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

I would like to ask the minister some questions. I do intend to move my amendments, but I do wish to ask some questions first. I will try and be as quick as I can, but there are some issues that I do want to quickly seek confirmation about. Has the addendum been circulated? I don't seem to be able to find it.

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

Minister, can you clarify the situation at the request of—

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

It was tabled in the House as part of the debate down there, but I will table it now.

The TEMPORARY CHAIR: And can a copy be provided to Senator Siewert?

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

That would be very helpful if possible, thank you. I'm just checking it's the one that I think it is. Why have falls been left off the definition of a serious incident?

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

Falls will be reportable under the Serious Incident Response Scheme where they are caused by unreasonable use of force towards a person, result from neglect by the aged-care provider or result in unexpected death. Where the fall is not reportable aged-care providers will still be required to identify, record, manage and resolve the incident; provide support to ensure the health, safety and wellbeing of the person; and assess the incident and take necessary remedial action to prevent future incidents.

The next point I will make goes to the management of the entire aged-care system as a whole. As of 1 July this year, under the national mandatory quality indicator program, residential aged-care services will be required to report all care recipient falls, so when you bring these two things together—

Glenn Sterle (WA, Australian Labor Party, Shadow Assistant Minister for Road Safety) Share this | Link to this | Hansard source

Minister, if you could resume your seat for just a moment. I call Senator Siewert.

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

The mic is not picking up everything, so I missed what you said just then. I apologise for that.

Glenn Sterle (WA, Australian Labor Party, Shadow Assistant Minister for Road Safety) Share this | Link to this | Hansard source

The minister might speak a little more loudly for the benefit of the senators in the chamber.

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

I'm happy to repeat it. From 1 July this year, under the national mandatory quality indicator program, providers will be required to report all care recipient falls. So we have two things working in concert: we have the quality indicator program and we also have the Serious Incident Response Scheme. They will be required to report all falls, including those which result in major injury, to Health through My Aged Care. So we have two systems working together. All falls will be reported under the quality indicator program, and that will then flow through to the rating system that providers get under the reporting of the quality indicators, which are also publicly reported.

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

I thank the minister for his answer. My concern is that it's then up to a provider to determine what neglect is, if the fall has resulted as a matter of neglect, and some of the other issues that you raised are then subject to a provider making that call. I understand the point you've just made about the quality indicators, but this is an extremely important issue. I still don't understand why all falls are not treated as a serious incident, because the nature of a fall, whether it's caused by someone being a little bit adventurous or by neglect, can lead to premature death and other serious implications.

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

I think I understand the question, but the point we're making is that all falls will be reported as a part of the quality indicator program. The question then becomes how you actually define a serious incident. Our view on that is, as I've explained to you in response to your question a moment ago, in those three circumstances that I've explained, it does require providers to make those assessments because all falls will be reportable under the quality indicator program. So there will have to be a process whereby providers make those assessments to consider those things. Of course, those things are also assessed as a part of the provider's ongoing accreditation process because all of the documentation that's gathered as a part of providing care is assessed as part of the provider's ongoing accreditation process.

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

But it's not as clearly transparent and accountable as—well, if you accept my other amendments that are about accountability and reporting data, it's not as immediately transparent as the process of reporting serious incidents, is it?

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

You're right, Senator; it is different, but there also needs to be some balance in the amount of work that goes into the administration of each of the various schemes, and that's why we've made the decisions that we have. All of the falls will be reported. The provider will be required to do an assessment as a part of that, as I've indicated to you, but that's the assessment that's being done through the scoping study, and particularly through the learnings that we've had by assessing other schemes, including the one that operates through the NDIS.

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

If someone is receiving respite care at a residential aged-care facility and they experience a serious incident, will providers be required to record and investigate that incident under the scheme?

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

My understanding is that, given they are in the care of the provider, that would fall under the requirements of the providers approved-provider status and therefore would be within the parameters of the Aged Care Act, which then brings in these particular requirements.

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

Could you take on notice—you said that was your understanding. It would be appreciated if you could—

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

Hold on a second—what was the question, Senator?

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

Could the minister take on notice to confirm—because it was a little equivocal—that respite care is covered under this scheme?

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

Respite is included, Senator.

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

I'll get to my amendments and what our proposals are in a minute, but given that the recording and publication of the data isn't as thorough as it could be, how will this current proposal result in continuous improvement and prevent similar incidents from occurring in residential care facilities? And how will the community, residents and family members know that?

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

There are two elements to that, and they come to the two elements which we've discussed before. I think the other point I should make is in reference to where we sit in the overall scheme of things with respect to the royal commission and where we go out of the back of that.

Clearly, the requirements for reporting—the requirements which I indicated before for falls in both categories under the mandatory quality indicator program and also under the serious response scheme—are going to require providers to assess the fall and the reasons for the fall. Quite frankly, a good quality system has a continuous improvement element as part of it. So that's one of the objectives of the Serious Incident Response Scheme—the assessment of the fall, the reasons for it and then the corrective actions that are put in place to deal with that. That would be my expectation of what would occur.

With respect to the data: I would agree with you with respect to the amount of data that is available and that exists in the aged-care sector right now. That's something that we clearly need to improve. That will be part of the work that we do post the receipt of the royal commission report in just three weeks time. It is clearly something that we need to do to improve the visibility of this information, not only for consumers and for the community but also for the department and for the quality regulator. This is clearly a direction that we will continue to move in and it is certainly part of our policy discussions at this point in time.

So the operation of a good quality system will do exactly what you've asked it to do because continuous improvement is one of the elements of a good quality system.

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

Thank you. I might ask you a few more questions on reporting when we get to the amendments. Have you given any consideration to evaluation of the operation of this scheme and, if so, what are you planning?

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

I'll have to come back to you on any particular cycle of evaluation of the scheme, but, from my perspective, a regular cycle of doing that actually informs continuous improvement. I understand where you're coming from and I agree with the concept that you're discussing.

We are currently doing some additional scoping work on the Serious Incident Response Scheme. A number of colleagues have acknowledged the fact that it doesn't include home care. We're doing the scoping work for home care right now, so that answers the issue that has been raised in relation to home care. But we believe that it was important to get the scheme up, running and operating, particularly in residential care. The bringing forward of the commencement of the scheme was part of our response to the royal commission's COVID report, so we're clearly responding in that sense, but it is something that we will need to continue to monitor, and my view would be that that should form part of our reform process that we'll embark on off the back of the royal commission.

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

I thank the minister for his answer, and in fact he's touched on my next question, about home care. I am aware of the time. Can I perhaps ask a question on notice: could the minister provide a written update to the chamber on where the feasibility and prevalence study to inform the introduction of the scheme for home and community care is at?

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

I'm happy to take that on notice and provide that information and perhaps a briefing if you require it.

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

I thank the minister and I appreciate the offer. I seek leave to move amendments (1) to (5) on sheet 1187 together.

Leave granted.

I move amendments (1) to (5) on sheet 1187 together:

(1) Schedule 1, item 2, page 4 (lines 8 and 9), omit "(other than in circumstances set out in the Quality of Care Principles)".

(2) Schedule 1, item 2, page 4 (line 11), at the end of 54-3(2), add:

; (i) a fall by the residential care recipient.

(3) Schedule 1, item 2, page 4 (line 22), omit "or (h)", substitute ", (h) or (i)".

(4) Schedule 1, item 2, page 5 (after line 17), at the end of section 54-3, add:

(8) Despite subsections (5), (6) and (7), the Quality of Care Principles must require an approved provider to refer a *residential care recipient involved in a *reportable incident under paragraph (2) to the recipient of an *advocacy grant under section 81-1.

Note: The referral of a residential care recipient involved in a reportable incident to the recipient of an advocacy grant is for the purpose of the residential care recipient being provided free, independent and confidential advocacy services. Advocacy services may include encouraging understanding of, and knowledge about, the rights of the residential care recipient and enabling the recipient to exercise those rights.

(5) Schedule 1, item 3, page 10 (after line 17), after subsection (7), insert:

(8) Without limiting subsection (1), the rules must make provision for:

(a) the publication of information relating to each reportable incident referred to in subsection 54-3(2) of the Aged Care Act, including but not limited to:

  (i) the number of each reportable incident, for all approved providers; and

  (ii) the number of each reportable incident, for each approved provider, in all facilities or services operated by the approved provider that provide flexible care or residential care services; and

  (iii) the number of each reportable incident in each facility or service that provides flexible care or residential care services; and

(b) the publication of the information referred to in paragraph (a) on a quarterly basis, on the website of the Quality and Safety Commission.

(9) However, the rules must not make provision for the publication of personal information in relation to any reportable incident.

These amendments relate to the comments that I made in my speech in the second reading debate, and that is to include the use of all restraints as reportable incidents, not just those outside the care principles; to deal with falls as reportable incidents under this scheme rather than as the government's current intention is; and also the referral of families and residents to advocacy services. Under the legislation, as I articulated in my second reading contribution, providers are required to provide support to those affected. What we are putting in here is a requirement to ensure that they're referred to advocacy services, because a lot of people want independent support if a serious incident occurs. We're not mandating the services; we're saying they should be referred to some advocacy services. There are some very good services out there.

The amendments also include the publication of reportable incident data, which is why I was asking that previous question. At the moment, they're not being provided in the manner that counsel assisting recommended, which was, as I articulated in my second reading contribution, about making sure there was global-, provider- and facility-level reporting of these instances in a timely manner so there's true transparency and accountability and the community and families have a very good understanding about what's going on. We don't see why this data could not be provided in this manner. I heard what the minister said in answer to my question: he agreed. I thank the minister for acknowledging the need for greater transparency and accountability, but we know this is needed in the serious incident report, so I don't see why that could not be done now. We don't need the royal commission to tell us again that this needs to happen. We know it needs to happen. We know it needs to be at that level. So I don't see why the requirements for the provision and reporting of that data cannot be included in this particular piece of legislation.

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

The government won't be supporting the amendments moved by the Greens, largely for the reasons that we've already stated through the discussion during the earlier parts of the committee stage. We don't believe that all uses of restraint should be reportable incidents. There is considerable work being done with respect to restraint anyway, and I think the Greens would certainly acknowledge that. There's some more information that I'll be able to provide to the Senate very shortly with respect to some work that I had done last year, so that will be available to the parliament shortly.

I think I've adequately put our position with respect to falls. As I indicated, we're about to embark on a very significant reform process with respect to a number of elements of the aged-care sector, off the back of the royal commission. I would differentiate at this point, not knowing what the royal commission is actually going to report as opposed to what counsel assisting has said. I would acknowledge that that gives us a good direction as to where the commission might go, but, with respect to those elements, the final report is three weeks away. We will then be very intently commencing a significant reform process for the entire sector. Part of that will be the reporting of a range of information and data that could be improved, in providing better public confidence in the aged-care sector.

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

The question is that the amendments moved by Senator Siewert, (1) to (5) on sheet 1187, be agreed to.

Patrick Dodson (WA, Australian Labor Party, Shadow Assistant Minister for Reconciliation) Share this | Link to this | Hansard source

Sorry, Chair; I should have risen earlier. Labor will not be supporting the Greens' amendments, and I have further things to say when the other amendments are moved.

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

Thank you, Senator Dodson. I put the question that the amendments on sheet 1187, moved by Senator Siewert, be agreed to.

Question negatived.

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

You've obviously recorded that we supported it, and, if others want to, they can indicate that they supported it. In the interests of time, I'm not going to call a division.

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

Thank you, Senator Siewert. That will be recorded.

Rex Patrick (SA, Independent) Share this | Link to this | Hansard source

I would have supported the amendments, if that can be recorded. I seek leave to move amendments (1) and (2) on sheet 1186 together.

Leave granted.

I move amendments (1) and (2) on sheet 1186 together:

(1) Clause 2, page 2 (at the end of the table), add:

(2) Page 25 (after line 9), at the end of the Bill, add:

Schedule 4—Staffing Ratio Disclosure

Aged Care Act 1997

1 After section 9 -3B

Insert:

9 -3C Obligation to notify Secretary of staff to care recipient ratios

(1) An approved provider must, for each residential care service operated by the approved provider and for each day referred to in subsection (4), notify the Secretary of the ratio of:

(a) care recipients to whom residential care is being provided through that residential care service; to

(b) staff members of the approved provider who provide a service connected with that residential care service.

Note: Approved providers have a responsibility under Part 4.3 to comply with this obligation. Failure to comply with a responsibility can result in a sanction being imposed under Part 7B of the *Quality and Safety Commission Act. Information notified under this section is made publicly available (see section 86-9).

(2) The ratio must also be broken down into ratios for each category of staff member referred to in subsection (5).

(3) In counting staff members for the purposes of this section, part-time staff members are to be taken into account as an appropriate fraction of a full-time equivalent.

(4) For the purposes of subsection (1), the days are the following:

(a) the 4 days, in each year, specified in the regulations; or

(b) if no days are specified in the regulations for the purposes of paragraph (a)—each 1 January, 1 April, 1 July and 1 October.

(5) For the purposes of subsection (2), the categories of staff member are the following:

(a) registered nurses level 1;

(b) registered nurses level 2;

(c) registered nurses level 3;

(d) registered nurses level 4;

(e) registered nurses level 5;

(f) enrolled nurses;

(g) nurses with a certificate IV or an equivalent qualification;

(h) personal care attendants;

(i) allied health staff;

(j) other staff members.

(6) A notification under subsection (1) must be made as soon as practicable and in any event within 28 days after the day to which the notification relates.

(7) The notification must be in the form approved by the Secretary.

(8) The notification may include an explanation by the approved provider in relation to any ratio notified. The explanation must not exceed 250 words in total.

Note: If an explanation is provided, the explanation will be made publicly available: see section 86-9.

(9) If, between making notifications under subsection (1), there is a change of more than 10% in a ratio notified under that subsection, the approved provider must, within 28 days of that change, notify the Secretary of the change.

(10) The Secretary must cause a review of the operation of this section to be undertaken as soon as possible after the first anniversary of the commencement of this section.

(11) The review must include a review of:

(a) the operation of subsection (4) and whether the ratio referred to in subsection (1) should be reported for both daytime and night time and for Saturdays and Sundays; and

(b) the operation of subsection (9) and whether the requirement to notify changes under that subsection creates an unnecessary reporting burden for smaller residential care services.

(12) The Secretary must give the Minister a written report of the review.

(13) The Minister must cause a copy of the report of the review to be tabled in each House of the Parliament within 15 sitting days of that House after the report is given to the Minister.

(14) In this section:

staff member of an approved provider has the same meaning as in section 63-1AA.

2 After subsection 86 -9(1)

Insert:

(1A) The Secretary must make publicly available:

(a) any information about staff to care recipient ratios of residential care services notified to the Secretary under section 9-3C; and

(b) for each residential care service for which information is so notified in relation to a day:

  (i) any information about the average claim made in relation to that service for that day under the Aged Care Funding Instrument (as in force or existing from time to time); and

  (ii) any information about whether, relative to other residential care services, that average claim is low, medium or high.

3 Subsection 86 -9(2)

After "(1)", insert "or (1A)".

As I discussed in the second reading debate—I won't talk for too long; I'm just reminding the chamber—this amendment is simply about making staffing ratios, and the qualifications of staff, available to people who may wish to put themselves into an aged-care facility. It may also assist relatives making choices in terms of putting people into facilities. It is a no-cost option, but it is informative to the users of the system. I'm hopeful that the Senate will support it.

Richard Colbeck (Tasmania, Liberal Party, Minister for Senior Australians and Aged Care Services) Share this | Link to this | Hansard source

The government won't be supporting the amendment. I think it's fair to say that this is a subject where the royal commission will have some very specific recommendations to make. We've seen some preliminary advice through counsel assisting, but also some very good evidence from a number of sources. I don't agree, Senator, that it's a no-cost option. It will incur costs. It will incur costs to providers, and that means it incurs a cost to government as the funder of the aged-care system. This will be one of the issues that will receive significant consideration from the government once we receive the report in three weeks time. So we won't support the amendment at this stage.

Patrick Dodson (WA, Australian Labor Party, Shadow Assistant Minister for Reconciliation) Share this | Link to this | Hansard source

Madam Chair, just for clarification, is Senator Patrick moving both these amendments at this time or just one amendment? Is he moving the amendments on sheet 1186 or is he moving amendments on sheets 1186 and 1191?

Deborah O'Neill (NSW, Australian Labor Party) Share this | Link to this | Hansard source

I believe he's just moving items (1) and (2) on sheet 1186 together, so we're just dealing with those particular matters.

Patrick Dodson (WA, Australian Labor Party, Shadow Assistant Minister for Reconciliation) Share this | Link to this | Hansard source

Thank you, Madam Chair. Labor will be opposing this.

The TEMPORARY CHAIR: The question is that amendments (1) and (2) on sheet 1186, moved by Senator Patrick, be agreed to.

Rex Patrick (SA, Independent) Share this | Link to this | Hansard source

by leave—I move amendments (1) and (2) on sheet 1191 revised together:

(1) Clause 2, page 2 (at the end of the table), add:

(2) Page 25 (after line 9), at the end of the Bill, add:

Schedule 5— Audio-visual recording

Aged Care Act 1997

1 After section 63 -1C

Insert:

63 -1D Responsibilities relating to audio-visual recording equipment

(1) This section sets out the responsibilities of an approved provider of *residential care relating to the installation, monitoring and review of audio-visual equipment.

Audio-visual recording

(2) The approved provider is responsible for ensuring that audio-visual recording equipment that complies with any requirements set out in the rules is installed in the bedroom of each care recipient in a residential facility which provides *residential care.

(3) An approved provider must ensure that:

(a) in the case of audio-visual recording equipment installed in the bedroom of a care recipient:

(i) the audio-visual recording equipment is operating at all times, in accordance with any requirements set out in the rules, when any person is in the bedroom; and

(ii) the audio-visual recording equipment is monitored, in accordance with any requirements set out in the rules, by a person or body independent of the approved provider; and

(iii) the images recorded by the audio-visual equipment are reviewed, in accordance with any requirements set out in the rules, by a person authorised in writing by the approved provider; and

(b) the requirements under paragraph (a) will only be taken to apply to an approved provider of a residential facility if each care recipient in the bedroom in which the audio-visual recording equipment is installed consents in writing, in accordance with any requirements set out in the rules, to the operation of the audio-visual recording equipment, and the monitoring and review of images recorded by the equipment; and

(c) for the purposes of this section, a reference to the consent of a care recipient will be taken to include a reference to the consent of a person who is authorised under a law of the Commonwealth or a State or Territory to give consent on behalf of the care recipient.

Cost recovery

(4) The approved provider may, in accordance with any requirements set out in the rules, recover from a care recipient the actual costs of:

(a) operating audio-visual recording equipment in the bedroom of the care recipient; and

(b) monitoring and reviewing images recorded by the audio-visual recording equipment in accordance with this section.

(5) To avoid doubt, an approved provider may not recover from a care recipient costs in relation to the installation of audio-visual recording equipment in the bedroom of the care recipient.

Definitions

(6) In this section—

care recipient means a person who is:

(a) receiving *residential care, provided in a residential setting, in respect of which the provider is approved; and

(b) either:

(i) *subsidy is payable for provision of the care to the person; or

(ii) the person is approved under Part 2.3 as the recipient of the care.

Rules

(7) The Minister must, by legislative instrument, make rules prescribing matters:

(a) required or permitted by this section to be prescribed by the rules; and

(b) any other matters necessary or convenient to be prescribed for carrying out or giving effect to this section, including, but not limited to:

(i) access to, and the use and retention of, images recorded by audio-visual recording equipment; and

(ii) protecting the privacy of care recipients.

(8) To avoid doubt, the rules may not do the following:

(a) create an offence or civil penalty;

(b) provide powers of:

(i) arrest or detention; or

(ii) entry, search or seizure;

(c) impose a tax;

(d) set an amount to be appropriated from the Consolidated Revenue Fund under an appropriation in this Act;

(e) directly amend the text of this Act.

I just want to refresh for the chamber that these amendments are in relation to the installation of opt-in CCTV in aged-care facilities. The CCTV would be monitored by professional medical personnel remotely and would be used to detect falls in rooms, so there's an extra set of eyes, but also to deter and deal with any misconduct that might take place inside a facility.

Question negatived.

Progress reported.