Senate Community Affairs Legislation Committee, , 1:43:22 to 2:12:10
NATSIAOC warns that the transition from block funding could lead to market failure and the loss of culturally safe services in remote communities.
Topics: First Nations, Social services
Speakers: Kim Whiteley, Penny Allman-Payne, Wendy Askew, Dorinda Cox, Unknown Speaker
I'm now going to welcome representative from the National Aboriginal Torres Strait Islander Aging and Aged Care Good morning. Thank you very much for appearing before the committee today. I understand that information on parliamentary privilege and the protection of witnesses giving evidence to Senate committees has been provided to you. For the Hansard record, could you please state your full name and the capacity in which you appear today?
Kim Whitley, CEO National Aboriginal Torres Strait Islander Aging and Aged Care Council.
I now invite you to make short opening statement and at the conclusion of any remarks we'll go to questions. Thank
you. Chair Senators, thank you for the opportunity to appear today. I am Kim Whitley, Chief Executive Officer of the National Aboriginal and Torres Strait Islander Aging and Aged Care Council. We're a national peak body representing Aboriginal and Torres Strait Islander elders and older people and the Aboriginal community controlled organizations that support them across aged care. I acknowledge the traditional owners of the land in which we meet and I pay my respects to elders past and present. I also acknowledge Aboriginal and Torres Strait Islander elders and older people across the country whose lives, leadership and lived experience sit at the heart of this inquiry. >> Excuse me. I want to begin with a simple proposition. Aged care reform only succeeds if people do not lose care in the process of reforming it. NATSIAOC supports the intent of the Support at Home Care Support at Home reforms. We support a system intended to be simpler, more flexible and more responsive. What our evidence focuses on is whether the the transition from Commonwealth Home Support Program to Support at Home is being designed and sequenced in a way that delivers those outcomes in reality, not just in policy. Our role is to provide system level advice on whether aged care reform is designed and implemented can deliver in practice. Particularly in contexts where the system has the least margin for failure. At present, there is a clear system risk. Foundational supports currently delivered through the Commonwealth Home Support are being destabilized before the Support at Home system is fully ready to absorb them. When this happens, the result is not reform, it's a gap in care. And gaps in care are not abstract. They mean people missing meals, missing transport, missing medical appointments and failing hospital discharge. Not because of individual circumstance, but because of system design. This risk is most visible in regional, rural and remote communities. But it is not confined to them. These contexts simply expose design assumptions that do not hold once services are stretched. CHSP is often described as an entry level program. For Aboriginal and Torres Strait Islander communities, that description does not reflect reality. In practice, CHSP functions as a critical safety net. It fills gaps created by long assessment delays, workforce shortages, thin or failing markets, digital exclusion and limited access to culturally safe assessment pathways. In many communities, CHSP is the only thing preventing complete withdrawal of support. We heard from one remote provider supporting an elder who waited for over a year for assessment. During that time, CHSP meals, transport, home support were the only thing keeping them out of hospital. Under Support at Home, that interim support is no longer guaranteed. The Support at Home model is built on assumptions that don't hold. In many Aboriginal and Torres Strait Islander contexts, it assumes functioning and competitive markets, workforce availability, digital access availability and literacy, stable housing conditions and families' capacity to absorb care when formal supports fall away. In thin markets, there is often one trusted Aboriginal community controlled organization or like we've heard this morning, one Meals on Wheels provider. If that provider becomes unviable under a transactional, fee-for-service, retrospective claiming model, there is no alternative. In these contexts, market exit does not create choice. It results in no care being provided at From NATSIAOC's perspective, there are three system issues the committee should be particularly attentive to. First, sequencing and continuity. Ensuring people do not lose care while systems transition. Second, thin markets. Not temporary implementation challenges, but predictable forms of market failure requiring deliberate safeguards. Third, cultural safety and governance. Which must be clearly assigned, measured, and enforced if reform is to deliver equitable outcomes as intended. Underlying all of these risks is a fundamental gap. Cultural safety is not embedded as a statutory infrastructure within the supported home. NATSIAHC has developed the nationally informed definition of cultural safety in aged care. At its core, it makes one principle clear. Only the elder or older person receiving care can determine whether that care is culturally safe. Without recognition, governance, mechanisms of governance and accountability, cultural safety remains fragile. Particularly during system reform. NATSIAHC is not asking for carve-outs or special treatment. We are asking that the reform settings reflect real-world conditions so that the system works for people with the least margin for failure. And therefore, works better for everyone. A system that genuinely delivers equity must do five things. Recognize unequal starting points. Treat thin markets as market failure. Guaranteed continuity of care. Embed cultural safety as statutory infrastructure. And lastly, invest in Aboriginal community controlled aging and aged care. This inquiry has a particular has a critical opportunity to ensure that aged care reform strengthens rather than undermines what currently works for Aboriginal and Torres Strait Islander people. NATSIAHC stands ready to work with the committee and the government to ensure the transition to support at home delivers equity in practice, not just in principle. Thank you. I welcome the committee's
questions. Uh thanks very much, Ms. Whiteley. Um and thanks very much for the comprehensive submission that you provided to the committee ahead of time. noting um your comments about um supporting the intent of the support at home transition. You said simpler, flexible, and more responsive. Um and if I go to your submission, um you talk about the fact that um CHSP has played a critical and stabilizing role uh in supporting Aboriginal Torres Strait elders and older people to remain safe, connected, and independent within their You've also um noted that CHSP supports day-to-day independence in ways that are culturally meaningful and protective. Um and then you go on further to say that there's a number of things that shouldn't be lost in the transition. You talk about community controlled holistic models of care, flexibility to respond to urgent and unmet need, proportionate and context appropriate regulation, uh and not risking core the loss of core services. And I guess my question to you is is it the case that CHSP is actually working well for First Nations communities? And is what we need a bigger investment in that service rather than simply transitioning it into support at home? Cuz it would seem to me that that there are a lot of good things in this program that are working.
From a uh Aboriginal Torres Strait Islander perspective and from our organizational perspective, our submission and preparation has been towards the transition. Um and so in that respect, um I'm unable and can take on notice whether we um our membership really do uh favor a commitment to CHSP or the transition to support at home. Obviously, um I echo the things in both in both the submission and in my statement today that things are working well. It provides um a great um platform and safety net of the flexibility that we've heard earlier today. So, I'll take it on notice if you would like a definitive answer on which one is going to be better as opposed to what is needed during the transition.
And I think I I I guess that's a key question for us because whilst, you know, the government has said not before, it certainly hasn't said when and it hasn't said definitely. And I I guess a starting point for us in this inquiry, certainly in the early stages, is to actually ask the question if there's something that's working well, should we actually be throwing it out or actually should we be investing in it more uh so that it continues to assist those people. So, I guess what I'm hearing from you is CHSP is working well, um and there are certainly many things about that that you wouldn't want to lose in a transition to support at
home. Absolutely, that's the case.
Yeah. Um and I'm very happy to take, you know, if you if you have further information on on on the two options, uh that would be great. But I'm certainly if that's good to hear that. Um You talk about in your submission um that providers consistently identified several CHSP funded services as fundamental to elders and older people's well-being um and that are at high risk under the support at home model. I'm just wondering if you could elaborate on that a little bit more.
In some remote and very remote communities, um an Aboriginal community controlled provider may be the only provider of service. Um An Aboriginal community controlled provider not only provides um aging and aged care services, they cover the the across the domain of health um from primary health care services to chronic disease management to child and health and well-being and also healing and and and plenty of other areas as well. So, in that context, those service delivery and opportunity for access um it is is limited um to what can be provided. the intent of the reforms, um our concern is whether the design and the sequencing fit that in practice.
Um you also talk about in your submission um that CHSP has enabled um flexibility and you wouldn't want that flexibility to be lost in any transition. Could you maybe um speak a little bit more in a practical sense as to what sorts of flexibility CHSP currently provides and and what that looks like in in practice?
I just note for the record again that we're not a service provider, but what we hear on the ground um from providers is that we can um that that I our elders and older people participate in group settings, um in individual service provision, as well as other activities um on a community level that provides and affords that flexibility under CHP that it doesn't um when it's aligned to um support at home and individual care.
Mhm. Thank you. Uh I understand that Senator Cox has some questions, so I might pass on the call and can I can always come back to me if if we have time. So, Senator Cox.
Thank you very much, Chair. Um thank you very much for appearing today. Um the government is committed to um that the National Aboriginal Torres Strait Islander Flexible Aged Care Program will remain as a separate specialized program providing culturally safe aged care services to older uh First Nations people during this period. Can you speak to us about the importance of
NATSIAHC funding uh Senator Cox as opposed to the CHSP, is that your
questioning? Yes, thank you.
Um the NATSIAHC funding um is is another domain that we we didn't look at in in relation to this this particular piece of work. However, I can speak to the fact that it is um the most in demand and also capped um for for providers uh providing services to First Nations people. And so, um like the aged care system with packages, um that cap is not um is not an equitable way for um lifting the accessibility for providers to um participate within service delivery, but also for elders and older people to
Okay, um what I'm what I'm trying to understand is, you know, that um in your submission, so just as a follow-on from that, you've stated that you don't oppose the reform as a matter of principle, but you would like to see a staged, safeguarded, and culturally responsive So I suppose for me it's explaining what does that look like and are there learnings from the um NATSIFAC funding that exists um that uh essentially could could ensure that we have a stage safeguarded and culturally responsive transition uh as part of that.
Sure. The um perspective that we hold strongly is that to protect the continuity of the trans during the transition, which means readiness and wait times, um accessibility to services, and as the previous speaker mentioned, the integration of those services from point of hospital to home care, um to and across the services.
That's great. Thank you very much. Thanks, Chair. That's all from me.
Oh, okay. I wouldn't mind unpacking a little bit more, Ms. Whiteley. Um the the the service providers that that you deal with in your space under your banner, I'm taking your point that you're not a service provider. My apologies for phrasing my earlier question in that way. Um are the majority of um people delivering services or organizations delivering services uh to First Nations people and community, are the majority of them at the moment providing uh CHSP services or supported home services or both? Where is the majority of service delivery sit at the moment in those communities?
>> The majority of services provided to Aboriginal and Torres Strait Islander people are under the flexible program delivery services such as CHSP and NATSIFAC funding. that is tied to the flexibility and so that um services can provided in a in a way that's culturally safe and for for community and for the elders receiving those services.
And in terms of um if there was more investment needed, like would you say are your providers telling you that uh the resourcing for those services is sufficient at the moment or does it require further what is the state of play, I guess, in terms of the availability of service?
>> Yeah, we're hearing that um that services need to be funded to a much higher degree than they currently are, particularly those um previously mentioned, um particularly the NATSIFAC funding, um which applies and allows for the uh flexibility and um delivery, particularly in wrote uh remote and regional areas as well. Mhm.
are there services that are providing any support at home services or is it NATSIFAC and CHSP and there's not really much penetration of support at home
services? There's a deficit in the data um to be able to provide any concrete advice in that regard um and and we don't have it at hand at the
moment. Mhm. Is that um is that data that you're able to obtain or is that data that um you would expect the department to have? Um I guess I'm I'd be interested in in looking at that and and whether or not or the committee would and whether or not that's something we could ask for you on notice or whether that's better a question actually directed to the department.
>> It's certainly a a question that the department is better placed to answer.
Yep. Okay. Um did you have a question?
Questions, I just wanted to flesh out something and it's in your in your um submission you're talking about lived highlighting some of the lived experience, but I just wanted to understand the actual severity of it. When you're talking about things like CHSP is the only mechanism preventing in many communities, particularly in regional remote and thin markets, CHSP is the only mechanism preventing complete withdrawal of support. So is that a common thing across the indigenous communities or is it just something that that that one provider that's provided feedback into you from
that we're hearing from um our First Nation providers, but also from our elders and older people uh because of the uncertainty around the systemic um changes, um a lot of people uh there there there's a fear uh to progress and and expectation around um waiting times, uh co-contributions, um there's no clear information about that and the people who are providing CHSP services uh aren't able to provide that information as well because we don't know what's going to happen once the transition date um occurs or we are not involved in pilot programs to see what that transition um will look like and whether accessibility of care or to care will be um enhanced
or decreased. So what type of CHSP providers are they? What what sort of services are they providing that would be in that sort of critical stage? Is it is it across the board or is it specific types of providers?
I'm sorry, I'd have to take that on notice. I'm not quite sure um whether you're talking Aboriginal community control providers are providing what services or or the amount of First Nations people that are involved in other generalist mainstream CHSP services. It's where in
these areas where the yeah, if that if that is the case that we're we're in critical situation where CHSP is providing the only you know, it's the only reason it's people haven't got complete withdrawal, it would actually therefore make it, you know, it's a big big thing if they're then looking to transition as to, you know, what what is the plan to put that in place and also um what types of services are going to be lost to people. That that's my biggest concern is what what would they lose.
They would lose transport, they would lose meals, they would lose accessibility um to to uh interaction and and cultural interaction as well. Okay, so the
government is aware of the the concerns that are being expressed, I'm assuming Well, it would be interesting to see, but if you have got any further details on that in regard to the types of and the areas that are actually impacted specifically in that sort of real critical stage, that would be really worthwhile to know. Okay. Thank you. Can
I ask a follow-up question? Um it it seems to me that because the majority of providers that are providing services in many of these areas and particularly the thin markets are CHSP providers who are therefore not involved in the transition um to support at home. Am I understanding it correctly then that there's very little information therefore has come to those providers about what actually is happening in the space, what's happening with CHSP, when things are going to happen? Is there a lack of communication from the department and the government around what that looks like?
To answer that question, we need to consider that accessibility to aging and aged care services is uh very underwhelming um in in regard to First Nation context. And so um of those that do those of us that do access um that data isn't is not
available. Mhm. My question though more is about communication from the department and the government to the service providers that you represent. Are they in the dark at the moment about what is actually going to happen because it seems to me that what I'm hearing from your evidence is they're not involved directly in the support at home transition because they don't provide those services and there doesn't seem to be any information forthcoming to your providers about what is going to happen to their services and
when. Yeah, that is absolutely the case and where there are um some work happening such as pilot supported home pilots, uh we are yet to be involved in that um to have a deeper understanding of what
that means. Mhm. All right. Thank you. Um I don't have any more questions. Thank you. Uh Senator Cox, did you have any final follow-up questions? Look, Ms. Whiteley, thank you very much um for coming and giving evidence today and we really appreciate your written submission. Um just excuse me while I go back to my right page in front of me. Um want to thank you very much for your evidence today. Uh the committee is reporting on to the Senate on Wednesday, the 15th of April, 2026 and there were a couple of questions uh on notice uh in this session. So the committee has agreed that responses to questions on notice uh should be provided by close of business on the 20th of February, 2026, but thank you very much for your time today. We really appreciate it. Thanks. Um we will now suspend uh and we will resume at