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Aged care scandals will continue unless the care model is transformed


The newly-announced royal commission into the aged care sector won’t be the last unless Australia changes the way it thinks about and delivers care.

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In fact, Australia has seen 20 inquiries into the aged care sector in the past 20 years.

South Australia is not immune to this challenge, having seen the most recent national royal commission sparked by the Oakden scandal in Adelaide.

The consistent factor across all of these inquiries has been workforce issues.

There are some serious workforce challenges that need to be confronted head-on, but for too long they have been ignored or placed in the too hard basket.

The UK has seen this train crash coming for many years – and is now right in the middle of it. When the National Health Service (NHS) was set up the average life expectancy was 66 – it’s now 82.

The NHS is now in crisis and has 90,000 job vacancies at the moment. This means hospitals in the UK have ambulances lined up out the front and patients are treated in corridors. Sound familiar?

If you think the problems with the health system in Australia are tough now, look to the UK for an insight into the future. It’s not only a shortage of hospital beds or doctors that are driving this, but an inability to deliver care in the community and in homes that keeps people well and out of hospital.

We need to think differently about the way care is delivered.

A recent report released by the Victorian Council on Social Services has revealed that by 2050, Australia will need one million additional workers in the aged care sector. Australia is a nation of 25 million people – where are all these workers going to come from?

One way we all need to think differently is to recognise that care is not about charity – it’s a human right. While many care services were born out of charities, we need to recognise that the care sector is now big business delivering an essential service to all of us as citizens.

If we see the care sector this way, then it’s obvious we need to manage this sector like we do any other industry. Too often work in this sector is not valued, pay and conditions are poor, employment is increasingly casualised and career options are limited. It should come as no surprise therefore that the people being cared for (and that will be the vast majority of us some day) are not being valued as they should be.

We make this point not to justify poor treatment of vulnerable people, but to point out that bigger sticks or more regulation aren’t the only ways to deal with the challenge.

When the time comes, and we need someone to come into our homes and care for us – to get us out of bed, to clean, feed and dress us – we will want a number of things: we’ll want the person caring for us to be well trained, have a stake in what they do and, importantly, be the same person every day.

People always need to be at the heart of the way care is delivered.

One way to do this is to make sure people are at the heart of the business models – whether they are not-for-profits or for-profit businesses. Employee ownership and the co-operative business model provide an important model for doing this.

Engaged employees deliver higher quality care. There is no greater way to engage an employee than to make them an owner of the organisation for which they work. This provides the carrot for better care, rather than the bigger and bigger sticks that we have seen fail time and again.

When it comes to the cooperative business model – when ownership is democratically shared amongst either customers, employees, or a combination – South Australia has a long history, but not in the care sector.

The State Government’s new Child and Youth Disability Services Cooperative is an example of this. Rather than outsourcing this service to the private sector, as other states have done as part of the transition to the National Disability Insurance Scheme, South Australia has set up a new employee-owned cooperative to deliver these services.

When people have a stake in an organisation like this, they deliver a much better quality of care. This makes the business more successful and means that profits can be reinvested in the staff development and better care.

We all need to be a lot more concerned about workforce planning issues in the care sector. We need to see the care sector as a crucial part of the local economy and, in South Australia’s case, the biggest driver of job creation.

But the care sector rarely features in economic development and industry strategies. That needs to change and until it occurs we will see many more royal commissions, longer wait times in hospitals and, unfortunately, more abuse of vulnerable people by the people charged with their care.

It’s time to think differently about the care industry in Australia and this needs to be done quickly. Cooperatives and employee ownership provide an opportunity to do that and South Australia should embrace it.

Dr Guy Turnbull is the current thinker-in-residence and former managing director of Care and Share Associates – an employee-owned cooperative in the UK care sector. Last year, he was named UK Entrepreneur of the Year.

David Pearson is the Executive Director of the Don Dunstan Foundation.

Dr Turnbull’s Oration ‘SA: Towards a Cooperative State’ will be held at 6pm tonight (Thursday 27 September) at the University of Adelaide. Book here.

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