Janet Rice (Victoria, Australian Greens) Share this | Hansard source

I am very pleased to rise today to support the passing of the Aged Care Amendment (Implementing Care Reform) Bill 2022. It's an important bill. It adds to the aged-care framework to ensure that we are providing appropriate care for older Australians. It's consistent with the principles that the Greens bring to aged care, where we believe that the federal government must play a central role in the funding, regulation and support of high-quality aged-care services and that older people should be able to access health and aged-care services as soon as they need them. We want to see a high-quality, affordable aged-care system characterised by quality support, nursing and personal care, whether that is in someone's own home, residential care or hospital. We also believe that this should be provided on a not-for-profit basis. This legislation doesn't go to that, but those are the aspirations of the Greens going forward.

We welcome the scrutiny that this legislation received through our Senate Community Affairs Legislation Committee inquiry process and believe that there was a lot of important information that in fact influenced this bill and also influenced how this legislation is going to be implemented in terms of things that will be in the delegated regulations down the track.

We heard clear evidence through the inquiry process that advocates want this commitment to nursing requirements implemented. We note that it was, indeed, a recommendation of the royal commission. We note that the timing has been brought forward from the royal commission's recommendation but that the sector overall supports bringing this forward.

The Older Persons Advocacy Network said:

OPAN strongly supports the requirement that Registered Nurses must be on site and on duty at all times (that is, 24 hours each day, 7 days each week).

While we acknowledge that the Royal Commission into Aged Care Quality and Safety recommended one registered nurse be on staff for both morning and afternoon shifts (16 hours per day), increasing to all day from 2024. OPAN believes a registered nurse should be available 24 hours per day as soon as possible rather than delaying implementation. The increasing health complexity and comorbidities of older people entering residential aged care requires a corresponding need for staff with the right health and medical skills to provide support. We know that health related incidents don’t just happen in the day time.

Similarly, the Council on the Ageing said:

This measure strengthens national minimum staffing standards in residential aged care and brings Australia into line with similar regulations in other countries.

Nurses play a vital role in aged care in partnership with allied health professionals, lifestyle coordinators and well-trained personal care workers.

COTA Australia has long supported the principle of ensuring the right skills are available in the right setting and at the right time, within each staff member’s professional scope of practice.

So we welcome this legislation. We are glad to see it being brought forward by the government and look forward to seeing it passed by the parliament.

I also want to thank the Australian Nursing and Midwifery Federation for their crucial advocacy and commitment on this issue. I met just yesterday with a delegation of nurses who were here to advocate for this legislation. I heard about their experiences of working in walk-in centres and aged-care homes, and in providing palliative care and a range of other types of care. One of them, Glenn, began his nursing training in 1978, so he's been in the field for a long, long time. One of the things he said to me yesterday stuck with me. He said the No. 1 thing that was going to make a difference to the older people he cares for was having more eyes, more feet and more hearts on duty.

Another nurse, Steph, talked of being a nurse in aged care, rather than in hospitals, even though the pay was less. I asked her why—why had she stuck with working in aged care? She said she really enjoys and appreciates the opportunity to work with older people at the end of their lives. She said she's not in it for the money; she's there because she cares.

This delegation of nurses, however, talked about nurses walking away from the job because, at the moment, the job is just too much; the stress, the overwork and not having the support they need are not what they signed up for. We have trained nurses across the country who are at the moment deciding they just cannot cope with the extra stress of being in the job, who are off doing other things. This is a critical part of addressing the workforce shortage of nurses that we face in Australia: actually bringing back into the profession those trained nurses who are currently working in other fields because they don't feel that they are being paid appropriately, that they are valued and that the job is sustainable for them in the long term. The nurses I spoke with yesterday talked of just not having the time to do the work that needs to be done when they're on the job. Clearly, increasing nursing staffing levels in aged-care homes is going to make a vital difference to people around the country, so it's really important that we enable this framework to be established.

This, of course, goes to the critical issue that Senator Ruston was just talking to. We know that, as part of implementing this framework, providers around the country, and especially in rural and regional areas, are going to need more nurses. We know that that is the fundamental issue, the tension, of introducing this legislation now and the time line it's being introduced on. Having more nurses around the country and putting in place a framework that requires that is a good thing, because nurses are providing crucial care and, as a country, we should be providing the best care possible for older Australians. But at the heart of the concerns that have been raised, particularly by regional and rural providers, is how providers are going to attract and retain staff when these reforms come into effect. Obviously, a crucial part of this legislation, and any exemptions to be put in place if providers, despite their best efforts, are not able to attract staff, is going to be in delegated legislation. In particular, that delegated legislation is going to lay out what those exemptions are. We too would have preferred to see more detail in this legislation, but at this stage it's a question of weighing things up: do you pass this legislation now or do you wait to see more detail in the delegated legislation? We recognise it's an important issue but believe that, on balance, it is much more important to get this legislation passed now.

I want to let people know that we are going to be scrutinising the delegated legislation very, very closely. I really look forward to working with the government as the delegated legislation is developed. I really look forward to ensuring that people across the sector, from the nurses to the providers to the community, have the opportunity to provide input into that delegated legislation to make sure that the framework the delegated legislation provides can best be implemented to support older Australians. So we are going to be looking at it really closely. And I'm confident that we will be able to work with the government, and that the government is going to be able to work with providers, workers and, most importantly, residents, to make sure the delegated legislation is appropriate.

Fundamentally, the issue with rural and regional facilities being able to access staff comes down to how many people are in the workforce. To tackle that we need to address the underlying issues about the pay and conditions the workforce is experiencing. We need to create an aged-care sector where nurses really do feel that the work they're doing is sustainable, that they're being paid well and that they're being valued and rewarded. We look forward to seeing the outcome of the Fair Work Commission's review into the pay levels of aged-care workers. As you know, the Greens are supporting a 25 per cent increase in pay levels for aged-care workers. Across the board, we need to be improving the pay and conditions of workers in the care industry so that it does become an attractive career path for more people and so that it does become a field where people feel they can work in sustainably—like Glenn, who has been in it since 1978—and so that it brings nurses back into the workforce who at the moment feel burnt out, who don't feel supported, who feel underpaid and who feel that there are other things they would prefer to be doing.

As we talk about the importance of implementing the recommendations of the royal commission and improving care for older Australians, there are a number of other points I would like to raise that we will keep on advocating for and that aren't being addressed in this bill. I look forward to continuing to work on them in the context of the complete review of aged-care legislation that is also underway. The first is the use of restrictive practices, which is something that my predecessor in this portfolio in the Greens, Senator Siewert, pursued relentlessly. I intend to continue focusing on that. I want to thank the advocacy groups around the country who have raised that issue with me. Nobody's human rights should be undermined for corporate profit, and this is something that we will keep on fighting for. I'm disturbed that since the royal commission showed the inappropriate overuse of restrictive practices—the royal commission highlighted it as a key issue—the data so far has shown that there hasn't been any reduction. So it's something that clearly needs to have ongoing attention paid to it.

The nurses I spoke to yesterday, when I was talking about restrictive practices, also noted the massive link, the correlation, with the size of the workforce and the importance of having enough people to actually be able to work with older residents so that it's not just the quick fix of restrictive practices. Often, despite their best efforts, they're without the workforce that's able to sit down and talk through issues with residents suffering from dementia and to give them that sense of being heard and being supported. Those restrictive practices are something that they then fall back on.

The other issue that I've consistently raised is allied health, and I continue to do so. It's reflected in the second reading amendment that's been circulated in this chamber. This legislation is addressing care minutes for registered nurses—it's a really important issue—but we remain concerned that the changed legislation now is not giving the same level of support to allied health professionals. We need to be ensuring that allied health is given the support and the serious attention it deserves, because the care for older Australians is genuinely multidisciplinary and is determined by a team approach. When all allied health professionals are there, residents in aged-care facilities, and older Australians in general, can access the levels of allied health care that they need and that they deserve.

Finally, I would like to make the point that there are a number of recommendations in the royal commission's final report that relate to palliative care—in particular, recommendation 80. That focuses on ensuring that dementia and palliative care training are available to everyone in the aged-care sector. Given that context, it's extremely concerning that we understand the work of the palliative care peak body is at risk due to funding cuts. That's an issue I'm going to be examining closely in Senate estimates.

In conclusion I would like to thank Minister Wells's office for their close engagement on this bill and the work that they've done in bringing it to the parliament. This is a piece of reform that has been a long time coming. It is going to make a crucial difference to people's lives. I would also like to thank Senator Ruston for her close engagement on this legislation, her work with me and her advocacy for the sustainability of smaller providers in rural and regional Australia, who are such a critical part of our aged-care system.

This is important legislation. We want to see it passed, and we want to see it passed today. It needs to be passed today to be supporting older Australians. We have a second reading amendment reflecting our advocacy on restrictive practices and allied health care, which are issues I will continue to engage on. I am very pleased to be able to share the Greens support for this legislation. We hope it will be passed by the Senate today.