Australians live one life, yet we fund five care systems

The Catholic tradition of healing, which gave Australia some of its first hospitals, much of its aged care, and a sizeable share of its community and disability services, has always rested on a single, unembarrassed claim. Each person is whole. Each person is sacred. Each person, in sickness and in health, in youth and in age, in capacity and in infirmity, deserves to be cared for as a single human being, and not as a patient on Monday, a resident on Tuesday, and a participant on Wednesday.

It is a claim worth restating, because the system we have built around it does not always honour it.

Consider three people Catholic Health Australia’s members will care for this week.

A man in his eighties has a fall, comes through emergency, has his hip repaired, and recovers well enough to go home. He waits three weeks in an acute bed because the home-care package he needs has not come through, and the residential aged care place his daughters were hoping for is months away. In those three weeks he loses muscle, confidence and independence. The taxpayer has paid roughly $2,000 a day for a hospital bed instead of perhaps $450 for an aged care bed. The bed he occupies is unavailable to the person on the elective surgery list behind him.

A young woman with cerebral palsy is admitted for pneumonia. She is medically ready for discharge in four days. She stays for thirty, because her NDIS plan does not quite cover the support workers she needs at home, and no part of the system has been given the job of bridging the gap.

A woman in her sixties with a terminal diagnosis would prefer to die at home. Whether she gets that choice depends not on her clinical condition, but on whether her GP knows the local palliative service exists, whether after-hours community nursing is funded in her postcode, and whether her family can take leave. The arithmetic of her dying is split between Medicare, the states, the aged care system and her own savings.

Each of these is, in a narrow administrative sense, seen as somebody else’s problem. The older man is seen as an aged care problem. The young woman is seen as an NDIS problem. The dying woman is seen as a palliative care problem. To Catholic Health Australia members – and to the doctors, nurses, carers and pastoral teams who actually deliver care in our member’s hospitals, aged care homes, home and community services and disability supports – they are simply three people, each owed the same fundamental thing.

This is why so much of Catholic Health Australia’s policy work refuses to stay in one portfolio.

We argue for reform of public hospital funding because the bed block clinicians see every morning is, in truth, an aged care problem and a community care problem wearing hospital scrubs. We argue for the move to demand-driven home-care funding because no older Australian should be told the support they were assessed for is real but not yet available. We argue for human oversight and contestable pathways in the NDIS because a young woman with cerebral palsy is not a budget category.

We argue that a person’s prognosis, not their postcode, should determine the palliative care they receive at the end of life. We argue that prevention deserves at least five per cent of national health spending, because the cheapest hospital admission is the one that never happens. And we argue for fair pay and decent housing for the nurses, carers and allied health workers who hold the whole care economy together, because they are not five separate workforces and should not be funded as such.

None of this is the work of one portfolio. None of it can be done well by one minister, or even by one government. It requires the unfashionable discipline of looking at the whole person, and then asking what the whole system would need to do to honour that person properly.

This is not a Catholic position because we wish it were. It is a Catholic position because the alternative – the person fragmented into a series of administrative encounters – is a small but real betrayal of human dignity. And dignity, properly understood, is not a religious preference. It is the load-bearing wall of any decent system of care.

Australian governments of both colours have done much that is good in health, in aged care, in disability and in palliative care. The next round of reform, whatever its political colour, will be judged on something narrower and more difficult. Not on the strength of individual line items. But on whether, taken together, they treat Australians as the whole people they actually are.

The patient is whole. The system, at last, must be too.