A broken and disjointed system: where to from here?

An overview of the Aged Care Royal Commission Interim Report

Surgeon Visiting And Talking With Senior Male Patient In Hospital Bed In Geriatric UnitThe Royal Commission handed down their interim findings on 31 October 2019. An extract from the report titled, A Shocking Tale of Neglect, highlights the overall sentiment mirrored throughout the report of a broken system, that has failed older people and their families, and failed to live up to the expectations of how people should be cared for in their final days.

Also noted in the interim report were stories of where providers in collaboration with residents, their families and carers are providing excellent care, with genuine patient choice a hallmark of these case studies.  However, if one was to only glance at the recommendations, or executive summary, the report paints a confronting picture.

WA Primary Health Alliance, as part of the Australian Government’s Primary Health Network (PHN) initiative prioritises aged care as one of seven priority areas.  We have the remit to partner with community, service providers, GPs and allied health professionals, to weave the fabric together so that care can be delivered in a manner that is fit for purpose, and access to that care is equitable no matter where you live.  Overall, we are committed in our aged care portfolio to:

  • Improve health outcomes for older Western Australians.
  • Develop targeted approaches to contribute towards age friendly communities.
  • Acknowledge that good health is not just about the physical, but also refers to the social, emotional and cultural wellbeing of the individual and their connectedness to their family, friends and community.
  • Work closely with the aged care sector and other key stakeholders to plan, commission and design community and health care systems that address the needs of older Western Australians.

The final report to be handed down by the Royal Commission will recommend large, system-wide changes that we all need to be ready for. It is not unreasonable to assume that a fundamental redesign of the whole aged care system will be suggested and an expectation that providers, funders and the workforce will be tasked with implementing solutions.

The Commissioners made two direct comments to the sector as a whole, inclusive of Government, about the deficiencies and outright failings in aged care:

“We [The Commission] are left to conclude that a sector-wide focus on the need to increase funding, a culture of apathy about care essentials, and a lack of curiosity about the potential of aged care to provide restorative and loving care—all of which is underpinned by an ageist mindset— has enabled the aged care system to hide from the spotlight. This must also change.

We [The Commission] have heard evidence which suggests that the regulatory regime that is intended to ensure safety and quality of services is unfit for purpose and does not adequately deter poor practices.  Indeed, it often fails to detect them. When it does so, remedial action is frequently ineffective. The regulatory regime appears to do little to encourage better practice beyond a minimum standard.”

The report focuses on workforce issues, undertraining and unqualified staff, lack of retention of high-quality staff, and a workforce under pressure. The Commission highlighted strategies and interventions that were identified in the A matter of care, Australia’s Aged Care Workforce Strategy released in June 2018.  It is expected the Commission will draw on this strategy in identifying recommendations in their final report around workforce.

Major problems were identified with care being delivered in both home and residential care including; wound management, food and nutrition, physical and chemical restraint, palliative care, continence management and oral health.

The Commission outlined a process by which they will deliver their final recommendations in the latter half of 2020 (expected 12 November), but provided three immediate actions for Government to consider in the interim:

  • More Home Care Packages to reduce long waiting lists for higher level care at home.
  • Tackle the overreliance on the controversial practice of chemical restraints.
  • Stem the flow of young people with a disability living in aged care and move those in the system out.

Providers in residential care play a role in reducing the overreliance on chemical restraints and should act immediately. For the other two recommendations, Government must take ownership and provide leadership in these areas.  We welcome the Government’s announcements of additional Home Care Packages and investment towards these recommendations.

We acknowledge the work of Leading Age Services Australia in providing the sector a detailed summary of the interim report. We note the five systemic issues they have summarised:

  • System designed around transactions not relationships or care
  • Minimises the voice of people receiving care and their loved ones
  • Hard to navigate; not enough information
  • Non-transparent regulatory model; no incentive to improve
  • Workforce under pressure, underappreciated, lacks skills

There is no doubt change is required in a broken and disjointed system. We need to find ways to genuinely engage with consumers, carers and their families to provide real choice and seek to provide models of care that align to the needs and wishes of people we are caring for.

WA Primary Health Alliance is committed to partnering with community, service providers, GPs and allied health professions, with whom we work to deliver better health, together. Our focus is on helping those at risk of poor health outcomes, so they can access excellent care closer to home.

View the interim report.

Our CEO, Learne Durrington also wrote recently about her personal experience of the aged care system and the role that WA Primary Health Alliance plays. Read about her experience.


Find out more about WA Primary Health Alliance.