Above: Paul Sadler, CEO Presbyterian Aged Care NSW & ACT
By Paul Sadler
This is an opinion piece written by Paul Sadler as a response to last week’s opinion by Ray Glickman, ‘Maintain the Rage’. Paul Sadler is CEO of Presbyterian Aged Care NSW & ACT(PAC), Vice President of Aged & Community Services Association of NSW & ACT (ACS) and President of the NSW Division of Australian Association of Gerontology (AAG). Paul also represents the National Presbyterian Aged Care Network on the National Aged Care Alliance (NACA). The views expressed in this article are personal and not necessarily those of PAC, ACS or AAG.
“The residential care reforms in LLLB are a very mixed bag, and we should not be scared of pointing out their shortcomings. But we must also insert a bit of realism into the debate about what is achievable, not purely the ideal.”
Ray Glickman’s opinion piece Maintain the Rage is an articulate summary of the disillusionment many residential aged care providers feel with the Gillard Government’s Living Longer, Living Better (LLLB) reform package. But I can’t help feeling that Ray’s prescription for action is only half right, in part because of a common misconception about the history and role of the National Aged Care Alliance (NACA) and in part because of a disagreement about the proper function of peak representative bodies.
Ray is quite right that LLLB is not the Productivity Commission’s (PC) reform agenda. In a minority government context, and with a budget deficit to be addressed, the Gillard Government squibbed it and shunned the fundamental reforms sought by the PC, including the shift to an entitlement-based system. Ray is also quite right that providers, and the sector as a whole, should be passionately advocating for adoption of the PC recommendations.
However, Ray’s analysis of the role of National Aged Care Alliance is, in my view, misplaced. To understand why I think this, we need to examine two aspects: the history, purpose and role of NACA; and the role of peak bodies.
The story of NACA
The National Aged Care Alliance came into existence in 2000 after the 1997 aged care reforms, at least in part to try to avoid the ‘divide and conquer’ practices of the former Howard Government, and the disunity among elements of the sector which contributed to the failure to allow bonds to be charged in high care. The not-for-profit provider peak, Aged & Community Services Australia (ACSA) was a founding member along with some of the church peaks.
NACA is a representative body of peak national organisations in aged care, including consumer groups, providers, unions, and health professionals. It aims to develop a united policy agenda to achieve better outcomes for the care of older Australians. NACA’s existence does not preclude its member organisations advocating for each group’s own interests.
NACA’s document, Leading the Way – Our Vision for Support and Care of Older Australians (September 2009), was reasonably influential in setting the scene for the Productivity Commission’s Caring for Older Australians Inquiry. The subsequent NACA Blueprint for Aged Care Reform (February 2012) backed this up, supporting most of the PC recommendations.
The fact that a large part of the sector had a unified position was a key factor – acknowledged by the Government – in getting elements of the PC recommendations accepted in LLLB. Importantly, this included the extension of accommodation bonds to high care places, a major plank of provider peak body advocacy for the past decade, and the very thing sunk by sector disunity in 1997. And we have some other useful reforms through LLLB, e.g. in community care.
“NACA did not advocate for a cut to the Aged Care Funding Instrument (ACFI), despite views by some providers that it did.”
The Government’s aged care reforms were always seen as falling short of the PC’s prescription and NACA’s own Blueprint for Aged Care Reform. To be sure, some of NACA’s broad constituency probably felt they got more of their particular interests addressed than others did, so perspectives of providers, consumers, unions and professional groups will differ on the details of LLLB.
NACA did not advocate for a cut to the Aged Care Funding Instrument (ACFI), despite views by some providers that it did. However, when the cut happened, I do believe NACA’s reaction was weak, with consumer organisations and the unions baulking at a strong condemnation of the Government.
NACA is now tasked with running a range of LLLB implementation advisory groups, across areas such as Specified Care and Services, Quality Indicators, the Gateway, Home Care Packages and Home Support Program. These are ensuring the views of the sector are heard as the details of aspects of LLLB implementation are worked out by the Department of Health & Ageing.
The role of the peak bodies
Ray’s argues that somehow national peak bodies, and the NFP providers particularly, must not ‘satisfice’ themselves. I presume by this he means that ACSA, the church peaks, NACA and other groups must not participate in the LLLB reform process, because participating gives it legitimacy.
Ray’s critique raises an important question – what is the role of representative organisations (such as the aged care provider peaks) after a Government announces its policy position?
One option is to stand on principle, name the reforms as falling short and withdraw from any participation with implementation. There is a real risk of throwing the baby out with the bathwater if you take that approach. As Ray points out, LLLB does make progress in some really important issues (e.g. community care reform) and some past political hot potatoes (e.g. bonds in high care). The residential care reforms in LLLB are a very mixed bag, and we should not be scared of pointing out their shortcomings. But we must also insert a bit of realism into the debate about what is achievable, not purely the ideal. I don’t believe that equates to selling the people we represent short.
“We need a clever, nuanced strategy, playing in as many fields at once as possible, so we can achieve our goals.”
The second option is to participate in the implementation process, seeking to improve the directions where possible and make sure the Department doesn’t make things worse in the details, while at the same time advocating for better, more comprehensive reforms in the future. We need a clever, nuanced strategy, playing in as many fields at once as possible, so we can achieve our goals.
I believe aged care peaks, such as ACSA and the churches, should remain key members of NACA, working with the other providers to get the very broad constituency now around NACA’s table to understand and, wherever possible, to support industry concerns. Part of our strategy must be to work with government departments, not just the elected representatives, to moderate unforeseen (by them!) consequences of poor government policies. We owe this to our members! At the moment, the NACA/Department LLLB advisory groups are the main game for this.
So Ray and I are in furious agreement about the good parts of LLLB, and its serious shortcomings. We are also agreed that we must fight for the political parties to adopt a ‘Back to the PC’ future. But I argue we must stay engaged with NACA and the Government as the elements of LLLB are implemented. This is the smart strategy – it is the art of influence.