The Greens leader, David Shoebridge, has seized upon a scathing report from the commonwealth ombudsman to pressure the government into restoring human override to its "unfair" aged care assessment tool - using the last two sitting weeks of parliament to do so. Because nothing says urgency like a 104-page document and a legislative deadline.
The ombudsman's report, published Monday, recommends the government change legislation so that aged care workers assessing older Australians for home support packages can amend the outcome when the algorithm-driven assessment tool makes an incorrect decision on funding. Known as the Integrated Assessment Tool (IAT), it apparently leads to unfair outcomes and has undermined public confidence in aged care. Assessors meet older people, complete a questionnaire about their needs, and then an algorithm decides whether funding should be allocated, and at what level - because what could possibly go wrong when you let a computer arbitrate the complexities of human need?
"People are tearing their hair out at what's happening," Shoebridge said. "We've got aged care workers who are trying to help their clients … and the computer just says no. The ombudsman has told us now that this has been unfair from the moment it was conceived of. That it's producing arbitrary and unfair outcomes for people who are at a stage of life where they desperately need help and support." In other words, the algorithm is doing exactly what algorithms do: being efficiently, unfeelingly wrong.
State health officials were so alarmed by algorithmic changes to the IAT, introduced in November, that they kept a log of hundreds of cases where vulnerable older Australians were severely under-assessed, Guardian Australia previously revealed. Nothing says "we're listening" like a spreadsheet of failures.
In a joint statement, aged care minister Sam Rae and health minister Mark Butler said the government will "consider the Ombudsman's report carefully" and are acting on some of its recommendations. They've commissioned an independent review of how the IAT assesses and prioritises people - because when in doubt, commission a review. Of the 10 recommendations made, six were accepted and two, including instating human override for assessors and amending the aged care legislation, were noted. "Noted" being government-speak for "we'll get back to you."
"We have two more sitting weeks of parliament, where the Senate and the House of Reps can come to some arrangement and put in place a human override for aged care," Shoebridge said, presumably while checking his calendar and sighing.
Rae said a new escalation pathway had already been introduced, allowing a wrong outcome to be escalated for review by a delegate, "adding a further layer of human oversight and nuance to the assessment system." Because nothing says nuance like a bureaucratic escalation process. "Our response aligns with the principles of the ombudsman's report, allowing for human discretion to overturn assessment decisions that are not fit for purpose in a way that is fair and responsible for all older people."
Commonwealth ombudsman Iain Anderson, however, was not entirely convinced: "I think that assessors being able to change decisions because they appear to be clinically inappropriate is really important, and so I am concerned that the escalation pathway will not necessarily do that." In other words, thanks for the extra layer, but it's not the override we asked for.
An aged care assessor with more than four decades of nursing experience, who spoke to Guardian Australia on condition of anonymity, said escalation pathways are not good enough. "The delegate has not sat in front of that older person," she said. "The delegate has not laid eyes on that person. I have." She noted that while she escalates cases to a delegate who received special training, it adds time and administrative work - because nothing improves a broken system like more paperwork. She said she and her colleagues are experiencing severe anxiety and distress due to their work.
"I'm too scared to 'accept' on the algorithm's decision, but I have no choice," she said. "It feels like I'm telling the algorithm and the government, 'great choice' and sometimes I need to walk away from the computer because I can't hit the button. It's not Sam Rae or Mark Butler that then has to face the client. They're not standing there after spending hours with clients, some of them in tears, and then telling them what the outcome is. I want the ministers to come to work with me and see what is happening." A novel idea: ministers witnessing the consequences of their own policies.
She said she has become "so anxious, and I get so agonised over every question that I ask my clients, that it puts me into a situation where I'm not finishing my work on time, I'm not reaching my KPIs, I'm working weeknights and weekends, and I am considering leaving this job." Because nothing says "efficiency" like driving experienced nurses out of the workforce.
The shadow aged care minister, Anne Ruston, told the ABC's Radio National on Tuesday that "the government needs to actually put proper human override back in," describing the escalation pathway as "only a Band-Aid on a symptom." A rare moment of cross-party agreement - or at least cross-party criticism.
Independent senator David Pocock accused the government of "resisting attempts to fix a problem it created." He added: "The Senate has offered a solution, the Ombudsman has now backed it, and the government needs to explain why it's still standing in the way. The Ombudsman's findings are extraordinary, including a finding that the department responsible for designing this system didn't even understand the legal framework it had created." Which is, of course, the most human error of all.