Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | Hansard source

The coalition acknowledges that the Aged Care Amendment (Implementing Care Reform) Bill 2022 continues in part the work of the fundamental and generational reform of the aged-care system to ensure it meets the needs of senior Australians both now and into the future. However, this bill is also an election commitment tick and flick. The bill is rushed, it lacks detail and it ignores the unique circumstances faced by rural, remote and regional Australia. This bill ignores the importance of good legislation.

The opposition will continue to work constructively with the aged-care sector, older Australians and their families, and the government to collectively address the many challenges that lie ahead, including the changing and the expanding expectations of aged-care services, the legacy of COVID and Australia's ageing population. The task before us is to maintain and sustain an aged-care sector that meets expectations, is affordable to those who need it and is equitable whether you live in Sydney, Mildura or Kununurra. We must ensure that the people this sector aims to support and their quality of life are at the centre of every piece of our decision-making.

Whilst the coalition supports the intent of this bill, it is very inadequate and suboptimal. It neglects to recognise many important and substantial consequences, because it has been rushed and doesn't even try to address the concerns of stakeholders about the severe lack of workforce and the uncertainty of what might be contained in the delegated legislation. This implementing care reform bill contains three schedules amending the Aged Care Act 1997; however the opposition is disappointed with the incredible lack of detail—details missing from this very important piece of legislation.

In government, the coalition called the Royal Commission into Aged Care Quality and Safety to ensure our oldest and most vulnerable Australians receive care that supports and respects their dignity and recognises the contribution that they have made to society. We responded to the recommendations of the royal commission by investing $19.1 billion to improve aged care and fund new home-care packages, respite services, training places, retention bonuses and infrastructure upgrades. Schedule 1 of this legislation goes to the heart of a very significant recommendation of the royal commission, recommendation 86.5, which states:

… from 1 July 2024, the minimum staff time standard should require at least one registered nurse on site per residential aged care facility at all times.

The opposition supports the implementation of the recommendation for a nurse on site 24/7 in every aged-care facility, in line with the royal commission's recommendation, as we know the workforce challenges the Australian care sector is facing. This is particularly acute for registered nurses.

Considering this schedule is not consistent with the time frame recommended by the royal commission and noting the current workforce shortages experienced across Australia, the opposition has concerns about the impact of the expedited time line on the broader healthcare sector. The new residential aged-care staffing targets are ambitious, and achieving them is going to be challenging, especially for small providers and rural, regional and, especially, remote providers. However, in the broader current climate of worker shortages and record-low unemployment, the whole sector will face significant difficulties employing and retaining the critical staff to continue to support our older Australians.

Despite these undeniable factors, the government has just looked at a few inner-city aged-care providers and has blatantly ignored a whole range of factors that the royal commission took into consideration when they suggested their time line. This conflict with the royal commission's recommendations is the reason the opposition is concerned by the one-size-fits-all approach in this legislation. We know that aged care comes in all shapes and sizes, issues vary from location to location and facilities have residents with varying levels of acuity of care needs. I note the testimonies to the Community Affairs Legislation Committee hearing into the bill and that many witnesses, including aged-care peak bodies, providers and advocacy groups, anticipate that accessing additional registered nurses will be difficult, if not impossible, within the time frame designated in this bill. The written submissions of the National Aboriginal Community Controlled Health Organisation stated:

There is a risk that many services may need to close, or that providers will leave aged care, especially in areas where there are no other services available. There is a known undersupply of health and care staff across the sector - in aged care, this includes registered nurses. The aged care industry needs adequate time to recruit and train additional staff.

Without clear advice and direction from the government, it is unclear how providers, including Aboriginal and Torres Strait Islander providers and those in rural, regional and remote Australia, will be supported to ensure that their aged-care services are not forced to close due to this accelerated requirement. Although acknowledging the government's amendments moved by Senator Pocock, they really do nothing to address the opposition's concerns about the lack of key information and the impact on rural, regional and remote nursing homes and the Australians who rely on them.

Another issue that has been raised by numerous aged-care providers is the matter of enrolled nurses and the potential impact of them of the strictly prescribed requirements of care minutes within recommendation 86 of the royal commission. Enrolled nurses are an absolutely critical part of Australia's aged-care workforce. They provide essential care to older Australians, they support registered nurses and they can assist administrative staff in the work that they have to undertake. Given the time frame that the government has set in this bill for aged-care providers to achieve having a registered nurse on site 24 hours a day, seven days a week, and noting that many providers remain anxious regarding that exemption and what the clauses will be, we call on the government to give consideration to the role of enrolled nurses in this time period.

The refusal of the government to provide details about subordinate legislation is not only concerning, as it avoids parliamentary scrutiny, but has been highlighted as a key issue for aged-care providers and other stakeholders. The government must provide answers to significant questions that remain unanswered, particularly surrounding this exemption clause, on which they have to date been completely silent. For example, what exactly is the exemption mechanism that will be detailed in this delegated legislation? When will the delegated legislation be available for the sector to be able to see? Will the delegated legislation be consulted on? When? Who will be eligible for an exemption? For those not eligible for an exemption, what are the penalties for non-compliance? All of these are very important questions for the security of the aged-care sector to go forward with certainty. They have been unanswered by this government, and yet it still wants to push this piece of legislation through this morning.

The opposition is particularly concerned about the possible additional burdens and requirements that will be placed on regional, rural and remote providers if the exemption clauses are not adequately defined. We note the unique circumstances of rural, regional and remote providers due to their geographical locations and the burdens that they are facing in finding additional workforce or competing with other sectors, like hospitals, for the workforce to meet the requirements that will be set out within the time frames in this bill.

These concerns were particularly shared by NACCHO, who said:

In order to meet the recommendations of the Royal Commission and the National Agreement and ensure Aboriginal and Torres Strait Islander people receive aged care from the most appropriate organisations, consideration must be given to alternative staffing models for services in urban, regional, rural, remote and very remote locations.

The cost to providers of a poorly drafted exemption clause has the potential to be significantly detrimental, especially since the detrimental changes in July to the distribution priority areas. Regional providers are now finding it extremely difficult to attract and maintain a steady, reliable workforce as qualified health professionals and their staff relocate to urban areas. It remains unclear whether the subordinate legislation will consider the acuity of care required by individual facilities in its implementation of the requirements for a registered nurse to be on site at all times. I note testimony from Dr Nicole Brooke, the Chief Executive Officer of the Australian Community Industry Alliance, who said:

The other problem is that, if you have one registered nurse for a whole facility, you're not defining the level of experience suitable to the level of acuity in those residents. You can have one registered nurse who's a new graduate and has been out—

in the community—

for two weeks, and that will still fulfil that requirement. But the level of acuity … with … palliation, dementia and delirium … isn't going to be supported by an inexperienced nurse or a nurse who's not familiar with the residential aged-care facilities …

The government must advise whether they will stipulate specific nursing requirements for services who care for residents requiring a very acute level of care. The government must advise the public if they are considering mobilising enrolled nurse personnel for situations where those personnel can be utilised. Instead of clear and concise articulated solutions to these issues, all we have had from the government is a talkfest, solution-less jobs summit.

In recognition of our concerns, the opposition will again seek to move an amendment to ensure that the draft subordinate legislation is presented to the parliament prior to the start of the schedule to allow providers the time to consider and consult on the proposed exemption clause.

Schedule 2 of the bill enables the government to cap charges that approved home-care providers can charge care recipients and removes home-care providers' ability to charge exit fees. In government, the coalition implemented for the first time a requirement for information to be published relating to the median prices charged for home-care services to support older Australians and their families to make more informed decisions on home care and the associated costs. We began the process of providing greater accessibility of information not only to assist with informed decision-making on home-care services but also to put downward pressure on home-care prices.

We support the government's continuation of our reforms to support older Australians to access important home-care services, allowing them to remain independent in their homes for longer. The government has also not provided clarity regarding who will set home-care caps and how the relevant deputy secretary of the department will work with the Independent Health and Aged Care Pricing Authority to decide what the relevant price cap is. There is also a lack of certainty regarding how much discretionary power the decision-maker will have for setting the home-care fees and whether this will be formulated using evidence based advice.

Schedule 3 of the bill requires the Secretary of the Department of Health and Aged Care to publish information in relation to the operation of aged-care providers, with the aim of further increasing transparency on aged-care services to allow Australians to make a more informed decision on aged care. The publication of additional information to increase sector transparency and to increase consumer understanding of the sector is supported by the opposition.

We're happy to see the government continue our reform work in this area. However, it must noted that, like schedule 1, the details of this schedule are subject to delegated legislation that has not been released by the government. Therefore, there are still questions regarding what exactly will be required to be published. We are calling on the government to ensure that, when amending the quality of care principles, they note that, of all aged-care homes who currently do not have a registered nurse on site at all times, 53 per cent are in rural, regional and remote areas, and 46 per cent of them are small providers. We're introducing amendments to ensure the government, who were elected on a platform of transparency, provide the necessary information to allow for adequate parliamentary scrutiny of this bill and its delegated legislation, and to ensure that providers are genuinely supported and not just another headline to fulfil an election promise.

Furthermore, the opposition will move an amendment to have an enrolled nurse on site and an RN on Telehealth 24/7. This will be a feasible option for some low-acuity providers or regional providers who are currently unable to attract a steady RN workforce despite ample and genuine attempts to do so.

The opposition strongly supports continued improvement in the aged-care sector and the care provided to older Australians; however, this bill is nothing more than a slap in the face for transparency. Furthermore, the opposition will move an amendment to require the secretary, when considering whether the provider has taken reasonable steps to ensure that the clinical needs of the care recipients in the facility will be met during the period for which the exemption is in force, to consider whether the provider has established reasonable measures to ensure the highest level of clinical care with the available workforce will be provided, which may include measures for support for clinical care by an enrolled nurse and through telehealth consultations with a registered nurse. This would not change the overall standard that the provider needs to take reasonable steps to ensure clinical needs are met.

Current workforce constraints and the extreme reliance in this bill on delegated legislation, the details of which have not been released by the government, is disrespectful to the aged-care sector and remains a serious concern for the opposition. Notwithstanding the very serious concerns the opposition have about this bill, we will always support improvements to care for older Australians and, therefore, we will be supporting this bill in the Senate.

I move:

At the end of the motion, add ", but the Senate:

(a) notes that, of the aged care providers who do not currently have a registered nurse on site, and on duty, at all times, 53% are based in regional and remote areas and 86% are small providers; and

(b) calls on the Government to ensure that, when amending the Quality of Care Principles to make provision for an exemption to the new responsibility relating to registered nurses, the disproportionate impact on providers in regional and remote areas, especially small providers, is taken into account".