Julie Collins (Franklin, Australian Labor Party, Shadow Minister for Ageing and Mental Health) Share this | Link to this | Hansard source

I appreciate the opportunity to outline Labor's position on these two bills. the government's Aged Care Quality and Safety Commission Bill 2018 and Aged Care Quality and Safety Commission (Consequential Amendments and Transitional Provisions) Bill 2018. Labor supports these bills; however, in saying that, we want to raise a number of concerns about not just this legislation but also the way the government has handled the quality and safety of aged care in Australia. As we heard over the weekend, the government has now called a royal commission into aged care and the safety not just of older Australians in residential care but of all of those receiving aged care services across Australia. More than one million Australians are currently receiving aged-care services across the country. I also acknowledge and thank the minister for facilitating a departmental briefing for me on this bill. That was very useful and I'm very pleased that we were able to do that. These bills, as many of you would know, are a consequence of the Carnell-Paterson review that was handed to government in October last year. That review recommended bringing together the functions of the current Aged Care Quality Agency and the Aged Care Complaints Commissioner. This was one of the 10 recommendations included in the Carnell-Paterson review.

The purpose of the Aged Care Quality and Safety Commission Bill is to establish the new commission, the Aged Care Quality and Safety Commission, from 1 January 2019. As we heard from the government, the new commission will be tasked with helping to restore the confidence of aged-care consumers in the delivery of aged-care services, given the context of recent public concern. We all know the context in which this review occurred and some of the terrible things that happened. With this new commission we want to provide a single contact point for aged-care consumers and providers of aged care in relation to the quality of care and regulation. The commission will be responsible for accreditation, assessment, monitoring, and complaints handling in relation to aged-care services and Commonwealth funded aged-care services. These aged-care services include all four areas of aged-care services, including residential aged care, home care, flexible care services, the Commonwealth Home Support Program and the National Aboriginal and Torres Strait Islander Flexible Aged Care Program.

The new commission will be led by a statutorily appointed Aged Care Quality and Safety Commissioner, who'll be advised by the Aged Care Quality and Safety Advisory Council. The commissioner will be appointed for a term of five years. The bill also establishes that the commissioner may seek and consider clinical advice. This would take the form of an expert clinical panel that would support the work of the commission. The second bill provides for the administrative matters required to transfer the functions and operations for the existing authorities into this new commission and provides for the continuation of appointments to the Aged Care Quality Advisory Council until the expiration of their current terms as new members of the Aged Care Quality and Safety Advisory Council.

As I said, we do support what this bill is trying to do. We absolutely do. In fact, we have been calling on the government to act on the recommendations of the Carnell-Paterson review and to act on the recommendations of a whole range of other reports that are currently before the government. We are really concerned that while the government has had this recommendation it's taken almost a year for this legislation to reach this place—October through to September. Really, in light of the concerns for the safety of older Australians, that's pretty unacceptable. I wanted to know why there'd been a hold-up and why this has been taking so long. I also understand that the Greens in the other place want to have an inquiry into this bill. I am concerned that that inquiry might hold up what is really important critical reform that needs to happen.

I want to make the point that Labor has not at any stage tried to impede the passage of this legislation or to delay it or to not cooperate with the government on trying to get these bills through or deal with this situation, because we understand how important it is for older Australians, their loved ones, their families and their carers to have some certainty and some confidence in the accreditation and safety of older Australians receiving aged care. We know that these bills are so important in restoring that confidence. We need to make sure that people have confidence in our system. Clearly, from the royal commission, from the Four Corners program, we know how bad some of those issues are. The royal commission will continue to deal with some of them, and I'm sure we'll see even more-harrowing sights than we saw on Four Corners last week over the next week and indeed throughout the royal commission. We want to make sure, and we'll cooperate in terms of the Senate committee, that that process is undertaken as quickly as possible and that there will be no further delays.

We also think that these bills are a missed opportunity for the government to give the commission stronger arbitrary powers, given the level of public concern in relation to some of the disputes people have with service providers. We don't want to see this become a toothless tiger. We think it is a shortfall that government didn't consider giving the new commissioner greater arbitrary powers to resolve disputes between consumers and providers in the aged-care system. We also want to put the government on notice that there must not be any changes to the current cost-recovery process and/or fees and charges to ensure the ongoing support for smaller providers. I did raise this in the briefing. I am concerned that some rural and regional providers are unable to pay the cost recoveries that are required for some of this process for accreditation and investigating complaints. We need to ensure that those providers are able to be sustainable, particularly in regional areas where options for consumers are limited. Although the advisory council is set to continue, I would also like to point out that the government has yet to fill three vacancies on this advisory council. I assume that as soon as the new commission is established they will do that as quickly as possible.

I also want to take this opportunity to put on record some comments about the Four Corners program that we saw last week, knowing that there is another one to come next Monday night. I want to say this to the staff who were brave enough to speak out: thank you. We understand how difficult it must be and that they don't want to put older Australians in jeopardy by speaking out. We also thank the brave family members who spoke out. We know how difficult it is. We also know that the majority of aged-care workers treat older Australians with dignity and try to deliver the highest possible care. But that is not always possible because there are simply not enough of those workers caring for older Australians. I want it put on the record: our thanks to the nurses, careers, doctors and allied health professionals who work hard to deliver for older Australians each and every day. It is not an easy task.

We recognise that every day around the country the majority of older Australians are treated with care and respect at residential aged-care facilities and in other aged-care services, but what we saw on the Four Corners program was totally unacceptable. Since that time, I have been inundated with reports from other concerned family members who are also telling me their stories of unacceptable standards of quality of care. I hope that this new commission, and the existing commission in the meantime, are able to deal with the influx of complaints that they are about to get and that they have the resources to be able to deal with that, because it is a very serious issue.

We are absolutely appalled by the images and stories that we saw on Four Corners. Like every other Australian watching, I was really actually quite sad and quite tearful when hearing these stories and seeing this crisis in our national aged-care system, particularly when seeing the standard of care that was delivered in some of the homes that we saw. We have always said we should judge ourselves as a nation by how we treat our most vulnerable. That includes older Australians. We cannot call ourselves a fair and generous country until we can ensure that older Australians have the love, care, respect, autonomy and control over their own lives to make choices about how they want to live. It is clear this standard is not being met in some homes and in some services around the country.

As I said, government has announced this royal commission since the introduction of these bills and since knowing about the Four Cornersreport. Indeed, they announced it the day before the Four Corners report went to air. I am concerned that the announcement of a royal commission, whilst we absolutely support it, might slow down progress. That is why we want to progress these bills and deal with them as quickly as we can, although without denying anybody the opportunity to speak and have their say.

The terms of reference for the royal commission need to be considered really carefully by the government. If you are talking about quality and safety in aged care, they do need to be broad. They need to be broadened—more than the public statements to date might suggest. In particular, they need to look at the long-term sustainability of the sector, the funding and the staffing. I don't see how you can have a discussion about quality and safety for older Australians in aged care if you don't have appropriately qualified staff in the sector who are paid well and who are trained well. Of course, we then need to have a discussion about how we fund that. The royal commission should also examine, in our view, the impact of the 2015 and 2016 ACFI changes. You don't fixed aged care by cutting the money available per resident. We think that that was a mistake.

We on our side of politics have been saying that the aged-care system is in a state of national crisis. Bill Shorten said that in May of this year. In the parliament we heard the minister actually have a go at us about that and have a go at our leader. The minister was, in fact, almost comparing it to elder abuse, which was quite disappointing. I know that the minister has since apologised for that. What is curious is how much the government knew about how bad the system was—yet they were willing to defend it and say, 'We don't need a royal commission. Labor was wrong to say there was a crisis.' This has suddenly changed in the last week. Of course, we're glad it changed and we're glad that these issues are finally coming to light, but it is disheartening when, for well over a year, we have been raising these issues about what a crisis the aged-care system is in. We weren't listened to and we were dismissed when we tried to raise these issues.

As I've said, there are more than a dozen reports with a whole range of recommendations currently sitting on the minister's desk. The government is claiming that it has acted on these. The government has cherrypicked some of these recommendations. It has not responded, for instance, to all of the recommendations in the Tune legislated review. Even by its own best admissions and the best, I suppose, long bows that it might draw, the government has only dealt with 18 of the 38 recommendations from David Tune's report. It has not implemented all of the Carnell-Paterson recommendations. This is obviously one of those that's still yet to be fully implemented.

There have been three ministers for aged care in five years. When you have three ministers and billions of dollars in cuts, and you have ignored a whole range of reports, reviews and inquiries into the system for years, it does make one wonder about how much accountability the government is going to have for what the royal commission does expose. Quite frankly, if these kinds of instances do come to light—like what we saw on FourCornersit does raise the question of who was in charge of the system. We know the issues with accreditation failures from previous inquiries. Clearly, there is a lot wrong in the aged-care system. There are systematic failures that people should have been aware of long before this royal commission was called. I think it has been totally unacceptable, and I think that those on the other side need to reflect on how we have got to the point where the government has called a royal commission into, essentially, how it has dealt with aged care over the last five years. I think there needs to be some accountability and some acceptance from the government of its failures in this regard.

We do not intend to hold up this bill, but I am going to be moving a second reading amendment in relation to this bill at the end of my speech. I want to talk about when we have tried to hold the government to account and force some people in the government, whoever they might be, to accept some responsibility for where we are today after five years in government. There has been a bit of debate about the billions of dollars in cuts to the aged-care system. It's not just Labor saying this; the government's budget papers say that this occurred. The minister wouldn't answer my question today. He obfuscated and, in my view, deliberately didn't answer the question in the way that it was asked and was not directly relevant to my final question. There is no doubt that the ACFI complex healthcare domain funding per resident in a residential aged-care facility has been cut as a result of the 2015 MYEFO and the 2016-17 budget. There is no doubt it is lower than it should be or would have been without those cuts.

As I said, it's not just Labor saying this; if you talk to the aged-care peaks and providers, they agree. Their assessments and analyses done on this say that there is an ongoing cut that adds up to almost $1 billion a year by the end of this year. They are saying there has been $3 billion cut from the system. Sadly, when you're talking about $3 billion out of a $17 billion or $18 billion budget for aged care, it is a substantial percentage and it impacts directly on staffing and quality of care. There's no way you can have a discussion about quality of care without acknowledging that it has an impact. We've had discussions, questions, leaks and debates in this place this week, but it is really quite disturbing that nobody on that side appears to understand that they have been in government for five years. They have essentially called a royal commission into aged care because they have mucked it up so badly that they need a royal commission to fix it. There is absolutely no other explanation for the royal commission being called.

When Labor introduced the Living Longer Living Better reforms in 2012-13 the changes were bipartisan. They locked in substantial growth in aged-care budgets for quite some time, but they also had a workforce supplement of $1.5 billion to go directly towards improving workers' salaries and training in the aged-care system to keep more people working in aged care and to attract people into aged care. That supplement was axed by the government and that money was absorbed elsewhere within the aged-care budget. That means we haven't done anything about workforce for some time. You cannot, as I said, have a discussion about quality and safety without talking about the workforce. The sector spoke to the minister, and eventually a workforce task force was established with John Pollaers as chair. He completed this work and handed the strategy to the minister in June this year, but it took until last week, and a further media release from me, for this document to be released publicly. The minister eventually said it should have been released publicly and apologised for the delay, but quite frankly how are we going to implement the recommendations of this task force now in light of the royal commission? I have not heard or seen anything from the government about an implementation strategy or funding for that. We have called on the government to implement the recommendations and thanked John Pollaers for some excellent work. We may not agree with every single tiny thing in it, but it is a good start and has been done with consultation.

The government needs to work with workers in the sector and their representatives in the unions to implement the strategy that is going to be required to meet the growing demand for workers. We know that programs like we saw on Four Corners are not going to encourage more people to work in the sector unless people can be confident that there is some impetus from government and officials to fix the system. We are talking about increasing a workforce of 340,000 people to over a million in the next 30 years. That is a very a significant number of people that need to be trained for, attracted to and kept in the aged-care workforce, and I just don't think that the government has focused enough on ensuring these workers are available and have the skills necessary to provide the quality and safety of care that is required for older Australians.

There has been a lot of discussion about the role of staff, particularly nurses and personal care workers. As I said earlier in my opening remarks, I think we need to look at the important role of allied health professionals in the aged-care setting, whether they be GPs, occupational therapists, physiotherapists, dietitians, podiatrists or others. A whole range of allied health professionals are important to how we ensure the safety and quality of services that are provided to older Australians. We all know the demographics. We know the number of people over 85 is rapidly increasing compared with younger age groups. It is projected to double by 2032. We know that will have a massive impact, as I said, on the number of workers available but also on how we fund the system going forward, which is why the future sustainability of funding needs to be seriously considered by the royal commission. We don't want to see the government not act, due to the royal commission, on the other things that need to be dealt with.

I have talked about the task force report, I have talked about the Carnell-Paterson report and I have talked about the David Tune report. It was good to hear the minister refer today to the Wollongong report on ACFI. Labor has been up-front. We think the Aged Care Funding Instrument that makes the assessment for residents in aged care is broken. I have said that for more than a year. The Wollongong report, again, has been sitting around for a very long time. I know more work is being done on it, but we need to progress these things much faster than is happening, because older Australians cannot wait until the end of a royal commission for some of these issues to be dealt with.

The home care waitlist is another issue that cannot wait until the government's royal commission ends. We now have 108,000 people, as at the March quarter, sitting on a waiting list. Some of those have no services at all and over 50,000 have no home care package at all. There are people currently today waiting on that waitlist for more than a year for a home care package. Indeed, sadly, I get reports all the time of people who die waiting. That's not unusual in aged care. I absolutely get that, but the stories from some family members are that they are just desperate to get their loved one a package; they just want to get their loved one some care.

The government needs to act on this waitlist. It cannot wait for the recommendations of a royal commission; it needs to do something about it today. In fact, it needed to do something about it six months ago, as I have said so many times in this place. So many of my colleagues on this side of the parliament have repeatedly called on the government to fix this waitlist, to do something about it. We have seen the government do a little bit. We got an extra 6,000 packages released, I think, in September-October of last year. In the budget, the government moved some money out of residential care and put it into home care to fund another 16,000 packages. There has been no evidence or suggestion from the government of when those 16,000 packages are going to be released. I have heard various reports that 3,500 were going to be released each year, and then I heard 8,000 in the first year. Quite frankly, the Australian public deserves to know how many of those 16,000 packages have been released. The June quarter data is now overdue. We still don't know what that looks like.

I just think the government needs to be much more transparent with people. Surely, if you are having a royal commission, you want transparency and honesty about what is going on in the system. So why delay a waitlist? Why not tell people where they are on the waitlist? Why not tell people how long they are going to have to wait for a package, rather than saying '12 months plus'? Twelve months plus doesn't help people plan. I know that the waitlist changes all the time and that people are exiting packages. They're going into residential care, to hospital or are becoming deceased, but people need a better idea of what '12 months plus' is, what the current wait time is. Surely, the IT systems with My Aged Care are at the point where people can get a better idea of how long they have to wait so that they can plan. Some people have been waiting for two years—12 months plus up to two years. That makes it really difficult for people to plan.

With this new commission and the safety standards, I am concerned about the services that people are receiving in their homes. Whilst we have seen some terrible things in residential aged care—we have seen the footage of some of the things that are happening in residential aged care—I am also worried about vulnerable, older Australians who are in their own homes. I am worried about what might be going on in those homes without proper oversight. I have had assurances from the minister that the new quality standards that were introduced applied to home care and that at the moment the commission is able to deal with complaints but that the new commission will deal with them in a much stronger way. When I hear stories about the increased number of accreditations for home-care providers—people who want to access essentially government money to provide services to vulnerable old people—I do become concerned about what their motivations are, how quickly accreditations are being registered and what might happen. I'm putting the government on notice: we will be keeping an eye on this, because we don't want to see a whole range of new providers, who are substandard providers, being accredited in a hurry and putting older people at risk in their homes with their services. We need to make sure that that process is extraordinarily robust and that the current systems in place are able to deal with that until the new commission comes on board.

As I said, I will be moving a second reading amendment. We support the bills and remain committed to working with the government and the sector to ensure that older Australians can age safely, happily and with dignity, but it does not mean that we will not call out the government when it is doing the wrong thing and it does not mean that we will not call out the government when it is slow to act. On that, 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 notes the Government's mismanagement of aged care reform".

Ian Goodenough (Moore, Liberal Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Nick Champion (Wakefield, Australian Labor Party, Shadow Assistant Minister for Manufacturing and Science) Share this | Link to this | Hansard source

I second the amendment and reserve my right to speak.

Ian Goodenough (Moore, Liberal Party) Share this | Link to this | Hansard source

The original question was that this bill be now read a second time. To this the honourable member for Franklin has moved an amendment that all words after 'That' be omitted with a view to substituting other words. If it suits the House, I will state the question in the form that the amendment be agreed to. The question now is that the amendment be agreed to.

Ted O'Brien (Fairfax, Liberal Party) Share this | Link to this | Hansard source

I'm delighted to rise today in support of the Aged Care Quality and Safety Commission Bill 2018 and its companion, the Aged Care Quality and Safety Commission (Consequential Amendments and Transitional Provisions) Bill 2018. While these bills are relatively straightforward and their provisions far from complex, the issues they will help to address and manage into the future are immense and, in time, will touch the lives of most Australians. The purpose of these bills, considered together, is simple enough: to bring existing aged-care agencies together into a new, consolidated agency and to make the necessary provisions to accommodate that agency.

This bill has a special significance for me as the member for the Sunshine Coast seat of Fairfax. The Sunshine Coast region has one of the highest concentrations of older Australians anywhere in the country, with 20.9 per cent over 65 years of age at the last census. That compares to 15.2 per cent for Queensland and 15.8 per cent nationally. The feedback I get from older Australians and their families across my electorate, from our annual Fairfax seniors forums and from regular meetings of the Fairfax Seniors Advisory Committee, is that more needs to be done to improve the quality of care; to provide better access to care, especially for those suffering dementia; and to weed out abuse and substandard care, wherever it is found. It is for these reasons that I stand here today in strong support of this bill.

Older Australians have no better friend than the Liberal-National coalition. Under the leadership of the Prime Minister and, in particular, the Minister for Senior Australians and Aged Care, we are resolutely committed to providing older Australians with access to care that supports their dignity. In so doing, we recognise the great contribution they have made to our society and to building the Australia that we all enjoy. To that end, the first bill seeks to establish a new Aged Care Quality and Safety Commission and, in so doing, marks a significant reform in the regulation of aged-care providers. While the aims and achievement of the bill should not be understated, it must be said at the outset that this is but a part of the government's broader agenda to strengthen and enhance aged-care regulation to provide the highest-quality care for older Australians. This newly created commission will by its existence consolidate existing accreditation, assessment, monitoring and complaints-handling agencies and platforms into a single point of contact for aged-care consumers and providers. The commission will be led by a statutory appointed Aged Care Quality and Safety Commissioner, who will in turn be supported by an advisory body, the Aged Care Quality and Safety Advisory Council.

Aside from directly establishing the commission as a prescribed agency, the bill also details the functions of the commission, the commissioner and the advisory council. The bill further describes various appointment processes, together with protocols for the sharing of personal information, including the protection and disclosure of such information. Operational matters are also treated by the bill in some detail, including right of entry to aged-care facilities, search powers, reporting and also disclosure requirements, all of which, together with other aspects of the bill, were the subject of an extensive public consultation with a range of stakeholders to comprehensively inform the recommendations of last year's Review of National Aged Care Regulatory Processes. This review, undertaken by Kate Carnell and Ron Paterson, was requested by the minister following revelations of the tragic circumstances surrounding the Oakden aged-care facility in South Australia.

The second bill, which deals with consequential amendments and transitional provisions, will repeal the original enacting legislation for the former Australian Aged Care Quality Agency and amend the Aged Care Act 1997 to replace references to previous agencies with references to the new Aged Care Quality and Safety Commissioner. This bill also facilitates an efficient transfer of functions and operations from the former agency and complaints commissioner to the newly established Aged Care Quality and Safety Commission. Importantly, the bill provides for a continuation of current appointments from the former advisory council to the newly constituted Aged Care Quality and Safety Advisory Council. This provision will allow for the new advisory council to start work immediately, with no service gaps, while also ensuring stability, a continuity of experience and expert advice.

That covers the broad strokes of the bill and the proposed legislation. Essentially, it's about bringing together all the relevant agencies, with no silos, to focus sharply on providing the highest-quality aged care within both residential care and home care streams. While these reforms make sense and align with key recommendations to government, we must never forget that they are really about people. They are about all aged-care consumers, both those in care and their families and friends. The challenges that impact on the provision of quality aged-care services in Australia are not only very personal when it comes to quality of life of older Australians and peace of mind for their families but also immense in scope.

I commenced my contribution to this debate with an indication of the high number of older Australians living in my electorate and across the Sunshine Coast. Of course, it's not just the Sunshine Coast that's witnessing an ageing population. The average Australian is getting older—in fact, much older. Over the 20 years from 1996 to 2016, the proportion of Australians aged 65 years or over increased from 12 per cent to 15.3 per cent. This group is projected to increase even more rapidly over the next decade, as the bulk of the baby boomer generation reaches 65 years of age. However, the critical pressure building on our aged-care system becomes even more obvious—and, worryingly, more immediate—when you consider the rapid increase in those aged over 85 years, a time of life when care becomes a reality for many Australians. Over that same 20-year period up to 2016, the number of Australians aged 85 years and over increased by 141 per cent, compared with a total population growth, including immigration, of just 32 per cent over that same period. Even on today's population numbers, we face a significant challenge. But come 2060, Australians aged 65 and over will, on current projections, account for one-quarter of the population, while two million Australians will be over the age of 85.

There are many reasons for Australia's ageing population, including sustained low fertility and increasing life expectancy. The significance of life expectancy was starkly illustrated by the Productivity Commission in a 2013 report entitled An ageing Australia: preparing for the future, in which it was claimed that for every Australian reaching 100 years of age there are 100 babies in their first year of life. However—and this is where the rubber really hits the road—by 2060 there'll be 25 centenarians for every 100 babies. The reality of an increasing life expectancy will effectively mean that, instead of living for an additional 19 years beyond the age of 65, a child born today can expect, on reaching 65, to live a further 29 years. This is a prospect that raises powerful issues around optimal retirement issues, superannuation and, of course, aged care.

While funding for aged care is at record levels under this government, we simply can't ignore the pressure that will be placed on the system in the decades to come. We must nail the issues that guarantee high-quality aged care, not just because we face a demographic challenge on a scale never seen before in Australia, but because we're talking about our mums and our dads, our uncles and our aunts, and our brothers and our sisters. We all deserve the peace of mind that comes from knowing that when time catches up with us, and those we love, there will be dignified, quality and affordable aged-care solutions available.

Last Sunday the Prime Minister and minister announced a royal commission into the aged-care sector. I welcome this announcement, because it reinforces the determination of this government to comprehensively address reported abuse and critical noncompliance in the aged-care sector, including the care of younger Australians with disabilities living in residential aged-care facilities. Damning new data suggests an alarming spike in assaults, including rape, and other serious risks to residents' health and safety that if proven demonstrate a clear abrogation of the duty of care at some aged-care facilities.

While the vast majority of aged-care facilities and their staff consistently provide the highest level of professional care, the nature and extent of these claims are clearly shocking. They have shocked Australians and, I believe, every member of this House. While the reported abuses are in themselves confronting, it's the sheer number and dramatic escalation in reported incidents that is especially appalling.

I don't want to dwell on this, frankly, but to ensure this House is clear on how grave this situation really is, let me raise some disturbing statistics. New data recently released by the Department of Health shows that reportable assaults in residential aged-care facilities have increased by 32 per cent in the last financial year to a record 3,773 reported cases. That's one for every 55 aged-care residents nationally. There was a 177 per cent increase in the number of residential aged-care facilities deemed to be a serious risk to residents' health and safety. There were 61 locations identified in the serious risk category by the Australian Aged Care Quality Agency in 2017-18, while at the same time reported incidents of significant noncompliance in aged-care services has skyrocketed by 292 per cent.

Despite the shocking nature of a growing number of seemingly isolated incidents, incidents that should not be and will not be tolerated, the overwhelming evidence from government agencies is that the vast majority of aged-care workers and associated professionals are committed to supporting older Australians in a respectful and caring way. This, too, has been my experience as I have engaged with aged-care providers and their staff across my electorate of Fairfax and the Sunshine Coast. We must, therefore, be careful not to draw conclusions that unfairly tarnish the reputation of so many wonderful care providers. Nevertheless, we cannot afford to leave a single stone unturned as we fine-tune Australia's residential care and home care system.

As a community we rightly expect the highest standards for the quality and safety of aged-care services. The Australian government shares these expectations. And whether it be by the reforms enacted by this bill, or indeed by the rigour of a royal commission, this government stands by the rights and upholds the dignity of older Australians. It is for these reasons that I take great pleasure in commending this bill to the House.

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to 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.

Keith Pitt (Hinkler, National Party) Share this | Link to this | Hansard source

( I rise to speak in support of the Aged Care Quality and Safety Commission Bill 2018 and the related bill. One of the reasons that this first bill is so important to the people I represent is that my electorate of Hinkler has one of the largest percentages of elderly people in Australia. As at March 2018, there were 27,738 on the age pension in my electorate and 47,506 had a pensioner concession card. At the end of the day we are here talking about regulation and oversight, but, more importantly, we are talking about people. And I want to speak briefly about the people who do need this level of care and what it is that they've done for our nation. These are the most resilient and stoic people I have ever met. If we look back to what it is that they have done for us, many of them were teenagers or young adults through World War II. Their parents lived through the World War I era. They've lived through the Korean War and the Vietnam War. They've seen technology move so rapidly: from the original meat safe to a refrigerator; from the development of television, and men landing on the moon in 1969, all the way through to now, with social media and expansion. It has been such an incredible change for them. And what have they done? They have been hardworking. They have been out building our nation—our roads, our farms, our industries, our businesses—and providing opportunities for their children and their children's children over, literally, decades.

The reason this debate is so important is that they deserve the dignity and the respect and the care that they have earned over the many years of building our nation, and I think we should be focused on them. That is the absolute reality: we should be focused on them. I look back to the things that they would have seen—the donkey hot water systems and the outhouses—they know what 'night soil' means. Many of them never had the opportunity to go to university as many of the people in this building did. In fact, it has extended enormously compared to what they used to do. They knew what hard labour was. It was hard labour—pick and axe and shovel. They have cleared our agricultural production areas. They have done everything that we need to make sure that our economy and our nation goes forward. So we need to look after them at their time of need.

Locally, what we are doing is providing more services. In my electorate in 2014 we provided an additional $8.6 million to an additional to 126 residential care places and 57 home-care packages. In 2016, it was an additional 278 residential care places. In 2017, it was an additional 174 residential care places. There are about 28 aged-care facilities in my electorate, with two new ones opening in Hervey Bay—The Waterford and Ozcare's new centre. These are two fantastic aged-care facilities. In fact, I'd describe The Waterford as a cruise ship. It has cruise-ship-like facilities. There are theatres. There are workshops and a Men's Shed. There are all sorts of local assets for people in that facility to utilise. But aged care is a changing business, so we continue to invest in new and expanded facilities throughout the aged-care approval rounds. Once again, the people who've worked hard, who've raised us, who've raised their children and who've raised their grandchildren deserve that respect and that dignity and the highest standard of care.

I'm very pleased the minister for aged care is here in the chamber tonight. Mr Wyatt and I have met a number of times with local constituents and with local providers, particularly over issues which have been raised with me in my electorate. As a result of those meetings, we had one of the first unannounced audits of an aged-care facility in this country. We've had the Aged Care Complaints Commissioner visit the electorate to meet with concerned residents and aged-care providers. Those aged-care needs continue to be met, but we must ensure that the standard is of the level that is required, so roundtable discussions with aged-care providers and families were a valuable opportunity for them to raise their concerns with the minister. The reason people bring these challenges to us is because they want action, and we took that action at the time. But what I don't want to do is to disparage those operators who are doing a very, very good job—to disparage those people who work in aged care every single day, in trying circumstances, doing their utmost. It is on them that I want to reflect, because they are doing a great job, and we shouldn't be out there making their time more difficult. That is why the Department of Health and the Office of the Aged Care Complaints Commissioner held two aged-care forums in Bundaberg just last month. Our first session was for consumers, seniors, their family and carers, and anyone else who might have been looking for information about how to access aged-care services. The second session was for aged-care services and health professionals. We had around 100 attend each session, and the feedback from the first session was very positive.

We need to provide those opportunities to those individuals who are concerned, because, at the end of the day, one day it may well be us needing these services. In my own personal life, that opportunity was of no avail for my grandparents, apart from one; they simply did not live long enough to need that care. So I think we should celebrate the fact that Australians are living longer and continuing to contribute.

While aged-care services are there, fundamentally, to provide services to people in need, they are also such a massive driver of our local economy. They provide employment. They provide the supply of services and goods. They are a huge driver of our local economy. For us, in an electorate where this is one of our biggest challenges, they are providing local jobs and strengthening our local regional economy. They are a massive driver of our economy, and the more we have, the better. Obviously we continue to need more facilities locally. So I'd say to all those providers out there: we have the numbers, but there are more people coming into care, and certainly the Hinkler electorate—Bundaberg to Hervey Bay—is an opportunity for you as a provider to deliver more beds and more services in our local region.

I've spoken a number of times about ACAT assessments and the fact that the wait time has once again become too long in regional Australia. I would say again to the state Labor government: you need to fix this. Just because someone does not live in the city does not mean they don't deserve the same standards. Many of our constituents look to these services, particularly in regional areas such as Childers, because regional centres become the catch-all for the smaller communities inland. As a coastal community, we pick up service provision to those people who have resided in Mundubbera, Gayndah and Eidsvold and in other electorates and who move to the major centres when they need these services. But, like all Australians who've lived somewhere for a long time, they would like to be able to stay home for longer, and we are providing those services. So, for those out there looking for that opportunity, I say again: move to the Hinkler electorate; that opportunity is there for you. There is affordable housing, it's a great place to live and it is a wonderful place to retire.

And we are debating, of course, the Aged Care Quality and Safety Commission, which will become a single point of contact for aged-care consumers and providers of aged care in relation to the quality of care and regulation. The commission will continue to regulate residential aged-care services, home care services, flexible care services and the Commonwealth funded aged-care program. The commission replaces the existing Australian Aged Care Quality Agency and the Aged Care Complaints Commissioner from 1 January 2019 by bringing together these functions into the commission. This will result in the commission being responsible for accreditation, assessment, monitoring and complaints handling in relation to Commonwealth funded aged-care services. While I'm on my feet and have the opportunity, I say to those individuals out there who have concerns about aged care that you should raise them. I've spoken to a number of people, and not only people who provide health services, or employees. If you have an issue, raise it with the Aged Care Quality and Safety Commission, once it is established, because that is its job as a regulator.

As part of the reform agenda, it is intended that the commission will be responsible for the approval of providers of aged-care compliance and compulsory reports of assault from 1 January 2020. The commission will be led by a statutorily appointed Aged Care Quality and Safety Commissioner, who'll be supported by an advisory body. I've also written to the aged-care minister—he might not have seen it on his desk quite yet—about the actual terms of reference of the royal commission, asking for the minister to consider the total transparency of costs and funding to show just how federal government funds are expended per patient for what services and how much per provider. I've asked the minister to consider greater transparency relating to profits and losses and how aged-care providers, both not-for-profit and for-profit providers, re-invest any of those potential profits into the facilities where the profits are generated to ensure that no profits are siphoned into a provider's general operating costs over a number of facilities, as well as the ability to make compliance reporting measures mandatory, not voluntary, in relation to adverse incidents, and the assessment of staffing needs with the focus on the number of staff, the qualifications mix required, staff training and competencies, and wages across the sector.

I've also asked about a review of the need for access to registered nurses, whether on call, per shift or through other means, and also an assessment of the needs of regional and rural facilities to investigate their specific needs to maintain viable services and ensure that any recommendations do not lead to closures and job losses in towns. If you live in a regional area, you are linked to that community, and it is important that those communities are provided with the opportunity that services provide in the capital cities. You should not have to move to a capital city simply to be provided with aged-care services. So I commend the bill to the House.

Debate interrupted.