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Australian Organ and Tissue Donation and Transplant Authority

CHAIR —We will now move on to the organ transplant agency. Ms Halton, because I allocated time because we had these agencies called, there could be some capacity at the end, if we do not go for the full time with the organ transplant authority, to recall some questions on item 13 generally, if the officers are available. I do apologise; there is not much you can do when you have got agencies—you cannot give them less than 15 minutes.

Ms Halton —Indeed. If those officers have not escaped the building we will restrain them.

CHAIR —It may not come, Ms Halton, but we will see.

Ms Halton —No. If they are still here they will be restrained.

Senator FIERRAVANTI-WELLS —On organ donations, I have questions now, but if we talking about filling time, I am sure I can do that, Senator Moore.

CHAIR —We all have capacities! For the Australian Organ and Tissue Donation and Transplantation Authority I know there are questions from Senator Fierravanti-Wells, Senator Brown perhaps, and Senator Siewert. We will start with Senator Fierravanti-Wells.

Senator FIERRAVANTI-WELLS —I understand that there was a recent article—and I have a copy of it, Ms Halton—which says, ‘Karen Murphy steps down as CEO of Australian Organ and Tissue Authority amid tax office, police investigation’; it is an article by Steve Lewis.

CHAIR —Do the officers have a copy of that?

Senator FIERRAVANTI-WELLS —I have a copy for them. It sets the background for some of the questions that I am going to ask. Are you aware of code of conduct investigations?

Ms Halton —I am not aware of code of conduct investigations. I am just reading this. Does it say ‘code of conduct’? I do not think it does.

Senator FIERRAVANTI-WELLS —No. I am just asking you whether you are aware if there any code of conduct inquiries as a consequence of these allegations in the paper.

Ms Halton —Can you be clear about what you mean—in relation to whom, and what code of conduct?

Senator FIERRAVANTI-WELLS —Ms Halton, there is an article in the press that says a former CEO has stepped down amid tax office and police investigations.

Ms Halton —Yes.

Senator FIERRAVANTI-WELLS —Are you aware of any inquiries that were made in relation to irregularities or otherwise pertaining to Ms Murphy?

Ms Halton —Yes.


Ms Halton —But let us be clear: ‘code of conduct’ has a particular meaning in relation to legislation, and my answer to that question is no.

Senator FIERRAVANTI-WELLS —All right. So in relation to the particular meaning of ‘code of conduct’ the answer is no—

Ms Halton —Correct.

Senator FIERRAVANTI-WELLS —but there were other inquiries that were made.

Ms Halton —There were some broader discussions with the authority in relation to a whole series of things about management and, in the course of that, some other questions were raised.

Senator FIERRAVANTI-WELLS —All right. Thank you. At the time of the commencement of the authority, if my memory serves me correctly, on the last occasion at estimates Ms Murphy said she was the only person who was actually there in the authority—I will withdraw that. What were then the processes for hiring and firing staff on the commencement of the authority?

Ms Halton —There are a series of public service processes, which I think you are probably fairly well familiar with, which were followed.

Senator FIERRAVANTI-WELLS —Okay. How many staff were there when the authority was established?

Ms Halton —As in all places, zero on the moment it was established, and a number shortly thereafter; I could take that on notice.

Senator FIERRAVANTI-WELLS —Yes, please, because that was the point I was making: I think, on the last occasion, Ms Murphy said she was the sole one. Were any members of the executive seconded from the department?

Ms Halton —Of the executive? It depends on what you mean by ‘executive’. In terms of our executive, no.

Senator FIERRAVANTI-WELLS —The question is in relation to the executive.

Ms Halton —Were staff seconded? Yes, they were.

Senator FIERRAVANTI-WELLS —Of the executive of the authority—I am asking whether any were seconded from the department.

Ms Halton —Yes, I believe there were.

Senator FIERRAVANTI-WELLS —Okay. How many staff are there now?

Ms Halton —At the authority? I will ask the acting CEO to answer that.

Ms Cain —As at 31 May, there are 32.6 full-time equivalent staff at the authority.

Senator FIERRAVANTI-WELLS —Are there any on secondment?

Ms Cain —Secondment from?

Senator FIERRAVANTI-WELLS —Secondment from the department. Anyway, take that on notice.

Ms Cain —No. There are other staff on secondment from a variety of agencies. There is a mixture of staff seconded from the Department of Health and Ageing. The way the authority has staffed up, including prior to my appointment as acting CEO, was through, generally, merit-based recruitment processes as per the Australian public sector requirements. So staff from the Department of Health and Ageing would have had every opportunity to have worked in the authority if they had wished.

Senator FIERRAVANTI-WELLS —How many staff have left since the authority was set up?

Ms Halton —Are you asking about turnover or are you asking about aggregate? Can we be a bit clearer?

Senator FIERRAVANTI-WELLS —Staff that have actually left the authority. It has had a high—

Ms Halton —The number of individuals?


Ms Cain —I would take that on notice.

Senator FIERRAVANTI-WELLS —And could you also take on notice how many of these were resignations and how many of these were people who were actually fired? If you could do that.

Ms Cain —Yes.

Senator FIERRAVANTI-WELLS —Can you advise why there appear to have been no permanent appointments to positions of authority in the sense of at least the executive? There seems to be a preponderance of acting. Is there a reason for that?

Ms Cain —I think that the decisions made in relation to using non-ongoing staff would not be unusual for a start-up agency. The nature of the work of any new entity changes over the first couple of years of the entity’s existence. For example, at the moment, we are going through a process of increasing the number of staff that are focused on delivering the nine measures of the government’s reform package so that we have appropriately skilled staff in place to deliver on eye and tissue reform, on supporting the 159 doctors and nurses that are operating across the 76 public hospitals so that we have good, skilled staff in relation to activity-based funding and things of that nature.

In that respect, we are currently changing the staffing mix so that we have fewer administrative focused staff and more skilled staff. In the first year of the operation of any new entity, I would have expected to have seen a higher level of administrative staff, but you would not have wanted to appoint them permanently because you would recognise that your skills need would change over a period of time.

Senator FIERRAVANTI-WELLS —You have an acting financial officer at the moment.

Ms Cain —We do.

Senator FIERRAVANTI-WELLS —When did the chief financial officer leave?

Ms Cain —The chief financial officer resigned in late March. I would have to take the exact date on notice.

Senator FIERRAVANTI-WELLS —Thank you. What were the circumstances surrounding his departure?

Ms Cain —He wrote a letter of resignation to me.

Senator FIERRAVANTI-WELLS —Were there any accusations of wrongdoing?

CHAIR —Senator, it is unusual to get into such detail about individuals, and I am conscious of privacy issues, but the officers will be able to determine what they can and cannot say.

Senator FIERRAVANTI-WELLS —Subject to privacy requirements could you take that on notice? Can I just then move to whether any reviews or audits have been undertaken at the authority?

Ms Cain —We undertake ongoing reviews of authority business on a number of fronts. Since I commenced with the authority on 17 March, we have maintained ongoing review of progress against the nine measures in the Australian government’s reform package. It is pleasing to see that each of those nine measures are on track and delivering well. We are cautiously optimistic about the level of donation rates in Australian in 2010 as a result of the reform measures, so we are keeping those under ongoing review.

We keep the HR and financial practices within the authority under ongoing review and, for example, provide training and up-skilling to staff where we decide that that is necessary. We go through usual external review processes. At the moment, the Australian National Audit Office is having a look at some of the financial and process issues within the authority. So, yes, we have a range of review processes ongoing.

Senator FIERRAVANTI-WELLS —When you joined in March, were you aware of any audits that had been undertaken prior to your arrival?

Ms Cain —I am not aware of any audits undertaken by the ANAO prior to my arrival, no.

Senator FIERRAVANTI-WELLS —I asked are you aware of any internal audits.

Ms Cain —I am sorry, internal audits. I misunderstood. The authority did have an internal audit process which revolved around the authority’s internal audit committee appointed under the Financial Management and Accountability Act, and I am aware of the internal authority audit processes that would revolve around that, yes.

Senator FIERRAVANTI-WELLS —So there is an internal audit, and you said that you are not aware of any ANAO audit. You are not aware or there has not been an ANAO audit done?

Ms Cain —Other than the financial statements last year which the ANAO reviewed and signed off on, I am not aware of any other audit that the ANAO has undertaken, other than the one that is underway now.

Senator FIERRAVANTI-WELLS —Would you like to take that on notice and make sure that you check your records in relation to that?

Ms Cain —No. That is fine. I do not need to take that on notice. The ANAO has signed off on the financial statements and is currently undergoing an audit, but that is the extent of the ANAO activities.

Senator FIERRAVANTI-WELLS —Sorry. Take me back again. The ANAO has undertaken a financial audit, and that is the extent of it.

Ms Cain —They have signed off on the financial statements at the end of last financial year, and they are currently going through an audit process which is ongoing.

Senator FIERRAVANTI-WELLS —So there is an ANAO audit.

Ms Cain —Currently. That is right, yes.

Senator FIERRAVANTI-WELLS —All right. Do you have an indication from ANAO as to when that is going to be completed?

Ms Cain —I expect a report at the June audit committee. Whether that will be a final report or not, I do not know.

Senator FIERRAVANTI-WELLS —Are there any investigations currently under way into any type of fraud or misappropriation of funds?

Ms Cain —In relation to administered dollars, I have looked at all of the expenditure over the current financial year. The answer is no.

Senator FIERRAVANTI-WELLS —Assuming the ANAO have signed off on the findings, are you aware whether that was qualified in any way?

Ms Cain —It was not qualified.

Senator FIERRAVANTI-WELLS —So, presumably, the ANAO was happy with its financial audit of the authority.

Ms Halton —We cannot speak for the ANAO. We can just say what the outcome was.

Senator FIERRAVANTI-WELLS —Certainly.

CHAIR —I would like to move to other questioners. We are running out of time.

Senator FIERRAVANTI-WELLS —All right. Just going back to the departure of the chief financial officer, are you aware whether this had anything to do with Ms Murphy’s departure?

Ms Cain —No.

Senator FIERRAVANTI-WELLS —Ms Halton, were you aware of these audits? Have you been following them as well?

Ms Halton —The ANAO audit?


Ms Halton —In the abstract, yes, but obviously I am not involved in the day-to-day detail.

Senator FIERRAVANTI-WELLS —All right. The authority commissioned both its internal audit process and the ANAO is the routine one.

Ms Halton —No. The ANAO one is not routine. There is a routine to ANAO coming in, but there is a distinction we need to make between the routine process of signing off financial statements on an annual basis versus ANAO audits, which, whilst at one level abstractly you can describe them as routine, are not an everyday occurrence, if that does not mix too many metaphors.

Senator FIERRAVANTI-WELLS —Okay. I just have a couple of questions on the DonorTrac system.

CHAIR —Senator, you are going to have to put them on notice while I move to Senator Siewert.

Senator FIERRAVANTI-WELLS —I just have one question.

CHAIR —No. You have had more than the share in terms of this segment.

Senator SIEWERT —Obviously the objective of the exercise is to increase donations. I would like to get some up-to-date figures, please, on where we are in this year compared to last with the increase in donations.

Ms Cain —Certainly. As at 31 May 2010, we had 118 donations in Australia. This is the highest end of May result in Australia in a decade. The previous highest as at end of May result was 102 donations in 2008. The year-to-date figures for 2010 have exceeded the figures at any point in the trend year to date of any other year in the last decade. We are cautiously optimistic that the combined measures of the additional 159 new doctors and nurses in the 76 public hospitals, together with the awareness campaign that started a couple of months ago, will have really good results for the remainder of the year, in terms of increased organ donation rates.

Senator SIEWERT —Thank you. Are there specific areas where you have seen a significant increase? In other words, is that donation rate consistent across the states?

Ms Cain —As you would probably recall, South Australia, for example, has always had high organ donation rates compared to other jurisdictions, but this year New South Wales has increased its numbers quite significantly. I believe that they had 12 donations in May?

Dr O'Callaghan —In May of this year.

Ms Cain —Which is a significant increase for New South Wales over the same month in any of the last 10 years.

Senator SIEWERT —Are you able to provide a breakdown of each state, comparing each state from, say, the 2008 figures that you quoted to the 2010 figures?

Ms Cain —We can do that.

Senator SIEWERT —Is there any state that particularly stands out? Because we have got limited time, I will not get you to go through each state now, but is there a state that is not improving in particular?

Ms Cain —No, I think that there is an improvement.

Senator SIEWERT —Consistent across the borders?

Ms Cain —You would not want to be looking month to month, because the numbers are relatively small overall, but I think that, largely, the trends are positive across all of the jurisdictions.

Dr O'Callaghan —There is evidence from all states and territories of improvements in performance of specific organisations, evidence of donations occurring in organisations or hospitals where there have not been donations either for a very long time or before, and there is evidence of an increase in particular pathways to organ donation which are more complicated or are, in fact, in new practices. I think sometimes the state to state comparison, because it contains averages of small numbers of hospitals in particular states, does not reflect the improvements that are occurring in specific hospitals right across the country.

Senator SIEWERT —Thank you.

CHAIR —Senator Fierravanti-Wells, you have got another chance.

Senator FIERRAVANTI-WELLS —I was just going to ask some questions on the DonorTrac system. Are there plans to shelve it?

Ms Cain —What we are going through at the moment is a very usual process of writing business specifications, which any organisation would do for any new IT system, developing a budget and determining what is the most appropriate product to support the business process. There are, for example, off-the-shelf products from the United States that we are having a look at which may be more cost-effective than building an Australian specific system, while still achieving the same sort of exchange of information. So we are just going through the business process at the moment.

Senator FIERRAVANTI-WELLS —I understood that the program was to be up and running by early 2010, so does that mean that you have decided to shelve that program and now go into a new IT system and possibly buy some American product off the shelf?

Ms Cain —No, it is—

Senator FIERRAVANTI-WELLS —Could you just explain.

Ms Cain —Yes, sure. It simply means that some good developmental work was done on a system called DonorTrac. That information is now available to the authority. It is appropriate for the authority to go through the normal due diligence transparent process of assessing the efficacy of that system and its cost-effectiveness against any other product. It is just about testing the market and making sure that there is an appropriate contestability.

Senator FIERRAVANTI-WELLS —It appears to have received widespread support amongst surgeons.

Ms Cain —It certainly has its supporters, and it also has some people who have highlighted where they think that off-the-shelf products might be more effective. Yes, it would be correct to say that there is a diverse range of views in relation to that system.

Senator FIERRAVANTI-WELLS —Okay. So it has been tested. Why do you say that the American off-the-shelf product is preferable ?

Ms Cain —I did not say that—

Senator FIERRAVANTI-WELLS —I see. It is one of the options being considered.

Ms Cain —It is one of the options; that is right.


Ms Cain —And it is appropriate to consider whether it is more efficient or cost-effective or has other benefits compared to developing a purpose-built system, which would need to be maintained and therefore have costs of an ongoing nature. So we are just weighing it up in a transparent manner.

Senator FIERRAVANTI-WELLS —When is it proposed to roll it out?

Ms Cain —It is not proposed to roll DonorTrac out or any other system out—

Senator FIERRAVANTI-WELLS —Your new system. If you are going to change from one to the other—

Ms Cain —Just to be clear, it is not about changing from one to another. There was no endorsement by the authority of DonorTrac. No budget has been set aside for DonorTrac. What needs to happen is a system of developing business specifications and going through a budgeting process and determining what the appropriate system is to support Australian clinicians in the Australian environment, and that is the process we are going through at the moment.

Senator FIERRAVANTI-WELLS —And I understand there were some recommendations of the expert advisory group. What were those recommendations, and—

Ms Cain —I am sorry, which expert advisory group and recommendations in relation to what?

Senator FIERRAVANTI-WELLS —I understand that there was an expert advisory group established to recommend the best option for implementation in Australia.

Ms Cain —I am not aware of an expert advisory committee established for that purpose.

Senator FIERRAVANTI-WELLS —All right. I might put some further questions on notice. Thank you.

Senator CAROL BROWN —I wanted to get some information about the public awareness program, DonateLife Family, and how that is going.

Ms Cain —It is going very well.

Senator CAROL BROWN —Has there been an increase in people signing up as organ donors?

Ms Cain —What we have done is develop that campaign on the basis of extensive research that has been conducted over the last couple of years, including some very precise benchmarking research that was done immediately before the campaign started. As you know, the campaign is all about encouraging people to have the really important conversation with their family about their intention to donate, because at the end of life it is the family that are going to be asked to give the final okay for donation. Understanding what the current trends are within the Australian community around family understanding of the decision to donate is what we have done in terms of establishing our benchmark.

What we are hoping to do is lift the consent rate in the first couple of months of the campaign from around 58 per cent to 65 per cent. That is quite an ambitious target, but the national advertising campaign has been incredibly well researched and we should set stretch targets where we are reasonably confident of being able to meet them. We will have the first tracking research results by the end of June, but already we have some quite remarkable indications that the conversation we are hoping that Australian families will start having is actually occurring. The campaign commenced about two weeks ago, and before that date we had around 300 Facebook friends that were engaged actively in a conversation about the conversations they were in turn having with their families. As of yesterday, there were over 6,000 people actively participating in some level of conversation on Facebook. To have people not just aware of the ad and aware of the messages but then translating into action on things like Facebook is a very positive early indicator, but until we get the research results at the end of June we will not have a final, definitive view about how we are really going.

Senator CAROL BROWN —So you do not have information about how many people have signed up to be organ donors.

Ms Cain —The thing that the advertising campaign is trying to do is not to increase registration rates but to increase family awareness of each other’s wishes, in terms of donation, because after somebody dies it is their family that will be asked to give the final consent to the donation, and so it is—

Senator CAROL BROWN —I understand that, but for me, I think it is a little bit linked, because we all know that in the Australian community the number of people who support organ donation is quite high. About 80 per cent of people actually support organ donations. But then we have that trouble about the consent, and that is where the awareness campaign comes in. Also, linked to that, if my partner had that discussion with me and said, ‘I have decided to do this and this is what I want you to do if something unfortunate happens,’ then he would sign up as well. Do you also track the people that sign up?

Ms Halton —I think this is a really important point, because it is great if people sign up because it means there is some objective evidence, and sometimes families need to know that they did sign up, even if they have had the conversation. But actually the act of signing up itself is not what we are targeting here, and quite deliberately so, because all the evidence says that it is the conversation that occurs, as you say, if there has been a tragic event. That is the crucial point.

In fact, what you do not want to do is to direct people’s action into the process of filling in a form. If there is only one action they take, you want that action to be for them to say to their loved ones, ‘Did I mention this? Take the lot, because it is no use to me,’ which is what I have said to my loved ones. If there is going to be one action people take, there is a danger. We know that in social marketing if you use a call to action which is ‘do something’ about whatever, people are likely to take one step. If the call to action gets them to register, that is not what we need. What we actually need is exactly as you say—to translate that 80 per cent response, ‘Yes, of course, okay,’ which is what people think, into an environment where their family members are confident about that. That comes from the conversation, and that is what the call to action is.

Senator CAROL BROWN —Thank you, Ms Halton. I understood that the first time. Do you monitor how many people sign up? Do you do that work?

Ms Cain —Medicare Australia maintains that—

Senator CAROL BROWN —I know they run the system, but do you—

Ms Cain —and we maintain a dialogue with them. What we are working on—and we can share the results; we will be making the results publicly available—and what we are particularly interested in monitoring is the consent rate at the point of a loved one dying. We are looking at what the family consent rate is and we have set those targets that I mentioned earlier.

Senator CAROL BROWN —Of those 218 as of 31 May, how many people did that assist?

Ms Cain —What I can tell you is the results as at the end of April in terms of transplants. As at the end of April, 88 donations had happened in the first four months of 210 resulting in 251 transplants. I should add that that is solid organ transplants and solid organ donations; that is not counting eyes and tissues. That is an average of around about 3.5 transplants per donor, which is an improvement on many of the previous results. So the donation rates are up and we are optimistic about the number of transplants that are resulting from each donation.

Senator CAROL BROWN —Thank you, Ms Cain.

CHAIR —Thank you very much, Ms Halton, and thank you to the officers for outcome 13. We will now suspend until 1.30, when we are going to come back with aged care. Ms Halton, I believe all questions on notice have now been received, so we have them all. Thank you very much.

Proceedings suspended from 12.33 pm to 1.31 pm

CHAIR —We will now go into consideration of outcome No. 4, Aged care.


CHAIR —Are you able to go through by each of the programs?

Senator FIERRAVANTI-WELLS —I will try. In fact I have organised my material to do that.

CHAIR —We will start with program 4.1, the aged care assessment team.

Senator FIERRAVANTI-WELLS —Ms Halton and minister, I think you would be aware of the article on the front page of the Sunday Telegraph entitled ‘This is how we care for the aged’. Ms Halton, are you aware of that article?

Ms Halton —Yes.

Senator FIERRAVANTI-WELLS —So you do not need a copy?

Ms Halton —I do not have one with me and I cannot say that I have memorised every single word of it.

Senator FIERRAVANTI-WELLS —My comments will be more general. Do we have the names of the nursing homes being talked about? The article refers to two organisations. It does not refer to the names of the nursing homes in question.

Ms Smith —You are correct. The article refers to the names of the two approved provider groups. As soon as we saw the article in question we looked at the department’s records and talked to the providers in question. We were able to identify the names of the two homes involved.

Senator FIERRAVANTI-WELLS —Do we have the names of the two homes involved?

Senator Ludwig —Do we want to read that into the record? There would be a public interest reason.

Ms Smith —It is protected information under the Aged Care Act. I cannot release that information.

Senator FIERRAVANTI-WELLS —I appreciate that. Have these nursing homes been sanctioned before?

Ms Smith —No, they have not.

Senator FIERRAVANTI-WELLS —For ease of reference I will refer to this way: one is under Bupa Aged Care and the other is under Domain Principal Group.

Ms Smith —Yes.

Senator FIERRAVANTI-WELLS —For the purposes of our discussion this afternoon I will just refer to them as Bupa and Domain, because that is information in the public domain.

Senator Ludwig —Thank you.

Senator FIERRAVANTI-WELLS —So neither of these two homes have been sanctioned?

Ms Smith —That is correct.

Senator FIERRAVANTI-WELLS —Did Ms Squires have a police check?

Ms Smith —Both providers were able to verify the identity of the home by checking their volunteer register. Ms Squires used her correct name and police checks were obtained.

Senator FIERRAVANTI-WELLS —When were these homes last visited by the agency, or when did they last receive a visit?

Ms Smith —The department visited the homes on Sunday afternoon, but in respect of their previous accreditation visits you would need to check that with the accreditation agency.

Senator FIERRAVANTI-WELLS —During the course of your investigation, I would assume an investigation has been undertaken, commenced.

Ms Smith —We initiated an own motion investigation as soon as we were aware of the issues in the media article.

Senator FIERRAVANTI-WELLS —What action has now been taken by the minister since the department became aware?

Ms Smith —The minister, I think you would be aware, put out a press release on Sunday. The department has commenced an investigation and the accreditation agency commenced review audits at both homes on Monday morning.

Senator FIERRAVANTI-WELLS —At the last election the incoming government indicated that they would be undertaking 7,000 unannounced visits, and there is material in relation to unannounced visits, so can you tell me how many unannounced visits either of these two homes have had since 2007?

Ms Smith —Unannounced visits are in the agency’s domain, so they would have to talk to you about their accreditation visits in respect of those homes.

Senator FIERRAVANTI-WELLS —Okay, I will ask the agency. Have you received any complaints about either of these two homes?

Ms Smith —We have received complaints, over what time period are you talking about?

Senator FIERRAVANTI-WELLS —Let us start with from since 2007?

Ms Smith —We have received complaints about both homes since 2007.

Senator FIERRAVANTI-WELLS —Can you tell me when those complaints were recived?

Ms Smith —I do not have a complete list of every complaint at both homes.

Senator FIERRAVANTI-WELLS —I would assume that since this happened on Sunday, the department would have made it their business and the minister would have it her business to find out as much as possible about these two nursing homes, and I am surprised you do not have this information with you today. I would have thought you would know I would ask questions about it.

Ms Smith —I can tell you numbers, but I cannot tell you—

Senator FIERRAVANTI-WELLS —The nature of the complaints.

Ms Smith —The nature of every instance.

Senator FIERRAVANTI-WELLS —That is fine.

Ms Smith —Since 1 May 2007, which is when the Complaints Investigation Scheme was introduced, we have received 10 contacts in respect of the Bupa home, and then, in respect of the other home, 27.

Senator FIERRAVANTI-WELLS —And in relation to those complaints, what action has been taken? You do not have any information at all about these complaints?

Ms Smith —We have investigated those complaints. In respect of the Bupa home, we have finalised nine of those, and the one remaining is actually the own motion investigation initiated by the department over the weekend.

Senator FIERRAVANTI-WELLS —In relation to Domain?

Ms Smith —In relation to the other one, we have finalised 24 of them.

Senator FIERRAVANTI-WELLS —Were the complaints found to have been valid?

Ms Smith —We had some in which the information was validated and some in which it was not. I would have to take that on notice in respect of each of the homes.

Senator FIERRAVANTI-WELLS —So you have obviously got some details about the complaints against these two nursing homes, but you do not have the nature of those complaints?

Ms Smith —I do not have exhaustive detail on each. I have summary information with me today.

Senator FIERRAVANTI-WELLS —You might like to give us the information that you have in relation to each of those nursing homes.

Ms Smith —In respect of the Bupa home we have had two finalised contacts in the most recent 12-month period: one in September 2009 and one in February 2009. The one in September 2009 was a report of a missing resident. That resident was located within 24 hours and there was no breach of the approved provider’s responsibilities identified. The February 2009 complaint was an alleged assault of a resident by another resident. The scheme conducted an unannounced site visit and our investigation did not identify a breach of the approved provider’s responsibility.

Senator FIERRAVANTI-WELLS —Let us take the Bupa ones. Turning to the matters and allegations raised in relation to Bupa, of the 10 you have given me, were any of those the subject of a similar complaint?

Ms Smith —I do not believe so, but I would need to check.

Senator FIERRAVANTI-WELLS —None of the complaints since 1 May 2007 relate to similar allegations to what is alleged in the Sunday Telegraph?

Ms Smith —Not that I believe, but I would need to check.

Senator FIERRAVANTI-WELLS —You do not have  as much detail.

Ms Smith —I do not have as much detail on the older complaints with me today.

Senator FIERRAVANTI-WELLS —Let us go to the Domain ones and similarly the nature of the complaints in relation to Domain.

Ms Smith —We have three contacts currently under investigation. There is one from February relating to alleged poor clinical care in respect of an infection stemming from inadequate monitoring of diabetes. That contact is currently under investigation. The resident in question has been discharged from the home and is now in Brisbane. In May 2010 we had a contact about alleged unreasonable use of force by a staff member on a resident and we are currently investigating that. Then we have the current own-motion investigation that we commenced on the weekend. Those are the three contacts that are currently under investigation. I think it is worth, in relation to this home, putting a little bit of background on the record. This Domain home has a fairly challenging resident profile.

Senator FIERRAVANTI-WELLS —I was about to ask you that. How many?

Ms Smith —There are a number of residents who would be younger than the typical resident population; more males than females; and people with alcohol-related brain damage or who have been homeless for much of their lives, or have some other acquired brain injury. That makes it a fairly challenging environment.

—What is the ratio? Give me a bit more of a profile. High, low: all high care?

Ms Smith —It is a high-care facility, and it has got a much younger profile. In terms of the three domains of the aged-care funding instrument, a lot of the residents have got high ratings in the behaviour domain but low ratings in the complex health care domain, so these are not people who are frail and needing a lot of clinical support but people who have got very complex behaviour.

Senator FIERRAVANTI-WELLS —How many people are there in the nursing home?

Ms Smith —I think there are 55 there currently.

Senator FIERRAVANTI-WELLS —So there are 55 at Domain. How many are at the Bupa facility?

Ms Smith —It is a 90-bed facility with 89 residents there at the moment.

Senator FIERRAVANTI-WELLS —What is the staff profile of each of these nursing homes?

Ms Smith —I do not have that information with me.

Senator FIERRAVANTI-WELLS —Is that part of the information that you will have available as part of their records?

Ms Smith —As part of an investigation, we would look at the staffing profile on the rosters because that is one of the issues that are alleged to have been impacting on care.

Senator FIERRAVANTI-WELLS —Obviously this story has generated a lot of media interest, both written media and radio. What about the department? Have you received any complaints or, as a consequence of this story, had people contacting the department with similar stories?

Ms Smith —I think there may have been a couple of inquiries to our New South Wales office following the story, but I would have to check actual numbers and whether people were particularly referencing the article as having prompted their call or whether they were just ringing generally. I would have to take that on notice.

Senator FIERRAVANTI-WELLS —So you have two nursing homes, both of which have a fairly consistent history of some complaints—

Ms Smith —In relation to the first home, I think 10 in a three-year period is not particularly remarkable.

Senator FIERRAVANTI-WELLS —What is the average number of complaints?

Ms Smith —I would have to take that on notice, but certainly 10 in a three-year period, with only two in the last 12 months, is at the low end. The other home, as I have noted, has a particularly challenging resident profile, so I think it is fair to say that there is a history there, but I do not think that is a fair statement in relation to the first home.

Senator FIERRAVANTI-WELLS —In relation to those visits, I will deal with the accreditation agency.

Ms Smith —The department took this article extremely seriously.

Senator FIERRAVANTI-WELLS —I would hope it did.

Ms Smith —As soon as we read the article we were working to identify the homes and ensure that an investigation was commenced as soon as possible. Without in any way wanting to diminish the seriousness of some of the issues raised in the article, I think there are some issues there where there may be a lack of experience with nursing homes. For example, there was a picture of pureed food there. It was described as slop in the headline, but it is actually a reality that, for residents with swallowing difficulties, it would be dangerous for them to eat other than pureed food. There was a mix of information in that article, some of which is a feature of nursing homes and what is required to care for residents of particular types, and some of which are very serious allegations about care.

Senator FIERRAVANTI-WELLS —Yes, I am aware of that. On the topic of food, what is the situation now in terms of monitoring of food to residents? What regulation and guidelines have the department or its agencies imposed in relation to food in nursing homes?

Ms Smith —There is an accreditation standard that relates to food and nutrition and that is monitored by the accreditation agency as part of its processes. Residents and their families also have the capacity to complain through the Complaints Investigation Scheme if they are concerned about food and nutrition. We are certainly very acutely aware that that is a critical issue for residents. I think with the increasing frailty of many residents and the sort of diagnoses they have, lack of appetite can be a feature of those conditions, and it is really important that homes understand how to keep adequate nutrition up to residents.

Senator FIERRAVANTI-WELLS —As far as the department is concerned, were there some reports in relation to—particularly in New South Wales—the New South Wales Foods and Standards Agency being involved, are you aware of—

Ms Smith —I am not exactly sure what you are referring to?

Senator FIERRAVANTI-WELLS —In relation to the more detailed questions about food, is that something that you have some input in, or is that something I should purely just ask the agency?

Ms Smith —The department has a role in terms of promotion of good practice around a range of issues relating to good quality care, including food and nutrition. We also will investigate complaints where they relate to food. In terms of the accreditation standards and what is found in monitoring of homes, that would be a question for the agency.

Senator FIERRAVANTI-WELLS —All right, what about pets in nursing homes, is that something that comes within your domain?

Ms Smith —Do you mean where the people are prevented from having pets or allowed to have pets?

Senator FIERRAVANTI-WELLS —Just in terms of access to nursing homes by volunteers with pets, is that a program that you—

Ms Smith —I am certainly aware that some nursing homes have pets as therapy programs as do hospitals, I think that can be quite a valuable addition to the range of activities a nursing home has for residents. I am not aware of any particular program that is causing concern though.

Senator FIERRAVANTI-WELLS —As I have been sitting here, I have just received an email, and I would just like to share this since we are following up this story that was in the Telegraph the other day, and it says:

Dear Senator, I can tell you from experience that a lot of nursing homes are bad, not only do they exploit the patients, they exploit the staff. A lot of staff are from non-English speaking backgrounds and their lack of English causes a lot of communication problems, lack of care.

She refers to her grandmother being in a place in New South Wales for respite and surgery. and she is blind, bedridden et cetera. This sort of commentary—and I ask this in the context of—in the last few days after this story, there has been on some of the talkback radio programs an enormous amount of interest and people calling in with story upon story, upon story, about difficulties in nursing homes. You obviously paint your picture of what the situation is, but clearly there are a range of problems out there. The fact that this can happen is indicative of a far greater problem in the system.

Ms Smith —We have taken the issues raised in that article very seriously, we have got an investigation underway. The government has also made a recent investment in the Complaints Investigation Scheme to improve its capacity to investigate complaints, so I think it is demonstrably an issue that has been taken very seriously.

Senator FIERRAVANTI-WELLS —But what about the underlying problems that the industry is facing, and there is review upon review, upon review, that has been done in this area, in particular since 2007 and yet the same problems seem to be emerging. The fact that we do see this sort of story, doesn’t that raise alarm bells about an industry in crisis and the more systemic problems that are in the industry that need to be addressed so that these sort of stories do not appear in the newspapers?

Ms Halton —Senator, you are asking the officer for an opinion, which she is obviously not going to give because that would not be appropriate. I should make the point that there were a number of measures taken in the budget in respect of aged care but the Productivity Commission, as you are aware, is also examining aged care. I think it remains for us, firstly, to wait while those measures are implemented and, secondly, while the Productivity Commission does its wholesale review, to think about where the future of aged care is going. But the officer obviously cannot answer a hypothetical or speculative question about opinion.

Senator FIERRAVANTI-WELLS —So did the Senate Standing Committee on Finance and Public Administration’s Inquiry into residential and community aged care in Australia examine ageing. So did the Productivity Commission’s 2009 Annual review of regulatory burdens on business: social and economic infrastructure services; so did the Auditor General’s Audit Report No. 40 2008-09: Planning and allocating aged care places and capital grants; so did the Productivity Commission paper Trends in aged care services: some implications; so has COAG; so have other internal reviews of the department that have not been released. How many more? Surely all these reviews that have been conducted on aged care must have given the department and the minister some inkling of the myriad of problems in this sector.

Ms Halton —The minister herself has received a small number of reviews. A number of those ‘reviews’ that you have referred to are in fact things that have been undertaken in respect of, for example, the deregulation agenda. I do not think it is appropriate to lump all of those together and say they are all wholesale reviews of aged care, because they are not. In fact, a number of things in the budget have responded to matters that have been raised but, precisely because of the interactive nature of a number of these issues, that is why the Productivity Commission is doing a top-to-bottom review of the program and the system.

Senator FIERRAVANTI-WELLS —Perhaps I can take you to the Productivity Commission and the terms of reference. I think you will see in box 1 of the Productivity Commission’s issues paper that they recently put out that it starts with a whole series of quotes from the so-called small number of reviews—you are trying to dismiss them as a small number of reviews; I think it is more than a small number of reviews. Anyway, there are quotes from a number of reviews that have already been undertaken in relation to aged care. The Productivity Commission’s first sentence—and I am sure you have read that document—says that major reform is required. It then quotes six or seven paragraphs from six or seven different reviews where, effectively, there are strident comments about the need for major reform of the sector. The point is that, yes, the Productivity Commission is doing this, but it seems to me that stuff is just going to be shuffled over to the Productivity Commission for yet another review when you already have a whole series of reviews which this government has not even bothered to respond to. Its response is to have another review.

Senator Ludwig —It is set out on the Productivity Commission’s website:

In undertaking the inquiry, the Commission will develop options for further structural reform of the aged care system …

I think it is entirely appropriate that the Productivity Commission undertake this work. I think it is also appropriate that we look to see what the outcome of that is. I think it is correct to also say that the reviews you have mentioned are not all reviews as such. The Auditor-General, COAG and the particular Senate committee inquiries are of a different character and I recognise that.

I think it is also fair to say that the government is reforming the aged care system. We have, I am advised, looked in the budget at how we can do that. In 2010-11 there will be $730 million more funding for aged care than if Mr Abbott had remained the minister. To date the minister has been engaged, particularly in that last one you mentioned in relation to the report in the paper. There is an aged care complaints investigation scheme in place. I think you are well aware of that.

I think it is also worth mentioning that if there are issues that surround us—for instance, if residents, relatives of residents, visitors, staff or volunteers in aged care facilities—have concerns about the operation of aged care facilities there is a complaints number they can contact. For those who may be listening it is 1800 550 552. It is one of those areas for which you can provide a complaints mechanism. It is effective. These steps were taken shortly after the paper produced that article. The aged care complaints body visited the site and I am advised that the independent Aged Care Standards and Accreditation Agency has commenced a full audit. So there is a process in place for dealing with current issues and dealing with the way forward. It is a challenging area. I think everyone accepts that. This government is taking it very seriously.

Senator FIERRAVANTI-WELLS —Then can you explain to me why it took from August last year until April this year for the terms of reference of that Productivity Commission to be announced.

Senator Ludwig —I can take that on notice. I am not sure of the process involved in that—unless the department has an overview of how that comes about.

Ms Halton —They are obviously released by the Treasury but, more importantly in this particular case, they were released as we followed discussions at COAG on a couple of issues in respect of aged care. There is nothing more I can say on that.

Senator FIERRAVANTI-WELLS —Some issues have been raised with me in relation to building codes and layers of duplication. Is there some intention to review building codes as part of concerns that providers have raised in relation to duplication and layers of codes to achieve accreditation?

Ms Smith —I think you might be referring to the building certification requirements. It was a recommendation of the Productivity Commission in relation to the regulatory burden report that we should examine incorporating the privacy and space requirements which are currently in the certification instrument into the Building Code of Australia. The government has accepted that recommendation and we are currently consulting with the Australian Building Codes Board with a view to incorporating the privacy and space requirements that are currently in a separate instrument into that. That is in direct response to the feedback the industry has provided.

Senator FIERRAVANTI-WELLS —Can you tell me where and how the extra funds allocated in the budget in relation to accreditation will be spent?

Ms Smith —There is an element of the complaints investigation scheme that provides additional funding for the accreditation agency. That is in recognition of the fact that, of the complaints the department examines, some will end up being an individual issue that only affects one individual, but some will raise a systemic question. The department in its usual way of investigating complaints will make referrals to the agency where we believe there is a systemic dimension to the concerns being raised. In line with the projected increase in complaints which we are seeing for a number of reasons—ageing of the population, increase in number of places and a general increasing community expectation, I think, about their right to complain—we have also projected an increase in activity for the agency. That is reflected in the budget papers.

Senator FIERRAVANTI-WELLS —You have allocated extra money for benchmarking. How will this be conducted? Are you going to directly fund providers?

Ms Smith —That is a question for my colleague.

Ms Podesta —In the budget the government provided $7 million for a benchmarking tool and business advisory services so that aged care providers can compare and improve their business practices. All of the residential aged care providers will be included in the benchmarking survey and it will use the data that is currently provided. This will enable each aged care facility to benchmark their operations against best practice and improve the quality and efficiency of their care delivery to residents.

Senator FIERRAVANTI-WELLS —In other words, you will also use this to track financial performance? Is that the intention?

Dr Cullen —We already track financial performance through the general purpose financial statements. The benchmarking study is done at a different level. Typically, the benchmarking study will be not at the level of the approved provider but at the level of the aged care home. It would also be done at a lower level of cost centres. You would collect costs separately on catering versus laundry versus utilities, et cetera and thereby allow providers to compare themselves to other aged care homes with similar resident mixes in order to see how their costs compare to others.

Senator FIERRAVANTI-WELLS —What is the timeframe for this?

Dr Cullen —It is an ongoing process. At the moment we are in the process of setting up a reference group, with the industry, of providers who would help us in the design of this but over the next 12 months we would hope to establish the benchmarking site. The intention at the moment is to have a web based site whereby providers can enter their data and at the same time select a group of peers and compare themselves to those peers on any sort of analysis that they want to. We would hope to have that benchmarking service up and running by the end of the financial year.

Senator FIERRAVANTI-WELLS —So that it is really for their own benchmarking against industry rather than any attempt to assist in the reduction of red tape?

Ms Podesta —Precisely. It is genuinely about business efficiency, recognising that it is in the interests of the approved provider to be as efficient as possible.

Senator FIERRAVANTI-WELLS —I just want to ask a couple of questions about the aged care assessment. How will this system continue if Western Australia does not sign up to the health plan? I noticed one of the provisions is that you are going to take over the aged care assessment. What happens if Western Australia does not sign up?

Ms Podesta —We are currently negotiating an implementation plan with each state and territory for the next two years—that includes the Western Australian government. This is part of the current national partnership on health services. We will have negotiations with those parts of the country who have signed up for the COAG reforms about how the assessment program will link into the unified aged care services as they are built. Western Australia currently takes responsibility with us for aged care assessment and at this stage they will be supported through the next two years once they have signed the implementation plan to go with the national partnership agreement.

Senator FIERRAVANTI-WELLS —In the budget allocated over forward estimates for aged care assessments it is actually a global figure. Can you break that down into the funding for each of the states or have I missed it? Where can I get that information?

Dr Cullen —You can find a notional breakdown in budget paper No. 3. Because it is a national partnership agreement, the notional state breakdowns are provided there. I say ‘notional’ because the forward estimates are driven by population parameters and can change.

Senator FIERRAVANTI-WELLS —One of the criticisms has been the inconsistency of the ACAT assessment across Australia. One assessment in one state or one location within a state may be different to another. Firstly, how is your takeover going to rectify those issues and secondly how do you build into that—is it a stock amount per ACAT team, or how have you assessed the budget in relation to those teams?

Ms Podesta —As part of the implementation plan negotiations and in the lead-up to the renegotiation of the implementation plan, we have been working closely with our colleagues in the states and territories to get agreement about new key performance indicators on timeliness, consistency and quality of their aged-care assessments. That is consistent with the previous COAG decision of 2006 to ensure that we have more consistent and timely arrangements with our states and territories. The new implementation plan will have new agreed key performance indicators for the transition period with the states and territories.

Senator FIERRAVANTI-WELLS —Have you, as part of that, made any assumptions in relation to the cost of each of these assessment teams and the variation of costs across Australia? What I am getting at is that the cost of running a team in one location may be different to another. Is that budget being determined based on the individual needs in a particular area as opposed to the other?

Ms Mackey —Part of the negotiations that are happening at the moment with states and territories around the new implementation plan for the aged-care assessment program looks at the transition period that will be required over the next couple of years and the information we need to make sure that we build a robust funding model for the future, including what the appropriate price might be for a comprehensive assessment.

Senator FIERRAVANTI-WELLS —And built into that, will there be some performance indicators? One of the concerns that I hear all the time is the delays to get an assessment. Are you going to build into that some more stringent time lines?

Ms Mackey —As Ms Podesta has indicated, in the current arrangements and in the implementation plan that is currently being negotiated there are key performance indicators which particularly go to timeliness. We will certainly be interested in making sure that there is a continued effort in improving timeliness.

Senator FIERRAVANTI-WELLS —You are going to set a time such as assessements within six weeks or five weeks or something like that?

Ms Mackey —We already have those arrangements.

Senator FIERRAVANTI-WELLS —Yes, I know, but they do not always work.

Senator CAROL BROWN —You could always have a little bit more time to indicate how the changes are going to be better than the current assessment process. How will the changes be more advantageous for the industry and the clientele?

—I think that is the right question. There are many parts of the age care assessment program which are phenomenally positive and, as a system of assessment, it is quite robust. There are certainly things that could be done to improve that. I think that is about national consistency and better training for staff, and better information for carers and for people who are being assessed, and then later follow-up for people. We will certainly be focussing on making sure that the work force have the right sort of training to be able to undertake that but that there are incentives to have a timely response around assessment needs.

One of the things it is important to note is that we have particularly focused on improving response for highest need. That is as it should be. So the vast majority of people assessed as urgent cases are assessed within two days—48 hours is the benchmark for priority one cases. There has been an improvement in the way the teams do that. That is the important part of it. There are a range of other things that can be done to improve the way we undertake assessment nationally, and they are around issues of cultural appropriateness, ensuring that the communication is done properly and consistently, that we have fair access to assessment services and that people understand what the assessment means for them in terms of the plans that they need to make about their life.14:14:49

Senator FIERRAVANTI-WELLS —One of the complaints raised with me is the discrepancy between the assessment done by ACAT and the assessment done by the registered aged-care faculty for ACFI purposes. Do you monitor the discrepancy rates or discrepancies between those two? Obviously you have to do it on a person-by-person basis, but the discrepancy between the ACAT assessment and the subsequent assessment that may be done by the registered aged-care facility is one of the things that is constantly raised with me.

Ms Podesta —I think you are asking a question that has been a particular focus in the work we are doing under the aged-care funding instrument review. I guess you are thinking particularly here about residential care—is that right?


Ms Podesta —So in the time lag that can sometimes happen between the time that someone has an ACAT assessment and when they enter a residential aged-care facility, has their condition changed? Or in the ACFI assessment that is made by the approved provider when they enter the home or place, what they identify as their needs and what is the mechanism. We have particularly been examining that issue. I will ask my colleague, because it has been part of the review, to particularly focus on that issue.

Senator FIERRAVANTI-WELLS —Thank you.

Ms Murnane —They actually serve a different purpose—a complimentary purpose, but different. The assessment team assesses that they are eligible for residential aged care. Nursing homes or aged-care homes will ask them, ‘What category do you think?’ They may say, but they do not do the detailed observation on needs for assistance that the home will then do over a two- or three-week period.

Senator FIERRAVANTI-WELLS —I appreciate that, but the issue is that when you have somebody who gets assessed there are certain expectations. It is not just the one person, it is usually a family or loved ones around, and there are certain expectations. Then of course you go to the provider, and often if there is a discrepancy it leads to potentially some tension. I appreciate that it is for different purposes and there are different tools. Nevertheless, there are still overlapping components, and that is what I was really getting to.

Dr Cullen —You will recall that on 1 January the Quality of Care Amendment Principles 2009 changed the definition of high and low in the ACFI in order to address this issue. That has been very successful in addressing this issue. Prior to the introduction of the ACFI, the rate of disagreement between ACATs and the then RCS assessment was 7.9 per cent. After the introduction of the ACFI in January this year, if we had kept the first definition of the ACFI the rate of disagreement would have been 15.1 per cent. Instead, under the new definition, the rate of disagreement was 8.4 per cent—in other words, exactly the same as it was under the RCS. So the changes made in January have resolved the issue back to the level of disagreement which is absolutely to be expected. Over 12 years of the RCS our experience was that about 8 per cent of cases would be in disagreement.

Senator SIEWERT —What was the date that the calculation was done of 8 per cent?

Dr Cullen —January 2010.

Senator SIEWERT —To when?

Dr Cullen —The month of January.

Senator SIEWERT —It was just the month of January?

Dr Cullen —In the month of January 2008, under the old system, it was 7.9 per cent. In the month of January 2010, under the new system, it was 8.4 per cent.

Senator SIEWERT —Have you done an average across a further time line than that?

Ms Podesta —No. We can take it on notice.

Dr Cullen —We could take that on notice, but the number of entries in January would be statistically significant. I would not have any doubt that that number would stand.

Ms Podesta —We will take it on notice, but because the number of entries were about the same they are statistically pretty valid. We will certainly give you the additional information.

Senator FIERRAVANTI-WELLS —Thank you. I am sure this and many other things are contained in the ACFI review, which we are still waiting for with bated breath.

Ms Podesta —Senator, the ACFI review is absolutely on track.

Senator FIERRAVANTI-WELLS —Good, I am waiting with bated breath.

Ms Podesta —All of the submissions have been published, the first part of the analysis has been published, the discussion paper is out.

Senator FIERRAVANTI-WELLS —I will wait for the final.

Ms Podesta —ACFI review reference groups have been meeting regularly and working with us.

Senator FIERRAVANTI-WELLS —I want to ask about the allocation for the one-stop shops. There is a budget allocation for one-stop shops, but not total, and the number expected and the location. Can you enlighten me on that please?

Ms Podesta —The government has committed $36.8 million over four years to streamline the front end of age care. The introduction of the one-stop shop and the locations will be linked with the local hospital networks. As such, we will be working with our colleagues on the appropriate location sites. I think indicated this previously in the briefing.

Ms Halton —Senator, I really think it is important to underscore what we are trying to do here. We all know, because we have either had family members in these circumstances or people tell us about it, that people expand a huge amount of shoe leather trying to work out how to get round the age care system and how to find a service. This is very much about providing a coherent, integrated place that people can go for that advice. And as Ms Podesta says, it is really imperative that this is integrated in the health reforms and that it is part of a coherent regional presence, which we did talk about first thing this morning.

Senator FIERRAVANTI-WELLS —In the appendices to the national hospitals agreement that we were discussing this morning, is the time line for this to happen contained in one of those appendices? I might have missed it. Or is it just to be determined?

Ms Podesta —No, there is a transition process. We will be progressively, over the next year, identifying locations and establishing one-stop shop outlets and services progressively as we finalise arrangements around transition, and then the Home and Community Care program will be building on the services that one-stop shops will be providing and the system that will underpin them. It will be a progressive rollout of the services of the one-stop shops, and progressive rollout of—some will be, as I think we have previously indicated, using the capital and stock of existing infrastructure, some will be new services and new sites. We will also have telephony and internet services that will underpin the one-stop shop services.

Senator FIERRAVANTI-WELLS —I want to go to the tender process for the ACAT reform changes. How will that tender process work? Will there be a tender process?

Ms Mackey —In terms of procurement for one-stop shops?

Senator FIERRAVANTI-WELLS —No, not about procurement. I have finished on one-stop shops; I want to go back and ask about the ACAT reform and the changes you are going to make. Does that involve a tender process?

Ms Mackey —The current provision of the ACAT program does not involve a tender process. It is service delivery through the state and territory governments.

Senator FIERRAVANTI-WELLS —So it is really just going to be a takeover federally?

Ms Mackey —In terms of the future of the Aged Care Assessment Program and how we make sure that comprehensive assessment is part of the front-end of age care, and linking in and part of the delivery of one-stop shops, that is what we will be working through over the next little while as part of the transition process. So there have been no decisions on future tendering of procurement or how those services might be delivered.

Senator FIERRAVANTI-WELLS —Okay. But if I understood Ms Podesta in a previous briefing, there will be potentially some sort of tendering process where some entity, not necessarily state government entity, will run this?

Ms Podesta —I think there is going to be a range of options that we will need to examine. We spoke previously, and the budget measure makes clear, the one-stop shops will be in a position to purchase some complex assessments. So there will be at least one feature of the system which provides for some funds to be able to purchase.

In relation to what the infrastructure is around the Aged Care Assessment Program, we have made a very strong commitment that we want to continue and build on the solid infrastructure that exists within the Aged Care Assessment Program. We went recently to the Aged Care Assessment Program conference and spoke with a very large number of staff and made a real commitment to staff that we are incredibly proud of what the program is able to deliver for older Australians. It is not our intention to start as if that does not exist; that would be ridiculous. This is about taking the best features of the Aged Care Assessment Program and looking to see what is going to make the most sense for people as they enter through one door, for how they enter into that system, and how the aged-care assessments can be done as quickly and comprehensively and, most importantly, with the highest quality. That is absolutely critical. We are not interested in going down the path of looking at how we can do it as fast and cheaply as possible. The critical question is to get the assessment done appropriately and to get it right so that people’s needs are identified and then they are supported and referred to the right services.

Senator FIERRAVANTI-WELLS —And not have to wait four, five or six weeks to do it. Chair, I want to move now from 4.1 to 4.2.

[2. 26pm]

CHAIR —We can go back to 4.1 if we have time and Senator Adams finds she has some questions. We will move now to 4.2, Aged care workforce.

Senator FIERRAVANTI-WELLS —At page 164 of the big yellow book, there is a reference at the bottom of the page to the aged-care workforce and reform of the system. It says that you will introduce new programs and restructure and expand existing programs et cetera. Which programs will be restructured and why are they being restructured? Will some be discontinued?

Ms Nicholls —In terms of restructuring the existing workforce programs, we currently have a number of workforce programs which have developed over time from 2002. Those programs were not necessarily logically integrated together. What we have taken the opportunity to do is restructure those programs into four major funding streams. We will have a focus on vocational education and training and a focus on training for nurses, enrolled nurses and registered nurses and postgraduate training. They are measures that we have already been doing and that have been part of the existing programs. We are also bringing in some new measures which are more about promoting professional practice and training. In particular, we are bringing in some initiatives to support clinical placements for student nurses to ensure that they have better quality clinical experiences during their training period.

Senator FIERRAVANTI-WELLS —This is at the top of page 165? If we look at 164 and 165 that might make it easier to both of us.

Ms Smith —The top of page 165 talks about the new programs. What Ms Nicholls is describing is the new elements of the restructured programs.

Ms Nicholls —In terms of the new elements of the old programs, we are looking at clinical placements so that student nurses will have better, positive and quality clinical placements in aged-care facilities. That will encourage them to look at aged care as a future career choice. We are looking at strategies to establish graduate placement programs for graduate nurses. When nurses graduate, they generally like to have a year which is perhaps more supportive than your normal employment. Certainly in the public health system they run graduate programs whereby students have access to additional training and support and access to clinical expertise and mentoring so that they can solidify their practical skills in their day-to-day delivery of care. So we are looking at trying to develop that for the aged-care sector as well. We are also looking at the establishment of a number of teaching nursing homes. Underpinning the concept of teaching nursing homes is the idea that it is partly about addressing workforce issues in terms of providing an environment which supports and promotes the development of good quality clinical skills.

Senator FIERRAVANTI-WELLS —Any sites identified there?

Ms Nicholls —No, not at this stage. The other aspect of teaching nursing homes is promoting quality in terms of good quality clinical practice. One of the key elements is that it promotes the links between the aged-care sector, between universities and education institutions, and between research areas. We would also be looking for links with the local hospital networks.

Senator FIERRAVANTI-WELLS Ms Murnane, we were talking about the current programs which are being restructured and Ms Nicholls was telling me about a series of programs that are now going to be restructured. That is what she just said to me.

Ms Nicholls —I was talking about the new elements that would be available under the restructured program.

Senator FIERRAVANTI-WELLS —Okay, but it is still a program that has a name and has been existing for a number of years.

Ms Smith —I think program 4.2 is the broad program name but within that, incrementally over time, there have been different programs introduced—support for aged-care training, more aged-care nurses et cetera.

Senator FIERRAVANTI-WELLS —I appreciate that. I have asked on a number of occasions for that to be detailed to me and all I have got in the latest iteration is ‘aged-care workforce programs’. It would really have helped me if somebody had listed them all for me. It would make it so much easier.

Ms Murnane —We can do that straightaway.

Senator FIERRAVANTI-WELLS —I have asked. This is now the second time. I actually asked Minister Evans and I did ask at a briefing.

Ms Murnane —We will have it to you after dinner.

Senator FIERRAVANTI-WELLS —Perhaps it is third time lucky.

CHAIR —Senator Fierravanti-Wells, Ms Murnane is in the middle of making a comment.

Ms Murnane —I was saying that the restructuring is in large part a replacement of new elements using the same bundle of money. So we will give you all those new elements with a full description and with the amount of money assigned to each of them. We will compile that and get it to you after dinner.

Senator FIERRAVANTI-WELLS —Old program and new program. That would be helpful. If you could, put the amounts of money next to each of those.

Ms Smith —As you have indicated, the material at the top of page 165 of the PBS is new programs to be introduced. There is the aged-care education and training incentives program, which is to encourage aged-care workers to up skill. That includes support for getting certificate training, enrolled nurse training and registered nurse training. There is also the building nursing careers program, which is an additional 600 fully funded enrolled nursing places and 300 undergraduate nursing scholarships. Lastly, the aged care nurse practitioners program, where we are hoping to encourage models of practice using nurse practitioners, which I think the sector is pretty exited about.

Senator FIERRAVANTI-WELLS —Can I just ask in relation to the teaching nursing homes: did you mention earlier how many you are intending to establish or do you not know yet?

Ms Nicholls —We do not know yet.

Senator FIERRAVANTI-WELLS —We have seen the program to bring nurses back into the workforce. I take it that is now going to be scrapped. It was not very successful. I think you had 139 of the projected 1,000. Is that the case?

Ms Smith —That program has been ceased and the funding has been redirected to other priorities. When the program closed on 11 May, 150 nurses had returned to aged care.

Senator FIERRAVANTI-WELLS —So, 150 of the projected 1,000. How much money was left over?

Ms Smith —There was $4.2 million.

Senator FIERRAVANTI-WELLS —And that has been redirected into the new initiatives or restructuring.

Ms Smith —Into allowing new initiatives to be delivered within the previous funding envelope.

Senator FIERRAVANTI-WELLS —The first category that Ms Halton was talking about?

Ms Smith —Yes.

Senator FIERRAVANTI-WELLS —How many on-the-ground nurses it is anticipated that these programs will collectively deliver? This is a very much a concern of many providers. The workforce issue is one that is always raised with me.

Ms Nicholls —Overall, we anticipate that we will be able to fund more than 31,000 aged-care training places and also provide more than 1,000 clinical and graduate placements. The 31,000 aged-care training placements include short-course and certificate level training for personal care workers as well as training for enrolled nurses and scholarships for registered nurses and postgraduate scholarships.

Senator FIERRAVANTI-WELLS —Over what period of time?

Ms Nicholls —Over four years.

Senator FIERRAVANTI-WELLS —They are all of the questions I have in relation to 4.2, Chair.

CHAIR —Does anybody else have questions on 4.2, which is Workforce? There being none, we will go on to 4.3, which is Ageing Information and Support.

Senator FIERRAVANTI-WELLS —Can you tell me a little bit about the Community Visitors Scheme?

Ms Smith —That program has been in place for a number of years—many, many years. I do not know, Secretary, whether you can add anything. It is from well before my time, anyway.

Ms Halton —I think it might date back to Ms Murnane’s time. Does it not?

Ms Murnane —I think so, yes.

Ms Smith —It is a program that provides for visitors to go to homes to visit socially isolated residents who, without the help of a community visitor, would not be receiving the sort of support that we know is important to the resident. It is a program that has done some really important things over many years and continues to be an important feature of what we do to support residents.

Senator FIERRAVANTI-WELLS —That is the generality of it. How does it actually operate? What is the nitty-gritty of it? Do you give out money to organisations? How does it work?

Ms Smith —We provide funding to auspices which are located in each state and territory organisation, and then those auspices recruit volunteers, who are then matched with particular homes and particular residents in their local area.

Senator FIERRAVANTI-WELLS —So you simply give them money. How much is the program?

Ms Smith —It is just over $9 million. We are just verifying the exact amount. It is $9.3 million.

Senator FIERRAVANTI-WELLS —Looking at the deliverables, is there a target number of visitors to nursing homes per annum? How do you measure its success?

CHAIR —What is the evaluation method?


Ms Veneros —Measures for the program involve training that is provided to visitors. Sorry, I need to find my brief.

Ms Smith —We have a target of 7,500 volunteers recruited to run the program.

Senator FIERRAVANTI-WELLS —That is your target. How many actual volunteers do you have?

Ms Smith —We have achieved our target.

Senator FIERRAVANTI-WELLS —I was just looking for those figures in the documents but I have not been able to find them.

Ms Smith —We can certainly give you some more information on notice.

Senator FIERRAVANTI-WELLS —If you could take it on notice. You said it is $9 million, but I cannot see the budget allocation over the four years. It is not specified.

Ms Podesta —The budget measure includes the advocacy services as well. You have asked specific questions about the visitor program part of that. The budget measure is the visitors and the advocacy services.

Senator FIERRAVANTI-WELLS —Which page is it on?

Ms Podesta —I do not know which page it is.

Ms Smith —We do not publish the forward estimates at the element of subprogram.

Senator FIERRAVANTI-WELLS —Can you take that on notice?

Ms Smith —We will take it on notice for you.

Senator FIERRAVANTI-WELLS —Is this where Ms Noeline Brown’s activities are funded as well? Last time there was some issue about what she had been up to. I notice that the website was immediately updated. Has she been earning her keep?

Ms Podesta —It is a very successful program. Is there any specific question you have?

Senator FIERRAVANTI-WELLS —Is she basically doing the same as she was doing before?

Ms Podesta —This year Ms Brown participated in and led 12 events up until 10 May. She has another 28 events scheduled to December. She is a very active, extraordinarily positive attendee and promoter of active and positive ageing.

Senator FIERRAVANTI-WELLS —Who initiates her activities?

Ms Koukari —Organisations contact the department. We have a specific phone line to contact Ms Brown and request her presence at various events.

Senator FIERRAVANTI-WELLS —So she comes and goes a lot.

Ms Podesta —I would just like to put on the record our apologies that the website had not been updated. It was not that the ambassador had not done the work. We had a staff member who was ill and therefore it had fallen behind. We apologise for that and we have made it a priority.

Senator FIERRAVANTI-WELLS —That is fine.

[2.43 pm]

CHAIR —We move now to 4.4, community care.

Senator SIEWERT —When should I ask about indexation? Have I missed that?

CHAIR —You can ask about that now.

Senator SIEWERT —It is a bit unclear which program item it sits in. An indexation announcement was made last Friday. Is that correct?

Ms Podesta —Indexation was announced last week, yes.

Senator SIEWERT —And the amount is 1.7?

Mr Cullen —Yes.

Senator SIEWERT —That is lower than last year, which was 1.9. That is correct, isn’t it?

Dr Cullen —Yes, last year the indexation rate was 1.9. Perhaps I could give some background. It is complex.

Senator SIEWERT —That would be appreciated.

Dr Cullen —Providers receive income from both residents and the Commonwealth. Resident fees and charges in general move in line with the pension, in other words they are in general indexed with average weekly earnings. That is about 30 per cent of the income of providers. Those fees in fact have tended to grow faster than that because a lot of that income comes from bonds which had been growing at a much faster rate. From government funding there are two sorts of government funding: care funding and accommodation funding. Care funding is indexed on 1 July each year. It is indexed by a wage cost index and this year that number was 1.7 per cent. Accommodation funding is indexed in March and September each year and is indexed by CPI. So providers have a complex range of income, some of which is indexed by average weekly earnings, some which is indexed by CPI and some which is indexed by the wage cost index of 1.7 per cent.

Why the 1.7 per cent this year compared to the 1.9? The index is a combination of movements in the consumer price index and movements in the minimum wage. Because the CPI was trending lower this year than last year, CPI in this period was at 2.4 per cent compared to 4.4 per cent the previous year, and the index is therefore lower. It is important to understand when looking at what providers receive that indexation is only one measure by which their funding increases. If you look on average over the last three years, funding has increased on average over those three years by 5.2 per cent per year. That is on a per resident basis, so this takes out all the growth in places. This is just for each resident on average 5.2 per cent a year. Historically—

Senator SIEWERT —Can I just stop you there. The 5.2 per cent is if you combine indexation and the increases in accommodation.

Dr Cullen —No, sorry, I am now just looking at the government funding.

Senator SIEWERT —Okay. So when you say it has increased by 5.2 per cent, this is an increase in actual government funding.

Dr Cullen —Government funding per resident has increased by 5.2 per cent per year on average for the last three years.

Senator SIEWERT —Does that include the conditional adjustment payments?

Dr Cullen —No, it does not. It includes one year of the conditional adjustment payment.

Senator FIERRAVANTI-WELLS —Just as a clarification, you are talking about the average figure now. Is that that $40,550—

Dr Cullen —Correct. I am saying that the average payment per resident this year will be $43,789 compared to $37,618 in 2007-08. Over those three years this is a 16.4 per cent increase, or 5.2 per cent per year.

Senator BOYCE —Is that because of the indexation or because of the high and low care mix as well?

Dr Cullen —There are three factors that affect that. One is indexation, one is what we call frailty drift, that the population has become frailer, and the other is new policy. New policy tends to put more money into the system. Historically all of our analysis shows that frailty drift adds about one per cent per year to the cost of delivering care, so we would tend to discount that 5.2 per cent by one per cent and say that in real terms for a resident of exactly the same frailty providers have been receiving 4.2 per cent additional per year. That is the real price increase that they have received, most of that through ACFI in the last three years, the introduction of the ACFI and ACFI grandparenting and also the operation of ACFI has delivered significantly more funding than the RCS. So over the last three years in constant frailty terms we have seen an average increase of 4.2 per cent compared over the same period with a CPI increase on average of 2.3 per cent.

Senator FIERRAVANTI-WELLS —I am sure Dr Cullen is the only person in Australia who actually understands this.

Senator SIEWERT —As I hear it I understand it.

Senator BOYCE —He does not understand it the way the operators understand it.

Ms Podesta —I think it is fair to say that we have tried to provide this information so that everyone can understand it. We understand that providers will always seek to maximise their case but we also I think it is important to put on the record that the indexation measure is one part of the increase. The ACFI changes are, for example, particularly significant for providers. We would be very happy to talk through with you the changes that have resulted as a result of ACFI. We have published this. It is on our website. ACFI has provided for providers approximately 2.9 per cent in real terms increase in funding.

Dr Cullen —I am sorry if my explanation was confusing.

Senator BOYCE —I am not disputing your information at all, Dr Cullen. I am simply pointing out that the aged care operators come to a different conclusion looking at the same data.

Senator FIERRAVANTI-WELLS —It is a bit like Ms Halton and I earlier this morning. We came to different conclusions about the same data, but we allow that to happen don’t we, Ms Halton?

Ms Podesta —Aged care is complex but we try also to be very fair. We have no reason to argue a case that is not correct. These are the facts of what the increase in the funding has been.

Senator SIEWERT —I could go down that line, but I am not going to because I have a whole series of other questions I want to ask. Going back to the increase in the accommodation CPI in March can you remind me what that figure was?

Dr Cullen —I cannot, Senator. It is a complex situation at the moment because the accommodation supplement when it was introduced some years ago was jumped up to the level of $26.88 and then it was kept constant at that level. I think it would be best if I took on notice an explanation on how the accommodation charge has been moving.

Senator SIEWERT —You said accommodation CPIs March and September, so I was just wanting to know—

Dr Cullen —It is on March and September and therefore over the year it would increase by 2½ per cent on average. At the moment because of government decisions it is moving faster than CPI because the maximum accommodation charge is moving from $26.88 to $32.38 over the next year and a half in six-month steps. There is a government decision in place which is moving the maximum at faster than CPI. I would like to take that on notice.

Senator SIEWERT —If you could take that on notice that would be great. In terms of the indexation then going on to where I am supposed to be which is community care, is the indexation that applies for community care going to be 1.7?

Dr Cullen —I should reflect that all the data I gave up until now was for residential care.

Senator SIEWERT —Yes.

Dr Cullen —Subsidies for community care would increase by about 1.7 per cent.

Senator SIEWERT —Okay, so the same indexation is applying for community care.

Ms Podesta —However, it is important to note that there has also been a new budget measure which will increase the viability payment for community care. About 400 eligible aged care providers for community care will receive an increase in their viability supplement as well.

Senator SIEWERT —Which ones are the eligible ones?

Dr Cullen —Rural and remote community care providers.

Senator SIEWERT —It is just the rural and remote ones?

Dr Cullen —Correct.

Ms Podesta —The viability supplement is around where there is a recognition of particular markets that are harder to service.

Senator SIEWERT —How much was that?

Dr Cullen —It is a $10.1 million over four-year measure which increases the viability supplement by 40 per cent.

Ms Podesta —And it will be eligible to about 400 community care providers.

Senator SIEWERT —That was the figure that I missed, sorry. In terms of the new process for HACC services, is it okay if we move on to that?

Ms Podesta —Do you want to talk about HACC as a result of the COAG decision or HACC as in business as usual HACC?

Senator SIEWERT —As in post the new process because I want to get my head around how that is going to operate. I know that I should get my head around how Victoria is going to operate but I am a West Australian so—

Ms Podesta —Do you want to know about HACC in Western Australia?

Senator SIEWERT —No, HACC in general, and I know that is complicated because of the agreement with Victoria. Can we go through how community care and HACC services are going to be delivered and the overall funding and where you are at with the states. Am I making sense?

Ms Podesta —There are three questions. Can we start with the first one. You want to know what the decision is with regard to HACC?

Senator SIEWERT —Where we are up to in implementing the decision.

Ms Podesta —On 20 April COAG agreed to transfer to the Commonwealth current resourcing for aged-care services, including Home and Community Care, in all states except for Victoria and Western Australia. That is the first decision that has been made. We have one year left of the current triennial agreement between the Commonwealth—

Senator SIEWERT —This is 2011?

Ms Podesta —Correct. So the current triennial agreement will continue until that time. After that time the responsibility will move to the Commonwealth for this program.

Senator SIEWERT —For all HACC services for aged care—that is including community care packages?

Ms Podesta —We already have responsibility for the packages.

Senator SIEWERT —Yes, so now is it all going to be delivered as one—

Ms Podesta —That will be the ultimate objective.

Ms Mackey —There is a staged process around the transition for HACC. The first stage of that process is the Commonwealth 100 per cent funding HACC services for older people. The second stage of it is a year later, where the Commonwealth takes responsibility for direct contracting of those services that are currently in the HACC space.

Senator SIEWERT —Except Victoria and WA?

Ms Mackey —Except Victoria and WA; I am talking about those other jurisdictions.

Ms Podesta —So we will have in Victoria a separate national partnership agreement to deliver HACC and, subject to negotiations with Western Australia, we would anticipate that something similar would happen in Western Australia. But with respect to the Western Australian decision, as you know—it has been discussed today—there is still no final landing place.

Senator SIEWERT —The way you are envisaging the West Australian process, the idea is that the services for aged care would still be delivered in the same way but by the state rather than the Commonwealth?

Ms Podesta —We would anticipate that that would be the case. The overriding objective from our point of view is no disruption in service delivery to the client. Obviously there would need to be negotiations and discussions about the logistics and the operations. But the overriding issue from our point of view is that there is no disruption to services. We are absolutely committed to making sure that the services on the ground are delivered, the arrangements at a government level about who administers the contracts and who pays for what need to be finalised. But we have no intention whatsoever that there will be a disruption of services to people in those states where there still needs to be some finalisation about the arrangements.

Senator SIEWERT —In terms of what I see as a bit of an artificial barrier between HACC services and packages, is the idea that the same rules will apply for both? Am I asking too difficult questions here?

Ms Podesta —No. I think you are asking the question which possibly is part of the reason why we are moving towards a unified aged-care system.

Senator SIEWERT —Exactly. That is why I am asking: is that actually what is going to happen?

Ms Podesta —There is a strong motivation to ensure a seamless transition for the client, and this is all about building an aged-care system so that the older Australian is assessed appropriately, the right services are made available to them if it is at the point in their life where it is a relatively low-level community intervention—buy your shoes or paint your roof, those things for daily life—then identifying the types of movements through the aged-care system progressively as people’s needs change. That is our vision. We do not expect that will happen in the first two years. It is going to be about a system build. But that is what the intention is—to have a one-stop shop where people enter into the system and, to a large degree, are case managed through as their needs change.

Senator SIEWERT —I am sorry I am jumping around in linking the issues. You were saying that not in the first year of the new process but in the second year of the new process the Commonwealth will take over contracting. Did I understand that correctly?

Ms Podesta —That is right. The responsibility will become the Commonwealth’s.

Senator SIEWERT —So the service providers will just deal with the Commonwealth from that point—

Ms Mackey —We anticipate.

Senator SIEWERT —Okay, I will get to what ‘anticipate’ means in a minute. For all community aged care services other than for WA and Victoria—

Ms Podesta —All services funded under the Home and Community Care Program, the community packages—

Senator SIEWERT —This includes—I just want to be clear—the current community care packages?

Ms Podesta —The community aged care packages.

Senator SIEWERT —I want to be clear that I am understanding—

Ms Podesta —Is it true that it is possible that there will still be, for example, state government entities that are contracted by the Commonwealth to deliver things? Absolutely. We do not anticipate that what will happen is that, because you are a state government with a contract to do certain things on behalf of the Commonwealth now, we will say, ‘You no longer do that.’ That is not our intention at all. In fact, depending on how we work out the process of having HACC delivered, it might well be that we negotiate some parts of it or that we contract some of the states to do some bits of it. If, for example—and if the point of your question is this—a state government is currently contracted to deliver community care packages, we do not anticipate changing that around, unless their performance is terrible.

Senator SIEWERT —I want to understand how the administration is going to work with current service providers who deal with both the state and the Commonwealth. The idea is that they will be dealing with only the Commonwealth.

Ms Mackey —It will only be for older people in terms of the Commonwealth funding. At the moment, HACC providers use a range of funding sources. Some of those funding sources come from other Commonwealth agencies and some of them come from other funding streams in states and territories, outside of the HACC stream.

Senator SIEWERT —That is where I was coming from. In terms of these boundaries—they are real, not artificial—there are different costs and different payments made under HACC from those made under the age care packages at the moment. That will disappear?

Ms Podesta —Over time. We recognise that this will be a very significant period of adjustment and transition. The idea is to move towards a nationally consistent fees and charging arrangement. But obviously we will look sensibly at what the impact is on local arrangements and on people. The idea is to move towards a fair and reasonable system.

Senator SIEWERT —Who will be doing that? We went through this morning and talked about who sets it for the hospital process. Who will be setting the fair and reasonable prices?

Ms Podesta —The Commonwealth will have responsibility for aged care.

Senator SIEWERT —Which body will be doing it? We are putting in place an independent body who will be setting the efficient prices—

Ms Halton —For the efficient price as described in relation to acute care.

Senator SIEWERT —I know. I am asking: who will be making those sorts of decisions for the aged care sector and for the community care?

Ms Halton —This will be done in the department.

Senator SIEWERT —It will be the department. So you are not going to move to some sort of independent process similar to that of acute care?

Ms Halton —There has been no decision to do that. I have not heard any suggestion that we should do that. No.

Senator SIEWERT —Obviously that is a pretty significant issue. We have just been talking about it in relation to residential care. It is an issue for community care as well.

Ms Halton —Yes.

Senator SIEWERT —There has been no decision made or—

Ms Halton —And no discussion of.

Senator SIEWERT —Is there going to be a discussion of how that happens?

Ms Halton —I am not anticipating that there will be a similar separate body, if that is the question. The bottom line is that, as we get into the detail of rolling out all these arrangements, there will have to be quite specific considerations made about a number of things, but I am not anticipating any particular change to the way we tend to manage these things in the department.

Senator SIEWERT —I realise that we are getting short of time so I will put some questions on notice. In terms of Western Australia, and I appreciate that you are a bit stuck because the negotiations are still ongoing, what is the worst-case scenario? I say that in terms of not seeing much improvement in the system in Western Australia. Is it the status quo? Is that likely to be the case? So you have still got the current system operating? Is that what we may end up with in WA?

Ms Podesta —In regard to Home and Community Care?

Senator SIEWERT —Yes.

Ms Mackey —In terms of the current HACC program, the Commonwealth has already been working closely with the states and territories on a range of improvement measures. In terms of Western Australia in particular, they have been looking at a wellness focus, which I am sure you are familiar with. So there have been some improvements in the program in that state in particular. No matter what the arrangements look like in the future, the Commonwealth, with it still contributing funds to the HACC program, would be seeking to continue to move forward with those processes that we have already been working on in partnership with the states and territories.

Ms Podesta —If it is the case that a state is outside the common arrangements and we have a specific national partnership agreement, then the Commonwealth will still maintain its very keen interest in improved outcomes and high levels of accountability.

Senator SIEWERT —Sorry, I phrased that badly. It was not a judgment on the services that are delivered, because I know they are good services that are delivered. It was more a case that we are still going to have the aged-care packages through the Commonwealth and we are going to have HACC through the states so we are still going to have what I see as being an artificial boundary and the complications between HACC services and what people can get and the aged-care packages.

Senator BOYCE —The line down the middle of the one-stop shop?

Senator SIEWERT —Yes. That is what I mean about the worst-case scenario. We have still got those two essentially ‘separate’ but not separate systems. So that is what we are going to end up with potentially.

Ms Podesta —The Commonwealth strongly supports a national aged-care system, and we can see the benefits for consumers. No matter what decisions our governments make, we will continue to work towards much harmonisation around the new arrangements.

Senator SIEWERT —That was a very diplomatic answer.

CHAIR —Senator Fierravanti-Wells, do you have anything under 4.4?

Senator FIERRAVANTI-WELLS —In the interests of time I will put questions in relation to 4.5 and 4.6 on notice. Then I thought we could move to 4.7. I think 4.7 and 4.8 and the agency are really where the rest of the questions are.

CHAIR —As everyone is agreed, we are happy to be in your hands. We are still on 4.4 at this stage and then we will go to 4.7.

Senator SIEWERT —Chair, can I ask about one key area?

CHAIR —Of course you can.

Senator SIEWERT —Are the DVA programs remaining completely separate to this process?

Ms Halton —DVA will continue their arrangement, yes.

Senator SIEWERT —I just wanted to double-check. Thank you, Ms Halton.

CHAIR —We will move on.

Senator FIERRAVANTI-WELLS —I want to ask a few questions on the Transition Care Program. This was much vaunted by your policy minister in June 2007. I refer to New Directions for Older Australians: improving the transition between hospital and aged care. There was much ado in that document about moving people out of hospitals and into aged-care facilities and also discussion about transition care. I will deal with transition first—the promise of 2000 transition places by 2011-12. I understand—and correct me if my statistics are wrong—that, by 30 June 2009, 698 had been allocated but only 228 were operational.

Ms Podesta —As of 1 April 2010 the rollout of the transition care places is exactly on track, as agreed with the states and territories. There are 84 operational transition care services and, as of 1 April, there are 2,698 operational transition care places.

Senator FIERRAVANTI-WELLS —As at 3 February, when we were last at estimates, we were still talking 228 operational. Do I understand from that that, as at 1 April, we have now gone from 228 to 698 operational?

Ms Podesta —2,698 operational transition care places.

Senator FIERRAVANTI-WELLS —I know. There were 2,000 before the previous election. I am only talking about the new ones.

Ms Podesta —698 new ones. If you are talking about the additional transition care places—

Senator FIERRAVANTI-WELLS —Yes. Where are they? Can I find out where they are? Do you have a list of those?

Ms Walker —I am just having a look for those at the moment. We may have them by state.

Senator FIERRAVANTI-WELLS —It would be helpful if you could take that on notice and provide a breakdown of them as to where they are.

Ms Walker —Certainly.

Senator FIERRAVANTI-WELLS —In terms of cost of transition care per day, interestingly, in your document reference was made to the figures that were done by Labor before the election:

The average cost per day of an acute public hospital bed is about $967, whereas the average cost for a residential aged care bed is just over $100 a day.

Can I ask this in the context of the decision that was made at the last election to redirect funding of $276.4 million over three years from high-care residential aged-care places to provide care in the long-stay older patients measure.

Ms Podesta —I am just checking so that I do not get this wrong. Would you like me to comment on the COAG decision in regard to the long-stay older patients measure? That is what you would like me to comment on. That is quite different to transition care.

Senator FIERRAVANTI-WELLS —I appreciate that; I will come to that. There are two parts. Let me finish off the first part. Under your transition care, what is your cost of transition? What are you assessing the cost of transition at, per day?

Ms Podesta —Transition care funding is provided in the form of flexible care subsidy under the Aged Care Act. It is provided on a flat rate per occupied place per day. For the four years, until 2012, each state and territory is paid at a different subsidy rate, which factors in a number of existing jointly-funded places and the rollout of new fully-funded places. That reflects the different take-up rates. In terms of funding rates there is no distinction between jointly funded and fully funded. All places are still jointly funded. However, we do have different daily subsidy rates per state and territory in 2009-10. Would you like me to tell you those different rates?

Senator FIERRAVANTI-WELLS —Yes, I want those.

Ms Podesta —For New South Wales, the Commonwealth daily subsidy rate for transition care is $137. 57 per day; in Victoria it is $138.27; in Queensland it is $140.26; in South Australia it is $138.67; in Western Australia it is $141.87; in Tasmania it is $140.09; in the Northern Territory it is $161.57; and in the Australian Capital Territory it is $128.14 per day.

Senator FIERRAVANTI-WELLS —Can you tell me the percentage of patients that are returning home—first of all, the number of patients.

Ms Podesta —Forty-five per cent of care recipients returned home from the transition care, and 60 per cent of care recipients have a higher level of functioning on exit than on entry. That is the current release; in 89 there were slightly different figures. Actually, I beg your pardon, Senator; may I just correct that. That was the target—60 per cent to have a higher level of functioning and 45 per cent to return home. In fact, 60.3 per cent had a higher level of functioning and 49.7 per cent returned home. So we have exceeded the target that was set. I apologise for that.

Senator FIERRAVANTI-WELLS —I have more questions on transition, but I will put those on notice. I do not have any more questions in program 4.7, so unless my colleagues have—

[3.15 pm]

CHAIR —We will go to program 4.8. I know a few people have questions in 4.8, so I suggest we go to Senator Siewert first to have two questions. We are sharing it around because we have 15 minutes before we go to the agency.

Senator SIEWERT —Does this count as one of my questions? Can I ask about young people in nursing homes here?

CHAIR —That is one! No, it does not count.

Ms Podesta —It depends on what the question is. I think we have had this conversation. We do not have responsibility for the young persons in nursing homes measure, but we do have some information.

Senator SIEWERT —Yes, we ran out of time yesterday.

Ms Podesta —What would you like to know? We will see if we can—

Senator SIEWERT —There has been some recent publicity around the issue of the number of people that have been moved out of nursing homes. If it is not appropriate to ask it here, I will put my questions on notice.

Ms Podesta —No, we can give you the data that we have.

Senator SIEWERT —That would be appreciated if you could.

Ms Podesta —I will just ask Professor Cullen to get his running shoes on and pull open his ‘impossible’ folder.

Senator SIEWERT —It is all a plot! I have a series of questions here. I will put the majority of them on notice, but if you could give us some of the data—

Ms Podesta —I have the briefing. What is the first question?

Senator SIEWERT —How many young people, out of the total in the program, have been moved out of nursing homes?

Ms Podesta —The number of young people under 50 in permanent residential care has decreased from 1,196 to 809. That is a decrease of 32.4 per cent.

Senator SIEWERT —And that is over the period of the program?

Ms Podesta —From 1988-89 to 2008-09.

Senator SIEWERT —Sorry—19—

Ms Podesta —Sorry; it is 1998-99 to 2008-09.

Senator BOYCE —That is people moving from nursing homes to other accommodation—is that right?

Ms Podesta —No, it is a number of—

Dr Cullen —Senator, you are asking about the YPIRAC program, which is managed by FaHCSIA. We are going to have to take it on notice.

Ms Podesta —We cannot answer the questions.

Dr Cullen —We cannot give you the answer. We can give you answers as to how many people there are in, and that number is going down, but we cannot tell you why they are moving out.

Senator SIEWERT —That is fine; I appreciate that.

Ms Podesta —My answer was in terms of the number of people—

Senator BOYCE —Yes, I was wondering if it included people who died and exited for other reasons.

Senator SIEWERT —So the 2008-09 figure is the number under 50 that are currently in residential facilities?

Dr Cullen —Correct.

Ms Podesta —That is correct, but we cannot give you the details about YPIRAC.

Senator SIEWERT —That is fine; I appreciate that. I was trying my luck.

Ms Podesta —I think we have answered your questions now, Senator.

Senator SIEWERT —Yes, thanks. I will put the rest on notice in terms of the program itself and an explanation of the program itself. Is it here that I ask about the current Aged Care Approvals Round?

Ms Podesta —You may.

Senator SIEWERT —There has not yet been an announcement of the current ACAR, has there?

Ms Podesta —No, of course not. The current invitation to apply for places was advertised on 30 January, and we do not anticipate that we will announce the results until October. That is the normal time frame.

Senator SIEWERT —Are you able to tell me the number of applications, or the response, you have had?

Ms Podesta —We are still assessing applications. One of the difficulties is that it is in a tender like process. It is difficult to give you information midway through a process. More than 12,000 places were advertised and, without being able to tell you whether every one of these applications conforms, we have had about 57,000 applications for places.

Senator FURNER —I understand, on information I have been provided, that some aged-care providers have raised difficulties in accessing GP services. Can you explain what the government is doing in supporting access for aged-care residents, please?

Ms Podesta —This is one of the budget measures, Senator.

Senator FURNER —Really!

Ms Podesta —There has been a new budget measure announced about improving access to general practice and primary health care. This will not actually be delivered through the aged-care part of the department, but, of course, we take a great interest in this activity, so we can give you broad information—my colleagues from the primary care division can probably give you very specific information. The measure is to provide a 50 per cent increase in the payment for GPs who provide at least 60 attendances to old people in aged-care homes. That fee will increase from $1,000 to $1,500 a year. The measure also more than doubles the payment to GPs who provide at least at 140 attendances to older people in aged-care homes—from $1,500 to $3,500 a year. These increased financial incentives are expected to support over the four years about 105,000 extra GP services for older people in aged-care facilities. We anticipate that about 1,200 extra GPs will receive the incentive payments. Just over 4,000 GPs currently receive those payments.

CHAIR —So further questions about that issue should come under primary care.

Ms Podesta —Yes—questions about the detail of these programs.

Senator BOYCE —Ms Podesta, estimates would not be complete without a question regarding the Evans Head nursing home—

CHAIR —Oh, Senator!

Senator SIEWERT —I wish we had bingo—how many out there would have just won something?

Senator BOYCE —Would you please tell me how long this has been—

Senator FIERRAVANTI-WELLS —If it was in the minister’s own electorate, she would have sorted it out by now.

Ms Halton —Oh, that is not fair, Senator.

Senator BOYCE —For how many years has this approval been on foot, and what progress, if any, has been made?

Ms Halton —I am obliged to point out that this is a bipartisan issue—

CHAIR —Through how many government—

Senator BOYCE —I have been asking questions about it since I arrived here, Ms Halton, in which case it was the government—

Ms Podesta —The pre-provider was allocated its initial low-care places in 2001 and additional low-care places in 2005.

Senator BOYCE —What has been the progress?

Ms Podesta —On 9 March, the council commenced a selective tender process to remediate the contaminated land at the site. This tender process closed on 8 April, and council is currently assessing the tenders. Council have informed us that they expect to award the tender—

Senator BOYCE —When?

Ms Podesta —this month. The remediation works are expected to commence in July 2010—I am thinking about putting on gumboots and going and seeing this myself, I have to tell you—and reach completion by November 2010.

Senator BOYCE —Is the department aware that the land that was initially proposed for a nursing home, including 13 housing blocks, is now available for sale? This land is not subject to native title claim and it is not contaminated.

Ms Podesta —We understand that they are building in co-location of independent living units adjoining the site of the aged-care facility. There is a business decision to do that.

Senator BOYCE —I will put other questions on notice, Chair.

Senator FIERRAVANTI-WELLS —I want to ask some questions about unallocated bed licences. The figures I have for last year are that 14,105 residential care places were allocated as at 30 June but they were not operational. Can you tell me whether that is the total number of allocated places that are not operational?

Ms Walker —Was your question about the number of aged-care places that had been allocated as at 30 June 2009?

Senator FIERRAVANTI-WELLS —How many licences are there that have been allocated to providers but are still not operational—the total number?

Ms Walker —As at 30 June 2009, there were 20,805 residential places that had been allocated that were in the process of being built.

Senator FIERRAVANTI-WELLS —And that includes some off-line ones? What are those off-line ones?

Ms Walker —Off-line places are still regarded as operational.

Senator FIERRAVANTI-WELLS —So they are in your 20,000?

Ms Walker —No.

Senator FIERRAVANTI-WELLS —They are in addition to that. Okay.

Ms Podesta —I think it is important to note that that is a consistent figure with the last five stocktakes.

Senator FIERRAVANTI-WELLS —Ms Podesta, I am not questioning it. I just asked the number; that is all. I did not need a justification for it; I just wanted the number. How many bed approvals are more than five years outstanding and hence not operational? How many are more than five years outstanding?

Ms Walker —As at 30 June 2009, we had 880 that were more than five years old, and I believe we have provided that response in a question on notice.

Senator BOYCE —Do you update those figures at all?

Ms Walker —We do it in the stocktake, which will be completed after 30 June 2010.

Ms Podesta —It used to be the case that it was done in a random process. It was impossible to see a trend. It is now done each year at the same time. That is why we can make some analysis of the trend of how we are going with our places.

Senator FIERRAVANTI-WELLS —Ms Podesta, I am conscious of the time. I need the number of bed licences that have been handed back since 2007 and I would also like a breakdown by planning regions of where those bed licences have been handed back and how many of those bed licences have been reallocated, firstly, for residential and, secondly, for community care places. Can you take that on notice?

Ms Podesta —We will take it on notice.

Senator FIERRAVANTI-WELLS —Thank you. Could you tell me about the cost-of-care study that was undertaken by Grant Thornton. The Grant Thornton company, I understand, presented the minister and the finance minister with the report on 14 October. Where is that cost-of-care study and is it going to be released?

Dr Cullen —It is not a government study, as I understand.

Senator FIERRAVANTI-WELLS —It is not a government study? So it is a Grant Thornton study. I will put that one on notice and ask you more specific details. Could you tell me about the zero-interest loans. There was $300 million in the first round. Now you have extended it. You have changed the criteria, with another $300 million. How many were allocated in the first round and how many signed agreements are there? In other words, what is the value of those allocated and how many signed agreements are there as part of the first tranche?

Ms Podesta —As at 28 April, we have executed 27 of the 40 loans offered through the first round. That totals more than $78 million to create 752 residential places and 77 community care places.

Senator FIERRAVANTI-WELLS —Could you take on notice where they are, please—what planning region they are in.

Ms Podesta —Certainly. Offers are made and loans are executed when approved providers meet milestones. It is important to note, I think, that it is not that we just have not done it; it is that an offer has not been made. As an approved provider meets the milestones agreed in the negotiations, then we execute the loan and make the funds available.

Senator FIERRAVANTI-WELLS —Okay. You have changed the criteria and extended it out to 22 years in the expectation of how much greater uptake?

Ms Podesta —The government has made a decision to have a new form of zero-real-interest loans. It was a budget measure. We anticipate that we will deliver 2,500 more aged-care places as a result of the expansion of the zero-real-interest loans program.

Senator FIERRAVANTI-WELLS —When is the 2009-10 ACA round to be announced?

Ms Podesta —We anticipate that, in line with every other year, it would be around October, closing in March.

CHAIR —It is now 3.30. Do you want to put them on notice?

Senator FIERRAVANTI-WELLS —Yes, I will put the rest of those on notice.

CHAIR —We thank the officers from the department in outcome 4.

[3.30 pm]