Outgoing Bolton Clarke CEO departs with some blunt feedback for Government

Stephen Muggleton has never shied from a challenge or doing the un-beaten path ‘thing’. From a revered start in teaching hospital management, Muggleton made the switch to aged care sector. Advised by colleagues he was committing ‘career suicide’ he deems it one of the best career decisions he’s ever made.

Look at the problem sideways

Always drawn to prying open and resolving issues, Muggleton found himself increasingly interested in resolving the planning and logistics complexities of high quality acute care. All the better challenge if exacerbated by staggering pressure of increasing demand; a reality many hospital and aged care leaders are navigating currently. An early eureka moment was in realising that hospital care was problematic not due to the easily thrown about term of inefficiency but rather a lack of step down and rehab services.

Discharging sub-acute and geriatric patients to free up beds would only see the same patient re-bound a few days later due to lack of access to good quality aged care services. This interconnectivity, and consequence of relationship, between care sectors lead Muggleton to take the leap to resolve the significant challenges posed by aged care at the time. ‘Career suicide’ would just have to be risked.

Energy and patience – not rhetoric but reality

Muggleton pin-points the relentless change and reform the aged care sector is expected to weather as a key point of frustration across his career. “Review after review” and needing to be constantly agile in adapting to four different funding systems (CAM/SAM, RCS, ACFI, AN-ACC) has not been for the faint of heart. Compounding these changes has been the ever present workforce challenges and rising issue of severe weather events. He contemplates that across his decades of work, even with the best team and intentions, CEOs and leaders cannot manage and control every challenge thrown their way. It is critical, he emphasises, for leaders in the aged care space to focus more on managing their energy than managing time.

Casting his mind back to starting in aged care, Muggleton advises that young leaders need to be more patient, with themselves and the systems they’re working within, and to solidify their long-term focus. He recalls being too impatient, and investing significant time and energy into trying to influence every new Minister and Review recommendation.

He believes the time would have been better spent on quality ideation and follow-through of best practice care models. He argues this is a better use of time for current leaders due to the strength of example over rhetoric. Muggleton advocates that quality best practice care models in practice, are far more compellingly effective, that in their inherent functioning they define policy settings. He highlights the success of the Bolton Clarke Research Institute and related Clinical Nurse Specialists being used to craft State Health Department care plans and as clear examples cited as industry best in the Royal Commission.

Leadership perseverance is needed and frontline time is critical

Unafraid to speak to the deeply entrenched frustration of relentless change facing the sector, Muggleton assesses the sheer volume of this change currently demands and necessitates perseverance.

Leaders must be ready to slog through. How? Far from remaining in the comfort of head office, Muggleton advocates that perseverance can be drawn from time with front line staff, and acutely seeing the positive difference being made to thousands and thousands of human lives. Particularly those that larger society forgets, of the frail and vulnerable. There is something inherently positive and potent about proximity to the front line work itself for all leadership in the sector.

Ministerial Hope

Commenting on the revolving door of aged care Ministers over the last few years, Muggleton speaks with positivity on Minister Butler’s tenure so far. With a genuine interest in the sector from the Minister, particularly his Living Longer Living Better reform, he assesses that the sector has seen some great initiatives. Of note, the new raft of dementia support programs, workforce compact and solidified relationships between aged care and primacy care sectors, along with stronger palliative care services, and the 40% increase in number of home care packages.

Speaking across the spectrum, Muggleton highlights Santo Santoro’s “genuine interest” in the sector. He experienced Santoro to have had a measured approach to the department, resisting being “captured” by it and consistently showing an interest in hearing providers’ perspective prior to launching into system changes.

Strength of Leadership is vital

Muggleton reflects that it is in the great skills-based Board and talented Executive team that Bolton Clarke was able to lay a foundation whereby a shared vision and capability was built. In resisting being bogged down in the short term, even if it was to pivot for yet more compliance change, Muggleton argues that Bolton Clarke was able to position for significant success in the sector. He sees the Group as having established an unerring cycle of planning that allowed for the optimal positioning in the market, to establish and roll-out an industry leading offering of short, medium and long-term strategic objectives.

That being said, Muggleton highlights the need for the agility of re-calibration by all levels of leadership to result in resilient alignment between the Board and Executive team. Tellingly for all leadership across the sector, Muggleton highlights that the unyielding and high levels of accountability and action orientation processes built into the systemic functioning of the Group was of great procedural cohesion and stability.

Muggleton praises the “incredibly talented and hard-working merger and acquisition team”, citing the likelihood of the team reviewing and rejecting over a 100 opportunities of new business. It is in this discipline and rigorous approach to new risks and opportunities that Muggleton argues underpinned the Group to confidently step into some significantly large calculated risks, and acquire high quality and sizable portfolios such as the McKenzie Group and Allity.

An Improved Sector

Contemplating the mood of the sector when he first entered, Muggleton remembers a turbulent time of “significant consolidation”, aged care groups being acquired left, right and center every month. These acquisitions being consolidated into corporate structures and prepared for parade on the stock market. He recalls a mood of severe competition and intense rivalries. He believes there was unnecessary, and perhaps wasteful, conflict between for-profit, not-for-profit and faith-based providers and their correlating peak bodies.

Muggleton steeled himself, and his leadership team, against what he hedged would come from Bolton’s growth in those formative and close-to combative years, that of drawing “antipathetic tall poppy criticism”. Instead, he was impressed and gratified to see an industry respond with “nothing but support from other providers on the journey”.

He sees, with the new crop of respected and character-filled CEOS, and the consolidation into one single peak body, an aged care sector transforming into a significantly more supportive and encouraging sector. He has experienced, irrespective of size, structure or constitution, that the majority of leaders have now trained their focus on realising the “shared vison of improved care outcomes [rather] than commercial competition or market share.” A change of significant benefit to the vulnerable and frail the sector seeks to protect and care for.

Government pitfalls in aged care reform

Maneuvering decades worth of government overhaul of the sector, Muggleton laments that the trend to double down on risk mitigation, through increased regulatory compliance, is as strong as ever. Peeling back the cover on why this trend persists, he comments, it as “an easy lever to pull”, and “a response to the need to be seen to hold providers to account.” Yet while holding providers’ to account is a noble overarching oversight measure, in execution it misses a beneficial end-game Muggleton suggests; that of exiting poor providers. All the while compounding Provider resource allocation through burdening excelling providers.

Pointedly he sees many of the recommendations to come out of the Royal Commission as being functionally tailoured to “a very small and unrepresentative number of providers who shouldn’t stay in the sector.” From his close relationship and proximity to many CEOs and Boards across the sector Australia wide, Muggleton strongly advocates that the significant majority of providers are “very well managed high-quality operators”.

Yet in being treated with the same brush by public overhaul measures, Muggleton notes that while many of these high-quality providers function with, “very sophisticated care and clinical governance systems” they are “yet are dragged down to the lowest common denominator and compelled to respond to the same regimes being used to monitor poor performers.”

He sees the mandatory response to result in essentially diverting funds, energy and time away from care to ticking boxes that the exemplary care has already been achieving. He advocates that “the tsunami of regulatory compliance reporting and checking should be even more risk focussed and oriented toward supporting and/or exiting poor providers.”

Instead of burdening thriving providers of high-quality care with increased compliance, public policy and practice needs to overhaul compliance to pointedly locate and elevate struggling providers who can come good, or secure “the exit of poor providers”.

Funding Inequalities need overhaul

Muggleton openly dismisses the current models of funding to care. Providers are able to provide what they’re funded to provide, “not funded to provide what’s actually needed”. He points ministers and leaders in the sector to look at the difference in terms of funding inequality as seen in treating the same patient and co-morbidities, in a nursing home as opposed to a hospital bed. The same patient can present in two situations, with the same needs and find polarising treatment due to differing funding. Muggleton muses that “it seems ageism remains the last bastion of socially acceptable discrimination.”

He goes further in saying that not only is the funding inadequate in the aged care setting, the model is inherently broken. Archaic in pulling from the 1920s style time and motion studies, Muggleton sees it as a medical model based on immobility. The “holistic restorative array of critical elements of care and support, like access to allied health professionals, reablement, dental care, GPs, grief and bereavement counselling are [acutely and] sorely missing from aged care.”

Muggleton raises the concern surrounding the disguise of a further major problem, that through “tricky nomenclature…two hundred and fifteen minutes of care” is spun into meeting needs appropriately. He wonders what residents are to rely on for the other 20.5 hours of the day.

Intersection pain is growing

Looking at higher structural challenges, Muggleton turns focus to the functioning of different state and federal responsibility for differing components of the broader health system, and the intersection of acute, primary and aged care yielding increasing pain points.

This intersectionality must turn to a whole system approach, he advocates. With hospitals at breaking points, he sees pressure only continuing to increase on State Health Ministers, who will likely, and understandably, respond in lobbying Government to increase aged care funding – if only as a measure to right the critical ship of hospital listing too heavily.

Yet if left to play out, how fatally will the hospital system be damaged. Muggleton’s early lessons in hospital management resound, with the lack support for step down sectors from hospital, such as aged care, resulting in increased rebounding to hospital beds, the pain points become societally wide across the full gamut of Australian demographics. Focussing reform to benefit the whole system at large, before irreversible damage is done is critical. Muggleton unequivocally calls for Government, if privileged with further re-election to elevate their mandate to secure broader system reform.

Leadership: Tenacious, talented and selfless

Muggleton speaks of being “really encouraged by the energy and tenacity of all the leaders in the sector who continue fighting for positive change on behalf of their residents and clients.” He continues to be impressed by innovators present in the sector, from “Natashia Chadwick’s dementia model, Rodney Jilek’s Community Home Model, Marcus Riley’s SONA Framework, and James Mantis award winning integrated living developments (based on people, place and participation)”. They all bolster his projections for the future.

Even with Government’s knee-jerk compulsion to “overcomplicate, overregulate and underfund residential aged care” Muggleton sees an encouraging response to this, that of encouraging innovation. Providers, out of necessity and response to “workforce and viability issues in residential aged care”, are leaning toward “developing care that is more tailoured, and support services offerings, within a Retirement Village/Assisted Living structure.” While change has been thrust on the sector, there is movement from innovative leaders to lead the change from within.

Muggleton reflects back on an agile, persevering sector, full of front-line staff and leadership who turn up daily to make a difference to those that larger society may forget. While innovation is often applauded in the spaces of the young, he sees a sector rising and adapting to meet “the more diverse and demanding requirements of ageing baby boomers with ideal and flexible solutions.” He sees a sector positioning and adapting to be ready for the change to come.