Designing reform is a key step for change. Tweaking policy ‘just so’, buffing up its inputs, to sparkle with clarity, is a part of a well-run program. But amid the hubbub, industry, and messaging of reform, an unapologetic distinction grounds the conversation. Policy design and its inputs, no matter how shiny, can never be the yardstick of how the whole thing has landed.
Impact, to those it was designed for, is unquestionably the metric of success. Juniper’s CEO, Russell Bricknell, in speaking on their latest Royal Commission Report Card re-orients the conversation of how, as a sector, success can even start to be pin-pointed. To unflinchingly look at the reality of thousands of seniors in the aged care system, and ask, has real, actual, seniors-actually-care-about-this-metric improvement been carved out?
“There has been a huge amount of change across our sector since the Royal Commission,
and there are reforms we should acknowledge as important steps forward”, Bricknell shares.
“But eight years on, we need to look beyond legislation and policy announcements and ask
a simple question: are older people getting the care and support they need when they need
it? For far too many older Australians, the answer is still no.”
Aged care reform progress – distracted by inputs
Juniper has awarded the government an overall grade of C-, when it comes to meaningful improvements for seniors. It is in digging beneath this that an uncomfortable disconnect emerges.
In collating and assessing huge tracts of data from government reports, independent reviews, inquiry submissions and sector research, alongside lived experiences of Juniper staff, seniors and family, a gap many have been frustrated by is named.
The report finds that amid the flurry of activity of reform, the sheer volume of projects, inputs and quality markers, transformational changes have yet to touch the lives of older Australians. In a hive of reform activity, seniors, and the sector professionals trying to support them, ask, where is the proverbial honey?
“We’re in an environment where the royal commission’s recommendations have been broken down and made into individual projects. The problem with it now, is that you get really focussed on ticking off the list and you lose the sense of what was the intended outcome”.
He shares, “you get really focussed on design, on the inputs, now we really have to look at the outputs”.
Royal commission recommendations in aged care – temperature check on outcomes
Recommendations have been translated into inputs, Bricknell notes, and packaged into projects. And while this is reform’s start, it is certainly not its end. Inputs cannot be the metric of success.
A Statement of Rights for older Australians has been delivered, but the report showcases that it has not been fully embedded. And the question remains: how far does the obligation of the government to uphold those rights extend in practice?
A consumer-directed model has been promoted, and yet, conversely, components of the Support at Home program have limited consumer choice.
The bedrock of dignified care is access when it’s needed. As seniors in hospitals rise, as providers field increasing calls of those in need, they do not have beds for, Juniper finds the supply of residential aged care places a rising pain point. Current policy funding settings are inextricably linked to suppressing new builds.
And at its heart, demand-driven access to preventative aged care is stymied, with access to early intervention services slipping. 200,000 older Australians remain in stasis waiting to receive, or even be assessed for, packages for care at home.
These are the outcomes of inputs. For Bricknell they are the litmus test, they are the temperature check of success. And they must be at the heart of the ‘pub test’ of has this ‘thing’, has reform, landed.
Shifting narrative – what is ‘actually’ happening?
For Bricknell, it’s shifting away from a narrative of “‘this is all we’ve done’, to ‘what has happened?”.
“We need to have more of a conversation about outcomes, asking, ‘how is my life as an older person improved in care’”.
The conversation, he says, must make space to examine the quality indicators themselves. “Looking at quality indicators even, care minutes for example, are we asking older people after a few years of this, has it actually improved their lives, is this what they are looking for as improvement and ‘success’?”
Bricknell says, “we’re simply not having these conversations right now, we’re inspired by Siegel-Brown’s work that perhaps we’ve created all these inputs that may be having bad outputs, we may find this is not what the royal commission intended and not what the public expects”.
“We need to have a conversation where all the players are willing to talk about this openly”.
The framing of the debate around aged care, he suggests, must adjust: “the conversation so far has been, ‘we’ve delivered this deliverable, we’ve made this announcement, we’ve implemented this regulation. We will keep people alive”.
He says, “no one is talking about, are we delivering the services that older people genuinely want, when they need it, that we can afford, and from that perspective, are we then going out and designing reform to meet the needs of older people”.
Outcome verified reform
“The Government has delivered significant structural reform”, Bricknell shares, “but it has not yet demonstrated that those reforms are translating into better outcomes for older Australians.”
Landing the plane, in the right spot, is the definition of success for Juniper. The conversation, he says, must surround data-backed assessment and verification of these outcomes. Sectors and seniors deserve to know if improvement has happened amid the myriad of inputs that have been loudly rolled out.
Honest assessment of where the sector’s at means more visibility to navigate where it should be, “the royal commission gave Australia a roadmap for change. Our focus must now be on making sure we reach the right destination”.
“Instead of starting reform from funding and siloed projects, reform must be rooted in meeting the needs of older people, that’s impact”, Bricknell shares.
“The Royal Commission called for an aged care system where older people could live with dignity, choice, independence and connection. Those outcomes need to be the measure of whether reform is working.”
