Kylea Tink (North Sydney, Independent) Share this | Hansard source

I want to start by acknowledging the member for Forrest and many of the things that she just said and shared. I thank her for being so generous with her stories and I echo much of what she actually said about the concerns she raised and the way that she encouraged those over 18 to take a moment to think about what they'd like as they age. Let's be honest about it: none of us should ever take lightly the opportunity and privilege it is to grow old.

Some of the most influential people in my life have been my elders, whether that was my grandmother or my nan, my great-aunts and uncles, my current aunts and uncles or just those around me who I have always loved and respected. Never have they denied me the opportunity to learn from their experiences, so it is with a sense of responsibility that I stand to speak for them on the Inspector-General of Aged Care Bill 2023. While they have shared their positive life experiences, I have also been there to witness the challenges they faced as they aged—from end-of-life care being offered in rooms with no air conditioning and with temperatures over 38 degrees Celsius outside; falls in centres that left them dealing with further surgical interventions; or simple confusion as the system closed in around them, moving so quickly that it became foreign and often frightening.

With that said, I do stand in full support of this bill, which establishes the new Inspector-General of Aged Care to provide independent oversight of the age-care system. The 2021 Royal Commission into Aged Care Quality and Safety concluded that Australia's aged-care system needed major reform. It provided 148 recommendations to address the systemic issues prevalent within the aged-care system, and I support the implementation of these recommendations in full. I'm pleased to see that this bill begins the work of implementing some of these recommendations, namely: the need for stronger governance. Enhancing aged-care governance through new and independent oversight is important for the integrity of our aged-care system. I appreciate that the inspector-general will be able to shine a light on the effectiveness of the system, identify areas of concern and recommend improvements where appropriate.

Those aged 65 years or older account for over 16 per cent of the population in North Sydney. They make up a very sizeable and respected part of our community and, gratefully, it's expected that this part of our community will grow. How this community is treated and cared for as it grows is critical, and it's a long-term national issue for Australia. It's reported that there are currently nearly 76,000 operational aged-care places in New South Wales. However, ongoing systemic issues brought to my attention by both aged-care residents and providers in North Sydney include the rising cost of care, workforce shortages, skills shortages and substandard care. These issues can be helped by a legislative response, such as this bill and many others like it, in order to create a healthy aged-care system in Australia.

I welcome the inspector-general's duties to monitor, investigate and report on the Commonwealth's administration of the aged-care system, and to do so independently. The aged-care system is a large and complex system that includes a range of programs and policies that need to be administered with integrity. The systemic issues that exist stem from problems inherent in the design and operation of the aged-care system. The royal commission provided us with the insight required to fully drive a positive change in the operation of the system, and we must fully embrace that opportunity. We cannot afford to let this potential for positive change pass us by. The same urgency with which these recommendations were presented is the urgency with which we must deliver on them, and that starts with this bill.

Urgent reforms must be met with adequate reporting and monitoring processes, and an inspector-general can bring the oversight necessary to achieve this. If people can't trust that the government is acting with their best interests at heart, policies become less effective, workers and residents will not support reform, and the aged-care system will continue to suffer. Rebuilding trust in the administration of the aged-care system is critical to its long-term success. The inspector-general's role in overseeing the aged-care complaints management process is a particularly welcome part of this legislation. The royal commission showed us that the importance of a transparent and effective complaints-handling process cannot be overstated. Complaints can be a window into the quality and safety of care, and managing the complaints process well is imperative in ensuring quality and safety standards are met.

Finally, I support the provision of a framework for the inspector-general to publicly report to the minister and parliament on the Commonwealth's administration of the aged-care system. Transparency in the reform process is critical to its success. To have nothing to hide is a position we want the system's administration to be in. As this bill is considered, we must look at it through our current human rights framework, which, while far from perfect, requires us to consider our obligations to protect individual, social and economic rights. The aged-care system needs to be a system of care based on the universal right to high-quality, safe and timely support and care, to enable people to exercise choice and control, to ensure equity of access and to provide for regular and independent review of the system.

There are a number of serious concerns coming out of the aged-care sector, calling for further reforms. As a result of consultation with the sector's stakeholders and aged-care residents across North Sydney, I've learnt of the following key concerns. Firstly, the cost of administering and receiving aged care in Australia is rising to unsustainable levels, and it is inevitable that the reforms being called for are going to increase these costs further. A better system, quite simply, will cost more. The Parliamentary Budget Office has projected that, over the next decade, government spending on aged care will increase by four per cent a year, after correcting for inflation. This means that aged-care spending will be growing significantly faster than the rate of all Australian government spending, which is currently predicted at 2.7 per cent. By 2030-31, aged care will account for five per cent of all Australian government expenditure, compared to 4.2 per cent in the 2018-19 year.

The financing of aged care relies on Australian government payments funded by general taxation and other revenue, supported by contributions from older people receiving care. As it stands, the Australian aged-care system is gravely underfunded, and it is compromising the quality of care available. Funding levels are based largely on historical precedents and ad hoc decisions, which bear little direct relevance to the actual cost of delivering care. For the quality of aged care in Australia not to be compromised, the Australian government must accept responsibility for driving these rising costs and must do all it can to help communities, individuals and providers cover them. If government funding isn't meeting the needs of the sector, which it currently isn't, then care becomes compromised and substandard.

According to the Aged Care Financing Authority, approximately 31 per cent of home-care providers and 42 per cent of residential aged-care providers reported an operating loss in 2018-19. The exacerbating impact of COVID-19 was not reflected in these statistics. An aged-care provider in North Sydney reports that 60 per cent of residential facilities are already operating at a loss, and costs are only going up. The short- to middle-term outcome will be decreased care and services. The medium-to-long-term outcome would be that hundreds of residential homes will have to close their doors, causing distress to existing residents and nowhere for future residents to go. With home care not an option for many of these residents, the only alternative for care would be to go to hospital into an already overcrowded primary healthcare system, which is already unable to cope with what it is facing.

The effect of an overburdened primary health system is to further strain the aged-care system. The hindrance to accessing adequate health care is a serious issue in aged care. It increases the burden on aged-care workers to provide care they are not trained for and should not be required to provide. The increasing burden on aged-care workers is a huge concern. The compounding expectation for aged-care workers to perform duties outside their job description is a result of a workforce shortage and poor policies. Workers are incredibly strained in their ability to meet the level of need present in aged care. For example, aged-care workers in North Sydney have expressed concerns to me about being subject to the NDIS regulatory system separately to the aged-care regulatory system. The workload this creates is unsustainable for them. They are calling for a uniform set of regulations. You can understand why the workforce is struggling, and why care has reached in some cases substandard levels.

As a result of COVID-19 and the exhausting demands on our aged-care workers, there is not just a workforce shortage in the Australian aged-care system but a skilled workforce shortage. The pandemic has caused a huge loss of workers from the sector, and financial strain is being felt by a majority of aged-care providers. A report presented by the University of Wollongong as part of the royal commission found that, on average, each resident in a residential aged-care facility is currently receiving 180 minutes of care per day, of which 36 minutes are provided by a registered nurse. It concluded that staffing levels within large parts of the Australian residential aged care fell well short of good or even acceptable practices. The royal commission calls for a standard of 215 minutes of care every day by 2024, of which 44 minutes are to be provided by registered nurses. In addition, when fully implemented in 2024, the standards should always require at least one registered nurse is on site at each residential aged-care facility.

The government's election promise to implement two of the three recommendations relating to the workforce shortage will require 14,626 new workers in 2023-24 alone and another 25,093 workers the year after. Around-the-clock nursing in aged care and mandated time spent caring for each resident will create a shortfall of about 25,000 workers over two years. This represents a real and an unattainable short-term goal, and we need longer term solutions to improve the sector's ability to attract new workers and retain skilled and experienced ones.

The recommendation in the report states that aged-care workers should have good-quality and easily accessible ongoing training and professional development opportunities available to them. It is recommended the skills national cabinet reform committee should fast track the development of accredited, nationally recognised short courses, skill sets and micro credentials for aged-care workers. Another proposition that I support includes the improvement of the relevant visa requirements so that skilled migrants can fill job shortages. But the fact remains the gap between what we need and what we have is fairly, it would appear, insurmountable at this stage. These issues of rising cost, workforce shortages, skills shortages and substandard care are shared sector-wide. The current state of the aged-care system in Australia is a detriment to our aspirations towards human rights. As I said earlier, the findings of the royal commission have provided us with an opportunity for positive change in the operation of the system that we cannot afford to pass by. I will continue to hold the government to account, and I look forward to continuing to work with the minister and her team as she progresses this essential work.

In conclusion, I want to offer my thanks and respect to those providing services and care in this sector, as it currently exists. I have met some truly incredible people and witnessed much compassion and commitment among those who work with the residents of these facilities. While there is much talk about what is broken in this system—it's very easy to try to find scapegoats—the reality is that the system requires us all to lean in towards it and accept our responsibility in how we can work towards improving it.

I thank the government for bringing this bill forward. I commended it as a really positive first step. I recognise the significant challenges that we still have in front of us to actually bring this significant reform about, but I do want to commend this bill and the decision of the government to improve the governance of the aged-care sector. I look forward to contributing to further reform strengthening Australia's aged-care system.

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