Following the events at Earle Haven in July 2019, we saw what has sadly become, the usual response to these events: politicians looking to gain political mileage by attacking all aged care providers and introducing ill-conceived legislative responses. The first of those was Queensland’s Health Transparency Bill 2019. The Bill has been promoted as a mechanism to improve transparent reporting by Queensland public and private health facilities. Relevantly for the aged care sector, it:
- Prescribes minimum nurse and registered nurse percentages and minimum average daily resident care hours for State owned residential aged care services; and
- Provides for information about State owned and private residential aged care facilities to be collected and published.
Information to be collected
There are two types of information that will be collected:
- General information being information that identifies a facility such as its name and location, details of the services provided at the facility and details about other services available near the facility; and
- Residential care information being information prescribed by regulation about:
- The personal care or nursing care provided to residents;
- Staffing for personal care and nursing care provided to residents; and
- Information that is meant to assist in understanding the information provided about care and staffing.
The prescribed information about staffing is the average daily resident care hours for a particular (but as yet unspecified) period which is to be worked out by:
- For each day in the period, dividing the total number of hours of residential care that nurses and support workers provide by the number of residents at the facility on the day; and
- Dividing the sum of the number of hours calculated under paragraph (a) for all days in the period by the total number of days in the period.
The hours spent by nurses and support workers used in the calculation must be hours where they are directly involved in providing residential care.
Will providers have to comply?
The information is to be submitted in response to a request from the Queensland Department of Health. Approved providers will not be required to give the information requested but if they choose not to they must inform the Department of their decision. The Department may then publish the facility’s name and the fact that it declined to provide the information.
If this Bill becomes law, it will create a number of problems for the aged care sector in Queensland. The most significant are outlined below.
Is it valid?
All States and Territories have agreed to the Commonwealth having responsibility for the funding and regulation of aged care in Australia. The Aged Care Act and its Principles establish a comprehensive and all-inclusive framework of law for the delivery of aged care. That includes laws about the use of information and information to be made available to consumers. There is little doubt that the Commonwealth’s intention was to “cover the field” when it comes to aged care laws. If it can be established that the proposed Queensland law is inconsistent with the Aged Care Act and Principles, it will be invalid to the extent of that inconsistency.
Will the information be useful?
Raw staffing numbers are unlikely to serve the purpose intended. The Government’s stated aims are to “ensure elderly Queenslanders and their families have access to comparative information to make informed decisions”, to “improve accountability to consumers and foster a culture of transparency” and to “enable informed choices”. Consumers and families already report confusion and uncertainty about the extensive information provided on the My Aged Care website. It is hard to see how this information will improve things; especially as it will do nothing to assist in assessing the quality of care provided at a facility and whether the type of care will be appropriate for a consumer.
The information to be published will not include any details about the needs of residents at the facility, the mix of staff or the adequacy and appropriateness of care. Human beings are all unique and that does not change when a person enters an aged care facility. The Government would assist consumers and families more if they increased the information and education available to the community about how to determine what care setting will suit them best and how to decide whether a facility or approved provider has the capacity to meet their individual needs.
What about clinical oversight?
Insisting that the hours taken into consideration must only be hours spent directly involved in providing care means that the information made available will not include anything about the extent of clinical governance or quality oversight at a facility. Having appropriately qualified staff overseeing and managing these issues is critical to ensuring the quality and safety of care provided to residents. If consumers are to be provided with meaningful information about a facility it should include details about the measures a provider takes to ensure quality and safety.
What impact will it have on viability?
This will also be yet another reporting requirement placed on approved providers who are already struggling with the requirement to divert more and more resources to documentation. Stewart Brown has only recently reported on the precarious financial position of many providers in regional and rural parts of Australian. In this environment, it is strange indeed that the Queensland Government is adding to overhead costs given the geography of this state.
Will it give State owned facilities an unfair advantage?
This law will also set up unrealistic comparisons between State owned facilities and those operated without the financial backing of a state government. Such comparisons will be particularly problematic in areas where a residential care facility, usually operated by a not for profit organisation, already finds itself competing with a multipurpose health service.
What happens next?
The Bill was referred to the Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee (the committee) for detailed consideration. Submissions to the inquiry closed on 18 September 2019 and the committee is required to table its report by 18 October 2019. Further updates will be provided as the Government finalises its response.