3.1
The committee has selected the 2021–22 annual reports of the following entities for closer examination:
the Australian Commission on Safety and Quality in Health Care (ACSQHC);
the Hearing Australia; and
the Australian Organ and Tissue Donation and Transplantation Authority.
Australian Commission on Safety and Quality in Health Care
3.2
The ACSQHC’s role, codified in the National Health Reform Act 2011, is to lead and coordinate national improvements in the safety and quality of healthcare. The agency is jointly funded by the Commonwealth and state and territory governments to achieve this outcome.
3.3
The agency has four strategic priorities that are informed by its functions, as outlined in the National Health Reform Act 2011. They are:
safe delivery of health care;
partnering with consumers;
partnering with healthcare professionals; and
quality, value and outcomes.
3.4
The ACSQHC reports on its functions, strategic priorities, and priority areas across its annual reports, corporate plans, work plans and Budget papers.
Report from the Chair
3.5
Professor Villis Marshall AC, Chair of the ACSQHC, looked at the key achievements of the agency throughout the financial year.
3.6
The ACSQHC continued to improve care for vulnerable people in the Australian community, with significant developments occurring in the aged care sector. The agency worked alongside the Department of Health and Aged Care and the Aged Care Quality and Safety Commission (ACQSC) to protect aged care residents from harm through the ongoing development of an Aged Care Clinical Standard.
3.7
The agency released a joint statement with the ACQSC and the National Disability Insurance Scheme Quality and Safeguards Commission to address the inappropriate use of psychotropics for older Australians and people with disability. This joint statement will complement the clinical care standard on the use of psychotropics, to be released in 2022–2023.
Report from the Chief Executive Officer
3.8
Chief Executive Officer, Adjunct Professor Debora Picone AO, discussed the ACSQHC’s ongoing work related to COVID-19 in conjunction with other initiatives, such as:
working with the George Institute for Global Health to deliver the National Sepsis Program;
publishing the Sepsis Clinical Care Standard, the Cataract Clinical Care Standard, the Acute Anaphylaxis Clinical Care Standard and the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard;
delivering the National Safety and Quality Primary and Community Healthcare standards; and
releasing the fourth Australian report on antimicrobial resistance in human health.
Performance reporting
3.9
The ACSQHC reflected on its performance during 2021–2022 by measuring success against its four strategic priorities. Details of achievements against these strategic priorities were complemented by a table of performance measures at the end of the discussion.
3.10
The committee notes that all targets are deemed to be ‘achieved and ongoing’. It would be beneficial if the ACSQHC provided context on how results are calculated and assessed. Some information is provided in the agency’s Corporate Plan, but this is absent from the annual report.
3.11
The committee notes that in the Corporate Plan, performance targets are listed against their corresponding strategic priorities. However, in the ACSQHC’s annual report, this detail has been omitted. It would assist the committee if the agency included a column in the table that denoted the strategic priority to its corresponding performance criteria. This would remove the need to refer to the Corporate Plan to gain further clarity on performance.
Financial performance
3.12
In 2021–22, the ACSQHC’s expenses totalled $29.8 million and generated income amounted to $30.6 million, with both figures increasing from the previous reporting period. A majority of income was generated via project funding ($9.8 million), contributions from the Commonwealth ($12.1 million) and contributions from state and territory governments ($8.6 million), totalling $30.6 million.
3.13
ACSQHC’s total assets were valued at $26.6 million in 2021–22 and liabilities valued at $20.9 million, with total equity valued at $5.7 million. Significant expenses included employee benefits ($13.5 million) and contracts for services ($9.9 million).
Compliance index
3.14
Under the Public Governance, Performance and Accountability Rule 2014 (PGPA Rule), Commonwealth entities are required to include a compliance index (or list of requirement) in annual reports.
3.15
In 2022, the committee drew the ACSQHC’s attention to several issues pertaining to the compliance index within their 2020–21 annual report. These issues have persisted and are re-examined below.
3.16
The PGPA Rule is the relevant legislation that stipulates reporting requirements for all entities of the Commonwealth. However, the ACSQHC has incorrectly referenced reporting requirements under the Public Governance, Performance and Accountability Amendment (Corporate Commonwealth Entity Annual Reporting) Rule 2016, which was repealed on 8 May 2016. The ACSQHC also made this error in annual reports 2020–21, 2019–2020, 2018–2019, and 2017–2018. The committee urges the agency to reference the correct rule in future annual reports.
3.17
The committee notes that the compliance index is not in the format required by the current PGPA Rule. Diverting from the specified list of requirements creates risk that items are inadvertently omitted. For example, the requirement for the ACSQHC to report on its purpose as included in its corporate plan is missing from the agency’s index. Going forward, the committee recommends that the ACSQHC use the correct compliance index, as referenced in Section 17AJ(d) of the PGPA Rule, to ensure that no requirements are missed.
3.18
Further, the committee observes that certain ‘if applicable, mandatory’ requirements have been omitted from the index. This makes it difficult to ascertain whether these items have been removed simply because they are not applicable, or if they have been accidentally excluded from the list of requirements. In future, the committee recommends that the ACSQHC denotes these items with ‘N/A’ to aid in transparency, rather than removing these items from the index altogether.
3.19
Lastly, issues persist where the ACSQHC has reported on items required by the PGPA Rule but have not referred to them in the compliance index. For instance, the agency stipulates their purpose on page 11 but does not reference this within the list of requirements. It is important that the agency lists the page reference to mandatory reporting items to maximise ease of access within the report.
3.20
The committee looks forward to the ACSQHC accurately completing the list of requirements as per the PGPA Rule in future annual reports and deems the 2021–22 annual report to be apparently satisfactory.
Hearing Australia
3.21
Hearing Australia is a corporate Commonwealth entity constituted under the Australian Hearing Services Act 1991 (AHS Act). Hearing Australia functions are defined under section 8 of the AHS Act, which include:
the provision of hearing services to voucher holders under the Government’s Hearing Services Program and to designated persons eligible under the Community Service Obligations Program (including children, young adults, adults with complex needs and Aboriginal and Torres Strait Islander people);
the provision of hearing services to Comcare clients and Commonwealth employees;
entering into arrangements for the supply, research, design and development of hearing services, including providing services to anyone with a hearing loss;
carrying out research; and
providing advice, education, training and consultancy services in relation to hearing services.
Chair and Managing Director’s review
3.22
The Chair, Ms Elizabeth Crouch AM, and Managing Director, Mr Kim Terrell, made the following comments in their review of Hearing Australia for
2021–22:
Some 3.6 million Australians have hearing loss and this number is expected to double by 2060. While we have achieved much, our role is as important today as when we were established.
In 2022, acknowledging 75 years of hard work, innovation and the support of our many partners, we continue to improve how we help people with hearing loss stay connected to their families, friends, communities and the life they love.
3.23
Ms Crouch and Mr Terrell also reported on the following key areas of work in 2021–22, which included:
helping more than 270 000 children and adults with hearing loss;
this included providing Government funded hearing services to 72 245 people under the Community Service Obligations Program and 147 363 pensioners and veterans through the Hearing Services Program;
providing services to 41 432 commercial clients;
providing hearing assessments for 12 016 young Aboriginal and Torres Strait Islander children as part of Hearing Australia’s broader commitment to improve the hearing health of First Nations children;
providing services during the widespread floods across the east coast of Australia in early 2022;
establishing the First Nations Services Unit which combines the work of Hearing Australia’s Community Services Obligations Program and Hearing Assessment Program (HAP) — Early Ears and Listen to Learn program to coordinate and streamline Hearing Australia’s services and engagement with Aboriginal and Torres Strait Islander communities;
co-designing an Action Plan to improve the hearing health of First Nations children which included consultation with 51 individuals representing 57 organisations;
progression of the work of the National Acoustic Laboratories to improve health, particularly through:
the development of an app which transcribes speech and displays text, which has been well-received globally with over 15 000 downloads across 43 countries; and
the inception of a First Nations Longitudinal Outcomes of Children with Hearing Loss, funded by the Department of Health and Aged Care.
Performance reporting
3.24
As outlined in its 2021–25 corporate plan, Hearing Australia’s vision is to:
…provide world leading research and hearing services for the wellbeing of all Australians… Our vision explains our purpose, why we are here and what we aspire to achieve. We have a clear responsibility to deliver the best possible hearing health care for our clients and the communities we serve, and to provide value to Government and our stakeholders.
3.25
Hearing Australia uses three strategic pillars to measure its performance:
delivering excellent outcomes
providing great value to Government and partners; and
being a high-performing organisation.
3.26
Each strategic pillar encompasses a number of priorities and specific activities The annual report outlines the results of key performance indicators against these priorities and activities. A summary of these results is as follows:
Table 3.1: Hearing Australia’s 2021–22 performance activities
|
|
|
|
|
|
Exceptional client experiences
|
Client satisfaction
|
Client satisfaction rate for adults
|
Yes
|
|
Impactful community outcomes
|
Service delivered to community and clients
|
Total Community Service Obligation clients seen
|
No
|
|
Total commercial clients seen
|
No
|
|
Reduce the
current rate of
hearing loss in
Aboriginal and
Torres Strait
Islander children
by at least half by
2029
|
As determined by ABS data
|
On track
|
|
Implement agreed hearing loss prevention initiatives
|
HAP communities target achieved
|
Yes
|
|
HAP program children target achieved
|
Yes
|
|
Hearing Australia projects successfully managed and delivered
|
On track
|
|
National Hearing Loss Prevention Strategy milestones achieved
|
On track
|
|
Help Aboriginal and Torres Strait Islander children with hearing loss
|
Reduce the average age of first fitting to under 5 years
|
On track
|
|
Services provided to children and young Australians
|
85% of children and young adults with a permanent hearing loss, are seen within 2 weeks of receipt of referral
|
On track
|
|
Services provided to Aboriginal and Torres Strait Islander peoples
|
220 outreach communities visited annually
|
No
|
|
Productive Government engagement
|
Provision of high-quality advice and support to Government and to partners to improve national hearing health outcomes
|
Quality of advice and support
|
Yes
|
|
Productive partner engagement
|
|
Purpose driven organisation
|
Lifting people capability
|
Capability program milestones achieved
|
Partially
|
|
Staff engagement and wellbeing
|
Monthly staff survey
|
Yes
|
Source: Hearing Australia, Annual Report 2021–22, p. 38.
3.27
The committee notes that the ‘business acumen and growth’ priority, which according to the 2021–25 corporate plan sits under the third strategic pillar, was not listed or measured in the performance activities section of the annual report. No explanation in the annual performance statement was provided to account for this omission.
3.28
While the committee appreciates Hearing Australia’s detailed explanation of the strategic pillars and the relevant performance measurements, it encourages Hearing Australia to ensure all performance targets as outlined in the corporate plan are reflected in the annual report.
Financial performance
3.29
As at 30 June 2022, Hearing Australia’s total revenue for the financial year was $267.9 million. This included $245 million from contracts with customers, $21.6 million of grant income and $1.3 million of other income. Hearing Australia advised that this revenue figure was $6.6 million or 2.4 per cent lower than the previous year, clarifying that this was largely due to the ongoing impacts of the COVID-19 pandemic and the large flood events that impacted the eastern states in the early months of 2022.
3.30
Hearing Australia explained that it experienced significant shortfalls in targets for its Community Service Obligation (CSO) program clients and commercial clients, which contributed to its financial performance results. For example, it stated:
Hearing Australia also saw 188,795 commercial clients which was 11,205 less than our target. This shortfall was more pronounced with multiple factors impacting our ability to see clients including the ongoing impacts of COVID-19 on clients and Hearing Australia staff and operations. Over 1,650 audiologist working days were lost in the first six months of 2022 due to isolation rules and/or our audiologists being unwell with COVID-19. This alone meant a shortfall of over 10,000 clients that could have been seen during this period.
3.31
Hearing Australia noted that increased commercial activity in May and June 2022 signalled a return to more normal conditions but acknowledged that given the challenges of the operating environment, it had been required to exercise ‘significant discipline’ regarding discretionary spending during the year to ensure it remained financially sustainable.
3.32
The committee commends Hearing Australia for providing a comprehensive breakdown of its financial performance detail and welcomes the level of detail in the notes to the financial statements. In particular, the committee appreciates Hearing Australia’s explanations relating to the shortfall in targets for CSO and commercial clients and how this impacted yearly revenue.
Compliance index
3.33
The committee notes that Hearing Australia’s list of requirements did not provide specific page numbers, and instead references either complete sections or subsections of the annual report. The committee highlights that it has commented on this issue in the past and suggested that Hearing Australia provide precise page number references to enhance overall accessibility and visibility of where reporting requirements have been satisfied in accordance with the PGPA Rule. The committee continues to urge Hearing Australia to provide specific page references in its compliance check list to improve transparency.
3.34
The committee looks forward to Hearing Australia actioning the above suggestion in its next annual report. It deems that the agency’s 2021–22 annual report meets the relevant reporting requirements and finds that it is apparently satisfactory.
Australian Organ and Tissue Donation and Transplantation Authority
3.35
The Australian Organ and Tissue Donation and Transplantation Authority, commonly known as the Organ Tissue Authority (OTA), was established in 2009. It is a non-corporate Commonwealth entity and sits under the Health and Aged Care portfolio. The OTA exists to increase organ and tissue donation through a nationally coordinated program, thereby boosting opportunities for transplantation across Australia.
3.36
The program is supported by several bodies and sectors, including the DonateLife Network, state and territory governments, and the donation and transplantation sectors.
3.37
On 1 November 2021, the OTA’s accountable authority shifted from the OTA Board to the OTA Chief Executive Officer because of changes to the Australian Organ and Tissue Donation and Transplantation Authority Act 2008. The OTA Board remains operational and now functions as an advisory board, with a particular focus on the national program.
Review from the Chief Executive
3.38
Ms Lucinda Barry AM, Chief Executive, summarised key areas of work for the OTA in 2021‑22, which included:
reviewing Australia’s decrease in donation and transplantation activity due to COVID-19. Border closures have made it difficult to match donors to recipients, and hospital visitor restrictions have made it harder to discuss donation options with families who have an end-of-life relative;
continuing to work with the transplant sector via initiatives such as the Australia and New Zealand Paired Kidney Exchange (ANZKX) Program and the Donation Rapid Response Taskforce;
monitoring and working with hospitals, alongside the DonateLife Network, to maximise donation and transplantation rates;
raising national awareness and increasing public support for transplantation and donation through initiatives such as DonateLife Week and an eye and tissue donation social media campaign;
collaborating with the clinical sector and professional groups to ensure safety and equity during the allocation, donation and transplantation processes; and
looking forward to the next five years to return donation and transplantation levels to pre-pandemic rates.
National Medical Director’s review
3.39
Dr Helen Opdam, National Medical Director, provided detail on the clinical priorities and outcomes of the OTA during 2021–22, including:
embedding best clinical practices in hospitals and ensuring that healthcare staff are receiving adequate training;
supporting families to ensure that decisions about donation are made in line with their and their family member’s values;
releasing the Best Practice Guideline for Donation after Circulatory Determination of Death in Australia, thereby promoting a nationally consistent and ethical practice;
reporting, reviewing and analysing adverse events to donation and transplantation through the Australian vigilance and surveillance program;
increasing living donor kidney transplants through the Australian and New Zealand Paired Kidney exchange; and
working with the Transplant Society of Australia and New Zealand (TSANZ) and Australian Red Cross Lifeblood on the virtual crossmatch, which enables a virtual assessment of organ compatibility.
Performance reporting
3.40
The OTA analysed its performance against its planned performance criteria, as per the Health Portfolio Budget Statements 2021–22 and the agency’s Corporate Plan 2021–22.
3.41
Performance measures were clearly articulated by the OTA. The agency delineated how its purpose informs its sole Outcome and Program, as well as its objectives and measures.
3.42
Targets were assessed as being met (where 100 per cent of the target was met), substantially met (75–99 per cent of the target) and not met (less than 75 per cent of the target).
3.43
The committee notes that of the four targets for 2021–22; one was met, two were substantially met and one was not met. The committee appreciates that the OTA provided an explanation as to why targets were not met or were substantially met, and acknowledges the ongoing challenges the organ and transplant sectors face as a result of COVID-19.
Financial performance
3.44
The OTA had a surplus of $480 741 in 2021–22 in comparison to the budgeted deficit of $512 000. The agency attributes this to difficulty in filling vacant positions and reduced staff travel due to pandemic travel restrictions.
3.45
Significant expenses included employee benefits, totalling $3.681 million, and rendering services, totalling $1.3 million.
3.46
The committee appreciates that the OTA has provided a thorough breakdown of its financial statements via its ‘notes to the financial statements’ section. The notes provided further information on expenses and provided the reader with a deeper understanding of the figures provided. The committee encourages the OTA to continue this practice in future reports.
General comments
3.47
While the committee acknowledges that colour and infographics can increase the readability of a document, the committee would also like to draw the OTA’s attention to the advice to government agencies on printing standards:
While acknowledging that the cost of colour printing has decreased, author bodies must have regard to limiting the use of colour and illustrations to where it enhances the reader’s understanding of the material. An excess use of colour, illustrations and photography is not fit for the purposes of accountability and reporting to Parliament.
3.48
The OTA may wish to reduce the amount of colour, illustrations and photos in future reports to ensure that these visual tools are only used when necessary. For instance, the image on page 20 takes up approximately one quarter of the page and does not provide the reader with any additional information. The committee looks forward to the OTA constructing next year’s annual report to rely less on these tools.
Compliance index
3.49
The committee appreciates that the OTA completed its compliance index to a high standard. Page references are correct and items that are not applicable to the agency are generally marked with an ‘N/A’ response. However, there were four instances where information about a particular requirement was provided in the report, but no page reference was provided in the index. For instance, external scrutiny items related to judicial decisions and Auditor-General reports were marked as ‘N/A’ in the compliance index, but information stating that the OTA were not subject to any of these matters was present on page 43 of the report. The committee reminds the OTA that it is important to include page references when information is detailed in the body of the document.
3.50
Overall, the committee commends the OTA on a comprehensive, easy to read annual report, and looks forward to the agency correcting these minor issues in the future. The committee considers the OTA’s 2021–22 annual report to be apparently satisfactory.
General comments on other annual reports
Compliance indexes
3.51
Annual reports are one of the principal accountability mechanisms of the PGPA Act, and the committee considers it vital that these documents be easily accessible and comprehensible for all readers. A compliance index (or list of requirements) is an important tool for accessibility.
3.52
The PGPA Rule specifies a particular format for agencies to use when completing a compliance index. The committee encourages all agencies to avoid unnecessary deviation from this format, which it considers best practice.
3.53
A compliance index should direct the reader to a specific page within an annual report in order to clearly indicate where a certain mandatory reporting requirement has been satisfied in accordance with the PGPA Rule.
3.54
However, the committee notes that some compliance indexes instead contained references to whole sections or subsections within a report, rather than providing a specific page reference. For example, Hearing Australia, the Australian Sports Commission and Food Standards Australia New Zealand referenced whole sections or subsections of their annual reports rather than providing specific page references for each mandatory reporting requirement.
3.55
Additionally, the committee notes that some compliance indexes contained incorrect references to page numbers. For example, the compliance index for the National Health and Medical Research Council referenced page 6 for information on performance pay, when it is instead on page 96. Additionally, Cancer Australia referenced pages 122–124 for additional information about organisations receiving amounts under reportable consultancy contracts or reportable non-consultancy contracts. However, this information is instead found on pages 114–119.
3.56
As stated in previous reports on annual reports, the committee strongly urges all entities to provide specific and accurate page references for each requirement to enhance readability and ensure overall compliance with the PGPA Rule.
Apparently satisfactory
3.57
As noted in Chapter 1, the committee has assessed all reports of the Health and Aged Care and the Social Services portfolios received between 1 May 2022 and 31 October 2022 as apparently satisfactory. However, the committee reiterates its requests for Commonwealth entities and companies to familiarise themselves with the requirements of the PGPA Act and PGPA Rule.
3.58
The committee anticipates that the matters identified in this report will be rectified in future annual reports.
Senator Marielle Smith
Chair