Zali Steggall (Warringah, Independent) Share this | Hansard source

I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 2) Bill 2021. This bill addresses eight aspects of the report of the Royal Commission into Aged Care Quality and Safety, including residential aged-care funding, screening of aged-care workers, code of conduct and banning orders, incident management, governance, and information sharing. It also establishes the Independent Health and Aged Care Pricing Authority. It will be associated with some $200 million of additional funding for the sector and oversight bodies.

There are 11 recommendations from the royal commission that are addressed by this bill, and I note that the peak bodies of the aged-care sector have expressed their dismay at the lack of consultation with them on the changes presented in this bill. I would encourage the government to improve on its process of consultation with the experts within the field, especially with those who are impacted by the changes, in advance of further reform. One would think that the lesson had already been learnt with the outcomes of the royal commission and the horrendous stories that shocked the Australian public, but there is still an inability for proper consultation with the sector when addressing reforms. This is particularly relevant to the new pricing model proposed under the legislation, the impact of which remains unclear. Some providers fear that they may be worse off under the new funding arrangements, but the government has refused to establish a better-off-overall-test for this new funding model, which is a concern. I welcome the adaptation of the NDIS worker-screening model to the aged-care sector. However, given the nuances of the two sectors, I believe it would be beneficial if aged-care providers were able to provide input and feedback on the screening process.

Schedule 3 of the bill establishes a code of conduct and banning orders for aged-care staff. While this is a welcome development, I note that peak bodies, such as Leading Age Services Australia, have significant concerns with the broad and vague terms of the code of conduct and the high penalties of up to $55,000 for breaches. These penalties may even be levied against volunteers. Their concern is that it is easy for different people to have different views about what 'acting with respect' means. The detail is important. They are also concerned that the code of conduct is duplicative in many instances because nurses and other allied health professionals will be subject to the aged-care code in addition to the relevant codes for their profession. The question will be: are they aligned or will there be discrepancies?

The new governance requirements established by schedule 5 of the bill make sense for larger organisations, including having a majority of non-executive members and a minimum number of clinical members. However, again, smaller owner-operated bodies may struggle to comply with these new requirements. I appreciate that exemptions may be granted, but I strongly believe it would be better to have more-specific guidance in the legislation or regulations around arrangements for different entity structures.

Overall, I welcome the bill and the progress towards implementation of the aged-care royal commission recommendations. The bill and the establishment of the code of conduct, governance and screening models will make some progress towards the complaints of aged-care workers in my electorate and those around Australia. But we still have a number of concerns from local nurses and aged-care workers. Aged-care workers in my electorate have highlighted to me the lack of training and oversight of carers, leading to compromised quality of care service among those providers. They've told me that there is a real gap in the care received by participants, depending on the carers allocated. Patients without family or close relationships or under public guardianship are often left behind with inadequate support. They have alerted me to instances of long waiting times for assistance, of poor hygiene in facilities and in the home and of staff administering medication to control behaviour. These stories are not unfamiliar. Many of them we heard during the royal commission.

This bill and the standards and conduct measures will go some way towards improving the conditions, but more needs to be done. We need to recruit and train the 40,000 additional workers promised to the sector. We need those additional staff urgently to improve the timeliness and quality of care for those most vulnerable in our society. Registered nurses remains a vexed question. There's still an unwillingness to address this issue. Registered nurses in my electorate who work in this sector—and, as the member for Mackellar said, they are the ones on the ground, who are doing the work—strongly believe that having a registered nurse allocation 24/7 to all residential facilities will greatly improve the quality of care outcomes for residents and other staff and reduce pressure on hospitals and emergency services. It is not good enough to claim an excuse that some areas in regional areas won't have access. We need to make sure we train the workforce and make registered nurses available to facilities. There should not be a difference in standard of care. We need to progress the requirement to have registered nurses on staff at residential aged-care facilities at all times. It makes sense, and it will improve the quality of care and outcomes for our already stretched health systems. This needs to be prioritised.

It's important for me, as the member for Warringah, to hear from families, from people participating in aged care and engaging with the system, and from professionals in that system. So I recently implemented a Warringah aged-care forum to hear from them directly. Implementation of the aged-care royal commission recommendations was a key issue raised at that forum. In my electorate of Warringah, there are 18 residential aged-care facilities. The purpose of the forum was to allow my constituents to raise their concerns and ask for guidance and assistance and for me to give them practical steps from an expert in the industry, as well as to hear their complaints and concerns.

The main themes that arose out of the forum were difficulties in navigating the application and assessment processes; questions about how to instigate either home care or residential aged care; the need to alert people to the option of the Commonwealth home support package, which can often be used as an interim support while people are on these very long waiting lists; and guidance on choosing a provider or aged-care facility, as well as other community resources that may help. The key issues raised included the very long waiting lists; convoluted and arduous application and assessment processes; the need to have a registered nurse on staff at residential care facilities 24/7, whereas at present there is no obligation to have a registered nurse on site at aged-care facilities at all times; the need to improve carer and staff ratios dramatically, because the statistics are horrific; the need for families to have pre-emptive contingency plans in place to prepare for abrupt changes in circumstances; guidance on estate planning and end-of-life preparations and assisting families on how to navigate these; and how and when the royal commission's recommendations would be implemented in full. These are the key concerns of residents of Warringah.

So I welcome this bill, as it progresses 11 recommendations of the royal commission. But, unfortunately, many of the concerns voiced by my constituents in the forum won't be directly addressed by this bill. I've written to the minister to raise the issues that came up in the forum, and I hope these will be engaged with and there will be some action in that respect. The bill lays some of the groundwork for improvements to the sector, but we need more progress on the implementation of the royal commission recommendations, including the establishment of staff ratios and registered nurses. This is probably one of the single biggest changes that could occur to improve the very real outcomes and the actual care of our most vulnerable.

We need government to commit to removing the age discrimination between the packages provided to people who acquire disabilities under the age of 65 and those who acquire them over 65. This is the big elephant in the room. It just doesn't get addressed by the government. It's a bucket that keeps getting pushed around. It's incredible discrimination that's still allowed to persist. While you're adapting so many compliance and standard measures from the NDIS to the aged-care sector, you should also make sure that the packages provided to participants are equitable and fair.

So I commend the government for implementing some of these measures, but I urge the minister and the government to listen to the professionals in the industry and implement more of the recommendations. We know Australia has an ageing population, and we need to do more to ensure that those most vulnerable are properly cared for in their old age. It is our responsibility, and it's the responsibility of everyone in this place.

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