This past week I have had the privilege of being a guest of the Australian Aged Care Providers Association. As well as being able to take part in speaking and workshops at their National Conference with over 2400 delegates attending, I’ve also been honoured to spend time visiting care and support facilities and projects in the area around Adelaide.
It’s been very insightful, and I want in a future blog to share some of what I discovered about how Australia is tackling issues facing aged care in remote and rural communities and whether there might be things we could adopt and adapt here in Scotland.
But without a doubt the most dominant topic of conversation during my seven days away has been what has recently occurred at the political level in Australia around health and social care.
In Scotland, the conversation around health and social care reform is urgent and vital, and there is no shortage of diverse opinions but it is often overshadowed by political squabbling as evident even in the last few days. Whether it is discussions about the National Care Service about which the Green Party will take a decision today or proposals to address workforce challenges including discrete approaches to immigration, these debates quickly devolve into party-political contests.
Along with many others I have stated before and am more than ever convinced having spent time in Australia that meaningful, sustainable reform of our health and social care system requires collaboration across the political spectrum. Such comment has been dismissed as utopian and folks have said to me it’ll never happen. But it can and I’m suggesting it should.
The recent experience in Australia – both with its Aged Care Act of 2023 and the ongoing 2024 reform, I believe, offers us an instructive example of how we can depoliticise health and social care reform and delivery and focus on the needs of people rather than the priorities of political parties.
The Australian Approach: A model for consensus
Australia’s aged care sector had long been in crisis, but it took the Royal Commission into Aged Care Quality and Safety to bring about comprehensive reform. The Commission’s recommendations resulted in the Aged Care Act 2023, which was a transformative piece of legislation. Central to its success was the bipartisan approach that Australian politicians adopted. After the release of the Royal Commission’s findings, the reforms were not treated as political capital for upcoming elections, but as a national imperative requiring cooperation.
In fact, the introduction of the new Aged Care Bill in 2024 was hailed as a rare instance of bipartisan commitment to long-term social care reform. Both the government and opposition worked together to craft a legislative framework that focused on the rights and dignity of older people. The Bill was designed to address systemic issues in funding, workforce support, and governance, with the shared understanding that reform was needed urgently. It is an ongoing process, and it is not quite over the line and the impressive Aged Care Minister addressed the conference and committed to robust partnership working with the care sector and those who use care supports. But there have already been massive strides including a huge eye-watering commitment to the workforce to increase terms and conditions, which has meant billions of additional resources committed to care and support.
In Scotland, we are at a similar crossroads. The need for reform is acute, but discussions around the National Care Service (NCS) have been mired in party politics and at present seem to be struggling and bogged down.
While every party and interest group including COSLA and the trade unions as well social care providers offers its version of how the care system should be funded and governed, the fundamental issues remain unresolved, and the people who rely on these services are left waiting. In the meantime, care workers continue to face burnout, residents in care homes lack the adequate resourcing of their care they deserve, and families remain uncertain about the future of social care provision in the community as homecare organisations struggle to continue.
Australia’s example shows us that progress is possible when political parties stop treating social care reform as an election battleground and instead commit to long-term solutions. There is a real need to bring all stakeholders – including politicians, care providers, workforce representatives, and, most importantly, the people who use these services – into the conversation.
Depoliticising reform: what can we learn?
- Independent Commissions:
One of the reasons Australia’s reforms succeeded was the establishment of the Royal Commission, which provided independent, apolitical analysis of the problems facing the aged care sector.
Some might suggest that the Feeley Report was our Commission and indeed it garnered a lot of consensus when it was published. I don’t really think we need a Royal Commission as is being proposed in England – what we lack is political agreement on how you embed the proposals and vision of Feeley because I simply don’t think that is on the table at the moment. We have lost the collective vision at the hands of party political priority.
- Bipartisanship:
Australia’s aged care reform was achieved through bipartisan negotiation. In Scotland, we must find ways to depoliticise care discussions by focusing on shared goals rather than divergent ideologies. Political parties in Holyrood must come together to agree on fundamental principles for health and social care reform. This may mean embracing ideas from across the political spectrum if they benefit the people who rely on these services and those who work in and deliver them. Those who work in and use care and support deserve real political leadership and a failure to come together and gain bi-partisan agreement will be a betrayal of the social care community and will not be soon forgotten. This is too important an issue to be kicked into the long grass, ignored or indeed fought over in a Holyrood playground.
- Stakeholder-Led Design:
The success of Australia’s Aged Care Act also rested on the involvement of a wide range of stakeholders. In Scotland, it is essential that any future reform is designed with the input of the people most affected – those receiving care, their families, and the workforce and employers. We have palpably failed to achieve this thus far because despite the warm rhetoric of embedding design approaches stakeholder engagement has been partial and non-inclusive. We cannot afford to continue to have reform designed by civil servants and politicians.
The inclusive Australian approach has ensured that the reforms are not only effective but also respected by those on the frontlines of care delivery.
- Long-Term Vision:
One of the issues plaguing Scottish social care reform is the tendency for short-term fixes based on political cycles. Australia’s reforms, while still unfolding, have aimed for a long-term vision of sustainability. By creating a framework that stretches beyond electoral timelines, Australia has demonstrated that meaningful change takes time but is worth the investment. The fruit is already evident even within months of change – workforce retention has improved, and recruitment has become easier because people can see that they are respected and valued maybe for the first time as a key economic sector in Australia. Scotland’s care system, like Australia’s, must be built for the long haul, with consistent funding, workforce support, and regulation designed to last for decades, not just until the next election.
Rebuilding Trust in the System
Australia’s reform process has also been about rebuilding trust in the system. The Aged Care Act of 2023 included provisions for better oversight, accountability, and transparency – elements that were critical in restoring public confidence. Scotland faces a similar challenge. Years of underfunding, mixed messages, and inconsistent policies have eroded trust in social care provision. We need clear, transparent policies that offer stability to those who rely on these services, those who work in them and those who provide them.
In conclusion, as we look to the future of health and social care in Scotland, we must be willing to take party politics out of the equation. Reforming our social care system to say nothing of the NHS, is not about winning elections; it is about ensuring that every person, whether receiving care and support or providing it, is treated with the dignity, respect, and support they deserve. Australia’s experience shows us that bipartisan, human-centred reform is not just possible – it is necessary. Scotland must follow suit and commit to depoliticised, evidence-based solutions that put people at the heart of our care system.
What do our politicians say? Are they brave enough to let go the levers of power, both local and national, and to allow a wider conversation and control? Or will we continue to squabble, disagree and dissent?
Donald Macaskill