(Image: Unsplash)

If the government’s plan to outsource aged care assessment hits the fence, it can blame Aged Care Minister Richard Colbeck.

Colbeck has managed the unlikely feat of drawing a direct rebuke from a royal commission and highlighting widespread opposition to a strategy that has mostly been kept out of public view.

The government has long planned to complete the outsourcing of aged care assessment that it began in 2014, when it put out to tender Regional Assessment Services (RAS), which provide assessments for people wanting to access home care packages.

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The next step was the outsourcing of Aged Care Assessment Teams (ACAT), which provide the much more complex assessments required to determine the level of care needed by older people either at home or in residential care facilities. ACATs work closely with, and usually operate from, hospitals, meaning any overhaul of ACAT arrangements would involve a potential stoush with the states.

The government’s plans are often referred to as privatisation, but this is only partly correct: both for-profit and non-profit providers won RAS tenders and would likely win ACAT tenders.

The RAS tender process was driven by Scott Morrison during his time as social services minister but, as critics have noted, it seems to have been put on hold while Malcolm Turnbull was prime minister before coming back to life after Morrison replaced Turnbull.

The Department of Health conducted an industry consultation over the holidays in the summer of 2019, presumably to keep the issue out of the public gaze.

But as the Department of Health’s notes from the consultation show, that didn’t prevent many in the industry from pointing out the obvious problems with outsourcing to for-profit providers, as would inevitably be the case.

Dumping existing ACAT teams would see the loss of experienced clinicians, especially geriatricians, and their replacement with lower-cost assessors with vocational education certificates. Meanwhile, the detachment of assessment from hospital settings would further fragment a system that, despite the best efforts of successive governments, remains too difficult to navigate.

Others fear aged care service providers would take advantage of the outsourcing process to move into assessment, creating a conflict of interest. “Some stakeholders believe a competitive model is unsuitable for assessment functions that focus on quality, consistency and equity of access,” the Department of Health admitted.

There’s a good case for a more integrated assessment process that brings together home care and residential care, and the stages in between, in a single coherent process, undertaken by a single, competent and properly accredited workforce.

But those benefits from “integration” have been overwhelmed by concerns, driven by the RAS experience, of for-profit poor quality assessment.

The states are also unimpressed with the ACAT outsourcing proposal. The Commonwealth health department — not the minister — quietly announced it would be proceeding with the outsourcing of ACAT teams in December — again under the cover of looming holidays.

NSW Health Minister Brad Hazzard then gave both Health Minister Greg Hunt and Colbeck a serve, saying he hadn’t been consulted, that NSW had “major concerns” about what he termed an “effective privatisation” and that there was no logic to doing it while an aged care royal commission was underway.

The royal commission, of course, had issued an interim report in November on the sickening state of the aged care sector in Australia, shaming the government into announcing a quick expansion in home care packages.

Hazzard’s intervention, which stirred up media interest in the outsourcing, prompted Colbeck to fire back, except the Tasmanian senator took unerring aim at his own foot.

Colbeck declared assessment was “certainly not going to continue the way it is now” and that the royal commission backed the outsourcing. The royal commissioners were, shall we say, underwhelmed at being verballed. Yesterday commission chair Tony Pagone issued a statement rebuking Colbeck.

Public concern has been expressed about statements made by the Minister for Aged Care and Senior Australians that we had decided to support the privatisation of the Aged Care Assessment Teams in our Interim Report. I take this opportunity to make clear that the Interim Report did not endorse the Government’s stated position but noted that we would monitor with interest the implementation which the Government had announced.

With both Hazzard and the royal commission itself referring to the “privatisation” of ACATs, the government is rapidly losing control of how the outsourcing process is seen. Nuances around putting to tender versus privatisation aren’t likely to survive long when it comes to dealing with vulnerable Australians, and Labor has form in exploiting fears about health privatisation.

Unlike Mediscare, however, there is real substance to fears low-cost for-profit providers will replace experienced clinicians and lose sight of the interests of the clients they are ostensibly serving.

Who do you want assessing the needs of your elderly mum — a medical professional with years of geriatric experience or a $200-per-assessment contractor for a multinational “provider of public services”?

As others have pointed out, however, the brawl over assessment is only the sideshow. The real problem is the urgent need for more funding for more, higher-quality aged care services, both at home — in addition to the $537 million the government announced in November — and in residential care.

An assessment process — good, bad or indifferent — is ultimately only as good as the services it can lead to. And on that challenge, the government is stuck in a holding pattern awaiting the royal commission’s final report.

Perhaps it should stop distracting them by verballing them.

Is the government creating another aged care crisis? Let us know your thoughts by writing to boss@crikey.com.au. Please include your full name to be considered for publication.

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Peter Fray
Peter Fray
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