Government under pressure to drop aged care algorithm after Four Corners report

Audrey Staniland, 96, had her support reassessed by the classification algorithm. (Four Corners: Ron Foley)

In short:

Pressure from across the parliament is mounting on the government to ditch the algorithm used to assess older Australians for at-home support packages after Four Corners shed light on how the tool works.

The federal opposition says the government has the support to pass changes through the parliament immediately.

What's next?

Health Minister Mark Butler said the episode featured "confronting" stories, but continued to defend the tool as leading to more consistent outcomes.

The federal government is standing by its controversial aged care algorithm, ignoring an offer from the opposition to provide a path through parliament to immediately fix the assessment process at the centre of hundreds of complaints.

Pressure is mounting on Labor over the algorithm after this week's Four Corners investigation, with the Coalition, Greens, independents and some Labor backbenchers, who did not want to be named, demanding the algorithm be either scrapped or urgently fixed.

Shadow Aged Care Minister Anne Ruston secured support when she introduced the bill in the Senate, aiming to overhaul what she labelled a "cruel tool" used to determine how much funding Support at Home recipients received by adding the ability for a human to override assessments.

While the Integrated Assessment Tool (IAT) involves input from clinicians filling out a questionnaire about the older person, controversially, assessors cannot override the algorithm's final decision on a participant's funding.

Anne Ruston says there is no evidence to prove the tool is working. (ABC News: Matt Roberts)

Experts, doctors and aged providers have all raised problems with this, including Australia's pre-eminent expert on health care algorithms, Kathy Eagar, who told Four Corners the algorithm needed to be completely ditched.

Last week, the Coalition criticised Labor for shutting down debate on the bill when it moved to the lower house.

"Labor could put human override back into aged care assessments today, by passing our private senator's bill in the House of Representatives," Senator Ruston said.

"Instead they blocked it even being debated, despite the fact it was supported by the Coalition, the Greens, and the crossbench."

Despite acknowledging there had been "confronting" cases, the government is resisting calls to allow human override, insisting the system is working quickly, fairly and has led to only a small number of review requests.

In the first five months of the algorithm's use, more than 1,000 people have asked for their outcome to be reviewed, with 207 people successfully receiving a reassessment.

Four Corners reveals the fullest picture yet of the secretive algorithm affecting the lives of tens of thousands of older Australians and their families.

Labor has previously announced it would set up a new "escalation option" so people in "extenuating circumstances" could request their outcome be changed, after the ABC first exposed concerns about the algorithm in March.

Legislation to enact the escalation option has not yet been introduced.

The government is also reviewing the priority system used to determine how quickly someone receives their approved funding, but is not looking into the classification algorithm.

Senator Ruston said what had been announced was not good enough.

"We need more than a so-called 'rapid review' into just one aspect of the faceless algorithm," she said.

"Just as Professor Kathy Eagar AM says, the assessment algorithm is beyond repair, it needs throwing out and starting again.

"Until the government commits to that, older Australians cannot have confidence they will get the care they need."

Crossbenchers slam algorithm in joint statement

Monday's episode of Four Corners also prompted a Greens motion in the Senate calling on the government to replace the IAT with a system that "reinstate[s] the ability for human override".

The motion was backed by the Coalition and crossbenchers, including from the Greens, One Nation and independents.

"We know that this … tool is consistently under-assessing older people's care needs, and we know from the answers that the minister continues to give, that the government is not fully alive to the issue," Greens senator Penny Allman Payne told the Senate.

Senator Ruston said there was "not one piece of evidence" to suggest the tool was working.

"A cruel tool, that this government refuses to acknowledge, is causing older Australians to die unnecessarily," she said on Tuesday.

Independent MP Andrew Wilkie said his office had been contacted by "perplexed and distressed" older Australians struggling to understand the outcomes.

"If the minister thinks this tool is working well, he has his head in the sand," he said.

Monique Ryan is among the crossbenchers who fear the tool is inadequate. (ABC News: Matt Roberts)

Fellow independent Monique Ryan was worried the tool could amount to a repeat of Robodebt.

"The government's use of algorithms in aged care and the NDIS raises significant concerns around a repeat of the tragedies of Robodebt," she said.

"We can't allow that."

Minister defends tool to deliver 'predictability and consistency'

Despite the mounting pressure and saying the ABC had shared "confronting stories," Health and Ageing Minister Mark Butler said he remained a "strong supporter" of the assessment framework.

"[The tool] didn't drop from the sky," he said.

"We're doing everything that we can to make sure this tool delivers the sort of predictability and consistency that the Royal Commission recommended."

In 2021, the Royal Commission into Aged Care Quality and Safety recommended "a single assessment process based upon a common assessment framework and arrangements [be] followed by all assessors".

The Integrated Assessment Tool (recreated in these images) contains more than 500 questions. (Four Corners: Nick Wiggins)

Mr Butler said he supported a system "that gives confidence to Australians that no matter where they live, no matter what particular assessor organisation that they use, that their package level will reflect their level of need".

But former acting inspector-general of aged care Ian Yates said in his response that Mr Butler had "avoided" dealing with questions about the algorithm.

"The system as it's set up now, which was not as it was recommended by the Royal Commission, will continue to produce Audrey's and all the other cases that were featured in the Four Corners story," he said.

"It's about budgetary control rather than about person-centred care."

Mr Butler said there was still "a very significant role of clinical assessors through this process".

While the government said the IAT allowed for standardised decision making, some Labor MPs have told the ABC they were facing heat from constituents over the system and had raised concerns with Aged Care Minister Sam Rae.

Government follows up cases of participants who spoke out

The Four Corners episode aired a story of a frail 96-year-old who was rejected from receiving more funding to help her pay for the rising cost of in-home care because of an outcome reached by the algorithm.

A long-time ABC reporter is one of nearly 100,000 Australians waiting on a crucial aged-care assessment.

Under questioning from Liberal Senator Richard Colbeck on Tuesday, Labor's Penny Wong said Audrey Staniland's inability to get more funding sounded "extremely distressing" and the minister had asked the department to look into her case.

One of the other Australians at the centre of the expose on Monday, Sean Dorney, has been told after eight months he would be reassessed for more funding after his decision to speak out.

In the first five months of the algorithm's use, more than 1,000 people have asked for their outcome to be reviewed, with 207 people successful.

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