Minister Shorten Press Conference on NDIS Participant Hospital Discharges, Medicare and Stuart Robert Investigation


SUBJECTS: NDIS participants medically fit for hospital discharge reduced wait times, Medicare, Stuart Robert investigation

BILL SHORTEN, MINISTER FOR THE NDIS AND GOVERNMENT SERVICES: One of the big issues that the Albanese Government promised to tackle upon election was getting people who are participants in the National Disability Insurance Scheme who are patients in hospitals - people who are medically fit for discharge but unable to be discharged because there was nowhere for them to go. Too much red tape. This was a significant problem.

I'm pleased to say that the average waiting time has dramatically fallen between when an NDIS participant who is medically fit for discharge is now able to be discharged and go to accommodation.

It was estimated in Victoria at the time of the election that a person with profound and severe disabilities who was eligible for the NDIS and was medically fit to be moved from hospital was waiting 160 extra days on average.

The December numbers reveal that now the average waiting time across Australia is now 33 days. This is still too long. But to put it in terms which I think make it relevant to all Australians: first of all, if you're a profoundly disabled person and you’re medically fit to be discharged from hospital, hospital is the last place you want to be.

It's not good for your welfare, it's not good for your health once you’re eligible to be discharged. Also, it's costing on average taxpayers around Australia two and a half thousand dollars a night for a patient who was fit to be discharged to be kept in hospital. Not only was this a horrendous cost for the taxpayer, it was leading to bed locks in a hospital system.

But I'm pleased to say the December numbers, the monthly numbers, reveal that the 160 day waiting time, which was reported prior to the election, is now in December, now 33 days. This is fantastic news for the literally hundreds and hundreds of people who have been able to be discharged. And of course, when you reduce the numbers of people in hospital, you free up hospital beds, you're reducing the cost to the hospital system of literally hundreds of millions of dollars over the last few months. So some good news as we start January.

One of the pressures on bed block in our hospitals, one of the pressures on the health dollar and most importantly, one of the pressures on the welfare of the family of disabled people. The news is getting better, not worse, which is a great way to start the New Year, as we intend to further reform the NDIS for people with disability and provide value for them and for taxpayers. Happy to take any questions.

JOURNALIST: Do you have the figure of how many NDIS participants across the country are ready to be discharged?

SHORTEN: Yes, that number, the number of people in hospitals who are eligible for the NDIS varies. It's gone up in recent months. That is, the number of people eligible for NDIS going into hospital, being hospitalized. In December its 2792 people with disability hospitalized. And of that less than 50% now are waiting to be discharged when they’re eligible to be discharged. And many of them have now got their plans and are able to be discharged.

JOURNALIST: Why is the wait times down?

SHORTEN: As Minister, I have appointed 54 people in the National Disability Insurance Scheme who are specialists working with hospital rehab teams. There used to only be about 28, 29 of them. So we've almost doubled the number of wranglers.

When someone has a profound disability this is a major, profound change to their lives. If you've had a catastrophic stroke in your forties, if you've been in a cataclysmic injury, could be a sporting injury or could be a, you know, some sort of quadriplegia or what happens is your life changes in a very dramatic fashion.

So when you get ready to be discharged, we've got to first identify that your condition has stabilized, that you no longer need hospital treatment. Then we've got to work out where you live and there's a problem emerging: there's just not enough housing.

But you've got to perhaps, ideally if you can move back to your own home, we've got to modify your house. Depending on the level of care you're required, you’ve got to put a team of carers in place. There's a lot of hospitals around Australia who are working on these issues. There's a lot of very good allied health clinicians.

What has changed since the election is that we've now doubled the resources that we're putting in from the National Disability Insurance Scheme to help pull it together, get a person a plan of care, home modifications in appropriate housing. Each individual is different, but by giving them priority and attention, we've managed to reduce the number.

There's still plenty of people in hospital and we need to do more. But it's a good start to the year based on December's numbers.

JOURNALIST: How will the government go about reducing the wait time even further?

SHORTEN: What we found is that there’s several causes for why someone is stuck in hospital when they don't need to be stuck in hospital. One was that our predecessors in the Disability Insurance agency was just simply taking too long. It was a series of single decisions. “Oh has the person, has their condition stabilized?” Then when it’s stabilized, then we would send a planner to talk to them about where will they live. And then once we've identified where they live, then we would ask the question about how many carers will they need. Literally, it was a series of single decisions. By putting more wranglers the other thing we've done more people to work with hospital staff who have been doing this for a hundred years.

What we've also done is delegated authority. What we were finding under the old system is that a person might know what needs to be done with, you know, the people at Alfred Caulfield, for example, you know, the Perth Hospital or the Brisbane Hospital or Canberra Hospital.

What was happening is that they didn't have the authority to authorize the right wheelchair or they didn't have authority at that local level to say, right, let's get the home mods. If we need a ramp, if we need to adjust the shower or, you know, the sort of things which are just necessary for living. What was happening is every decision would have to be referred up and up and up in a bureaucratic game of chasing your tail. So we've given more power to the hospital teams and the local wranglers, and we've also cut down the red tape and time.

But now we are finding that in order to reduce the numbers further, States have to step up and provide more social housing. I know the states are complaining about bed block. We're doing our bit for people with disabilities to reduce the bureaucracy at the federal end, but we do need more housing, more appropriate housing, and that's the next challenge for 2023.

JOURNALIST: Is there a number on, given the far fewer number of days spent in hospital beds in the delayed setting, adding up all those days and how much hospital activity that amounts to and therefore how much money saved by State governments?

SHORTEN: It is possible to do some back of the envelope calculations. For every hundred people that we can reduce that saves hospitals around Australia on average two and a half thousand dollars. So for every hundred people reduced every night, that's saving our health system two and a half million dollars. So that's every night. So if you can reduce the waiting time by 100 people and reduce the average waiting time by 100 days, that's $250 million we're saving the hospital system.

JOURNALIST: Over the period in which this delay has been shrunk, do you know how much it amounts to because of the success you've had? 

SHORTEN: It started to shrink after a change of government. We found that our predecessors didn't measure it. Part of the problem with health care and disability care in this country is sometimes the States say, “oh, that's the Federal Government's responsibility.” And then other times the Federal Government say “that's a State responsibility.” People are sick of the sort of each way blame game. And at the end of the day, it's a person with a disability who's not defined by living on the run by the state or the feds and it's a taxpayer’s dollar. It doesn't matter if it's going to the State or the Federal Government. It's still, at the end of the day, a taxpayer dollar. So by putting more wranglers in, problem solvers, by giving them more delegated decision making, I have no doubt – I can't quantify down to the last dollar and cent – I know this is saving State hospitals hundreds of millions of dollars and that's just good for everyone. And it's also, most importantly good for a person with disability

JOURNALIST: There’s been a lot of talk about Medicare today. Should more Medicare or more of the Federal Government $750 million be spent on primary care?

SHORTEN: So using multi-disciplinary teams, I think that you find that Minister Butler and indeed the whole Albanese Government is committed to more primary care. The States make a good point that we need to have more attention on primary care. The reality is that it has been a neglected area. It's axiomatic or it's common sense and I'm sure everyone would nod their head in agreement that first of all, if you can invest in preventative health, that no one needs to see the doctor, but it is far better to invest in primary care where you can deal with the issues before they become secondary and tertiary issues and require hospital attention.

So the Federal Government has taken steps to create a fund to help assist with primary care. I've got no doubt that'll be one of the areas for reform. And now last week the Federal Government and State Governments talking to each other rather than just saying its someone else's fault. What's great about the NDIS is that it is helping reduce what we're doing and these December numbers show that Federal Labor, and the Albanese government, is reducing bed block in State hospitals, which has a down payment or a dividend not only for the patient but for the taxpayer.

JOURNALIST: Can I just clarify, has there been a drop in the number of people medically fit for waiting to be discharged?

SHORTEN: There has been an absolute drop in the number, but of course, as the number of people who go into hospital increases, inevitably the number of people who are medically fit for discharge and still waiting increases slightly. But as a matter of fact, there's been an absolute drop from May to now.

But what's also interesting is, say in June, when we first started measuring this, there were 2375 people who were NDIS who were in hospital, and 1450 of them were medically fit for discharge. As of December there's now 2800 people in hospital who are NDIS relevant and 1300 of them are medically fit for discharge. So there's been a drop in absolute numbers, but it's even more significant when you look at the proportion, the number of people who are NDIS in hospitals because of COVID and RSV and seasonal conditions, the numbers increased. But the absolute number of people who are fit for discharge are still stuck in hospital is still below what it was that we inherited.

JOURNALIST: The Stuart Robert investigation – has that preceded at all?

SHORTEN: Yes the two agencies, Services Australia and the National Disability Insurance Agency, independently of the Government, have commissioned Mr.Ian Watt to do an investigation. Which I'm not aware of the progress of the matter. It shouldn't take forever and we'll see what happens. We'll find out what is happening and the propriety or otherwise of what's transpired under the last government. Mr. Robert and Synergy 360, the lobbying company.