Mike Freelander (Macarthur, Australian Labor Party) Share this | Hansard source

I rise today to support the Aged Care Quality and Safety Commission Bill 2018 and the amendment moved by the shadow minister, the member for Franklin. But I must say, to quote that great Rugby League broadcaster and master of tautology of my adolescence, Rex Mossop, this is like deja vu all over again. Those on the other side can talk the talk, but they don't walk the walk. With anything to do with health care, they talk about it, but they do very, very little. They do not understand public health policy.

It's taken five years and three Liberal Prime Ministers, but aged care has finally got to somewhere near the top of this government's priorities. It's taken a lot of heartache, a lot of impassioned advocacy and lobbying, countless warnings of a national aged-care crisis, 10 or more independent studies and parliamentary reviews and reports in the last decade, an exponential increase in the number of breaches of aged-care standards reported to the government in the last 12 months, a petition of 240,000 signatures to parliament this week, and the looming spectre of a two-part Four Corners program, but they've finally got there. It's all come in a shambolic and clumsy rush, leaving the minister comprehensively hung out to dry. Just how long aged care will stay a priority for this government, of course, is another matter.

The track record to date is far from encouraging. Until last Sunday, this government had consistently rejected and rubbished previous calls for a royal commission, including from this side of the House. It had accused those calling for urgent reform of fearmongering, all the while siding with those opposed to the most basic guarantees and protections for our most vulnerable. The bill before us today was tabled before the balloon went up on the slow and dilatory efforts of the last five years. It's a telling fact that the bill takes up only one of 10 recommendations of the government's own Carnell-Paterson review. What a week ago, however, might have been sold as a substantial reform now looks anything but that.

Most of us will have now seen part 1 of the Four Corners two-part program on aged care. Those who haven't seen it should. It's not easy viewing. It is, by degrees, incisive, troubling, heart-rending and anger-inducing. Over the best part of 40 years, I've come across some pretty disturbing and very nauseating things in our health and aged-care systems, and you wonder if you still have the capacity to be shocked and revulsed. Sometimes you think you've seen it all, and, at times on Monday night, I half-wished I had. Others will feel the same. You don't need to be a doctor or a lapsed health professional to feel that way. All you need is the barest skerrick of humanity. What Four Corners depicted was human misery and suffering, stretched out on a rack built by a combination of government stupidity and private greed and indifference—the logical playing out of a sort of business model that is beneath contempt and beyond satire. If you felt nothing else, you felt an acute sense of shared failure.

How could we as a society be so blind and so uncaring? How is it that we did not take notice of the scale of patient neglect and really basic human needs, such as nutrition? How did we miss so many good employees and carers being consumed or crushed by the system? How is it that the aged-care system and the taxpayer are being so routinely gamed for profit on such a massive scale? Aged care, rightly, ought to be at the top of the national priorities in any caring society, especially one as rich as ours. Older people already make up a considerable proportion of Australia's population—in 2017, over one in seven people were aged 65 and over—and we can expect that the proportion will rise steeply in the next 20 years.

Treasury's fourth Intergenerational report in 2015 noted:

A significant change over the past 40 years has been the increase in the number of people accessing aged care services. The Australian Government provides aged care funding for residential aged care and a range of community care services, including care in the home. Australian Government expenditure on aged care has nearly quadrupled since 1975. Expenditure is projected to nearly double again … by 2055, as a result of the increase in the number of people aged over 70.

Added calls on the federal budget for aged and health care were also a function of special factors like declining rates of home ownership, high levels of private debt and inadequate levels of superannuation.

The full impacts of accelerating demographic change are only now starting to be felt and coming home to roost. As Professor Simon Eckermann of the University of Wollongong explains, the large increase in life expectancy over the last 40 years has generally pushed back the inevitable costs associated with the last five years of life—the years when the health expenditure on an individual peaks. For the last 30 or 40 years, ageing effects have only explained about five per cent of the increase in health expenditure. That will change. As a country, we need to get moving on this issue—indeed, we should have been taking action years ago. Any more years of government inaction like the five we've just had are a recipe for disaster, so these bills are welcome. They create what COTA has referred to as 'a one-stop cop' to monitor and enforce aged-care standards nationally. They aim to provide for better outcomes for those in care, and come with a $106 million support package in the budget. Of course, they are to be welcomed, as we welcome all sensible reforms, such as the introduction of unannounced reaccreditation audits of residential aged-care facilities. But these reforms alone represent only the beginning. And they need to be made to work. As the Aged Care Guild has noted:

… the establishment of An Aged Care Quality Commission is a positive step … but it is important that it doesn't just become another layer of bureaucracy.

As Bill Shorten noted, adequate pay and having enough qualified people are essential to getting things right. The Australian Nursing and Midwifery Federation, representing one of Australia's most respected callings, agrees. The government has an enormous task ahead of it, if confidence is to be rebuilt and aged-care standards are to keep pace with community expectations.

Over a quarter of a million people were using residential aged care, home care or transition care in June 2017. In addition, almost 723,000 people were assisted in their homes under the Commonwealth Home Support Program. Already, governments spend around $17 billion on aged care, with the majority—about 69 per cent—going towards residential aged care. The expenditure on residential care was 2.7 times the amount spent on home care and support. The Australian government provides around 96 per cent of the government funding for aged-care services. Worryingly, a sizeable proportion of that money appears to be being skimmed off for private gain and not finding its way to those whom it is our duty to care for and protect. Regrettably, most policymaking under the coalition is a bit like oranges at half-time in the footy; it's something they squeeze in between bouts of internecine warfare.

On Sunday the Prime Minister announced a royal commission into aged-care services, but did not announce the terms of reference, the time frame for reporting or the name of the commissioner. At this point, the public haven't even been advised precisely what aspects of aged care will be examined. In May, when the Leader of the Opposition called on the government to act on a spike in complaints and concerns about aged-care services, he was accused of fearmongering and conduct verging on elder abuse. A few weeks ago, when interviewed by Four Corners for a program that went to air this Monday, the minister said a royal commission would be a waste of two years and $200 million. What a shambles!

And now the government wants us to proceed in a bipartisan manner. They want Labor support for the royal commission and they want our support for these bills. If they get their act together and stop name-calling—and accusing the opposition leader of elder abuse, for example, which was really way over the top—they will have our support. And they'll have it even though they've rushed this bill upon us today, knowing full well that it has been referred to a Senate committee for consideration and that they are still awaiting the report of the House of Representatives standing committee on aged care. They have not allowed any real window for public comment. This bill really ought to have been brought forward sooner, and treated with greater urgency and greater respect. That way, this debate could have proceeded after the public carers and health professionals had had their chance to be heard.

On Sunday, even before the government had made official its leaked announcement on a royal commission, Bill Shorten was on the Insiders program, ready to offer our in-principle support and encouragement. He could do that because Labor knows what it's doing. We know about health care and community health, and we know what needs to be done to lift the quality of aged care and public confidence in the provision of aged-care services. No one wants older Australians and their families and friends to be living in fear. No-one wants to see health professionals, like those we saw on Four Corners, being driven out of their jobs or pushed to the point where they just cannot face it anymore. It is a human tragedy.

The government needs to do better and governments of all colours need to own their mistakes and oversights, particularly in aged care. People want us to explain ourselves. They want us to take responsibility. They want us to fix problems and not pretend those problems will go away. This minister and this Prime Minister's problem is not that they don't mean well; it is that they are playing catch-up and trying to do it while their party is still focused on itself and on political damage control. It is damage, incidentally, that it has inflicted upon itself.

The government has taken four years to come to its senses and realise its budget cuts to aged care and welfare generally in 2014 and after were an unmitigated disaster. They were never going to be accepted by this parliament or by the Australian people, nor was the government ever going to solve the so-called debt and deficit crisis that the Liberal spin doctors manufactured as a rallying call for their 2013 election campaign. Labor has supported more funding, better planning, better systems and the coordination and delivery of aged-care services every step of the way for years.

Like others on this side, I spoke in June this year in support of the Aged Care (Single Quality Framework) Reform Bill 2018, arguing that the coalition needs to get over its pathological mistrust of the public sector and its view that government support is only for those whom it considers deserving. As I said back then, and I quote:

Aged care is heavily regulated because it is heavily funded by the taxpayer, and the taxpayer wants, deserves and has a right to know that they're getting value for money.

…   …   …

The government is in the field because people need to know that adequate regulation is in place, and they want it to be there. The government is there to make sure that the myriad rational decisions that work for the majority of individuals don't oppress the minority, or aggregate the poor or the disadvantaged into a collective decision that is against their best interests.

I'm also keen to have this bill go forward as soon as practicable, because we are running out of time to get changes made as our population ages. If you want a parallel to other policies, just think about climate change and energy policy.

This government won't be helping if it turns aged-care policy in an ideological battleground. That should not happen. That would be a real pity, because over the last decade we've fallen significantly behind in our provisions for aged care. We need to admit it. We only have to look at the waiting lists to see this. Politics has the potential to derail good aged-care policy and both of the major parties need to work together to get the best results for older Australians. I'm pleased to see that the Aged Care (Single Quality Framework) Reform 2018 was passed by the parliament this month. It is a start, as are these other bills.

To conclude, the government and this Prime Minister might further promote a spirit of cooperation and bipartisanship if the Prime Minister could divest himself of some of the judgemental rhetorical flourishes he has employed in talking about measures such as those that we have before us today. In Sunday's media release, the Prime Minister observed:

We are committed to providing older Australians with access to care that supports their dignity and recognises the contribution that they have made to society.

This immediately reminded me of the Prime Minister's comment on assuming office that:

We believe in a fair go for those who have a go.

We on this side believe in a fair and equitable system for all.

Support for the aged and the infirm should not rest on the moralising or value judgements that this government and this Prime Minister are prone to. You doesn't desert the poor or the starving because, to be blunt, you think they have either underachieved or stuffed up. It is easier to help the 'deserving', but we need to be helping everyone. Where is the charity in what the government is suggesting if they only help the 'deserving'? Government and government ministers have wide powers and responsibilities, but playing God isn't one of them.

This bill has the potential to improve a service that is damaging, is inadequate and does not care for the most vulnerable in our society. We need to protect the most vulnerable in a non-judgemental way. The poorest in our community, those who can't fight for themselves, need to be supported by the government in a practical and bipartisan manner. I commend this bill and the amendment moved by the member for Franklin to the House.

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