Getting it right on time, place and care

There’s a lot of focus these days on how much various parts of the care system cost taxpayers; and rightly so. But should productivity in the care economy be defined as ‘more services per dollar’ or as ‘fewer crises per life’? The Productivity Commission’s 2025 interim report, Delivering Quality Care More Efficiently, has me wondering.

There are no surprises in the report. Australia’s care system (aged care, disability, veterans’ services and early childhood) is inefficient. Providers face separate audits that check for the same things, workers go through different screening schemes for similar work, and data is spread across regulator portals that don’t talk to each other.

The commission’s recommendation is for more alignment: one-worker screening checks, mutual recognition of audits across aged care and NDIS standards, and a standardised quality and safety reporting framework and data repository so information can be collected consistently across sectors. All very worthy objectives in my book.

But does alignment solve fragmentation? People don’t live their lives neatly within a single program. Over time, most of us will touch more than one part of the care system (childcare, disability supports, hospital care, aged care, etc). Each has its own rules, funding streams and reporting requirements. These systems don’t talk to each other, which means repetition, multiple assessments and services that don’t line up. At a systems level, it’s hugely inefficient. At an individual level, it can be hugely traumatic.

As Amana Living chief executive, Stephanie Buckland, told attendees at the recent Business News Future of Aged Care Sector Briefing event, what we should be aiming for is “right care, at the right time, in the right place”. If that doesn’t happen, one part of the system fails and the burden is pushed onto another. For example, if there isn’t enough care or support at home, pressure builds on hospitals as people fall ill or hurt themselves. That’s more expensive for governments and worse for individuals.

A single regulator might streamline regulation, but it doesn’t fix the lack of integration that makes the system inefficient for the people who rely on it. The interim report does acknowledge this. It recommends ‘collaborative commissioning”, starting with health. Local hospital networks, primary health networks and Aboriginal community-controlled health organisations would, in an ideal world, plan services together, share data and pool funding.

The aim is to reduce fragmentation, fill service gaps and cut preventable hospitalisations. It’s a practical way to join up services around people rather than programs, even if the initial focus is quite narrow. The report also proposes a national prevention investment framework, recognising that prevention is cheaper and more effective than cleaning up after crises. These are the reforms that could genuinely integrate care, building a system that works around people rather than institutions.

Again, the philosophies behind these initiatives are neither new nor controversial. However, they do appear to receive less focus in the report than ‘regulatory alignment’; perhaps because integration means tackling the blurred lines between state and federal responsibility.

Health sits with the states, the NDIS is national, aged care is Commonwealth run and prevention falls somewhere in the middle. No level of government wants to bankroll services if the savings fall to someone else.

As Ageing Australia chief executive, Tom Symondson, pointed out at the Business News event, that’s why collaborative commissioning always seems to stay stuck in pilots, and prevention never quite makes it out of the framework stage. While everyone acknowledges integration is the answer, there’s less agreement in terms of who pays for it or who gets to claim the benefits. By contrast, regulatory alignment is much easier.

Is this the blind spot, though? Productivity in care won’t come from harmonising audits or consolidating data alone. It will come from integration: joining up health, disability and aged care so people experience one system, not three. This would mean, for example, data would actually follow the person, funding could be pooled across programs, and a prevention-first approach could be developed that rewards continuity rather than crisis. As one of my esteemed colleagues likes to say: “You can’t make a string quartet more productive by making them play faster.”

Care is the same. You can tidy up regulation all you like but it won’t fix the fragmentation that wastes resources and ultimately puts people at risk. Real productivity in care comes when the system itself works as a whole. That will only happen when governments stop passing the responsibility parcel and decide who is actually in charge.

Disclaimer

The information contained in this publication does not constitute legal advice and should not be relied upon as such. You should seek legal advice in relation to any particular matter you may have before relying or acting on this information. The Lavan team are here to assist.