Senate Community Affairs Legislation Committee, , 5:31:04 to 6:22:16
Discussion turns to delayed hospital discharges, known as bed block, and the status of intergovernmental health reform agreements.
Topics: Health, Infrastructure
Speakers: Hon Anne Ruston, Blair Comley PSM, Greg Pugh, Julia Atkinson, Natalie Siegel-Brown, Dorinda Cox, Emily Harper, Hon Malarndirri McCarthy, Prof Michael Kidd, Rachel Blackwood, Sonja Stewart
um prior to lunch when we were talking the 60% age care or the interim funding measure. Um Miss [clears throat] Stuart, you made the comment and I I wrote it down um that the reason um or the the result of inter releasing interim packages at 60%. um was so people were able to access um packages earlier than they otherwise Um so this sort of like partial care um what would have been the weight list or the packages had you not done this what what was the assessment that you determined um in your decision making about the 60% um what is the weight lists been reduced by >> as a result of that
>> I just got to remember exactly what I said because I think I said it rather [clears throat] than in the context of something else that was being put to me was that can you just
>> I'm happy to get hands out to drop the transcript.
>> No,
>> you said >> Yeah, I wrote I wrote it down as you
were saying. >> I'm not I'm not sorry. I'm not um I'm not saying that I didn't um say that. I just need to recall the context because I think I said it in a context and I think that context is important. I've just got to recall what that was. There was a >> um and apologies it was a few hours ago. So I just need to Can you recall what I
said? I can't recall precisely the wording and um it's been offered we can go back and check hands. I think the intention there is to note that there is a minimum service offer where you get 60% of your full funding you get a full service offer which as the name suggests you get 100%. If you are in the national priority system and you do not get access to an MSO, you then wait that additional period of time before your full service offer becomes available. >> So do I have the numbers around the um the further delay? No, I don't. That's why we have gone at have used this as a tool in the program to get people access to that care earlier particularly when we are experiencing as high a demand as we currently are when we've got 350,000 odd people in the program.
>> Well, you knew you had 350,000 people in the program when you chose to when the decision was made to to roll it >> over. I still haven't actually worked out why providing somebody with a package at 60%. Is is of any advantage in terms of the rolling out of the program. I I still you have still given me no reason why you just didn't give everyone their package at 100%.
I I've got my recollection now of um so I think it was about um so my recollection is a question around that this was around driving savings I think that's what it was put to me from my memory and my response in that context was it was around the access that I think that's how I recall it just wanted to
>> that's all right we it's on the record so we'll get it out before the end of today and we'll ask you to maybe um cuz you also made the comment that the vast majority of people who are on packages are on 100%.
>> Well, that's correct.
>> 93% of people, new people who have come on to packages are not. I don't think the vast majority of people coming on to new packages um equounced to 7%.
>> I completely stand by what I said in terms of when you look at how many people are receiving support at home and then you look at the number that are um getting services um albeit um at a reduced amount the 60% it is a small proportion. I stand by what I said.
>> I will let those 37,000 people know that they're just a small proportion. I'm sure they don't feel that way.
>> Senator, I think the math is kind of clear. It's a stock and flow issue. You've got the existing 300,000 on supported home on full packages. >> Then you have in any one year you will have roughly 20% of people on the reduced package coming on that year, which is only the flow. So the as Miss Stewart said, the vast majority are on 100% package.
>> I think I understand that. But my point was that everybody that's new that's coming on, 93% of them are not receiving their full package when they come on. And no one has been able to explain to me the rationale behind why that is necessary. No one can explain to me how much money has been allocated to these packages. Nobody's been able to explain that to me. You've got to accept the fact that that I can ask these questions because you won't give me answers. That's why I keep asking them. Um so in terms of um the single assessment system the department um in the process said that they were going to um publish real-time data on weight list and assessment weight lists and that was a recommendation of the age care services When will we see real time data on weight lists and weight times published?
I have to go back and double check that um commitment. That might be where we want to move to in the future. As I said earlier in uh my previous evidence, we've got a couple of legislative requirements around what we report and when. Uh one of those is the section 342A wait times report. Uh but the other the other reporting component that I mentioned was that we are going to get back into um the quarterly reporting cadence that we had under the home care packages program. Uh and the first of those which is for the Q2 2526 so November and December last year should be available uh early March.
>> Okay. So is there any intention or capacity to actually go to real-time
what you mean by real time data. I'm not trying to be cute. There is kind of a sense of real time data that some people might think about I want it for today's date or I want it for this hour's date. And then there is what is practical real-time data for administrative processes where you actually have to do some data assurance. And then the question is is the lag you know a week or a month or at the end of a quarter. I I personally would wouldn't interpret real time data to mean that every day you're putting up a piece of data flowing from an administrative system.
>> And what would you think that would you
reasonably timely access to the data when you have confidence the data is not going to bounce around because you have other other processes in place and we face this across the portfolio to be honest um depending on for example capacity of people to um put in further documentation or change their position those numbers can bounce around if you don't allow those processes to follow
>> so ideally the quarterly reporting that I've mentioned um will provide the more granular level of detail that we'd like to get out there publicly and then if we could get an aggregate or some of the the topline data points that um yourselves and the Australian public are most interested in. So those ones around how many places have been released this month, what is the size of the support home priority system, an an ideal uh cadence for that would be monthly because I think that takes the full month's data, let you see what's come, what's gone, and where we're at at that point in time. And then it also gives the Australian public a realistic expectation of what they can expect by when as part of their age care journey.
>> And so when's that likely to be
available? That's what we're moving to um in the coming months.
>> So that's the one that's going to be available in March.
>> So the one that's going to be available in March will be the detailed quarterly report and then a decision around when we can move to monthly after that if that's if that's where we end up going um will be uh to be confirmed.
>> What I'd be really keen to understand is what you think a definition of real time because I mean by your definition Mr. commonly you know ABS data would be real time which we clearly know that it's not. So you know if you're not going to accept that then it'd be nice to know what you actually define as real time um real time data. So, um, what's the average cost of a, um, a supported home
>> just well, Mr. I might have a better answer on that average. But I can give you the uh the annual budget amount uh for classifications 1 to8 because the average would obviously sit somewhere between those u annual amounts which is $10,731 for the classification one all the way up to $78,16,000.35 for classification 8. But I think to provide an average may be slightly misleading because it depends on what services you can receive within each of those classification levels.
>> Simple financial calculation.
>> So 78,000 plus 10 88,000 90,000 let's call it 90,000 divided by two 45,000. There you go. Mental maths. That's
assuming there's an even distribution
across which might not >> I got to say that that rather cute answer you just gave me is quite clearly not correct and I thank Mr. Comley for understanding that I don't know whether most of your packages are level seven. I don't know maybe most of them are level one. So your answer is really quite
>> I was merely responding to the question around what the um the simple maths answer was Senator. So if it was misleading then I that wasn't my
>> So could you give me the answer?
>> I'm not sure we have that on hand. I
>> because maybe in that answer we might actually work out how much a package Maybe you could tell me what the average package cost of the 83,000 packages that have been and are to be released in 25
>> Take that. >> Take that on notice. Yep.
Maybe somehow we might actually get the answer. >> I think the officials have taken that question. >> Thank you, chair. I understand. So just understanding um in terms of the um the myo um this year's myo um it shows um in the papers that uh there is a saving of $80 million over two years from 2526 through rep prioritizing unspent funds in the Commonwealth Home Support Program growth funding grant opportunity to other age care services. So, I'm just interested to understand given the incredibly high level of demand, what was the reason behind um the $80 million under spend that has been repprioritized
um senator. So Commonwealth Home Support Program is a grants program provides block funding to a range of different organizations across the country to [clears throat] deliver a whole range of different services. Um because it's a block funded program um it's not as responsive to supply and demand as for example uh an entitlement based or um package based program might be. So what it means is that government has to plan for how much funding they're going to put into each and every funding agreement um for each provider, each region, each service type. Uh and sometimes that planning um isn't isn't 100% 12 months down the track. Um so it's one of the downsides of that that model of funding. Uh what it looks like in practice is that in the Commonwealth Home Support Program, there are some areas where there uh we hear that providers are not able to service all of the clients that are knocking on their door and there are some areas and some service types where providers are not able to spend all of the funding that has been allocated to them. Uh for the latter type, um that funding would be returned to government. Um so
>> so can I just um stop you there? Sorry. Um I I I understand that there is like a it's not uniform across the landscape in terms of the allocation of grant funding. That makes a perfect amount of sense. But I'm just keen to understand. So the money that's been reallocated has been reallocated to other programs, not back within the CHSP program. I I gather
from >> That's correct, Senator. And that's why it appears as a measure.
>> Yeah. Sure. Sure. We get that. But I what I don't understand is that if Well, maybe I should ask you. My understanding is that there is way more demand for CHSP services if you look at the macro level um than that is currently being delivered. And whilst I understand that there may be places where that funding couldn't have been, you know, may not be able to be expended for whatever reason, why wasn't that $80 million redirected to other CHP CHSP services that um were finding that their demand exceeded their
fair question Senator and I guess to take it to an even more macro level it would be fair to say that there is um increasing demand on the age care system period uh and um government needs to make difficult decisions around allocation of funding uh when faced with a very compre proportionally small underspend as compared to what the total of that program is and it is $7.2 $2 billion over two years. Um that $80 million is proportionally very small. Uh the government could redeploy that funding within that program. It would be a 12 to 18 month period lead time in which to do that because it would need to be done through a grants round. Uh so government needs to make difficult
>> Can I ask you then on the basis that you just said that it would need to be reallocated within the next 18 months? I'm assuming you mean by the 1 of July 20.
>> No, Senator, what I mean is it would take a period of time to reallocate that funding. And so in because you need to go through a an appropriate Commonwealth grants round process in order to reallocate that funding and it needs to be in line with the Commonwealth grants guidelines. Um so uh it it's the way the program is structured. We don't just pour money out the door um willy-nilly. It needs to go through a process and and that has to you know have property in place and people need to be given the opportunity to apply for that funding. Um
>> don't you heat map the country and work out where there is greatest need? Do do you not have any idea where the demand for services are?
>> We have some idea of where the demand for services are. Yes. Um do we have a perfect heat map of where the demand for services are? No, we don't. Um and uh that goes to some of the evidence that I provided earlier today around the um imperfect nature of the data that we're dealing with in this program. Um we aren't able to follow a client's journey from assessment through to service provision. Um so what we do do or have done historically when deploying growth rounds and this is a something that governments have done and um a hund00 million growth round was deployed uh not last no the the funding went out last financial year. Um what we do is we look at relativities across different service types and service areas. uh and um we see well where are those relativities higher in a mismatch between a referral number of referrals going out versus number of referrals being taken up. Now that particular gap is always going to be an overestimate because not when when somebody gets assessed for Commonwealth Home Support Program, they may get a whole range of codes for different service types and they may choose to only take up some of those um and then that they may wish to take one up but not able to access that service in their region due to service availability. We don't at the at the present moment have the ability to disagregate those issues and so we have to operate um broadly on estimates. Um, so we look at those relativities. Uh, we don't have, uh, I would love a heat map of where the supply and demand is for CHSP, but we
>> Okay. Thank you. Um, did we manage to get any data around what had happened in terms of new builds um, in the last 6 months of 2025?
Uh, Senator Emily Harper again, Market and Workforce Division. Um, so the team are working away on that request. Um, regrettably I'm not going to be able to provide it today, so I will need to take that on notice if that's okay.
>> Okay. Thank you. No, thank you very much. Um, understand. um because I mean it obviously is a huge issue um going forward. Um I know that Senator PCO asked you some questions earlier today around um hospital bed block um and in response to his questions I think it sort of became apparent that there was difficulty in the collection of data because you require the states and territories to provide you that information. Is that
correct? I think the first thing um that we require is a agreed definition of um delayed discharge of older people across Australia. Um and then the states and territories would provide data against that definition.
>> Okay. So what's the process in determining that definition?
>> Yeah. Uh so um there's senior officers uh from health departments as well as in the commonwealth that work together on that uh definition and um we have committed to do that um in 2026 um yeah so so we work together collegiately on that [clears throat] as well as look at evidence um uh from independents on
that. So, you don't have the national figures. You you can't you can't provide me with national figures. Um because you're worried about the definitional issue.
>> Uh I wouldn't say I'm worried about the definition. I'm say it needs to have an agreed to definition by states and territories in the Commonwealth and then that um data is collected against that definition.
>> So, why are they taking so long to do that? I would have thought given the noise that we've heard out of the states and territories of recent times, they'd be pretty eager to get a definition.
If I may on this one, Senator, we've only just signed a national health reform agreement.
>> I think we noticed that.
>> Yeah. >> And um
>> I'll ask you about that in the next section.
>> Well, that was in cross portfolio.
>> Like you're still here.
no, I mean I think the the reality is that um the question of delayed discharge of older patients has been a significant issue between the Commonwealth and the states. And so the question about what are the drivers of that has been a significant issue. Uh we've been working on the definition together. Um but we haven't been able to reach agreement. I think that um the signs are I think more positive about moving towards a definition. >> Uh I would I would hope within the next 3 or 4 months. Mhm. >> Um it is true that the states and territories are putting some data into the public domain uh based on a definition that the the comworth wouldn't accept as being um a definition that we would support across the
did the department have like I think it was the last estimates it was sort of roughly estimate there was about 3,000 older Australians across the country that were
>> we we wouldn't endorse any particular figure because we just do not think there's a robust definition that would allow you to to determine that.
>> Nonetheless, there's not nobody in a hospital bed. Um, so do you like in terms of the National Health Reform Agreement as an example? Um clearly there would have been this has been a really big issue when it came to the the agreement because obviously the states and territories have been um you very harsh in their criticism of the fact that they've been made to um have the you know the older Australians were causing the bed block in their hospitals and obviously there's a cost associated with that. In the process of those those negotiations, did the states and territories indicate to you what they thought the quantum cost was of what they determined was bed block?
>> Uh there were various not so much within those negotiations but through health ministers meeting they've put various estimates over time.
>> Do we have an idea of what the their understanding of the they believe is the estimated cost of
>> I think you'd have to ask them. I'm just I'm just not going to endorse a number which we think we don't have a robust definition underlying it. And then there are also some quite interesting methological issues about what you would determine the cost of those patients are.
>> So So does the department have um have any capacity at all to do an assessment of the clinical and health outcomes for those older Australians that are stuck in hospital beds because they can't get access to home care packages or there's not a place in a residential facility or aren't they your problem?
>> I mean, the others may want to comment. We we we actually work in a very active case management way with the states and territories in a range of locations to try to find solutions to this. It's not a one-sizefits-all. We are acutely aware that um a hospital setting is often not the right setting from a from a clinical or other well-being perspective for these um patients. Um, but I think everyone who's looked at this just does not feel it's a one-sizefits-all answer to how you deal with [clears throat] this. There are specific geographic locations. There are specific issues of complex needs of of people. It it is not straightforward. So, we spend a lot of time we have a regional age care network that spends a lot of time in case management. Uh, we have a lot of bilateral engagement with states and territories more generally to see how we can deal with this issue. So we we take this issue very seriously.
>> And I'm not questioning for a minute that you don't take this the issue seriously, but it just seems to be that the person who's stuck in a hospital bed for I think somebody was actually quoted as a thousand days in a hospital bed. Um that you know that is pretty unreasonable outcome for those those people. And you know lots of bilateral meetings and conversations and working groups and and the like is actually not delivering any outcome for those older Australians that are in stuck in hospital beds. Um the age care PE bodies um have made comment around that the final hospital funding agreement, sorry, the NH removed a previously proposed additional $2 billion that was intended to address the issue of older people stranded in hospital due to the lack of age care options. Um >> do you know why that was removed? It
>> was the request of the states and territories. they wish to have that money as hospital funding without tied to long-stay older patients.
>> So is the expectation of the the states and territories that there will be a separate means or mechanism through which the needs of older Australians that are in hospital who shouldn't be in hospital will be dealt with. So in effect that really says they want the $2 million billion dollars to go into their hospitals but this problem still remains um in terms of older Australians for which the government the federal government have put $2 billion on the table still. So it's still our problem in the sense of the federal government accepts responsibility for age care I assume. We're not saying we don't have responsibility for age care. We've got people stuck in hospitals because of an inability to access the age care services either at home or in residential care. And the government's just said, you know, the $2 billion that we're going to give you to address this problem that we accept is our problem. Well, no, we're not going to give you the $2 billion without you having to do that and we still got our problem. I'm you sort of understand why I'm a little skeptical about the negotiation. So, so
the first thing we would um say is the question of um delayed discharge is both an inhosp and an out of hospital issue. It is not un it is not solely a question of what happens out of the hospital. Um and I would I might ask the CMO to comment on this because I know he's got long experience with this. The the second thing is in terms of um what the states believe the next move of the Commonwealth one. think you'd need to direct that question to the states. What what I can just report is that in the end of the negotiations, it was the states and territories that said we would prefer to have NH funding rather than $2 billion to address long stay older patients
>> and did they accept responsibility for those additional patients?
>> I think you'd have to discuss that with the states and territories. CMO would you like to comment on the inh hospital and out of hospital issue in terms of delayed discharge because it is quite complex and we also and you might want to comment we do actually see different clinician practice around different places with respect to these decisions
>> I suppose I'm actually like and with great matter respect um professor kid um you always sit there very patiently all day um I'm my issue around um you know the in in hospital out of hospital. It's really more around understanding the responsibility in terms of the funding. I mean, I'm I'm really interested in understanding how Australian taxpayers funding is spent. Two weeks ago, the prime minister handed 25 billion additional dollars to the and bought no reform or change with it. It was just basically $25 billion to what it looks like appeared to make the the state shut up for all their winging and carrying on that they've been done. But we haven't resolved any of the issues. So we haven't we didn't address the issue of of thriving kids to a great extent. We have certainly haven't addressed the issue for age care which is the matter of the subject of this conversation at the moment. So quite bizarre that they've just handed it over. But but back to the actual bed block issue in itself. You say you don't have a definition of of what bed block late discharge delayed discharge I think was term that you used that you're working on it at the moment with the states and territories. But interestingly um in um AIHW data under two codes they collect this information. One of them code Z7511 a person awaiting admission to residential age care services and code Z742 need for assistance at home and no other household member able to render care. So they've got a definition of it and that's a federal government agency and I think that sits under your portfolio of responsibilities doesn't it?
>> It does and AHW will be here later in fact in the process of finalizing the definition for the use in states and territories. We're engaging with AIHW to make sure we leverage off the work they've done. >> You just have to be a little bit careful this data is used for a range of purposes and you have to make sure that the definition is designed for the purpose that it's used for. That is why we're engaging with AIHW. But I'll be happy to have AIHW talk to that when they're here. But I do think it's important to to give the CMO an opportunity here because it is not a one cause reason why you have delayed discharge. So if if you would mind I think it is important the CMA provide
>> Sure. Professor K off you go.
>> Thank you Senator Professor Michael Ko chief medical officer. Um just the the first thing I just want to talk about was terminology. I I don't like the term bed block because that tends to put the onus on the individual the patient who's in the bed rather than on the system. Um I much prefer the term uh delayed discharge or or delayed uh transfer transfer of care. Uh as as we've heard this is not a heterogeneous sorry this is a heterogeneous group of people. There are lots of different factors uh which determine uh why someone uh may have uh delayed discharge and extended period of hospitalization. There are some very high level definitions which are used around the world uh around no longer being a perceived clinical need for hospitalization but people often remain in hospital for uh so-called nonclinical reasons. Now some of these may be social factors. Some of these may be mental health factors which differ from the cl the uh the physical uh reason they're in hospital uh and particularly for for older people uh linked to dementia and some of the challenges uh which exist for many people uh with dementia and finding appropriate um places for those people uh to be uh once they are discharged from hospital. Also, people with physical uh uh disability uh may have very significant rehabilitation needs uh which may impair or impact their ability to go back to their own home uh or into uh some supportive facilities. I guess I guess the other u issue that's really important is that many of these people uh decline further while they're in hospital and may actually again develop a a clinical reason for still being there. We know hospitals are not a healthy place for uh older people to be in for very long periods of time. There is the risk of serious infection. There is the risk of decline of function particularly if people are bedbound and not being supported to move around and be mobile uh impact on nutrition, impact on their their uh emotional and mental health uh as well. So it is a very complex issue and uh I think for each uh person who finds themselves um in in the position of delayed discharge we need to be treating each person as an individual.
>> Oh 100% I would never disagree with
>> Senator Russ just checking how much more time you might need in this outcome.
>> Um probably not terribly much. I just um Penny Senator Payne just asked sent me through a couple of questions which I I won't prosecute.
>> So another block of questions. Is that
>> No, no, she's only got a couple. >> Yeah. And then I've got one more block.
>> 5 minutes, 10 minutes.
>> Um I'll go as quick as I can. Promise, promise. I promise I'll have it finished before time.
>> It's okay. I just uh would need to advise um an agency that they are being released from um
>> um Oh, so um CI I've
>> No, no, I'm not. It's not >> Try not to jump the gun and preempt what I'm saying. [laughter] Uh I already have clearance for another agency who's in the next block, but I'd like to give them some notice. Um so um the uh Australian um radiation protection and nuclear safety agency uh are now released from uh this hearing who were appearing in outcome one. So, I'm happy for you to continue your line of questioning, but it definitely wasn't to release a witness that you'd already indicated you'd like to ask a question. >> Thank you for questioning my chair duties in >> so yes, thank you.
so yeah, just these are on on behalf of Senator Orman Payne. Um, she just wanted to know how long assessments take in hospital settings versus community-
We'll wait for the right person to come to the table.
>> Sorry, I'm jumping around.
>> No, no. My my my recolction is the hospital settings are literally it's like an average of zero days or one day. It's pretty well instantaneous. >> Community settings are a little bit longer, but we'll have person with the
Uh so I can give the median weight times for age care needs assessments conducted in October 2025 which was one day for hospital assessments and 31 days for age care needs assessments conducted in a community setting.
>> Okay. So basically the the message to older Australians get yourself admitted to hospital if you want to get an age care assessment. >> So
>> I mean Senator I know you you said that partly not tongue and cheek but we're actually generally trying not to give that message. So we [laughter] have had actually people argue to us you should get priority to get an age care assessment and in fact a package if you're in hospital but we do we are nervous about a perverse incentive that people might take that path
>> indeed well quite a lot of perverse incentives that exist within the age care system because we have a rationed care system. Um, so once again from Senator Wine, the average cost of a home care package service used to be published on a quarterly basis. There was no data published on the 31st of December. Will similar data be published under support at home going forward. And when will it next be published?
>> So Senator, that is the that will form part of the quarterly reporting that we um described earlier. So ideally that will be published in March for the
first. So you'll just miss December altogether or you'll do a six sort of a five month block of data in March.
>> Uh so it'll be November December and that will come out in March. And as I said at the very start of the hearing we're just going through our data validation verification processes being very early in the program and then the January February March uh quarter will be published uh ideally in April.
>> So what was the last data published?
>> Published? >> Yeah. uh it would have been the last data published will have been as it related to the home care packages
>> So when was that published?
>> That was published uh 31 was published for the period for the month ending the 31st of October. Y >> before we transitioned I think it was published in late >> uh it was in December.
>> Okay. So the 31st of December it's just because of the messing around with the change over. Okay. Um I'm sure Senator Payne will come back to me if she wants any other um questions added to that. Um I just um on behalf of Senator Little just wondering in terms of the data that we've asked, do you have any granular data in relation to indigenous Australians and you know whether um they are waiting longer or shorter times um you know are they you know what are in terms of all of our data about waiting times, weight lists, access to care um being stuck in hospitals etc. Is there any of that data that's able to be provided um not just as a as population based data but that would be specific um to indigenous Australians to try and see if we can work um
>> uh not immediately but we can absolutely look at whether we can do something in the warehouse that's got an indigenous flag attached to an indivi an individual person and see what we can produce.
>> Okay. So sometimes you may not actually know that. Is that what you're saying? because that the person may not have actually provided the data to identify themselves as an indigenous st. Yeah. So, Senator Little just wondering that if there was any data that you had that could actually be um disagregated to understand that would be good. Um I'm I'm quite happy to quickly whiz to um the IG if she is still in the building. Oh, you're Um in um your submission um to the inquiry on the age care um age care rules, you expressed some concern that the definition and regulation of restrictive practices may not adequately protect older Australians, particularly those with dementia. I just keen to understand where you saw the risks under the current rules in relation particularly to patients with dementia.
Thank you, Senator Natalie Seagull Brown, Inspector General of Aged Care. Uh so senator one of the issues that we raised also in the 2025 progress report which that particular matter was part of is that there appears to be under the current regime relating to restrictive practices in age care dissonance between the reduction and elimination approach taken in disability which has been a long-standing approach well progressed compared to that in aged care. And as we know the current regime sunsets at the end of the year. We'd like to see a much stronger approach taken towards reduction and elimination of restrictive practices. some of the risks that uh we perceive whether it be around the um supported decision- making elements that where somebody else can give consent to restrictive practices or or in particular understanding the behaviors that lead to a person being restrained and you particularly raised dementia senator >> is that uh while we don't have mandatory training around understanding what particular behaviors are communicating And very often we know that behaviors are a form of communication. Well, we don't have that for dementia. People with dementia could be being restrained um not as a last resort. And that really should be the mantra of restrictive practice usage. That is the mantra that is applied in disability discourse, in mental health discourse. Uh and it is a serious risk in institutionalized settings such as residential aged care particularly for those with dementia.
>> Yeah. Yeah. Indeed. So in terms of the um the recommendations of the Royal Commission around dignity, safety and quality of care. Do you think that the current rules adequately um I suppose respond or fully meet what you think the intent of the Royal Commission was in relation to the the treatment particularly of people who are suffering significant cognitive
decline. From rec recollection, our our submission was making the case that we need to be a lot stronger in our reduction and elimination uh approach with restrictive practices. And indeed uh I've publicly committed to a piece of work uh that we've already started to canvas with the ACQSC on what a pathway towards reduction and elimination of restrictive practices in age care would
>> Yeah. So, um, do you have a a sort of a thought in mind about what kind of urgent amendments could go, um, to the age care rules that would enable that to happen? I mean, or is is it sort of more your role to to identify the problems and challenges and let somebody else design the solutions?
>> That's pretty much a case of the latter there, Senator. However, that said, the whole I guess the the point of us doing that particular piece of work on what reduction and elimination of restrictive practices would look like in age care is to provide that evidence base and effective. So, as you would be aware, my role is to drive greater accountability within the age care system and to be the oversight body for the government's administration of the age care system. As you'd know, that's what my legislated role is. So in creating uh a framework of principles around what we would expect to see for an approach to reduction and elimination, the idea of that piece of work is then to be able to use that to hold legislative and policy approaches accountable to that.
>> Yeah. Yeah. I understand how difficult it is. before I hand back to the chair, um Oh, sorry. You've got something. I was just Um, so just to a question, seek some guidance from you, Mr. Mr. Comley. I can sit here and annoy the hell out of everybody by asking you every single one of those questions that I've got in my pack. Um, I've actually sort of already asked them on notice and you've refused to give them to me on notice. But if I put them on notice now, will you are you going to respond to them as questions on notice? because the last thing I want to do is
>> Yes, I we will I will take them on those. Yes.
>> Okay. So, okay. All right. Well, if that's the case, um I will do that and in future I'll send you letters as questions on notice from now on instead putting them in there. So, that means poor old ministers, we're going to get all these questions on notice that you're going to have to answer because you don't answer my letters. But anyway, I won't go through that now. Um so um there's a health minister's meeting scheduled for this Friday I understand.
>> That's correct.
>> Yeah. So is the issue of delayed discharge? Am I allowed to use >> Delayed discharge more commonly known in public um speak as bed block. Um is that specifically um listed for um discussion um at on the agenda for this week?
>> Uh I will just get someone to check. My my recollection is um as is common practice in health ministers meeting there are formal agenda items and then there are matters of other business that have been signaled by jurisdictions. >> My recognition is it's in that category of >> an item that's been signaled to be covered under other business.
>> So that would that mean that the the matter had been put on the agenda by a jurisdiction?
>> Uh typically yes.
>> Yeah. So you didn't put it like the federal government hasn't put that on
>> yes another state jurisdiction put it on the agenda. We obviously happy to discuss it because we want to progress the definition.
>> Okay. Because I mean it sort of strikes me as you know I I get the the unique challenges as professor kid outlined but at the end of the day the responsibility for for services that relate to age care and older Australians belongs with the federal government. So sort of keen to understand you know what sort of priority the government is actually putting on addressing this issue with older Australians being in a place that is not necessarily the best place for them. So you know maybe minister you can give me an undertaking or maybe you can speak to Minister Butler but is this issue going to be treated as a urgent priority on Friday?
>> Thank you Senator. Well it certainly has been treated as an urgent issue uh as uh Mr. said it did come up in the previous meeting uh between the prime minister and the minister. Uh clearly the states and territories made a decision about what was important for them and that was the outcome of that. But it is important to us as the commonwealth to make sure this is an ongoing uh discussion
>> 42 minutes.
>> Wow. I did try and press a little bit harder. Uh gives us great pleasure to release all of the witnesses for uh outcome three in aging and age care including the inspector general of age care. Uh thank you folks. We will take a short suspension so that we can welcome the uh officials and witnesses for the next outcome which is outcome one.