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1. |
The ANAO recommends that the Department of Health and Ageing assess the merits of alternatives for how the department applies the aged care planning ratio and sub-ratios across states and territories, so as to better take account of differences in state and territory demographics, including health status.
DoHA response: Agreed |
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2. |
Recognising the scale and increasing complexity of the Aged Care Approvals Rounds (ACAR) process, the ANAO recommends that the Department of Health and Ageing put in place appropriate costing arrangements that track the costs of key components of the ACAR, so as to inform management decisions relating to program delivery.
DoHA response: Agreed |
7.14 The Committee held a public hearing on Wednesday 25 November 2009 to examine this audit report. Witnesses from the following agencies attended and gave evidence:
n Department of Health and Ageing (DoHA); and
n Australian National Audit Office (ANAO).
7.15 The Committee heard evidence on the following issues:
n debriefing of unsuccessful applicants;
n requirements of special needs groups;
n review of planning ratios and allocation process;
n Indigenous allocation;
n costs of key components of the Aged Care Approvals Rounds (ACAR); and
n post-allocation monitoring of providers.
7.16 The ANAO recognised that the debriefing process for unsuccessful applicants is important as it allows applicants to improve future applications.[3] The ANAO acknowledged the improvements DoHA has made to the process in recent years but found that some stakeholders still find the feedback and advice they receive too generic:
Providers would like more detailed information about how their applications could be improved, and the reasons for DoHA decisions.[4]
7.17 The ANAO suggested the DoHA ‘continue to seek to improve the debrief process, via staff training and by continuing to evaluate future ACAR debriefs’.[5] The Committee queried why the ANAO had not made this suggestion a recommendation in light of its findings. The ANAO advised that it is satisfied that the Department is taking positive steps to improve the process and therefore did not feel a recommendation is required:
One of the things that we try to do when we think about whether a recommendation is a useful idea or not is to take on board what the agency is already doing, and they have been progressing their thoughts in that area. As I said, they are using more senior people to provide the feedback.[6]
…
And they have done some work to consider what the feedback responses have been. We found that DoHa was actively reviewing the comments provided.[7]
7.18 In 2007 the ANAO found that not all states were addressing all five special needs groups identified in the Allocation Principles.[8] A number of states were only including information on selected special needs groups to the Aged Care Planning Advisory Committee (ACPAC) considering allocation of Aged Care Places in their state. In response to a recommendation by the ANAO to improve overall administrative effectiveness, including this deficiency, DoHA ‘disseminated ‘National Best Practice Guidelines on collection and Assessment of Supporting Information for ACPACs ‘to its state and territory offices in January 2008’.[9]
7.19 Although the ANAO found overall improvements to the information provided to ACPACs during the current audit, only two of the four states had fully adhered to the guidelines with regard to the five special needs groups.[10] The ANAO concluded there is still room for improvement. The Committee asked DoHA why there are inconsistencies across state and territory offices. The Department maintained that a standard set of information is provided to all ACPACs but that the ACPACs are independent advisory committees and may not do things in an ‘exactly standard way’.[11]
7.20 The Committee asked how transparent the deliberations, recommendations and names of the ACPACs are. DoHA assured the Committee that the names of the committees are publicly known and that, although their deliberations are confidential, the information they provide is incorporated into the Departments guide that is distributed to applicants.[12]
7.21 The ANAO found that the current practice of applying the planning ratio uniformly across states and territories does not recognise demographic differences and recommended that alternative methods be explored to improve equity of access to aged care.[13] The Department responded that the Government is planning a review of the process.[14]
7.22 The Committee asked if the proposed review has commenced, what form it is taking and whether or not it is addressing the ANAO recommendation. The Department told the Committee:
The Government has indicated that it will provide a reference to the Productivity Commission to undertake a public inquiry into aged care in Australia. This inquiry will examine the needs of Australia’s aged persons for the next 20 years and look at appropriate standards and funding arrangements to secure the best outcomes from aged care services. It is anticipated that the inquiry will consider issues around the planning and allocation of services.[15]
7.23 To accommodate the fact that the conditions of ageing often affect the Indigenous Australian population earlier, the ANAO found that DoHA allocates places for Aboriginal and Torres Strait Islander people aged 50-69.[16] To achieve this, DoHA reallocates places assigned to the whole Australian population aged 70 years and over.[17] The ANAO suggested that:
DoHA could provide advice to the Minister for Ageing on options for incorporating the Indigenous population aged 50-69 into the national planning ration target. Taking account of the Indigenous population aged 50-69 in the ration would improve DoHA’s ability to plan for the aged care needs of that population and plan the distribution of places accordingly.[18]
7.24 The Committee asked if DoHA has, or intends to, provide such advice to the Minister. The Committee also asked whether or not the intended government review would consider specifically allocating extra places for special needs groups, particularly the Indigenous population aged 50-69 years. DoHA informed the Committee that it expected both these issues to be covered by the intended inquiry into aged care in Australia to be undertaken by the Productivity Commission.[19]
7.25 The ANAO found that DoHA was unable to provide ‘specific data or estimates on the costs and funding approach related to the planning and allocation of aged care places and capital grants’.[20] This indicated that DoHA had not ‘systematically considered the resourcing’ of the process.[21] In order to continue to meet its goals to provide aged care places in an increasingly competitive market, the ANOA recommended that DoHA put in place a costing framework to track the costs of key components of the ACAR.[22]
7.26 The Department agreed to improve the cost tracking process but did not provide details of how it would go about this.[23] The Committee is concerned that the lack of data will inhibit DoHA’s ability to implement future efficiencies and asked DoHA what action has been taken, or is planned to be taken, to implement the recommendation. DoHA informed the Committee:
As part of the Business Planning exercise for 2009-10, the Ageing and Aged Care Division and the Office of Aged Care Quality and Compliance undertook an exercise to improve the quality and consistency of resource allocations for aged care activities to ensure that the resource allocation was accurate for the round and affected activities. The results of this exercise were then submitted as part of the Business Plan for both of the Divisions which have responsibility for aged care programs.[24]
7.27 After the allocation of places, the ACAR applicant has two year to ensure the places become operational. Over recent years, increases in building costs and construction times have made it more difficult to meet this deadline. The ANAO acknowledges that the DoHA is taking a more active role in monitoring this process in an attempt to ensure compliance. However, the ANAO found that DoHA had difficulty monitoring whether or not providers meet the conditions of allocation as the records where held on paper in files in state and territory offices.[25] The ANAO suggested that DoHA consolidate its records of conditions of allocation to enable post-allocation monitoring of providers.[26]
7.28 The Committee asked DoHA what actions it is taking to improve post-allocation monitoring of providers, for example has it implemented physical inspections. The Department informed the Committee that the intended enhancement of its Places Tracker IT system will provide a capability to undertake systematic and IT-assisted scrutiny of the conditions of allocation on a centralised and coordinated basis.[27] The Committee asked for an update on this process. DoHA replied:
Since 2007, the Department has entered conditions of allocation into the National Approved Provider System 9Places Tracker). The Department is undertaking work to incorporate information on past allocations into this system. This is a large task requiring manual data entry of information held in a variety of different forms and records systems including paper based files in state and territory offices of the department. The compilation of this information in the system in a readily available from is a necessary pre-cursor to more actively monitoring conditions of allocation from allocations prior to 2007.[28]
7.29 The Committee acknowledges that overall the planning and allocation of aged care places and capital grants by DoHA is operating effectively. The Committee notes that the government is planning to undertake a review into aged care in Australia that will address concerns regarding planning and allocation of services.
