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

Today I stand to make a contribution in relation to the Aged Care Bill 2024 and the Aged Care Legislation Amendment Bill 2024, which are before us. The opposition has been very clear right from the get-go that we will support sensible policies, because we need a system for aged care that is strong and delivers the dignified care that we believe every older Australian deserves in ageing.

This legislation delivers on a recommendation of the royal commission appointed by the coalition to implement a rights based act for aged care. After the royal commission brought its findings down, the coalition invested more than $18 billion to support the immediate recommendations and needs of the sector at the time. But it's really important for us to realise and remember that aged care is not a sector; aged care is a journey of ageing for older Australians and everything that goes with that. It's about respecting the older people in our society.

So, through good-faith negotiations with the government, the coalition has sought to ensure that the reform package that is before us is improved in many ways. We did so before the package was presented to the parliament, and we've continued to do so since the package has been available for public consumption, but there is no doubt that the issues that are before our aged-care system are absolutely undeniable. We've got aged-care homes across Australia. Nearly half of them are reporting that they're operating at a loss. We have an ageing population, but we have an even greater increase in the number of Australians who have a desire to stay at home as they age, which means that we have to fundamentally change the way we deliver aged care and support the needs that we need to put in place to effect that change.

There's no doubt that this bill represents a very significant package of reforms, which is why we pushed to have the bill referred to the Community Affairs Legislation Committee for inquiry. We absolutely valued this opportunity—that, at last, finally, the government was prepared to have a conversation with Australians—older Australians, their families and the sector more generally—about this significant package of reforms. Up until we put it through the Senate process, there had been an extraordinary lack of transparency about the process to date.

It was really disappointing to find, though, that the majority report that was delivered by that inquiry, which was the majority report of the government senators on that inquiry, made no recommendations around how the bill could be improved to reflect much of the concern that we heard during that inquiry. The only recommendation the majority report made was that we should pass the bill. We've been very critical of the government right the way through about the lack of consultation, but I'm even more critical of the government because, even when we got the opportunity to speak to Australians about what they thought about the bill, the government still refused to recognise many of the improvements that could be made to the bill to make it better and to make sure that it delivered on what older Australians were expecting it to. They simply just thought that they'd push it through in its original state.

We will continue to criticise the government on the things we think they have failed to do. But, most particularly, I will be critical of the government because they have yet to demonstrate to me, to the parliament or to the sector that they themselves are ready for the massive changes that this bill will bring in should it start on 1 July 2025. One great question that is yet to be answered is: are the government's IT systems even sufficiently in place for the sector to be able to plug in to their changes? There are going to be massive IT changes that the sector will have to make.

Given all the information that was submitted to the Senate inquiry, it is clear that we are going to need to make substantial amendments to this bill to make sure that it is delivering what it says it will, and I will not be rushing this through this parliament. For that reason, we will be moving a number of amendments. We are going to act on the hard evidence that we heard during the committee process. We need to recognise that there are still a number of quite significant shortcomings if this bill is actually to deliver on the promised outcomes.

We must be transparent about the release of the subordinated legislation. If there was one thing that the inquiry process delivered time and time again it was that people are concerned that they simply don't have enough information to even understand what is going to be required of them, whether that's older Australians and their families or whether that's the sector in terms of implementing this bill. Withholding this critical information from stakeholders denies them the ability to fully understand what the implications are. So we will continue to fight to make sure that we have transparency about what is yet to come. This is not the end of the journey, government. This is the start of the journey, and we will continue to scrutinise every single piece of subordinated legislation that you bring into this place to make sure that your rush and lack of consultation do not detrimentally impact on the older Australians this bill is endeavouring to support.

But can I say that the coalition remains absolutely supportive of a rights based framework for older Australians. Putting choice and control at the centre of our aged-care system is absolutely paramount. We know that that's what the royal commission recommended, and we absolutely support that. But we also need to understand the quantum of change that is before us, and we also need to understand that much else that's contained in this bill is certainly not delivering on the recommendations of the royal commission, and that is to put choice and control back into the hands of Australians.

The coalition has sought and gained significant changes from the original proposal that was delivered to us behind closed doors in March because we wanted to make sure these reforms are fairer for older Australians, particularly for older Australians who've worked hard all their lives to save for their retirement and for older Australians who find themselves in a situation where aged care is out of their reach in terms of affordability. We wanted to make sure every Australian has access to aged care in a fair and reasonable way, which is why we demanded that grandfathering be put in place. That means that every Australian who has already started their aged-care journey will see no change to their financial circumstances, whether they be in residential care, in-home care or even on the waiting list to receive a home-care package because they have already been assessed as needing one.

We will also make sure that there are caps on clinical care and caps on home care because older Australians need to understand what is going to be the quantum of the ask on them in terms of their own support of their ageing journey. We also made sure that taper rates were much lower than the ones that were previously proposed by government so that older Australians would not be hit with extreme changes as their incomes went up. We also wanted to make sure that the government guaranteed that they would always be the majority funder of aged care—most particularly around making sure that every Australian, regardless of who they are or where they are, will always receive a high level of clinical care. These were very important changes that we sought to achieve, and we're pleased that we have been able to achieve them.

We were also very concerned about the lack of recognition of rural, regional and remote Australia and the challenges of the shallow markets that are there. So we secured an additional $300 million to go to rural, regional and remote aged-care homes to make sure they were able to develop the capital works so that they could provide the facilities for people that lived in their community. We understand that getting access to these kinds of services is often a great challenge in rural and regional communities—it's hard to get the workforce but it's equally difficult to get capital building.

We also fought hard to remove criminal penalties. Our position has always been that criminal penalties were unnecessary. The royal commission didn't recognise criminal penalties because they already exist in our legal system under work health and safety, banning orders and other criminal codes, and these are adequate measures to make sure that we protect the safety of older Australians. That is not to say that in any way, shape or form we believe that the safety of older Australians should be compromised; we just believe this once again overreach. We've also successfully eliminated provisions that would have forced unionisation into every aged-care home in this country, taking away the focus from the delivery of quality care and increasing mandates felt the hardest by small providers.

While there have been significant achievements made by the coalition during our negotiations, it's important that we remember this package is still fundamentally flawed. This is a package made by the Labor government. The bill has not been co-designed. In fact, we were excluded from the process of the design of this bill almost from the get-go, and were brought into the process only after it was finalised. The issues that we believe need to be addressed that have not been addressed in this bill in any way, shape or form are issues like workforce, regulatory impacts and the implementation timeframes of this bill. These issues continue to go unaddressed, and if they do so, it could result in very serious consequences. Last year 49 aged-care homes closed, which is a very telling statistic.

The coalition is seeking to ensure the introduction of this bill will not force more closures of homes. Instead, we need to make sure it's actually going to incentivise the critical builds that we know we need. We remain very disappointed about the lack of transparency by government throughout this process, and I think the Senate inquiry highlighted the fact that many Australians were equally frustrated by the lack of consultation or inclusion in this process, and the continuing lack of consultation or any oversight for the many rules that would actually drive this particular piece of legislation.

Workforce is one of the biggest issues. I don't think I've been into an aged-care home in Australia in the last 2½ years where the first thing they've said to me wasn't about the challenges they're acing in workforce. The idea that we've got some one-size-fits-all response to aged care is just ridiculous. Markets are different, geographic locations are different. We see it manifest itself in many different ways, whether that's in the financially crippling reliance on agency staff to fill shifts or the inability to fill shifts themselves, which means nursing homes are closing down or closing beds. People moving hundreds of kilometres away from their communities and loved ones just to be able to get a bed. There's throwing out of enrolled nurses and allied health when it comes to the provision of care, even though those workers are extremely valued in the care of older Australians.

I know every aged-care provider wants to deliver the highest-quality care, and I acknowledge the amazing workforce that works in aged care, but all the reforms in the world are not worth the paper they're written on if you do not have the workforce to deliver them, and if your financial viability is so threatened that you're worried you're going to have to close your doors. Today's paper showed the government's removing of homecare caps for cleaning and gardening is exactly the kind of issue that we fought really hard on, saying, 'You cannot consult behind closed doors because that's not consultation; you have to speak to people.' I'll give a shout-out to Hannah, who drove all the way from Yankalilla to Port Lincoln to give evidence at the inquiry because she could see the fallacy of these caps. Eighteen hours of gardening every year is an hour and a half a month. If Hannah was trying to prepare for the bushfire season, it was hardly going to achieve that outcome.

Through this process, at least the government have recognised the fallacy of these caps and have a bit more of a flexible approach to these things. These are the kinds of things that are happening that are completely at odds with the decision to go forward with a bill that gives choice and control to older Australians, and these stupid bureaucratic decisions that haven't been consulted remove that choice and control for older Australians that we are so keen to make sure we see.

On home care, another point that I really want to raise here is that this bill makes no reference whatsoever to the Commonwealth Home Support Program under which 800,000 Australians already are receiving a level of care in their home. The government made a decision to release 24,100 home-care packages, when we know that the waiting list is currently 76,000 and it will mean that the waiting time will blow out from five months to six months. Knowingly, this is a design feature of this government's decision—that they are actually going to blow out the waiting time. But, aside from the current failure to ensure that enough home-care packages are being delivered, the government haven't been transparent about the rules, and witness after witness after witness said that.

So we think this bill needs amending in so, so many ways, and I'll foreshadow now that I'll be moving a second reading amendment to that effect. We believe that we need to make sure that we understand transitional requirements. We need to understand the transition pathway. We need to understand information so that older Australians, their families and the sector understand. We need to make sure that the Commonwealth Home Support Program recipients have got greater clarity. We need to understand the caps that they're still proposing for the service list. We need to understand how the service list has been designed. We also need to understand things like the scale of unrecoverable debts and with whom and where they will reside. We also need to make sure that we have dignity for all older Australians in the high-quality care that we want for them.

So, as I said, we need to make sure that we do get this bill right and we need to do it right once. We cannot afford to have all of the errors that sit in this bill get passed in this place. So the opposition—and, I am sure, the Greens—will be moving a series of amendments during the committee stage to try and make this inadequate bill better. Fundamentally, we believe in a rights based framework for the delivery of Australian aged care, because we believe that having choice and control delivers the dignity back to older Australians, and that is the most fundamental reason that this bill is in this place. But, because this government can't be trusted to provide the kind of transparency and detail we need, we will continue to prosecute that case.