Opinion: Sometimes you read, hear or see something presented and realise it encapsulates matters beyond its immediate scope. Often the insight is not intended. I had that experience this week on reading a report on aged care released by Te Whatu Ora.
The report was prepared by an external consultancy. (Why on earth, with the resources and relationships available to Te Whatu Ora and Manatu Hauora, was it considered necessary or appropriate to pay for an external review on a core part of their work?)
It is, of course, part of a longer review, following the foundation principle of consultancy that any report should ideally function as a job description for the next report.
This first report is a “strategic assessment” of aged residential care and home support services – a description of the current position and concerns. You may not unreasonably have thought that the various people who have for years developed policies for, monitored and funded these activities could have done this work.
If they could not, then they have no shortage of input, including plenty of recent submissions and studies commissioned by those providing such services. So, not surprisingly, what the consultants found after “engaging with the sector” was simply what was already known.
Their policy recommendations will follow but there is more than enough in their first report to make it clear that:
• There is a lot of demand for residential aged care services currently and prospectively for which the facilities, trained people and funding are not available; and
• Though the private retirement village and aged care model may deliver sufficient residential care facilities for about half of the aged population, there is simply no current model for decent levels of such care facilities for the rest.
Those responsible for the sector, turning a blind eye to these facts, comfort themselves (though not the aged) with the thought that home care will fill the gap. The latest report appears geared to buttress this view. But in practice, this pious hope ignores the realities of the available workforce, let alone the cost of delivery, the real care demands of ageing including dementia, the suitability of home facilities and the impact on housing stock. Home-based care is a vital part of a solution but it is not a panacea.
The impact, of course, is most negative on low-income and low or zero-wealth-aged people and their families. The health inequities of a lifetime are intensified in the final stages. It is all depressingly familiar across social services.
So it is a real problem but it is not new nor unknown. It must be confronted and solutions found. This is where my wider concerns kick in, and they extend well beyond wasting resources on consultants to tell us that the wet stuff falling out of clouds is rain.
The same consultant also recently found that the Environmental Protection Authority was much slower on reviewing new agri-chemical products than equivalent overseas jurisdictions (already well known) and that this is directly comparable to the relative funding allocated by successive governments (ditto). The options include reducing local reviews or increasing funding (no prizes for guessing the likely outcome). What they do not analyse (because they were not asked) is whether our environment has been harmed by any delays or what the risks are from looser processes.
The wider concern is that we do not need to spend resources on identifying our problems because the big ones are already obvious. The problem is our collective unwillingness to address them.
Just as aged care shortages and risks of agri-chemicals are well known, so are such matters as the costs of National Superannuation, the absence of wealth or capital gains taxes, poor dental care and many other aspects of public health, shortages of and inappropriate housing, water supply, wastewater and sewerage infrastructure, carbon and methane emissions, and so on. This list seems endless but it is all well known, not remotely new, and mainly housed securely in cans being kicked down a potholed road.
None of these are likely to be fixed by income tax cuts or looser (loser?) regulations. None at all by realignment of defence and spying arrangements. None by removing Māori rights or nomenclature. None by reducing public employment. None by being “open for business”. None needs another expensive report or set of “expert” advisors whose expertise is primarily based on their ideological proximity to the governing parties.
Lists of “priorities” or “targets” may assist in making politicians look busy. Anyone in business is well aware of the danger of being a “busy fool” – vigorously attacking matters that look within reach but are not the most important objectives. In my experience the bigger the list, the bigger the noise about it, the bigger the fool. Same thing applies in government.
The thing is, the really big problems require collective action, they are not the sort of things private business is likely to pick up and solve (which does not exclude private business from being involved in delivery). They also require leadership that has the courage to spell out the large-scale trade-offs involved and to prioritise public welfare over private interest.
Maybe we have had a government like that, but not in my lifetime. As the old folk song had it: “Everybody’s doin’ something, I heard it in a dream / But when it’s too much of nothin’ it just makes a fella mean”.
Consultants are just the sound of cans being kicked down potholed roads
Opinion: Sometimes you read, hear or see something presented and realise it encapsulates matters beyond its immediate scope. Often the insight is not intended. I had that experience this week on reading a report on aged care released by Te Whatu Ora.
The report was prepared by an external consultancy. (Why on earth, with the resources and relationships available to Te Whatu Ora and Manatu Hauora, was it considered necessary or appropriate to pay for an external review on a core part of their work?)
It is, of course, part of a longer review, following the foundation principle of consultancy that any report should ideally function as a job description for the next report.
This first report is a “strategic assessment” of aged residential care and home support services – a description of the current position and concerns. You may not unreasonably have thought that the various people who have for years developed policies for, monitored and funded these activities could have done this work.
If they could not, then they have no shortage of input, including plenty of recent submissions and studies commissioned by those providing such services. So, not surprisingly, what the consultants found after “engaging with the sector” was simply what was already known.
Their policy recommendations will follow but there is more than enough in their first report to make it clear that:
• There is a lot of demand for residential aged care services currently and prospectively for which the facilities, trained people and funding are not available; and
• Though the private retirement village and aged care model may deliver sufficient residential care facilities for about half of the aged population, there is simply no current model for decent levels of such care facilities for the rest.
Those responsible for the sector, turning a blind eye to these facts, comfort themselves (though not the aged) with the thought that home care will fill the gap. The latest report appears geared to buttress this view. But in practice, this pious hope ignores the realities of the available workforce, let alone the cost of delivery, the real care demands of ageing including dementia, the suitability of home facilities and the impact on housing stock. Home-based care is a vital part of a solution but it is not a panacea.
The impact, of course, is most negative on low-income and low or zero-wealth-aged people and their families. The health inequities of a lifetime are intensified in the final stages. It is all depressingly familiar across social services.
So it is a real problem but it is not new nor unknown. It must be confronted and solutions found. This is where my wider concerns kick in, and they extend well beyond wasting resources on consultants to tell us that the wet stuff falling out of clouds is rain.
The same consultant also recently found that the Environmental Protection Authority was much slower on reviewing new agri-chemical products than equivalent overseas jurisdictions (already well known) and that this is directly comparable to the relative funding allocated by successive governments (ditto). The options include reducing local reviews or increasing funding (no prizes for guessing the likely outcome). What they do not analyse (because they were not asked) is whether our environment has been harmed by any delays or what the risks are from looser processes.
The wider concern is that we do not need to spend resources on identifying our problems because the big ones are already obvious. The problem is our collective unwillingness to address them.
Just as aged care shortages and risks of agri-chemicals are well known, so are such matters as the costs of National Superannuation, the absence of wealth or capital gains taxes, poor dental care and many other aspects of public health, shortages of and inappropriate housing, water supply, wastewater and sewerage infrastructure, carbon and methane emissions, and so on. This list seems endless but it is all well known, not remotely new, and mainly housed securely in cans being kicked down a potholed road.
None of these are likely to be fixed by income tax cuts or looser (loser?) regulations. None at all by realignment of defence and spying arrangements. None by removing Māori rights or nomenclature. None by reducing public employment. None by being “open for business”. None needs another expensive report or set of “expert” advisors whose expertise is primarily based on their ideological proximity to the governing parties.
Lists of “priorities” or “targets” may assist in making politicians look busy. Anyone in business is well aware of the danger of being a “busy fool” – vigorously attacking matters that look within reach but are not the most important objectives. In my experience the bigger the list, the bigger the noise about it, the bigger the fool. Same thing applies in government.
The thing is, the really big problems require collective action, they are not the sort of things private business is likely to pick up and solve (which does not exclude private business from being involved in delivery). They also require leadership that has the courage to spell out the large-scale trade-offs involved and to prioritise public welfare over private interest.
Maybe we have had a government like that, but not in my lifetime. As the old folk song had it:
“Everybody’s doin’ something, I heard it in a dream / But when it’s too much of nothin’ it just makes a fella mean”.
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