Jonathon Duniam (Tasmania, Liberal Party) Share this | Hansard source

It's always a delight, and somehow I always have the good fortune, to follow Senator Polley in debates. It's a Tasmanian thing. We travel everywhere together in pairs, and here we are again.

It is a pleasure to be able to rise to speak on Senator Hinch's Aged Care Amendment (Ratio of Skilled Staff to Care Recipients) Bill 2017. I commend any senator or any member of parliament or any member of the community or any stakeholder who takes an interest in this issue and actually wants to do something to ensure that some of the things we've read about, heard about, seen for ourselves or know about don't occur again. I don't think there's anyone out there without serious issues who doesn't want to address these issues, although it's a case of making sure, as Senator Polley rightly pointed out in her contribution—one of the one or two things that she said that was right and accurate—that responses to these issues are evidence based and that we have the facts at our disposal to make sure we make the right decisions. I absolutely agree with Senator Polley on that very point.

There's a couple of things I want to highlight. I was having a look at the explanatory memorandum of this bill. It made a reference to ensuring that aged care is more focused on the protection of the elderly than on the profit margins of aged-care facilities. One thing I did notice—and I'm sure it's unintentional—as we travelled around the country meeting with stakeholders and aged-care providers is that there were a great many providers that are not for profits. They run on the smell of an oily rag. If you go and meet with these entities you see that they're not making huge profits, building large staffrooms and taking their staff on big retreats overseas or anything like that; they are actually very trim and efficient organisations. I think we need to acknowledge that fact as well—that some of these organisations do the best they can with what they have, particularly in my home state and the state of Senator Polley, Tasmania. Many of the aged-care providers run things very efficiently and do a great job with limited resources.

Senator Polley referred to the inquiry that took place through the Community Affairs References Committee, which I had great delight in participating in as a member. It was one of my first inquiries. Being a new senator and someone who hasn't had a great deal of experience in this space, it was very much a learning experience to meet with stakeholders and understand how the industry actually works, what consumers are looking for, what hurdles the industry faces and what government needs to do, along with stakeholders, to address the concerns raised in this inquiry. As senators may know, over an extensive period of time this inquiry had 12 public hearings right across the country. We travelled to every corner of the country from April 2016 through to June of this year—Melbourne, Perth, Bunbury, Darwin, Alice Springs, Launceston, Canberra, Townsville, Wollongong, Adelaide and Broome—plus there were a number of very informative site visits, not all of which I could attend.

The committee did a very thorough job, and I commend Senator Polley for driving that inquiry and setting up the agenda for the work the inquiry undertook. We were left with very few questions as to the state of play in the industry, so it was an excellent learning experience for me. I'm not sure whether Senator Hinch has read the report, but I do recommend that he has a look at it, and I will go through some elements that I think are salient to this debate. A lot of issues were canvassed, including the one this bill touches on and that we as a committee deliberated on at length. As Senator Polley acknowledges, it was a consensus committee report. There weren't additional comments. There was no dissenting report. We actually all agreed that there were things that needed to be done. As a government senator on that committee it was my view—and, Madam Acting Deputy President Reynolds, you were on that committee as well, and you shared my view—that it was that committee's role to make these recommendations.

One of the key things that jumped out at me in the hearings I participated in was rural and remote or regional aged care and being able to provide the necessary workforce to communities that probably don't have access to the larger numbers of prospective employees—and skilled employees at that, if we refer to this piece of legislation—that larger population centres do. Even in Tasmania, Hobart, its largest city, and Launceston, its second-largest city, have their own struggles when it comes to attracting people to these professions. As the report notes, particularly on this issue of remote and very remote areas, aged-care services may be provided by a limited number of organisations and in some cases by just one provider. We heard about one organisation, a local government organisation in the MacDonnell Regional Council, which was the only provider in their region for aged-care services in the eight remote Aboriginal and Torres Strait Islander communities in Central Australia. That gives you an indication, at one very extreme end of the spectrum, of how difficult it is for some organisations to provide and sustain these mandated ratios we're talking about here.

The Australian Institute of Health and Welfare noted in relation to this issue that people who live in rural and remote areas face additional difficulties in accessing health care and ageing related services. Rural and remote areas have fewer services available, particularly in close proximity to where people live, and the services that do exist may not be attainable, for example, due to the cost or lack of transport. In addition, service providers in rural or remote areas face challenges in service provision. The costs of building and operating facilities are higher, and—this is probably the most important and salient part with regard to this piece of legislation—there are fewer skilled workers available.

So, while I agree with the principle and the intent of this legislation, I think we need to take stock of what the committee report found and look at the recommendations of this committee report with regard to this particular issue, because there are some difficulties and complexities around how you achieve these sorts of things. The end aim, I think we would all agree, is a better standard of aged care for everyone; as for how we do that, there are many different avenues and issues that we need to deal with. But, when we hear things like this from institutions like the Institute of Health and Welfare, we need to make sure we understand the complexities, because simply putting in place a mandated ratio may have unintended consequences and will have aged-care providers like the MacDonnell Regional Council falling foul of that, meaning they may not be able to operate their service in a set of communities that require it, and no-one else is going to be able to provide those services.

The committee also looked very closely at the changing nature of aged-care services and services for the ageing in this country. It isn't what it used to be 20 years ago; I think that's fairly widely acknowledged. It's a very different landscape, with much more complex sets of needs on the part of many residents in many facilities, with increasing numbers of dementia patients with high-care needs, and all sorts of ailments and illnesses that carers now need to deal with. According to our report, the estimate is that the number of workers required for the aged-care sector will need to grow from 366,000 to 980,000 to meet the needs of increasing numbers of older Australians accessing aged-care services. That's a huge number of people that are going to be needed to be brought into this industry to support this vital part of our community—the people who have, in the generations that have gone before us, built our country.

In Tasmania alone, interestingly—being a very passionate Tasmanian—we'll require an additional 4,000 workers by 2025 to meet future demand. That's greater than the population of the town in Tasmania that I grew up in. That's a significant challenge that we have to take seriously and address, but by way of a measured and comprehensive response to the issues and not a blunt instrument or one element of the problem being dealt with to the exclusion of others. I think it is important we deal with this in an holistic way and make sure we don't leave off the agenda other elements that need to be dealt with.

Indeed, the changing service delivery in the aged-care sector is something that we considered and many submitters expressed a great deal of concern about. You'd have to agree that there are many providers who thought the Consumer Directed Care model was an unsustainable model—and they're in the know; they're the ones who are trying to provide the services as they're funded—but this model does demonstrate again this problem we have with regard to rural and regional communities. This model, where customers have greater choice and control regarding the services they access, is difficult in a very remote or a regional community, where, as I've already stated, there are limited services available and limited people that may be able to provide those services in a qualified way.

Noting some of the comments in the report around this particular issue, the report says, as I've already stated:

Some submitters also raised concerns that CDC is not appropriate for remote communities, as it presumes the existence of multiple service providers from which to choose, which is generally not the case in remote areas. Additionally, the generally smaller numbers of people accessing services, and the additional costs of delivering services in remote locations, have not been factored in to CDC modelling.

We have to take that into account, and I think the same would apply for a mandated ratio as the one-size-fits-all approach to dealing with this issue. In some cases—again I refer to the MacDonnell Ranges example I cited earlier—mandating that floor for skilled staff may make an entity unviable, unsustainable, and the end result may be that there are no services provided at all. We have to take that into account when considering this piece of legislation. Indeed, the block funding model, which has been used previously, is something that submitters indicated would be better for these rural, remote, very remote and regional communities. That's something to take on board and it may be a way of dealing with how to ensure that these regional communities can provide the suite of services at the best standard that Senator Hinch is calling for—something I do support.

I turn to the issue of making sure we can attract and retain qualified, skilled and appropriate staff in this sector. As has been noted a number of times already, it is difficult to attract people into the industry, particularly in rural and remote communities. It was interesting to hear—I suppose on reflection this was something I should have expected to be the case—about the difficulty that providers have in attracting staff to join the aged-care sector. The unions echoed that very sentiment, and it was interesting to hear why that was the case. All of this feeds into a problem I think we'll have in addressing the intent behind this bill, and that is ensuring that there are people coming through to meet the mandated ratio this bill proposes.

Submitters to the inquiry said that the reputation of the sector was very poor—when people are choosing a career path, aged care might be way down their list when they compare it to being a nurse in a hospital or having some other career in the care sector. This was a career, according to the people submitters had spoken to, that those in the industry, those contemplating life post training and where to get a job, would put at the bottom of their list, for a number of reasons. The working conditions are less than optimal, which goes to many of the points that Senator Hinch has made, and Senator Polley also. Importantly, there is a lack of career path and professional development opportunities.

I was encouraged, though, to see many institutions across the country, indeed some universities, getting in on the act of improving this situation—some of the new training opportunities and the innovative ways that prospective carers are being trained—and we saw some world leading practices and new programs with regard to hands-on training for future aged-care workers, particularly in the dementia space. It was really encouraging to see that, but I note the concerns of many submitters that there was not enough of a career path. Where does the career path take individuals who want to work in this field and what professional development is there? That's an important note for all providers, those who employ carers, and the employee representative groups, the unions, to take on board—as, indeed, is the issue of low rates of remuneration. All of these things feed into a concern I have about simply trying to mandate a specific number of skilled staff to do a certain job in certain areas.

Specifically, though, the committee did examine the issue of mandating staffing ratios. A number of submitters did express extreme difficulty with the concept of implementing such ratios in their businesses, in their not-for-profit organisations. Some said that ratios could stifle innovation. They suggested that mandatory ratios are incompatible with consumer directed care, a matter I discussed a little earlier—the need to provide these consumer directed care models will be stifled through the implementation of a mandated minimum ratio of staff. They also indicated that the expected change to the role of rostering and service provision to be customer led rather than industry led is also of concern. It comes back to that point of the sustainability of the entities that provide these services. That's not to say we shouldn't work towards ensuring that we do have the best possible suite of resources available to support the people who live in these facilities and require the support that's being provided to them.

That is what our committee report found: there are a whole suite of things that we need to work on. Sadly, it's not as simple as one small, discrete area of policy that needs reform; it is a whole-of-industry change that this committee looked at. With all of the concerns provided over the more than 12 months that evidence was taken, the 12 hearings we had and the numerous site visits, there was a comprehensive view of all of the issues the industry faces. The for-profit providers, the not-for-profit providers, the union groups, individuals and the training facilities all had their perspectives on this and they all provided their views. I would urge Senator Hinch, if he hasn't already, to have a look at this report. It is excellent reading.

Just in the time I have remaining, I will look at the recommendations. As Senator Polley said, there were 19 recommendations. They were good recommendations, and I'm hoping we'll see a response to those in the near future. As Senator Polley mentioned, the aged-care workforce strategy is a crucial piece of work to actually make sure that, moving forward, the industry does deal with the issues that this bill deals with. Also those who participated in our inquiry, by way of submissions or as witnesses, raised those issues with us as well. On the development of that strategy, the committee also—as Senator Polley pointed out as well—recommended that we have at our disposal the data necessary to understand where the workforce is going and what we need to do to ensure that we can sustain its growth. It has to be evidence based; any solution to this issue has to be evidence based.

The committee did, on this particular issue, recommend that the government examine the introduction of a minimum nursing requirement for aged-care facilities, in recognition of the increasing majority of people entering residential aged care and the complex health needs that they have. It also recommends that an aged-care workforce strategy include consideration of and planning for minimum nursing requirements, amongst the other 19 recommendations. They were, as I say, very comprehensive, as was the entire inquiry. I encourage Senator Hinch to have a look at the fine work of this committee and thank him for bringing on the bill for debate.