Helen Polley (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Aged Care) Share this | Link to this | Hansard source

I rise today to speak about some of the challenges that an ageing population presents for Australia. Plenty of people have spoken in this chamber and in the other place about these challenges before. One of Labor's most unrecognised but vital achievements was passing the Living Longer, Living Better reforms.

Our commitment to older Australians has been outstanding. The member for Port Adelaide and Senator Collins and indeed their staff should be particularly proud about what they accomplished. But of course the matter of an ageing population is still something that Australia must consider carefully. We all know what problems we face as a First World country with baby boomers heading towards retirement. Politicians from across the political spectrum have repeated the statistics that many of us have heard many times before. They are sobering.

The amount we are spending on health care in this country is rising at six per cent per year. This is twice the growth rate of our GDP. Our spending on hospitals is accelerating dramatically. They are receiving some $18 billion a year more than they received a decade ago. A considerable percentage of this expenditure is of course dedicated to looking after older Australians, and this is quite simply unsustainable over time.

According to the Productivity Commission, total Australian government spending reported on ageing and aged-care services is now close to $13 billion a year. This of course will not get any easier anytime soon. As I stand here today, just over 10 per cent of the population is aged over 65, but by 2050 it will be close to a quarter. Because health costs are higher at the end of life, the vast bulk of the nation's health budget will soon be spent on older people, many of whom will be retired and not paying tax.

By the time we reach the point where one in four people in this country is aged over 65, the number of people of working age in Australia—20 to 64—relative to older people—65 plus—will fall from the current ratio of five to one to a daunting 2½ to one. The problem of attracting staff to work in residential facilities is also well known The work is incredibly taxing, the responsibilities immense and the financial reward far from generous.

The Productivity Commission has pointed out that increasing numbers of residents with higher and more complex care needs have added to the workloads of care staff in residential care settings. As we speak, some 50 per cent of the aged-care workforce is within 10 years of retiring, and it is proving particularly challenging to attract young, capable people to undertake this line of work. So I want to be absolutely clear when I say that the challenges we face in this country with an ageing population are immense. Every politician, every expert in the field, every stakeholder and every aged-care provider knows it.

But today I do not just want to speak about the problems we face due to an ageing population; I want to talk about opportunities that are right in front of us. I want to talk about how we can innovate to not only save billions of dollars in public health expenditure but also ensure that our older Australians live their lives with greater comfort, dignity and independence. I want to talk about solutions which are not only within our grasp but more than achievable if we demonstrate foresight and think creatively.

What are the solutions? What is the best way to confront this? We have to act if we are to ensure that we can properly look after our older Australians, but we cannot compromise economic growth and expenditure in other areas. I think that everyone in this chamber, in this entire building, would agree with that statement. But here is the key: improvement has to come from efficiency gains, not spending cuts.

In this context it is very much worth heeding the words of the Grattan Institute's Stephen Duckett and Cassie McGannon, who contributed the following:

Reducing health spending growth will not be easy. As Grattan's Game-changers report last year showed, Australia already has one of the OECD’s most efficient health systems, in terms of life expectancy achieved for dollars spent.

Sweeping cuts to health funding, or shifting costs to consumers, could have serious consequences. Blunt cost-cutting risks reducing health and well-being, and could ultimately lead to higher government costs due to illness, increased health-care needs and lower workforce participation.

We need to focus on targeted investment. We need to focus on innovation, not simply cuts.

Several weeks ago in Melbourne the former Independent member for New England, Tony Windsor, delivered a remarkably candid and perceptive speech at a Victorian Women's Trust event honouring our former Prime Minister Julia Gillard. Mr Windsor was discussing the virtues of fibre-to-the-premises broadband versus the coalition's model when he said in relation to the current Minister for Communications:

Malcolm talks about benefit costs … I make this plea to Malcolm—and there might be some academics in the audience … —someone should do the work on what fibre-to-the-home does in relation to the aged-care debate long term … We have a significant problem. Peter Costello—

a reference, of course, to our former Treasurer—

recognised this some years ago in terms of the ageing of the population. We are going to have a big bump of older people … coming through the system. If five per cent of those people could stay in their homes for one or two years additionally, or whatever the number you want to pick, what impact would that have on the capital costs of this bump coming through the system? What impact would it have on the operational costs of supplying those beds? What impact would it have on the psyche of the people and their families?

He went on, and this part is crucial:

It is nonsense to suggest that there is a better way of doing this. If Tony Abbott wants to be the infrastructure champion of the decade—

that is the key infrastructure issue—

that is the one thing that connects all the dots, the health, the education, the business, the social aged-care issues. It is the one thing that removes distance and remoteness as being a disadvantage for country people.

The former member for New England is exactly right. If we approach this properly, if we innovate and consider what is best for an ageing population, we can succeed in immeasurably improving the lives of older Australians whilst saving the nation billions of dollars. It is right there in front of us.

The answer lies in solutions such as telehealth. Telehealth is not something that many Australians will be immediately familiar with. Previously, when we talked about technology to help older people, we were referring to monitors which sent out an alarm if someone fell. But today we can do so much more with world-class broadband: the sky is the limit. Modern telehealth innovations allow for houses full of sensors which transmit data in real time to monitor things like health and even mobility.

What is even more valuable is the use of sophisticated consoles so that these people can speak face to face with friends and family but also nurses, doctors and specialists. Instead of admissions to hospital or residential aged-care facilities, we can have monitoring of older Australians in their own homes. They can live where they want, where they feel comfortable, and they can communicate with others in the process, combating social exclusion while having key health indicators monitored.

The technology is advanced enough that the CSIRO's Geoff Haydon, who is working on the NBN telehealthcare trial in northern New South Wales, said that the modern equipment enables professionals to:

Manage and monitor people as though they were in a retirement village, while they're still in their own home.

As those who have a relative or friend in residential care will tell you, it is an expensive and complex proposition. The amount paid depends on personal assets, but the average bond paid by new residents is now approaching a quarter of a million dollars. So once again it becomes clear: staying at home, even for just a little longer, not only is preferable from a health and happiness angle but also makes financial sense.

The Australian Bureau of Statistics agrees, noting that by regularly monitoring the health of older Australians with this technology we will not only improve their quality of life but also help prevent illness or injury. Consultations with health professionals will enable monitoring of lifestyle risk factors and overall maintenance of good health.

Successful telehealth monitoring saves money in a range of ways, some of which are not immediately obvious. We need to consider reduced ambulance journeys, reduced travel to doctors and specialists, reduced numbers of acute incidents arising out of chronic illness, and reduced hospital visits and admissions. The list goes on, and over time the billions add up.

Most of the studies on telehealth have come from overseas, notably the United States. However, studies conducted in Australia by not-for-profit aged- and community-care provider Feros drew incredible results. Some 80 per cent of clients in a trial reported that telecare had improved their quality of life during the program, and 69 per cent of clients reported being less concerned about the daily severity of their condition.

But let's talk numbers. Daily telehealth supervision every day costs just over $7. Let's compare that figure to the staggering $967 that is spent on an average acute hospital bed stay, beds which are of course limited in number and desperately needed.

When Access Economics was commissioned by the Department of Broadband, Communications and the Digital Economy to provide a cost-benefit analysis of introducing a telehealth intervention into aged care, the results were staggering. Based on a target population of just over 17,000 older Australians, it was estimated that the intervention could save over $17 million in net present value terms, with a further $6.8 million in health system savings. If the benefits from reduced pain and suffering are included, the total gross benefit is a further $9.5 million. Just imagine if this were deployed right across the country, if every household were connected to world-class broadband.

But here is the other component of this solution: to take advantage of telehealth, we need world-class, medical-grade broadband. We need fibre-to-the-premises broadband. Unfortunately, when it comes to discussing the NBN, the coalition have sought to trivialise the benefits associated with superior broadband and pretend that it is something that will benefit a small fraction of the Australian population.

In fact, earlier this year I appeared on a panel television show, The Nation, alongside Senator Eric Abetz and Senator Peter Whish-Wilson. I was slightly horrified to hear what the Liberal senator from Tasmania, my home state, had to say on delivering fibre-to-the-premises broadband to every household and business. He said:

It's like saying that every home needs the Rolls Royce parked in the driveway.

This is actually how the Liberal Party and the Liberal government think.

But of course we have heard even worse. It was in fact our now Prime Minister who said earlier this year:

The National Broadband Network is a luxury that Australia cannot now afford. The one thing you don't do is redo your bathroom when your roof has just been blown off.

But it gets even worse. When asked in relation to fibre-to-the-premises NBN in December 2010, our Prime Minister said:

… do we really want to invest $50 billion worth of hard-earned taxpayers' money in what is essentially a video entertainment system?

A video entertainment system! A luxury that is likened to renovating your bathroom! That is how the coalition views the NBN, as a glorified video entertainment system.

What if I were to inform those opposite that fibre-to-the-premises NBN is almost certainly worth building for the healthcare benefits alone, especially for those older Australians who need day-to-day assistance to live their lives to the fullest extent possible? In fact the former head of the National E-Health Transition Authority estimated that 30 to 40 per cent of total NBN usage across all areas will be for health applications. These are applications that will of course be particularly valuable for the old and infirm. Fibre-to-the-premises NBN is a massive infrastructure achievement that will enable older Australians to access medical-grade reliance connections. We have to do this. We really do not have a choice. Even if we were to ignore the numbers, the cost benefits, the trials, the indisputable evidence that this is a superior solution, there is something else I would like to remind everyone of. Embracing telehealth technologies through fibre-to-the-premises broadband makes an enormous difference to the lives of older Australians. I have to say that in my new role as shadow parliamentary secretary for aged care, I have been able to visit several residential facilities and speak to older Australians and I plan to continue to do a lot more of this and to speak about this important issue into the future. (Time expired)

Penny Wright (SA, Australian Greens) Share this | Link to this | Hansard source

I rise today to tell a story that is grim and shameful. But the ending has not been written yet, so it is possible that this story could finish with a good ending. As we are still in the story, it really depends on us.

I want to begin by acknowledging that I am making this speech in a parliament that is on the land of Ngunawal and Ngambri people. Everywhere we stand and walk and live in Australia is Aboriginal land. I feel both proud and privileged to be able to share this continent with Australia's first peoples, who have one of the oldest continuous cultures on this planet. But this is also a matter of poignancy for me, because I am very aware that there are far too many Aboriginal and Torres Strait Islander people in jail in Australia. Our first peoples are some of the most imprisoned peoples in the world. And the statistics relating to the incarceration rate for Aboriginal young people aged between 10 and 17 are particularly horrifying.

I will set the scene by going to some evidence before a Senate inquiry in Perth in April this year. This was an inquiry into the value of a justice reinvestment approach to criminal justice in Australia. Justice reinvestment is a response to the escalating rates of imprisoning people that we have been seeing in Western countries, including Australia, over some decades. It is an approach that looks at reducing crime, by strengthening the communities which give rise to the most offenders. Less crime means fewer victims and safer communities; it is good for everyone.

I have spoken on justice reinvestment before in this parliament, and I will come back to it. But first, this evidence came from Mr Peter Collins, the Director of Legal Services at the Aboriginal Legal Service of Western Australia. He said:

In 2005, I appeared for a 16-year-old boy from a place called Onslow who spent 12 days in custody for attempting to steal a $2.50 ice cream. In 2009 I appeared for a 12-year-old boy who had never been in trouble who was charged with receiving a Freddo frog worth 70c. He did not come to court, because his mum got the dates confused, and he was remanded in custody. The police eventually withdrew that charge but defended the decision to prosecute on the basis that 'it was technically correct'. In 2010 I appeared for a 16-year-old boy with a serious intellectual disability who had never been in trouble. He was charged with receiving a soft toy. He was given a bail curfew condition which his mum was unaware of. He was at his aunt's place when he should have been at home. He was arrested and taken into custody. The bail condition of the curfew was removed by the magistrate, but it was not recorded on the police computer. He was found out and about that night, remanded in custody and spent four days in custody—Friday through to Monday—before he was released again by a magistrate. In 2011, we appeared for an Aboriginal girl from Roebourne in the Pilbara who was charged with trespass. She was found on the weekend playing in playground equipment in the local primary school.

… There is every reason in the world for those charges to be diverted away from the system to keep children out of not only the court system but also, in many of these instances, the custodial environment as well.

There are alarming statistics behind this evidence. In Australia today we are locking up more people than ever before. Over the last 30 years, Australia's prison population has tripled—to around 30,000. It has been growing four times faster than the underlying population growth. This is bad enough, but there are two groups of Australians who are particularly affected by this increasing tendency to use prisons as a first rather than last resort. Although they make up just 2.5 per cent of the population, Aboriginal and Torres Strait Islander Australians account for 26 per cent, over a quarter, of the adult prison population. Australia's Indigenous people are one of the most incarcerated peoples in the world. On current figures, Indigenous adults are 14 times more likely to be imprisoned than their non-Indigenous counterparts.

But it is the statistics about the imprisonment of our Indigenous young people which are most distressing. In some jurisdictions they make up approximately half of the total juvenile detention population. In Australia, on average, Aboriginal and Torres Strait Islander young people aged between 10 and 17 are 31 times more likely to be in detention than their non-Indigenous peers.

These soaring incarceration rates come with an enormous cost, both economic and social. In dollar terms, prisons are phenomenally expensive. Australia spends about $3 billion a year on keeping people in prison. It currently costs over $300 a day or $80,000 a year to keep someone in prison. What else could we do with this money? This increase in criminal justice spending is actually unsustainable. It is this which is causing policymakers around the world to reconsider the opportunity cost of prisons. The fiscal reality is: the more we spend on incarceration, the less we have available for other essential services like health and education.

The Northern Territory is a perfect case study. In the NT about half of all the juveniles in detention are Indigenous, but less than half of Indigenous primary school students are achieving national minimum reading standards, compared to more than 85 per cent of non-Indigenous students. This year, the NT turned down the offer of $300 million of Gonski funding from the previous government and went on to cut $16 million from their schools budget. Instead, they increased spending on law and order and on building a new prison, costing half a billion dollars, which will already be 83 beds short when it opens next year. Their choice has been imprisonment over education, but where will that lead?

It is important to remember that the real price of spiralling incarceration rates is not just the cost to taxpayers of building more prisons. There is also the long-term impact that imprisonment has on each prisoner, on their family and on their community. Each time a person is imprisoned they are not out in the community doing their parenting, participating, making a contribution. As pointed out by the Australian Youth Affairs Coalition in its submission to the Senate inquiry, the costs to young people, who are often Australia's most vulnerable and disadvantaged, are far-reaching. They said:

The true costs of incarceration far exceed the per day costs of housing young people in detention. Incarceration often results in the loss of employment and income, further disengagement with education or positive relationships, can exacerbate debt issues, and result in the loss of housing, such that homelessness becomes an issue on release.

The reality is that, despite these costs, prisons do not actually prevent crime—they come into play after a crime has already been committed and they are often only a temporary solution. People usually return to the communities they came from and they commonly leave prison in an even more dysfunctional state than when they first went in.

According to the Australian Institute of Criminology, about 25 per cent of prisoners will be reconvicted within three months of being released from prison and about 40 per cent will be reimprisoned within two years. As things currently stand, the statistics show that offenders in Australia leave prison more likely to commit future crimes and more likely to commit more serious crimes. So, on all measures of success, prisons are a failed institution. There is no evidence that prisons are working.

It is clear that a new approach is needed, and this is where Justice Reinvestment comes in. This involves a shift away from spending in prisons and into communities. It works by taking a portion of the public funds that would be spent on future imprisonment costs and diverting that money back into communities with a high concentration of offenders. That is because there is very clear evidence that a large number of offenders come from, and return to, a relatively small number of disadvantaged communities. Investing in those communities will give the best results, the best 'bang for buck', when it comes to reducing crime. This investment funds programs and services which then work to overcome the underlying causes of crime in those communities.

'Mapping', using demographic information, helps determine the neighbourhoods that will benefit most from the additional investment in prevention, early intervention, diversionary programs and rehabilitation. The communities in question, including victims of crime and families of offenders, have a central role in the design and implementation of these local initiatives. The results are then rigorously evaluated to make sure they are effective. Yes, it is really an old idea, that front-end investment saves back-end costs—or 'prevention is better than cure'—but it comes with a new evidence base and a new rigour, and it works. We have seen from the United States, most notably Texas, that if Justice Reinvestment is properly implemented it can reduce crime and imprisonment, improve public safety and strengthen our most disadvantaged communities, all without breaking the budget.

Texas is often used as an example because it is one of the most unlikely, and exciting, success stories. In 2007 it had one of the highest imprisonment rates in the United States, and officials estimated they would need to spend $2 billion over the next five years building new prisons. Instead, they invested $241 million in alternatives such as alcohol and drug treatment programs, improved probation and parole services and nurse-family partnerships to support young mothers in disadvantaged areas. They generated savings of $444 million in just one year. Six years on, crime rates continue to drop dramatically and growth in the prison population has slowed almost to a halt. Justice Reinvestment has been taken up by 17 US states and, most fascinating, it has been embraced by both Democrat and Republican politicians. That is because it makes financial and social sense.

If they can do it in the US, can we do it here? This was the very question addressed by the Senate's Legal and Constitutional Affairs References Committee when it inquired into the value of a Justice Reinvestment approach in Australia earlier this year. The conclusions were very encouraging. While acknowledging the differences between the US situation and ours, the committee strongly endorsed the principle of Justice Reinvestment and supported further investment to explore the potential of Justice Reinvestment for Australia. The majority report recommended that the Commonwealth government take a leadership role through COAG by funding trials and establishing an independent, non-political advisory body to assist states and territories who are interested in taking up a Justice Reinvestment approach

Over the last few years, the concept of Justice Reinvestment has been gaining momentum in Australia. There are coalitions of groups now in New South Wales, Victoria, South Australia, Queensland, Western Australia, the Northern Territory and the ACT, all strongly advocating for its implementation. The most advanced project is the New South Wales Justice Reinvestment Campaign for Aboriginal Young People, which was launched by Governor Marie Bashir and boasts a long list of high-profile supporters and champions. At the national level, many organisations, including the National Congress of Australia's First Peoples and ANTaR, are all playing an active role in advocating for Justice Reinvestment as a meaningful way to address the shameful overrepresentation of Aboriginal and Torres Strait Islander people in Australian prisons. There is also ongoing valuable academic research being conducted in Australia, including at the ANU National Centre for Indigenous Studies and the University of New South Wales's Justice Reinvestment Project.

The imperatives, both financial and moral, to move away from our imprisonment culture are very clear. If Australia's prison population continues to grow at an average rate of four per cent per year across the nation, we will need to add 10,000 new beds to the prison estate by 2020, at an estimated cost of over $5 billon. The human costs will be immeasurable.

That is the story so far. How it ends is up to us. We have a choice. We can choose to turn off a policy path, one that we have been following for 25 years and that has clearly been an abject failure. We can turn towards a smart approach, based on good evidence, that will actually reduce the number of people we lock up and that will also improve disadvantaged communities. But that would mean rejecting a beguilingly and simplistic 'tough on crime' mantra, which is so tempting for politicians in the throes of an election campaign or for newspaper editors who want to sell more papers. It would require a truly principled approach.

Still, if the Democrats and Republicans in the United States can put aside their differences and stand together, then surely we can do that here. But it would not be a bipartisan approach. In this parliament it would be a tripartisan approach. As an Australian Greens senator I am committed to finding and working with like-minded politicians across the parliament. Just imagine the young lives we would transform if we could just start to turn the statistics around. It would be a good ending.