? Or was it more the department advising up that an advertising campaign was required?

Ms Beauchamp : It was a broader decision of government. I think it was looking at how we pull all the threads together across government around issues that impact on ageing and making sure younger people provide for themselves. There was a task force that was established in the Department of the Prime Minister and Cabinet looking at all of these measures. It was part of the decision-making process of government.

Senator WATT: So the advice you provided was in response to a request from government or, put another way, from ministers, rather than something that originated in the department?

Ms Beauchamp : It was an option included in the development of the whole ageing package: how do we tell people about it? It's really in the context of communication.

Senator POLLEY: Wasn't there always a risk that the advertising was encouraging the community that there were home care packages but, at the time, there was no availability for them? In fact, during that time, the home care package waitlist went from 108,000 older Australians to 121,000 older Australians. So wasn't that really about advertising for packages that just were not going to be able to be delivered?

Ms Beauchamp : I don't think the waitlist was dependent on the communications campaign. The communications campaign was a much broader communications strategy.

Senator POLLEY: Yes, but we're talking about the home care package—advertising it, under this budget—

Ms Beauchamp : The demand for aged-care packages and home care packages comes from the basis of need and assessment—

Senator POLLEY: So it wasn't from this—

Ms Beauchamp : population growth and the like.

Senator POLLEY: advertising campaign?

Ms Beauchamp : Well, I can't be definitive, but there are other factors that go into considering whether someone is eligible for a home care package.

Senator POLLEY: Yes, and we realise that, because you only have to look at the amount of people who are on waiting lists. So you don't accept my observation that that list could have and would have grown because of the advertising campaign?

Ms Beauchamp : As I said, the advertising wasn't about advertising home care packages; it was about advertising everyone's literacy around what you need to take into account as you age—whether it's health, finance, employment or, indeed, future support for aged-care services.

Senator POLLEY: But, in that period of time, we are talking about 13,000 additional people going on that waiting list. If you look at the increasing rate of people who are still waiting for a home care package, there was a significant jump during that time, from 108,000 to 121,000—

Senator Scullion: We don't believe—

Senator POLLEY: with 13,000 additional people going onto that list—

Senator Scullion: We understand the question. And—

Senator POLLEY: Excuse me! I haven't finished.

Senator Scullion: No, but perhaps you could get to the question—

Senator POLLEY: If you're looking at the amount of people, it increased during that period of time—13,000. That's a greater increase than the period before. Can we expect, as to the increase from the 121,000, that, when we finally get the list of the last quarter, it's going to be significantly increased?

Ms Beauchamp : We'd have to look at that, and I'm not making any assumptions, but, again, the government has already provided for an additional 20,000 in MYEFO; 6,000; 14,000 extra in the budget, and of course we need to look at what the future demand is going to be.

Senator POLLEY: So 20,000 additional places since the budget, the MYEFO—20,000 additional places. The 14,000 is over three years. And we have, now, in excess of, I would suggest, 121,000 older Australians who are waiting for care, and too many of those aren't getting any care.

Dr McCarthy : We estimate around three-quarters of those people are receiving some form of Commonwealth subsidised care, and around half have been connected to a home care package. As Ms Buffinton has said, as Minister Wyatt has said, we encourage people to accept an interim-level package whenever it is offered so that they can be connected to care, and where there are those particular circumstances, such as the one you've mentioned, we can look further into those matters to help ensure those people are aware of the range of services that might be available.

Senator POLLEY: The campaign that was run certainly made people aware of the support they could get, but it did nothing to allay the fears of people who are on the waiting list who aren't getting any care and also those who are not getting the level of care that they want. Many of those 121,000 are level 4 packages, who are people also living with dementia who aren't getting their support. Is that not right? And I just want to confirm that you are—

Senator Scullion: Well, perhaps we could get an opportunity to answer that question, Senator.

Senator POLLEY: I haven't finished my question. Sorry.

Senator Scullion: Well, I'm just answering your previous question, Senator, because you've got about four in a row. I just wonder if it's possible to take on notice those people who they've claimed have dementia and are waiting for a new level of support that the senator asserts. Can I just say, Senator, how much better we are off now than when you were in government. You know why you didn't have a lift?

Senator POLLEY: You haven't done anything—

Senator Scullion: Because there was no transparency provided whatsoever.

Senator POLLEY: Your government is so good at looking after older Australians you've had to call a royal commission into your failures.

Senator Scullion: We're doing a much better job that you've ever done, Senator. I can promise you that.

Senator POLLEY: That's how good you are. When a 99-year-old woman has to wait since 2017—

Senator Scullion: Well, we have to establish that, and we have indicated that we will do just that.

Senator POLLEY: I am bringing this evidence to the committee, and I stand by it She's 99 years of age and has been waiting since 2017.

Senator Scullion: Well, it is not evidence, Senator. You have provided us with a statement, and we have indicated that we will respond to that.

Senator POLLEY: I think the Australian public have every right to have concerns about your ability to run this area.

Senator Scullion: Well, Senator, we are looking into that. You've provided us a statement, and we've indicated that we will look into that.

CHAIR: May I jump in at that point and ask: when is the last time the former Labor government had the wait list data? Do we ever have that?

Senator WATT: I thought we were doing estimates for this year, but we're going back years now.

Senator POLLEY: We are going back five years.

Senator Scullion: We've actually been mentioning well before this year, so I think it's a pretty reasonable precedent.

CHAIR: You started comparing—

Senator DEAN SMITH: The answer to the issue actually might be in the historical decisions that were taken.

Dr McCarthy : As I mentioned in answer to an earlier question, the national queuing process, the transparency of the waiting list, has only been available since some very significant changes to home care that were made in February 2017.

Senator POLLEY: Can I move on, then. This relates to this area. Can the department confirm that it has received and read a letter that the shadow minister wrote to the Prime Minister regarding the Home Care Packages Program, and can the department confirm if it has provided any advice to the minister in relation to that correspondence?

Dr McCarthy : I don't have the correspondence in front of me.

Senator Scullion: Could you table the letter.

Senator POLLEY: I certainly can. I am very happy to table the letter. So can the department confirm whether you have given any advice to the Prime Minister or the minister on that letter?

Dr McCarthy : We will have a look at the letter, Senator, and we will endeavour to answer your question.

Senator SIEWERT: Before you go on, can I jump in and ask another question on home care?

Senator POLLEY: Yes, sure.

Senator SIEWERT: Can I go to the issue of admin fees on home care packages? I've actually got a copy of the bill, or an invoice, that shows fees of 38 per cent. When I talked to somebody else about how outrageous that was, I got told by somebody they've heard figures of 45 per cent. I know that we've gone to this issue before, but are you monitoring the admin fees?

Dr McCarthy : Well, we're doing more than monitoring. In fact, this is an issue of great concern to the minister also, and so we've been in discussions with the sector about ensuring that older Australians have much greater transparency in relation to administrative fees and what they actually comprise. As part of the budget, there will be much better information available on My Aged Care for older Australians so that they know exactly what services are being offered, so that they can compare and contrast across providers and get the best service possible.

Senator SIEWERT: Are you considering putting a cap on the fees?

Ms Buffinton : At the moment, we've got a committee that is working through this. Just as Dr McCarthy outlined, actually the minister has instituted a three-step process. He got a roundtable of both consumer representatives and provider representatives to join with the department on how to get greater transparency and look into the issue of administrative fees. What the minister did, first of all, is to get the transparency. He asked providers to immediately publish their current pricing on the My Aged Care service finder. He wrote to all providers. He is requiring all providers to publish their current pricing information on the My Aged Care service finder by the end of November.

Senator SIEWERT: The current pricing?

Ms Buffinton : Their current pricing. Then, based on the work of this committee—and this includes consumers and organisations like Seniors and Council of the Ageing—we're coming to: how should prices be rendered to get the maximum transparency, where it's quite clear what fees are for what purpose and that there is comparability so that you can literally put three providers' price side-by-side. They're going to need to fill in a template that will be on My Aged Care so you compare the methodology of all three providers and understand clearly the transparency. There will be a link, then, to the detailed pricing sheets of all providers coming off My Aged Care.

Senator SIEWERT: If they've already got similar pricing and they're already up around 38 per cent, that doesn't help people to find a lower cost provider. So my question is are you considering, or have you considered, capping?

Ms Buffinton : One of the discussions for the group, including with consumers, has been on the nature of administration fees—do you make them transparent and let the market engage with that, which we've seen with exit fees, the drive-down in the market of those fees, or do you cap—that's part of the discussion that has been taking place within that group.

Senator SIEWERT: So the government hasn't made a decision?

Ms Buffinton : They have not.

Senator SIEWERT: So you said a three-step process? You said roundtable?

Ms Buffinton : Yes. We're in the process at the moment at the final stages—because we need to get this on the website for the end of April.

Senator SIEWERT: Next year?

Ms Buffinton : Yes. That's why the minister had a three-step process, realising that by the time you design the templates, you get them written into the IT, that they're actually released into the IT environment—that's why he's expecting their current fee schedules to be in place by the end of November. And then—

Senator SIEWERT: So that's the second stage?

Ms Buffinton : And the new method would come in by the end of April.

Senator SIEWERT: That's the end of the third stage? Is that what you are saying?

Ms Buffinton : That's correct.

Senator SIEWERT: When I asked about the issue around capping, you said there's still a discussion, but it sounds like in fact it's not being discussed?

Dr McCarthy : Any capping of any fees would obviously be a decision for government.

Ms Buffinton : But certainly, if I—

Senator SIEWERT: Yes, if you let me finish.

Ms Buffinton : Sorry.

Senator SIEWERT: You said there was the three-step process; you just took me through the three-step process. When I asked about capping you said it's still under discussion, but you said the end point is publishing the fees in April next year.

Ms Buffinton : Yes.

Senator SIEWERT: That does not include a discussion of capping.

Ms Buffinton : So that would be how you display an administration fee, if it's going to be displayed, is it going to be a single unit price, is it going to be—

Senator SIEWERT: So can I be clear—

Ms Buffinton : Certainly, if I could reflect on the group, that in fact consumer groups at this stage are open to the fact that you might not have capping, as you describe, because actually they're wanting to be able to compare different services, including some that are coming in with a very low overhead but no wraparound care, others that are offering genuine package management, and then are there organisations that are just purely charging a very high administration fee and not offering any additional care. So that is part of what the discussion has been.

Senator SIEWERT: Or are charging more for additional care, which is what I'm saying. So they're charging high admin fees and then in fact extra for additional care. So the consumer is getting the worst of both.

Ms Buffinton : I think it's fair to say that we're very aware of the problem and that's what has been part of this group with this discussion.

Senator SIEWERT: During those discussions, you're talking about the My Aged Care site, and one of the overwhelming criticisms I hear is the complexity of the My Aged Care site, still?

Ms Buffinton : As part of the budget package, we have additional money. We've just been in the process of finalising a tender for a new digital provider—so a website provider. One of the things that we're aware of is that we have had limitations on that. We've acknowledged that in previous estimates hearings. In terms of making a new service finder, each time we're making it much better. The new service finder is going to be much more easily searched, with greater clarity of information. But, equally, people can ring and get the same information orally through the contact centre. We will be linking to individual service providers, as well. We're also stipulating what needs to be attached to the individual service agreement. So this same page will be attached to that service agreement so that that can't change without a consumer being very aware of what they've signed up to, what is the level of administration cost and what's the cost of the care. So we're going for a much greater level of transparency than we've had.

Dr McCarthy : In relation to the complexity of My Aged Care, I also draw your attention to a very significant revamp earlier this year. So now, for those consumers who choose to use the website—and they can choose to use the website or they can call one of the contact centres—the display is now, I think, a great improvement on what it was before.

Senator SIEWERT: I acknowledge there's improvement, but I'm still getting people complaining about the complexity. There's a mixture between the complexity of the issues and the nature of the decisions that have to be made and the timeline—

Dr McCarthy : Yes, you are absolutely right.

Senator SIEWERT: intersecting with the complexity of accessing the information.

Dr McCarthy : Yes.

Senator SIEWERT: I acknowledge they get rolled together.

Ms Buffinton : We acknowledge that it's complex, which is why we're constantly trying to work with consumers to improve that access over time.

Senator SIEWERT: That is why, bearing that in mind, I am not terribly convinced yet that, given what we've just said, putting that information side by side at the moment is actually going to help people reach an informed decision.

Dr McCarthy : We'll make sure. As Ms Buffinton said, we work with consumers, with people who are actually accessing the services, to try to ensure that whatever changes we make are able to be understood by the people who will be accessing the services. We can always do better—absolutely—but we are trying to ensure that those improvements are made in close consultation with consumers.

Ms Buffinton : So, for example, over time, we've changed the content of the home care booklet quite a bit, both in terms of how we pitch the information but also how consumers can be informed to help step them through, in very simple terms, what questions they should ask when they are talking to a Home Care Package provider or how they should compare and contrast the different offerings. One of the things we are looking at is a small pamphlet. ACATs already give a lot of information out when they're doing the assessment, but we acknowledge that there can often be quite a period of time before you are making that decision. So it's about sending out information to help the consumer as the offer is coming through. We actually give them answers to, 'How do you search?', 'What are the really important questions?' and 'How do you compare different providers?'

Dr McCarthy : I should also mention that, beyond My Aged Care itself, one of the measures in the budget was funding over two years to trial navigator services to assist people seeking information. This was a recommendation of David Tune. The trials are in relation to leveraging the Financial Information Service offices. You probably know about that. It's a service provided out of DHS. The trials for that are commencing in coming weeks and a request for tender was issued on 28 September to seek an organisation to coordinate and deliver those trials. So that's another measure designed to help ensure that people, particularly those who have particular difficulty accessing and understanding services—that's a trial to see how we can do better there.

Senator SIEWERT: Thank you. Can I go to the issue of unspent home care funds. Do you have a picture of what that level is now?

Dr McCarthy : We do in aggregate.

Senator SIEWERT: Are you able to provide that?

Ms Buffinton : I will double-check. Here it is. We know the figures are provided once a year by home care providers into the Aged Care Financing Authority. Their last report was for 30 June 2017, and that was $329 million. That ACFA report usually comes out in about November, so we will have the next report in the next month or so.

Senator SIEWERT: Okay. Do you have an idea whether that has continued to grow, or is it starting to stabilise?

Ms Buffinton : Generally, at this stage, I don't know. But, with the level of funding going into the sector, I would imagine that there is a proportional growth.

Dr McCarthy : Yes, so it will always grow—assuming the same proportion of people might want to accrue unspent funds, it will grow. So, we'd need to do some per capita analysis in trends over time.

Senator SIEWERT: Looking at the issues, I'm aware of some people that save some money for crisis. But there are also other reasons why people aren't spending the money, including delay in decision-making, complexity of the issues we've just talked about. In terms of the analysis of that process, have you done, or are you doing, an analysis of what they are?

Ms Buffinton : We've certainly been having a look at the issue of unspent funds. So the first part of when we did our modelling leading into home care is: what portion of funds across the system would we expect for an older person saving for, for example, respite care? Certainly we looked at about 10 to 12 per cent of funds being held as what we would consider to be something you'd expect because of the nature of home care and the fact of respite care or a major piece of capital equipment or something like that.

In terms of unspent funds, some of the areas that we've also looked at included the use of level 2 and level 4 as opposed to the use of level 1 and level 3, which is quite significant. We've had this discussion before. Because we used to have high and low, assessors have been used to giving out, 'What's a low? That's a 2' and 'What's a high? That's a 4,' as opposed to the use of level 3, remembering level 3 is about $33,000, significant care, and level 4. So we were getting feedback that a number of people had historic ACATs and then their level of care need, really, even though they're now getting level 4, probably might not yet be that level of frailty of level 4—unspent funds. So that has caused us to engage with providers in looking at how we write to consumers and outlining that, if they don't feel they need that level of care—and we've got lots of examples of people actually taking this up and saying, 'Thank you; actually, I don't feel like I need that at this point in time'—assuring them that, if they do come into the system again, because of their date of their ACAT, they will come immediately in when they're ready to get that level of care.

Senator SIEWERT: They don't go on a waiting list then if they scale it back?

Ms Buffinton : Well, they're on the waiting list, but they don't lose their place on the waiting list. If they do what you might say was the right thing, if they sit to the side and come in when they have that little bit of frailty, their original date is when—if we've already offered them a level 3, when they say, 'I now would like a level 3,' and six months have gone by, they will get a level 3 pretty well immediately, because their date is their original date. We don't change that date.

Dr McCarthy : You never lose your place.

Ms Buffinton : That's where we're trying to encourage that dialogue between the consumer and the provider. We've also talked with ACATs in getting the consistency around Australia of how they're using level 1, 2, 3 and 4, and we've seen that greater level of consistency.

Senator POLLEY: Can I now go back to the letter that I've tabled. Can you advise whether or not the department has given advice to the Prime Minister or the minister in relation to that correspondence, and then we can move on?

Senator Scullion: The letter is actually to the Prime Minister. I know it's cc'd to Ken Wyatt, the minister—

Senator POLLEY: Yes, I did ask whether advice had been given to the Prime Minister or the minister.

Senator Scullion: I was just trying to be help, Senator. Off you go.

Ms Beauchamp : Can I take it on notice? I'm not aware, personally, whether we provided advice to Prime Minister and Cabinet, seeing it was written to the Prime Minister.

Senator POLLEY: And to the minister. So is it—

Ms Beauchamp : It was a cc to the minister, I think.

Senator POLLEY: Yes, it was—so whether you've given advice to the Prime Minister or to the minister in relation to it. Can you come back to us on that today?

Dr McCarthy : We will endeavour to come back to you.

Senator POLLEY: Excellent. In the interest of time, I'm prepared to put on notice Commonwealth Home Support Program questions. Chair, I'm proposing to move over Commonwealth Home Support Program and go to Aged Care Quality Agency unannounced visits.

Senator DEAN SMITH: Before we do, I've got a couple of questions I'd like to ask.

Senator POLLEY: On what?

Senator DEAN SMITH: On where you've just been, actually. I'm just curious, if I've heard your evidence correctly, the current experience is the result of the introduction of the national queuing process, an added level of transparency. What would the consumer experience look like if those reforms hadn't been introduced?

Dr McCarthy : There were a number of aspects in relation to the previous arrangements.

Ms Beauchamp : Consumers wouldn't have had any visibility of what was happening nationally, what sort of waiting periods there were. The information that was provided previously was demand coming through providers, so it wasn't reflecting exactly the assessment process around consumers, and it was down to regions. It was a plethora of information that was not coordinated in any way and didn't focus on the consumer, only focused on the provider system.

Dr McCarthy : The consumer, were they to move interstate or to another area, would lose access to that package, because the package was allocated to the provider, not the consumer. Now, as the secretary has said, not only is there much more transparency about how long they might need to wait, but also the package belongs to the consumer, and they can be assured that their priority is part of a national priority and not simply dependent on how many packages had been allocated to providers in their local area.

Senator DEAN SMITH: So if you're a consumer, you've got a greater degree of comfort because you're allocated a package that stays with you, even if you might actually shift geographical location.

Dr McCarthy : That's right.

Senator DEAN SMITH: The system is more focused on the consumer, because under the previous arrangements it was the provider that was providing the information.

Dr McCarthy : Yes.

Senator DEAN SMITH: What other failings of the previous system were there that led to the current reforms?

Dr McCarthy : I think one of the objectives that the change in policy was seeking to achieve was more equity in the allocation of packages. So it doesn't depend on where you live and how successful the providers in your area had been in applying for packages. It depends on your need as assessed, and that's now part of a transparent national queue.

Senator DEAN SMITH: So, the individual needs of the aged care recipient are now the priority, whereas, under the previous system, your need would have been governed by who your provider was and, as you said, their ability to access?

Dr McCarthy : Your need was assessed under the previous system, as Ms Buffinton indicated: high versus low. But you, the consumer, had to find a provider who had packages available, as opposed to the current system, with the provider having to market themselves to people to whom packages have been allocated.

Senator DEAN SMITH: Hearing your evidence, there's obviously been a bit of a mismatch between demand and the number of places that have become, or been, available? Is that a correct summation?

Dr McCarthy : There is very high demand for home care. There always has been—

Senator DEAN SMITH: Was the demand now being experienced planned for? Was it expected? Was it known?

Dr McCarthy : Until the decision was taken to create a national queue, there was not the understanding that we have now of the level of demand, because that level of demand was, as Ms Beauchamp said, a function of the aggregate of the waiting lists of every individual provider. It's always been the case that under the previous system, where providers had to apply in a competitive round for home care packages, they were always highly competitive rounds. So, we knew there was very high demand. We did not know, though, to the level of detail we know now, how many people were waiting to receive a package.

Senator DEAN SMITH: So, under the old regime, how was it possible to plan?

Dr McCarthy : Under the old regime providers would not have had access to the information that we now make available, region by region. I have just checked that and, yes, that's correct.

Senator DEAN SMITH: Were the previous targets that were set inadequate?

Dr McCarthy : The estimates work is that there's what's called a planning ratio—a certain number of, as it was at the time, home care packages, residential care places, per thousand population. So, those ratios have been in place for many years. And the planning that's done via the forward estimates is based on those ratios.

Ms Beauchamp : I think there are now a lot more people, particularly with the flexibility arrangements, wanting to stay at home. So, there has been a substantial demand and probably will be an increase in demand for home care packages for people to stay at home for as long as possible.

Dr McCarthy : Hence the measures over MYEFO and the budget to put more home care packages into the system.

Senator DEAN SMITH: I understand.

Senator POLLEY: We're moving on now to the issue around unannounced visits. Can the committee be advised about how many full-time-equivalent agency staff make up an assessment team and the teams that go out to accredit or audit residential aged care homes?

Mr N Ryan : Depending on the number of beds and the size of the home, we will send between one and three surveyors onsite. The vast majority of our surveyors—and I think I have some data specific to that—are employees of the quality agency. We do have a number of contract staff who are on non-ongoing contracts, and we do maintain a large number of external surveyors. They will do a minimum requirement each year to maintain currency. At 30 September 2018, there were 295 registered quality assessors—169 were employed by us, and 126 were external assessors on a contractual basis—and 193 of our quality assessors have been registered for more than five years. I'm happy to answer any further questions.

Senator POLLEY: Can you explain the process that's undertaken by the agency when it comes to unannounced visits? Do agency staff simply turn up at the home at the front door? Does any notification happen prior to any of these unannounced visits? How does it actually work?

Mr N Ryan : All visits, or the vast majority of visits, now undertaken by the quality agency are unannounced. As you might recall, unannounced assessment contacts, the so-called unannounced annual visit, have been unannounced for the period of the scheme up until now. You will note that the government—Minister Wyatt—announced the move to unannounced reaccreditation audits for all homes applying for reaccreditation after 1 July this year. Of the homes that had applied for reaccreditation in the last financial year, I think we've gone through all—there might be one or two left to go, but they've all been completed. So, all reaccreditation audits now are completely unannounced. They know when we're there, because we knock on the door or we present ourselves to the front counter.

Senator POLLEY: Prior to any unannounced visits taking place—that is, prior to the government adopting the Carnell-Paterson recommendation—can you confirm how much funding was provided to the agency for these site visits?

Mr N Ryan : I beg your pardon. Could you repeat the question? I didn't quite hear.

Senator POLLEY: Prior to the government's adopting the Carnell-Paterson recommendations, have you been given any additional funding to carry out these site visits?

Mr N Ryan : You'll note that government announced a new injection of funding about a month ago. Excuse me for not having the date. We did receive some additional resources at that time.

Senator POLLEY: How much?

Mr N Ryan : I beg your pardon?

Senator POLLEY: How much is it?

Mr N Ryan : About 2.8 FTEs at this time. That's for surveyors. We maintain an ongoing conversation with the Department of Health around ensuring that there are adequate resources to meet the growth in referrals from the complaints commissioner, the growth in review audits that we undertake and the growth in findings of serious risk that we undertake. I maintain very close contact with the secretary and her senior staff around that matter.

Senator WATT: Before we go to that new funding—we might come back to that—can we just go back. I don't think Senator Polley quite got an answer to her original question: prior to the adoption of the Carnell-Paterson recommendations about unannounced visits, before that recommendation, what funding was provided to the agency for site visits?

Mr N Ryan : Christina Bolger will answer that, thank you, Senator.

Ms Bolger : Just to clarify the earlier question in relation to unannounced reaccreditation audits, we are in a transition period because the date of application relates to the application for reaccreditation, so in this transition period we have both unannounced and announced audits undertaken, until the remainder of those who had applied under the previous rules are processed. But that will all be complete by the end of this year, and we are increasing the rate of unannounced audits over that period.

Senator POLLEY: What number is there of those that haven't been completed?

Ms Bolger : I can take that on notice, Senator. Each month, obviously, that rate increases as more providers are being processed under the new rules.

Senator WATT: And I still don't think we've had an answer to the funding that was provided.

Ms Bolger : Yes, I'll come back to that as well. Reaccreditation is a cost-recovered activity. Under the previous arrangements and under the new arrangements for unannounced reaccreditation audits, that isn't appropriated funding. It's actually cost-recovered from the industry. That is published in our Cost Recovery Implementation Statement on our website.

Senator WATT: That's for reaccreditation audits?

Ms Bolger : Reaccreditation audits are cost recovered.

Senator WATT: As opposed to unannounced site visits?

Mr N Ryan : Compliance visits.

Ms Bolger : Yes.

Senator WATT: Or site visits.

Ms Bolger : The other figures that Mr Ryan cited relate to increased compliance monitoring and activity on assessment contacts, which is part of our ongoing compliance monitoring.

Senator WATT: What we're trying to get to is what the change has been. I still don't think we've had an answer. Prior to the Carnell-Paterson recommendations, site visits used to occur—correct?

Mr N Ryan : Correct.

Senator WATT: Not unannounced reaccreditation visits?

Mr N Ryan : They both occurred.

Senator WATT: So you used to have unannounced—well, my understanding is that the old system was that you had announced accreditation visits as opposed to unannounced accreditation visits.

Ms Bolger : That's correct.

Senator WATT: And you also had site visits?

Mr N Ryan : Correct. As Ms Bolger has said, the volume of money for reaccreditation audits, which used to be announced and are now unannounced, is fully cost recovered. So that funding increases relative to the activity, and it's fully cost-recovered under government policy. The range of other activities that we undertake—unannounced assessment contacts, the unannounced visits and a range of other compliance activities—is funded by appropriation.

Senator WATT: What was the appropriation provided for those visits—leave aside the cost-recovered ones—prior to the Carnell-Paterson recommendations?

Mr N Ryan : I would need to take that on notice so that I'm completely accurate with that.

Senator WATT: And can we get what the new figure is, following the change?

Mr N Ryan : Correct. Yes, we will take that on notice.

Senator WATT: But if we're thinking about the reaccreditation visits, which have changed from announced to unannounced, what you're saying is that they've always been and continue to be cost-recovered. So it might be that government funding has gone up or down, but, whatever the case, the money is retrieved from providers?

Mr N Ryan : Yes. There was a review in the cost-recovery approach about two years ago. They had been funded on a cost-recovery basis, but there was a refinement under the CRIS approach two years ago. So that volume of activity is self-funded; it's far more specifically funded under the new approach. We'll come back to you, just so that I can be clear, with the appropriation for everything other than reaccreditation and cost-recovered activity, pre and post the announcement.

Senator WATT: Did you say that, with this change to unannounced reaccreditation visits, there's been an increase of 2.8 FTEs to do that?

Mr N Ryan : Correct.

Senator WATT: So we've moved from a system of announced visits to unannounced, and the minister has committed to more of them?

Mr N Ryan : Yes.

Senator WATT: And we've actually not even got three full-time extra employees to do that?

Mr N Ryan : Yes. But, if you look at the range of work, we have a funding methodology that says that equates to some hundreds of activities. We make good use of our staff, and we make sure that we talk with the Department of Health to ensure that, as the activity grows, we have funding. You will appreciate that, because of the public, parliamentary and media scrutiny over aged care, there have been significantly more referrals to Rae Lamb, the complaints commissioner. There were just shy of 1,100 referrals to us last year. So our activity is increasing around compliance monitoring, and we continue to talk with the department to ensure that we have the funding to meet that need.

Senator POLLEY: In relation to this funding that you've been given—and you say it's 2.8 equivalents—was there any provision for the agency to organise outside-of-office-hours visits—that is, outside nine-to-five working arrangements, including nights, weekends and public holidays to take these unannounced visits?

Mr N Ryan : Whilst it's accurate that the majority of our work does happen during working hours, we can and do on a frequent basis—where we have particular concern, regulatory intelligence or other forms of concern—conduct unannounced visits after hours, on weekends et cetera. If I receive, or if my agency receives, a level 3 referral from the complaints commissioner—that's where she has assessed that there are some matters—we will fly staff to those locations on the next available flight. That might be after hours and it might be on weekends.

Senator POLLEY: Can you provide us the numbers of night, weekend or public holiday unannounced visits?

Mr N Ryan : I'm happy to take that on notice, Senator.

Senator POLLEY: In terms of unannounced visits outside normal work hours, you're saying that you currently undertake those where needed on a weekend or a public holiday or at night—

Mr N Ryan : Correct.

Senator POLLEY: but you can't provide that information to us now?

Mr N Ryan : No, we hadn't anticipated that specific question, but we would be happy to come back with the data.

Senator POLLEY: So you were always funded to be able to undertake these unannounced visits out of normal work hours?

Mr N Ryan : We are funded to undertake a scheme of activity. We are funded to do compliance monitoring and, where risk or urgency is indicated, we will do that whenever we get there, including after hours, public holidays and weekends.

Senator POLLEY: So you'll be able to provide to us a list of details of when these have taken place. Have you changed the process that you have of having assessors going in on a regular basis to the same providers?

Mr N Ryan : We're very concerned about what's called regulatory capture—that is, where the same surveyor or teams of surveyors go to the same site time and time and time again. They often can't see what's in front of them because they're so familiar. So, for the integrity of our regulatory scheme, we actively mix and match surveyors. We do so relative to the specific needs of that particular visit. Around a compliance visit, if we had particular concerns around the clinical conduct of the home, we would assign a highly experienced nurse. Often, especially if we've got a volume of work, we will fly our surveyors interstate to avoid that kind of regulatory capture or the risk of regulatory capture.

Senator POLLEY: In relation to the unannounced visits, we heard from the minister in terms of the concern around safety, and the new safety and quality commission will increase these unannounced visits. Can you tell me how many of these will be out of hours, of a night and on public holidays?

Senator Scullion: It's hard to predict.

Mr N Ryan : That's very, very hard to say. I think the most accurate answer that I can provide is: if we have specific intelligence, or a referral from the department—from the secretary or her delegate—or from the Complaints Commissioner or her delegate, or other information, we will prioritise the timing and the extent and the resources based on risk. We are a risk based regulator.

Dr McCarthy : There's a measure in the budget that will enable the new commissioner—work has started on this already—to do even better and more effective risk profiling. It's through tools such as that that decisions can be made about when a visit takes place, how often, et cetera, including if it needs to be out of hours.

Senator POLLEY: Can you elaborate a bit further in terms of the preparation that you're doing? Can you give us some more detail on that?

Ms Beauchamp : The budget last year announced the bringing together of three functions into the new Aged Care Quality and Safety Commission. That will give the commission much more flexibility in terms of how it should allocate its resources. I think we're looking at over 400 ASL and a budget that goes from about $64 million to $79 million per annum over the forwards. In addition, the government has also announced another $15.6 million just recently, last month, which is about getting more compliance activity—more opportunities for these unannounced visits and the like on the ground. The new commissioner and the new organisation will then be able to determine whether to put effort into the front end or into the back end around compliance. And it needs that balance, so that'll be up to the new commissioner, based on the information that has come from Mr Ryan and Ms Lamb as well, in terms of their experience. But I think the bringing together of the three functions will provide that added flexibility. Of course, looking at the risk profile is going to be important in terms of understanding where those frontline staff need to be allocated.

Senator POLLEY: Would it be a fair assessment to say that, yes, things will change for the better but that there has been concern that it hasn't been a common practice to have these unannounced visits out of hours?

Mr N Ryan : In the last three years, building on what the secretary has said, we have moved to a mathematical performance model with the CAT tool, which we've talked about before in these hearings. Clearly, the government's announcements to do greater identification of risk profiling in residential aged care will inform that from a broader policy point of view. We have done many more after-hours and weekend visits over the last 18 months to two years, relative to risk. In fact, all of the work that the secretary has talked about will increase the coordination of the functions—better information systems, better understanding of risk, better targeting of regulatory response.

Senator POLLEY: So you're now saying that there was a regular amount of unannounced visits undertaken out of normal hours of a weekend and public holidays.

Mr N Ryan : That was a regular activity, but the volume of it—we'll need to collate figures.

Senator POLLEY: What do you call 'regular'? How do you define 'regular'?

Mr N Ryan : Well, regular would be relative to—if you wanted to look at the way that we would understand it, if we had particular concerns based on a referral from the complaints commissioner or a referral from the department or other information, we prioritise our visits based on our assessment of risk.

Ms Bolger : And, if I could just add, they were much more likely to be a compliance-monitoring visit—which is like a surveillance visit to understand the extent of a risk or respond proactively to a referral—than they were reaccreditation audits, because the reaccreditation audits, under the previous arrangements, were on application and there was a process around those. So it was much more likely to be a compliance-monitoring visit that we would do in the circumstances of an indication of risk.

Senator WATT: I appreciate that you're going to come back with some actual figures and I appreciate that these unannounced visits occur after risk-based analysis, but do the after-hours ones happen generally on a weekly basis or monthly or a couple of times a year? Have you got any sense of that at all?

Mr N Ryan : I would ask Ann Wunsch, who is Executive Director Operations, to come and provide an answer on that. Ms Wunsch has oversight of the day-to-day service delivery of our organisation.

Ms Wunsch : The rationale for conducting a compliance-monitoring visit out of hours would be information that was before the quality agency about—

Senator POLLEY: We know that.

Senator WATT: I've got the rationale. What I'm trying to establish is how regular are the after-hours unannounced visits. Is it a weekly thing or monthly or a couple of times a year?

Ms Wunsch : There are two types of these visits. One is where a review audit or an unannounced visit is over a number of days, and it may start later in the week. We take the view that we would like to have the audit assessment team spend a couple of hours on a Saturday or a Sunday with access to weekend staff, to interview them and to understand what, say, the weekend activity program looks like or what the staffing levels are et cetera. That may be an activity that has been arranged to occur through the week, but we want to sample specific information during the weekend.

Senator WATT: But, if you're saying these are ones that have started sometime earlier in the week, they're hardly unannounced, are they, if someone turns up?

Ms Wunsch : No, they are unannounced.

Senator POLLEY: Well, they are when they first arrive, but they won't be at the weekend.

Ms Wunsch : But this activity will take some days, so it's unannounced from the outset.

Senator WATT: What I think we're trying to get to is visits where your people turn up for the first time, unannounced, after hours.

Ms Wunsch : Understood.

Senator POLLEY: On a Friday night.

Ms Wunsch : Understood.

Mr N Ryan : We will come back with that.

Ms Wunsch : We'll come back, but it is not something that is occurring weekly. It's more likely something that is occurring less frequently than that, and it's based on information that we have before us. If it's about an overnight staffing issue, for instance, or about concerns around weekend care practices, that would be a rationale to commence the visit at night or on a weekend, and we would use that intelligence to inform the need to assign a team to commence at that point in time.

Senator WATT: Do any of these unannounced visits begin on a public holiday?

Mr N Ryan : That would not be regular.

Senator WATT: Okay, but on a night shift you're saying it would be regular to commence?

Ms Wunsch : The consideration of assigning a team to commence at that time is regular. The actual assignment would depend on what we understand the risk to be, and it would be less frequent than monthly.

Senator WATT: Less frequent than monthly for a night shift?

Ms Wunsch : But I would like us to provide the data to you, because it wasn't a question we anticipated, and we would like to give you a full account of this.

Senator WATT: That's fine. Can I just clarify one other thing coming out of Senator Polley's questions: the point about the process for one of these unannounced visits. Mr Ryan, I think you said we've got the unannounced reaccreditation visits.

Mr N Ryan : Yes.

Senator WATT: And we've got the general unannounced site visits.

Mr N Ryan : We've got a couple of general unannounced site visits. We do a minimum of one unannounced assessment contact every year, but if we have a particular compliance concern—that's where we think there's specific risk—we will go more than once a year. Where we have particular concerns, if we were to do an assessment contact and we found something of concern, we would do what's called a review audit.

Senator WATT: Whichever type of unannounced visit we're talking about, you're saying that in every single case, for an unannounced visit, the first the provider knows about this is when your people turn up at the door?

Mr N Ryan : Correct.

Senator WATT: They don't get a phone call saying, 'Hi, we're coming in a couple of hours'?

Mr N Ryan : No.

Ms Beauchamp : Okay.

Senator POLLEY: I just want to confirm that it's not a regular criterion that you make unannounced visits at night, but, if you look at the complaints that are raised and at what happened on the Four Corners programs, there are a lot of incidents that happen at night, and they don't stop on the weekend and certainly not on a public holiday. So that's an area where you concede, do you not, that it hasn't been as regular as it will be in the future?

Mr N Ryan : I can't speak for the new commissioner, whose appointment is being announced today. I can't speak for Ms Anderson on that point. Where we have any concerns, we have access to all sorts of information to help us understand what happens overnight, even though we might not be there to witness it at that particular time. We have access to all of the clinical files. We have access to the staff rosters. There's a whole range of information. So the fact that we're not there at night doesn't mean we can't understand what occurs on a regular basis overnight, and it doesn't stop us interviewing residents. In fact, one of the good stories over the last 12 months is that the 10 consistent questions around consumer experience reports give much greater effect and voice of the experience of consumers. But, if your point is asking if we take into consideration the need to visit after hours and on public holidays and weekends, of course we do. As we strengthen and as the new quality and safety commission strengthens its risk approach, that may well increase.

Senator POLLEY: Can you confirm that the agency will reach the target set by Minister Hunt and Minister Wyatt of 500 unannounced reaccreditation audits this year? Accordingly, to do a simple calculation to meet this target, there would need to be around two visits each week. How many days are actually being done now?

Ms Wunsch : You're talking about unannounced reaccreditation audits?

Senator POLLEY: Yes.

Ms Wunsch : The teaming for unannounced reaccreditation audits has been established over time. It is allocated on the basis of the size of the home, and it is translated into the number of assessor days. Size, complexity of the care recipient cohort, risk and intel inform the size of the team and the number of days allocated to that visit.

Mr N Ryan : We will complete the visits.

Senator POLLEY: You're confident you'll meet the 500 unannounced reaccreditation visits?

Ms Wunsch : Yes.

Mr N Ryan : As we do every year, yes.

Ms Wunsch : Yes.

Senator POLLEY: Thank you.

Senator SIEWERT: In terms of the mental health announcement made in the budget, should I be asking about that here or in mental health, or both? I just don't want to get to mental health and have them go, 'Oh, you should have asked in aged care.'

Ms Beauchamp : It's probably better in the mental health area, as part of the bigger package.

Senator SIEWERT: Okay. But can I ask you if you've been engaged in discussions with either PHNs or mental health around how that funding that was allocated in the budget for increased access to mental health services.

Dr McCarthy : Yes. My colleagues in that outcome will be able to speak about that in more detail, but there has already been quite a lot of consultation on the guidance material that will be provided to the PHNs in relation to how the measure is rolled out.

Senator SIEWERT: Okay, I'll follow up with them later on.

Ms Jolly : I will just add to that they came to the last NACA meeting and gave quite a detailed presentation about where they're up to, and had quite a good engagement with the committee at that time.

Senator SIEWERT: Okay, thank you very much. Could I go on to the workforce task force report. First off, can you give us an update on what actions you're taking in relation to that report—where to from here?

Ms Beauchamp : Can I just confirm it's the John Pollaers task force?

Senator SIEWERT: I beg your pardon, yes, sorry.

Ms Beauchamp : Okay. I just wanted to check.

Senator SIEWERT: I was making an assumption you knew what I was talking about, sorry.

Ms Beauchamp : There has been significant work going on, obviously, and it has continued to be led by John Pollaers. What the government expects is that the industry itself look at how to improve the quality of the workforce, but I'll ask Dr McCarthy and Ms Grinbergs to go through some of those details.

Dr McCarthy : As you know, Mr Pollaers will continue to work with the industry. He worked with the industry in the development of the report, and the government has since asked him to take that forward with industry to ensure that he's assisting them to drive what is, as he has said, a strategy for industry to be driven by industry. I know that he has already met with industry representatives. You will recall, Senator, that one of the actions related to the Aged Services Industry References Committee. The members of that committee were announced today in a joint announcement by Minister Cash and Minister Wyatt, so that's now kicking off. I will ask Ms Grinbergs to provide any more information on updates.

Ms Grinbergs : Along with the measures that Dr McCarthy has just mentioned, there are a range of activities across a number of the other strategic actions that are occurring in other areas, including through the MBS review, for example, and also work looking at research in other areas.

Senator SIEWERT: What are the areas of research that have been undertaken?

Ms Grinbergs : We've been looking specifically at what work has been occurring through the Dementia and Aged Care Services Fund in the past, and what we might look at directing funding towards in the future in terms of investment that will support the workforce.

Senator SIEWERT: Okay. What time line have you got on that?

Ms Grinbergs : We don't have a specific time line at this point. There's no specific time line that has been set for us in that regard.

Senator SIEWERT: What levels of costing has been carried out in terms of looking particularly at staffing levels, training and qualifications? Have you done any costings around workforce and, particularly, has Professor Pollaers done any work there?

Ms Grinbergs : Are you asking: did the task force undertake any costings?

Senator SIEWERT: I didn't understand that they had—not that are publicly available.

Ms Grinbergs : That's correct. The task force itself didn't undertake any of that sort of analysis.

Senator SIEWERT: Yes, that's what I understood.

Ms Grinbergs : There's a range of submissions that were made. For example, there's a submission by StewartBrown, which is publicly available—

Senator SIEWERT: Yes, I'm aware of that one.

Ms Grinbergs : where they've modelled a series of costs.

Senator SIEWERT: Yes. Have there been any others done or have you commissioned any others?

Ms Grinbergs : Not that I'm aware of.

Dr McCarthy : Not that we're aware of, Senator.

Senator SIEWERT: I will be really clear: none have been presented to government? Other than the StewartBrown one in the submission, which I'm aware of, have any others been done by government or presented to government?

Ms Grinbergs : Specifically related to the workforce? Not that I'm aware of.

Senator SIEWERT: That leads me to the next question. When you say, 'Not specifically relating to workforce,' have others been?

Dr McCarthy : Obviously, we cost measures as a matter of course through the course of the year.

Senator SIEWERT: Yes, but have you commissioned any other work on costings related to any aspect of the task force report?

Dr McCarthy : No.

Senator SIEWERT: So no further work has been done on the overarching cost of the workforce, other than the StewartBrown work?

Ms Beauchamp : No, not yet, and we're waiting for the outcomes of what John Pollaers is looking at. But, of course, now with the royal commission, with the focus on staffing quality, that will also factor into any future considerations that government might want to have.

Senator SIEWERT: Do I take from that that you may not pursue that, then, until after the royal commission?

Ms Beauchamp : Pursue what?

Senator SIEWERT: Pursue further work and costing on workforce until after the royal commission?

Dr McCarthy : I don't think we can pre-empt—

Ms Beauchamp : No. I think they will obviously be decisions for government. It's very clear that the Prime Minister and our ministers have said that the reform work will continue. And it will continue, and we'll wait for the outcome of the John Pollaers work around quality of the workforce. As Dr McCarthy said, I think a reference group has been established this morning as well to look at the skills of the aged-care sector workforce. So I think we'd be pre-empting—it'd be too early to do any work on providing any advice to government at this stage.

Ms Jolly : Senator, I just wanted to ensure that you weren't hearing from this that we're not progressing the measures under the workforce task force report. For example, on recommendation 9 around strengthening the interface between aged care and primary acute care, there is work happening at the Commonwealth-state level around ageing and aged care, and there's quite an active discussion around how those interfaces will work going forward. I just wanted to ensure that, whilst we're having a discussion about costings, there is actually work progressing through the recommendations of this report that are relevant to the Commonwealth. It's just not in a formal answer to your previous question.

Senator SIEWERT: Is it possible to take on notice, then, where things are up to against each of those recommendations? I'm aware I'm going to run out of time.

Dr McCarthy : Yes.

Senator SIEWERT: That would be great if you could take that on notice. I want to go back to the work of Professor Pollaers. Is there a document or something that outlines the nature of the work he's continuing to do?

Ms Grinbergs : No, not at this stage.

Senator SIEWERT: So what is he doing. I think it's good that work's continuing; I just want to know, more precisely, the nature of the work that he is doing.

Ms Jolly : At this stage Professor Pollaers has been working with the minister's office and the peaks to really define what it is that you're asking for and to look at how to take forward the industry actions under the plan, of which are the vast majority. So it's really a negotiated discussion. It's not that government has said, 'This is exactly what we want you to do by this particular date.' Those discussions, really, are happening and we're working with the minister's office and then with John and others on how to then define that and take that forward.

Senator SIEWERT: Okay, so there will be more form around it once those discussions have been held?

Ms Jolly : Well, the minister's office has been leading some of those discussions, and we continue to support them in what they would like us to do in terms of supporting the work that John's indicating he's doing.

Senator SIEWERT: It's interesting to note that the reference group was announced this morning; I haven't yet seen that. Could you provide us with a link to that? That would be useful, if that's possible.

Ms Jolly : Yes, sure.

Senator SIEWERT: Thank you. In terms of the actions that you've taken on notice to report against, are you setting timelines on some of those and, if so, could you include that, please?

Ms Jolly : Yes, we can.

Senator SIEWERT: Okay, thank you.

Dr McCarthy : Chair, I have an answer to Senator Polley's earlier question about the letter from Ms Collins, if I can read that in.

CHAIR: Yes.

Dr McCarthy : The letter that was tabled was responded to by the Assistant Minister to the Prime Minister, Steve Irons MP, and signed on 9 October, so there has been a response.

Senator POLLEY: So you did give advice then? Advice was sought from you?

Dr McCarthy : Well, I think as we explained, it was a letter to the Prime Minister copied to Minister Wyatt. It's been responded to.

Senator POLLEY: So you didn't actually give any advice on the letter?

Dr McCarthy : We advise our minister.

Senator POLLEY: Right, so there was no advice—I just wanted to clarify that.

Dr McCarthy : Again, we'd need to check back. It would be usual for the Prime Minister's department to seek advice. So we might have provided information to the Prime Minister's department, but you'll appreciate we don't provide advice directly to the Prime Minister.

Senator POLLEY: Yes, I understand that, but you'll take that on notice to see whether there was advice given.

Dr McCarthy : We can do that.

Senator POLLEY: That's great. I have one more question. It relates to the announcement today of the new safety and quality commission. It will increase the unannounced visits. I was just wondering whether any of those will be after hours or at night or on public holidays. Since Minister Wyatt has had the responsibility for the Aged Care portfolio, has the department ever briefed him on how the assessment teams operate, including at what times, at residential aged-care facilities?

Ms Beauchamp : On the first part of the question, in terms of the announcement today and the new commissioner, I mentioned the strengthening of the new commission. Of course, now that it's combining the three functions, it will look at what it needs to do around after-hours visits on public holidays and in the evenings, and that will be taken on board. In terms of advice that Mr Ryan has provided to the minister about the prevalence of the visits, I'll hand over to you, Mr Ryan.

Mr N Ryan : Thank you, Secretary. We have never advised the minister in terms of trend data or performance as an overall period of time. We will have advised the minister and his office from time to time if there was a particular home of concern where we did an unannounced visit on a particular evening or weekend. But, as I understand your question, it is: is that like a dataset that we provide to the minister and/or to the secretary? We don't.

Senator POLLEY: So you haven't provided any information or advice to the minister in relation to having out-of-hours assessment teams go in, even following the Four Corners program?

Mr N Ryan : I think I've answered the question: other than specific advice to the minister or his office around particular activities related to a home, or a particular concern. That is advice that we have and do provide on a regular basis. As for there being a dataset that says, 'X per cent' or, 'Y per cent of activities are conducted after 5 o'clock at night or on the weekend', we have never gathered or reported that or advised the minister on that data in that form.

Senator POLLEY: So you've never given him any advice that you needed additional funding to carry out those out-of-hours, weekend and public holiday assessments of unannounced visits?

Mr N Ryan : We provide regular advice and we work very closely with the department to make sure that we have adequate resources to undertake our work. Those are ongoing discussions, as with any statutory agency like ours. I've never had that specific conversation, because the way that we administer our funding is relative to risk, volume and broader activities. That's not a specific lens that we do, other than in determining risk, which team and what time we should go, and that's on a case-by-case basis.

Senator POLLEY: I have some final questions for the Aged Care Complaints Commissioner—after all, you've been here sitting through this. Can you give us an update on the number of full-time equivalent staff working in your agency?

Ms Lamb : In the last figures I saw, which I think are very recent, we have something like 154 FTEs. We try to maintain 157, but it's a constant struggle. There's a lot of churn.

Senator POLLEY: Did the agency provide any briefings or advice to the department, the Minister for Health or the minister for Australian seniors, or their staff, prior to the Four Corners program airing?

Ms Lamb : We're constantly, like the other agencies, providing advice relating to my functions. Under the Aged Care Act, if either the secretary or the minister asks for advice relating to my functions, I'm required to provide it. It's an ongoing process. I couldn't pinpoint anything specific to a request relating to Four Corners.

Senator POLLEY: Have you provided any briefings or advice to the department, the Minister for Health, the minister for senior Australians, or their staff, about the need for the government to hold a royal commission?

Mr N Ryan : That's not an area I would venture into. As a statutory officeholder that's a policy decision or a political decision.

Senator POLLEY: With the growing number of complaints across residential and home care, when do you determine is the best time to provide your concerns to the department or the ministerial office?

Ms Lamb : We focus on trying to resolve the matters ourselves. That's our remit. Obviously, I operate on a no-surprises basis, so, if I have particular concerns about trends I'm seeing and things like that, then obviously I make both the department and the minister aware of those things. Again, it's an ongoing conversation that happens and it's happened with previous ministers I've worked for, too, or worked with.

Senator POLLEY: Do you have regular meetings with the Minister for Senior Australians and Aged Care and the Minister for Health?

Ms Lamb : I haven't met the Minister for Health very often, but I do meet with Minister Wyatt quite regularly and have also done so with his predecessors.

Senator POLLEY: Do you meet regularly with the department?

Ms Lamb : Yes.

Senator POLLEY: Would you be able to provide the dates of the meetings that you've had with the Minister for Senior Australians and Aged Care?

Ms Lamb : Yes, we can take that on notice.

Senator POLLEY: In relation to the increased number of complaints that you've had, is it something that you're able to cope with, with the staffing levels? Have you sought any additional funding?

Ms Lamb : We have coped to date, but, in recent times, obviously, if you've seen the annual report, you will have seen that we've had a very significant increase over time. I have been, as I indicated earlier, in ongoing discussions with both the department and the minister. As you may be aware, in the recent budget announcement, there is some funding for complaints. There are still active discussions going on with the new commission.

Senator POLLEY: You made a comment earlier in relation to the churn that's happening. Can you explain to us why that's happening?

Ms Lamb : It's a bit the nature of the business. Complaints, as you'll appreciate, is a pretty difficult area to work in. There are very high stakes, there's a lot of emotion involved and there's significant time and investment spent in training people. It suits some people more than others. Even those who are extremely good at it need time out. I've worked in previous complaints roles and it is the nature of the game to some extent that you do have a large amount of staff turnover, and that's been my experience here.

Senator POLLEY: Has that increased since the airing of the Four Corners program?

Ms Lamb : No, not to my knowledge. Again, it's an ongoing thing that we're constantly dealing with. We are recruiting all the time with the support of the department.

Senator POLLEY: What would be the churn rate at the moment?

Ms Lamb : I'd have to take that on notice. We can certainly give you that figure. To my knowledge, it hasn't changed significantly. It has been high and higher than the department's rate for a while.

Senator POLLEY: Thank you very much.

Proceedings suspended from 13:00 to 14:01

CHAIR: I now call the meeting to order. We are starting with outcome 1. Senator Murray Watt.

Senator WATT: I will begin with questions about the Medical Research Future Fund. You'll remember that we dealt with this at the last estimates round as well and there were some questions on notice taken, which I think have now been answered. I will take you to one of those questions, SQ18-000730. I don't know if you've got copy with you, but it basically asked for a breakdown of commitments that had been made from the fund. Are you familiar with that one? Yes? I think that provided a breakdown—presumably, as of the date of that answer, which I think was in June. Has the government made any further commitments from the MRFF since that response was provided in June?

Ms Edwards : There have been no further allocations of funds. There have been some decisions made about suballocation of things within the things already committed in the streams. But, no, the total of $1.7 billion is still correct.

Senator WATT: How much has that fund got in it all up?

Ms Edwards : This is a Finance question, so I can only go so far—

Senator WATT: Yes, I remember that.

Ms Edwards : but the estimate is: by the end of '18-19, $9.471 billion. That is the estimate that Finance have told us.

Senator WATT: Could you say that figure again?

Ms Edwards : $9.471 billion by the end of '18-19 is the estimate that the Department of Finance indicated.

Senator WATT: That's the amount that's available for allocation?

Ms Edwards : That's the amount that's in the whole of the fund, going for a total of $20 billion in '20-21. And then there are amounts available for distribution, which is a different amount.

Senator WATT: Up until now, about $1.7 billion of commitments have been made from that fund?

Ms Edwards : That would be the amount of it, yes.

Senator WATT: And nothing further since the date of that question on notice?

Ms Edwards : No.

Senator WATT: I don't think your response included one of the things that I had asked for, which was a breakdown, an annual profile, of each subprogram—for example, a breakdown of the $20 million for Mackenzie's Mission, which is a part of the $500 million Genomics Health Futures Mission. Is it possible to get a breakdown of those subprograms, even if that's on notice?

Ms Edwards : We can certainly take it on notice. Some of these items may not have had breakdowns arrived at yet because of work going on, but we can certainly take on notice to see what actually has been available.

Senator WATT: If you could do that, that would be great. As much as you're able to for subprograms. Has the government contracted anymore funds since this response?

Ms Edwards : I think that is a yes, although I wouldn't be across the detail of exactly what has happened in that time frame.

Senator WATT: Just so I understand the stages here: the fund has been created, it has about $9 billion available for allocation—

Ms Edwards : The fund has been created. It has about $9 billion in it currently. There's an amount earmarked as possible disbursements. Disbursement amounts are allocated against particular priorities, following the strategy and the priorities sent by the advisory board. Then, within those allocations, actual arrangements are put in place to have money given to researchers and so on, and those are through a variety of mechanisms depending on the nature of the research and the allocation.

Senator WATT: There have been some contracts signed since that response was provided?

Ms Edwards : My understanding is yes, where it's an ongoing process, but I don't have that detail, Senator. Perhaps we could take on notice what—

Senator WATT: I'm happy for you to take some details of that on notice. Do you know the dollar value that is being contracted?

Mr McBride : We're at various stages in the process for various programs. For example, rare cancers, rare diseases and unmet need went out to tender on 24 June and closed 16 August, but we're still finalising that. Whereas, for example, $199 million in project funding for a wide range of health challenges including cancer, cardiovascular disease, stillbirths and mental health has been announced, and we're now going through a grant process. All those things that were announced, and that we went through in the last estimates, are at various stages of rolling out to contract.

Senator WATT: I just had another look at the question on notice. You had table 2, which was funds contracted on or before 18 June 2018. I suppose what I'd ideally like to get today if I can is what the total is since. I see you have a total there of $69.7 million for funds contracted on or before the 18th. I wouldn't mind getting an updated figure for that.

Ms Edwards : We don't have it here, but we will see whether we can come back to you today on that, as at the end of September or sometime. I'm not sure how it works, but we'll have a look at it.

Senator WATT: In an ideal world, if you can come back to me today with the total and then if you can take on notice the breakdown of the greater detail of what those contracts have been for.

Mr McBride : So total contracted since budget or total contracted overall?

Senator WATT: I think I'm mainly interested in since 18 June. Do you know how much has been contracted—this table says 'funds contracted on or before 18 June 2018'. Does that go back to the inception of this fund?

Mr McBride : That's my understanding.

Senator WATT: If you were to give me the extra that has been contracted since then, we're probably going to get the total. Have any stakeholders expressed any concerns to the department about the governance or politicisation of this fund?

Ms Edwards : We don't have any stakeholders. We have very close engagement with members of the research community and we talk to them, both through the set processes and a one-off. Myself, Mr McBride, Ms Kneipp and various members of our staff are talking to people all the time. It's certainly true to say that people might raise issues about whether they do or don't get access to funds. In terms of the specific question—

Senator WATT: Have any stakeholders, whether they be researchers or others, in particular expressed concerns about the involvement of the minister in deciding priorities or particular projects that should be funded?

Ms Edwards : Not to me.

Ms Kneipp : Contestability is really important in the field of funding research. Australia's reputation is based on research excellence. The act itself, of course, is limited to funding research. The board developed a set of funding principles in 2016 that the government subsequently endorsed in 2017. Those principles talk about the importance of contestability. When programs are designed, the program design features work with the act and with those principles for funding that the board has.

Senator WATT: What I'm asking is whether you are aware—for instance, some stakeholders have expressed concerns to the opposition about some disbursements, saying they were captain's calls by the minister. No-one has heard similar concerns in the department?

Ms Edwards : Senator, at the end of the day, the decisions are a matter for the minister. There's a very complex process that we go into in order to provide advice, including through the advisory board. It wouldn't surprise me at all that some researchers or other members of the community might not like where the final decision goes or think something should have been done in a process in a different way. We certainly have discussions about those sorts of things.

Senator WATT: In any grant program there are always going to be winners and losers. There are going to be people who are going to be upset that they missed out. I see that as quite a different thing from stakeholders expressing concerns about a minister or a minister's office getting involved, getting their hands dirty and really directing where the funding is going. Has anything happened like that?

Ms Edwards : Certainly nothing like that formally that has come across my desk or that I'm aware of. The main thing I get from researchers is great enthusiasm at the huge amount of investment that has been made and great enthusiasm to get involved for their research and so on. Obviously, there are conversations happening all the time. I couldn't say whether that particular issue came up or not, but certainly no-one has written or raised formally with me, or, I believe, the secretary, anything to that effect.

Senator WATT: You'd be aware that the Australian Medical Research Advisory Board provides guidance to the government about this fund's strategy and priorities. Have any members of the advisory board expressed concerns about the governance or politicisation of this fund?

Ms Edwards : That's the board that Ms Kneipp was talking about just now in terms of providing strategy and priorities.

Senator WATT: Never been raised?

Ms Beauchamp : Not with me.

Ms Kneipp : Not formally, no.

Senator WATT: You don't know, either, Mr McBride?

Mr McBride : I've only been in the department two weeks. I don't know anything at all!

Senator WATT: Where did you come from? You were at DSS, weren't you? I was trying to remember.

Mr McBride : If you've got any questions about DSS!

Senator WATT: I'm very pleased that you stayed within the community affairs committee, so I still get the chance to ask you questions.

Senator SINGH: You just said 'not formally'. Does that mean there have been concerns raised informally?

Ms Edwards : I think I was just saying to Senator Watt that we have all sorts of conversations all the time, and there are definitely people saying, 'You should have done this one differently,' or, 'This one should have been contested' or—

Senator SINGH: It's not about that. This is about governance and process. We're talking about something fairly specific when we talk about governance and the process of—it's not just any old concern in relation to what we're specifically asking.

Mr McBride : The priorities are published, and then you contrast the minister's decision against those priorities that have been independently advised. That gives a level of transparency and accountability that I think is appropriate. If you compare the two, the announced measures have been in line with the priorities.

Ms Kneipp : I think, as Senator Watt said, there are always people who are disappointed with the outcome of grant rounds. The thing with the MRFF is that it's creating lots more opportunities for researchers to compete and bring their ideas forward.

Senator WATT: Leaving aside any complaints having been made to the department, are any of you aware of any concerns about governance or politicisation being raised with the minister?

Ms Edwards : I'm not aware of any.

Senator WATT: Minister, are you aware of that?

Senator Scullion: Well, no, I'm not aware at this point. That would clear: the reason why I wouldn't be aware is that I haven't had a conversation with them about this. Can I say, you're probably at a bit of a disadvantage. If either of you have a particular research grant that someone has taken umbrage with, please, if you want us to ask about that particular matter, perhaps a question on notice around that specific issue would be better to deal with it. No, I haven't had any.

Senator WATT: I will certainly have a think about that. Maybe, Minister, if you could take on notice whether any concerns have been raised with the minister or his office about the governance or politicisation of this fund, particularly around the minister's involvement in decisions regarding the allocations from the fund?

Senator Scullion: Certainly.

Ms Edwards : Noting of course that the decisions are matters for the minister.

Senator WATT: Sure. You would hope under advisement, though. That's the way it's supposed to happen.

Ms Edwards : There's a very large structure around the strategy, the priorities and the advice from the department; all sorts of round tables and advice.

Mr McBride : Consultation.

Ms Edwards : Plenty of advice.

Senator WATT: Is anyone in the department aware of any assurances the minister has given the board or others that he won't make any more so-called captain's calls?

Senator Scullion: I don't think it has been established that he's already made any, Senator.

Senator WATT: So it is a separate—

Mr McBride : Given that every decision is a decision for the minister, it is hard to characterise what would be—

Senator WATT: I think the objection is to decisions that the minister is making in isolation from advice that he's receiving.

Ms Edwards : Not aware of any such assurance or conversation to that effect.

Ms Beauchamp : I think the fact that we're going through a quite substantial consultation process on the next round of priorities probably reflects the minister's desire to get as much input from the research community as possible—public forums have been held, we have a number of submissions and I think more than 1,000 stakeholders have been engaged in the overall consultation process on the next priorities, which to me obviously indicates that we need to get engagement from the research community in terms of the next wave.

Senator WATT: Could you take on notice for me whether the minister has provided any assurances to the board, either verbally or in writing, that he won't make any more so-called captain's calls regarding funding allocations?

Ms Beauchamp : That is quite a—

Senator Scullion: If we have to accept the premise—you understand that, Senator—that there have been captain's calls made, and I don't think anyone has established that. If you like, we will check with the minister's office whether or not any complaints around those matters you articulated before have been made.

Senator WATT: Thank you. And whether any assurances have been given by the minister that that sort of thing won't happen in future.

Ms Edwards : We're a bit perplexed, because the legislation says he's to make the decision, so he's not going to give an assurance that he won't make any more decisions.

Senator Scullion: He is making the decision—

Senator WATT: I think the point is: in isolation from advice.

Mr McBride : So, you would say: inconsistent with the priorities?

Senator WATT: Yes.

Ms Edwards : We will take that on notice.

Senator WATT: That would be great.

Senator Scullion: We will do our best.

Ms Beauchamp : The premise of the question is that he has made captain's calls, in your terms. I think that's the first thing that needs to be established.

Senator WATT: Captain's calls are bringing back knighthoods without the rest of your cabinet agreeing with you. In a health sense it's probably ministers making decisions separate to advice that's been received.

Ms Edwards : We can take on notice whether the minister has given any assurance about making decisions without advice or in contradiction to the strategic priorities.

Senator WATT: That's probably a good way to put it.

Senator GRIFF: I'd like to refer to the MyHospitals website, which was set up around eight years ago, I believe.

Ms Beauchamp : We're still in outcome 1. I want to get the right people up here.

Ms Edwards : There is nobody in the room at the moment who—

Senator Scullion: Perhaps if you can ask some questions, there might be someone—

Ms Edwards : I don't think any of us were around eight years ago.

Senator GRIFF: I'm not going back eight years, I'm coming to now. It was set up eight years ago but it continues to list a large number of important safety and performance indicators as 'under development', which have been there since its inception. Mortality indicators are one of the indicators listed as 'under development'. Is there a reason why Australian patients are effectively being kept in the dark as to whether the hospitals they visit have a worse mortality outcome than the national average?

Ms Edwards : I think our first step is to have a look at this website and see if it's one of ours and, if it is, find out who manages it. We certainly are not keeping anyone in the dark about anything. We need to get to the bottom of—

Ms Beauchamp : It is the Australian Institute of Health and Welfare.

Ms Edwards : It is a website managed by the Australian Institute of Health and Welfare, which is a statutory authority. I think they were here in the discussion earlier this morning and then they were let go and were expected back sometime later this afternoon. Or you could put them on notice.

Senator Scullion: We might be able to assist. Can we try some questions. We can certainly get them back here as soon as we can. Perhaps if you can just have a discussion about what you'd like to know about that site and see how we go.

Senator GRIFF: It's only that the majority of indicators there are 'under development'. Being under development for eight years is a very long time. If you look at that site now you will see that 'unplanned readmission rates', 'mortality' and a whole series of other categories there have been under development. When are they going to show this information, or, if it's not going to be provided, don't list it as being under development, because it's been under development for a very long time.

Ms Beauchamp : We'll have to see where that information is currently held. I know there are a number of PDF files there that have got December 2017 and others, but I think we'll wait for the Australian Institute of Health and Welfare to come back. They were here at 9 o'clock this morning, and I think they're coming back under outcome 4.

Ms Edwards : They are.

Senator Scullion: We'll make sure we get that question to them so they can come back armed.

Senator GRIFF: This next question might also fall under their area, but I'd like to ask it to you as well. At the COAG Health Council meeting in August, ministers agreed:

… to commit to create a data and reporting environment that increases patient choice through greater public disclosure of hospital and clinician performance and information.

Those are very positive words, but we've now been waiting over six years for those indicators as per 'under development'. Have there been concrete steps the department has taken to implement the COAG commitment for public hospitals, private hospitals and clinicians?

Ms Edwards : To be clear, is this a resolution from the most recent—

Senator GRIFF: August.

Ms Edwards : There's a lot of data work being done with the AIHW, the department and the states and territories. The AIHW, as you've pointed to, has a website. They're doing a lot of projects. One of the things we're doing is looking at collecting data on primary care to try to have a repository of that and on making sure that our hospital data for the states and the Commonwealth work together to make sure that that's a seamless data asset. We use AIHW as an independent data expert to work with us on those sort of things. We totally recognise that data—and this is something that our COAG health ministers recognise—is absolutely fundamental to actually doing improvements and reforms across the health system. So a lot of the policy work we're doing in primary care, in hospitals and on funding arrangements across the board are based on that.

There are very important data arrangements that work in the department so that we can give access to researchers to de-identify de-aggregated data. So there's a lot of work and safeguards that go on in relation to that for the MBS and PBS. There's also work across other departments, such as with the Department of Social Services and the Department of Education and Training, to see the extent to which we need to share data and match it and so on in a very careful way. As the minister has said, the Institute of Health and Welfare will be here later this afternoon, and they're obviously the absolute experts on data management. We work closely with them. But were there some more specific questions you had for us at this point?

Senator GRIFF: It's really about stages. In August it was agreed. You have a website that's been there for eight years and, for at least six-plus years, has been under development. My understanding is the AIHW only reports currently on staph bacteria and nothing else for hospitals other than financial information as well. Do there's a whole lot of information that I imagine is available, and it would make sense to start publishing it so patients can see the status of where they're going to be.

Ms Edwards : I hear your concerns. I think we need to ask the institute about that website and how long that has been in development, because I'm not across that. It is certainly a really high priority. For example, the data needs across the Commonwealth and the states is one of the hot topics we're talking about in the development of the new health agreement going forward to make sure that we can increase the data assets and increase the sharing of them in a safe and secure way. We've got pilot projects going on in collaboration between states, the Commonwealth and the institute about how we match up data, follow patient pathways and so on. It's a huge area. I'd say we definitely take it seriously. Ministers take it seriously in all jurisdictions. There's a high commitment and a high resource allocation to it. The institute will be able to answer your specific questions about that website. The work that was agreed in August is an important piece of work, but it's one piece within a whole suite of data work that's been done in collaboration between states, territories and the Commonwealth and that we're moving ahead with quickly and carefully.

Senator GRIFF: I think the important thing is that, while states and the Commonwealth sharing information is great, it needs to be made public. That's the most important part of this whole exercise.

Ms Edwards : It needs to be made public in a safe and secure way, and that's why we have quite an important process to release data for research purposes and so on in a de-identified, de-aggregated way. We need to be extremely careful, as you'd be aware, about how we make data public. That's one of our key considerations. But, yes, we need to be transparent on data, to the greatest extent we can, and we need to give researchers and others access to that data so that they can really drive health improvements in policy.

Senator GRIFF: There needs to be a publicly searchable database that's very much not just for researchers. I think that's the key thing.

Ms Edwards : To the extent that it's possible, without any risk of revealing personal information.

Senator GRIFF: Yes.

Senator Scullion: There are four areas, it appears as well, that have been developed and they are in costs and time of waiting—so, costs of cancer and costs of acute admissions, and those sorts of matters. But, you're quite right. Hopefully, whoever is arriving will have some answers to that one.

Senator GRIFF: Minister, are you aware of whether the health minister has directed AIHW to make this a priority and set a target date?

Senator Scullion: No, I'm unaware of that. Perhaps you can ask the department as to whether they are aware.

Ms Edwards : I don't know—

Ms Beauchamp : I think, as you mentioned, it came through COAG. There has been lots of discussion with the states and territories about sharing of information. In the context of renegotiation of the next agreement, it was agreed the AIHW would collect all of this information. The states and territories would feel much more comfortable if AIHW did it rather than just providing information direct to the department. It is a priority for all ministers in the context of finalising the next healthcare hospitals agreement.

Senator GRIFF: Thank you. Chair, I have some My Health Record questions next. Do you wish to stay where we are?

CHAIR: That is all right, we will come to Senator Di Natale.

Senator DI NATALE: I also have My Health Record questions.

CHAIR: Okay, so we will go to Senator Watt.

Senator WATT: We also have some My Health Record questions. I think we all have My Health Record questions, but Senator Di Natale might have other questions in this outcome as well.

Senator DI NATALE: No, I don't.

CHAIR: We will go to the next outcome. Senator Steele-John, do you have questions in outcome 1?

Senator STEELE-JOHN: Chair, I do apologise. I have questions for the National Health and Medical Research Council. I'm failing to see which outcome they are in. Are they after or—

Senator Scullion: Was that outcome 1?

Ms Edwards : The NHMRC was not called to estimates on this occasion.

Senator Scullion: But, Senator, you can still ask the questions and we will do our best to try to provide those questions on notice.

Ms Edwards : You can put them on notice for the council.

Senator WATT: Which outcome do they fall under?

Ms Edwards : Outcome 1—we're in the right outcome.

Senator STEELE-JOHN: What would be most beneficial: would it be better for me, since they're not here, to put them on notice, in writing?

CHAIR: Yes, I think so.

Ms Edwards : That would be convenient to us, Senator. You could try us if you want to.

Senator STEELE-JOHN: I could try you. Senator Scullion, do you have a preference?

Senator Scullion: You can do a bit of both.

Ms Edwards : You could ask the first question.

Senator Scullion: We're keen to provide information. If we don't have it, we'll take it on notice.

Senator STEELE-JOHN: All right. Firstly, a really basic one that you might be able to help with, Minister. On 10 September, the parliamentary friends group of ME/CFS wrote to Minister Hunt regarding research that we had been presented, as a parliamentary friends group, in relation to the recent breakthrough research by Dr Staines and by Griffith University, Sunshine Coast, in relation to this condition. I wondered whether you might be able to provide me with an update as to when we might be able to get a response from the minister?

Ms Edwards : Thank you, Senator, for explaining the sorts of questions you've got. Those are things we are aware of, but they really are detailed matters for the NHMRC, so I think it would be more convenient to put them on notice.

Senator Scullion: That one we will put on notice, but if you have others—

Ms Edwards : If that's the general theme of them—very detailed ones—we wouldn’t be able to answer them.

Senator STEELE-JOHN: No, sorry. I might have misspoken. I'm referring to a letter that the committee wrote to the minister. That wasn't actually a question for the NHMRC.

Ms Edwards : We can take that on notice—

Senator Scullion: We'll take that on notice.

Ms Edwards : and we'll liaise with the NHMRC to the extent required in answering that.

Senator STEELE-JOHN: If that is considered a detailed question, I will put the rest of these questions on notice. Thank you.

Senator WATT: It sounds like all of our remaining questions relate to the My Health Record. Mr Kelsey, I suspect most of these questions will come to you. The last we heard—I think this was at the Senate inquiry we had recently—was that about 900,000 people had opted out of the My Health Record. What's the current figure?

Mr Kelsey : The current figure is 1,147,000.

Senator WATT: So now over a million people have opted out from My Health Record.

Mr Kelsey : That's correct.

Ms Edwards : What's happened since the last occasion—remember, it was about three per cent. As we had expected and hoped, the rate of opt-out has trended down quite significantly. It's still coming in. We're getting close to the end of the opt-out period. We're still well under five per cent. So we're certainly on track to where we had expected and where the minister indicated he wanted us to land.

Senator WATT: On this point about coming to the end of the opt-out period, you're probably aware that last week this committee recommended a 12-month extension to the opt-out period, but that recommendation was immediately rejected by the minister. Probably, Minister, I need to put this to you: why is the government refusing to follow this sensible suggestion?

Senator Scullion: I can understand that you would believe it's a sensible suggestion, Senator, because it's your suggestion. Could I just indicate that we wanted a closure of the database in so much as we knew that the day after the books are closed anyone can close their My Health Record in any event, because the process is there at any time to say, 'I want to opt out now.' For those people in the future, there's not an opt-out date that is not available. We needed to close those in order to give the benefits of the My Health Record to the wider Australian population. It is so important to note that people can opt out the next day. The very next day, the following day, they still have an opportunity, as anyone does, across the process, to exercise their right to opt out. That is the reason that I understand the minister decided he would not follow specifically your advice.

Senator WATT: Just remind me: the current opt-out date is 15 November—is that right?

Ms Beauchamp : That's correct.

Senator WATT: When the minister previously extended the opt-out period for one month, he said that it 'gives Australians more time to consider their options as we strengthen the 2012 My Health Record legislation'. He linked that opt-out extension to the new and improved legislation. We had been told that that legislation would be passed by now, and that was part of the reason why we rushed our inquiry. Of course, that hasn't happened, and we now won't be sitting until a couple of days before the opt-out period closes. If it was so important to extend the opt-out period on the basis of the new and improved legislation, why wouldn't the government extend the opt-out period at least until a point after the legislation will be passed?

Ms Edwards : On the timing, in the period in which people can opt out—although, as the minister says, they can continue to leave the system at any time—the records won't be immediately created. There's about a month-long period after that in which paper forms, which we have talked about before, have to be reconciled and so on. There's actually a period until a date in December. The legislation will be back before the parliament well before then, we anticipate.

Senator WATT: You'd be aware that the opposition and others have floated a range of amendments that we think need to be made to this legislation to give people greater protection. Wouldn't it be a better way to go to wait until those protections are made and the legislation is strengthened before people face that cut-off date for an opt-out?

Ms Edwards : The amendments and the matters are for another day—

Senator WATT: It's for the parliament, yes.

Ms Edwards : All of the matters in the report are being considered. The legislation will continue in the parliament shortly. The opt-out period ends on 15 November, but then there's a month's period before any records are created. Obviously, the report has come down, it's being studied carefully in the department and advice will be provided by the agency. The key issue that the minister made clear in deciding not to further extend the opt-out period is the desire to make sure people have the benefit of the My Health Record as quickly as possible.

Senator WATT: Minister, does the government contend that the existing My Health Record legislation is now strong enough for the rollout to proceed, even though it hasn't been amended yet?

Senator Scullion: My understanding is that there'll be consideration not only of the report of this committee, which is a multiparty committee. And I understand there'll be consideration of improving the privacy elements of that. Certainly there's been a lot of input from stakeholders, from the privacy commissioner to the President of the AMA, which you'd be well aware of. I would think that the government—and someone can yell at me—will be considering amendments to the legislation to take into consideration some of those matters.

Senator WATT: Yes. That is the exactly the point, Minister: there have been a range of stakeholders providing some really constructive suggestions about how that legislation can be strengthened. The opt-out period closes on 15 November. We may not even get to debate this legislation and the amendments before the opt-out period ends.

Senator Scullion: On 16 November you can still opt out—that's the point. In terms of just this issue of opt-out, we're just ending it so we can actually say: 'That's the demographic we're dealing with. We can move this forward.' If somebody says, for any reason, 'I've changed my mind; I want to opt out,' they can opt out whilst this process is going on.

Ms Edwards : Some important issues have been raised in the course of the public debate. There are some things in the legislation already before the parliament. There are some additional matters in the Senate report. We're interested in all of those things, in terms of both potential legislation that might be preferred and administrative processes that the agency's looking at hard—to protect victims of domestic violence and all those other issues that are raised. This is a balance in making sure that as many Australians as possible can have the real health benefits, to save lives, through having a broad-spread My Health Record.

It's important also to remember the context. There are already more than six million people with My Health Record. Although I wouldn't for a moment say we don't take very seriously the concerns that have been raised—we do—there has not, to date, been any significant instance of the sorts of issues that have been raised. So we are confident that there are significant safeguards and standards in the existing legislation sufficient for it to continue, and we'll continue to look at improvement through the current bill, through the matters in the report and otherwise.

Senator WATT: Sure. But over a million people have now opted out, presumably because they lack confidence in the system.

Ms Edwards : For a range of reasons, no doubt—as they can. As the minister says, anybody who's concerned now can leave the system at any time.

Senator WATT: You'd be aware that both the AMA and the College of GPs have called for a further extension in the last week. Are those groups wrong to do so?

Ms Edwards : It's a matter of public discussion. Different views will be around. Those groups have also been really clear about the great benefits of My Health Record.

Senator WATT: You would remember that the opposition supports the concept of My Health Record as well. But it's now not only a Senate committee that has called for an extension. You've got two of the leading groups in the country, the AMA and the College of GPs, also calling for a further extension, and the government is just charging on.

Senator Scullion: No, what we've said is that it closes on the 15th; if you still want to opt out on the 16th, 17th or 18th it's still available to you. I'm not sure on what basis the AMA and the other organisations you've met have those concerns but, as we've indicated, we'll be seeking to clarify the My Health Records Act when it comes before parliament.

Senator WATT: In August, Minister Hunt justified the extension that he gave to the opt-out period at the time by saying it was a key request from the AMA and the College of GPs, so why is it that the minister listened to them then but he refuses to listen to them now?

Ms Edwards : I'm sure the minister's listening very closely to all comments being made and following debate. It's a matter of balance between the very great benefits that are to be gained by moving to a widespread My Health Record and responding to stakeholder concerns. We have to do all things at once—look at the things that have been raised; see what changes, administrative or otherwise, need to be made; and move towards a real step change in the way health works in this country.

Senator WATT: Has the minister, or his office, requested the department to work on any amendments or additions to the legislation in light of the recommendations of our Senate inquiries?

Ms Edwards : The minister has asked us for analysis of everything there and what options might be to either address them or not. We provided a range of advice on the things over months and months, including in relation to the report and including potential amendments. But it was generally advice on what's been raised and what we can or should do about it.

Senator WATT: So the minister has effectively provided the Senate inquiry reports to the department and asked for advice?

Ms Edwards : I think we got it straight off the website the minute it went up.

Senator WATT: Yes, I'm sure. He's asked for advice on the recommendations that were made.

Ms Edwards : It's an ongoing discussion. We've been providing advice and having discussions about this in an ongoing way. Whether there's a formal request to do it I'm not sure, but it's certainly our understanding that we're providing analysis and advice.

Ms Beauchamp : It's normal for the government to respond to such committee reports. Of course, we have been asked to look at the recommendations, and I think the minister wants not only to give due consideration to the committee reports but to maintain dialogue with other stakeholders as well. So I think he wants to take a very considered approach in terms of whether there should be any amendments to legislation, whether it needs to be clarified and what the minister said. So, yes, we're providing that advice.

Senator WATT: Has the department provided any advice that involves further amendments to the legislation?

Ms Beauchamp : We have provided options and advice, yes.

Senator WATT: But, to your knowledge, no decision has been made on that at this point?

Ms Beauchamp : The matter is currently under consideration.

Senator WATT: Okay. So you haven't been asked to progress any further amendments? It's a matter still under consideration?

Ms Beauchamp : Further amendments will be subject to the minister and the government, and the department quite rightly is providing options and advice on legislation.

Senator WATT: Okay. Back in July, the minister undertook to launch a new public information campaign about the My Health Record, and that now does appear to be rolling out with some advertisements starting to appear on TV. How extensive is that campaign?

Mr Kelsey : I'll take that. Can I invite my colleague Ronan O'Connor to come to the table, please.

Mr O'Connor : The communications campaign has ramped up for that additional month. You'll have noticed that the TV campaign started last Sunday. That's running for a period of three weeks until the end of opt-out. It ran last week, it's running this week, there'll be a break, and then it will run for the last week of the opt-out period.

Senator WATT: That's the TV component of it?

Mr O'Connor : Yes.

Senator WATT: My recollection is that there were other components for this as well, weren't there?

Mr O'Connor : Yes. We have increased paid media in relation to digital. We've also increased slots within AM radio, and we have also continued with the community engagement that has been happening on the ground, which has been led by PHNs.

Senator WATT: And what's the overall budgeted cost of that campaign?

Mr O'Connor : Which component of the campaign?

Senator WATT: The overall communications campaign for the My Health Record.

Mr O'Connor : The overall communications element for My Health Record, just from a comms perspective, is $27.75 million. That can be broken down into a number of different components. In relation to the paid advertising campaign, it's $5.45 million. Then there have been additional costs associated with the additional month in relation to the extension, and that comes in just over $5 million.

Senator WATT: So it was initially $5.45 million for paid advertising—TV, radio, online, in newspapers and whatever else. But there's now an additional $5 million.

Mr O'Connor : As a consequence of the month's extension and the increasing communication, yes, just over $5 million.

Senator WATT: Okay. Sorry, Minister. Just for me to wrap up on this point about a further extension of the opt-out, you're right that people can opt out at any point into the future, but the problem here is that, if people don't opt out before 15 November, whether they like it or not, a record's going to be created for them. That's different to the system we've had up until now, where someone had to actively choose to have a record created for them. So the problem is that, whether I like it or not, I'll have a record created for me, and I might not know about it if I haven't seen this communications campaign. The Senate inquiry highlighted a whole range of problems with these records around privacy and other issues. So again I'd just ask you to give some consideration to a further extension so that the legislation can be passed and the privacy issues can be dealt with before people start having records created for them.

Senator Scullion: I will pass that view on to the minister.

Senator WATT: And as I said, it's not just my view; it's that of the AMA and the college of GPs as well.

Senator DI NATALE: I also have some questions around My Health Record. Can I ask about the polling or research that's been done amongst health providers? Do you have any information on that? Can you talk to me about what the nature of that work looked like?

Mr Kelsey : We have a whole raft of benefits realisation projects looking at behaviours.

Senator DI NATALE: What are they called: benefits realisation projects?

Mr Kelsey : Yes. To determine the impact on clinical quality and efficiency of—

Senator DI NATALE: It sounds a bit 'hollow man' to me: benefits realisation project.

Mr Kelsey : Yes. It's the normal phrase in this—

Ms McMahon : I can maybe add to that. We constantly monitor the impact of the My Health Record as feedback on whether or not we're actually achieving the sorts of benefits that the government would expect from this investment. It's measuring a range of implementations of the My Health Record—whether there are any changes in clinical practice or consumer behaviours. One of those projects is the polling to which you referred earlier.

Senator DI NATALE: How is that done?

Ms McMahon : We basically run surveys. We have undertaken two surveys with just over 500 clinicians.

Senator DI NATALE: How do you select those? Is that a randomised sample?

Ms McMahon : I'll need to take that on notice. We went to market and have selected a provider to do that.

Senator DI NATALE: Is that a cross section of all GPs? It's not a self-selecting group who want to participate in the survey?

Ms McMahon : No. I will take the methodology on notice.

Senator DI NATALE: I am assuming they're reputable and they have done that—you've got a good cross-section. I think we spoke about this during the inquiry and I don't know that we had any hard data, but if you have any hard data on that. What are some of the questions that were tested?

Ms McMahon : Some of the questions were—in using the My Health Record have you experienced any benefits?—and, if yes, there's a range of options. For example, have you changed your prescribing behaviour? Have you had an improvement in the way that you have managed the medicines of the patient? For a pharmacy, it asks if they've had any changes in dispensing. For a general practitioner, if they have changed the way that they would order a pathology test. One of the benefits we expect is that fewer pathology tests will be ordered if people are able to see them.

Senator DI NATALE: You obviously test general trust in the system and doctors' confidence that information will be kept private. Is that one of the questions?

Ms McMahon : Yes, one of the questions—

Senator DI NATALE: Are you tracking that? I'm interested in knowing whether there was a change at all over the recent public media attention, shall we call it, in terms of doctors and health care professionals trusting the system, and their concerns around privacy.

Ms McMahon : Yes. We did ask a question in the sample where—we asked the question in April and May and then in July and August.

Mr Kelsey : We're going to have to take that on notice. We included some summary results in the submission we provided to the Senate inquiry. There is some data. To remind senators of those results, in the first wave, which was the first polling we did, which is statistically weighted and demographically significant, 14 per cent of GPs surveyed reported not needing to order a pathology or diagnostic imaging test, because they were able to see a previous test result through the My Health Record.

Senator DI NATALE: On the percentage of health professionals who believe patient information will be kept private? I'm interested in the most recent survey results, both before and after the recent controversies, I'll call them. The percentage of health professionals who believe that it will be safe from unauthorised access. The proportion of health professionals who use it for themselves or for their families, and whether they'd recommend it to patients, family or friends. And on people's attitudes towards the system—whether they believe there are potential benefits—whether those numbers are tracking up or down. I'm very interested in the trends over time with each of those specific indicators.

Mr Kelsey : We'll take that on notice. Some of the questions aren't quite the same as the ones you've asked, but we'll provide you with data.

Senator DI NATALE: Are you able to provide us with a full survey?

Mr Kelsey : Yes.

Senator Scullion: I think quite a sample of that survey is made by submission into the Senate inquiry.

Senator DI NATALE: I know you're not trying to hide it and you have said you're happy for us to look at it. It does impact on what the next steps look like, in terms of people's trust and clinicians' trust and how we continue to build that. Delete means delete. Can you tell me what the time frame for implementing that looks like?

Mr O'Connor : It will be implemented as soon as practically possible when the legislation changes.

Senator DI NATALE: What does that mean? Is that a technical challenge for you? When you say 'as soon as possible', what does that actually mean?

Mr O'Connor : We need to wait for the outcome of the legislative process to determine what it is. We're planning on the basis of hard deletes, complete deletion of all the records off the databases and so forth as well. There's a process in place where we'll make that happen as soon as practically possible after the legislation changes.

Senator DI NATALE: What's as soon as practical after the legislation.

Ms Edwards : I think the point is that until the legislation is passed—we need to know exactly what the parameters are. What's in the draft could change.

Senator DI NATALE: A hard delete is a hard delete.

Ms Edwards : Assuming that's what the parliament supports at the end of the day.

Senator DI NATALE: Hypothetically, if tomorrow there was a law that said hard delete means a hard delete—

Ms Edwards : In accordance with the current draft.

Senator DI NATALE: how long would it take?

Mr Kelsey : To clarify, if the legislation was passed through the Senate in the sitting week of 12 November, our anticipation is we would have introduced the changes to hard delete by about 7 December—before records are created, depending on the time in the legislation.

Senator DI NATALE: Is it possible to fully delete a record—is it going to create issues where you've got that gap, where records are created but the hard delete doesn't occur until afterwards?

Mr Kelsey : At the moment, depending on the timing of the legislation, the hard delete technology would be created before the records were created.

Senator DI NATALE: What was the date you said?

Mr Kelsey : 7 December, depending on the process of the legislation.

Senator DI NATALE: Is there any work undertaken to allow record-holders to delete individual items from their record?

Ms McMahon : They exist today. Today a consumer can go into their privacy settings and identify a particular document—

Senator DI NATALE: You can hide it.

Ms McMahon : You can hide it. You can also effectively remove it, which deletes it from the system.

Senator DI NATALE: That's a hard delete?

Ms McMahon : Of that specific part, but not the entire My Health Record of that person.

Ms Beauchamp : You can also tell clinicians not to upload it.

Senator DI NATALE: But in some instances I suppose that will happen regardless. I might go to the question of information being uploaded. Let's go to pathology and radiology providers, for example. One of the concerns that people have is that there are instances that actually happen right now where you might get a result and the result finds its way to a patient before the doctor has an opportunity to sit down and explain the result. Sometimes it can be something nasty. We know that happens now, but it's likely that we're going to see that become more common because doctors aren't going to be required to review tests before the results are uploaded. Is that right?

Mr Kelsey : That's not correct, no. Pathology and radiology reports have a seven-day lag before they are made available on My Health Record to the consumer.

Senator DI NATALE: But not all clinicians will talk to patients within those seven days. That result will be uploaded after seven days.

Mr Kelsey : We work closely with all relevant clinical bodies on determining that.

Senator DI NATALE: I understand that. I think in most cases doctors will do that, but there are always cases that slip through. In seven days a doctor might be busy, forgets to check a result, whatever, and it doesn't happen. Suddenly the patient can see it.

Mr Kelsey : That is correct.

Senator DI NATALE: That's a possibility, and that will be more common now because people will have the results uploaded to their own record, which they can access at any time. Are there any systems or processes in that setting that are there to protect patients?

Ms McMahon : I think we said more the opposite. You made a comment earlier in your question that this system changes the requirement for a doctor to review the results before speaking to the patient. The My Health Record doesn't change that requirement. The doctor is still required to do that before speaking to the patient and there's an obligation on them to provide feedback to the patient if there's an issue. We see My Health Record as providing the consumer the opportunity, in the event there's a failure in the test orderer actually reviewing that and getting on to them to provide them feedback, to see if there's a result and follow that up to preserve their own clinical safety and improve the quality of their—

Senator DI NATALE: I'm not saying there are not benefits to it, but there are also risks. At the moment, as a consumer, you don't have access to a centralised database where you can look up your own stuff and go, 'I had my pathology test done eight days ago, and here it is.'

Ms McMahon : Yes.

Senator DI NATALE: That doesn't happen now, whereas it will soon.

Ms McMahon : That's right.

Senator DI NATALE: And for those instances—there are certainly benefits to what's being proposed, but there are also risks. One of the risks is that—

Mr Kelsey : I think at the moment, if I'm not mistaken, if you've been a resident in Australia for up to three years you are able, for example, when your doctor orders a pathology test, to get the test results to be directed to you as well as your doctor at the same instance. I think there is quite a large volume—I don't know the exact numbers—of people seeing their tests at exactly the same time as their doctor.

Senator DI NATALE: As I said, it does happen now but it doesn't happen frequently. Usually tests are sent to the prescribing or authorising doctor, and you go back to see the doctor—your way of accessing that information is to go and see the doctor. That's the pathway. If a doctor hasn't seen it in seven days, it ends up on My Health Record and the patient's got access to this record—this can happen to everybody. It's going to be even more common where those errors are more likely to be picked up by patients who access their record and are curious. There are examples, in the instances you've just described, where someone asks and says, 'I want to see the result of my MRI scan.' I think there's one example of where someone got an MRI sent to their home and they found out they had a brain tumour, and they hadn't had a discussion with the doctor yet. You end up with this pathology result saying, 'No support, don't know what questions to ask, but I've got the radiologist's report that says "brain tumour".' My question is: what are the supports that are being built around that?

Ms Edwards : I understand the point, but it seems to us that, if you have a brain tumour and your doctor has failed to look at your report within seven days, the problem there is not with the—

Senator DI NATALE: No, no, sorry. In practice—I know from experience—a hundred people come in with a headache, and you might write a hundred referrals for a MRI but you don't know which one is going to have a brain tumour.

Ms Edwards : No, but on the one that does, you would look at it quickly and you'd ring them straight away.

Senator DI NATALE: You're getting these results in all the time. You would hope there is not a breakdown, but there are breakdowns. There are breakdowns. What I'm highlighting is that it's going to be more common. That's an extreme example, but there will be others. There'll also be language in reports that sounds alarming, but it may not be. There'll be questions raised by pathologists or radiologists where they're raising the possibility of X, even though it's a small possibility, and that might find its way to a patient.

Ms Edwards : We understand the point. There's been a lot of consultation with the sector about what is a reasonable period to expect the doctor to have a chance to look at it and contact the patient, and seven days has been arrived at as a fair point. There will be instances—and some of those instances will be saved by the fact that the patient's looked at it and been able to bring it to the attention of the doctor—where people might find nasty results when their doctor hasn't got around to it, or ones that they've misunderstood. We appreciate that. It is a balance between consumer choice and control over their own health and records and trying to avoid these circumstances.

Senator DI NATALE: I'm asking what thought has been given to structures and processes around that, for example. Let me give you a practical one: what if someone goes away on holidays? Can the doctor request that the result is not uploaded for longer than seven days? Is that possible, or is that seven-day period locked in?

Mr Kelsey : If the doctor and the patient agree that the results should not be uploaded to the My Health Record, that's well within the gift of the patient at the time the test is ordered. But it needs to the based on the consent of the patient. So, yes, absolutely, if that's the common view, that someone is going on holiday and they don't want to receive their result until the doctor has seen it, then it would not be uploaded to My Health Record at their discretion.

Senator DI NATALE: But, as far as you are aware, at this stage, the seven days is agreed and the responsibility is entirely now on the doctor to take care of what happens in those circumstances?

Mr Kelsey : That's the agreement that's been reached with the sector, yes.

Senator DI NATALE: Okay. Have we got more questions on My Health Record?

Senator SINGH: Yes, I do.

Senator DI NATALE: Perhaps we can go across to Senator Singh, Chair, and I'll just get organised here and come back.

Senator SINGH: Mr Kelsey, I think you'll remember that last time you were in this committee's hearings I asked you about your interaction with journalists; in particular, if you had sought for any journalist to change or remove any critical coverage, directly or indirectly. You chose to take that on notice. I've gone through some of your answers on notice. Over and above what you've already provided in answer to that question on notice, have you had any interactions with the website Healthcare IT?

Mr Kelsey : Healthcare IT?

Senator WATT: Or their US owner.

Senator SINGH: There are two different ones, but I'm asking about that one first.

Mr Kelsey : I'd have to take that on notice but, as I said at the last meeting, there are many, many health websites, those sorts of online websites. As I said at the last inquiry—I think it was an inquiry, rather than estimates—

Senator SINGH: Yes.

Mr Kelsey : we talked about the fact that the job of the agency is to correct, where appropriate, inaccurate commentary on My Health Record. It is not to seek to correct criticism; it's purely based on factual accuracy. If there were factual inaccuracies in reports on the Healthcare IT website then, yes, the standard practice would have been to seek correction of those items.

Senator SINGH: That's why I'm asking about that particular website. The other one is the one Senator Watt referred to, the HIMSS. That is the Healthcare Information and Management Systems Society, which is a US-owned website.

Mr Kelsey : I'm not aware it's a website. HIMSS is an organisation that organises events.

Senator SINGH: Well, it has an online—

Mr Kelsey : It may well have a website, yes.

Senator SINGH: Yes, it has an online news interaction. I'm asking specifically about media coverage on either of those two platforms.

Mr Kelsey : There may well have been cases where we sought correction of articles published on those websites. Were they not included in the—

Senator SINGH: No, they're not included in the answer to the question on notice. You raise, obviously, a few other websites.

Mr Kelsey : We'll go back and provide any further interaction with that.

Senator SINGH: So there's no-one at ADHA who knows about those two platforms and who could answer that?

Mr Kelsey : Healthcare IT News is one of many websites that report on things like My Health Record. I think the request on the—

Senator SINGH: Okay. You'll take it on notice?

Mr Kelsey : Yes, that's fine.

Senator SINGH: Does ADHA have any sort of commercial or financial arrangements with HIMSS?

Mr Kelsey : I'd have to take that on notice. HIMSS is a company that organises events and runs a system for measuring the digital maturity of hospitals. I would say now that I don't think we do have any commercial arrangements with HIMSS. They actually have a big conference coming up in a couple of weeks in Australia. We may sponsor—

Senator SINGH: Are you a sponsor of that conference?

Mr Kelsey : It could be that we sponsor a booth at that conference.

Senator SINGH: Is there a financial component to sponsoring the booth?

Mr Kelsey : There would be if we were taking a booth.

Senator SINGH: Right.

Mr Kelsey : I'm informed by my colleague that we have a booth at the forthcoming HIMSS conference in Brisbane, which would involve a financial transaction of some sort.

Senator SINGH: How much are you paying HIMSS for that sponsorship?

Mr Kelsey : That I'd have to take on notice. It'd be small. I don't know exactly how much. It would be an exhibition stand, essentially. It's a conference which has many, many exhibitors. I can certainly find out how much we're paying for the stand.

Senator SINGH: Okay. So you are aware that there's some financial component as far as your sponsorship of the HIMSS conference is concerned, but you are not aware of any other interactions in relation to copy that HIMSS have published?

Mr Kelsey : Healthcare IT News, I'm pretty sure, is an online news report that HIMSS owns. But I don't think HIMSS itself publishes material. It doesn't have a website as such. But Healthcare IT News is—let me just check—

Senator SINGH: I'm actually online looking at it at the moment.

Mr Kelsey : Okay—Healthcare IT News. They publish—just like Pulse+IT and the other online trade journals—information about digital health, and they have certainly reported on My Health Record.

Senator SINGH: That's right. They have.

Mr Kelsey : What we will do is provide on notice any interactions we've had with them where we've sought correction of copy.

Senator SINGH: Yes, that was the question.

Mr Kelsey : I will provide that on notice.

Senator SINGH: Okay. I'd like to explore the issue of the Parliamentary Library's July FlagPost about My Health Record. As you're aware, that post was taken down and later amended after an intervention by the health department. Earlier this week we heard from the Finance and Public Administration Committee's hearings that the department's chief operating officer, Matt Yannopoulos, was the first to contact the Parliamentary Library with concerns. Welcome, Mr Yannopoulos. Who first alerted Mr Yannopoulos to the existence of this My Health Record FlagPost?

Ms Beauchamp : Before I let Mr Yannopoulos respond, could I just correct a statement you just made.

Senator SINGH: Yes.

Mr Kelsey : I think you said that the Department of Health and the interventions we made led to the decision by the Library to pull down the article. The Library, as was articulated by Dr Heriot in the earlier committee, is an independent body and an independent agency. They make decisions based on the merits or otherwise of their own information. At no time did we ask them to amend or pull down the article. It was their decision. As to when the department was first informed of the article or the blog, I'll let Mr Yannopoulos say where he heard the information.

Senator DEAN SMITH: Secretary, your account is an accurate one. The Parliamentary Librarian made it very clear that the decision was hers and hers alone as an independent officer. I was a member of the Finance and Public Administration Committee earlier in the week, when she made that statement.

Ms Beauchamp : That's correct, yes.

Senator SINGH: Just to correct, what I said earlier was that the post was taken down and later amended after an interaction with the Department of Health.

Ms Beauchamp : I thought you said 'an intervention'.

Senator DEAN SMITH: Well, Senator Singh is changing her language now.

Senator SINGH: No, I'm not, because I have it written in front of me. So I know clearly what I said, because it's written down in front of me. So I'm not changing it, Senator Smith. We can go back through the Hansard and look at it.

Senator DEAN SMITH: I'm sure it will say exactly the same as what I just said now. So I guess we will unravel some of that, Ms Beauchamp. I wanted to ask Mr Yannopoulos: was it your idea to call the Parliamentary Library's Jonathan Curtis?

Mr Yannopoulos : It was a discussion I was having with Mr Kelsey and others. We were monitoring the media each day through the My Health Record opt-out period. The FlagPost was published, I think two days earlier, on 23 July. As it was getting a lot of media focus, particularly the focus on the legislation issue, we decided—and I took the action—to call Mr Curtis. I don't know if you've seen that Hansard from earlier in the week. I suggested that I would like them to have a look at the article. I would put in writing to Mr Curtis our concerns. I did that at 1.31 on 25 July. At 4.42 on that day—and these emails were tabled, I believe, earlier in the week because they were sought under FOI—he wrote back and said he disagreed and they weren't going to alter the article. We had another look and put some more points to him later that evening. I think I sent the email at 9.58 pm. Then, of their own accord, on the morning of 26 July they removed the article, and he emailed me at 8.42 to say he was doing that. I emailed him back shortly thereafter and said thank you. Then Mr Curtis rang my general counsel at 2 o'clock to say that they intended to republish the article with updates, and, at 6.24 pm on 26 July, the article was republished.

Senator SINGH: Thank you for those dates, Mr Yannopoulos.

CHAIR: We have five minutes to go for output 1.

Senator SINGH: I just need to finish this particular issue about the Parliamentary Library with the Department of Health. We're nearly there! In finance and public administration estimates on Monday, we heard that, after Mr Yannopoulos' contact with Mr Curtis, the Parliamentary Librarian, Dianne Heriot, got a message to contact you, Ms Beauchamp. How was this request conveyed to her?

Ms Beauchamp : I tried to ring her, after speaking to Mr Yannopoulos and our people, just to give her a heads-up in terms of some of the comments we had on the FlagPost.

Senator SINGH: To give her a heads-up?

Ms Beauchamp : Yes, that Mr Yannopoulos had been in contact with her people.

Senator SINGH: Why did you feel the need to personally intervene in that way?

Ms Beauchamp : It's not unusual for people to draw to the attention of whoever is in charge some comments and liaisons that agencies are having with their staff. I also reiterated the fact that there were some errors in the article, particularly the article's description of the My Health Record Act as a 'significant reduction in the legal threshold' in terms of protecting the privacy of an individual's health information.

Senator SINGH: Did the minister or anyone in his office ask you to intervene?

Ms Beauchamp : No. This was after I spoke to the Chief Operating Officer.

Senator SINGH: Did you have any conversations or contact with the minister or anyone in his office about this issue before you spoke with Dr Heriot?

Ms Beauchamp : No.

Senator SINGH: I've run out of time, but I want to ask Mr Yannopoulos: when was the last time you or anyone else from this department initiated contact with the Parliamentary Library about a FlagPost concerning health policy?

Mr Yannopoulos : I've never done it. For anyone else, I would have to take it on notice.

Senator SINGH: You've never done it. Have you ever done it, Ms Beauchamp?

Ms Beauchamp : It would be remiss of us in terms of any factual information that was provided about a policy that we were administering on behalf of the government if we thought there were inaccuracies. It's not unusual for us to contact various organisations where we think there might be a problem.

Senator SINGH: So it's not unusual, but you've never done it before?

Ms Beauchamp : I haven't rung the Parliamentary Librarian because no other information like this has been brought to my attention. It was the week after the commencement of the opt-out period for My Health Record. There was some confusion in the public domain, and I just wanted to put on the record what our view was in terms of administering the policy directions of government based on what the Digital Health Agency had raised with us.

Senator SINGH: Does the Department of Health have proper formal processes and procedures for contacting the Parliamentary Library?

Ms Beauchamp : I don't think we need processes and procedures to have a conversation with a public official.

Senator SINGH: Okay; thanks.

Senator GRIFF: Can I go back to the 1.14 million who opted out. Have you got that broken down by state?

Mr Kelsey : We don't, I'm afraid.

Senator GRIFF: On notice, could you provide that by state and also by gender and age?

Mr Kelsey : I'm not sure we will be able to do that, because, obviously, when people opt out they don't provide us with a geographical location. But if we can, we will provide it.

Ms Edwards : If I can jump in: of course, the opt-out period hasn't ended and the paper forms are not yet reconciled. I wonder if what you're really after is those breakdowns of the final—

Senator GRIFF: I would like to see it at this stage—at this point.

Ms Edwards : I only raise it because I think it might be a large amount of effort on an unfinished process—

Senator GRIFF: Yes, fair point.

Ms Edwards : and I'm not sure whether it's actually going to be feasible or easy to do it. Obviously, I understand why you want the information, and it would be very important at the end. But, for example, you'll have virtually none in remote areas because we're doing paper forms there for their convenience. So I wonder whether if it would be possible to give you a breakdown of the final, if it's possible.

Mr Kelsey : If it's possible, yes. I'd agree with my colleague that it would be more useful to have that breakdown at the end of the process.

Senator GRIFF: That's fine. I'd also like to know, and perhaps you might be able to explain—whether it was your drafters or after the approaches of others—how section 70 of the act, relating to law enforcement agencies, became part of the actual act. Was it a decision made by health department drafters or was it after approaches by the A-G's Department or someone else?

Ms Edwards : You're talking about in the original legislation?

Senator GRIFF: Section 70, yes.

Ms Edwards : I don't know if we have anyone who'd have the detail, but they're reasonably standard types of provisions. I don't know what exactly happened, but there are things that the drafters say to you, like, 'These are the sorts of things that you have in a normal act like this.' It's some years ago now, obviously, but certainly it's not a surprising provision to find—the one that we're now proposing to alter.

Senator GRIFF: Have there been any access requests from law enforcement agencies to date?

Ms Edwards : 'No', I think, is the answer.

Mr Kelsey : Not to the agency.

CHAIR: We've run out of time, because it's now past 3.15.

Senator GRIFF: Chair, I've got about 10 minutes worth on My Health Record. Everybody else has had that.

CHAIR: Are we at outcome 2?

Senator WATT: We'd be happy for this to go on a bit longer, Chair, if you'd like.

CHAIR: Then we give up outcome 2?

Senator WATT: Yes. We think, particularly later in the night, we'll be able to really contract the amount of discussion.

Senator SIEWERT: Save time.

Senator WATT: For outcome 5, for instance, we don't have too much.

CHAIR: Okay. And what happens to outcome 2? That's mental health.

Senator SIEWERT: No, we'll need our time there.

Senator WATT: I think we'll need all our time there. It's just Senator Griff's been waiting a fair while, so we'd be happy—

CHAIR: I think some of those questions will have to go on notice, unfortunately, because I need to give Senator Di Natale some time.

Senator DI NATALE: I think what Senator Watt's saying is we're probably going to make up quite a bit of time, because, like you, Senator Watt, we're going to be able to contract some of outcome 5. I suppose what we're seeking is permission to maybe just spend a little longer on this.

CHAIR: Do we know what outcome you'll be giving up? Because we will let the people go.

Senator SINGH: We'll make the time up, I think.

Senator WATT: Yes. It's not so much that we will not do anything, but we won't need as much time for outcome 5 as the program says.

Senator SINGH: We'll make up it up later on.

CHAIR: All right.

Senator GRIFF: Okay.

Ms Rishniw : Senator, you asked about law enforcement agencies and requests. The department is aware of only one request from a law enforcement agency in the six years of the operation of My Health Record. It was at that time from the Tasmanian police in relation to a serious murder investigation, and no records were released.

Senator GRIFF: All right. I understand from some clinics that the default option for their practice management system is to upload all new patient records to the system. For patients with an MHR, the new record goes into their MHR, which is pretty obvious. But what happens to the records of patients who do not have an MHR if their records are being uploaded to your system?

Ms McMahon : If a patient doesn't have a My Health Record, no records from the local system are uploaded into the My Health Record.

Senator GRIFF: But I understand that the practice management system is still giving you everyone, with new records included even if patients don't have one, because the practice doesn't necessarily know that that person has opted out. So, if the bulk is given to you, do just ignore all records that don't have a match in My Health Record?

Ms McMahon : No, it doesn't work that way. There's a call made from the practice management system which is called, I think, 'get My Health Record', and it's a query to the system: does a My Health Record exist for this individual? It uses the individual healthcare identifier, or the IHI. An answer is returned, which is 'no' if they don't have one, and then no documents are sent.

Senator GRIFF: I've also had a constituent approach my office with concerns about records that have been removed from his MHR by an entity defined only as 'an external provider'. He contacted MHR and was told three different stories. One person told him it looked like the records had been removed by a doctor, another said Medicare had removed them, and a third said it appeared to be a coding error. That is obviously an unsatisfactory state of affairs. Given it's a system that permits record owners to know exactly who has accessed their My Health Record, why is an identity defined as 'an external provider'? How can that happen?

Mr Kelsey : It's difficult to comment on an individual case. We'd have to look at that. But I'm not immediately aware of such a denomination being possible within the system. The only denomination of a provider would be the name that is given to what's called the HPI-O, the organisational identifier. If there were one that was attributed to something called an external provider, that would be the name of a thing. And I'm unaware of the name of a hospital or the name of a pathology company that's 'external provider'. If that individual wants to make contact with the agency, ring the call centre, we can obviously investigate that. But the way the system is set up is to identify the identity of the organisation.

Senator GRIFF: Okay. I will pass that on to my office.

Ms Edwards : Just to be clear, I don't think—in our understanding of how the system operates and how it is coded—that aligns with the agency's understanding. We'd say that obviously there needs to be an investigation. If you can provide all those details to the agency, we will investigate that particular case and come back to you directly.

Senator GRIFF: Have you established metrics for dealing with problems within your organisation? Are there particular metrics that you have in place for how long it will take?

Mr Kelsey : Yes. We monitor customer complaints. Ronan, perhaps you could speak to that.

Mr O'Connor : In relation to customer complaints and consumer interaction through the call centre, there is a small survey that we ask people to complete at the end of their calls. On that basis, the satisfaction rates at the moment are roughly 95 per cent. That's particular to the call centre itself. We also have a process internally, within an agency, where we capture correspondence in that agency, and that's responded to.

Senator GRIFF: Thank you. That will do for me, Chair.

Senator DI NATALE: I'm interested in what the government's doing in terms of engagement with the College of General Practitioners; in particular, the concerns they have around the current practice incentive payments used as the tool to incentivise, if you like, GPs. I think the college and others are concerned that that's not an appropriate tool to remunerate GPs for the time it takes to fill in the information. The whole thing relies on uploading data. Are you currently considering any other forms of remuneration for general practitioners to complete this information?

Ms Edwards : So you're asking about ePIP?

Senator DI NATALE: Yes.

Ms Edwards : We haven't got the ePIP people here. The people who know that stuff aren't physically here at the moment.

Ms Rishniw : I can answer part of that question. In terms of the Electronic Practice Incentive Program, which is part of the broader incentive program to GPs: that is a program and a payment that actually looks at a range of things. It looks at better digital practice, common use of terminology, improvements in systems. My Health Record is one of five criteria of eligibility that are used under that program, and it is by no means the only criterion. So it's one incentive payment to try to improve digitisation of GPs across—

Senator DI NATALE: Yes, across general practice.

Ms Rishniw : Indeed.

Senator DI NATALE: I suppose my question is: is there any other payment model that's being looked at to make sure the information is being uploaded to My Health Record?

Ms Rishniw : We would hope that the benefits of the system actually incentivise upload by GPs.

Senator DI NATALE: But it takes time. All this stuff takes time in general practice. I know there's a long-term benefit, but they've had a huge freeze on their Medicare indexation for many, many years. The cost of providing those general practice services increases but their payments haven't, and this is another burden on their time.

Ms Edwards : It's a big question. We are, as you would know, redesigning some of the other PIPs at the moment and talking very intensely with the college and others about that—that's the one that's going to be the PIPQI. We are obviously going to have a look at the ePIP requirements, because the one that relates to My Health Record will be affected by the opt-out, given that so many records were created, and so on. We have a number of forums where we talk with the AMA, the RACGP and others about all sorts of issues, including PIP, My Health Record and so on. If you're asking: is there a current proposal to pay GPs to upload to My Health Record? No, there isn't. But we're continuing to talk to them generally about primary care and all the different bits that make up the way we have payments to GPs in primary care.

Senator DI NATALE: Is it fair to say that you are looking specifically at trying to provide a model that remunerates GPs for uploading information?

Ms Edwards : No, we're not.

Senator DI NATALE: So you're saying you feel that the current ePIP—I mean, it might be redesigned, but it's not targeted specifically to My Health Record—

Ms Edwards : We're having a general discussion with the peaks about how primary care happens and how we're going to improve it, but we do not have a specific proposal to pay people for uploading into My Health Record.

Senator DI NATALE: You're asking GPs to do something that's going to take time and means they can see fewer patients, which means they get less income—it's pretty straightforward. I know there's a benefit. As I said, I support doing it. But you are putting another impost on general practitioners, who have been right royally screwed over because of the MBS freeze. This is another burden. I'm just wondering whether any consideration is given to remunerating them for it.

Ms Rishniw : I'm sure the agency can clarify. My Health Record, for most practitioners: the more they use it, the simpler it will be. It's a two-click process at the moment if they're using it and they've got compliant software.

Senator DI NATALE: That's not the feedback I'm getting.

Ms Rishniw : Ideally, the more practices use My Health Record and the more consumers use My Health Record, the simpler it will be and the more useful.

Senator DI NATALE: Sure. Again, right here and now you're asking them to do something that means they're going to see fewer patients and they're going to take a hit.

Ms Edwards : We hear the comment, and it goes to the whole issue of primary care and so on. I think what Mr Kelsey and others can talk to you about is all the work that's been done with the medical software industry to make it a very seamless and, as Ms Rishniw said, a two-click or even less process. That stuff is still embedding and it'll become less difficult—it's a training and learning thing as well. That doesn't go to all of the things you've raised, but it is actually the key focus. I don't know if you want to comment on that, Mr Kelsey?

Mr Kelsey : Not on remuneration.

Ms Edwards : No, but on how—

Mr Kelsey : Yes. Perhaps I could invite my colleague Dr Meredith Makeham to give a sense of the amount of work we have done to work with the College of GPs and other colleges representing general practitioners, as well as the broader medical community, on making My Health Record as streamlined and as useful to them as possible.

Prof. Makeham : Thank you. The first point to make about this is the actual time that it takes for a general practitioner to put a shared health summary into My Health Record. I'm a practising general practitioner also, for context. It's actually, in the proprietary software that's most commonly used, three clicks or four clicks. It should take 20 seconds or so, perhaps 30 seconds. And it would depend on the quality of the data in the GP's system and their appetite to check the accuracy of the information going into the shared health summaries they actually upload.

In terms of the effort that's been put into making the software more user-friendly, there's been a lot of work that the Australian Digital Health Agency has done in collaboration with the vendors who create the software and that interface. In fact, the systems have been streamlined as much as possible. There's also been a lot of work that's been done with the Royal Australian College of General Practitioners. I'm a former member of the Expert Committee—eHealth and Practice Systems. I am aware that, yes, it does take a little bit of time to put a shared health summary up, but it's quite minimal.

Senator DI NATALE: As you said, it depends a bit on what your system already looks like, doesn't it?

Prof. Makeham : Yes.

Senator DI NATALE: Part of the problem here is that if you're running a very modern, efficient digital practice then it's reasonably straightforward, but if you're not then the demands are significantly higher than what you've outlined, aren't they?

Prof. Makeham : Yes. I think the important thing to reflect on about that is that My Health Record is actually shining a spotlight on the data quality sitting in all of our practice software systems. Of course, as we become more familiar with the method for putting shared health summaries up and we're exposed to the data quality in our systems, it's actually an opportunity for us to have a conversation with our patients about the accuracy of their medications. It's a great safety benefit for people to have that opportunity to have a shared health summary put up.

Senator DI NATALE: Thank you. I'm done.

Senator GRIFF: Just very briefly, I'd like a bit of clarification in relation to accessing public and private hospitals. Will every junior doctor and every nurse have their own, as I understand it, HPI-I, an Individual Healthcare Identifier, or will they have access through a HPI-O—in other words, the organisation? Is it through an organisation or will they all have an individual identifier?

Ms McMahon : In terms of hospital staff, there's a legal requirement, and we have a portal operator agreement—a contract—with each hospital so that, when they connect to the My Health Record, they have the hospital connection. That is the core connection. Some hospitals—basically all of the private hospitals and some public hospitals—also enter and send us the HPI-I for each of those healthcare providers, but others use their local authentication—that is, the local log-ins that the nurse or junior doctor or others would use to authenticate themselves within their local system.

Senator GRIFF: So, one log-in to the system per hospital is possible?

Ms McMahon : No. We have one connection for the hospital, which is the link from that hospital through to the My Health Record. We capture that and—

Senator GRIFF: But, if somebody is logging into the terminal, they would either have—

Ms McMahon : If they're logging into the terminal, then their local log-in is retained or they capture the HPI-I. They must do one or the other, but it must go down to the individual person who is logging in. That's a requirement in the legislation and under our portal operator agreement.

Mr Kelsey : You can't log in as an organisation.

Senator GRIFF: I'm getting a little confused because you're kind of saying both. It could be one or another?

Ms McMahon : It is.

Senator GRIFF: I'm working in XYZ hospital and we just have a log-in for the organisation. So Dr Di Natale, next to me, could use that to go in, although he might have a separate identifier as well. But he could go in and log in or I could log in using the same password if it's an organisation set-up. Is that correct?

Ms McMahon : No. Dr Di Natale would have his own log-in as Dr Di Natale to the Cerner implementation, or whatever it is, in Royal Prince Alfred Hospital. And then we have one pipe from that hospital to the My Health Record which sends information around the authentication of that person. It could be that Dr Di Natale has an HPI-I captured by that hospital system or it could be just the local log-in they use with their user name and password. But, either way, Dr Di Natale would need to be identified as an individual.

Senator GRIFF: Everyone on that floor would be using an individual log-in?

Mr Kelsey : Yes, by law they have to do that.

Senator GRIFF: Thank you.

ACTING CHAIR ( Senator Dean Smith ): Thank you. Are there any other questions? There being none, we'll move on to outcome 2.

Mr Kelsey : Sorry, Chair, could I clarify one point that I made earlier on. Healthcare IT News, as we clarified, is an online news provider in digital health. I was mistaken in that, in the question on notice that we provided back to you, you asked, 'Could you provide some examples on areas where you sought to correct inaccuracy?' and, in fact, Healthcare IT News isn't included on the list which covers a number of other providers. So we will, as I say, on notice, provide you with requests for correction of Healthcare IT News reports. But I was wrong to say I thought they were already included in the response to the prior question taken on notice.

Senator SINGH: [inaudible] on notice.

Mr Kelsey : Okay; yes.

Senator SINGH: Both—the one for which you're paying sponsorship to the conference.

Mr Kelsey : Yes, we will.

ACTING CHAIR: Thank you. We are about to move on to outcome 2. I thank officials for making themselves available. Just before we begin outcome 2 and for the interest of the senators and the minister, we welcome Minister McKenzie. Labor senators have expressed an interest in asking questions in outcome 2, which deals with health access and support services, as have senators Siewert, Di Natale, Rice, Waters, Leyonhjelm and Griff. Who would like to begin?

Senator SINGH: I'll start, thank you. Just before we go there, this morning, I think Ms Beauchamp or Ms Edwards, you said that I had to come back here to ask about the national action plans?

Ms Beauchamp : Yes, national action plans that's correct, under the preventive health program.

Senator SINGH: So that's 2.4. Is that what you're saying?

Ms Beauchamp : Yes.

Senator SINGH: Is that correct, 2.4?

Ms Beauchamp : Yes.

ACTING CHAIR: It says on the program 2.4 preventive health and chronic disease support, yes.

Senator SINGH: We'll go to mental health first.

ACTING CHAIR: We will, that's right. Are you leading?

Senator SINGH: Yes.

ACTING CHAIR: Thank you, Senator Singh. Off you go.

Senator SINGH: Obviously, we are aware now that the government called another inquiry into mental health on 7 October. The Productivity Commission is now conducting an inquiry into mental health. I want to know how this inquiry is going to differ from the plethora of previous inquiries we have had into mental health, over a number of years, that have already been undertaken. What's this one going to do that is going to be any different from past inquiries?

Ms Edwards : Obviously, we can tell you about the terms of reference and where the inquiry is up to, but we don't manage the Productivity Commission, so those questions primarily would go to Treasury I presume. We have information about it.

Senator SINGH: That's publicly available isn't it, the terms of reference?

Ms Edwards : They're publicly available. We can tell you—

Senator SINGH: I don't need you to read out the terms of reference. That's fine.

Ms Edwards : We can tell you a little bit about it but it's primarily managed in another portfolio. Although, of course, we're very interested in it and will be engaged in it—

Senator SINGH: Are you aware that since the nineties there have been 150 state and federal government review, inquiries and reports into mental health?

Ms Edwards : I'm was not aware of that particular number, but I'm not surprised. It's a very important and complex area.

Senator SINGH: Are you aware of how many reviews or inquiries into mental health the department has been involved in?

Ms Edwards : No. Many, I presume, over the years.

Dr Morehead : Every few years.

Senator SINGH: Does waiting on this new Productivity Commission inquiry's report have the potential to delay reform needed in mental health?

Ms Edwards : I wouldn't have thought so. We have a very big agenda in mental health and we're progressing that quickly. It's very important. We hope and expect the Productivity Commission report to really contribute to the knowledge and to provide us guidance, but we certainly wouldn't stop doing what we're doing or thinking about new things in the interim.

Senator SINGH: Has the commission been in any kind of correspondence with the department or vice versa in giving advice regarding this inquiry since it was called by the former Chair of the Mental Health Commission?

Ms Gleeson : The former Chair of the National Mental Health Commission advisory broad, Professor Alan Fels, wrote to the Minister for Health on the matter, not directly but to the department.

Senator SINGH: That would have been about 18 months ago was it?

Ms Gleeson : That's correct. It was 2 March 2017.

Senator SINGH: There's been no other correspondence with the department?

Ms Gleeson : Not directly with the department. We do consult with the commission in our everyday work.

Senator SINGH: What about the minister, has the minister been in correspondence with the department since this was called for by Mr Fels?

Dr Morehead : Yes. There have been discussions about it since 2 March 2017 when Professor Allan Fels did make a request to the minister. The minister has been quite active in terms of consultations with the states and territories about what the scope of the commission inquiry should be, noting that it is the Treasurer who hands the terms of reference formally to the Productivity Commission. The Productivity Commission is within that portfolio, so it does need to be activated as an inquiry by the Treasurer. However, Minister Hunt, as the minister responsible for mental health, has been talking to states and territories to get an idea of how broad that scope should be and what sorts of things states and territories would want to see in such an inquiry. That has been happening in the interim. The formal terms of reference, as we know, have not been released. The announcement has been made that there will be an inquiry but the formal terms of reference have not yet been released.

Senator SINGH: Ms Edwards, you were alluding to the terms of reference before.

Ms Edwards : I was just generally saying we can tell you what's publically available and what's happening.

Senator SINGH: Would that have been a draft terms of reference you were going to talk to?

Ms Beauchamp : Yes. I think there's been consultation occurring at the moment with states and territories. Certainly our minister and the Treasurer have had ongoing correspondence and discussions about this, particularly from a Productivity Commission's role in terms of looking at the role of mental health in the Australian economy around employers, prevalence and emerging issues. I'm not too sure where the minister is up to in terms of consultation, but the government is expecting to have the terms of reference finalised this month. It will probably take in the order of 18 months to finish the inquiry.

Senator SINGH: This month has not got much time left, so it'll probably be in the next week.

Ms Beauchamp : We hope so.

Senator SINGH: You said you know where the minister is up to in his consultations with the various states and territories. Are you not playing any role with the minister in that consultation process?

Ms Gleeson : I can answer that. The minister wrote to the states and territories on 3 July and the final feedback was received on 18 September, so the department has received all that correspondence, yes.

Senator SINGH: So the consultations are finished then?

Ms Gleeson : That's correct.

Senator SINGH: Who made the decision to call the inquiry during Mental Health Week?

Ms Edwards : That's the Productivity Commission in the Treasury portfolio. We wouldn't be able to comment on the decisions made in that portfolio. The government made the decisions.

Senator SINGH: So the Department of Health didn't. Is that correct?

Dr Morehead : The Department of Health didn't advise on what a suitable time would be to announce that. That wouldn't be our role. Obviously, Mental Health Week does get a lot of awareness. I think that announcing that Productivity Commission inquiry during that week was because everyone's attention was on mental health. It is a week where all things mental health are done. In terms of the decision making around it, the department doesn't play a role, but I guess one could see that it is an appropriate time during that full week of focus on mental health to announce such an inquiry.

Senator SINGH: Just help me out here: who made the announcement? Was it Minister Hunt?

Dr Morehead : It was Minister Hunt with the Treasurer.

Senator SINGH: Minister Hunt with the Treasurer?

Dr Morehead : Yes.

Senator SINGH: I thought it was. I just wanted to make that clear, because you're saying to me that the minister's department, the Department of Health, did not advise or play a role in the decision about it being made in Mental Health Week.

Dr Morehead : We knew that the announcement would come in Mental Health Week, in terms of being across what the minister's office is doing. It is not up to us to make a decision as to when such inquiries are announced publicly.

Senator SINGH: You didn't advise the minister to make the decision in Mental Health Week, so that was done in the minister's office?

Ms Edwards : The Treasurer made the announcement and the minister was involved. We heard about it. As Dr Morehead said, it seems like a sensible time to have done it, but it wasn't our role and we weren't involved in it.

Senator SINGH: You may need to take this last one on notice. In light of the Productivity Commission's inquiry, are you able to provide a breakdown now of the forward estimates in relation to mental health programs and services from the Health portfolio being funded in the 2018-19 year?

I am aware of some media reports where the minister has said that there would not be a chance of any reduction in funding, so I'm interested to see that breakdown.

Ms Edwards : Yes. I think we provided a question on notice from the last estimates which gave pretty much that information; we could refresh that if you'd like. You might want to check if that's the sort of information you want, before we—

Dr Morehead : In general terms, in 2018-19, the estimated Health portfolio expenditure on mental health services is $4.7 billion. This is an increase in the estimated funding over 2017-18 by 9.6 per cent. So it's gone up 9.6 per cent over a year—the Commonwealth funding on mental health.

Senator SINGH: So you can take on notice the breakdown of programs if you like.

Dr Morehead : Yes.

Senator SINGH: But thanks for that, for the spend.

Senator SIEWERT: Obviously these are questions that I'm going to try to get through quickly, given the time. First, as to the National Mental Health Service Planning Framework, I'm trying to find out where it's at—basically, where it's up to and when it's going to be available.

Ms Gleeson : The framework is available to state and territory departments and to PHNs.

Senator SIEWERT: Sorry, I should have said 'publicly'—when it will actually finally be published.

Ms Gleeson : There's not currently an intention to make it public. It operates under a licensing arrangement that's been agreed through the Mental Health Principal Committee of AHMAC. The reason for the licensing arrangement is: it's quite a complex tool to use, and those who do use it need to go through a training process in order to make sure that the outputs of the tool are used and calculated appropriately. That's been an agreement that's been in place for a couple of years now.

Senator SIEWERT: So it's now available to the PHNs in the states and territories?

Ms Gleeson : That's correct.

Senator SIEWERT: Is some of the data that is being used—the population dynamics et cetera that are fed into it—going be available?

Ms Gleeson : Data is also available through the AIHW, and I would have to take on notice the specifics of that. What we do make available publicly, in regard to the framework, and what we're going, increasingly, to make available, is information about the taxonomy that underpins the tool, so that there's a greater understanding of how the tool operates.

Senator SIEWERT: Do you monitor how it's being applied?

Ms Gleeson : We have canvassed the jurisdictions in terms of their utilisation of the tool. If you give me a moment—

Ms Edwards : I think we went both to the stakeholders involved in development and to the states and territories about who should have access to it, and we're aware that it's important for it to be available as widely as appropriate, but with the safeguards Ms Gleeson has been talking about, to be careful. The decision was made: at this point, PHNs and states and territories. But we'll be continuing to liaise with states and territories about whether there are additional people who should have access to it and how we might facilitate that over time. But at this point that is limited to PHNs and states. We'll see how it's going, how it's going up. We agree that where possible, we should be making things more available. But we just need to be cautious to make sure it's properly used and so on. So it's a work in progress.

Senator SIEWERT: In terms of that process—and I understand what you've just said—do you have a time frame for when that might happen?

Ms Edwards : I think it'll be an ongoing process. I don't think we've got a particular review point at the moment. It's a new thing.

Ms Gleeson : Yes. I chair an interjurisdictional group that looks after the licensing and training arrangements to support the tool and further development of the tool, and we monitor access on an ongoing basis. We're currently considering a number of requests—

Senator SIEWERT: For access, you mean?

Ms Gleeson : That's right—not broad public access, but for organisations.

Senator SIEWERT: Organisations?

Ms Gleeson : That's right.

Senator SIEWERT: It's picking up along the way that organisations are questioning its use and whether the PHNs, in the states and territories, can get access to it as well?

Ms Edwards : Yes. We've got requests about that. There's no in-principle objection to it. It's just about assessing each application. It's a very meaty tool. We need to make sure it's used possibly, so we'll consider each request with the states and territories in turn. We certainly hope that we can increase the legitimate uses that organisations have for it, but we're cautious.

Senator SIEWERT: I might put a few more questions on notice about that. I'll move on to aged care. At estimates in May, there was a fairly general discussion. There was a new announcement through the budget that it was going to go through the PHNs.

Ms Edwards : Are we talking about the servicing and residential care?

Senator SIEWERT: Yes.

Ms Edwards : The $82.5 million measure?

Senator SIEWERT: Yes. Sorry, I was talking in shorthand. I beg your pardon. Could you outline the progress you've made in determining how that's going to be allocated and what it's going to focus on? Also, importantly, is that money ring-fenced just for mental health in residential aged-care facilities or is it going into a general pot for PHNs?

Ms Edwards : It's ring-fenced. It will be a particular schedule. The headline is that we think the measure is on track to commence from January. Obviously it's phased to have a slower start-up. We're starting slowly. We have contract variations happening with the PHNs now—those are all with the PHNs, as I recall—and those will come back incrementally and then money will be released. The PHNs are proceeding to roll it out. We've got a workshop planned in mid-November to discuss implementation approaches and to support PHNs for initial services. We're consulting with the mental health and aged-care subgroup. We're consulting with other advisory groups in relation to aged care, including the National Aged Care Alliance and the Aged Care Sector Committee. All 31 primary health networks will be required to commission the primary mental health services to meet the needs of individuals living in residential care. The initial services to be delivered will be determined by the PHNs, depending on the need and so on. This could start with a brand new service in some aged-care facilities ahead of broader implementation or it could extend an existing service which is meeting the need that our PHNs are finding in their region, and PHNs will certainly be encouraged to support accesses as equitably and efficiently as possible. As we talked about last time, we're looking at giving PHNs real direction—that they have to provide these services for people in these facilities, leaving enough leeway so we can try new approaches to try to meet this need. We're working with them at the moment to roll that out, commencing in January.

Senator SIEWERT: Thank you. When you say all 31 will be required, how is funding being allocated to those 31?

Ms Edwards : Each PHN has a funding offer at the moment, dependent on how many people and so on.

Senator SIEWERT: That's what I'm asking, sorry. On what basis is the money being allocated to each of the 31?

Ms Edwards : I'm not exactly sure how the formula has been devised. We could take that on notice.

Senator SIEWERT: Could you take on notice the formula?

Ms Edwards : It relates to numbers in each PHN region.

Senator SIEWERT: Does it also take into account regionality and remoteness?

Ms Edwards : Yes.

Senator SIEWERT: Could you take on notice what it's going to look like and, once those arrangements are finalised, the allocation to each PHN?

Ms Edwards : Given that the variation is coming back now, we should be able to provide that on notice shortly.

Senator SIEWERT: That's what I was sort of figuring. Thank you. In terms of how the PHNs are going to allocate the resources and the services, how does the department engage with that decision-making to ensure that PHNs are actually providing the types of services that meet the residential aged-care needs?

Dr Morehead : As Ms Edwards said, we have specified to PHNs that it could be a brand new service if they feel that is what is appropriate for their area. Because the PHNs are on the ground and in their local communities and already providing quite a lot of mental health services, they're the best ones to decide what would be appropriate to fund. They will then go ahead with the money that we have given them and they make all the decisions about how to commission those services. They would usually put a call out to see who wants to tender for the services. They then select the most appropriate service provider. That would commence from that day.

Ms Beauchamp : Being a new initiative, we have to make sure we monitor the demand.

Senator SIEWERT: Absolutely. That's why I was asking what role you have.

Ms Beauchamp : When we're looking at equity and priorities in terms of need we have to monitor this pretty early, particularly as it's being rolled out over the next few years to 2021. We will have a role in that with the PHNs.

Senator SIEWERT: You'll be monitoring both the service and the demand for the services and the need?

Ms Beauchamp : Yes.

Ms Edwards : And the effectiveness of the approaches that are tried. We want to give flexibility to try new things so we can see how it's best to deliver it. If it's working we want to export it and share it with other PHNs. If it's not working, we want to work with the PHNs to change the approach.

Mr Bedford : To add a little more to what my colleagues have said, under the contract the PHNs are required to provide a needs assessment. That's identifying the needs within their region. That aligns with what the funding schedule sets out. Following that they have to provide an activity work plan to the department too. Both those deliverables are viewed by the department and assessed to make sure that they're in line and suitable with both the funding agreement contractually as well as what the needs of the community are.

Senator SIEWERT: Can I go to PIR?

Ms Edwards : Are you talking about NDIS transition or PIR—

Senator SIEWERT: I'm talking about both, actually. Tomorrow I'm going to be chasing up the new psychosocial stream. I know I frequently stray between the two because it's quite complicated between the agencies.

Ms Edwards : I'm still learning it, so that's why I'm asking.

Senator SIEWERT: What I'm after is what's happening with PIR—people that are transitioning, but also relating back to the allocation of continuity of support funding and gap funding. I understand there's been some additional money allocated to address the block funding that was going to be removed for some of the programs. Do I have a correct understanding there?

Ms Edwards : Let me summarise quickly what I think the streams are. We have people applying to transition to the NDIS from PIR and Day to Day Living in Health and also other programs that aren't in the Health portfolio.

Senator SIEWERT: I'm going to be asking about those tomorrow.

Ms Edwards : They're transitioning. Those that transition get a package under the NDIS and so on. Those that aren't eligible for the NDIS are entitled to the continuity of support program. That's a particular commitment that will be through the PHNs to say those people should continue to get equivalent support, not necessarily exactly the same, going forward if they're not eligible for the NDIS, in addition to the psychosocial measure we have talked about previously. That is now all agreed with the states and territories. That's $160 million all up, including the state and territory contribution. That's there to address new demand or additional demand for psychosocial. It's in addition to continuity of support. Of course we want PHNs to be working with—

Senator SIEWERT: Yes. It's what we call gap.

Ms Edwards : The commitment for people who were on PIR or Day to Day Living, is a psychosocial in addition. In addition to that we've departmentally made some investments into the PHNs to try and improve the front door nature of it. If people come looking for the NDIS or mental health services we're facilitating them being able to flip seamlessly back between the two to try to help with the transition. The additional thing I think you're referring to is that we are making sure that if there's any delay in people being—

Senator SIEWERT: That's what I wanted to find out about, too.

Ms Edwards : You can raise tomorrow about the great efforts and new work they're doing with this stuff in the NDIS to make it easier for psychosocial.

Senator SIEWERT: I will follow it up there.

Ms Edwards : But if you're on PIR or Day to Day Living now and you haven't had your assessments checked by 30 June or you haven't had a package allocated yet—and we don't know if there'll be any or many of those—we have a commitment, working with DHS, to make sure you continue on support in the interim period. The gap you think might be there is being covered over.

Senator SIEWERT: I want to know about the other programs. I may end up putting questions on notice. I want to know for that group, the very group that you mentioned last that haven't transitioned yet and aren't through the process—we'll come to the front door in a minute—that group that are with existing providers, my understanding is that—you just touched on it—there is additional funding to help that group that aren't yet due for continuity of service, aren't going through that process yet, and haven't tested their eligibility yet.

Ms Edwards : I'm not sure about additional funding. What we're doing is making sure that the funding remains with the providers while they still have the clients.

Senator SIEWERT: Has additional funding been specifically allocated for that, so that the providers have surety about being able to support those clients?

Ms Edwards : The providers have surety, but it is really a matter of making sure the money follows the person. It isn't additional money that is being given. The position is, 'You're still in the program; you haven't transitioned yet; you will continue to have that.' There might come a point where there is a particular provider who only has one client left, and it might be better to transition someone into the continuity of support or the psychosocial or whatever. Those things we are leaving open and working closely with. The commitment is that, as we always said, if you're on PIR or Day to Day Living you will have continuity of support; and if you find yourself in no person's land because you haven't yet been assessed or put on a package, we will continue to give you support also.

CHAIR: The committee will resume at 4.15.

Proceedings suspended from 16:01 to 16:16

Senator GRIFF: I just have a couple of areas I want to touch on very briefly while we're still on 2.1. I would firstly like to refer to the Head to Health website that was launched in October last year. When I do a Google search of 'mental health help', it comes up with about 673 million pages of relevant sites, and Head to Health doesn't feature anywhere near the top, even if you limit the search to Australia. What is Head to Health intended to achieve that isn't a duplication of what's already out there?

Ms Edwards : I think the key thing about Head to Health is that it refers you to websites that have been examined and accredited as actually being quality.

Senator GRIFF: Run that past me again.

Ms Edwards : You can go and search on Google for a mental health support app. The quality of it, whether it's clinically proven, whether it's dangerous and all of that stuff are really a bit at large. One of the things about Head to Health is that we have tested and checked the accreditation of these sites. They're actually of benefit to people and trustworthy and current. That's why there's a much smaller number on Head to Health.

Senator GRIFF: But, unless you actually know about it, you wouldn't find that site at all.

Ms Edwards : It's disappointing if you weren't able to find it. We think we've put in all the triggers, hooks and so on for it to be found. The key thing is to try to help people find online resources which really are credible and safe. Ms Jarvis might be able to help.

Ms Jarvis : Since 6 October there have actually been 360,163 active sessions, which is an average of around 1,000 sessions a day, so the website is actually getting quite a bit of traffic.

Senator GRIFF: That's good to hear. How much has actually been spent on the project in total?

Ms Jarvis : $28.6 million has been allocated.

Senator GRIFF: What period is that for?

Ms Jarvis : From 2015-16 to 2019-20.