Search This Blog

Monday, January 29, 2018

Left-Turn necessary for Labor at this year’s National Conference to end narrow ‘Policy Convergence’

by Dr Tristan Ewins ; ALP member of over 20 years

In 1998 radical American Leftist intellectual, Noam Chomsky made the telling observation that:

“The smart way to keep people passive and obedient is to strictly limit the spectrum of acceptable opinion, but allow very lively debate within that spectrum....”

Another name for this phenomenon is ‘Convergence Politics’.

In Australia there is ‘Convergence’ on the economy, with debates focusing on relatively minor differences ; but where heated debate on the so-called ‘Culture Wars’ fills the vacuum.

Every day in the mass media we are subjected to the positions of ostensibly “Centre Right” and “Centre Left” political parties.  But in reality the ‘relative centre’ has shifted way-right on the economy since the 1970s.  And dissent against that orthodoxy is minimal. Where it occurs it is modest.

The Hawke-Keating years saw convergence on ‘economic neo-liberalism’  in Australia – and there has been no significant turning back since.  Kevin Rudd attempted a Mining Super Profits Tax but was quickly ‘disciplined’ by the mining industry, and removed in short order with a ‘palace coup’.  For a time Sam Dastyari focused attention on corporate tax evasion.  But while corporate tax evasion arguably costs the Australian people tens of billions annually, in reality Dastyari’s proposals were minimal. (in the hundreds of millions)  Julia Gillard delivered a National Disability Insurance Scheme, but it was argued that  ‘savings’ had to be made elsewhere to compensate; the  logic of which was thereafter embraced more enthusiastically by the Liberals.

Under Bill Shorten Labor has committed to reforming Superannuation Tax Concessions, making some cuts in the applicability of Negative Gearing, and reforming Capital Gains Tax Concessions. ‘The Guardian’ argued in 2016 that these measures would save $100 billion over ten years.  This is substantial in the relative scheme of things ; but less impressive when you consider inflation.  Perhaps after that is factored in we’re talking about around 0.5% of GDP in a $1.6 trillion economy.

Shorten received a lot of Kudos from the Australian liberal left (for instance Fairfax journalists) for these ‘bold’ policies. But the fact these measures are considered so remarkable only underscores the reality of ‘Convergence Politics’ in Australia on the economy.

Meanwhile vigorous debate rages in the context of ‘The Culture Wars’. The Equal Marriage debate has been won.  But at a cost whereby Australia’s economic and cultural Right-wing are attempting to claim substantial Christian strata as a ‘base’.  (But this should not be taken for granted; it should be fought ; socially-conservative should not necessarily mean economically-conservative  or economically-Liberal ; nor should ‘Christian’ necessarily mean ‘socially conservative’) 

And now debate turns to the date for ‘Australia Day’ and the content of the National Curriculum – or at least how it is applied in Victoria. 

These debates are truly important. They are more than ‘distractions’.

After the ‘Australia Day debate’ the next logical step is for a Treaty with indigenous peoples.  And Conservative attempts to promote a National Curriculum which mixes Ideological Liberalism with uncritical nationalism – are deeply concerning.  But Labor’s position on the National Curriculum is also arguably too-conservative.   Arguably the National Curriculum should promote  ‘active, informed and critical citizenship.’  Which means deep and inclusive pluralism when it comes to informing students of the interests, social movements and ideological perspectives that have comprised Australian society. Here I am thinking along the lines of ‘post-Marxist’, Chantal Mouffe’s ‘radical pluralism’ , or ‘Agonistic Democracy’ ; and how those principles might be reflected in curricula.

 Nonetheless these debates are more ‘tolerable’ for capitalists and the wealthy than debates which question neo-liberalism, labour market deregulation (but no right to strike),  and ‘small government’.  (Though perhaps the debate on Education is less ‘tolerable’, here, than the Equal Marriage debate.  There is the potential to detract from narrow emphasis on ‘labour market demands’ ; and to encourage critical thinking and active citizenship which may meaningfully strengthen our democracy).  

The debates are substantial ; are not ‘merely distractions’ ; but the way public debate is presented these debates do constantly and over-the-long-term deflect attention away from a substantial, more wide-ranging debate on the economy, and especially economic power and inequality.   

Debates are also framed in such a way as to divide Labor’s traditional constituencies ; with the decline of class as a central ‘reference point’, and erroneous assumptions of ‘essential working class conservatism’ and ‘aspirational’ mentality’. ‘Political correctness’ is also regularly beaten-up in order to weaken Labor’s base via attrition.  In response Labor needs policies and language which promote social solidarity.

But anything which truly questions ‘Convergence’ is summarily dismissed as ‘Hard Left’.   Outgoing Labor President Mark Butler has made welcome demands for internal democratisation . But his description of British Labour’s Jeremy Corbyn as ‘Hard Left’ is regrettable. Corbyn is trending towards something more ‘traditionally social-democratic’ ; and has plans for railroad and utility re-nationalisation  that would ‘set a precedent’ whereby decades of privatisation are not necessarily permanent.  The policies are progressive, but not radical ; and Butler’s dismissal of Corbyn shows that ‘Convergence thinking’ still has a strong grip even within the ALP Left.

What would a ‘break’ from Convergence Politics look like?  The author of this article has been working on an updated  (unofficial)
“Model Platform” for Labor (currently in draft form) which is suggestive of a genuine reform footing for the ALP.  As a democratic socialist my long-term aim is the eventual surpassing of capitalism with a truly fair, rational and democratic economy. But even Marx understood that the transition from feudalism to capitalism took centuries. (though Marx did think socialist revolution a nearer prospect at the time)  And now there is the likely prospect ‘a clear and genuine break’ will not occur in our lifetimes.  Though the prospect of further crises and economic convulsions is nonetheless real.  Perhaps ‘barbarism’ is the more-likely prospect ; though we have to fight.

On the other hand, many on today’s Left still look to the Nordics for inspiration.  The Nordic model may not have ‘abolished’ capitalism ; but what some see as ‘the end goal’ is not everything. Billions of people will live in the context of historic compromises we fight for over the decades to come.  Their security, opportunities and happiness truly mean something with or without the over-arching capitalist context.  Yet sadly most in the Labor Party have not supported policies which meaningfully progress Australia towards something ‘Nordic-inspired’. 

The ‘ALP Model Platform’  (otherwise ‘For an Equal and Democratic Australia’) , suggests a short to medium term orientation, which breaks with ‘convergence thinking’, and has the meaningful aim of reaching the OECD average Tax to GDP ratio over as long as three terms of Labor Government.  That means raising progressive tax by $80 billion/year in today’s terms, or 5% of GDP.  (keep in mind the economy is worth over $1.6 Trillion)  It falls far short of the Nordics. (perhaps over $300 billion/year would be necessary) But it is suggestive of meaningful and substantial progress. (no more ‘one step forward, two steps back’ ; ‘the forward march of labour re-commences’)

What this means is substantial progressive restructure of Australia’s tax mix ; funding big improvements to the social wage, welfare, public provision of infrastructure.  It also means National Aged Care Insurance ; slashing hospital and public dental waiting lists ; industrial rights and liberties including a ‘re-regulation’ of the lower end of the labour market which delivers to the working poor ; strategies to improve life expectancy for indigenous Australians and the mentally ill ; progress towards free higher education ; support for mutuals and co-operative enterprise – with strategic public ‘co-investments’ which help these maintain the scale necessary to remain competitive ; an end to insufficient and ‘punitive’ welfare ; a big investment in public housing ; and much more.  These are central to the ‘ALP Model Platform’: a document intended to influence debate leading up to Labor’s National Conference this year in July 2018.

Those who want to support the Model Platform can ‘Like’ the ‘ALP Model Platform Supporters’ Page’ at Facebook and take part in debate there.

Labor has long been a ‘broad church’ with its own ‘internal pluralism’, and that is not likely to change.  But Labor should straddle the political ground across ‘traditional’ social democracy to democratic socialism ; and arguably there is also a place for what may be called ‘classical’ social democrats.  (radicals inspired by the original (largely Marxist) social democratic parties ; and those who followed in their wake)

Arguably a  strong radical-left can also contribute to the climate of culture and public opinion as well.  The Communist Party of Australia never had serious electoral success.  But it was a cultural and industrial power.  Ultimately it broke with Stalinism, also ; and in many ways that legacy is important and valid. 

In the US, Democratic Socialists of America (DSA) has been registering impressive gains in membership. They intervene within the Democratic Party ; but at the same time they are more broadly-based. They demonstrate how a Left movement can be a cultural, political and electoral force ; but not be restricted to a single electoral strategy.  DSA includes radical perspectives, but are not narrowly Leninst.  Perhaps a similar strategy could also ‘bear fruit’ in Australia ; with a strong challenge against ‘Convergence’ – which all progressives should agree has to end.

The ‘ALP Model Platform' Supporters’ Page can be found here: (PLS Join!)

The current draft of the Model Platform can be found here:

Please join the supporters group ; and get like-minded friends to join if you support a strongly-progressive but realisable platform for the ALP.

Monday, January 15, 2018

The State of Aged Care in Australia Today - by Sharyn Ladiges

by Sharyn Ladiges  (ALP member and activist)

It’s been 20 years since the government brought in the Aged Care Act 1997 to deliver a new model of care for older Australians who could no longer live at home and required assistance with daily tasks. The act aimed to facilitate choice and independence for the elderly, and direct services to those with the greatest needs.

But the legislative change also coincided with an era of advanced ageing and more complex needs in our elderly.

People who had previously entered low-level residential aged care (then called hostels), are now cared for in the community. Once they enter aged care, they’re older and sicker than before, and have more complex needs. Since 2008, the number of older Australians admitted to a residential aged care facility has remained steady, but the proportion of people with high-care needs has progressively increased.

Older and sicker Australians

Currently, around half of people living in aged care have dementia, depression, or another mental health or behavioural condition. The proportion of older people requiring high care for complex needs, which includes assistance with all activities of daily living such as eating and bathing, has quadrupled from 13% in 2009 to 61% in 2016.

When the act was introduced, more emphasis was placed on supporting older people to remain at home for as long as possible. Now, the transition to permanent care only occurs once all options have been exhausted. The needs of the elderly population often outgrow the available community aged care support. This then requires an admission into one of Australia’s 283,000 (subsidised) residential aged care beds. As a result, our aged care facilities are increasingly functioning as hospices for the frail elderly with complex care needs.

The main flaw of the act was to repeal the legal requirement for all aged-care facilities to provide 24-hour registered nursing care to assess and manage resident’s changing clinical needs, wounds and unrelieved pain. So residents have minimal access to this. Too few have access to the necessary help from a geriatric medicine specialist (doctor), psychologist or social worker. And their families have minimal access to psychological and social support, and bereavement follow-up.

Why was the act introduced?

The 1997 act replaced two outdated and confusing 1950s laws to create a single statutory framework for Australian aged care services. It detailed the responsibilities of aged-care operators in relation to quality and compliance. It also empowered the relevant minister to set out principles covering matters such as quality of care, accountability and user rights.

The introduction of the act fuelled a much-needed capital works program funded by low interest bonds from older people entering residential aged care. This was meant to make aged care facilities more home-like, while also meeting care needs.

A major achievement of the act has been the amalgamation of hostels (social care accommodation for older people) and nursing homes (frail aged accommodation with 24-hour nursing care) into a single, user-pays regulated system. Now, people live in one institution, but are classified as having either low-care or high-care needs.

This was to provide older people with an opportunity to “age in place”. So, to have a seamless transition into higher-level care as lower-level physical care needs intensified; and to ensure people living in an aged care facility received all of their care needs in one location.

Major pitfalls of the act

The act’s repeal of the legal requirement for 24-hour nursing care reflected the social model of care underpinning the legislation. The idealistic yet impractical philosophy took the focus away from nursing and medical care. So now, the bulk of personal care is provided by a pool of untrained and unregulated aged-care workers supervised by a very small number of registered nurses.

Registered nurses employed in aged care are central to assessing, planning, monitoring and delivering complex care to older people living in these facilities. But there are too few registered nurses (and they are often managing the facility) so they have limited capacity to ensure the older person’s function, comfort and dignity is optimised, their mobility maintained and dependence minimised.

These skilled nurses also have few opportunities to ensure the resident’s family members receive the appropriate level of psycho-social and spiritual support they often need. Primarily because they’re dependent on the unskilled workers alerting them to changes in the resident’s condition or the families concerns.

Aged care facilities lack the clinical infrastructure of our hospitals. So, if a registered nurse is not on duty, there are few people the unskilled care workers can call for timely clinical review.

If the GP can’t be contacted and the registered nurse is not on duty, an ambulance will be called and the frail older person will be transferred to hospital for assessment.

What needs to happen

Numerous inquiries have highlighted the need for a skilled aged-care workforce to ensure older Australians have access to the level and quality of health care they deserve. These health care gaps persist largely because the act’s principles, while possessing the status of law, are not subject to the same parliamentary control and public accountability.

A new nursing skill mix model is urgently required in aged care to address the level of unmet health care needs. At a minimum, the act should be amended to stipulate appropriate staffing requirements for the delivery of direct clinical care, including the presence of at least one registered nurse at all times. As part of the skill mix, a higher ratio of registered nurses and enrolled nurses supported by a team of care workers is required.

The availability of a nurse practitioner, with advanced training and prescribing rights, and a geriatrician to all aged care facilities would do much to improve timely access to medical care. It’s also likely the addition of this tier of health professionals into aged care would reduce the need for unnecessary emergency department presentations. These are often distressing for the resident and their family, as well as being costly to the system.

Unfortunately, the act fails our most vulnerable members of society and their families by not providing them with the skilled nursing, medical and allied health care they require in their last year, weeks or days of life.

Afterward (by Dr Tristan Ewins, blog publisher)

Sharyn Ladiges
has described the evolution of the Aged Care sector very well, and has made a compelling case for "a new nursing skill mix model" which would include a registered nurse on site at all times.  This has long been a core demand of Aged Care workers, nurses, and families. Also broader 'staff to resident' ratios are necessary to ensure all residents in high intensity care receive the care they need ; including regular turning to prevent bed sores and so on.

Arguably, though, we could do with a National Aged Care Insurance Scheme model involving relatively comparable resources as the National Disability Insurance Scheme  - but hopefully learning from any problems which have been experienced in the implementation of that model.  This would provide comprehensive services for all in need of any kind of aged care: ageing in place ; low intensity residential care ; high intensity residential care...

Firstly we need to get rid of user pays: for both high intensity and low intensity Aged Care (and 'ageing in place') ; and fund fully from progressive taxation.  User pays mechanisms have often been onerous ; have forced the sale of family homes ; have weighed relatively heavily on some working class households.   Aged Australians from all kinds of backgrounds should have access to the same very high quality Aged Care services as one another ; where no-one experiences relatively inferior quality care on account of socio-economic background.

Secondly we need to ensure *happiness* and mental health as well as physical health.  This means ensuring social and intellectual engagement for people of a variety of backgrounds and interests.  It could mean outings ; forums ; access to information technology ; creative and artistic activities ; listening to or even playing music ; mediated discussions ; access to books ; reading and discussing the papers, current affairs, the news ; watching and discussing films, and so on.  This needs to be addressed in both low and high intensity care, and for those 'ageing in place'.  Perhaps more effort and resources need to be put into addressing loneliness amongst those 'ageing in place' alone as well.  High quality food needs to be ensured for all as well ; as does privacy; and access to pleasant surroundings - eg: gardens ; where possible sunshine ; and so on.

Finally , we need to be taking a close look at the 'for profit' part of the residential aged care sector.  Private providers should not be gouging residents and families ; and the sector needs to be thoroughly regulated to prevent 'short-cuts' and so on to reinforce 'bottom lines'.  We need more emphasis on the state sector and on 'not for profits' ; and subsidising these to ensure the highest quality care for everyone.

Thanks again to Sharyn Ladiges for her informed overview of the development of the sector and the issues it faces today.