Senate Community Affairs Legislation Committee, , 3:14:54 to 3:43:59
The hearing concludes with a focus on the government's commitment to reducing wait times and the ongoing consultation for the 2027 transition.
Topics: Social services, Health
Speakers: Hon Anne Ruston, Julia Atkinson, Greg Pugh, Sonja Stewart, Dorinda Cox, Penny Allman-Payne
do we have any idea when we're going to know when it's going to be introduced because you keep talking about you know no earlier and I acknowledge that that is the language that's being used but it's not particularly helpful for planning or the like. So when do you think we're going to be in a position to know when the people who are on CHSP are likely to be brought into the the single model?
Yeah so so that that will be a decision of government. However I would reflect on what I had said previously in terms of the processes and ensuring that older people are well communicated that the system has the support that it needs to do it that consideration has been given into implementation and any particular challenges. So while it is a decision of government today those decisions with very big system change have been made with a series of considerations which which would be up to them. However today that is the process by which has been used and given the size of this reform I would assume it would be the same.
You're not giving me a lot of confidence. So how many people currently receive
is my
>> 835,000? Do you expect every one of those 835,000 to be merged onto supported home or a single model? As you currently sit here is the advice that you've received from government in relation to your work is it your expectation that every one of those 835,000 people will be merged into a
single model? So the so the government commitment is no earlier than 1 July 2027 that program and those participants. I would reflect though and I can defer of course to my colleagues that you know this is a really important part of the entry to the system and being older person centric centric sorry centric and that the nature of the services that they receive stuff around social isolation as well as a lot of services which are very similar to supported home. So it would the the intent would be that those program participants would move across into support at home. Whatever changes would be made to do
that. Yeah so thank you for that. So so what you're telling me is that 835,000 people as we're sitting here today who knows what it will be when you eventually work out when you're going to do it that every single one of those people will transition into the single model. That's what you've just said to me is that correct? Is that is that what your expectation currently is in relation to the advice that you've received from government about their policy position in relation to people who are currently on CHSP that you are working towards a single model where everybody will be on supported home when you bring this in sometime no sooner than the 1st of July 2027. Is that correct? Yeah so I would
say that that is an option.
>> at the moment so so what you're now telling me is that that we may not have a single model. So what is your advice from government in terms of what you're working are you working towards providing um the the necessary developmental work for it to be a single model or are you not?
So I'm working towards the implementation of that commitment around community home support into supported home. I However, there's
Can you actually tell me exactly what it is you are working towards? So, you seem to be using a whole heap of words. Is it your Is the direction from the government to you as as the department? I mean, you obviously only work on the policy direction and that's completely reasonable. Um is the policy direction that you're currently operating under an expectation that sometime after the 1st of July 2027, there will be a single model of care for older Australians receiving their care in their home?
I was trying to answer that question but apparently before. Yeah, point of order,
chair. This There's so many interruptions. Ms. Stewart was trying to answer the question. Um can we please allow her to give her answer in full? Um Interrupting her with statements isn't being helpful for the for the officials to be able to answer the questions. Uh
thanks, Senator Cox. I'm also satisfied though that it is relevant and appropriate for questions to be directed to the question asked and as yet we haven't got a clear answer and I think it's appropriate Uh I'm Thank you, Senator Cox. I'm satisfied that Senator Ruston is being respectful and I'm now going to give the call to Ms. Stewart to answer the question.
Thank you. What I What I was going to say is that I The way that the question is being posed is one straight into another and what I was going to say is that while there could be a supported home program, it could have a slight adjust adjustment to accommodate the CHSP. That is one option. That's what I want. Mr. Pew, did you want to go any further on that? Yeah,
probably just to build on Ms. Stewart's points. We'll just take a a quick step back to what the Royal Commission recommended and that was a single in-home aged care program. What Ms. Stewart is has rightly pointed out is there could be support at home with CHSP transitioning in. It could be a different model. There are a whole range of options. These are the options that we are putting to government and these are the options that we are that we are
was supposed in a sense that's what I'm trying to get to the point is that um
decisions
>> Yeah, you you
Like there's many people Sorry, chair. This is a point of order. There's many
>> a point of order, Senator Cox. It's not
a person talking over Senator Ruston. All I can hear is your voice while Senator Ruston's trying to ask a question.
must be getting a bit of feedback. Senator Cox, Senator Cox, you must be getting feed getting some feedback on the line because um the the chair isn't talking over me at all.
Uh I can hear her. The mics are hot. So, I can hear her with her commentary in the background and it is very distracting to most of the officials but also the others listening online.
Well, you're not in the You're not in the room, so you can't you don't know that and I'm telling you she is not speaking over me at all.
No, she's speaking in commentary. I didn't say she was speaking over you. I said she was speaking in commentary. It is She is.
Uh can we just suspend for a moment,
recommence, please?
Thanks. Um does the department um expect that block funded programs will remain under the new single program? Is that something that you are expecting and
of our advice but I might power hand over to Ms. Atkinson.
Uh thank you, Mr. Pew. So, um just further to some of the previous comments from Mr. Pew around the Royal Commission, I think it's probably useful to reflect back on um specifically what the Royal Commission recommended and the Royal Commission advised or recommended to government two things. One, that there be a a single in-home support program, so one program. Um they also recommended that some of the services under that program be funded through block funding. Uh at the time that the government responded to that Royal Commission, um the the government undertook to continue to consult and consider on what that final funding model may look like and the government today continues to do that. Um I'd reflect as well on the evidence presented earlier this morning from many stakeholders and in reviewing some of the submissions to this inquiry, there are a lot of ways in which you could create a single in-home care program under supported home. Um lots of ways. Some of them advocate for retaining block funding for some service types but not others. Some advertise advocate for block funding on a larger scale and some advocate for no block funding and a consistent fee-for-service model under a packaged arrangement with individualized care. So, these are some of the the options that have been spoke about in the community amongst experts over many years and by the Royal Commission. I think reflecting on that optionality and complexity would give I hope some context to the advice that we will not go into any detail that we are providing to government but some of the issues that we may need to consider when when working through those options and and what government's considerations
probably I mean my Yeah, hearing what you're saying and that that's that's very useful but I mean the concern that I'm generating or hearing today is that there are all of these things that that could be um considered in terms of getting to um that single sort of point of entry or single home care in home system that could have a whole range of different things that sit under it but nobody knows when the decisions are going to be. Well, they don't know what they're likely to be. They don't know when the decisions are going to be made. They don't know when they're going to have to gear up for it. They don't know what the transition's going to look like. So, to that end, um one of the things that we're seeing at the moment with discussion in another part of your agency around the NDIS is that the government is now trying to sort of reverse engineer out of the NDIS a group of um uh of of participants that are um a lot of It's largely around those with mild to moderate developmental challenges and and sort of some of the more mild to moderate disability and to move them back into that sort of community supported state-based sort of community health funding model. Um so, my question to you is have you been having discussions with your counterparts in the NDIS um about um some of the the implementation frame time frames, the the risks and and the like um in order to be making some of the determinations that or decisions that you're making at the moment?
Yeah, so I wouldn't go into um that that area about the NDIS. It's not an area that I'm responsible for and I'm not going to
>> have you been speaking to them? That was all my question was. Beg your pardon. Uh my question was have you been having conversations with them about the lessons that they've subsequently learned because they went for a all-in model and now they're trying to reverse engineer out. Have you been having
>> I won't be um talking about conversations that I've been having and advice that is being provided.
>> No, I wasn't asking you for the advice that's been provided. I was just asking if you had a conversation or you having conversations with them. I mean, that's that's not confidential or in any way likely to cause a problem. Have you been speaking to the NDIS around their experiences um in terms of the
challenges?
>> Not to date. Do you have a transition road map um
I'm not going to go into the specifics of the things that we have prepared or not only to say that we provide advice um on a range of options to government around about a range of implementation.
>> I wasn't asking you what that road map was or the details of. I'm just asking you if you have done a road map. There there is nothing in breach of any convention that would prevent you from telling me whether you have
Well, as part of the advice that we provide on different options, there's different ways to implement over different time frames.
Okay. Um Have you done any work on the impact of combining the programs on wait times and wait lists?
That work has I'll get Mr. Pew to talk about that but that's already been
form part of the suite of modeling that we've been undertaking. Yes. Probably just to clarify as well Ms. Stewart's earlier point. So, obviously as a single portfolio, we talk internally all the time and so while we might not have had a specific combination about what you refer to, which I assume you mean the Thriving Kids program is being reverse engineered. I don't think we've had a specific conversation around how can we reverse engineer CHSP into supported home to make it work but we do have [clears throat] implementation lessons learned discussions with our counterparts across the portfolio on a regular basis. And that is exactly what you would expect of
across government and that hasn't commenced when we've had our colleagues move into the portfolio, those discussions have been going on for many years and also across other portfolios as a part of the care economy and that is what you would expect as as Mr. Pew said from the public service.
Yeah, you would but it didn't seem to be something that was forthcoming as an answer. So just back to the question around the impacts on wait times and wait lists. I'm just keen to unpack that cuz one of the big concerns that has been expressed by in submissions we've received and evidence that we've received this morning is that we've got you're in the process of transitioning the 230,000 or so people that are on home care into supported home which is obviously a big job that taking a lot of your focus at the Then you've got 835,000 people who are on CHSP, some of which are waiting for their package and some which are just on CHSP. What is your anticipation in terms of the wait times and the wait lists about what happens to those people when they come in? Do they go on to the end of the wait list and will they like no longer have any services until they get access to supported home? I mean, what what is the thought I mean, I I ask this not because I'm trying to be tricky. I would suggest there are a lot of older Australians and their families who are really really worried about what this might look like and I'm just wondering whether you had an opportunity to give some confidence that they will at least receive no less service than they are prior to their transition to when they post rate. So can you can you give us a guarantee that no older Australian in the process of this transition will be left with less support than they have prior to the transition. Just up. I
might make a a quick correction and I am also not trying to be tricky, but I think you mentioned 230,000 people transition. It was actually significantly higher than that and the CHSP at home was actually 328,014. So quite a quite markedly higher. And then when you talk you're you're absolutely right in the context of we've got 835,000 people left to go. So as part of our modeling, as part of our optionality to government, there is a principle that none of these people would need to be reassessed for service. They would not be left without service. We have learned and we are looking closely at the the changes in the pricing construct between home care and support at home and how we might make sure that if there are similar changes that I'm not saying there are going to be, but if there are similar changes that occur, that that is better communicated and people are very aware of what they've been transitioned into. So they're the they're probably the from an official's level the guarantees that we can provide and then of course, you know, there's the translation between the policy and the implementation. So all of those things will need to be have a very very close eye to as we go through the
process. Yeah, but thanks for that. But to be clear, if I was listening to what your answer just then as an older person who was on CHSP, I don't think they would take from that that you've just guaranteed that they will have no less service than they currently do.
Well, I did say it was a underlying principle of all the options that we are model modeling. I don't know if it is for me to give that guarantee, but I mean, I'll give them a personal guarantee, but I don't know if that extends any further. I'm not expecting
you to do that. Maybe a question that I'll ask the minister next week. You also mentioned Mr. Stewart that that you had done some modeling in relation to wait lists and wait times. I'm just wondering if that was possible to have that tabled. I mean, I know you might say you might probably don't have it with you, but
Well, well and I don't know if I can table it because it's all sorry, it's delivery process of of government. I think Mr. Pew might be able to say this, but we
I don't think I what I said was that we were doing with every option what I was saying was with every option there's differences in terms of how it's implemented. That's what I was thinking I was saying in a plan for that. Not
interested. Well, maybe it was you Mr. Pew that made the comment about about you done some some modeling on wait lists and wait times whether that
was So I mean, it's part of the delivery process of government. So at the right time we maybe able to make that available, but I can't give that to you now. Was
there was there any in your in your work that you've done does any concerns were raised or is it's all absolutely fine and wait lists are not going to get any longer than they
state the commitment first, so I think that's important in terms of the commitment that we're working towards which is average of 3 months wait time 1st of November 2027. I think that's important.
So yeah, >> [clears throat] >> I noticed that that was in your submission about that you were I think it was by the end of 2027.
Yeah, so it's 2 years from the beginning of the supported home program. So the 1st of November 2027 average wait time would be um 3 months.
>> 3 months. Have you got a was there any number that was associated with that? Like so it's 3 months, but how many people? I mean, 3 months for you know, a million people is probably not great, but 3 months for 20,000 people probably definitely shows an incredibly marked improvement. I mean, was there an actual number of people that was associated with that 3 months?
I can get that for you on notice, but it would be the three I can't remember my number now, 328,014 plus the 83,000 that have been washed through in the program plus any additions in the second year of the program. So I don't have that number, but it's it's higher than than the combination of those two figures.
That makes sense. Yeah, okay. Can I just just put you on notice? I will follow we're obviously together again next week. I'm be really keen for you to be able to come with some really good data in relation to that 3 months by the end of 27 and how what your modeling says how many new packages will need to be released over that period of time to reach that 3 months and what the numbers are. So
thank you. I absolutely and I think we might have given that previously, but we can come
prepared with that. Well, you haven't given it to me, so that would be great.
Thank you. Senator Cox.
Thank you very much, chair. Thank you to the department officials for appearing today. What volume of funding does the government commit to the CHSP and how many older Australians does it support? I like how many how has this volume of funding changed over time?
Thank you, Senator. So um I think the the last time the CHSP was extended in 7.2 billion dollars is committed out till 2027. So that's 2025 to 2027 supporting about 835,000 people. Obviously people come and go from the program every day, but that's a fairly consistent estimate. We have about 1,300 providers across every aged care planning region in the country. That funding does increase on indexation year on year. As you would expect a program of that size. Additionally, there was a extra funding provided specifically for meals of an additional 10% indexation to address cost of living challenges not in the last budget, but the one before I believe. So yes, it is a very large program and continues to commit and invest billions of dollars into the aged care
That's great. Thank you. You know, co-contributions are already a feature as part of CHSP. Could you talk us through how that system of co-contributions works currently?
Yes, I can. So in CHSP you're quite right, Senator. CHSP does have co-contributions as a feature of the program. So the way that they work in the program is distinct from supported home or packages in the past. CHSP clients are not subject to a means test. We instead expect providers to work closely with clients around what is affordable for them to pay for services and the government provides a recommended reasonable range of consumer contribution to providers according to each service type. Now that range is based off of a study that was undertaken in 2019 commissioned to organization Aither Alliance and that study sought to determine the overall cost of services in CHSP and to allocate a reasonable contribution for older people. So you can find the CHSP pricing framework online as part of the CHSP program manual and those those prices are in there and you'll see a range of which each service type that the government provides for each service output and a reasonable range for each client. I should also state that CHSP does have hardship arrangements. However, these are managed by um CHSP providers. so uh CHSP providers are required to have a hardship policy. Um that policy must be published uh and that they are they must undertake to provide uh um reasonable hardship arrangements for older people if they cannot afford to pay um a contribution as was previously agreed. Um older people should also uh that provider cannot charge um a consumer contribution in CHSP without first having that that rate agreed with the older person. Um and since the new Aged Care Act has come into place, that is now consistent with Support at Home Program, uh expected to be contained in the older person's service agreement. Um so as you can hear, there is some consistency across the two programs in that there is an expectation that older people who can afford to do so make a contribution. Um there is uh some some elements that are not consistent and in particular that is that uh clients in CHSP are not means tested uh and that there is a greater onus on providers um to determine what is an appropriate rate um and to determine uh and and be reasonable uh about hardship arrangements. And the government provides uh as much advice as as possible to help providers uh in guiding those decisions.
That's right. I just wanted to pick up two points that you made in in in answering that last question. Um one of those is that co-contribution rates are currently, and this is my understanding, are currently being set individually by providers, which obviously presents some difficulties in terms of um different experiences for older Australians. Um but also the lack of consistency between providers and regions. Could you elaborate for me on that? So so that is
quite right um to to the sense that providers uh that that they do set their rate. However, they can't do that without the agreement of of the older person. And they do it uh we expect that it is reasonable and we provide guidance around a range that is reasonable. So yes, it is it is different in the sense that um in Support at Home, the consumer contra rate contributions are set at a total percentage um of the the the price of the service output and that percentage uh is guided by means test.
That's right. Thank you for clarifying that for me. Um what efficiencies and service improvements does the department expect to be realized through the consolidation of CHSP uh into Support at Home? Um and on the back of that, how will these outcomes be measured and evaluated over
Uh so I can probably start with the the first one. Um at the moment, we do have uh sort of disparate contribution arrangements across the various programs. And so uh if we were to move to a model that had a greater level of consistency, that would obviously provide more surety for uh providers, for older people, and also um be a little bit easier to understand as you move through the continuum of services from your entry level all the way up to your highest acuity needs at the top end of Support at Home, but then also in the residential aged care uh program. So um that's probably uh one of the key points that I'd make in relation to the first part of that question, Senator. Uh the second part of that question is we have got currently um an evaluation uh process underway for the Support at Home Program and the Single Assessment System Program. Uh and we would be using um that as our as our baseline to then um expand uh probably for the duration of the rest of this transition process uh for as for as long or a shorter period as that takes. So um we want to monitor this very very closely and make sure that we've got our policy settings uh right.
That's right. Thank you very much, Mr. Pew. Um that's the final question for
Cox. I just have one final question before we finish. And Mr. Pew Mr. Pew, I'm just I guess wanting to clarify my understanding. So my understanding is from the evidence that you've given that the department has given a range of options to government about what the transition for CHSP into Support at Home might look like. They've been given various models. The options they are now sitting with the minister, and the department is awaiting a decision of the minister before you know which one that is. Is Is Is that the evidence that you've given
today? Uh with some gray areas in between. So there are obviously a lot of back and forth conversations that happen in relation to each of those options. So I wouldn't be sitting there saying that the department's done its duty and that we're simply waiting for the minister and he's dragging the chain. Uh what I'm saying is that we are in an open back and forth consultative process. Uh the government rightly wants to understand that it's got the absolute right policy settings in place before it makes a decision. And so that is both incumbent on the department to provide that information and the government to make a decision based on the best advice available to it. That's the evidence that I'm providing. All right. Thank
you. And I appreciate the clarity. Um well, that concludes our hearing today. Um I want to thank all the witnesses who've um appeared today and also to Hansard and broadcasting for their assistance and as always the secretariat. Um the committee will report to the Senate on Wednesday the 15th of April 2026 and has agreed that responses [clears throat] to questions on notice should be provided by close of business on the 20th Feb 20th of February 2026. Uh and the committee now stands adjourned. Thanks very much.