Helen Polley (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Aged Care) Share this | Hansard source

Labor is extremely pleased to talk about the hundreds of thousands of aged-care workers supporting older Australians to grow old, because they are a group of people that the Turnbull-Liberal government has forgotten. Personal care workers, nurses, support staff, allied health professionals and a range of other workers are critical in ensuring older Australians can choose the care they want, receive it where they want and grow old with respect, dignity and safety.

Unfortunately, we have had four years of inaction when it comes to the aged-care workforce from the Turnbull-Liberal government. Indeed, in four years the only thing that the Turnbull government has actually done is to scrap Labor's $1.5 billion workforce compact. This was a policy that was working to deliver higher wages, improve career structures for aged-care workers, enhance training and education opportunities, improve care development, improve career development and workforce planning, and develop better work practices. This was a policy that was developed by an independently chaired workforce advisory group to ensure workforce reforms led to improvements in services for older people and benefits for the workforce. The care of older Australians and the hardworking Australians who care for them has simply dropped off the agenda for the Turnbull government, which appears to be more focused on its own survival.

Labor strongly supports moves to ensure that we have adequate, safe and appropriately skilled aged-care staffing levels that meet the care needs of recipients. It's clear that more work needs to be done to support and grow our aged-care workforce. The demographics of our nation are well known. Around 1.3 million Australians are currently receiving some form of aged care, provided by almost 400,000 aged-care workers. About a quarter of all Australians are expected to be 65 years and older by the middle of the 21st century. As a result, demand for residential aged-care services is projected to increase by almost 68 per cent in the next 40 years. Ensuring there is a sufficient workforce to meet the increasing demand in aged-care services is a major challenge for the sustainability of this sector's future. Increasing demand is predominantly driven by two factors: the ageing population and the increased prevalence of dementia, with the associated need for higher levels of support and care.

The Productivity Commission's Caring for older Australians report in 2011 stated that, in order to meet ever-increasing demand for aged-care services and support, the aged-care workforce will need to more than triple by 2050. This need for significant growth was again affirmed in 2015 by the Aged Care Financing Authority. This represents a workforce growth rate of about two per cent annually in order to meet future demand, at a time when the overall employment-to-population ratio will be declining. By 2050 we will need to have more than one million Australians working in the aged-care sector—a 300 per cent increase. According to the National Aged Care Workforce Census and Survey, the aged-care sector is already confronting workforce shortages, which will be exacerbated as sectors competing for the same workforce, such as disability services, simultaneously grow with the increased rollout of the NDIS.

Further, increasing rates of complex chronic conditions and a mismatch between the first language of some older Australians requiring care and the current workforce present some even greater challenges in keeping pace with the diversity and skills required for the care of our ageing population. Indeed, the growth rate of the number of older Australians living with dementia—currently at around 400,000 Australians and expected to exceed 900,000 by 2050—is a key consideration in the future of the aged-care workforce. The aged-care workforce will need to broaden its skills and capacities in order to assist older Australians with increasingly complex needs, such as dementia and other cognitive impairments, the increasing incidence of mental illness, palliative care and HIV. We're not even touching the effects of the epidemic we're having at the moment with drugs such as ice.

More than 80 per cent of direct-care workers in home and residential aged care are women, and as many as 40 per cent of recent hires in residential care were migrant workers. This paints the picture of a diverse workforce that has significant capacity but that also faces unique and complex challenges. In the context of cost pressures in residential care, in particular, it is also worth noting that staff costs represent 67 per cent of the total expenses in residential care. That's a significant amount of their budget.

Aged-care providers are accredited and monitored by the Australian Aged Care Quality Agency. The regulation of staffing and the provision of Commonwealth government funded aged-care services is legislated in federal law. Aged-care providers must comply with accreditation standards detailed in the Quality of Care Principles 2014, overseen by the Aged Care Quality Agency. While there is no prescribed minimum staffing standard, the accreditation standards for residential care facilities require there to be appropriately skilled and qualified staff sufficient to ensure that the appropriate services are delivered to older Australians. With the exception of public Victorian and Queensland aged-care facilities, most state and territory jurisdictions do not legislate minimum staffing ratios or determine a required skill mix for nursing.

While the vast majority of aged-care providers in Australia provide high levels of care and support and have well-managed and well-resourced staffing systems in place, we have serious concerns in regard to a number of significant failures of care at facilities only months after being found to have met accreditation standards. As a result, Labor has backed the Commonwealth government's independent Review of National Aged Care Quality Regulatory Processes, which is currently under way. It is expected that this should consider how regulatory processes can be improved to support appropriate staffing levels and staffing mix, and we look forward to reviewing the findings and recommendations of this report later this month.

It's critical to the future of the aged-care sector that families can have faith that their loved ones will be safe and will receive a high level of care in residential homes. There is no doubt that more work needs to be done to address deficiencies in the current regulatory processes.

While Labor has shown a genuine commitment to work with the government and the aged-care sector to ensure senior Australians can age safely and happily in their own homes or in residential homes, the lack of urgency shown by this government is deeply disturbing. Too often we hear stories of aged-care homes where just one registered nurse is responsible for the care management of hundreds of residents, sometimes across multiple homes. Too often we hear stories of personal-care workers with little more training than a first aid certificate being responsible for the primary care of vulnerable older Australians. This is unacceptable.

Labor will stand with aged-care workers and aged-care recipients and demand better outcomes that support our workers and protect older Australians. Fundamentally, the question of how we can achieve these outcomes, whatever it comes down to, has to be based on evidence. We have to have an evidence-based approach to our regulatory system.

Labor is completely committed to working with the unions and aged-care providers to support a strategy to meet growing demand in the aged-care workforce, with a framework that ensures decent conditions and career progression for workers and a high level of care for consumers. We fundamentally believe that this approach includes looking at the issues of 24-hour registered nurse coverage, nurse ratios and the skills mix that will enable enrolled nurses, assistant nurses and personal care workers to provide sustainable quality of care. Labor believes that the skills mix is critical to ensuring sustainable, quality care. It requires regulatory and administrative processes that will support that outcome. An evidence-based approach to the training and educational development of the workforce, and a review of regulations that govern accreditation, quality and compliance, are critical to this process.

Labor continues to progress this commitment from opposition through a number of mechanisms. Importantly, we have been a driving force behind the inquiry of the Senate Standing Committee on Community Affairs into the future of the aged-care workforce. Can I put on record that that committee travelled around Australia. We went to regional Australia and to remote Australia. We had people from the government. We had senators from the government. We had Green senators. I travelled along with my colleague Senator Watt. We all heard the same evidence. There is no doubt that the government is fully aware of the issues facing this sector. But the reality is that it's not just the responsibility of the people on the committee or the minister responsible for aged care; it is the responsibility of every member of parliament and every senator, every member of state government and every member of our local governments, because we all need to play an active role in ensuring we address not only the aged-care issues in this country but also issues concerning ageing. We all have to take that responsibility. In fact, there needs to be a greater conversation in our communities about how we want to show our respect and give safe, well-trained, highly skilled care for older Australians. We should never accept anything less than that.

The inquiry investigated a number of key issues and addressed some key questions in the future development and regulation of the aged-care workforce. There were 19 recommendations in the report, which all aligned with Labor's 2016 federal election commitments and which were unanimously supported by the government senators, the Greens Senator and the Labor senators. There is a clear need for an aged-care workforce strategy, and the report made a number of recommendations about what the strategy needed to address. It's pleasing to see firm recommendations about the active role that the Turnbull government needs to take in workforce development. They're a key stakeholder and funder of the aged-care sector, after all—unlike the former minister, who said it was not their responsibility. Quite frankly, it's a responsibility of government, the sector and the unions. We all have a role to play.

Other key recommendations for the government include the examination of the introduction of a minimum nursing requirement in aged-care homes; a national employment screening and working registration scheme; the implementation of the national code of conduct for healthcare workers; the publication of staff ratios in aged-care homes to help people make informed decisions; and nationally consistent accreditation standards to ensure quality across the board. The report also made recommendations on the direction of the aged-care workforce task force, which was allocated $1.9 million in the 2017-18 budget, which include better support for regional and rural workers; efforts to tackle pay issues in aged care; and a national campaign to promote the benefits of working in aged care.

Labor strongly supports the recommendations of The future of Australia's aged care sector workforce report. The approach detailed in this report includes further examination of minimum nursing requirements in the context of increasing demand and the complex needs of these older Australians. Unfortunately, this approach requires the Turnbull government to actually confront these issues and provide guidance and resources in regulating the growth of the aged-care workforce. Importantly, the report, which was adopted unanimously, as I said, by all political parties, recommends the age care workforce task force include all stakeholders—that is, the unions, the workers and the providers. All of them need to be involved. This makes good old-fashioned common sense. If the task force is to be credited, it must have representation from across the full range of providers, unions, carers, health professionals, employees and consumers. For a moment, we had a glimpse of hope from the Turnbull government that maybe, just maybe, they were starting to understand the importance of aged-care workforce development and regulations. Indeed, Minister Ken Wyatt said in response to the release of the inquiry report:

The task force will be required to consult widely within the health and aged care sector, and engage with other sectors, including social services, education and employment.

Planning for this is well underway, with the task force expected to be established in July 2017

This appeared to be a positive step, particularly considering the statement from Senator Nash, who stated in February estimates of 2016—my favourite time of the year here in the Senate is estimates—that the aged-care workforce is a matter for the sector. Unfortunately, this appears to have been nothing more than a hollow promise. We are now into the second week of September, many weeks after July, and there is no detail about who will make up the task force, no detail about when or how the funding will be delivered—no progress whatsoever.

To add insult to injury, it appears that a package that sits alongside the task force, the $33 million Boosting the Local Care Workforce package, designed to help existing service providers in the disability and aged-care sectors grow their workforce, has dropped the aged-care sector from its focus altogether. In a media release from 30 August 2017, the Turnbull government announced that 10 organisations have been shortlisted and invited to apply to deliver the $33 million package. The 10 organisations include groups and peak bodies for the disability and employment services sector.    Even though the grants are supposed to be targeted to the aged-care service sector and the disability service sector workforces, no aged-care peak body has been invited to apply for the grant. It's just another clear sign that the government is recklessly overlooking the needs of older Australians and the people who provide their care.

We know for sure that the nature of aged-care provisions is changing, and it is changing for the better. We're all living older, but we need to keep up with the times. When last in government, Labor delivered the biggest reforms to aged care and ageing policy in a generation. Labor's $3.7 billion strategy known as the Living Longer Living Better aged-care package provided a ten-year plan to deliver choice, fairness, quality, sustainability and respect to our aged-care system. We delivered a strong framework to build the aged-care services that Australians deserve, and progress was being made. As a result of this approach, more Australians are able to choose the type of care and support they receive when they grow old, and more Australians are able to choose to grow old in their own home and decide who provides their care.

But if we are going to go forward—Labor did all the heavy lifting, but we didn't do it all on our own. We showed the leadership that was needed, but we worked with the opposition of the day, the unions, the sector and consumers. That was the framework that was supposed to be the foundation. These guys in government have absolutely taken their eye off the ball. You can't take $4 billion out of a sector and then expect the same type of care. It just cannot be delivered. I thought we'd made progress in that Senate committee, and I commend Senator Duniam, who was very open to seeing what was happening in our community, not only in aged-care homes but in what we're trying to deliver in our own homes. There are some real challenges there, and we have said time and time again that Labor wants to work with the government, but we have to earnestly address these issues— (Time expired)