Murray Watt (Queensland, Australian Labor Party, Shadow Minister for Northern Australia) Share this | Link to this | Hansard source

The Aged Care Legislation Amendment (New Commissioner Functions) Bill 2019 provides for the transfer of functions and powers from the Department of Health to the Aged Care Quality and Safety Commission. The Aged Care Quality and Safety Commission was established on 1 January 2019. Specifically, some functions and powers will be transferred from the Secretary of the Department of Health to the Aged Care Quality and Safety Commissioner. This bill does not transfer or provide for any additional powers to the commission or commissioner.

This I will talk to later in the speech, but, given the spotlight on aged care and the number of complaints that the commission has received, I'll say that this is another missed opportunity for the Morrison Liberal government to act on aged care. In terms of the bill before the Senate, it shifts the primary point of contact for providers and consumers in relation to quality of care and regulation from the Department of Health to the commission. The bill will provide for the commission to: approve providers for the delivery of residential care services, home-care services and flexible care services; undertake compliance and enforcement actions, including monitoring the compliance of approved providers and imposing sanctions where approved providers do not meet their aged-care responsibilities; and, finally, to administer the responsibility of approved providers to make compulsory reports of assaults.

We know that this is a serious issue. Disappointingly, the Morrison Liberal government has again been slow to act. Recommendation 6 of the Carnell-Paterson review called for the enactment of a serious incident response scheme. This review was handed to the government in October 2017. That's over two years ago. This was also a recommendation included in the Australian Law Reform Commission's elder abuse report. This report was handed to the government in May 2017. That's 2½ years ago. Evidence has also been given at the Royal Commission into Aged Care Quality and Safety, and counsel for the commission raised concerns about the department's inability to move promptly on the Serious Incident Response Scheme. There are five specific appealable decisions by the secretary to the Administrative Appeals Tribunal. These will transfer to the Aged Care Quality and Safety Commissioner and will remain appealable to the AAT. Labor welcomes this transfer of responsibilities. Currently, no decisions made by the commissioner are appealable to the AAT. The only option for people seeking a review process, having made a complaint to the ACQSC, is through the Commonwealth Ombudsman. Even though there could have been some improvements, Labor will be supporting this bill.

I would like to turn my attention now to the government's record when it comes to reforming the aged-care system. Where do you start? Well, the recent announcement is a good example of how consecutive Liberal governments have approached aged-care reform. It's been six years of inaction underpinned by billions of dollars cut out of the residential aged-care budget by the Prime Minister when he was Treasurer. Ad hoc, piecemeal reform is never a good thing when you are dealing with older vulnerable Australians and their care. Consecutive Liberal governments have failed to reform the system in a methodical way. The problem is the Liberals have only acted when pushed politically or, now, by an interim report delivered by its own royal commission.

I wanted to set out some of the issues, because facts speak louder than words. There is no doubt that every facet of the aged-care system is broken. Why is this the case? The answer is simple. No genuine long-term reform has been undertaken by consecutive Liberal governments over the past six years. There have been four ministers for aged care in six years. The Prime Minister, Mr Morrison, has twice refused to put aged care as a priority at the cabinet table. The fourth minister for aged care, Senator Colbeck, sits in the outer ministry. How does he have the necessary resources and decision-making opportunities if he is not sitting around the cabinet table? You would have thought the Prime Minister would have made aged care a cabinet priority, given he did call for the establishment of the royal commission—but no, he didn't.

How do we know that the aged-care system is broken? As I've said previously, every single facet of the aged-care system is broken. Why do we say this? Older Australians cannot access the care they need. Packages delivered under the Commonwealth Home Support Program are exhausted. Last week's announcement of 10,000 home-care packages means there are still 110,000 older Australians assessed and waiting for their approved home-care package. That's 110,000 older Australians who this government has assessed as needing a home-care package, and yet they continue to wait because of the funding cuts from this government. How is this acceptable? How did the Morrison government ever let the waiting list get to this unacceptable level? What's the minister's plan to deal with the remaining older Australians on the home-care package waitlist?

Under the watch of successive Liberal governments, the waitlist has grown from 88,000 older Australians to, at its height, 120,000. This is not good enough. It is totally unacceptable. What's even worse is that more than 16,000 older Australians have actually died in one year waiting for their approved package. That's around 300 older Australians a week dying, having been assessed for a home-care package but being forced to wait for it because of this government's funding cuts. How can the Morrison Liberal government defend these figures? The government has known about these figures and done nothing. Fourteen thousand older Australians have had to enter residential aged care in one year alone because they could not stay at home any longer, waiting for care that wasn't there. That's around 200 older Australians and their families and carers, every single week, having to make a decision that waiting at home for their approved package is no longer an option and being forced to go into residential aged care. The government has known about these figures and done nothing. How does this happen? Others enter emergency departments or the hospital system due to their increasing care needs.

Not only is there a distinct lack of packages available but there's also the increasing length of time that older Australians have to wait for their approved home-care package. Many approved for the highest level of home care are now waiting more than 24 months to receive their approved packages—24 months! How does this happen? I, along with other senators, have brought examples to this chamber of people aged well into their 90s who are waiting 18 months, two years and longer for a home-care package that they've been assessed as needing. These are people well into their 90s. They're already well beyond the average life expectancy of an Australian, and this government is forcing them to continue waiting into their late 90s, if they do happen to survive that long, to get a home-care package. That is a disgraceful way to treat older Australians.

The home-care package waitlist is a national disgrace. Last week the government had choices. It could have delivered more reform around the home-care packages program. Providing more home-care packages is part of the response, but what about more reform? What about the almost half a billion dollars in unspent funds across the home-care packages waiting list? Why isn't the government looking at ways of using these funds for those who need care now? We've got the ridiculous situation where there's a massive waiting list for home-care packages but at the same time there are funds that have been provided for home-care packages that are not being spent by the government. What about making the prioritisation queue actually work properly and give care to those who need it most? For example, what about older Australians in their 90s or those with a terminal illness? What a wasted opportunity for this inept government. This is just not good enough.

For years Labor has been calling on successive Liberal governments to fix and reform the home-care packages waitlist crisis. We know that Australia has a growing ageing population. We also know more Australians are choosing to age in their own home. The minister admitted that older Australians are waiting too long for their home-care package, but what is his plan? What is his plan for the remaining 110,000 older Australians on the waitlist? When asked in question time last week what advice the minister for aged care would give a 95-year-old woman with a terminal illness who is on a waiting list for a level 4 package and has been told that under this government that package will not be available for another 22 months, the minister said, 'That package is much closer.' Minister, how much closer is this 95-year-old woman with a terminal illness to receiving the care she needs? The honest answer is: she is no closer to getting the care she needs and she may not ever get that care.

The Prime Minister last week talked about his family situation. To be honest, most Australians are in that same situation. What does the Prime Minister say to the same 95-year-old woman with a terminal illness who has been told she has to wait for 22 months to get the home care that she has been assessed as needing and has been approved for? What does the Prime Minister say to that older Australian? How much will her wait time go down because of the government's announcement? The truth is that it won't go down at all. She's still going to be waiting 22 months.

The commissioners for the royal commission had three urgent recommendations, and the government's lacklustre response to the first urgent recommendation from the royal commission around home care has been criticised by everybody across the sector. The aged-care sector is saying that the government is still not doing enough. Clearly, last week was another missed opportunity.

Away from the home-care packages waitlist crisis, there was also a missed opportunity when it comes to resourcing the Aged Care Quality and Safety Commission. It's clear the Prime Minister and ministers for aged care and health are yet to even read the Aged Care Quality and Safety Commission's 2018-19 annual report. Take, for instance, the staggering number of complaints received by the commission last year. The latest data revealed a 35 per cent increase in the number of complaints about aged care in one year alone. Around 8,000 complaints were made, but it was the complaints in the delivery of home care that had the biggest rise from 1,014 in 2017-18 to 1,552 in 2018-19. This is a direct reflection on the Morrison Liberal government's inaction on long-term reform to aged care. More people are waiting for home care and we're seeing more complaints about home care, so why didn't the Morrison government use last week's announcement to give stronger powers to the commission and the commissioner?

We know from evidence given at the royal commission that some older Australians and their families who have made complaints are not satisfied by the processes and the outcomes. Surely, with the number of complaints on the rise, Minister Colbeck could have used this opportunity to strengthen the commission rather than maintain the status quo. This could include applying penalties for service providers who are repeat offenders when it comes to delivering substandard care. It may also mean giving the commissioner the ability to arbitrate on complaints. The government could also have invested in people; although we've seen a dramatic increase in the number of complaints, the staffing levels at the commission have remained static.

This leads me to the Royal Commission into Aged Care Quality and Safety. The royal commission's interim report was handed down on 31 October. The reflections of the commissioners laid bare the disturbing state of aged care in Australia. In the words of the commissioners, aged care in Australia is 'a shocking tale of neglect'. The evidence before the royal commission has been confronting and heartbreaking. Witness after witness has said the same thing—that the aged-care system is failing older Australians.

So the question remains: with all the evidence and solutions at hand, why hasn't the government delivered a genuine reform agenda for aged care over the past six years? It also took weeks for the government to respond to the royal commission. They didn't actually have a plan ready to go, despite the number of warnings and despite the number of reviews that we've seen in the aged-care system. It's not like the government were blindsided by the commissioners' reviews and the interim report. The commissioners made mention of the more than dozens of reports, reviews and inquiries the Morrison Liberal government has received. Experts have put forward hundreds of recommendations, with the majority of them not fully implemented and many of them left without a response.

We have to ask: why was the Morrison government caught so flatfooted and without a plan, especially around how to deal with the home-care packages waiting list? The Morrison government has known for more than two years that over 100,000 older Australians have been assessed and are waiting for their approved home-care packages. This is no secret. When the last waiting list data report was published in September, the Prime Minister, Mr Morrison, said that home care was a budget priority. The commissioners were very clear about what they identified as needing urgent action. Providing more home-care packages to reduce the waiting list for higher level care at home was the commissioners' first priority. They described the home-care packages waiting list as neglect and stated that funding should be forthcoming from the Morrison government. We would have thought that the home-care package waiting list being described as 'neglect' would have resulted in a different response from the Morrison government. But, no, it's just the same, just like all the other announcements—too little, too late.

The Prime Minister, having called for the establishment of the royal commission—and after making his own budget cuts when Treasurer—has now abrogated his responsibilities. He has not listened to the growing chorus of voices calling for urgent action to fix Australia's broken aged-care system. He has also not taken seriously enough the statements made by the commissioners, who have described the home-care packages waiting list as neglect. It's abundantly clear that there are 110,000 older Australians who will wait longer for care in their homes.

This is a disgrace. As I've said, the Morrison Liberal government could act quickly when it comes to home-care packages. Labor has been calling on the government for more than two years to deal with the growing waiting list. This is a government that is being accused by its own royal commission of neglecting older Australians who are waiting for home care. We can, and the government should, do better.

Earlier, I raised the fact that billions of dollars had been cut from the aged-care budget by the Prime Minister when he was Treasurer, and 7.30 raised this very issue when reporting on the royal commission's interim report recently. Part of the program was an exchange between the Prime Minister and a former Australianjournalist, Mr Rick Morton. It was in fact an exchange that took place just over a year ago, when the Prime Minister was facing questions about the cuts he made to the aged-care budget. I'd like to spend a bit of time on these cuts, because they have had a significant impact and I know that the government disputes they were made at all. That's why we need to get on the record what the facts are.

It's fair to say that consecutive Liberal governments have a strong record when it comes to cutting the aged-care budget. Tony Abbott, when he was Prime Minister, cut $110 million from the dementia supplement in residential aged care. The Prime Minister, when he was Treasurer, cut almost $500 million in the 2015 mid-year financial review, and the exchange between the Prime Minister and Rick Morton centred on the $1.2 billion cut to the Aged Care Funding Instrument that can be found in the 2016-17 budget. Under this Prime Minister as Treasurer, almost $2 billion was cut from residential aged care alone.

These failures start at the top. The now Prime Minister, Scott Morrison, was the architect of cuts to aged care that have contributed to this broken system. Government officials confirmed at estimates last month that the viability of the aged-care sector is at risk after years of Liberal cuts. The head of the Aged Care Financing Authority, the government authority responsible for aged-care funding, admitted the viability of the aged-care sector is at risk. I asked this question of the head of the financing authority at Senate estimates:

Does the Aged Care Financing Authority have any concerns about the viability of the aged-care sector given all of these factors?

The head of the agency's answer was clear. His one-word answer was 'yes'. He does have concerns about the viability of the sector, and this can also be confirmed in the agency's 2019 annual report.

It is incredibly concerning that the viability of the aged-care sector is at risk, with 250,000 older Australians currently in residential aged care. We've already seen the impending closure of three facilities in the last month—two on the Central Coast and one in Shepparton. Of course, it is not that long ago that we saw the disturbing scenes at Earle Haven nursing home on the Gold Coast, which I've spoken about many times. The viability of the aged-care sector is at risk because of the Liberals' cuts and inaction. This government must be held responsible for where aged care in Australia is today. Older Australians deserve better.

I would like to end by saying that the royal commission has shone a light on what's wrong and on what we need to do to assure Australians that there are facilities that do a good job. Labor acknowledges the hard work of all of the commissioners and the commission team and notes the valuable contribution of the late the Hon. Richard Tracey QC. I would also like to say this: there are a lot of really dedicated, hardworking staff in the aged-care system who are doing their very best, but we know they need more resources and more support as they go about their day-to-day work. For too long the government has been hands off. It needs to do more and it needs to do it quickly. We've said for a long time now that there aren't enough aged-care workers and that those there are must be better paid. A message from Labor to older Australians, along with their families, carers and loved ones: please be assured that we will keep putting pressure on this government to fix the aged-care system. (Time expired)

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I rise to make a contribution on the Aged Care Legislation Amendment (New Commissioner Functions) Bill 2019. This bill transfers additional aged-care regulatory functions to the Aged Care Quality and Safety Commissioner and is the next phase of the establishment of the role of the safety commission and the commissioner. From 1 January 2020, the commissioner will be responsible for approving aged-care providers for the delivery of aged-care services, home-care services and flexible care services; undertaking compliance and enforcement actions, including monitoring the compliance of approved providers and imposing sanctions where providers do not meet their aged-care responsibilities; and the administration of the responsibility of approved providers to make compulsory reports of assaults.

These functions and this bill are a very important next step. We know that there needs to be serious reform in aged care. We know that from the interim report of the royal commission, but, even without that, just listening to the lived experience of residents, and also the families of those who have passed on, is particularly important. Listening to the lived experience of care workers also is very important, as is listening to organisations who provided a lot of evidence to the royal commission. It's obvious that serious reform is necessary.

These reforms are the second phase of this process and are part of the government's response to the Carnell-Paterson review. The first stage of the reforms came into effect this year with the establishment of the Aged Care Quality and Safety Commission and the accompanying commissioner—the inaugural commissioner—Janet Anderson. The establishment of the commission marked an important step towards better oversight of the aged-care sector as a whole, allowing for information to flow more readily and easily, rather than being siloed in the various agencies in the Department of Health. We have circulated a number of amendments because we don't actually think that there's enough in the current legislation to ensure fully transparent and accountable oversight. I'll come to that later.

This bill includes reforms that are an important step towards strengthening the commissioner's existing regulatory functions and powers. It is incredibly important that we get these changes right if we are serious about creating a strong commission, giving strength to the commissioner and avoiding in the future the regulatory failures we are seeing presently. This bill didn't go to an inquiry, and I think that is a shame, given that there are a number of important issues that are still to be addressed. That's why a series of amendments have been circulated. I understand these reforms are very important, and we don't want to see them held up. We will be supporting the bill, although, as I've just articulated, we will be proposing a suite of amendments that I believe strengthen the commissioner's functions and powers. They have the support of many in community based organisations working in this space who have been calling for some of the amendments for a long time. They called for them in the first round of the rollout of the changes initiated by the Carnell-Paterson report, which established the commissioner and the commission. They called for those amendments and they have continued calling for those changes.

Our main concern with the bill is it doesn't address key changes identified during the establishment of the commission last year. We have previously supported stakeholder calls for the commissioner to receive complaints about My Aged Care, the Aged Care Assessment Team and the Regional Assessment Service systems. My Aged Care is the single entry point for older people to access information on aged care, referrals for eligibility, assessments and connections to appropriate services in their local area. I would be extremely surprised if other members of this place had not received strong criticism from constituents trying to access aged care—both older people and their families. I would be very surprised if they hadn't also received complaints about that system. There are myriad problems continuing to plague the My Aged Care website and call centre. Evidence provided to the Royal Commission into Aged Care Quality and Safety indicated:

… older people have trouble using the contact centre and website, they face confusing and duplicative assessments and they are not supported to connect to services.

In 2017-18 the Commonwealth Ombudsman received 164 complaints about the Department of Health, with 44 per cent of these being about My Aged Care.

It is clear there is a need to provide people with an effective and adequate mechanism to lodge complaints about My Aged Care and assessments, given this is a crucial element of our aged-care system. The commissioner already handles complaints about other aged-care services. It makes sense that they also handle complaints about My Aged Care and assessments. While I appreciate that the commissioner is taking a 'no wrong door' approach, we believe that the commission will not be seen as a single point of contact for older Australians until they are able to receive complaints about My Aged Care and the assessment process. When you think about it, the very process whereby you first make contact with the system is flawed, yet people can't complain about that to the commission. This is why I've circulated amendments that allow the commissioner to deal with complaints about the performance of the assessment process and electronic platforms relating to aged care, such as My Aged Care. I hope the government will seriously consider these and take on board these important amendments.

One of the key recommendations of the Carnell-Paterson review was for the enactment of a serious incident response scheme. In March this year a report was released by the government that recommended the scheme be overseen by the commission. I understand that a consultative process for the Serious Incident Response Scheme has been finished. At estimates we learnt the government is still working on the finer details of the scheme. It is crucial that we get this scheme right, but I have serious concerns about the time it has taken to get this scheme off the ground, particularly when you think about what we're hearing at the royal commission.

Alex Gallacher (SA, Australian Labor Party) Share this | Link to this | Hansard source

Senator Siewert, you will be in continuation. It being 12.45, we will proceed to senators' statements.