Dr Kerryn Phelps, AMA President, Channel Nine 'Today', with Tracey Grimshaw

PHELPS: Good Morning, Tracey.

BISHOP: Good Morning.

GRIMSHAW: Kerryn, can I start with you. You said yesterday aged care was in a state of despair and disrepair. Was that an exaggeration?

PHELPS: No, not at all. If you talk to relatives of people who are trying to find aged care accommodation, you'll certainly see the despair. And, similarly, you'll see the frustration when you talk to people who work in the public hospital sector and in the aged care sector. That there is an enormous challenge out there for any government to be able to take aged care into this century and beyond. And we need to look beyond this current generation and at least to the next 50 years when we're expecting between 1.1 and 1.2 million people to be over the age of 85.

GRIMSHAW: So, before we come to the Minister, are you pointing the finger at the Federal Government, at State Governments or at nursing homes who flout the system?

PHELPS: I think this has to be a whole of sector challenge. We need to be getting together the people who are nursing in aged care, the people who are providing aged care facilities, governments, opposition parties who are wanting to be in government, the medical profession and patient groups, consumer groups. I think everybody needs to be able to look at the aged care sector and say - here are our problems, here's how we need to go forward. For example, we did a survey of public hospitals just recently and 93 per cent of the doctors working in public hospitals identified lack of aged care places as a major problem. We have, just in Victoria, the equivalent of one entire major hospital, with people who are aged, who have qualified for aged care places, who are sitting in hospital waiting to get out into another sort of facility.

GRIMSHAW: Okay. Minister, do you concede that you have a lot of work still to do?

BISHOP: There's always a lot of work to do with regard to aged care, Tracey, because what we inherited was a system that needed dramatic reform and change and that's what we've been putting in place. To make care better for residents, and in aged care homes that's what we have, residents. In hospitals, we have patients. Patients who need medical intervention, who need surgical intervention or other sorts of treatment. But in aged care homes we're not pseudo hospitals, we're running homes. Now there is a need for having a better method or seeing this transition between the various health areas. Now under the health agreements the Commonwealth Government funds state hospitals who in fact have rehabilitation programs and proper discharge policies for older Australians, but it's not happening. I can tell you the stats. We have 1.3 million incidents of people over the age of 70 going into hospital, one point one million of them go home. We have 82,000 of them are transferred to a different acute care hospital and we have 32,000 coming to aged care homes and we have 38,000 who pass away.

GRIMSHAW: So you're saying that State Governments are not fulfilling their end of the bargain? Is that what you're saying?

BISHOP: That's true. Every year they're cutting the number of public hospital beds they have. Between 1998/1999, for instance, 1,000 public hospital beds were cut. So, and the time that people are allowed to stay in hospital has gone down. I think the average is now something like 3.6 days - that's not enough for older people who need rehabilitation and so on. So there's a great need to look at that rehabilitation stage for older people who need more care than perhaps somebody who's fit and able and can get back quickly…

GRIMSHAW: Okay.

BISHOP: … and that money that the Commonwealth provides really has to be spent in those areas. And I quite frankly would like to see that money tied.

GRIMSHAW: Kerryn, does that sound like a fair explanation to you?

PHELPS: I can hear a couple of very familiar themes emerging. And whenever you talk to the Commonwealth Government they say it's all the fault of the States, and you talk to the States…

I'm not saying they're saying it's the fault of the Commonwealth.

BISHOP: I'm not playing that game. I'm simply saying what the stats say, what the facts are…

PHELPS: I acknowledge.

BISHOP: … and I've given you those figures.

PHELPS: I acknowledge that there is a problem…

BISHOP … and it's very important.

PHELPS: … but the State Governments are also facing a situation where they are accommodating people with very high dependency needs in the hospitals but who aren't sick enough to stay in the hospitals…

BISHOP: Kerryn, you know as…

PHELPS: … and so what we need, just let me finish. What we need to do is to develop some models of transitional care or rehabilitation…

BISHOP: I agree on that.

PHELPS: … so that it's not a one way street…

BISHOP: That's exactly right.

PHELPS: … and, what we need to do is to not say it's the Commonwealth's responsibility or it's the States' responsibility. But one of the reasons that we want to get this Aged Care Summit up and running is to say, is there some better model of funding so that we have one part of government that takes responsibility for aged care. And is the way that it's currently structured, an impediment to progress in the aged care sector. Certainly that's the message that we're getting from people in the industry.

GRIMSHAW: Okay. Well let's let the Minister answer that one.

BISHOP: I think what we have to see is, now those agreements, those health care agreements will be up for renegotiation. And it's very important, to my way of thinking, that in those negotiations we set aside some of that money and earmark it for older people to have proper rehabilitation and proper treatment in hospitals. One of the things that's a problem is we don't have enough gerontologists i.e. doctors who are skilled in the treatment of aged care. It's not terribly flash, it's more flash to be a cardiac surgeon or to be someone dealing with kidneys, or somebody dealing with something else. But there are not enough doctors who are getting training. So there's room to talk with universities about the training that doctors get about the care of older people.

GRIMSHAW: Okay.

BISHOP: Just as I'm doing now with the Council of the Deans of Nursing, talking about the generic skills that they are learning, and that's already happening. And I'd like to see it happen with doctors as well.

GRIMSHAW: Okay, Kerryn, one of the other keys points that seemed to me, that you made yesterday was about the accreditation process. And you suggested that that ought to be run by the industry and not by the government. Does self-regulation work?

PHELPS: I think self-regulation, if it is owned by the industry and supervised by government, can certainly work. And we do have other models that are in the health sector which do work and it's certainly something that the aged care sector is prepared and ready to take on. And I think that this whole issue of the standards in nursing homes and aged care facilities is very important. I will just pick up on one point from earlier, and that is, that some of these elderly people - particularly the more frail - do have very high dependency needs and need a lot of nursing and medical attention and are not always getting it. And part of that is because the funding for those people is insufficient…

GRIMSHAW: Okay.

PHELPS: … but I do think that the accreditation issue is important. At the moment we don't have benchmarks for quality of care and I think they…

BISHOP: Yes we do.

PHELPS: … they are

BISHOP: … they're in the accreditation

PHELPS: … they are necessary to include.

BISHOP: We do have benchmarks for quality of care. The accreditation system is the first time we've had legislated requirements. And indeed for people who are our most dependent people, who are level one, the income per person for that level one resident is about $66,000 per year to fund their needs. As the needs are less there is less funding and we have a lot of people who are in homes who are able to live good independent sorts of lives with assistance. Our policy is to keep those people by and large at home and to give them services at home. So there's a whole range of reform that's being put in place.

PHELPS: Well at the moment the waiting time…

BISHOP: … but to say, we have increased

PHELPS: … the waiting time at the moment for those home care packages is

GRIMSHAW: Excuse me, Kerryn.

BISHOP: I did wait and listen for Kerryn.

GRIMSHAW: Time is going to beat us unfortunately. We may have to continue this another day.

BISHOP: I mean we do agree between us that we are concerned about care for individuals. That's my passion, my residence. And we have partners who are providers, who provide that care and I'm sorry, but self regulation is not on and we've seen too many examples of why it isn't. There is a need to have a compliance and a policing system, if you like.

GRIMSHAW: Okay. I hate to say that we're out of time. I know we could go on for at least another 20 minutes with this, we may have to save it for another day. Thank you both for your time this morning.

PHELPS: Thanks, Tracey.

BISHOP: Nice to see you, Kerryn.

Ends