In a speech last week, the prime minister boasted, deservedly, about Australia's performance in beating back COVID-19. Our health response has been world class, he said, bettering those of similar developed and sophisticated economies around the world. Mr Morrison observed that the mortality rate from the virus in Australia is barely 4 deaths per million people, which is remarkable.
Central to this success has been our amazing health system and the workers that operate it. Like with anything of great importance, we have our moments when we criticise aspects of our health services. At its core, however, our Medicare-based system has a mix of quality, efficiency and fairness that is hard to find anywhere else.
We need to learn from the success of our health system, because we have other public services where performance is far from world class. Here I am thinking of aged care, disability care and childcare. They are areas where federal government expenditure is soaring. In the current budget, $21.9 billion is allocated to the My Aged Care scheme, $16.3 billion to the National Disability Insurance Scheme and $8.3 billion to the Childcare Subsidy scheme. From most angles, each looks deficient. When held up against the health system, each looks a mess.
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The problem, I think, is that the aged care, disability support and childcare subsidy schemes operate with what experts call a personalisation model. This involves the distribution of federal money direct to a private provider, selected by an individual or household after a bureaucrat has conducted an assessment of eligibility and need. The major problem with the personalisation model is that services tend to be piece meal and unregulated with no attention given to the permanent presence of professionals, the training of staff, or the building of independent institutions - all key elements of our successful health system.
What you get in a personalisation model, especially, is an emphasis on low-cost labour. The Hunter region is a good example. The occupations category 'community and personal service workers' in the census includes carers in the aged, disability and childcare sectors. These workers have certificate 3 and 4 level training rather than degrees. Many have no formal training at all.
In the decade 2006 to 2016 (the last census), 'the community and personal service workers' category in the Hunter grew by over 35 per cent. This was the largest increase of any occupational category in our region. The category numbered 31,500 workers by 2016 and grows by the day, with federal expenditure on my aged care, NDIS and childcare subsidy schemes projected to total $60 billion by 2022. It's an astonishing amount, and we should be asking whether we are getting value for money.
The caring sector is populated with dedicated, hard-working people. But conditions for workers in the care sectors are often insecure and genuine career options are limited. Moreover, because there aren't enough jobs to go around in regions like the Hunter, especially for women without professional qualifications, private providers get away with employment practices that wouldn't be tolerated in the formal health system.
The quality that we expect in health care comes from the high level of professionalism in the sector. Training levels are world class, delivered by superb medical, health and nursing schools around the nation. Administrators are well-paid and impressive. They have to be because professional associations and well-subscribed unions watch them like hawks. Medical businesses - from the local GP through to giant corporations - prosper without the need for stifling regulations. Research is funded by prestigious government awards, private investment and generous philanthropy. In comparison, aged care, disability support and childcare lack most of these ingredients. In these sectors, there is little attempt to develop anything of permanence, especially the presence of a highly trained workforce.
Sure, making services for the aged, disabled and young children more sensitive to the varying needs of individuals and households makes good sense. But first you need to build a system that is durable, one with quality at its core. Australia's defence against the virus showed the merits of a health care system that prioritises training, working conditions and long term public investment. The other care sectors are lacking by comparison.
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