Senate Community Affairs Legislation Committee, , 1:15:14 to 1:37:24
Providers express concern over the pace of reform and the potential for increased administrative costs under a fee-for-service model.
Topics: Social services, Health
Speakers: Tim Hicks, Maria McLaughlin-Rolfe, Penny Allman-Payne, Hon Anne Ruston, Marcela Carrasco, Dorinda Cox, Speaker 12
you.
Uh thanks very much, everyone. And can I say thanks very much for keeping your um opening remarks brief. Um if I could just pick up, I guess, on a couple of themes um from your submissions and your opening statements um before I share the call. Um Mr. Hicks, you said that we don't need wholesale change. You've made comments around the need to particularly maintain some forms of block funding. Um Ms. Watson, when I looked through your submission, it talks about um some of the really important um benefits to CHSP and block funding, uh the fact that it, you know, might not be viable if it goes to a fee-for-service model. Also note your points which you and other submitters have made, though, that CHSP has been underinvested in. And I guess what I'm keen to understand from you all is is when when you say um we need to extend the transition time, and you use the example of the NDIS, and I do note that the NDIS is now turned around and gone, "Oh, we need this other program called Thriving Kids because actually the model doesn't work for everyone." Have you approached your submissions uh and your comments from a position of you're assuming that we're definitely transitioning CHSP into Supported Home? If the que- as opposed to if if the question was put to you, would we be be- better off keeping CHSP and making the modifications that you're talking about, investing in it more so that it's not an underinvested program, but is really complementary to Supported Home. I I'm keen to understand if you were given the choice, because the way we the terms of reference are framed, it's an assumption, but I I'd like to take a step back and go, "Actually, should we even be doing And that's open to all of you.
If by uh enrolling CHSP into Supported Home, we mean introducing individualized budgets and or individualized plans for everyone on CHSP, then uh no, we should not proceed with that. It would be uh contrary to everyone's interests, I'd argue even government's. Um however, you could say we've already begun the integration into a single program. We have a single assessment workforce now, a single assessment tool. Um we should have a single co-contributions framework that would be fair. Um and there are other aspects that we might want to make consistent. We also have the same regulatory arrangements now applying across CHSP providers and Supported and Supported Home providers. So so I don't think um it it's necessarily a case of not proceeding with the government's commitment, but it's about what that um change actually means in practice. confusing, and administratively it can
be a challenge for providers to manage
Maria if you want to add to that.
program. It is that entry level, you know, those low-level touch early touch
hoc-ishly. Um and so that in itself, you know, sees that there is a value in CHSP being able to cater for those entry level clients coming into the system. Uh
Uh thank you. Um I um I think it's been stated, uh there's certainly value in retaining a number of service under the block funding arrangements uh for certainty for providers, the community organizations, um as previous statements have been made. Uh, one of the benefits, however, that I think we haven't, um, um, discussed today at least is that the coordination of care that is possible under supported home. Um, and having the distinction between uh, true entry-level care requirements and how we can continue to provide that under a CHSP type model uh, while making sure that we are providing the right level of coordination for people who are on those uh, more complex ends of care. Uh, what we have seen, uh, um, as supported home has begun, um, and we end up like packages commencing is that a lot of the clients coming through for end-of-life care are actually coming straight from CHSP into end-of-life services. Um, so there is a high level of complexity under CHSP that's, um, at the moment probably being going unnoticed, um, and and it's something that we really need to, um, factor into the transition.
Thanks very much. I'll pass the call on
you thank you very much. And um, so I'm just keen to understand what in um, um, what has been the involvement that you've had so far in relation with the the Department of Health and aged care about their expectations about what's going to happen over the the next 18 months. And you know, particularly, um, Ms. Watson on the basis of your concerns in relation to transition etc. Um, what advice have you had to date or interaction with the government about what is actually happening over the next 18 months? Um,
well, I'll say the focus at the moment [clears throat] from our perspective is still transitioning into the new aged care act and the new supported home program, um, noting that we're only a few months in. As for this upcoming transition, I mean, as a national body, um, that doesn't deliver services, we as far as I know, there hasn't been any mechanism established to coordinate that transition. Um, but from a provider perspective, Maria, if you uh, similar to add to that. So so
probably similar because supported home has been the focus and and sort of we're only 3 months into supported home. So it's very early days and we are still working with uh, embedding. You know, there's quite a significant amount of supported home that still needs to be embedded. And some of the and at the moment the challenge is that with the transition, is it system design issues or is it just transition issues with supported home? Um, so we do need time to embed that to then really understand where the gaps might be. Um, and and just on the back of the release of packages at the moment and the actual minimums, um, allocations, CHSP is filling that gap at the moment. Um, so we are finding that, you know, the the 60% allocations are not meeting people's needs. The assessment, um, of a number of people through the assessment process is not necessarily being assessed at the right level. Uh, and so there is a gap, um, even with the current way the packages are being released. Um, so it's to support CHSP is supporting that, um, significantly at the moment.
>> Sure. Mr. Higgs.
The the focus has been on the implementation of supported home and I think that's appropriate. We we we really haven't fully implemented supported home yet. We've started it, but we're still, um, getting elements of it embedded down. And, um, you know, key things like price regulation. Now, we've done some analysis of the prices that are, um, published on on My Aged Care. If we look at a service like cleaning, there's a range from around $60 to 130 over $130, um, with the median sitting at around 104. Um, if you were to introduce price caps at the median price right now, that would create massive structural change for those organizations in the higher price categories. Now, we're we're actually a little bit below that. We're in the bottom third of prices, so it's not such an immediate issue for us, but it will cause massive market disruption if that's what occurs. And we need to resolve those sorts of issues before we start thinking about another big change. And I'll also put a call out to our workers who have just been working incredibly hard and continue to work incredibly hard to get out statements, to deal with issues with systems and invoices. And they need to be able to focus on that and then have a bit of a period of time where they can just focus on improving the quality of care before thinking about any major system changes.
So on that basis, would you be recommending that, um, there's a further deferral in relation to any suggestion in relation to the implementation of a of a single sort of point of entry model? So keep CHSP running for a longer period of time than
quite sensibly left it open that that they would be, um, would would take a little bit longer to make changes to CHSP. Uh, it it'll depend in part on what changes we make. You know, things like increasing funding levels, um, maybe opening up commissioning a little bit. That that sort of stuff could occur more easily. If we're talking a wholesale restructure of the system and introducing individualized supports for everyone, then that's a much bigger change, would take a much longer time frame to implement. I think we can probably, um, work out broad policy directions by the end of this year and then based on what those broad policy directions look like, make decisions about the time frames to
implement them. Yeah. So in terms of the um, one of the the big challenges appears to be that there there seems to be this ongoing anxiety about what's actually happening. Service providers, particularly those that, um, are, you know, very focused on providing, um, the CHS services, um, they're cuz they can provide no certainty to their staff or their communities about the ongoing service. Um, that this we're seeing a shrinking of service delivery in that area, particularly in some of our shallower markets. I mean, what's the kind of time frame? I mean, I know you guys are big, um, and you have much more resilience in this area. But I mean, what what is your view about what kind of time frame um, would be needed to give certainty back out to the sector, um, so that they can continue to deliver in these entry-level services, which I mean, we're talking at 835,000 people on CHSP at the moment. I mean, that's an awful lot of people. It's, you know, I think it was the chair made the comment, you know, it it took probably you made about the comment, Ms. Watson, you know, it took us a lot of years to move, um, you know, 300,000 Australians with disability onto the the NDIS. And even that was fraught, you know, with with challenges. We're talking 835,000 people who effectively may have their services delivered in a different way or administered in a different way. I mean, I'm just keen to understand what kind of time frame you think that is reasonable in and how long after you've embedded all the changes from the new act, not just supported home, but everything else that's involved in the new act. I mean, is this just turning into sort of reform overload for the sector and most particularly for the older Australians and their families who are trying to navigate this at a time in their lives when, you know, sometimes they're facing great
Um, to that I would say we it's difficult to put in I mean, yes, in our submission we've outlined we would need a couple of years for this transition to occur. Um, I think having some certainty from the government about when the transition would occur would be really helpful. And like with the new act, providers in our network were ready and willing to just make it happen and they've all done an amazing job in implementing a new system. Um, I think the concern that we hold is that even if the this transition does take place, whenever that may be, we don't want to see this resignation with the CHSP that, oh, well, it's going to be absorbed, so it's not worth investing in. Yeah. With
that to that point is like do you actually know what is going to happen to those 835,000 people that you are currently supporting now? What is it going to look like um, potentially on the July 2027? I mean, I I I acknowledge that it's not before July 2027, but I mean, that's the date that's sticking in everybody's mind. Do you know what it's going to look like post that date? Any idea at
all? No. And I would also add that taking into account the current wait list and queues for supported home, how are those CHSP participants going to absorb into those queues? And I I don't think those queues are going to get any shorter. So just what what where is the equity going to be for people um, who who have maybe been waiting for supported home for a for a long time and don't have any services right now. Um, and balancing all of that out and Yeah,
looks like we're building the plane while we're flying it. Um, I'm happy to leave it there, chair.
Over to you, Senator Cox.
Thank you very much, chair. Um, can I uh, ask um, how you all make use of your co-contributions with respect to the funding of the CHSP services that you currently provide and if that system does work effectively.
Um, I'm I'm happy to to start on that. So one of the attractive things about CHSP is that there's quite a lot of discretion for providers to waive co-contributions for individual clients. Uh, and it's a lot easier than applying for a hardship application to government. And I think more broadly, that's one of the benefits of CHSP is that it leaves a lot of the discretion about, um, service delivery at the local level rather than making it, um, with an administrative decision maker. Um, so it's it's really a case-by-case, uh, basis, but we do generally charge, uh, the that s- co-contribution that's in the guide for each of our services.
And I would add to that um agree. Um the thing is that does send its own challenges though because that also is a barrier to people going into supported home because of how the co-contribution um system is in is different across both programs. So, there needs to be a consistent approach to how we apply co-contributions uh because that's why we see people choosing to stay in CHSP particularly when they're actually at the level of supported home level services under CHSP.
Can I Can I also just add one one thing cuz it's relevant to this and it came up earlier. When we do the comparisons between CHSP prices and supported home prices, we need to be careful to add the co-contribution to the rate that's in the in the guide that government pays, but then also consider that not all the the volume of outputs that providers paid for are necessarily delivered every year. So, the actual unit cost is published by the Productivity Commission and it's quite a bit higher than the than the the notional unit price in the guide. So, we just need to be careful when we're making accurate comparisons.
I am Sorry, I'm not I'm not sure whether you can see um we can see me on the screen. Um just to just to add to that um what we're seeing is even though the programs are not yet transitioning, we've got clients who are transitioning into supported home as their assignments for uh packages are coming through. Um and so, there is definitely the issue of co-contributions. It has been a factor in people making decisions um about moving into supported home. on add to that the uh 60% packages which don't add value for money for a lot of the clients who are having those assignments coming through. Um and so, definitely there's a need for some greater clarity around co-contributions um the way that the um you know, standardizing um the way that uh payments co-payments are expected um and essentially the you know, providers are putting those those dollars those co-contributions back into service delivery in any case.
Thank you very much. Um Can you just I'm really interested in ways in which your organizations can be made more efficient through this transition um of CHSP to supported home. Have you got any ideas that you can share with the committee in relation to that?
I think uh the key one is to open up the commissioning to a more competitive and regular tender process and to have multiple providers operating within market so that if one provider is not um up to scratch whether from a quality or efficiency perspective, there's enough uh other capacity there to take over. Um And you know, there there's huge variations in the unit cost from state to state astronomical and I'm not quite sure what's going on with that data, but but that would be the number one thing to improve if efficiency and cost effectiveness under the Commonwealth
From our perspective, I suppose when I think about the system end to end, you know, CHSP has such a valuable um role to play for those entry level, but what we do need is we need a a a clear pathway of and and strict pathways of how people you know, evolve between their low level entry level services as their needs continue to change. How do we actually make it easy and seamless for them to actually move through the system. So, block funding is perfect for those entry level low touch services. Um they're not complex, you know, but as people get more complex as they age and we want to be able to maintain people in their homes as long as possible. And so, that's the luxury of CHSP having that flexibility to be able to flex according to those changing needs while we move people into the supported home program. So, having that flexibility is really important and if they're all in supported home and the the the the assessment the review time frames, you know, people deteriorate from the time that they get their assessment betw- from the time they get their assessment to the time they get an allocated package, their conditions have changed in a lot cuz there is such a significant wait. And so, supported CHSP is actually filling that gap. So, we need a you know, that whole transition across the whole system needs to be much more streamlined and have very clear um thresholds across each.
Uh the timeliness of transition is part of that is an important piece in this as well. Um you know, it's it's just been mentioned the the wait times for services um and the impact it has on the changing needs of an older person as well. So, um making sure that uh assessment and commencement of service are very closely linked together.
Thank you everyone. Thank you, chair. That's the end of my question. Uh
thanks, Senator Cox. Um I just have one more question and I think Senator Ruston has one, too. Um I spoke to a a very small community-based service provider in regional Queensland year and a half ago who said his comment was that you know, supported home was coming in. They'd been told that the whole thing was going to transition into supported home. They're CHSP provider. They said that they spent $150,000 on literally going through and doing the work to to see if they could make the transition. And what they learned out of spending that $150,000 was that they would not be able to provide their service at all under supported home because it just wasn't cost-effective or manageable. Uh and I think that's sort of similar to what we've heard from Meals on Wheels that unless they have advanced block grant block grant funding uh that can't work for them. I guess what I'm interested to understand from you is is it the case that your organizations would be able to deal with that a little bit better because you're so big? And if you were just providing a CHSP service, could that stand alone if it had to move to that supported home model or would would you need to exit the system? Because that's my concern that that smaller providers who are place-based and local providing CHSP services actually can't afford or manage the transition to a different model because they don't have the overlay as well of of being a large supported home provider.
I I'd argue that what will change is the way we do ever have to deliver services. I mean, yes, we could make the transition, but we would not be delivering services the same way that we do now. Um I'll take our community nursing services as an example cuz that's our big CHSP contract. Um we maintain a lot of specialist capability um clinical nurse consultants, wound care specialists um and so on and so forth. And that lets us deal with more complex needs, keeps people out of hospitals in Victoria. It's part of the reason why Victoria has very low um rates of long stay older patients in hospital. Um it would be difficult to maintain that kind of capacity on um a sort of fee for service um package-based model and you'd be competing with agencies that'd be offering junior nurses at low rates of pay with very little kind of clinical
A single um CHSP provider? I think what would what we would see is they the administrative burden might become too much um which might mean that their level of service delivery actually drops. The ability for them to be able to deliver the volume that they're doing now would be lesser. Um I think that you know, it it would um it would cause When we talk about a system that needs to be sustainable and investable, I think that would be a challenge in that