The conditions for radical reform of aged care are now present, NSW Ageing and Disability Commissioner Robert Fiztgerald has told a key aged care  conference.

“The moment is with us, the politics are right,” Mr Fitzgerald told the ACSA National Summit in Canberra on Wednesday.

“There are two ways public policy occurs. Either because there are  are bright, intelligent people capable of leading that reform, the second is crisis.

 “You’ve got all the elements, you’ve got all the evidence, you’ve got the insights of royal commissions and other inquiries. You’ve got your own intelligence. We’ve been through a pandemic, which has focused these issues, and the politics are right.

“So if I’m any strategist at all, your moment has come.”

Commissioner Fitzgerald said the two biggest barriers to meaningful reform included workforce issues and financing.

“Those issues remain exceptionally perplexing, and those two issues are really, really significant,” he said.

Learn from the NDIS

Commissioner Fitzgerald said in designing the new Care at Home System it was important to learn from the failures of the NDIS model, which was based on providing blocks of service for a fee.

“One of the tragedies of the NDIS is that it’s transactional,” he said.

“You need to create a system that is relational, not transactional. If we don’t the home care system will fail, it will be flawed like the NDIS.

“It is incomplete if we simply have a model that has turned every aspect of a person’s life into two hour blocks for which there is a particular fee.”

The provider market

There should be a range of providers under the new system, Commissioner Fitzgerald said  – including for profit, not for profit, mutual and government.

“This notion that we can simply open up a market, and let it rip, has been shown to be fundamentally flawed, and governments need to reassess in the light of overwhelming evidence that that does not deliver for the well being of the group as a whole,” he said.

“If we want a quality system in which the the values and the incentives that operate within the system are aligned, you need that mixture.”

However the market based approach would not work for some people and shouldn’t be required in all cases, including first nation’s people, older people experiencing homelessness and mental illness, and thin markets.

Common funding approach

Commissioner Fitzgerald acknowledged the push from the Support at Home Alliance for a common funding approach across residential and home care.

He said he supported this in some areas but would be concerned if social support, including respite, equipment, community transport and general care, were included.

“There is actually no reason to put them in at this point in time,” he said.

“It will over complicate the system. My advice is you do not have to put everything into the marketised model to start with. Learn the lesson of NDIS.”

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