Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Hansard source

Senator Hinch, as I said to you earlier, when people thank you for bringing an issue to this place it usually means we're all going to talk about it. When you bring forward these particular issues, it's an opportunity for the Senate to again re-examine things that are so important and so critical to our community and, indeed, as you pointed out in your contribution, to everyone of us. No-one is isolated from the issue of looking at aged care and the needs of aged care.

In terms of the process, I'm just wanting to put on record some of the concerns that have been raised over years of consideration through a range of committee inquiries and the Productivity Commission review in 2011. The Productivity Commission did an independent review of the future of aged care in Australia and put on record a number of key statistical pieces of information on which financial decisions and budgetary decisions need to be made. Consistently though that review, it reminded all of us that the needs and the numbers of people requiring care are continuing to grow and also that the complexity of those needs are continuing to grow.

I'm taking up some of the points that were raised by Senator Polley and Senator Duniam. However, when we have a chance to come here to talk about an issue, such as aged care, it is always an opportunity to go back and have a look at the number of community affairs inquiries that have touched on this issue. Even since I've been here—I have counted and I guarantee this won't include all of them—over 100 recommendations have been made by various groups saying what should happen in this space, and there's such a common element across these concerns. Always, it begins by saying that we understand that this is a really important issue. Then the recommendations go on to talk about the need for trained, effective staff, saying that these needs will become more difficult, and that there needs to be a whole-of-government response, and in particular that the response should take into account the needs across the whole of our country.

I think the way that Senator Duniam reflected on the most recent report of the Senate Community Affairs References Committee—which I was not a member of—made those points very clearly. That report was again an example of the strength of the community affairs committee and the general committee process in this place. When you look at the terms of reference that were agreed upon and then at the interest and the passion expressed by the wider community in being involved in the process, you understand why it is absolutely important that there are opportunities for people in the community—people with lived experience, people with concerns—to be involved in the process of the Senate committee experience. They should then be able to have a sense of confidence that the effort they have put into coming forward and the great bravery that many of them have shown in talking about their own experiences will be responded to by the government of the day, whichever flavour it is, and that the response will reflect some consideration of future policy direction. That is often where there is frustration about the way the system operates.

The committee affairs committee inquiry into the future of Australia's aged-care workforce went on for over 12 months. It travelled across the country, as we have heard from senators who were part of that process. Committee members talked with hundreds of people who came forward to give evidence to this inquiry. I understand there were very many more submissions. Out of that came a very detailed inquiry report, with 19 recommendations, some of which referred specifically to the issues in the private member's bill brought forward by Senator Hinch, as well as going across general conditions in aged care, regulation in aged care and resourcing for aged care. The recommendations also went to making sure that any Australian citizen, any Australian person—anyone living in our country—who requires aged-care support will be able to have that support in the best possible way for them and their families. So, again, trying to enforce absolute models can be very dangerous in terms of policy direction. However, given that statement, I need to say very quickly that I am concerned that, too often, a focus on flexibility and innovation can be a way of excusing taking no action at all.

I am always concerned that, when we fall back into talking about innovation and working in different ways, that is somehow being used to take any focus away from the issues and problems that have been raised. I am very much aware of the concerns about putting in place mandated ratios, but when I am told, and when I read the evidence, that that could stifle innovation, I'm very concerned that is another way of saying that that could stifle actual care. In terms of the information we have before us, I want to stress that not only should the Senate committee process allow a wide range of engagement from the community, from care givers, from providers of services and from people who are seeking service; there should also be a very formalised process through the general government process to ensure that there is open consultation and regular advisory processes that allow people who are actively interested in this space to give advice to government, to respond to any of the concerns that are raised and to bring forward their ideas as to how the system can best work. That could be a way of balancing concerns about innovation with looking at exactly what the needs will be.

The recommendations from the latest aged-care inquiry said that there needed to be awareness of future aged-care workforce requirements, including the impacts of sector growth, changes in how care is delivered and the increasing competition for workers. That last element refers to the wider aspects of care in our community. As we look at the introduction and expansion of the NDIS, we have constant demands for better and more available trained staff in that space. One of the things that has been raised in this discussion is that we can't now look at individual areas of care need without taking into consideration the wider care expectations of the community. So, at the same time we're talking about specialist care needs in the aged-care sector, we have to be aware that we now have more information, more evidence and more designated need for people who have care for a whole range of disability requirements across the country. This is, indeed, creating this quite serious issue around increasing competition for workers. This actually leads on to an understanding about the way in which we need to have clear training programs across the whole area so that the people who do make the choice to work in this industry understand they will be well protected, that they will have effective training and development, and that they will have an opportunity to use their skills in the best possible way.

In the general committee process we have in this place we have the opportunity to listen to people who want to talk to us. One of the more effective programs we've had in the parliament around the issues of aged care and disability care is the opportunity for people to come and talk to us in the parliament about what they most need for their personal circumstances. I well remember a few years ago, in a previous Senate community affairs committee inquiry into aged care, around the year 2012, we had visitations from people who were users of the aged-care system and who came to see anybody in this parliament and talk with them about how they viewed their own lives, how they viewed the increasing care needs they were looking at into their futures, and what they expected from their government in terms of response. It was incredibly valuable, I think, for senators to sit down and talk with people in the Main Committee Room here who had come voluntarily as people currently receiving aged-care services, and to listen to them about how they felt about their situation and how they felt about the people providing care for them in their homes.

Senator Hinch, one of the most impactful statements that you made in your contribution earlier was when you made it very clear to all of us that when we're talking about aged-care facilities or aged-care service centres, what we're talking about is the home for people who are living there. I think sometimes that is forgotten in the discussion. There is such a semimedicalisation of the process that we do not see that, for people who are living in the various facilities—and that seems to be the generally accepted term, 'facilities' or 'areas'—this is where people live. This is where they are needing care to just get through the days and nights of their lives. I think the concept that must remain central is that we're talking about home in that sense.

In thinking about that term, one of the things I want to talk about—because I know we're going to hear contributions from a number of people about the aged-care process—is a linkage that I have always felt is particularly important, which is the linkage between effective aged care and palliative care. One of the previous committee inquiries in which I was involved was an inquiry in 2012 into the issue of palliative care in Australia. In that inquiry, one of the most impressive forms of evidence we got was from people who were working in aged care and were talking about how they believed that there should not be a distinction at that level between aged care and people who were living towards the end of their lives in those processes. There's considerable data that looks at the fact that people who are now moving into high-care facilities are moving at an older age and with many more complex needs. They are very much more fragile as they move into that time of their lives.

What we heard in that particular inquiry is that there doesn't seem to be any acknowledgement or, in fact, more specifically, any funding or resourcing acknowledgement for the extra care that is needed for people who need actual end-of-life care under the model of the palliative-care processes. We had really interesting and very compelling evidence from a number of facilities who had, at their own cost because there was no funding model which applied in this process, put resourcing in to allow them to have a very high level of particularised, very specialised care under the palliative care model which ensured that people were not only getting the appropriate medication and having regular GP attendance but also, at that time, having personal contact. People were able to sit with the person who was at that time of their lives over extended periods of time so that there was this personal relationship. There was not only skilled knowledge but also quite personal relationships.

That's important because what we heard very often throughout the various inquiries which we've been a part of is that one of the real elements under the resourcing models that we have is that there is simply not enough time for the people who are working in the various facilities to spend personal time with the people for whom they're caring. They have a range of professional duties which they have to perform, all of which are counted in the accreditation process. That's particularly important. No-one actually denies that there has got to be this basic level of personal care and professional support, but what we lose is that element of genuine personal relationships and care.

That issue was raised by the people from various facilities who talked to us about it, and it was certainly raised by the patients' families who said that, when they go to visit, they find that their loved one—their family member—is lonely, feeling isolated or has not had the opportunity to effectively communicate their own needs. It has been so strongly enunciated to so many people in this place by actual workers who are now working in the industry, and these are workers who have professional care qualifications. They're certainly workers who have nursing qualifications and they're people who work in the facilities themselves. They say that they just do not have the time to provide that particular personal care. They gave us data that indicates the number of people for whom they have to provide care for within a certain time and the number of people who are working on wards in that period.

Recently, the New South Wales government moved to reduce the ratio of nurses in their state-controlled aged-care services. It was brought out by a number of people that you need to have a particular ratio of nurses on duty in any of the facilities over a particular time to fulfil a range of particular professional duties, medication needs and nursing procedures and to ensure that they have the appropriate supervision in an agency. But what they also wanted to ensure is that people felt as though they were being supported and cared for when they most needed it in their facility.

We have heard statistics this morning. We've heard about a number of things that the government is doing. One of the things that we're waiting very impatiently for is the result of the Tune review which was required to be done on the legislation that was passed in 2013—the Aged Care (Living Longer Living Better) Act. If anything, the particular title of that legislation is one that I think we should hold very close to. If you're looking at how we can best survive in this life, you'd say that a piece of legislation that was designed to allow people to live longer and live better is something that legislation should be designed to do. As a result of that legislation, there was required to be a comprehensive review about the whole process. That review has been completed by David Tune, and it has been presented to the minister, Ken Wyatt. We are now waiting for that to be made public.

Again, in the many Senate inquiries which people have been involved in, many people put forward their suggestions and took up the opportunity to be a part of that review. Consumers, carers, representatives of consumers, aged-care workers and aged-care providers all came forward and gave their information about how they felt that program of legislation had been implemented and their suggestions for what could be done better.

One of the things that did strike me, though—and I think this is a concern in the particular environment in which we're operating—is that very many of the submissions that were put up on the website for this review were put forward anonymously. That has not happened in many of the Senate committees in which we've operated. People gave their names, came forward and spoke openly about their issues around aged care. But when I was reading through the submissions that were up on the website, for this review that was done on Living Longer Living Better, very many were anonymous, and I'm concerned about that. I'll be interested to see, when this review is tabled by the minister, whether any reason is given for that.

The reason I say this is that, in the evidence we have received in previous inquiries and also in evidence about the New South Wales situation where they were looking at changing the ratios, people expressed that there was a fear amongst workers and a fear amongst residents of putting forward any concerns or complaints. That in itself is a genuine worry. If we cannot have a process where people are able to give information freely and to give evidence about which they are deeply concerned, we are not going to have that open consultation that we best need. As parliamentarians, as policymakers, we need to have confidence that people will come and talk to us. We have that so often in our Senate inquiries. If we lose that, if people become frightened of expressing positions of difference or frightened of giving advice, I think we will not be able to effectively develop good policy.

The issues around ageing and aged care are important. Senator Hinch, I think it is absolutely critical that the hot-list discussion continues and we have further consideration of the issue of mandated ratios. I think that will be part of an evidence based—I do love that term—process into the future. But I do not want to have any issue around care, and ensuring that we have absolute standards of care for our people across the community, being pushed aside to say that we have to be more concerned about innovation in this space and being more flexible.