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

Labor supports the passage of the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, but I'd like to foreshadow that at the end of my remarks I'll be moving a second reading amendment. I think all Australians would recognise that administration of the aged-care system in this country has been one of this government's greatest failures, and that is saying something. This bill will make urgent and needed amendments to the Aged Care Act to implement three measures in response to the Royal Commission into Aged Care Quality and Safety, and, in the case of restrictive practices, in response to the Independent review of legislation provisions governing the use of restraint in residential aged care. It needs to be made clear that the government's response to the aged-care royal commission falls far short of where it needs to be in terms of solving a number of key issues in the aged-care system and fails to deliver enduring changes and reform for the long term.

I will start with the first key change in the legislation: the overuse of restraints in aged care. Substandard care can take many forms, and the royal commission concluded that 30 per cent of older people in aged care, almost one in three, have experienced some form of substandard care. The royal commission specifically heard about the excessive use of physical and chemical restraints in residential aged care, which robs older Australians of their dignity and autonomy in their final months. Older people with mental health issues, particularly those suffering from the later stages of dementia, are often heavily medicated or physically restrained. In the final three months of 2019-20, residential aged-care services made 24,681 reports of intent to restrain and 62,800 reports of physical restraint devices. Far too many people experience the aged-care system as uncaring, unkind and even inhumane in its response to them and their needs.

This bill will make a number of important changes in regard to restraints and restrictive practices. It will clarify the definition of 'restrictive practice' in the Aged Care Act so that it is in line with the NDIS definition and ensure that all restrictive practices that limit the freedom of movement of an aged-care resident are included. It will expand the Aged Care Quality and Safety Commissioner's ability to respond to breaches of approved aged-care providers' responsibilities in relation to restrictive practices, with new abilities to issue written notices and make applications for civil penalty orders. It will provide that the quality care principles set out clearly when an aged-care provider is able to consider the use of restrictive practices—importantly, only ever as a last resort. While it is disappointing to see the royal commission's recommendation around the introduction of independent expert approval for the use of restrictive practices, this bill will help prevent the overuse of restraints and restrictive practices in aged care.

The second key change in this legislation is the introduction of assurance reviews. The introduction of assurance reviews, while not specifically recommended by the aged-care royal commission, is welcome, if they do as described and increase the effectiveness, efficiency and transparency of the home-care system. While this move is welcome, it is disappointing that the government hasn't followed more closely the recommendations from the aged-care royal commission to increase transparency and accountability measures. We know there are many aged-care providers doing amazing work who are dedicated to the health and wellbeing of those in their care. That's not to mention, of course, the incredible work that aged-care workers themselves perform. But we also know that there are far too many aged-care providers who are not doing the right thing. While the government likes to appear to be tough on bad providers, when you dive into the detail of its response to the royal commission, so often it turns out that they're letting those providers—the bad ones—do what they want. These assurance reviews are fine, but why not make the reports and recommendations that come out of these reviews all public? Why leave this up to the Secretary of the Department of Health? This is the same person that is in charge of system governance. Could there ever be an opportunity when it wouldn't be in their interest to release one of these reviews? Labor is committed to doing things very differently here. We want to see a transparent and accountable sector, a sector where bad providers are not allowed to run riot and do what they please, as this government has let them do for so long.

The third key change in the legislation is replacing the Aged Care Financing Authority. The government agreed to establish an advisory group to replace the authority, which will commence operations from July 2021, to ensure the government continues to receive advice on financing issues of the aged-care sector. A new advisory body will be established to provide advice to government on aged-care financing issues.

This bill and its changes are welcome. There is no doubt that the changes to rules around the use of restraints and restrictive practices are needed. There is no doubt that transparency and accountability in the aged-care sector need to be dramatically improved. But why is this the only legislative action the government is taking right now in response to the damning and wide-ranging findings of the aged-care royal commission? Why is this the only bill we're seeing, months after the royal commission handed down its final report? Where is the sense of urgency on aged care from the Morrison government? They have received 21 expert reports into the state of aged care in Australia since 2013, reports that largely foreshadowed the shocking findings of the royal commission's eight-volume report, which told us how bad the crisis in aged care is. Given just how shocking and damning and completely unacceptable those findings were, where is the sense of urgency to fix the problems identified? Where is the sense of urgency to improve the level of care that older Australians are receiving? But maybe we shouldn't be surprised. Maybe it doesn't matter how bad things are in aged care for the Morrison government, because they like to take things slowly and take things easy.

The Morrison government has neglected the aged-care sector for eight years. If you need any further proof of that, just look at the title of the royal commission report: Neglect. That is the way the royal commission summarised the work of this government over eight long years. For eight years this government has neglected older Australians who have received aged-care services. It's neglected hardworking and dedicated aged-care workers for eight years. Don't just take my word for it. The royal commission described the government's approach to aged care in its final report, where it said:

At times in this inquiry, it has felt like the Government's main consideration was what was the minimum commitment it could get away with, rather than what should be done to sustain the aged care system so that it is enabled to deliver high quality and safe care.

In fact, that really does sum up the approach of this government to so many issues—in particular, aged care. What is the bare minimum they can get away with? This is an absolutely damning finding from the royal commission. The crisis in aged care has been brewing for years. The 21 expert reports that are gathering dust on the minister's desk warned the government that this was coming, but they chose to neglect the aged-care system for eight long years. It is a national disgrace, and the ministers responsible should be ashamed for the part they have played in this crisis.

Despite the royal commission's damning words, this government's approach still seems to be to do the minimum it can get away with. At the end of the day, this is the Prime Minister's crisis. It's happened on his watch. When Mr Morrison was the Treasurer, he even cut funding to the sector by $1.7 billion. How can anyone trust Mr Morrison to fix the aged-care crisis? How can older Australians trust Mr Morrison? How can their families trust Mr Morrison? How can aged-care workers trust Mr Morrison?

The aged-care royal commission graphically highlighted the failures of the government, failures that have happened on their watch and while they have failed to watch, failures including maggots in the wounds of residents and failures including the two-thirds of residents who are malnourished or at risk of malnourishment—that is, two-thirds of residents are literally starving in the care of their own government. How can anyone stand by and let that happen for eight long years? How can the government sit there and still refuse to show any real urgency while this is happening? They should be ashamed.

The Morrison government have failed to listen to Australians in aged care, to their families and to the workers in the system when they raised the alarm bells about the absolutely dire conditions in some residential homes. They've failed to listen to families about the impact on their lives of having to wait years to get high-care needs home-care packages. They've failed to listen to workers about being exhausted, about being overworked, about being under-resourced, about being underpaid and about being undervalued.

Who can forget the performance of the aged-care minister at the recent Senate estimates, where, yet again, he refused to back in a pay rise for aged-care workers? What a way to treat the people that we depend upon to provide services and care to the elderly in our community—our grandparents, our parents, our loved ones. Of course, this minister, along with his predecessors, failed to listen to those 21 expert reports that the government have received on the issues.

If you ask anyone to describe the government's record on aged care in one word, they will say the same thing: neglect. But they still aren't listening, not even to the royal commission that they were forced into calling. They haven't learned their lesson, because their response to the aged-care royal commission is, as the royal commission found, the bare minimum they think they can get away with. Not a single issue is actually fixed.

The Morrison government's response to the aged-care royal commission falls far short of where it needed to be. It failed to deliver enduring improvement and reforms for the long run. They've fobbed off, delayed or outright rejected key recommendations. Of the 148 recommendations, over half are not being implemented or aren't being implemented properly. So often in their response, the government claims to have accepted a recommendation. But, when you actually look at the detail, times are pushed back, sometimes by years. Key sections of recommendations are often excluded. Sometimes they say they've accepted a recommendation, but their response doesn't even pretend to match it. That is a very strange definition of the word 'accept', which is what the government claim to have done. It's the same old behaviour we've come to expect from a government that says one thing and does another—that does the bare minimum to deal with the aged-care system. This is a government that makes a big announcement but never follows through on detail—on aged care and so many other things.

The government's response to the royal commission falls flat in five major areas in particular. Firstly, nothing will change without reform to the aged-care workforce. There was nothing to improve wages for overstretched, undervalued aged-care workers. Secondly, the government is gifting $3.2 billion to providers via a basic daily fee increase, with no strings attached to ensure it goes to actual care or better food and not management bonuses or a new office fit-out. Thirdly, the government has failed to clear the home-care package waitlist of 100,000 people. Only 80,000 packages were included in the budget over the next two years, and thousands join the waitlist every year. The maths don't add up. This government is not even going to clear the current backlog before a single new person joins that waiting list. Fourthly, the government has ignored the recommendation to require a nurse to be on duty 24/7 in residential care. This is core to improving clinical care for frail Australians. And, fifthly, the government's promise of mandatory care minutes for each resident is also full of holes. It doesn't meet the royal commission recommendation, and we now know that cleaning and some admin will be included as care. As important as those roles are, it doesn't satisfy what the royal commission was talking about. Why bother calling the royal commission and then ignore so many of its recommendations? Why bother calling the royal commission and not fix the crisis it identifies?

And that's before we get to the impact of COVID on aged care. Recently we have seen the government's neglect of aged-care residents and workers play out yet again, with potentially deadly consequences. Because of this government's failures in quarantine and its failures in the vaccine rollout, we again saw COVID-19 cases in aged care. People are angry about it, and they have every right to be so. Last year we lost 685 residents in aged care to COVID-19. This government left the door open to this tragedy happening again. What residents and staff went through last year was nothing less than absolutely traumatic. Residents lost their friends and their companions.

Just this week we found out that still only 30 per cent of aged-care workers have had their first vaccination. We found out yesterday that about 15 per cent of aged-care workers have been fully vaccinated. These people were supposed to be fully vaccinated by the end of March. They're the government's top priority, and only 15 per cent of people have been fully vaccinated. If you listen to the government talk about it, you'd be unable to tell. The Prime Minister says that the vaccine rollout is not a race. The aged-care minister says he's comfortable with the speed of the rollout. Neither the health minister nor the aged-care minister can seem to get their numbers straight. Unless the government acknowledge their faults and their mistakes in aged care, how is anyone supposed to trust them to fix it? Right now there is no plan from this government, and no plan and no targets mean no urgency.

In conclusion, what is absolutely clear to me is that, wherever you look now, the story of aged care is: don't send the Liberal and National parties on a job you trust only the Labor Party to do. The last eight years of neglect by this government have shown another three years won't make a difference. To summarise, while we welcome the changes in this legislation, the government response to the royal commission falls far short of where it needs to be. My second reading amendment notes, among other things, the government's failures in relation to aged care. I move:

At the end of the motion, add: ", but the Senate:

(a) notes the:

  (i) systemic, ongoing failures in Australia's aged care system as evidenced by the Royal Commission into Aged Care Quality and Safety, including, but not limited to, the use of restrictive practices and the lack of transparency and accountability in aged care,

  (ii) inadequacy of the Government's response to the Royal Commission into Aged Care Quality and Safety, including delayed and diminished legislative action on key issues and recommendations, including, but not limited to:

(A) the malnutrition crisis, with two thirds of aged care residents either malnourished or at risk of malnourishment,

(B) the Home Care Package waitlist,

(C) improved pay and recognition of hardworking and dedicated workers,

(D) improved transparency and accountability around public funds,

(E) mandatory care minutes, and

(F) ensuring a registered nurse is onsite at residential facilities 24 hours a day, and

  (iii) Government's failures in protecting aged care residents and workers due to their poor management of COVID-19 outbreaks in residential aged care, and

(b) calls on the Government to explain, as a matter of urgency, their plan to fully vaccinate aged care workers and keep aged care residents safe".

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

I rise to make a contribution to the debate on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. The Greens welcome this bill as the government's first attempt to address the royal commission, but we don't think it goes far enough. The government's response to the royal commission is basically designed to look like they are accepting most of the recommendations of the royal commission, but, if you look at the details, in fact that is not the case. In addition, it is going to take far too long to roll out the recommendations that they do truly accept and it's going to take far too long before we see the changes needed to our aged-care system put in place. I'll come back to that in a bit more detail later on.

I want to address some of the provisions in this current bill. Restrictive practices, which are addressed in this bill, have been a serious issue in aged care for more than 20 years—a very long time. In this place a number of us, including me, have been strongly advocating to end the use of physical and chemical restraints in aged care. Restraints, including the use of dangerous antipsychotics, have for too long been used to control older people's behaviour. They've been used to quieten people because the aged-care facilities are not designed the way they should be. Instead of addressing the issue, they restrain, both physically and chemically, older people who are in need of care and need our compassion. It is not a compassionate approach to drug somebody to manage their behaviour or to physically restrain them.

The Royal Commission into Aged Care Quality and Safety found that the prevalence of restrictive practices in aged care is unacceptable and the ongoing use of restrictive practices represents severely substandard care. As expressed by the commission in their final report:

The inappropriate use of unsafe and inhumane restrictive practices in residential aged care has continued, despite multiple reviews and reports highlighting the problem. It must now be stopped.

My comment here is that, in terms of those reviews, governments have not enacted those recommendations. They have been slack when it comes to these issues. It's about time we finally started addressing these issues properly and sending a strong message to those providers—and I'm not using a broad brush here—who are not doing the right thing.

The introduction of the minimising the use of restraints principles in 2019 represented an important step forward in regulating restrictive practices in aged care. However, as I articulated in this place, they fell short in many areas, including the absence of behaviour support plans and the absence of any requirement to gain informed consent before using chemical restraints.

I'm pleased to note that this bill provides a stronger framework and better safeguards for the use of restrictive practices in aged care. Importantly, it aligns the definition of restrictive practices with the definition used in the disability sector. It also provides the Aged Care Quality and Safety Commissioner with additional powers to respond to providers who break the rules around restrictive practices, including through the application of civil penalties. Another positive step forward is the requirement for providers to create behaviour support plans when using restrictive practices from 1 September this year. I believe this will help providers to think through how they are using restrictive practices and ensure that they are only used as a last resort.

I would like to go through some of the areas where the new restrictions do, unfortunately, fall short. For example, the new regulations do not apply if the use of restrictive practices is necessary in an emergency. Stakeholders noted concerns that the use of 'necessary in an emergency' is broad and subjective. COTA in particular raised concerns that there are no time lines in the regulations attached to an emergency. They believe that no more than seven days should be the absolute maximum period that emergency rule should apply. Allowing aged-care providers to determine when an emergency has passed could provide a loophole. From our discussions with the department we understand that using the emergency provisions on the same person more than once will constitute a red flag for the Aged Care Quality and Safety Commission. I seek clarification on this matter to ensure this is the case, and I will continue to follow this up.

The royal commission recommended that restrictive practices should only be used after alternative evidence based strategies have been explored, applied and documented. I am concerned that the regulations qualify the need to use alternative strategies through the phrase 'to the extent possible'. This leaves the door open to aged-care providers to determine alternative strategies only to the extent that they believe is necessary. The royal commission also recommended that restrictive practices should be prohibited unless recommended by an independent expert. The regulations require an approved health practitioner to approve the use of restrictive practices. However, it is unclear whether these health practitioners will need to be independent of the facility and the provider—there is a conflict of interest if they are the health practitioner of the actual facility and the provider. As a result, aged-care providers may be able to use in-house health practitioners to approve the use of restricted practices, which, as I said, is in my opinion a clear conflict of interest.

The draft regulations include chemical, physical, environmental and mechanical restraint, and seclusion, as restrictive practices. Some providers were concerned about the need to obtain consent from substitute decision-makers where a person lacks the capacity to give their consent, particularly in the case of locked or secure facilities, and the impact this could have on public guardians. My understanding is that secure facilities were already in the scope under the existing minimising the use of restraints principles. So providers should have been seeking consent for locked or secure facilities under existing provisions. This is a really important point.

I was pleased to see that the draft regulations were put out for public consultation as an exposure draft, and I understand that the department did not receive much feedback and anticipates that the final version will be similar to the draft. While the regulations will provide more guidance and stronger protections, it's clear that we need to address structural issues in aged care if we are going to end the use of restrictive practices altogether—things like staff training, minimum hours of care, adequate mixtures of staff and enough registered nurses. The royal commission found that the overuse of restrictive practices in aged care often comes from a lack of knowledge about restraints, their impacts and alternatives. The department must ensure that we have adequate training and education in place for providers if they are going to successfully end the use of restrictive practices in aged care.

This bill also introduces home-care assurance reviews of the delivery and administration of home care. Under the changes, the secretary will be able to collect information in relation to assurance reviews. The secretary will also be able to publish information on providers who do not comply with notices to produce or do not provide reasonable assistance. My understanding is that the government, as they said to the committee, plans to undertake 500 home care assurance reviews in the first 12 months with a focus on unjustified administration charges and overheads. Given that there are around 928 home-care providers operating in Australia, not all providers will undergo assurance reviews, which is a concern. The department also clarified that the results of the reviews will be published on its website. While I welcome attempts by the government to improve the transparency of home-care fees, it's critical that the government takes more action to improve transparency and accountability across the whole aged-care sector.

Finally, this bill abolishes the Aged Care Financing Authority. Our understanding is that a new advisory group, reporting to the new National Aged Care Advisory Council, will replace ACFA from July. We don't have further details about the new advisory group, including who will sit on the group and what level of independence it will have. Given that the ACFA will be abolished, we expect that the government will publicly commit to a process for commissioning and publishing independent reports on the financial performance of the sector. Today I'm calling on the government to ensure that there is no gap between the dismantling of the authority and the introduction of the new group that will provide advice on financing issues in aged care, and to continue to fund and publish independent annual reports on the financial performance of the sector. The government has started its reform agenda but there is still much work to be done and many unanswered questions. It's up to the government to lead on these reforms. We will continue to do everything we can to demand significant ongoing funding commitments to achieve the structural reforms required to build a safe, accessible and high-quality aged-care system.

At this stage, we have still got far too many issues going on in aged care. We still have enormous waiting lists in aged care. We still have the ridiculous situation where you have to wait for nine to 12 months for level 3 and 4 packages and, in the meantime, you get put on interim packages. For some interim packages the waiting time is nine to 12 months—and that's while you're waiting for your other package, which also has a waiting time of nine to 12 months! It's an absolute farce! This situation needs a lot more urgency than the government is providing to these reforms. Where is the money in the budget for workforce pay rises? We get the weak excuse from the government that they're waiting for the Fair Work case, when anybody who has any understanding of aged care knows that carers, nurses and other personnel working in aged care need a wage rise. Put it in the budget!

We are not going to improve aged care until we have a workforce that is significantly increased. Everybody knows that we need a significantly increased workforce and that we need to pay them properly for the work they do and the dedication they show. Why wasn't it in the budget? Why wasn't it there? Don't hide behind the Fair Work case. They're taking the case because, for years and years, aged-care workers, personal care workers and nurses have been underpaid. We haven't had the right skill mix. You can't get your workforce to the level you need until you're paying them properly for the hours they put in and the work they put in. We can't deliver the hours of care, for those older Australians in aged care, until we have a workforce that is properly supported with ongoing training and other ongoing supports and until we have proper ratios in aged care. The way the government's going, we are years and years and years away from achieving the sort of aged-care system that Australians can only dream about at the moment.

Not only are we not addressing the issues, and not only has the government not put in the funding to properly pay aged-care workers, but we can't even get the vaccination process working properly. We can't get older Australians vaccinated, and we can't get our workers in aged care vaccinated, despite the deadly and awful lesson that was learned in Victoria last year, when we saw so many deaths. You would have thought that, no matter what, the government would have guaranteed that those living in aged care, and those providing the care and working so diligently in aged care, would have been vaccinated by now—all those who wanted it. You would have thought that would have happened, at the barest minimum. But no. It hasn't happened, nor has it happened in the disability sector.

We have a long way to go before we fix aged care in this country. Where's the government's commitment to all those other recommendations and making sure it happens at the pace that is needed? It isn't there, and it needs to be there. The Greens will be supporting these amendments, and I indicate that we are supporting Senator Watt's second reading amendment, because we need a greater sense of urgency to make sure those home-care packages are rolling out, that we've got the workforce there and that the provisions that we are agreeing to today, such as those on restrictive practices, are put into operation as soon as possible so that we can guarantee to older Australians that they're not going to be restrained, either physically or chemically, when they enter aged care.

Helen Polley (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. This bill will make urgent amendments to the Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act 2018 to implement three measures in response to recommendations of the Royal Commission into Aged Care Quality and Safety. In the case of restrictive practices, this bill responds to the independent review of legislative provisions governing the use of restraints in residential aged care.

The royal commission handed down a damning account of the state of Australia's aged-care sector. It's a national disgrace. Scott Morrison is responsible for the aged-care system, he is responsible for the funding cuts and he is responsible for the terrible neglect identified by the royal commission. The Liberals failed to listen to Australians in aged care, to their families and to the workers. The Prime Minister failed to listen to the 22 expert reports and now even the report of his own royal commission. So we argue that this is not 'a once-in-a generation reform to aged care'. The Liberals had ample opportunity to reform the sector, and now I feel that they have fallen short again.

In question time yesterday, we learnt that only 15.6 per cent of residential aged-care staff have been fully vaccinated. They still don't have a register set up to track the number of staff who have been vaccinated. Just a few months ago, aged-care workers were told they will get vaccinated on site in aged-care homes. That never eventuated. The Morrison government also said that aged-care workers would be first in line. Now they're being told that they have to drive hours out of their way in their own time at their own expense. These are some of the lowest-paid workers in this country, yet they're on the front line during this pandemic. They don't necessarily have ready access to transport, and they have other commitments. So these workers should have been able to be vaccinated in their workplaces as a matter of priority. The federal government, the Morrison government, have failed in the rollout of the vaccine program in this country.

But let's go back to the bill. Schedule 1 of this bill makes amendments to further strengthen the legislation on the use of restrictive practices in aged care. The bill defines the term 'restrictive practices' in the Aged Care Act in alignment with the definition applied under the National Disability Insurance Scheme, the NDIS. This is something that Labor welcomes, as the new definition is clearer than the one it replaces and ensures that all restrictive practices are included.

The bill also expands the Aged Care Quality and Safety Commissioner's ability to respond to breaches which approved aged-care providers are responsible for in relation to restrictive practices, which is very important. The commissioner can issue written notices to providers who do not comply with their responsibilities and can also apply a civil penalty order if a provider does not comply with a written notice. The schedule will also provide that the Quality of Care Principles must set out matters in relation to restrictive practices, including when an aged-care provider is able to consider the use of restrictive practices.

While, at first glance, this schedule does provide more guidance, from my work as the chair of the scrutiny of bills committee I'd have to question why a number of key matters and definitions regarding when it is appropriate to use restrictive practices will be left to delegated legislation. It is concerning that matters such as these cannot be scrutinised appropriately by the Senate.

Additionally, this schedule seeks to provide that the Quality of Care Principles may provide that the requirements of the principles do not apply if the use of restrictive practices is necessary in an emergency. This provides the minister with extensive power to determine in delegated legislation when the requirements for the use of restrictive practices no longer apply. I would add that there is also nothing in this bill, on the face of it, which defines what constitutes 'an emergency'. The royal commission specifically heard about the excessive use of physical and chemical restraints in residential aged care which rob older Australians of their dignity and autonomy. Older people with mental health issues—particularly those suffering from later stages of dementia—are often heavily medicated or physically restrained. It is so important that we help prevent the use of restrictive practices and restraints so that older Australians can age with dignity. I still question why the minister has so much discretionary power to determine when it is appropriate and why a definition for 'an emergency' is not in this bill. I would argue that 'administrative flexibility' is not a significant or sufficient response.

The second schedule of this bill will amend the Aged Care Act to empower the Department of Health secretary to conduct reviews. These reviews will ensure the arrangements for the delivery and administration of home services are effective and efficient. The assurance reviews will inform the continuous improvement of the home-care policy and the education of approved aged-care providers. The introduction of these reviews, while not specifically recommended by the aged-care royal commission, is welcomed. However, that is only if they do as described and increase the effectiveness, efficiency and transparency of the home-care system. We know that there are many aged-care providers doing amazing work who are dedicated to the health and wellbeing of those they care for—and it's not just the providers but, more importantly, the workers who are carrying out this care—but we also know that there are far too many providers who are not. It is highly concerning that an additional $17.7 billion will be spent throughout the aged-care sector without what Labor would deem an adequate level of transparency and accountability measures. Every dollar that is spent in the aged-care sector by the government should be going into care and not providers' profits, and we fear that, given the current parameters, this cannot be guaranteed.

The third schedule makes amendments relating to the Aged Care Financing Authority. The government replaced ACFA with a new working group that will report to the National Aged Care Advisory Council. The council was recommended by the royal commission under recommendation 7. Also, it was about time the Liberals overhauled the Aged Care Funding Instrument. We've known for many, many years—for the eight years this Liberal government has been in power—that it was an outdated system and did in fact need replacement. The government has just sat on reports, and this report, in particular, they have had for the last four years. So this government has been dragging its feet, trying to delay putting appropriate levels of funding into the aged-care sector. It then had to call its own royal commission into its own failings and five or six ministers that have had responsibility for aged care in this country in the last eight years. It finally called a royal commission into its own failings.

But it is disappointing to see that the government's response to the royal commission's final report, Neglect, falls short of resolving a number of key issues within the aged-care sector. It will also fail to deliver the improvements and reforms for the long term. Mr Morrison has failed to listen to Australians in the aged-care sector, he's failed to listen to the families and in particular he's failed to listen to the warnings of those people working in this sector.

There have been 22 reports handed down to this government alone, and they've failed to act. Now we see they're still failing to act on all the recommendations of their own royal commission. The Liberals are failing to deliver significant reform. We know that the aged-care workers in this country do a fantastic job. The majority of them are very dedicated, but they're overstretched and they're underpaid. We know that there was an opportunity for this government to put in a recommendation of support to ensure that aged-care workers in this country received a pay rise. But what did the government do? Nothing at all.

We know that the number of aged-care workers will need to almost triple to over a million workers by 2050. How can we attract people into the sector if we are allowing wages to currently stay at $21.09 an hour? How can we improve the care and quality in the aged-care sector if we don't acknowledge that properly remunerated staff are warranted and deserved in this country? Yet they're sending $3.2 billion to providers with basically no strings attached. There is no real guarantee that any of that money will go to provide actual better care, better food and better pay to these workers. That money should not be going into management's fitting-out of their offices. That money needs to go to ensuring that older Australians are treated with dignity and they get the care that they deserve.

This government has also ignored the recommendations of the royal commission to provide a nurse seven days a week, 24 hours a day. Without having appropriately staffed nursing available to them, we see older Australians ending up in accident and emergency, being left in emergency rooms, waiting for hours and hours to be treated. This is not good enough. We need to see the full recommendations, the 250 mandatory care minutes per resident provided in residential aged care. Again, staffing levels are central to many of the areas of quality care problems that we have seen and that have been reported over so many years being rectified.

I am happy to say that the Tasmanian Liberal government yesterday made the announcement that they're putting $3 million into training for aged-care and disability workers. Fantastic. I always acknowledge money that's invested into these areas. But, again, what we aren't seeing is any assurances that we are going to stop what we see as a transient workforce within the aged-care sector. People are using it as a measure to have a job while they're looking for something that pays better wages. What we need to ensure is that we have the best trained, most highly skilled, most motivated and best paid workforce in this sector and in disabilities.

But, if we go to the area of home-care packages, we see the failings of this government under Scott Morrison, who used this sector as his own personal ATM. He left minister after minister who has failed in this sector day in, day out. He reappointed Senator Colbeck as the minister with responsibilities in this area. I must say, most of the real decisions have been made by Minister Hunt. What is left is somebody who we have seen demonstrate failure to be across the issues in this chamber every single time he's asked a question in relation to aged care or vaccination of older Australians and aged-care workers. This government has failed to deliver home-care packages in a timely manner to people who have been assessed as needing the highest care in this country, the level 4 package. They have announced more money to go into aged-care packages but they've done nothing to ensure that there are aged-care workers who can deliver level 4 and level 3 care in a timely manner.

This is a government that uses smoke and mirrors. They like to make these announcements but they are never there for the follow-up. As a former Treasurer, Scott Morrison is responsible for taking out billions of dollars. Time and time again he has used this sector as his own ATM and spent that money in other areas. Now we are in a crisis. We have been in a crisis for the last eight years. We've seen this government fail to turn this around at every opportunity. They failed so much that they had to call a royal commission into their own failings. That's how good this government is! Mr Morrison says to the Australian people, 'Aged care is a priority.' Well, I would hate to see what this Prime Minister would do if this weren't a priority, because it's a bungled system that has been gutted by this government. (Time expired)

Marielle Smith (SA, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. This bill is in response to the Royal Commission into Aged Care Quality and Safety, which handed down its final report in March this year. While Labor supports this bill, it has to be said that the government's broader response to the royal commission has been inadequate. I want to use this opportunity today to speak to that.

The Liberals have failed to provide an adequate and sufficient plan to provide the reform to the aged-care sector that we know we need. They've failed to listen to Australians in aged care and their families and to the workers in our aged-care sector. They are not stepping up to deliver all of the enduring improvements we know are necessary to ensure that all Australians live out their later years with the dignity that they deserve. Let us be clear: aged care is a responsibility of the federal government. This makes aged care Prime Minister Morrison's responsibility. The Prime Minister, as we've seen time and time again, likes to shirk his responsibilities. There's always someone else to blame. It's always someone else's problem. But on aged care he cannot shirk his responsibilities. The job of regulating aged care and the providers within it falls squarely on the shoulders of our federal government.

For eight long years the federal government has presided over a system that the commissioners evidently felt, in handing down their interim report, could be summarised in just one word: neglect. The royal commission heard absolute horror stories of the treatment of older Australians, of black and blue bruises from falls ignored or dismissed, and of the abuse of chemical and physical restraints. We heard that an appalling two-thirds of aged-care residents were malnourished or at risk of being malnourished. That's two-thirds of our elderly fellow citizens in residential care not getting enough to eat. We heard of people being fed on just $6 a day. It's absolutely grotesque. In the last two years alone, of 100,000 people, we've had 28,000 Australians die while waiting for home-care packages which would allow them to enjoy some independence while they remain well enough.

We owe so much more to older Australians. In many ways, they built the society that we share now. Everyone knows someone in aged care, has a loved one in aged care or expects to have a loved one in aged care at some point. All of our elderly—everyone, every Australian—in aged care deserves so much better than what this government has presided over.

While Labor supports this bill, it has to be said that the government's broader response to the royal commission has not been good enough. Through the term of this government they've received 22 reports about the state of aged care. Now they are ignoring or failing to fully accept key recommendations of their royal commission. The government's failure is particularly pronounced when it comes to workforce issues in our aged-care sector. They have ignored, delayed or outright rejected key recommendations designed to address the poor wages, conditions and job security of workers in this sector.

Labor knows the vast majority of aged-care workers are dedicated individuals who go that extra mile to do what they can with already stretched time and resources to care for people's loved ones. I know many of them suffer immense distress when they're not able to provide the level and standard of care they know residents deserve, because they are not being supported to do so. These workers are truly essential to our society and to our economy, and how incredibly important and essential that their work is has been on full display these past couple of years. But you would never know that from the way that they've been treated by this government and the way their needs as a workforce have been ignored. The government has failed to implement the commission's recommendation of minimum standards for the amount of time qualified staff spend each day with residents, and the Prime Minister needs to explain why he has failed to accept this recommendation and also the recommendation that a nurse be on premises at all times in residential facilities.

Labor has been consistent in arguing that nothing will change in aged care without better support for the workforce. The Productivity Commission estimates Australia will need 700,000 additional aged-care workers by 2050 due to our ageing population. It can and should be an opportunity for well-paid, secure and profoundly meaningful work for hundreds of thousands of Australians, yet the government has no plan to increase wages of nurses and carers. Can they name just one meaningful thing they've done to provide genuine and meaningful support to workers in this industry or to make it an attractive industry—one that matches the level of importance to our society that it deserves? It is for these reasons, amongst others, that Labor is moving a second reading amendment to the bill, calling out the government's broader failures in aged care, and I hope it enjoys the support of this chamber. After eight long years of neglect of our aged-care system and our older Australians, it is only Labor who can be trusted to design and implement the real reforms necessary to ensure every Australian gets to age with dignity, comfort and respect, unlike this government, who has taken a bare-minimum approach rather than implemented the deep structural reform required to fix residential aged care.

Before I conclude my remarks, I want to take the opportunity to acknowledge the incredible aged-care workers in my home state of South Australia, some of whom I was lucky enough to meet when they came on a parliamentary delegation recently. They were in all sorts of roles, not only caring for residents but also working in more behind-the-scenes roles in our aged-care facilities: working as cooks and attendants, supporting our elderly in need. These workers had harrowing stories for me of the things they wanted to be able to do and the support they wanted to be able to provide to the residents in their care, but they felt so under supported and undervalued.

Particularly during this pandemic, where their work has become incredibly dangerous, they've feared what might happen if they contract COVID and pass it on to residents within their care. They've been very distressed about that reality, and they're very distressed about failures in the vaccine rollout, failures that mean that they're not protected at work, that they're not able to provide the protection for the residents they care for and that the residents they care for aren't protected to the extent that they should be. It's very distressing for these workers. I just want to acknowledge them and acknowledge the incredible work they're doing. They're waiting for more support from the federal government. They're waiting to be heard and to be given the reforms in their sector which mean they can go into work each and every day and provide that care and assistance to those that they look after. Labor supports those workers. We're listening to them. We understand how very, very tough it has been. We will continue to raise these issues in this chamber to make sure that aged-care workers' voices are heard and to make sure that residents in aged care are heard and supported. It's just not good enough to let these workers and these residents be ignored.

The royal commission's findings were absolutely harrowing. I know everyone in this chamber found them deeply distressing and disturbing. So now, as legislators, it's our opportunity to act to get it right, to look at the recommendations and to not do the bare minimum to just get by but to do everything we need to do to ensure that we are doing the absolute maximum to support our workforce and those living within aged care.

In conclusion, Labor will be supporting this bill. We are supporting this bill because it goes some of the way towards fixing serious problems within our aged-care system. But we do not stand here pretending it fixes everything. We think it does the bare minimum that it needs to do, and that's simply not good enough. It's simply not good enough for workers in residential aged care; it's simply not good enough for residents, who need genuine and meaningful reform. But, that said, we will support it. We need some action. We will be moving amendments to try and get this right, to get it done better.

Marise Payne (NSW, Liberal Party, Minister for Foreign Affairs) Share this | Link to this | Hansard source

I thank senators who have contributed to the debate. The Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021 makes three urgent changes to deliver the first stage of aged-care reform in response to the royal commission and to ensure that senior Australians receive the high-quality and safe aged care they deserve.

From 1 July 2021, this bill introduces important limitations on the ability for approved providers to use restraints and strengthens protections for aged-care recipients from any abuse associated with this practice. The term 'restraint' will be replaced with 'restrictive practices', continuing regulatory harmonisation with the disability sector. Further and more specific details of the strengthened obligations on approved providers will be prescribed by the Quality of Care Principles 2014. The bill and the amended principles provide a framework to minimise the use of restrictive practices. The amendments do not authorise the use of restrictive practices where it is otherwise unlawful. The Aged Care Quality and Safety Commissioner's powers will be expanded to include the ability to give a written notice if a provider does not comply with its responsibilities relating to the use of restrictive practices and the ability to apply for a civil penalty order if they do not comply with the written notice.

The bill establishes an annual program of risk based assurance reviews of home-care providers. The Secretary of the Department of Health will be able to require approved home-care providers and their employees to provide information for the purposes of program assurance and to prepare and publish reports on the assurance reviews. This builds on our existing work to improve transparency of the aged-care sector and fosters community confidence in the costs of the care they receive. The bill also repeals the requirement for the minister to establish the Aged Care Financing Authority, the ACFA. An advisory group will be established to replace ACFA from July 2021 to ensure the government continues to receive advice on financing issues of the aged-care sector.

Again, I thank senators for their contributions to debate on this bill. The health, safety and wellbeing of senior Australians is of the utmost importance to the government and is driving our plan for generational change of the aged-care system.

Scott Ryan (President) Share this | Link to this | Hansard source

The questionis that the second reading amendment moved by Senator Watt be agreed to.