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Submissions on system governance

Call for submissions: Aged care system governance, market management, and roles and responsibilities

The Royal Commission into Aged Care Quality and Safety is inviting submissions from interested individuals and organisations on the topic of system governance, market management and the allocation and clarification of roles and responsibilities for these functions. A number of questions for consideration are provided on this page.

The final date to provide submissions is Monday, 13 July 2020. We intend to publish all submissions received on the Royal Commission’s website. However, we reserve the right to not publish submissions, or to redact information in submissions, before publication.

Please email submissions to: ACRCSystemGovernance@royalcommission.gov.au.

In providing a submission, you can also:

  • write to the Royal Commission at GPO Box 1151 Adelaide SA 5001 or
  • telephone 1800 960 711 (between 8:00am-6:30pm ACDT Monday-Friday except on public holidays. Interpreter service available).

By their Terms of Reference, the Royal Commissioners are required to consider what can be done to strengthen the system of aged care services to ensure high quality and safe aged care, and to consider systems to ensure that high quality care is delivered, such as governance arrangements and management support systems. The aged care system requires clear and structured leadership. Establishing clear roles and capabilities of those responsible for the aged care system is essential to ensuring quality and safe aged care.

In 2012, the Australian Government took ‘full funding, policy, management and delivery responsibility for a consistent and unified aged care system’. The system is highly complex. Aged care is delivered through a very large number of disparate for-profit and not-for-profit (including government) providers. The services are heavily subsidised. Some government funding is provided through grant agreements and some through market-like delivery models recognised under statute and delegated legislation. There is very significant regional variation in the conditions under which care is provided. Regulation of the system is divided between a Department and statutory bodies, most notably the Aged Care Quality and Safety Commission. Consultation between government and the aged care sector (including the aged care workforce) chiefly occurs through a number of non-statutory committees and other informal mechanisms. The health, wellbeing and quality of life of individuals receiving aged care can be heavily dependent on the smooth interaction of the aged care system with other systems of human services, including health care, disability services and housing. The system is affected by many other external factors, such as the availability of a well-trained and sufficiently plentiful workforce.

The Royal Commissioners are making inquiries into system governance and market management within the aged care system. They are considering whether improvements should be made to institutional arrangements to improve system governance and market management, and to improve clarity about roles and responsibilities for these functions. The Royal Commissioners are considering commissioning arrangements between government and service providers.

In this context

  • ‘system governance’ means effective and appropriate governance arrangements for a system of essential human service delivery as multifaceted, complex and unpredictable as the aged care system
  • ‘market management’ means the subset of such functions that relates to fostering an adequate supply of high-quality services to meet needs for aged care, including needs across all localities and diverse needs groups
  • ‘commissioning’ refers to effective and appropriate ways of selecting, contracting and collaborating with service providers

For those interested members of the public and institutions who wish to make submissions to the Royal Commissioners on the topic of system governance, market management and the allocation and clarification of roles and responsibilities for these functions, we note our particular interest in receiving submissions which address the following topics:

  1. The essential characteristics of system governance in the Australian aged care system.
  2. How system governance can support the delivery of quality and safe aged care services with regard Australia’s geographic and demographic characteristics.
  3. A description of the role of a system governor in the Australian aged care system, including consideration of what structure a system governor should take.
  4. Potential legislative and administrative reform to be considered in the design of system governance in the Australian aged care system.
  5. The role, if any, of market management in the Australian aged care system. 
  6. The role, if any, of commissioning/tendering in the Australian aged care system.
  7. When and how a system governor ought to monitor and intervene with the performance of market-like mechanisms in the Australian aged care system?
  8. Whether there are functions that should be exercised by the system governor in the location or region where the services are provided? Whether there are functions that should be exercised by the system governor centrally?
  9. Other matters that you consider relevant to the overall governance of the aged care system.

In particular, we invite you to respond to the following propositions relating to the potential roles of Topic 5. Market Management and Topic 6. Commissioning/Tendering.

Market Management: This role should be seen as the task of actively managing established and emerging markets for aged care services across Australia. It involves establishing the structure, shape, coverage and composition of providers; defining the ‘rules of the game’ between providers and consumers, managing the shape and composition of the system to ensure the number and mix of providers required to service demand across urban, rural, regional and remote Australia; building capability, including workforce, facilitating new entrants and leavers to improve the overall performance of the system; supporting innovation and the exchange of information across the system and ensuring the system reacts to an increasing and diverse demand for age care services.

Commissioning/Tendering: This role encompasses how providers are to be identified, selected and approved or licensed for participation in the system.  The commissioning method could range from self-selection subject to accreditation through to a process of pre-selection and accreditation or by contracting, either through select or open tenders.

Where tendering is used, it might involve the conduct of either national or regional tenders, the scope of which could vary from all aged care services to particular selected service types.  The tender documentation should outline the service requirement to be met, including standards and outcomes, governance, staffing, financial matters and may include floor prices. It should seek responses outlining the organisation’s alignment to the required service requirements and price to deliver each service offering. Effective commissioning does not cease once contracts have been signed. There should be continuing consultation between government and the service provider with a view to refinement of service delivery outcomes to meet unexpected conditions and challenges.

Please use examples, where possible, in your response to the above topics.

In light of the effects of the COVID-19 pandemic on the Royal Commission’s program, there is no certainty that a public hearing will be conducted on these matters. If necessary, we will invite the Commissioners to reach their conclusions on these matters on the basis of evidence and submissions in documentary form.