Larissa Waters (Queensland, Australian Greens) Share this | Hansard source

I rise to speak to the Aged Care Bill 2024 and the Aged Care Legislation Amendment Bill 2024. Our concern is that these bills risk creating a two-tiered system that bakes in inequality. The Greens share the concerns of older Australians that these bills will increase their co-contributions and accommodation costs but don't guarantee enforceable rights or the quality of care for participants. We have significant concerns that, in buckling to the demands of the Liberal Party, the Labor Party has abandoned criminal penalties for dodgy aged-care providers, which it had promised and has now junked to get the deal with the Liberals. We've also got concerns about chapter 4, which contains the new funding model, because asking people to pay more for their care with no guarantee of improved quality is simply taking us in the wrong direction. So we will be moving amendments to address both of those concerns when we come to the committee stage on this bill.

The royal commission showed us the depths of pain and suffering that proliferated in the aged-care sector, and this was in part due to a regulatory system that was driven by for-profit providers. The deals done between the government and the coalition on these bills lead us to have significant concerns that these bills actually won't address the issues that were identified in the last royal commission and, frankly, wouldn't stop another royal commission into the aged-care sector in future.

The key concern for us is that the rights within this bill remain aspirational for providers. They are not enforceable. The removal of criminal penalties, as part of negotiations between the two big parties in this joint, has been a significant concern for us and also for many participants and advocates. The Office of the Inspector-General of Aged Care in a submission on the bill called the rights contained within it 'aspirational'. They said:

The Office considers the approach taken in the Bill to safeguard individuals' rights to be largely aspirational. In particular, the Office is concerned that it will not implement a rights-based framework as clear or as robust as Royal Commissioners envisaged, because the pathways available to individuals to understand and assert their rights lack the necessary vigour to drive real change.

This would be bitterly disappointing for participants, their loved ones, their families and advocates who have seen far too often how the rights of older people in aged care come last and are subsumed by the profiteering of the aged-care providers.

The shameful evidence we saw throughout the royal commission shows the sector lacks serious regulation, and we are concerned that, without enforceable rights, this regulation remains far too relaxed to prevent another royal commission. Professor Kathy Eagar told the inquiry that, in her view, this bill is a lost opportunity to genuinely fix aged care once and for all. She has no doubt that within a matter of years the sector will be back in crisis. The lack of enforcement of rights was also an issue for the National Older Women's Network, who told the inquiry:

It appears that the framers have been convinced that the aged-care sector is too big to fail and so their demands remain a priority. The act, by not making the rights enforceable and actually spelling out the fact that they aren't enforceable, means that we know the words of rights are window dressings to offer appeasement and focus our attention.

'Window dressing' is what these rights are if they're not enforceable. That was the view of many submitters, and it's a view the Greens share.

Post the royal commission, we cannot let providers off the hook. Older people deserve clearly enforceable rights and access to high-quality care. The lack of safeguarding those things in this bill jeopardises that purpose. We hold significant concerns that the aspirational rights for providers do not go anywhere near the heart of the problem in aged care—that its operation as a market means the incentive of providers, the profit motive, always trumps the provision of high-quality care. Further, although this bill partly reforms the complaints process, we hear time and time again from participants and their loved ones who are frustrated with the lack of real justice that they see issued against providers.

The removal of the worker voice during negotiations between the government and the coalition is also of deep concern. Workers are at the coalface of this sector, and they are the ones who see when things are going wrong. Removing their ability to influence the safety of their workplace is a detriment to them and to participants. We've seen appalling conduct from industry consultants, lobbyists and providers who try to game the system, and we've seen this most clearly with the failures of the star-rating system and a watering down of care minutes. A worker's voice would have gone some way towards ensuring aged care is monitored properly. We're also concerned about the strength of whistleblower provisions. In the absence of a worker voice, it is critical that participants and workers are protected from adverse consequences for whistleblowing. The royal commission showed us that people must feel safe to speak up when something is wrong, particularly in a sector like aged care, when it can be a matter of life and death for people.

Now I move onto issues pertaining to funding in chapter 4 of the bill. While the Greens support the wealthy paying their fair share, opening the door to an expanded user-pays model only risks serving to increase the profits of private providers that are already robbing older Australians blind. If more emphasis on user pays is the answer, then you are asking the wrong question. The government needs to be responsible for funding an accessible system for all Australians who need it. We have significant concerns that this bill takes aged care down a pathway that will be very difficult to unwind. Instead of treating aged care as health care, as it should be, this bill and this government, with the support of the opposition, are completely embedding it as a marketplace. Participants and the government will continue to subsidise for-profit aged-care providers.

This bill entrenches aged care as a marketplace, and all the while it turns the screws on co-contributions from participants. The varying contribution levels risk pushing older people to ration the care that they receive. In the submission that ACOSS—the Australian Council of Social Services—wrote on this bill, they say:

Australia has a longstanding principle to provide universal, essential health care services, so that decent care is available to everyone, regardless of their means. Such services have traditionally been provided either free of charge (such as public hospitals), or at modest cost (such as General Practitioner consultations).

The Bill now puts this principle in direct jeopardy.

That is ACOSS saying that the principle of universal health care that we pay taxes to fund is in peril because of this bill. Additionally, in the submission to the bill from the Nursing and Midwifery Federation, ANMF, they pointed out:

Aged care should be publicly funded and owned, particularly as the sector relies heavily on taxpayer support and … The proposed … separation of clinical and non-clinical care also creates an unnecessary distinction that can lead to financial burdens for residents while undermining comprehensive care.

Further, the increase to the maximum room price is of significant concern. There is little evidence that there'll be any limitation on providers simply lurching to increase the room price as soon as they can to collect another $250,000. This bill lacks safeguards to protect against that. The government should be increasing taxes on billionaires and big corporations to properly fund the overburdened aged-care system rather than continuing down this pathway of rationing care and opening the door to unaffordable services and higher profits for private aged-care providers.

Beyond the substantive concerns with the bill, the community and the Senate have been provided with very little time to consider the full implications of these reforms. This bill is substantive, and participants and advocates were given just two weeks to read the over-500-page bill, to put in a submission and to participate in the inquiry process. We heard from many people in the community who felt that they had been completely sidelined during that process. Feedback through the inquiry highlighted how complex a task for participants and advocates this has really been. Participants also highlighted the emphasis on provider perspectives. One lived-experience witness told the inquiry:

The airwaves have been dominated by government and corporate provider lobbyists, and our voices have not been heard and certainly not sought. So we are indeed grateful that this committee is prepared to hear evidence from us, although hearing time still seems to be dominated by commercial interests.

Many submissions also noted that the significant delegation to the rules has meant that it's incredibly difficult to appraise the full implications of the legislation. There are over 600 references in the bill to the rules. We haven't actually seen all of the rules. I understand there's only one tranche of them. So the Senate is essentially being asked to form a position on legislation when we don't know the full shape of it yet. That should be ringing alarm bells to everybody in this chamber. The significant amount of delegation to the rules under the bill also leaves much of the decision-making up to the government of the day. With the amount of contribution levels that have been delegated, we're concerned that this is leaving it open for a future government to turn the screws, notwithstanding that some of those rules will be disallowable.

Every person fortunate to live into old age will need to be cared for, and if this really is the once-in-a-generation opportunity for reform, then it's critical that the government gets it right. We cannot risk a two-tiered system that bakes in inequality. The elderly are not commodities; they're human beings. It should be an obligation of any moral society for the government to ensure that older people can get the care that they need. I want to acknowledge the work that Senator Allman-Payne, who is our aged-care spokesperson but is currently suffering from COVID—though thankfully seems to be on the mend—has done in this area. She, through me on her behalf, wants to thank all of the older people, their families and their advocates who took the time to give evidence and engage in this process—both the Senate inquiry process and also the royal commission process that preceded it. That inquiry process was far too brief, and those people really feel like their voices were not properly considered, which is an indictment on this government rushing through such big reforms. We want to thank the people who did take the time to engage and reassure them that we've heard them, that our view is that people in their later years deserve dignity and safety and that we will always fight for them.