WEBVTT - The aged care algorithm replacing human judgement

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<v Speaker 1>I'm Daniel James, and you're listening to 7am. There can

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<v Speaker 1>come a point in growing older when staying in the

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<v Speaker 1>home you love depends on someone helping you out of bed,

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<v Speaker 1>making a meal, or making sure you're taking your medication.

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<v Speaker 1>That care can mean holding on to your independence, to

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<v Speaker 1>familiar surroundings, and to a life that still feels like

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<v Speaker 1>your own. But now, the government is using an algorithm

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<v Speaker 1>to determine home care funding, replacing assessor's judgement with a

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<v Speaker 1>formula They can overlook the complexities of someone's life, but

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<v Speaker 1>with no ability for humans to override the decision, even

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<v Speaker 1>when they know it's wrong. Today, aged care expert Professor

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<v Speaker 1>Cathy Eger on the human consequences of handing those decisions

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<v Speaker 1>to an algorithm and the people whose needs are not

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<v Speaker 1>being met as a result. It's Friday, October 30th. Cathy,

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<v Speaker 1>thanks for joining us. The government is using an algorithm

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<v Speaker 1>to determine how much funding older Australians receive for care

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<v Speaker 1>at home. You've managed to reverse engineer that algorithm to

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<v Speaker 1>understand how it makes those decisions. What did you discover?

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<v Speaker 2>What I discovered is two things, really. One is something

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<v Speaker 2>I already knew before I did the engineering bit, which

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<v Speaker 2>is we should be using these sort of tools to

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<v Speaker 2>as decision support tools, not as decision-making tools. And the

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<v Speaker 2>second is that the algorithm itself is fundamentally flawed from

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<v Speaker 2>a technical perspective because it was designed by people who

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<v Speaker 2>don't understand algorithms.

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<v Speaker 1>Right.

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<v Speaker 3>And what kind of decisions is the algorithm making? So

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<v Speaker 3>a clinical assessor assesses somebody. And in the past, the

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<v Speaker 3>clinical assessor said, well, I've assessed Kathy Eager.

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<v Speaker 2>This is what she needs. And these are the services

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<v Speaker 2>she's going to need. And the cost of those services

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<v Speaker 2>is X. The process now reverses that logic and it assesses,

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<v Speaker 2>this is what the assessor says you need. This is

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<v Speaker 2>how much the algorithm says that translate to in dollars.

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<v Speaker 2>And then the assessor has to work out what services

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<v Speaker 2>you can afford to from the dollars you've been given.

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<v Speaker 2>Things like whether the person has dementia, whether they live alone,

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<v Speaker 2>whether they're homeless and live in a car. None of

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<v Speaker 2>those things are taken into account. The other thing that's

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<v Speaker 2>missing is that it doesn't actually take into account whether

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<v Speaker 2>they have a carer, and if so, what their carer needs,

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<v Speaker 2>what support they need to continue being carers. There's thousands

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<v Speaker 2>of factors involved that an experienced clinical assessor will take

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<v Speaker 2>into account about a person that no algorithm is ever

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<v Speaker 2>going to be able to take into account.

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<v Speaker 1>So why did the government introduce this algorithm or these algorithms?

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<v Speaker 2>It's a very good question and it doesn't make any

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<v Speaker 2>sense to use an algorithm in aged care because aged

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<v Speaker 2>care is a care and support scheme. It's not a

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<v Speaker 2>financial entitlement scheme. In my view, the government's never been

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<v Speaker 2>transparent about why it introduced the algorithm and it said

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<v Speaker 2>things like, oh, assessors gave people too much before, which

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<v Speaker 2>is not true.

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<v Speaker 4>Under the previous system, we had $ 4 billion of value

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<v Speaker 4>allocated to people incorrectly and therefore unable to be deployed

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<v Speaker 4>to look after older people.

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<v Speaker 2>There's no evidence for the claims that they've given. I

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<v Speaker 2>think they've introduced the algorithm in support at home because

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<v Speaker 2>this is the prototype that they're intending for the National

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<v Speaker 2>Disability Insurance Scheme, which has been full of cost blowouts

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<v Speaker 2>and scams and all those sorts of things that we've

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<v Speaker 2>seen in the media. Aged care has not experienced those problems,

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<v Speaker 2>but the government has put the two together. The NDIS

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<v Speaker 2>is an insurance scheme. But the aged care system is

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<v Speaker 2>a care and support scheme, and I don't think the

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<v Speaker 2>government understands the difference between those two schemes.

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<v Speaker 1>An algorithm, of course, can't take into a factor the

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<v Speaker 1>important nuanced health information of individuals and support needs of

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<v Speaker 1>their family. How badly can that distort the funding someone receives?

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<v Speaker 2>It can distort the funding in two ways. Obviously... the

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<v Speaker 2>cases that are speaking out are the people who don't

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<v Speaker 2>get the funding that they need. But it's also the

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<v Speaker 2>case that some people are getting too much funding because

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<v Speaker 2>the algorithm doesn't take into account so many other factors.

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<v Speaker 2>So two people might look exactly the same in the algorithm,

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<v Speaker 2>but one person lives in a home they own that's

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<v Speaker 2>all on one level, that's got ramps and rails, that

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<v Speaker 2>has safety devices, et cetera. The other person lives on

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<v Speaker 2>the second floor of a block of flats that they

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<v Speaker 2>rent and they're not allowed to put a nail in

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<v Speaker 2>a wall. Even though they look the same on paper

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<v Speaker 2>or in the algorithm, their need for care is really

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<v Speaker 2>different and an assessor can take that into account and

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<v Speaker 2>an algorithm can never take that into account. We will now.

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<v Speaker 5>Recommence the discussion inquiry into support at home. And I

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<v Speaker 5>now welcome Professor Cathy Eager. Professor Eager, thank you so

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<v Speaker 5>much for joining us.

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<v Speaker 1>And Cathy, you presented to a Senate inquiry and demonstrated

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<v Speaker 1>that a single point on the algorithm scoring system could

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<v Speaker 1>mean the difference between someone getting $ 40, 000 or $ 80, 000 in

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<v Speaker 1>annual care funding.

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<v Speaker 2>And on the basis of a one-point difference in a

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<v Speaker 2>48-point scale is a $ 40, 000 difference for the person.

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<v Speaker 1>How is that even possible?

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<v Speaker 2>Yes, it's crazy. This is due to the fundamental errors

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<v Speaker 2>in the design of the algorithm. If somebody gets a

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<v Speaker 2>score of 24 or less, they can actually be allocated

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<v Speaker 2>up to 80,000. But if they get a score of 25,

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<v Speaker 2>a one-point difference.

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<v Speaker 2>Then they might actually get 41,000. That's crazy. And it's

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<v Speaker 2>because of technical design flaws in the algorithm.

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<v Speaker 1>We'll get to those design flaws in a moment. But

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<v Speaker 1>our understanding is that the algorithm itself can't be overruled

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<v Speaker 1>by the person doing the assessment. Is that correct?

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<v Speaker 2>Yeah, it's true. So what happened was the people who

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<v Speaker 2>designed the system and the assessors were trained to believe

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<v Speaker 2>that that in the event of an error in the algorithm,

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<v Speaker 2>that the assessor can override the algorithm. And all the

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<v Speaker 2>manuals were said that, the training was done on that basis,

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<v Speaker 2>and the week before the system went live, everybody was told, well, actually, no,

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<v Speaker 2>assessors are not able to override the algorithm. So even

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<v Speaker 2>though the IT system allows for override, They are not

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<v Speaker 2>allowed to override it, even when they know that it's

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<v Speaker 2>resulting in huge fundamental errors.

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<v Speaker 1>Now, Cathy, you've designed healthcare funding algorithms yourself. How did

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<v Speaker 1>the government end up with a system that, as you say,

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<v Speaker 1>has such fundamental problems? Was it even tested before it

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<v Speaker 1>was rolled out?

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<v Speaker 2>The process was long and drawn out. And the first

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<v Speaker 2>part involved engaging consultants, a consultancy firm, not a research group,

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<v Speaker 2>but a consultancy firm, to design the assessment tool and

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<v Speaker 2>the algorithm. So there were two parts. One is design

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<v Speaker 2>what's called the integrated assessment tool that assessors use, and

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<v Speaker 2>then that's fed into the computer algorithm. It appears that

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<v Speaker 2>the public servants managing the project didn't like the algorithm

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<v Speaker 2>and that the consulting firm developed. So they then put

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<v Speaker 2>that aside and a group of them formed a little

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<v Speaker 2>working party and they designed the algorithm in-house.

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<v Speaker 1>Do we know how much expertise these public servants had

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<v Speaker 1>when they were redesigning this algorithm?

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<v Speaker 2>Yeah, well, the public servants are very good expert public servants,

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<v Speaker 2>but they're not clinicians and none of them have got

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<v Speaker 2>a background in algorithms or or in funding system design,

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<v Speaker 2>they are career public servants. That's what a public servant does.

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<v Speaker 2>So they were doing something well beyond the expertise of

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<v Speaker 2>a public servant. And it's not the fault of the individuals.

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<v Speaker 2>The public service should never have taken on that job.

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<v Speaker 2>It did not have the skills for it. And even now,

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<v Speaker 2>A year later, it still can't admit, the public service

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<v Speaker 2>can't admit, that they got it wrong.

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<v Speaker 1>Still to come, the damning new report taking the aged

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<v Speaker 1>care system to task.

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<v Speaker 5>So critically, we think that the legislation needs to be

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<v Speaker 5>amended to ensure that there can be a change to

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<v Speaker 5>an outcome if it's clinically not appropriate.

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<v Speaker 1>Cathy, this week the Commonwealth Ombudsman released a damning report

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<v Speaker 1>into the assessment system. He found a reasonable person would

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<v Speaker 1>lack confidence that the system was fair or consistent. Having

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<v Speaker 1>investigated this yourself, what do you make of those findings?

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<v Speaker 2>Oh, look, I'm delighted by the Ombudsman and what he's

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<v Speaker 2>come out and said in that review. The ombudsman didn't

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<v Speaker 2>look at the algorithm per se. He rightly said that

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<v Speaker 2>the ombudsman's office does not have the clinical expertise. So

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<v Speaker 2>the ombudsman recognised that you need clinical expertise even if

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<v Speaker 2>the department didn't. The ombudsman assessed how the system operated,

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<v Speaker 2>and the most important recommendation from my perspective is the

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<v Speaker 2>first one, which is that assessors should be allowed to

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<v Speaker 2>override the algorithm if the algorithm gets it wrong. The

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<v Speaker 2>ombudsman also made a really interesting recommendation. which is that

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<v Speaker 2>the department should undertake a root cause analysis to identify

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<v Speaker 2>how it is that it made so many mistakes and

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<v Speaker 2>where we've got such a flawed system. And that would

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<v Speaker 2>be extraordinarily valuable if the department does it, which it

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<v Speaker 2>has actually agreed to do. The last one is a

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<v Speaker 2>recommendation that the ombudsman made, which is that the Australian

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<v Speaker 2>National Audit Office should now do a performance audit of

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<v Speaker 2>the whole system and assess whether the department's use of

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<v Speaker 2>public resources was efficient, economical and ethical. And I'm taking

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<v Speaker 2>that to mean how is it that you could bring

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<v Speaker 2>in a consulting group, pay them millions, and then on

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<v Speaker 2>the most important bit, which is the algorithm, a group

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<v Speaker 2>of public servants completely ignored it and made up their own.

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<v Speaker 1>Yeah. The government has defended the algorithm, arguing that it's

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<v Speaker 1>delivering faster and more consistent assessments and that relatively few

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<v Speaker 1>people have challenged their results. What do you make of

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<v Speaker 1>that defence?

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<v Speaker 2>There are two parts to that. One is that it's

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<v Speaker 2>more consistent results. And what I said at the Senate

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<v Speaker 2>about this is very true. If you want to consistently

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<v Speaker 2>get things wrong, use an algorithm that's the wrong algorithm

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<v Speaker 2>for the job. And I think the consistency argument is

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<v Speaker 2>being used... in an incorrect way to imply that somehow

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<v Speaker 2>that's equitable. But the algorithm does work for some people

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<v Speaker 2>and it doesn't work for others. It's not equitable. It's

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<v Speaker 2>just the same. And the second issue is that the

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<v Speaker 2>system is so complex. We are talking about frail, older people,

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<v Speaker 2>a sizeable percentage of whom have dementia and Most people

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<v Speaker 2>will be in this program for three years before they

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<v Speaker 2>either die or go to residential aged care. Many people

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<v Speaker 2>are just giving up because the only way you can

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<v Speaker 2>appeal is to write a really complicated, fill in a

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<v Speaker 2>really complicated form. When they went live, you had to

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<v Speaker 2>write a letter, put a stamp on it, take it

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<v Speaker 2>and post it to a PO box in Adelaide. It

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<v Speaker 2>was designed to make it almost impossible for older people

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<v Speaker 2>to appeal, and so hardly anybody did. But that's not

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<v Speaker 2>a sign that the algorithm's working. It's a sign that

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<v Speaker 2>the system is designed to alienate a very frail population.

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<v Speaker 1>Cathy, what does it say about the way we're approaching

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<v Speaker 1>aged care, that we're replacing the judgment of experienced assessors

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<v Speaker 1>with an algorithm that rather than using technology to help

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<v Speaker 1>them do their jobs better.

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<v Speaker 2>Well, what we're happening at the moment too, and I

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<v Speaker 2>should just add this, is that a lot of very

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<v Speaker 2>experienced assessors are leaving. They feel like data entry clerks

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<v Speaker 2>and they hate the idea that they assess somebody and

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<v Speaker 2>they know that they should be getting level six and

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<v Speaker 2>they're getting level two and they're the ones who are

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<v Speaker 2>getting the flack. We are losing experienced assessors in favour

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<v Speaker 2>of an algorithm that is not fit for purpose. And

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<v Speaker 2>what government is doing is using an algorithm to ration

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<v Speaker 2>support at home. And they think they're making a cost

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<v Speaker 2>saving to government. But a person sitting at home not

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<v Speaker 2>getting the support they need is not just quietly sitting

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<v Speaker 2>there saving the Commonwealth money. They're ending up in emergency

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<v Speaker 2>departments and in hospitals. They're going to residential aged care

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<v Speaker 2>because they've had a fall. They've forgotten to take their

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<v Speaker 2>medication when they need to. They've got malnutrition. All these

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<v Speaker 2>other things that go wrong when you leave an old,

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<v Speaker 2>frail person at home without the support they need. So

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<v Speaker 2>it's penny wise, pound stupid. And I think there are

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<v Speaker 2>two issues. One is Government has adopted this new technology

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<v Speaker 2>without actually understanding how to use it. And the second

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<v Speaker 2>is that they're using this new technology well beyond what

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<v Speaker 2>the technology is capable of doing.

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<v Speaker 1>Well, Cathy, it sounds like a fundamentally flawed system. Thank

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<v Speaker 1>you for bringing it to our attention.

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<v Speaker 2>Thank you.

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<v Speaker 1>Also in the news, a Darwin teenager will face court

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<v Speaker 1>after being charged with terrorism-related offences related to possessing violent

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<v Speaker 1>extremist material and instructions for making 3D-printed guns. The charges

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<v Speaker 1>follow a joint investigation by Federal and Northern Territory Police

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<v Speaker 1>and ASIO after a tip-off about extremist material being shared online.

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<v Speaker 1>The Australian Federal Police says it's increasingly concerned about the

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<v Speaker 1>speed at which young Australians are becoming radicalised online. And

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<v Speaker 1>the Albanese government's free trade agreement with the European Union

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<v Speaker 1>is facing growing opposition, with farming groups urging Parliament to

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<v Speaker 1>reject the deal. The National Farmers Federation says the agreement

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<v Speaker 1>fails to deliver meaningful improvements for Australia's beef, dairy and

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<v Speaker 1>sugar exporters, despite government claims it will boost the economy.

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<v Speaker 1>The Coalition is also opposed to the deal in its

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<v Speaker 1>current form, raising questions about whether it can secure the

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<v Speaker 1>parliamentary support needed for the agreement to take effect. I'm

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<v Speaker 1>Daniel James. You've been listening to 7am. We'll be back tomorrow.