The Royal Commission into Aged Care Quality and Safety was supposed to deliver a pathway to better care for older Australians.
But that path just got a little more bumpy.
We knew there was some division between the two commissioners.
The final report, released on Monday, shows just how deep that division goes.
Who are the commissioners?
Lynelle Briggs, a former chief executive of Medicare and previously a public service commissioner, was named a royal commissioner in 2018.
Western Australian judge Joseph McGrath was named alongside her. But within two months, he had stepped aside due to family reasons.
Richard Tracey, a former Federal Court judge, was named to replace him, but died in 2019.
By that stage Tony Pagone, another former Federal Court judge, had joined as commissioner.
Ms Briggs and Mr Pagone produced the report that was released on Monday.
How were they divided?
The report covers eight volumes and is still being digested by experts.
But it’s clear Ms Briggs and Mr Pagone were far from agreement on many issues.
There is the big stuff, like the creation of a new statutory agency — the Australian Aged Care Commission — put forward by Mr Pagone, but not supported by Ms Briggs.
Instead Ms Briggs recommends the Department of Health takes on responsibility for the sector, including major internal changes, and adds “and Aged Care” to its name.
Ms Briggs was critical of Mr Pagone’s suggestion.
“In addition to the cost and inevitable delays in setting up a new body, I am concerned that the creation of a new, arms-length Commission to oversee the delivery of aged care services would weaken the direct accountability of Ministers for the quality of aged care,” she said, also suggesting the new body will lead to “dysfunctional governance”.
But Mr Pagone disagreed.
“The independence of the Commission will mean that it can give undivided attention and focus to its task of being an effective system governor of aged care,” he wrote.
They also disagreed about how means testing should be applied in order for people to qualify for government assistance.
There’s also the small stuff.
Across 148 recommendations, there were 43 points of disagreement between the two commissioners.
Ms Briggs made 29 independent recommendations or sub-recommendations, and Mr Pagone 14.
And some divisions seem relatively minor.
A new primary care model was wanted by both, but Mr Pagone wanted it trialled for 6 to 10 years first, while Ms Briggs wanted it implemented immediately.
They even disagreed on how the proposed Aged Care Research and Innovation Fund would allocate research funding.
Why is this so significant?
Many parliamentary inquiries produce dissenting reports.
In fact, it’s a common way for different perspectives to be recognised and considered in the development of public policy.
But royal commissions are typically large, expensive, definitive inquiries on an issue, setting out a clear agenda for government reform.
This one took more than two years and cost $92 million.
That there are disagreements over the best way forward means there might be delays in implementation as the government considers its preferred option.
The government has tried to counter the risk of delay by announcing an immediate investment in the sector.
But as many continue to suffer in the aged care system at the end of their lives, even one day’s delay means Australians are likely to die in substandard care.
What happens now?
Prime Minister Scott Morrison would not be drawn on which commissioner’s model he favoured, saying they had each “pored over this, heart and soul, for years”.
“I’m not surprised that … in coming to understand what the way forward is there’ll be difference of views,” he said.
The next stage is for the government to provide a response, but Mr Morrison warned reform would take years.
Ian Yates, the chief executive of Council on the Ageing Australia, said the split “indicates the complexity of this public policy issue”, but said he hoped it would not delay reform.
“There are not two different destinations — the royal commission has said to the government, this is where we need to get to,” he said.
But the federal opposition fears the division will slow progress.
“I would be so angry if the government used that as some sort of excuse not to engage in proper reform,” Shadow Aged Care Services Minister Clare O’Neil said.
“That would be just continuing this record of eight years of neglect and funding cuts, that have got us to the point where we are today.”