Sussan Ley (Farrer, Liberal Party, Shadow Minister for Women) Share this | Hansard source

I rise to speak on the Aged Care Amendment (Implementing Care Reform) Bill 2022, and I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House:

(1) notes that, of the aged care providers who do not currently have a registered nurse on site, and on duty, at all times, 53% are based in regional and remote areas and 86% are small providers; and

(2) calls on the Government to ensure that:

(a) when amending the Quality of Care Principles to make provision for an exemption to the new responsibility relating to registered nurses, the disproportionate impact on providers in regional and remote areas, especially small providers, is taken into account; and

(b) further consideration of the bill is deferred until two sitting days after a draft of legislative instruments relating to the following matters are made available:

(i) exemption from the responsibility related to registered nurses as proposed in section 54-1A of the bill; and

(ii) information about aged care services that must be publicly available as proposed in section 86-10 of the bill".

The coalition supports the implementation of the recommendations of the Royal Commission into Aged Care Quality and Safety, and we want to make that very clear. In response to the recommendations of the royal commission, the previous coalition government invested $19.1 billion to improve aged care and to fund new homecare packages, respite services, training places, retention bonuses and infrastructure upgrades. This bill continues our work on the fundamental and generational reform of the aged-care system to ensure that it meets the needs of senior Australians both now and into the future.

This bill, the Aged Care Amendment (Implementing Care Reform) Bill, further responds to the recommendations of the royal commission which are contained in three schedules that amend the Aged Care Act 1997. The opposition is disappointed, however, that this legislation lacks any details on how the schedules will be implemented. It also dismisses the full details of one of the key recommendations of the royal commission. Schedule 1 of this legislation seeks to deliver on a Labor Party election commitment to have a registered nurse on site at all aged-care homes, 24/7, by 1 July 2023. Recommendation 86. 5 of the Royal Commission into Aged Care Quality and Safety states:

… from 1 July 2024, the minimum staff time standard should require at least one registered nurse on site per residential aged care facility at all times.

The opposition supports the implementation of the requirement for a registered nurse on site 24/7 at every aged-care facility, in line with the royal commission's recommendations.

The royal commission took into account a range of factors when recommending their time line, recognising workforce shortages, the pressure placed on aged-care homes throughout the pandemic and the time required to train or access this additional workforce. Despite these undeniable factors the government has brought the time line forward by a year, in conflict with the royal commission's recommendations. The opposition has genuine concerns regarding the impact this will have on the aged-care sector, particularly on small aged-care homes and those in rural, regional and remote Australia. And everyone would acknowledge that on this side of the House we have more representatives of rural, regional and remote Australia. The bill fails to demonstrate where the additional workforce will come from and how this workforce can be accessed in the short time frame set by this bill, and whether this will have significant impacts on other care sectors which are competing for the limited number of registered nurses available.

I note the testimonies from the Community Affairs Committee's hearing into this bill, where many witnesses, including aged-care peak bodies, providers and unions, anticipated that accessing additional registered nurse will be difficult and, in some cases, not even possible in the foreseeable future. The written submission from the National Aboriginal Community Controlled Health Organisation stated, 'There is a risk that many services may need to close or that providers will leave aged care, especially in areas where there are no other services available. There is a known undersupply of health and care staff across the sector. In aged care, this includes registered nurses, and the aged-care industry needs adequate time to recruit and train additional staff.' Without access to the details that will be contained in the delegated legislation, it is unclear how providers, including Aboriginal and Torres Strait Islander providers and those in rural and regional Australia, will be supported to ensure that their aged-care services will not be closed due to this requirement.

These concerns are heightened by the lack of detail surrounding the exemption clause for schedule 1, which will create uncertainty for many providers. The lack of transparency surrounding this subordinate legislation also avoids parliamentary scrutiny and has been highlighted as a key issue for aged-care providers and other key stakeholders. The government must provide answers to the significant questions surrounding this exemption clause. Providers deserve to know the details of the exemption mechanism: who will be eligible, the length of the exemptions, the penalties of noncompliance and who the decision-maker will be. The opposition is particularly concerned about the impact on regional and rural providers of the uncertainty that exists until these questions are answered and the delegated legislation is seen.

We note the unique circumstances of rural and regional providers due to their geographic locations and the challenges they face in finding the additional workforce to meet the requirement, exacerbated by the time frames set out in this bill.

These concerns were also shared by the National Aboriginal Community Controlled Health Organisation, as I announced earlier. They said, in order to meet the recommendations of the royal commission and the national agreement and ensure Aboriginal and Torres Strait Islander people receive aged care from the most appropriate organisations, consideration must be given to alternative staffing models for services in urban, regional, rural, remote and very remote locations. So the opposition believes it is essential the delegated legislation outlining the details of the exemption mechanism should be tabled before this bill is further considered.

In recognition of our concerns, the opposition will seek to move an amendment, which I have circulated, to ensure that the draft subordinate legislation is presented to parliament prior to the passage of this legislation. The cost to providers of a poorly drafted exemption clause has the potential to be significant, especially for providers already facing difficulties accessing adequate workforce and whose viability is already under pressure.

It is also unclear whether the subordinate legislation will consider the acuity of care required by individual facilities in the implementation of the requirement for a registered nurse to be on site 24/7. I note testimony from Dr Brooke, the Chief Executive Officer of the Australian Community Care Alliance, who said the other problem is, if you have one registered nurse for a whole facility, you're not defining the level of experience suitable to the level of acuity in those residents. You can have one registered nurse who's a new graduate who's been out for two weeks and that will fulfil that requirement, but the level of acuity with palliative, dementia and delirium isn't going to be supported by an inexperienced nurse or a nurse who's not familiar with the residential aged-care facilities.

Schedule 2 of the bill enables the government to cap charges that approved home-care providers can charge care recipients, and it removes home-care providers' ability to charge exit amounts. In government, the coalition implemented for the first time a requirement for information to be published relating to the median prices charged for home-care services to support older Australians and their families make more informed decisions on home care and the associated costs. The coalition government began the process of providing greater accessibility of information to assist with informed decision-making on home-care services and to put downward pressure on home-care prices. We support the government's continuation of our reforms to support older Australians access important home-care services, allowing them to remain independent in their homes for longer.

Schedule 3 of the bill requires the Secretary of the Department of Health and Aged Care to publish information in relation to aged-care providers with the aim of further increasing transparency on aged-care services and allowing Australians to make more informed decisions on aged care. The publication of additional information to increase sector transparency and increase consumer understanding of the sector is supported by the opposition. We absolutely agree on the importance of increasing transparency in the aged-care sector, and we're happy to see the government continue our reform work in this area. However, we note that, like schedule 1, the details of this schedule are subject to delegated legislation that has not been released by the government. There are still questions regarding exactly what will be published.

So, in conclusion, and to speak to my amendment, the opposition strongly supports improving the aged-care sector and the care provided to our older Australians. However, the extreme reliance of this bill on delegated legislation, the details of which have not been released by the government, denies the parliament the opportunity to scrutinise the impact of this legislation. That's why our amendment has been introduced—to ensure the government, who was elected on a platform of transparency, provides the necessary information to allow for adequate parliamentary scrutiny of this bill. We propose that further consideration of this bill be postponed until such time as the draft legislative instruments relating to schedule 1 and schedule 3 of the bill are tabled in parliament.

We also note that 53 per cent of all aged-care homes who currently do not have a registered nurse on site at all times are based in regional and remote areas, and, of this, 86 per cent are small providers. Considering this, we're calling on the government to ensure that, when amending the quality of care principles to make provision for an exemption to the new responsibility relating to registered nurses, the disproportionate impact on providers in regional and remote areas, especially small providers, is properly taken into account. So the opposition calls on the government to provide greater transparency on the details that will inform the implementations of the schedules of this bill.

Nothing in the introduction of our amendment should detract from our real and genuine passion for reform of the aged-care system. This is something that the royal commission picked up on, that we ran with, that we funded and that we want to see done incredibly well and properly. Failures in that system have brought members of this House to tears on many occasions, both within this chamber and outside it, when they've looked at the circumstances of their own families and when they've seen the struggles of the providers in their own, often rural and regional, communities. The level of care and concern is very high. And in no way do we want to politicise what should not be a political debate.

But what we are saying is that the government must stick with this promise of being transparent—of demonstrating the detail of the legislation. Where they have changed the royal commission's recommendations, and where that change could have a deleterious effect on rural and regional and remote providers, as demonstrated by the committee hearing, then we must see the detail, because uncertainty only adds to insecurity—insecurity of our wonderful community based providers. The member for Forrest, who's at the table, has many in her own electorate that she has spoken about on many occasions. Personal examples have been brought forward on many occasions. We need to see that detail so that we can reassure our community based providers, who work under incredible pressure and do what they do incredibly well, and also reassure our older Australians and their families. I thank the House.

See this speech in context