Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Hansard source

I rise to speak on the Aged Care (Living Longer Living Better) Bill 2013 and the related bills. For the many of us who have had a relative requiring care, the experience can be a daunting and at times personally distressing experience. Irrespective of their financial position, our grandfather, grandmother, mother or father deserve respect, dignity and quality in their senior years. As family members we want to know what options are available for our loved ones. The simpler the system is to navigate, the better for all concerned. There should be opportunities for appropriate care in the home. Understandably, so many want to stay in the surroundings they love and that are familiar to them and their family. If they require residential care—low or high care—there should be options readily available, preferably in their local community.

I do respect the intent of aspects of the reforms that have been proposed. We know that there are many, many challenges ahead and the proportion of the population over 70 years of age is expected to double over future decades. The incidence of chronic disease continues to grow rapidly. One million Australians receive aged-care services subsidised by the Commonwealth, and that is expected to more than double by 2050. Despite this, the government's approach to aged care and much promised reform has been protracted to say the least. The government announced the Productivity Commission's terms of reference almost three years ago. The draft report was released in January 2011, and the final report was provided to the government in June of that year. The minister and Prime Minister did not publicly release the report until August 2011, and it took a further 250 days to respond to the PC's recommendations in the form of the Living Longer Living Better policy.

The government trumpeted the release on the day as a revolution for the sector. The government continues to claim that this policy is a $3.7 billion investment when it is not. Not surprisingly, stakeholders were initially enthusiastic given the flashy headlines. Looking at the finer detail, the proposals are nowhere near as ambitious as first made out. That has been a current theme across the last six years under the stewardship of this government. The government is saving over $560 million through means testing, and they include that as part of the so-called $3.7 billion investment. Over $2½ billion is being redirected from existing programs, including $1.6 billion from the Aged Care Funding Instrument. Places and funding are to be transferred from residential care to home care, and funding will be cut from the Long Stay Older Patients initiative. The net investment over four years is just $284.6 million, not $3.7 billion. In fact, it is less than one per cent of the existing aged-care budget over the forward estimates. The unanticipated changes to ACFI and how they are applied have reduced confidence in a sector already struggling to break even.

It is, to say the least, a ham-fisted and counterproductive way to initiate reforms. In the few months following the policy's release, $3.5 billion of capital projects were found to be in jeopardy as a result of the uncertainty caused. In fact, independent analysis undertaken by the Centre for International Economics for Leading Age Services Australia found a revenue black hole of more than $750 million for providers due to the ACFI cuts. The average reduction for each affected resident is estimated at between $20,000 and $30,000 in care funding every year. This corresponds with what we are hearing from providers, and it is particularly hard on the smaller operators and those in regional and rural areas.

The minister has implied that there has been rorting and 'unusual claiming'. However, at Senate estimates it was confirmed that there has not been a single prosecution in the last five years. The sector is crying out for incentives to invest in new capital to open new beds. The government's actions so far appear to have had the opposite effect. The other significant aspect, recently launched by the government, is the workforce compact. This complex arrangement appears to be linked to the funding lost through the ACFI changes. Under the compact, providers with 50 beds or more must have an enterprise bargaining agreement to receive that funding. Those with fewer than 50 beds do not require an EBA but must still comply with the compact obligations to access funding. In itself, this will impose further cost pressures, again particularly affecting smaller providers in rural and regional areas. Providers unable to comply with these requirements will not be able to access the funding.

Across the sector there is recognition that the hardworking staff in aged care need to be paid well for the demanding and important work they perform, but this proposal, certainly by any objective analysis, seems more about propping up the beleaguered HSU than about genuinely helping the workers, those in care or, indeed, the providers.

The bills before the parliament today enacting the government's Living Longer Living Better policy reflect a small hit-and-miss selection of the Productivity Commission's recommendations. Specifically, the bills: (1) remove the distinction between low-level and high-level residential care; (2) provide a new means test combining income and assets tests and new annual and lifetime caps on means tested care fees; (3) allow accommodation costs to be paid through a refundable lump sum, a rental periodic style supplement or combination; (4) make changes to home care, including requiring contributions for people that enter home care on or after 1 July 2014; (5) establish a new aged-care pricing commissioner; (6) extend the operation of the accommodation bond guarantee scheme to new bond arrangements reflected in the government's reforms; and, finally, establish the new Australian Aged Care Quality Agency to replace the Aged Care Standards and Accreditation Agency from 1 January 2014.

The Aged Care (Living Longer Living Better) Bill 2013 removes the distinction between low care and high care, which is intended to provide one approval process for residential care. It is argued by the minister that this will reduce reassessments and allow individuals requiring a permanent residential care place to access services according to need. The bill proposes changes to the residential care subsidies and fees for residents who enter care on or after 1 July 2014. This includes a new means test combining income and asset tests and new annual and lifetime caps on means tested care fees. As stated in the minister's second reading speech an annual cap of $25,000 will apply for means tested fees, with a lifetime cap of $60,000. Both are to be indexed. Any contribution does require an appropriate safety net. We do not want a situation where people are precluded from necessary care because of what they are required to pay. It is appropriate that the proposed contributions and respective caps are examined as part of the Senate inquiry.

I recognise that there is a delicate balance between funding quality care, ensuring affordability of care and the sustainability of the system overall. In relation to accommodation costs the bill will allow fees to be paid through a refundable lump sum, or a rental periodic-style supplement, or a combination of the two. It is stated that aged care providers will not be able to distinguish between care recipients based on means of payment. Clause 52G(3) provides that the minister may by legislative instrument determine the maximum amount of accommodation that an approved provider may charge, including the maximum daily accommodation payment amount and the method for working out the refundable accommodation deposit. The bill also proposes a new form of home care to replace community aged care packages, extended aged care at home and dementia packages. An income tested care fee will apply to home care for all except pensioners. This again will be capped by year and by lifetime.

The Aged Care Pricing Commissioner is also established for the stated purpose of making decisions on pricing issues. The functions of the commissioner are as follows: to approve extra service fees; to approve accommodation payments that are higher than the maximum amount of accommodation payment determined by the minister; and other functions as determined by other acts or by the minister by determination. Whilst I acknowledge that there are lead times for these changes, the independent review proposed in the legislation is not to commence until 2016 and will not report to parliament until 30 June 2017.

The two bond security amendment bills extend the operation of the Accommodation Bond Guarantee Scheme to new accommodation payment arrangements. The Australian Bond Guarantee Scheme, prescribed in the 2006 act, provides a mechanism by which the Commonwealth may repay outstanding bond balances to care recipients should a provider become insolvent or be unable to refund the balances. There is also the capacity for the Commonwealth to recover the cost of refunding these bonds which is amended through the relevant act to reflect the changes to accommodation payments.

The Australian Aged Care Quality Agency Bill 2013 establishes a new agency. This is to replace the Aged Care Standards and Accreditation Agency from January next year. Aged care providers will be responsible to it for quality assurance of aged care services delivered in the home or a residential facility. The functions of the new agency are as follows: accrediting residential care facilities; conducting quality reviews of home care services; promoting high quality care, innovation and continuous improvement amongst approved providers of aged care; and providing information, education and training to approved providers of aged care.

I am yet to be convinced that red tape in what is already a highly regulated sector has been appropriately streamlined or that it has even been genuinely a priority for the government in this process. I do support high standards and efficient regulation to ensure consistent, quality services for the many vulnerable people in care, but nothing is achieved by unnecessary red tape except a diversion of much needed resources away from those most in need. If we want an innovative and efficient sector, unnecessary red tape cannot be ignored.

The related Australian Aged Care Quality Agency (Transitional Provisions) Bill 2013 enables the transfer of assets and liabilities from the Aged Care Standards and Accreditation Agency Ltd to the Commonwealth to facilitate the establishment of the new agency. Over $20 million was included in the budget for the Aged Care Financing Authority and over $14 million for the Aged Care Reform Implementation Council. About half the council's budget is for communications. The financing authority's role will be to provide independent advice on pricing and financing issues. It will make recommendations about subsidies and payments. It will also approve higher fees for accommodation and extra services not covered by subsidies. While there may be good intent and while we do not disagree with some of the functions performed, there has been a proliferation of separate bureaucratic structures under this government; in fact, it is a hallmark of this government. We believe more focus should be on the resources for front-line services and reducing where possible costly bureaucracy.

The government's time lines are peculiar on these bills. Despite years of deliberation, the bills were only introduced in the last sitting period, and the minister has said that they should be passed immediately. The government has set the snail pace of these reforms to date. The government has not brought the bills on for debate until today. I am not sure why or how procedurally the minister was expecting to ram the bills through the parliament. This is far from what should be normal process.

The coalition is keen to support good reform in this important area. Disappointingly for some, the reforms proposed fall very well short of what was promised. The House should remember that this is the minister who is responsible for delivering 16 early psychosis prevention and intervention centres, yet since 2010, when that promise was made, a grand total of zero of the 16 has been delivered. This is despite the Prime Minister herself saying:

I want to be absolutely clear—mental health will be a second term priority for this Government.

Those people right across the Australian community in the mental health sector, those people who access services provided by mental health providers or, indeed, those people in the aged-care sector can add that quote from the Prime Minister to the long list of broken promises that has come to plague this government. For the aged-care sector, this is not a good track record, and it comes on the back of so many other implementation blunders across the rest of government.

The bills have rightly been referred to a Senate inquiry, and the coalition will carefully consider the findings and the submissions. A number of changes will be enacted by regulation rather than legislation, and some of that detail is yet to be provided and will also require responsible scrutiny. This House should have the opportunity to properly consider any complex changes to aged care. The Senate inquiry provides that opportunity. We need to ensure that we can at least achieve the best outcome from what is before us.

In closing, I want to say to the many providers that I have spoken to around the country, particularly regional providers, that we hear their concerns. We do share their view that this minister has a tin ear when it comes to the concerns that they have raised either with the government or through the peak bodies about some of the sections within this act. It is exactly the reason that we set up the Senate inquiry and asked for people across the sector to provide input so that we can improve this legislation. As I say, the time lines on this legislation have been protracted. It has gone on for the last six years. It is interesting to note that out of the billions of dollars that this government wasted in its response to the GFC not one dollar was spent on aged care: no money for additional infrastructure or for providers, no money in wage compacts, no money for patients and services provided to the clients and residents within aged-care facilities—not a dollar.

This government came into power in 2007 promising that it would reform the aged-care sector. This minister has only been in the portfolio since the second half of these six years of the disastrous Rudd-Gillard government, but the dysfunction has continued up until this very day, and we are seeing it play out in this bill. We all want to see a better outcome for older Australians in terms of their interaction with the aged-care system, and the coalition is committed to trying to resolve some of those outstanding issues. We wanted to entertain consideration of this bill, but we also wanted to ask for providers, for care givers, for people of good intent to come forward to that Senate inquiry to make sure that their detail was provided, that their concerns were aired, and we expected that the government would listen to some of those concerns. This is a government that cannot be trusted. It says, 'Trust us in the detail; we've got the bare bones of the legislation now and we'll rush all of the other detail through in another process,' but this government cannot be trusted.

The Treasurer will deliver the speech tonight that people are anticipating will chart some way forward from the disaster of the last five or six years, but people will not get the outcome that they want from this Treasurer, they will not get the outcome that they want from this government, because that has been the track record over the last six years. Because of this government's dysfunction, because of distractions with leadership, because it has promised surpluses and then failed to deliver them, because it has spent money and run us into enormous debt, it is unfortunate that people who are looking for aged care-services in our country today have suffered because of that distraction. They have suffered because this government decided that aged care was not a priority for the Rudd government and it has not been a priority for the Gillard government.

I think the responsible course of action for this government to take would be to listen to the concerns of those who raised them, quite rightly, in the Senate process and to look at sensible amendments that could be proposed to try and improve this bill. As a parting gesture to the Australian people, with only a few months to go before the next election, in the dying days of the Gillard government, please listen to those concerns of the aged-care sector, of the aged-care providers and the people who seek care and are being cared for in these facilities around the country. Listen to the expertise that they bring to the table.

Listen to their concerns about this compact. They do not want to feather the lifestyle of people like Craig Thomson who now occupy the upper echelons of the HSU. That is what this bill provides: it is taking money away from one part of the aged-care sector and seeing it, at least in part, dispersed back through the HSU. The HSU is a disgraced union body in this country. The member for Dobell, I note, has just been told that he cannot run again for the Labor Party—three months before the election. It is absolute contempt that the Labor Party has for the people in the seat of Dobell and, indeed, that through his own actions he has.

This bill seeks to confer an ultimate benefit on the HSU. People are asking why is that the case, why divert money away from aged care and impose another cost burden on aged-care providers in terms of having to engage with the HSU? Why do they need to do that? I will tell you why: because they decide the preselections of people who sit on this government bench. They decide the preselections of people like Craig Thomson and others who come into this parliament and ultimately decide whether or not they will direct their backbenchers, and frontbenchers, to vote for Julia Gillard or Wayne Swan or Kevin Rudd or Bill Shorten or Mark Butler or—

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