Promises, progress and reality:are we reforming care, or reforming compliance?

Meditrax Care Practices Forum 2026 · 30 Years of Care

Thursday 10 September 2026 · 9.00am

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Budyeri kamaru - hello in Gadigal language.

I want to acknowledge the Gadigal people of the Eora Nation, the Traditional Custodians of the land on which we meet today, and pay my respects to Elders past and present.

In Aboriginal and Torres Strait Islander cultures, elders are recognised not simply as people to be cared for, but as people whose continuing contribution matters. Their value is not measured by their productivity, their independence, how quickly they can perform a task, or whether they fit neatly into a system. Their value is inherent.

As I prepared for today, I found myself thinking about how different that is to the way many modern systems operate. Because systems tend to measure what is easy to count.

Human beings tend to value things that are much harder to measure. And that tension sits right at the heart of the conversation I want to have with you this morning.

But before I go any further, I also want to acknowledge something I suspect many of you are feeling. Aged care is overwhelming right now.

More important than the ‘overwhelm’, is that all the new reforms, reporting obligations, increased administrative burden can feel as though the machinery of the system is becoming more complex at precisely the moment we should be focussing on what matters most: better lives for older people.

I spent much of my time as Inspector-General speaking publicly about exactly this issue: the unintended consequences that arise when implementation becomes disconnected from the outcomes we are trying to achieve.

But what I want to explore with you this morning is both sides of that reality.

Firstly, I want to recognise that the system itself may be creating complexity, rigidity and compliance burden that gets in the way of care, despite the best of intentions. But secondly, I want to explore the places where your influence still lies.

One of the things I have learned from working alongside older people, providers, nurses, pharmacists and clinicians is that the people closest to care are often far more powerful than they realise.

You are the first to see what is helping, what is harming, what is missing and

what needs to change.

So this is not a speech about enduring the system we have. It is a speech about recognising where reform is falling short, where it is succeeding, and how together we can exercise far more influence over the future of aged care than we sometimes give ourselves credit for.

Part 1 · A word about the person standing in front of you

Now, six weeks ago I stopped being the Inspector-General of Aged Care. Which means this is one of the first few speeches I've given without my former title. No statutory powers. No reports to Parliament. No holding government’s feet to the fire in a Senate Committee.

But I realise that most of what I know about aged care never came from those powers anyway. It came from older people. It came from people like you - clinicians, nurses, pharmacists, care workers and providers. It came from people telling me what was happening when nobody else was asking.

In truth, a lot of the evidence I relied upon as Inspector-General is sitting in this room. In your observations, your judgement, your experience. The things you've tried. The things you've seen work. The things you've watched go wrong.

And while aged care policy is often discussed as though it is shaped somewhere far away by ministers, departments and regulators, the reality is that the people closest to older people exercise extraordinary influence over whether reform becomes bureaucracy or better care.

Today I want to talk about both sides of that equation: where the system is making your job harder than it needs to be, and where your collective influence remains one of the sector's greatest untapped strengths.

Part 2 · What people actually want

I want you to imagine yourself much older. Not as a nurse or a clinical governance manager or in any professional capacity. But as a person who has reached a phase of life where you are dependent on others for care. What would you most want? And what would frighten you most about being dependent?

I have asked those questions of older people, of advocates, of workforce, of providers, of departmental officials. It won’t surprise you that nobody has ever said to me: “I hope my care minutes are calibrated to at least two hundred and fifteen a day.”

What they say is: I don't want to lose control of my life. I don't want to be reduced to ticked-off tasks, or time slots, or to a body that lives out its day in a bed.

And when the conversation turns specifically to medicines, older people rarely talk about pharmacology. They say:

I don't want to lose the parts of me that make me, me.

What strikes me every time I hear that is that they're not talking about medicines. They're talking about identity. About independence. About being able to participate in their own life.

Which is why the real question is never just whether a medicine is clinically effective.

I

t's about whether, on balance, it helps that person remain more fully themselves.

Part 3 · The promise and the plumbing

The tension I want to explore with you this morning is that the government has finally built a legislative framework around what older people say matters most: dignity, identity, connection, independence and the ability to remain themselves.

The aspiration is right.

But in implementing that aspiration, we often fell back on the familiar habits of the system: reporting, compliance, process and assurance.

As a result, many clinicians, pharmacists and providers now find themselves trying to deliver highly relational, humane outcomes through increasingly bureaucratic structures.

That is not a criticism of reform itself. It is a challenge about implementation.

Because when the effort required to demonstrate care begins crowding out the time available to deliver it, we should not be surprised when outcomes suffer.

And nowhere do I see that tension more clearly than in medicines.

Part 4 · What your own data is trying to tell you

Let me show you what I mean.

We decided, as a country, that we would measure antipsychotic use and polypharmacy in residential aged care.

That’s a really important thing.

Across nineteen quarters of national data, both have fallen significantly. That is real progress, and many of you in this room helped achieve it through careful medication review, difficult clinical conversations and a relentless focus on quality use of medicines.

But the interesting thing is what happens next; the ‘so what?’

Because if reducing antipsychotics is not an end in itself, what outcome were we actually trying to achieve?

• Better cognition?

• Greater independence?

• Better quality of life?

• Fewer hospitalisations?

• Greater participation in daily life?

The truth is that all those answers sit in different parts of the system.

The medication indicators sit in one table.

Hospitalisations sit in another.

And resident quality-of-life and consumer-experience measures sit somewhere else entirely.

Nobody requires us to put them together and ask the obvious question:

Did the change we made actually improve the life of the person receiving care?

Because a reduction in antipsychotic-prescribing is an output.

But whether an older person is more alert, more connected, more independent and more able to participate in their own life is an outcome.

And this captures the broader challenge I see right across the aged care reforms right now.

We have become very good at measuring what we did.

But we are still much less disciplined about asking what happened because we did it

Part 6 · The on-site pharmacist: a good idea meeting an unforgiving design

And I think I see exactly the same pattern in respect of the implementation of on-site pharmacists in RACFs.

The original idea was never really about pharmacists. It was about outcomes:

We wanted better medication decisions, fewer medication-related harms, and ultimately better lives for older people.

Putting pharmacists into residential aged care was the mechanism we chose to help deliver that ambition.

But somewhere along the way, the implementation and the measure of its effectiveness started narrowly focussing on the mechanism itself.

We became interested in whether the role had been established, whether the hours were being delivered, whether RACFs had access to pharmacists and whether the program was operating as intended.

None of that is unreasonable.

But they are all questions about whether the intervention exists, instead of whether its intended outcomes were realised as a result.

And so rightly, criticisms of the policy implementation have shifted to questions of whether it has created the conditions for a pharmacist to influence care.

How much experience, What sort of relationships need to exist between pharmacists, nurses and prescribers.

And importantly whether pharmacists are sufficiently integrated into the life of the RACF.

In other words, is this about mere presence? Or the actual capability to delivery the outcome?

That question is critical because it takes us right back to the broader theme of this morning.

The thing that improves outcomes was probably never the simple presence of a pharmacist. It was the ability of that pharmacist to influence what happened next.

Yet influence is considerably harder to count than attendance.

A meaningful clinical relationship is harder to quantify than hours on a roster.

And because those things are difficult to measure, we often default to measuring the simpler, “countable” thing instead.

Before long, we find ourselves treating the measure as the outcome.

We can demonstrate that a pharmacist was there.

What is much harder, and much more important, is understanding whether their presence changed the trajectory of care for the people living in that service.

And that is where this comes back to the broader point about outcomes.

We know expertise matters, relationships matter and influence matters.But expertise is harder to measure than attendance.Relationships are harder to measure than hours.Influence is harder to measure than compliance.So we end up measuring the thing that is easiest to count.

And before long, the measure starts standing in for the outcome. We begin valuing what can be counted rather than finding ways to count what we value.

In the case of on-site pharmacists, we can readily demonstrate whether somebody was present. What is much harder to demonstrate is whether that presence changed what happened to the people living in that service.

• Did prescribing improve?

• Were harms prevented?

• Did residents become more alert, more mobile, more engaged in their own lives?

• Did families feel more confident?

• Did clinical teams make better decisions?

  
  

Those are the outcomes.

Because the purpose of the reform was never to put pharmacists in buildings. It was to improve the lives of older people.

And that is the broader challenge for all of us. The things we care about most in aged care, safety, dignity, independence, connection and identity, are often the hardest things to measure. But if we don't find ways to count them, we shouldn't be surprised when the things we can count begin to dominate practice.

Part 8 · Innovation, and the question you point it at

Which brings me to innovation, because you have a whole day of it ahead of you.

I am not a tech-sceptic. I do think the opportunity in front of this sector is real, and maybe even larger than most people in it realise.

But I want to encourage you to think of it in the vein of what I have just described...

We know that technology is only ever as useful as the question we ask of it - so rather than using it to count more activity, could we use it to answer the outcome-questions we have spent too little time asking?

You are already sitting on electronic medication management data, falls data, hospitalisation data, incident data and, increasingly, quality-of-life and consumer-experience measures.

The challenge isn't that the data doesn't exist.

It's that our systems and reporting frameworks rarely require us to look at those things together and ask what happened to the person as a result of the decisions we made.

So if you are not already, ask yourselves whether technology could be used to answer:

• What happened to falls in the ninety days after deprescribing?

• What happened to night-time sedation and daytime engagement?

• What happened to hospital presentations after that medication review process was introduced?

• What happened to the resident's own rating of their quality of life after their medication list reduced from fourteen medicines to eight?

Those are not theoretical questions. In many cases, they are answerable with data you already collect, already report and already hold.

The real opportunity is not collecting more information. It might be whether technology can connect the information we already have to understand outcomes rather than activities.

Part 9 · How do we teach government to measure outcomes?

Which brings me to the question I was actually asked to answer this morning.

How do we get government to measure outcomes instead of outputs?

My honest answer?

Governments measures what they can defend. All governments do it - I have worked in State and Federal Governments and seen them all do it, time and again, in almost every health and human service you can think of.

And please don’t think I am painting public servants as ogres here. Departments and regulators are not staffed by people who don't care - most came into this work for the same reasons you did.

But they are constrained by what they can justify, or materially report in an instant: to a Minister, to Senate Estimates, to an auditor, to a journalist.

And an output feels really defensible. You can name how many reviews are conducted. How many pharmacists are credentialed.

But an outcome is harder. It is contested, it lags - and it requires somebody senior to accept, in advance, that the answer might be bad.

But just remember this: you hold the evidence and the ideas as to what we should be measuring

YOU are influential because you are the people closest to what older Australians actually experience.

You see the consequences of decisions long before they appear in a government report. You see what happens after the policy announcement, after the implementation plan, after the compliance framework has been written.

You know whether a resident became more alert after a medication review. Whether a fall rate changed after a clinical intervention. Whether a family feels more confident. Whether a person's life became bigger or smaller.

And when those observations are paired with data, they become something very powerful.

One nurse noticing a pattern is important.

Forty RACFs seeing the same pattern, and being able to demonstrate it, becomes difficult to ignore.

That is why I think there is a real opportunity for this sector.

Not simply to collect more information.

But to connect the information you already hold and use it to answer the questions that matter most.

Because in the end, reforms don't succeed because they were announced or because we counted the easy-to-count stuff.

They succeed because somebody can show that an older person's life became better as a result.

And the people best placed to show us that are sitting in rooms like this one.

Part 10 · Five things, none of which require permission

So what do you do with all of that?

If you agree, that outcomes deserve as much attention as compliance, then there are some practical things you can start doing tomorrow morning. None of them require a legislative amendment. None of them require permission.

First, record the outcome, not just the intervention.

Every one of you has had a deprescribing success.

And I suspect the formal record often reads something like:

"Olanzapine ceased. Reviewed at six weeks. No adverse effects noted."

That's important.

But so is:

"Six weeks later she is back joining lunch most days, and her daughter says she has her mother back."

One tells you what you did.

The other tells you what happened because of what you did.

Over time, that distinction matters.

Because a collection of those stories, systematically recorded, becomes evidence.

Second, report the unintended consequence, not just the compliance issue.

One of the things I learned as Inspector-General is that systems are generally much better at seeing breaches than they are at seeing perverse outcomes.

When a policy, standard or process produces a result nobody intended, tell somebody.

Tell your peak body, tell the Commission, tell the Inspector-General.

And tell them when reporting outcomes WORKS!! The good stuff tells us as much about how to recalibrate the system as the bad!

Third, ask this one question more often. "What did the resident say about it?"

Ask it at medication committees, at clinical governance meetings, at incident reviews, at quality meetings.

I am not saying you should ask it because resident perspectives trump clinical judgement.

But because they often reveal whether the outcome we intended is the outcome we actually achieved.

Fourth, compare notes.

One of the challenges in aged care is that organisations often experience the same issue at the same time and assume they are the only ones seeing it.

The value of forums like this, and organisations like Meditrax, is not that someone arrives with all the answers.

It's that they create opportunities for people to see patterns they would never see on their own.

And sometimes that is how change starts.

Finally, protect professional judgement.

Sure - compliance and standards and governance matters.

But they are tools.

They are not the purpose of the work.

The purpose is the older person sitting in front of you.

So when the answer isn't obvious, make room for professional judgement.

Make room for curiosity.

Make room for someone to ask whether the process is achieving the outcome it was intended to achieve.

Because some of the most important improvements in aged care have started with somebody looking at a result and asking:

"Is this actually helping?"

And that, ultimately, is the mindset I am encouraging today.

CLOSING

I know that when you go back to work tomorrow, the system won't have changed.

The reporting requirements will still be there. The overly-rigid compliance that takes away from care will still be there. The workforce challenges will still be there.

One of the reasons I spent so much of my time as Inspector-General talking about implementation was because I genuinely believed, and still believe, that some of the frustrations you experience are not incidental. They are a consequence of trying to deliver deeply human outcomes through structures that can sometimes become preoccupied with process.

But if that is all we take from this conversation, then it becomes a rather depressing speech.

The other thing I learned over the past two years was that the people closest to older Australians often have a much clearer view of what is happening than anybody designing policy from a distance.

Again and again, I saw clinicians, pharmacists, care workers and providers identify problems long before they appeared in any official report. I also saw them quietly solve things that no reform package had anticipated.

That stayed with me because it reminded me that influence in aged care does not sit exclusively with people who have statutory powers, government positions, or impressive titles.

A great deal of influence sits with the people who notice what happens after the policy has landed.

It sits with the person who asks whether the resident is actually benefiting from the medication review, rather than simply whether the review occurred.

Or the clinician who decides to record what changed in somebody's life, not just what changed on their chart.

And it sits with the service that starts connecting its own data and discovers that something it thought was helping is actually causing harm, or that something it thought was routine is producing extraordinary outcomes.

Those things might feel small at the time.

But they are how systems learn.

The reason I spent so much of this morning talking about outcomes is that I think there is an extraordinary amount of untapped evidence already sitting in this sector - and in this room.

Older people are remarkably consistent when they describe what successful aged care looks like. They do not usually talk about a program, a review or a compliance requirement.

They talk about whether life still feels like their own.

What gives me hope is that the people best placed to make that outcome visible are you.

Governments tend to measure what they can defend. It is much easier to report how many medication reviews occurred than whether somebody's life improved because of them.

But every time you go beyond recording what was done and describe what happened because of it, you are changing that equation.

Every time a clinician records that a resident started joining lunch again after a medication change, every time a pharmacist can show that deprescribing reduced falls or improved engagement, every time a service connects its clinical data to a resident's own experience of quality of life, an outcome becomes visible.

And once outcomes become visible, they can be measured. Once they can be measured, they become defensible.

And once they become defensible, they become much harder for governments, regulators and the wider system to ignore.

That is why I am more optimistic than many people expect me to be.

Because the people in this room are not simply implementing the system.

Every time you document an outcome, every time you connect an intervention to a person's experience, every time you make visible what actually improved somebody's life, you are teaching the system what success looks like.

And if enough of us do that consistently, I think the system gradually begins to move.

Thank you.