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Thursday, June 30, 2022

Money is vital but systemic reforms that improve service accessibility are just as important: expert

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There have been a raft of promises from both parties regarding aged care reform, but they are both missing a vital foundation, according to a Victorian public policy expert and chief executive.

Dr Danny Davis, managing director of not-for-profit community service provider LINK Community and Transport (LINK), has been working to improve the effectiveness of government programs, having completed his PhD on the topic of quality-driven governance models

He tells Aged Care News that if he just had 30 minutes with Prime Minister Scott Morrison and Opposition Leader Anthony Albanese, he’d offer some unique points of advice.

The funding structure that’s there at the moment has created a really annoying system, a really inefficient system and, really, a system that is much less helpful than it could be… if you just pour more money in, it’s not going to solve those problems.

Managing director of LINK Community and Transport, Dr Danny Davis

“Would it surprise you if I didn’t start by asking for more money to be poured into the system?” he asks, smiling.

Davis says that whilst adequate funding for evidence-based programs and reforms is vital, such funding is meaningless if not complemented by systemic reforms that improve service accessibility.

“The funding structure that’s there at the moment has created a really annoying system, a really inefficient system and, really, a system that is much less helpful than it could be.

“You’ve got to start there, because if you just pour more money in, it’s not going to solve those problems.”

Dr Danny Davis, CEO of LINK Community and Transport, says that reforms must focus on improving accessibility of aged care services, if increased funding is to be properly utilised.

The federal health department, in a 2020 analysis of the Commonwealth Home Support Programme (CHSP), found that 15 out of the 17 service types provided in-home were underutilised by over 20 per cent.  

“Those numbers are actually repeated across all sorts of different programs and policy areas,” Davis explains.

Underutilisation of services is happening, Davis explains, because older persons and their families are not provided any centralised assistance that will help direct them to the one, or multitude of services, they need.

“Anecdotally, anybody you speak to has just had a hellish journey trying to find services for themselves or for their parents,” Davis says.

“All of the pressure comes back onto the individual, and you get these nightmare stories out of people like me: white, middle aged, well educated, understanding the sector — even I have trouble, so how the hell are our clients getting through this?”

Anecdotally, anybody you speak to has just had a hellish journey trying to find services for themselves or for their parents.

Dr Danny Davis

Davis says that not-for-profit organisations, like LINK, try their best to develop solutions in particular service areas, but that more holistic service solutions must be enabled.

“It’s really fragmented … it means the phone call with the client goes ‘hello, are you eligible for the funding we administer? No? Bye-bye!

 “And so the person has to go from place to place trying to find —magically — the right place that actually has some funding.

“If they’re lucky, they find one service when, really, they need three or four.”

Davis advises that service centres must be designed so that older clients and their families are comprehensively aided and referred directly to suitable programs and providers.

“We [LINK] turned around purposefully and deliberately, and basically now have social workers on the end of the phone.

“And the phone call is now, ‘Hello, how are you doing? Let’s see what services are out there that might be able to help you’.

If you don’t deliver services, you’re not going to get the benefits and for government to see underutilisation as a ‘savings’ … it is really not understanding the basis on which the funding was assigned in the first place.

Dr Danny Davis

“And that’s not just funded services from within the aged care program: it’s actually everything across community, different government programs from different policy areas and, indeed, just stuff that’s happening in communities.

Davis emphasises that governments should not be congratulating themselves on returned surplus from aged care program provisions, as the long-term impact on the community will come back and bite in the long term.

“If you don’t deliver services, you’re not going to get the benefits and for government to see underutilisation as a ‘savings’ … it is really not understanding the basis on which the funding was assigned in the first place.”

In terms of the workforce crisis, while Davis notes an expansion of the aged care workforce is needed to provide adequate clinical care, he would like to see greater encouragement of volunteering for other basic services.

“The really basic stuff of just keeping people active, keeping them connected, is about actually activating community, about creating a caring community before people touch the health system.”

“Volunteer work is a cost saving to the community, but it actually creates a sense of a caring community, also.”

“How much economic and social value could be created through better, more proactive, more vocal, more engaged leadership?”

“Leadership in helping create a volunteering, participating active society is probably more important than throwing dollars at it.”

Finally, Davis believes there should be reviews of how federal funding for community transport is distributed, with Victoria only receiving 10 per cent, per capita, of the funding afforded to other states this last financial year.

“It’s just a bizarre anomaly of how things were run in the state and how they got handed over as part of the Commonwealth program,” Davis says.

“It should provide equity across states. Why is Victoria at 10 per cent of the other states per capita? Victoria’s vulnerable people are getting 10 per cent of the funding that is provided to other states; that is wrong and needs to be addressed.”

Frustrations aside, Davis concludes that if he were able to have that 30 minute sit-down with either political leader, he would frame the conversation empathetically, and with optimism that real change is very much within our reach.

“It’s maybe a strange thing to say, but I would approach the PM and the senior bureaucrats with some degree of empathy.”

“It’s hard. It’s complex.

“It can change from the ground up by creating environments where people can be the change … but there’s a long way to go.”

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