Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | Link to this | Hansard source

I stand to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022. At the start of my contribution, I foreshadow that I intend to move a second reading amendment to this bill, so I will now move:

At the end of the motion, add ", but the Senate is of the opinion that the Government has disrespected older Australians, their families and aged care providers due to their political restriction of the passage of similar legislation in the last Parliament when they were in Opposition".

The opposition will support this bill. The reason that we will support this bill is that we believe that the continuing work that was started by the previous coalition government is absolutely fundamental and generational in its reform of the aged-care system to ensure it meets the needs of older Australians, both now and into the future. And we're going to support this bill not just because it mirrors the royal commission response that we introduced last parliament but also because it delivers a very critical second stage of the reform package which was commenced by our government in response to the royal commission's final report.

In the introduction and debate on this particular bill that we had put forward in the last parliament, the provisions that were contained in the bill were absolutely essential in terms of the speedy response to the royal commission recommendations and the ability of the aged-care sector to move forward as quickly as possible to address many of the concerns that were raised by the royal commission. But at the time, Senator Rex Patrick, who is no longer in this place, moved an amendment in relation to the requirement for aged-care facilities to have nurses on site at all times. They moved an amendment that required nurses to be on site 24 hours a day, seven days a week by 2022.

Now we know very, very clearly that access to nurses in all of our care settings has been extremely difficult. At the time, the now Prime Minister of Australia, when asked by a journalist, 'It does take a long time to train people as nurses,' Mr Albanese responded: 'Of course it does. But that is why you need planning and commitment to do it.' The journalist then said, 'But that sounds like a long-term thing, not something you can solve tomorrow, doesn't it?' Mr Albanese responded, 'You cannot find a nurse tomorrow. That is the truth.' Mr Albanese said this in February 2022, and yet in April 2022 he and those opposite voted to force aged-care facilities to have 24/7 nurses by 2022, against the recommendation of the royal commission. In doing so, they allowed the bill, which was so important to addressing the reforms in the royal commission report, to lapse, and so aged-care providers and older Australians were left in limbo for six months for political gain by those that are now in government.

It is absolutely disgusting to consider that Mr Albanese and Labor would have played politics with older Australians for the last six months by not facilitating the passage of this bill in the 46th Parliament when they could have—by delaying this critical legislation solely for the purpose of political gain. I can see no other reason, because they had absolutely no intention and never did—because they know they can't—to have 24/7 nurses in aged-care facilities by 2022. They then made a commitment sometime later to do it by 2023. We'll see when they bring their next bill into this place whether they're actually going to honour that commitment, because, sadly, I believe, and I think most Australians believe, that there is absolutely no chance that that particular provision will be able to be delivered for Australia.

The government's treatment of older Australians since the election has been nothing short of disappointing. There is the fact that we've ceased the provision of rapid antigen tests into aged-care facilities that are experiencing outbreaks, and then there was the embarrassing backflip we saw around the decision to extend ADF personnel support to our frontline workers in aged-care facilities, which they had intended to no longer continue.

Mr Albanese and the government promised, and continued to promise during the election campaign, more support for aged-care providers, and so far, I have to say, we haven't seen a lot for it apart from rhetorical flourish. But it's also disappointing that in the particular piece of legislation that is before us the government has chosen to remove the worker-screening regulations contained in the coalition's bill which was before this place in the 46th Parliament, because they were such important regulations and were, in consultation with the sector, supported by the sector. This is one of the few differences, I might say, between this bill and the coalition's legislation in the 46th Parliament, with the exclusion of the change of dates, which obviously had to occur because of the six-month delay in putting these really important reforms into this place.

Our worker-screening schedule responded to recommendation 77 of the royal commission and established an authority for nationally consistent pre-employment screening for aged-care workers. You would think that that would seem like a pretty sensible thing to do. Our legislation sought to establish a code of conduct which would have ensured that poor behaviour of approved providers, workers and governing persons was held to account. I'm glad the government has adopted our code of conduct and the subsequent amendments in this piece of legislation. But, as I said, it's disappointing that the government has capitulated—one would suggest probably to the unions—by removing our specific schedule on worker screening. It's absolutely essential that this government stands up to the unions and implements important policies to protect the rights of our aged-care sector workers and allow a nationally consistent database to be established for the care workers in ensuring the interests of all Australians and making sure older Australians have confidence in our aged-care sector.

Our plan was to have one database to simplify processes for employers, including aged-care providers, making it easier for NDIS carers, aged carers and veteran carers to move between their caring roles. This would have protected residents and allowed employers to know their employees are fit and proper to be caring for older Australians. Instead, Labor is delaying the commencement of this particular reform by excluding the schedule just to, I would imagine, fulfil an election commitment on what appears to be, on the face of it, a carbon copy of our regulations anyway. Put simply, this delays protections for older Australians. They are trying to redo what has already been done. We will be keeping a very close eye on further upcoming aged-care reforms that are going to be introduced by the Albanese government to ensure the legislation and regulations are introduced and implemented so that poor conduct in the sector is held to account and ultimately stopped.

Overall, this bill has nine schedules which directly relate to the Australian government's response to the royal commission. This bill, like the coalition's bill, replaces the outdated aged-care funding instrument from 1 October this year with the Australian National Aged Care Classification, or AN-ACC, residential aged-care funding model. This responds to the royal commission's recommendation 120 and represents a significant funding reform for residential aged care by completing the final step in the implementation of the model. Along with the introduction of the AN-ACC funding model, the bill permits the Secretary of the Department of Health and Aged Care to publish information relating to the new star-rating system for all aged-care service providers. This will allow families and future aged-care residents to make an informed decision about which aged-care provider will be the best fit for their needs.

The bill will also extend the Serious Incident Response Scheme from residential home care to home care and flexible care delivered in home and community settings, in line with royal commission recommendation 100. Under the scheme, providers of in-home care services will be required to identify, record, manage and resolve all incidents that occur. This will provide further transparency and protection for aged care. Schedule 6 of the bill aims to provide consistent quality and safety protections for consumers and reduce regulatory burden for cross-sector providers and workers, in line with existing regulations in the disability sector. Additionally, the bill implements the second of a three-phase reform process established by our government to create a new financial and prudential monitoring compliance and intervention framework for the aged-care sector. Finally, the bill expands the functions of the Independent Health and Aged Care Pricing Authority, responding to recommendations 6, 11, 115 and 139 of the royal commission.

The opposition is absolutely committed to supporting the health, the safety and the wellbeing of older Australians. That is why we made, whilst we were in government, a massive commitment to the implementation of the recommendations of the royal commission, with $19.1 billion committed by our government at the time to support the implementation of these recommendations. When in government, we were extremely disappointed that the opposition sought to play politics with this time-critical legislation that is before the chamber today. I think it shows extraordinary disrespect and the extent to which the Labor Party is prepared to go to get itself into office, and that it would use older Australians as a pawn in that particular play. So the opposition absolutely implores those opposite to continue our generational reform that we had put forward. We also implore those opposite to please put the interests of our aged-care sector and particularly our older Australians who rely so heavily on it at the centre of what you do going forward, because clearly you did not do that in the past. So make sure that everything you do in your endeavours to continue our reforms to improve our aged-care sector is done in a way that supports older Australians and not yourselves, and we will support you. We will support this bill but, in the process of doing so, we will seek to amend it to make sure that the interests of older Australians are fulfilled.

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

Thank you, Deputy President, and congratulations on your elevation to the position of Deputy President. I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022. I have to say, I have been waiting 10 long years for this moment. To be on the government benches with a bill that we as Labor senators and as a Labor government introduced is a really proud moment. I have watched nine failed aged-care ministers stand in this place and argue on many occasions that the sector was not in need of reform and, yet again, already we have the opposition trying to rewrite the history.

It was Minister Butler who started these reforms with Living Longer Living Better. That was the foundation for reforming the aged-care sector in this country but it was interrupted by the election of the Abbott, Turnbull and Morrison governments, who stalled on every occasion until they finally had to call a royal commission into their own failings. Already in this debate the shadow minister is trying to rewrite history. We will put the facts on the table because we know on this side of the chamber who started this reform and who tried to block it for 10 long years. In fact, many of those ministers oversaw this crisis in aged care. They had report after report gathering dust in those nine ministers' offices while this sector was deteriorating.

In opposition, I put question after question to the countless ministers, including the former minister, Richard Colbeck, from my home state, who was an absolute failure in the responsibility he had. He let down older Australians. He always had the view that there was nothing to see, nothing to hear here. That was his attitude to reform. I don't want anyone to forget that it was the former Prime Minister Scott Morrison who broke the hearts of older Australians when he oversaw this ongoing crisis in this important sector. He made a solemn commitment to fix the sector but he didn't—another election failure. I, as did others, called for the royal commission into this sector, but it was the former government that waited and waited and denied and denied the necessity to have a royal commission when they finally had to cave-in because of their own failings.

During the royal commission, Australians were devastated by the evidence provided and the government's response. So, yesterday in the other place and now today, the Albanese government is putting aged-care reform on the agenda of the Australian government. This is a momentous moment in our nation's history. The Albanese Labor government does this with an absolute commitment to older Australians living within residential aged care and those receiving care in their own homes. Every older Australian deserves love and care in their older years. They deserve quality care in residential aged care or in their own home. It doesn't really matter whether you are in a residential aged-care home or whether you are receiving care in your own home, you deserve time with your carers. You deserve to have someone to be able to sit and engage with you, to hold your hand. You deserve to feel wanted, needed and, most importantly, you need to be respected.

Labor took to the election a commitment to 24/7 access to registered nurses in the aged-care sector homes in this country, and we will implement this. We stand by this. It already happens in my home state of Tasmania, so, ultimately, we can deliver on this commitment.

Ultimately this bill is about respect for older Australians and what they have contributed to our country. This is a bill which will return security, dignity, quality and humanity back to the aged-care sector. I acknowledge all the work that has gone into this bill. It has been, as I said, years in the making. I note the efforts of Minister Wells—and I congratulate her on her appointment—and Minister Butler to bring this bill to the parliament during this first week of the 47th Parliament. And the former shadow minister Shayne Neumann and I would like to acknowledge the Prime Minister for showing such leadership in this area.

I would like to make some comments in relation to the former shadow minister Shayne Neumann. I loved the time I spent working with him. He had a commitment to listen and learn from the sector and from older Australians what sort of reform we needed going forward. As Minister Wells said yesterday in the other place, reforming aged care starts by listening. Australians have been hearing for far too long about the horror stories overseen by the former government. But Labor has always been listening and advocating. Too many parliaments have overseen this and done nothing. As I said, there was almost 10 years of neglect under the Abbott-Turnbull-Morrison governments. Labor understands this. We understand the concerns of older Australians and their families, because older Australians have been crying out for action and for reform. Well, no longer will you have to be ignored by a federal government, because we hear you. Most importantly, we see you, and we, as the Australian government, will take the action that is necessary to reform this sector.

Today shows what a high-order priority aged-care reform has within the Albanese government. I note that there has also been extensive consultation with unions, aged-care workers, providers and residents to ensure their experiences are considered in the implementation of this bill. The sector is informed. They have also been listening and they must continue to listen to ensure that we get it right. This is beholden not only on the government but also on the sector, the unions, the workers. Having walked in the shoes of aged-care workers on many occasions during my time in this place, I must say there is no more committed workforce in this country than those who work in the aged-care sector. I take my hat off to them each and every day, because they front up to care for some of the most vulnerable and frail Australians and they do it with respect. But they, in turn, need to have that respect. They need to be paid an appropriate salary. They need to know that their work is respected by the government and by the community.

We know the amount of extensive consultation that was undertaken during the royal commission. The department has also undertaken significant consultation on each of the measures in this bill and the recommendations from the royal commission. This includes consultation with older Australians and their families, advocates, peak bodies, state and territory governments, providers and the general public. Furthermore, the measures in this bill, aside from schedule 2, were previously considered by the Senate Community Affairs Legislation Committee, and a number of stakeholders made submissions to that inquiry. As the assistant shadow minister for aged care several years ago, I was in the privileged position of seeing firsthand all the wonderful people living and working in this sector. I visited countless residential aged-care homes across the country. I walked in the shoes of the aged-care workers. I know what these people do each and every day. I witnessed the best of aged care and, at times, I witnessed the worst. I believe that this bill will be the start of genuine reform in this sector. I want to acknowledge all the hardworking people who work in this sector. As I said, those workers need our respect, they need our support and they need to be remunerated appropriately so that we can keep the very best people working in this sector, because our older Australians deserve nothing less. Every Australian deserves dignity in care, and, in particular, during their final years they deserve the best care a rich nation such as ours can give them, so this is the beginning of a long journey to reform the aged care sector.

The Albanese government's Aged Care and Other Legislation Amendment (Royal Commission Response) Bill implements a series of urgent funding, quality and safety reforms, including in response to several recommendations of the Royal Commission into Aged Care Quality and Safety's final report, Care, dignity and respect. The bill implements nine time-critical aged-care measures, including a series of reforms that respond to several recommendations of the final report of the royal commission. The measures will introduce a new aged-care subsidy calculation; provide a legislative basis for the star ratings system; introduce a code of conduct and banning order scheme; extend the Serious Incident Response Scheme to aged care delivered in home settings; strengthen the governance of approved providers; enhance information sharing across related sectors; increase financial and prudential oversight; broaden the functions of the renamed Independent Health and Aged Care Pricing Authority; address issues with the informed consent arrangements in respect of the use of restrictive practices in residential aged care; and develop a new comprehensive workers registration scheme, with criminal history checks continuing to apply in the meantime.

The last element I just mentioned is something which I campaigned for in opposition for many years. If we are to improve the quality of care within the sector, we must ensure the best people with the best intentions work in this sector. There is no point introducing this bill without such an intention, and this element will ensure an aged-care worker who is not up to the job cannot leave one aged-care home and start working in another aged-care home in a neighbouring suburb. I am firmly of the view that this element in this bill will work well to ensure the right people are attracted to the sector. The bill replaces the outdated Aged Care Funding Instrument, ACFI, with a new model for calculating aged-care subsidies called the Australian National Aged Care Classification model, which has been developed in consultation with the aged-care sector and consumer groups. Since April 2021, residential aged-care recipients have been progressively assessed and classified under the AN-ACC, and the funding under the new model will commence on 1 October 2022.

Importantly, the bill includes several measures that will provide additional protections directly to older Australians. These protections cannot be delayed any longer. For far too long, a lack of protection for residents has allowed much of the reported abuse. Consequently the Serious Incident Response Scheme will be expanded to establish obligations on approved providers of home care and flexible care in a community setting to report and to respond to incidents and to take actions to prevent incidents from recurring. For far too long, too many aged-care homes have not been adequately monitored. A new code of conduct will set high standards of behaviour for aged-care workers, approved providers and governing persons of approved providers to ensure that they are delivering aged care in a way that is safe, competent and respectful.

All of these matters addressed in this bill will go a long way, as I said from the outset, to start the real reform in this sector. But what we have to do is support those workers in aged care, we have to support the providers and, most importantly, we have to return to the days when we respected older Australians in this country and ensure that they get the care that they so desperately need and that they deserve. You can't allow the sector to not put the care and the interests of older Australians first and foremost. This is going to take a lot of money, but what it's really going to take is a will to reform this sector and a will to support the workers to give them the opportunity to keep the best possible people in aged care. We have to attract nurses back to aged care. Those nurses who work in aged care know that the work that they do is so important, so we have to find a way to provide additional nurses not only for our aged-care sector but right across this country. We have to ensure that we have access to the very best general practitioners in our communities in residential care.

I commend Minister Wells and Minister Butler and, of course, the Prime Minister for taking the first step to re-establishing the best aged-care sector in the world, because we deserve nothing less and older Australians deserve nothing less, and they have the support of this government.

Janet Rice (Victoria, Australian Greens) Share this | Link to this | Hansard source

The health, the wellbeing and the rights of older Australians are absolutely critical, and our aged-care systems so often in recent years have failed them, and that's been an indictment of Australian society. It's no surprise that the state of aged care has been a focus of government for a number of years now, which is reflected in the attention rightly given to the royal commission—in fact, the circumstances that led to the royal commission coming into being—and its recommendations, and the focus that both the Labor Party and the Liberal Party and us as Greens and the crossbench put on aged care during the election, because it's very clear that something needs to change. The system is broken.

The Australian Greens believe that the federal government has to play an absolutely central role in the provision, the regulation and the support of aged-care services. We believe that older Australians, their carers and their families should have the right to choose appropriate and affordable care services that meet their needs and maintain their dignity, their independence and their quality of life. So, of course, we want to see a high-quality aged-care system characterised by quality support, quality nursing and personal care; safe and comfortable surroundings for older people, whether in residential, home or hospital care; and for this to be what everybody gets—to not have people falling through the cracks, to not have providers that aren't meeting these standards.

Older Australians have got a right to freedom from discrimination and freedom from violence, a right to social security, a right to work and a right to health, and we want to see and enable a paradigm shift towards seeing older people as rights-holders and as active contributors to society. We need a human rights approach to aged care, and we feel that the regulatory framework underpinning aged care must be based on the human rights of older Australians and acknowledge the interdependence and the interconnectedness of those rights. Under a rights based approach, older people would be guaranteed access to the level of care and support that they are assessed as needing.

Now, of course, we are hoping that the complete right of the Aged Care Act that is going to begin this year is going to reflect this human rights based approach and is going to have this total reconsideration of the paradigm that we hold older Australians and aged care in. Clearly, what we are debating today, the Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022, is not that. It's an interim measure. It's a bill that is implementing some urgent recommendations from the royal commission, but it is just an interim measure. And we also know that it is largely the same bill that the previous government brought to the previous parliament. It was interesting to hear Senator Ruston talking about the delay of that bill. It was a bit of a rewriting of history, because I remember that that bill actually got through the Senate. It had been through the House and it had gotten through the Senate with an amendment that said 'required—24/7 nurses in aged-care homes', because the majority of the Senate felt that that was an important provision to be in place. And then the government chose to not take that amendment through the House. So it was the previous government that blocked the adoption of aged-care legislation at the end of the previous parliament.

The bill that we are looking at today is pretty much the same as the previous government's approach. We are really grateful that there have been some amendments to it. I'm very grateful to the previous government that they adopted most of the Greens amendments in the final version that went before the last parliament. We have also, after discussions and negotiations with the Minister for Aged Care over the last month, had some other measures that the Greens were very concerned about adopted in this new legislation. We are particularly pleased that the government has removed the previous schedule 2 on screening checks, because there was clearly a lot more work that needed to be done on the issue of screening checks for aged-care workers. It's a very important measure to make sure that the people who are providing aged-care services are able to be relied upon to be the most quality people possible, but there were some big issues with the screening checks as they were previously outlined in schedule 2.

There are other areas, in particular, where we feel that this bill should go further, but we recognise that it is an interim approach. We also know that it's in the context of further legislation that the government is going to be bringing before the parliament, that is also being introduced. That legislation is going to go off to committee to implement the measures that were in their election commitments, particularly around workforce and making sure that the care being provided is of the highest quality and that there is transparency of information on where aged-care providers are spending their money. We look forward to having a thorough interrogation of that bill and to see that bill pass through the parliament as well. But, similarly, both of those are just going to be interim measures before the required full rewrite of the Aged Care Act.

A critical change, of course, in this bill compared with our current aged-care legislation is the introduction of the Australian National Aged Care Classification, or AN-ACC. My predecessor, Rachel Siewert, worked really closely with the sector, highlighting the problems with the previous instrument, the Aged Care Funding Instrument, which is no longer fit for purpose. Overall, we are broadly supporting this bill, but we have two major concerns with it as it stands. One is the lack of mandatory requirements for the provision of allied health services under the new AN-ACC funding model. Allied health services like physiotherapy play a vital role in maintaining the wellbeing of older Australians. Without adequate access to allied health services, many residents of aged care and many people receiving home support would not be able to adequately manage their pain or reduce their risk of falls. Physiotherapy, for example, has been shown to decrease falls by 55 per cent. Under the previous funding model, the provision of allied health services, or a certain amount of allied health services, was mandatory. It is now no longer mandatory under the AN-ACC. The allied health professionals that I have spoken to are extremely concerned. We know that it is so important for older people to get those services as they require them—and physio, for example, is critical.

I've been messaging with my family as to how we can manage the care of my mother. She's currently in respite care after a fall at home three weeks ago. She broke two ribs. She spent a week in hospital. She's now had a week in respite care. She's hopefully going to be able to come home after that second week in respite care. So my sisters and my brother and I are trying to manage who can stay overnight with her over the coming months and what the long-term future for mum living at home by herself is. She was receiving physiotherapy but not enough. Clearly, there is a problem with the system. It's also incredibly complex to access care, even if it is theoretically available, even when you've got a family, like we have, of five siblings who are all doing our part to sort out the bits of care that mum is entitled to. Actually making it happen can be incredibly difficult. I think about the people who haven't got that level of family support, who are trying to manage their care packages pretty much on their own and not getting the support they need. The importance of allied health services to older people's quality of life was recognised by the royal commission, which recommended that residential aged care should include a level of allied health appropriate to each person's needs.

But, of course, it is not only people's access to it that we're concerned about; we are also concerned about the fact that there's a widespread shortage of allied health workers in aged care. According to the Australian Physiotherapy Council there was a shortage of 6,000 physiotherapists even before the pandemic. Without the provision of guaranteed funding for allied health services in aged care, this shortage of essential services could substantially increase. I've heard from allied health professionals and their representatives, who fear the worst for their industry and for the older people who need their services. One physiotherapist expressed to me that the lack of guaranteed funding for allied health in the AN-ACC model would be the death of allied health. If we want to improve the quality of services for older Australians in earnest, we must ensure that they've got adequate access to critical services, like allied health, and we have to make sure that allied health is funded properly.

In my discussions with the minister over the last weeks, it was clear that changes are needed but that in terms of what's going to happen and what the best model for ensuring that those allied health services are provided there is further consultation required with the sector. We acknowledge that there were problems with the previous funding model. We also think there are problems with this current funding model. So we will be supporting this legislation on this problem with allied health on the basis that there is still more work to be done on guaranteeing allied health services for older Australians.

The other really big concern that we have, which is reflected in the second reading amendment I'm going to be moving and also in a substantive amendment, is in relation to schedule 9 of this bill regarding restrictive practice. Let me start by revisiting the important work of the royal commission on this issue. In their final report, they noted that restrictive practices are:

… activities or interventions, either physical or pharmacological, that restrict a person's free movement or ability to make decisions. Where this occurs without clear justification and clinical indication, we consider this to be abuse.

They said that not only do restrictive practices have questionable success in minimising changed behaviours but they can result in serious physical and psychological harm, potentially increasing health complications and in some cases causing death. They also set out a clear pathway in recommendation 17. They said:

… the use of restrictive practices in aged care must be based on an independent expert assessment and subject to ongoing reporting and monitoring. The amendments should reflect the overall principle that people receiving aged care should be equally protected from restrictive practices as other members of the community.

When the previous Liberal government introduced changes through the previous bill, we welcomed the amendments that would reduce restrictive practices but were concerned that they didn't go as far as they should towards implementing the recommendations of the royal commission. As my former colleague Senator Siewert wrote in her additional comments to that legislation:

However, we believe the new regulations do not go far enough and do not fully implement the Royal Commission's recommendations on restrictive practices.

…   …   …

While the regulations require approved health practitioners to approve the use of restrictive practices, it is unclear whether these health practitioners will need to be independent of the aged care facility and provider. As a result, aged care providers will be able to use their in-house health practitioners to approve the use of restrictive practices.

In this legislation, we are assured that there are going to be some changes in terms of the hierarchy of a substitute decision-maker, and we understand that there are substitute decision-makers for if the older person is not able to give consent, which in these cases they would not be able to. We understand the concerns that the government is grappling with—that state and territory legislation is overall responsible for determining who alternative decision-makers would be. In some states and territories, that framework does not exist. So we understand that in subordinate legislation we are going to get a hierarchy of decision-makers. We understand that it is going to have to be done in accordance with a behavioural care plan. But this is all in subordinate legislation. We are basically having to take it all on trust.

It's easy to talk about principles, laws and regulations as though they're abstract frameworks, but they're not. They are matters of people's lives. The use of antipsychotic medication in aged-care facilities was identified by the royal commission as a significant problem. Post the royal commission, the statistics say that it's still continuing. I'm running out of time, but I want to share some case studies with you about people who have died because of the use of chemical restraints. According to the March 2022 residential aged-care quality indicators, as many as one in five aged-care residents are still receiving antipsychotics in 2022. So we are still really concerned.

In terms of schedule 9, we are willing to take on trust that, yes, okay, the subordinate legislation is going to better outline who the alternative decision-maker is to be, setting up that hierarchy. But the bit that we are particularly concerned about, also in schedule 9, is that, following this framework, any aged-care provider doing that would have immunity from prosecution if anyone wanted to take action against them about inappropriate use of restrictive practices. This is totally inappropriate. It is totally using a sledgehammer for a problem about which I have not been able to get any justification as to why immunity from prosecution is required. So I will be moving an amendment to address this, to remove that part of schedule 9, because I think it's a really important issue in a bill that otherwise is making steps forward to improve the quality of aged care for our older Australians.

Hollie Hughes (NSW, Liberal Party, Shadow Assistant Minister for Climate Change and Energy) Share this | Link to this | Hansard source

I listened closely there to Senator Rice, and I think what is apparent looking around the chamber—and certainly I'm in exactly the same boat as Senator Rice, with elderly parents—is that lots of us are struggling with this in our daily lives, in that we are dealing with it remotely. I have a mother who has been in high-needs aged care for over three years after eight years of dementia, and a father that, unfortunately, is following, and to navigate and negotiate your way through this is difficult. It is devastating and fraught at the best of times, even with the best of intentions and a supportive family. So I am pleased that we are seeing as much reform as we can to the aged-care sector coming through, and that we're making it easier for families, who quite often have to deal with this, as at times it is the elderly parents that aren't really that attuned to what is actually happening around them and it is the adult children that are left, then, to negotiate this system for them.

I guess, in one way, it's good that Labor's first aged-care bill is almost a mirror image of what was put forward under the former government in the last parliament and does directly relate to our response to the royal commission. But, again, what's incredibly devastating for families like ours that are going through this is that Mr Albanese was prepared to play politics on this issue. He was prepared to sit on his hands, he was prepared to block this legislation being implemented and he was prepared to look at the amendment of former Senator Patrick that was requiring 24/7 nurses with an exemption for rural and regional centres. For those of us that have an interest in rural and regional Australia, what was being proposed would have seen nurses leave aged-care facilities in rural and regional areas because they would have been required to be staffing metropolitan facilities. Now, on this side of the chamber, we actually respect rural and regional Australians and believe that they have equal rights to those that live in metropolitan areas. But we know that those opposite, who are now the government, do not see rural and regional Australia in the same light.

There are two things, though, that were recommended by the royal commission but will no longer be part of this reform. One is workers-screening regulations. We actually believe that people that go to work in these facilities should be working them correctly. They should go with the right intent, they should be qualified and they should be able to deliver the services that elderly Australians require. The other thing that's going to be missing is a legislated star-rating system. As we've talked about, for those of us that are facing the challenges—looking for facilities, looking at options for our parents—being able to see how a facility performs in a very simple way would actually be of benefit for a lot of families.

But, again, this isn't about making it easier for families looking at aged-care options. This is about appeasing union mates and making sure that the unions are all up to speed, all happy, and that the paymasters are being served. So we will be keeping a very, very close eye on what sorts of reforms this government is now looking to put in place, because it should always be about the people going into these facilities and not about the politics, not about the unions and not about appeasing those that demand the most from you because they pay for you.

What we've seen is a delay to this significant legislation. It's disrespectful. It's disrespectful to all Australians. It's disrespectful to older Australians. It is absolutely disgraceful that you sat on your hands, that you refused to support this bill in opposition, but now your first bill almost directly mirrors our legislation. The funny thing is, though—and we saw it yesterday in question time—the complete lack of ability to be across a brief, the complete lack of understanding. Government is hard, people. You actually have to do things now. Lucky for you there was legislation drafted. You've just made a couple of changes here and there and watered it down a bit where it suited you. But, thankfully, someone had written something.

What's going to happen, I think, and what we'll continue to see as time goes on—and we saw it from Senator Watt's performance yesterday in question time: absolutely no comprehension; he couldn't even give a number—is a reaching back to the coalition government, with the Labor Party looking at legislation and saying: 'How did they do it? We don't know what we're doing. We're not across our brief. We don't understand how to actually govern.' It's a little bit interesting when you see those who were very, very good when they sat on this side of the chamber—they had lots of things to say, lots of interjections, lots of commentary—go to the other side of the chamber, where they're actually supposed to do work; they're actually supposed to govern for all Australians, including elderly Australians, including farmers. Those opposite now in government are supposed to actually work for Australians, to make sure that this country is running and to keep Australians safe, whether it's from foot-and-mouth disease, whether it's elderly Australians in aged care. You actually have to make decisions. You actually have to be across your brief. You actually have to understand the detail. You have to understand that there are impacts on everyday Australians when you go and legislate emissions reduction targets, create a lawyers' picnic, remove any responsibility from yourselves and tie Australia's economy up in more and more red tape, green tape and any other padlock you can manage to find, to ensure that Australia is put at an economic disadvantage internationally because, you know, it makes you feel good shutting down every coal-fired power station in this country.

We've got the Greens here. They need to ring their mates in Germany. They understand how things work. They understand that people in their country want to see the lights on. They want to put their dishwashers on. They want to make sure their fridge is still running. But those opposite are more interested in virtue signalling, in shrouding themselves in wokeness, which is really just an opportunity to be mean, to be rude. I think we saw that last night after the outstanding speech by Senator Price, when those opposite—those who deemed it worth even attending the chamber—couldn't bring themselves to even stand up. If they'd noticed the courtesy prior to that, those of us on this side of the chamber gave Senator Stewart's speech the recognition it deserved—not those opposite.

Anne Urquhart (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

Point of order, Madam Acting Deputy President: I would draw the attention of the current speaker to the fact that we are actually on the aged care and other legislation amendment bill, and I ask you to draw her back to that point.

Claire Chandler (Tasmania, Liberal Party, Shadow Assistant Minister for Foreign Affairs) Share this | Link to this | Hansard source

Senator Hughes, I think Senator Urquhart is correct. We are here debating the aged care and other legislation amendment bill, and, if you could focus your comments on that, that would be appreciated.

Hollie Hughes (NSW, Liberal Party, Shadow Assistant Minister for Climate Change and Energy) Share this | Link to this | Hansard source

Well, we would like to see a focus on aged care, because that includes aged care in Indigenous communities. We have Senator Price here, who understands the importance of proper legislation around Indigenous communities—not virtue signalling, not the paternalistic Greens looking at Senator Price last night like she didn't know what she was talking about. They couldn't even bring themselves to stand up. Senator Price understands that Indigenous aged-care facilities would not be included in some of these regulations because of all the different little exemptions that are required. Those opposite seem to think that they know what's best, because they'll tell them what's best. They'll tell them what they need to be doing and how they need to perform. They don't take advice from those on the ground, whether it's with aged-care reform, where they're just taking our legislation, or whether it's turning around and removing the cashless debit card, where we're going to see humbugging, domestic violence, access to alcohol—all of these things—come back, because they don't know how to govern. They don't know how to make decisions for the benefit of Australians. What they know is how to virtue signal. What they know is how to completely drag down everyday Australians, to upset the family budget, to make it harder for families to get into aged care and to make it harder for families to navigate the system. That's all those opposite want to do.

But why are we surprised? We can look at some of the things which they could have done to continue to support the aged-care sector but have chosen not to. Those opposite, now in government—who purport, and who have always purported, that they are the bastions of care and that they are the bastions of supporting people and looking after people—at the first available opportunity ceased access to the rapid antigen tests for aged-care homes. So, whilst on this side of the chamber they were happy to squawk about the requirements for rapid antigen tests—hilariously, at a time when the Premier of WA had actually made them illegal, but never let the facts get in the way of a good screech across the chamber, as Senator Watt knows only too well—at the first opportunity they removed access to free rapid antigen tests for aged-care homes as outbreaks were occurring.

Now there's another thing that they did as soon as they could get in. We know those opposite, now in government, actually really don't—and they never have—support our defence forces or the work that they do; at every opportunity they look to cut defence spending. The Defence Force has actually provided critical support to those in the aged-care sector throughout the COVID pandemic. But of course those opposite get into government and the first thing they do is remove that support—get rid of the Australian Defence Force assisting in aged care.

Where we are is the situation where they don't know how to write legislation, so they've just pretty much picked up what we put forward before. They've gone out to their union mates and asked them, 'How can we help you?' It wasn't, 'How can we help older Australians?' or 'How can we help families?' It was, 'Hey, union mates, how can we help you?' So the first thing they do is to remove the schedule that requires worker screening. To every Australian out there whose parents are subjected to workers who are not up to speed, who don't have good intent and who don't have the ability to look after your elderly parents, you only need to look to those now sitting on the government benches—over there on the treasury bench. It was never about you and your family, it was never about you and your parents; it was always, and always will be, about their union mates.

Anne Urquhart (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

tor URQUHART (—) (): I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022. I was told a story recently about the elderly mother of a friend who was moved into the secure ward of an aged-care facility and who had a fast-developing dementia. The family chose the facility because it had a good program of activities tailored to the needs of dementia sufferers. They stretched the family finances as far as they could to do this because they wanted their mother to have the best possible care. Like so many people in their position, they had to clean out and sell the family home—the only significant asset that their mother owned—to pay for that care.

Their mother's dementia first manifested in a loss of language. Over time she completely lost all her words. Communication of any kind became a constant struggle, except when the music therapist came to visit the aged-care home and played her guitar. Then she could sing: songs from the war years, songs from her childhood, songs ingrained in her memory many years earlier. That clearly gave her great pleasure. There is increasing scientific evidence that music seems to be robust and to withstand the effects of neurodegenerative decline and other acquired brain injuries. Neuropsychologist Catherine Loveday wrote back in 2016:

One key finding is that music is a particularly good cue for autobiographical memories—these are memories that reinforce our sense of identity and play a hugely significant role in how we connect socially and emotionally with those that are close to us. Tunes that we first encountered between early adolescence and our late 20s seem to be particularly evocative.

For this woman's family to discover that they could hear their mum's voice again and to see clearly how much joy the singing brought her was an incredible revelation.

But, soon after, the aged-care home had a massive round of cost cutting, and the contract with the music therapist was not renewed. And, with no-one to play the tunes and encourage her, their mother fell silent. Her physical needs continued to be met. She was cared for by a dedicated staff who did their absolute best to ensure that she was clean, she was fed and she was comfortable, but her voice was no longer heard.

On a new roster after the cost cutting, the staff were far too time poor to even put on a CD for her to listen to or to regularly take the dirty plates and cups out of her room after meals. Then, in what were clearly further savings measures, the menus were changed, and the meals presented to residents became far less appetising. Residents' dietary preferences went completely out the window. Despite all the notes and the records on the file of my friend's mother, she was regularly served meals of fish. She had always hated fish and, when she had a voice, had always made that very clear.

The night that my friend's mother passed away, there was a nurse on duty who could deliver the medication and particularly the pain relief that their mother needed. As my friend said, that was so important. I shudder to think what that night would have been like if that nurse had not been there. 'Surely there should be a nurse on every shift?' was the question.

That all happened over 10 years ago, but the warning signs were clearly there. Over that decade, the problems in our aged-care system continued to mount to the point of crisis. Over the last two years, the COVID-19 pandemic has served to emphasise and to highlight the weaknesses and flaws in the system and actually worsen the crisis, a crisis that is crying out to be addressed.

So this government, the Albanese Labor government, has taken on the task of restoring dignity, care, accountability and humanity to aged care, and it is because we must. The passage of this bill before us, the Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022, is a critical step in reforming the aged-care sector. The urgency to do this is not simply based on people like me hearing stories from friends with parents in care, as devastatingly sad as they may be. A royal commission has formally heard the testimony and seen the evidence that reform is desperately needed. This is the evidence the Royal Commission into Aged Care Quality and Safety has enshrined in its reports.

The royal commission hearings presented mounting evidence of systemic flaws and inadequate care. The commissioners absolutely nailed it when they gave their interim report released in 2019 the title Neglect, just one word which summed up the terrible state of the system. The Australian people were shocked and at times horrified by the evidence the interim report presented. Neglectthat is what it presented. Then, when the final report entitled Care, Dignity and Respect was released in 2021, the royal commissioners called for a fundamental reform of the aged-care system. They said:

The extent of substandard care in Australia's aged care system reflects both poor quality on the part of some aged care providers and fundamental systemic flaws with the way the Australian aged care system is designed and governed. People receiving aged care deserve better. The Australian community is entitled to expect better.

And the Australian community is absolutely entitled to expect better. Well, this government has listened closely, and the bill before us starts us on the road to better. This reform can't come quickly enough. As the Minister for Aged Care, the Hon. Anika Wells MP, has said in the other place:

Too many parliaments, too many governments have shunned the hard work needed to support our aged-care system. … Over the last decade there have been 23 reports, inquiries, studies, committee reports and a royal commission telling us the same story.

It is a story of neglect and of government ignoring aged-care concerns. They represent many, many missed opportunities. The previous speaker, Senator Hughes, spoke about how we had picked up the previous government's bill, but Neglect, those 23 reports, those inquiries and those studies were all on the previous government's watch. We must not miss this opportunity, and there is a lot of work to do before we get to effect meaningful change.

This bill begins that work. It amends aged-care law and other legislation to implement a series of urgent funding, quality and safety measures, several of which were recommended by the Royal Commission into Aged Care Quality and Safety. Schedule 1 of the bill relates to the new Australian National Aged Care Classification, AN-ACC, the model for calculating aged-care subsidies that was endorsed by the royal commission. Schedule 2 of the bill is a new measure that will facilitate the publication of star ratings. Schedule 3 introduces a code of conduct for the aged-care sector, as recommended by the royal commission. Schedule 4 of the bill extends the Serious Incident Response Scheme to home care and flexible care. Schedule 5 of this bill strengthens the governance of approved providers. Schedule 6 facilitates increased information-sharing. Schedule 7 of the bill will increase government oversight of how refundable accommodation deposits and bonds are used. Schedule 8 of the bill expands the functions of a renamed Independent Health and Aged Care Pricing Authority.

Schedule 9 of the bill will enable the implementation of an interim solution with respect to the requirement to obtain informed consent for the use of restrictive practices. Schedule 9 to the bill also provides a limited immunity from civil or criminal liability that may arise in relation to the use of a restrictive practice, where someone follows all of the requirements under Commonwealth law in relation to the use of a restrictive practice. This provision does not provide a broad immunity to negligence in respect of the use of a restrictive practice.

The bill replaces the outdated Aged Care Funding Instrument with a new model for calculating aged-care subsidies, called the Australian National Aged Care Classification model, which has been developed in consultation with the aged-care sector and consumer groups. Since April 2021, residential aged-care recipients have been progressively assessed and classified under the AN-ACC, and funding under the new model will commence this year, on 1 October.

Importantly, the bill includes several measures that will provide additional protections directly to older Australians—protections which cannot be delayed any longer. The Serious Incident Response Scheme, SIRS, will be expanded to establish obligations for approved providers of home care and flexible care in a community setting to report on and respond to incidents and take action to prevent incidents from recurring. A new code of conduct will set high standards of behaviour for aged-care workers, approved providers and governing persons of approved providers to ensure they are delivering aged care in a way that is safe, competent and respectful. Improved information-sharing between care and support sector regulators will enable proactive monitoring of cross-sector risks and will better protect consumers and participants from harm. An interim solution for the provision of consent to the use of restrictive practices will also be established while state and territory consent arrangements are reconsidered.

The bill also includes a series of measures that provide greater transparency and accountability of providers. Star ratings will be published for all residential aged-care services on My Aged Care by the end of 2022. Star ratings will enable senior Australians and their families and carers to make informed decisions about their aged care. From 1 December 2022, approved providers and their governing bodies will be required to meet new responsibilities that will improve governance. Approved providers will be required to notify the Aged Care Quality and Safety Commission of changes to key personnel, and the current disqualified-individual arrangements will be replaced with a broader suitability test. Amendments will also be made to increase financial and prudential oversight in respect of refundable accommodation deposits and bonds. The functions of a renamed Independent Health and Aged Care Pricing Authority will be expanded to include the provision of advice on healthcare and aged-care pricing and costing. This bill makes a series of important changes that will improve the health, safety and wellbeing of older Australians and will assist older Australians and their families to understand the quality of care and the operations of providers. As I said, there is a long road of reform, and there is much more to do.

The husband of a local aged-care worker regularly calls my office in Davenport. He's incredibly worried about his wife, who is on the brink of burnout. Every week, she is pressured to work a lot of extra shifts, often on her days off. She often arrives at work to find there aren't enough other staff to work with her to safely provide the care that is needed in a timely fashion. She loves her job. She loves caring for vulnerable older Australians but is seriously considering leaving the industry. It is a story that I'm sure all of us have heard, and I hear it constantly from workers in the aged-care sector. Coupled with that is an intense concern about the family finances, as they struggle every week to make ends meet on her low wage. There are thousands of families and thousands of workers in this country in this same situation, and that should not be the case.

Above all, we must ensure that the voices of those in aged care are heard, and those are the residents and the people working in the aged-care system. Our elders deserve dignity and respect in their later years, and, when their voices fall silent, we must do everything we can to support them to sing again. I commend this bill to the members of this chamber, and I hope that all the members in this chamber will join us on the road to reform the aged-care sector.

David Pocock (ACT, Independent) Share this | Link to this | Hansard source

This is not my first speech, but I'd like to take this opportunity to talk about aged care. There are few policy areas that are as heartbreaking as aged care. We've all seen the stories of older Australians suffering in our nation's aged-care facilities. Over the past few years there have been many reports of people being neglected, receiving inadequate care and inadequate nutrition, and in some cases left to die in the very places charged with caring for them.

The people of the ACT speak to me frequently about their concerns about aged care and their hopes for creating a high standard of care for older Australians. The 148 recommendations of the Royal Commission into Aged Care Quality and Safety are the road map for creating this high standard. That's why my community has asked that I do all I can to ensure the recommendations are implemented as quickly as possible—so that we can build an aged-care system that puts people and their wellbeing and safety first.

It is great to see that this is the first bill that we're being charged to consider, and I'm glad to play my part in seeing it become law. While this bill is for transitional arrangements, the changes are urgent and desperately needed. However, this bill should not be beyond a measure of some simple scrutiny. While I thank the minister, her staff and her department for engaging early and providing high-level briefings, a single day to get across the detail contained within these 147 pages is not enough. We cannot properly do our work here in the house of review if we are not given the time to view the details, consult with our communities and reach out to experts. I hope the time lines placed on this bill are an exception and not the rule, and, where fast time frames are needed, I would encourage the government to do us the courtesy of releasing an exposure draft. However, I do recognise how important it is to pass this bill and the reforms within it and to put in place codes of conducts and clear up the governance arrangements of aged-care providers.

I will not slow down this bill's consideration, but I do want to briefly touch on a few points. I've heard concerns about how the Independent Health and Aged Care Pricing Authority will work. After the bill is passed, the pricing authority will have the dual responsibility for setting the prices for healthcare services delivered in public hospitals and for services delivered in the aged-care system. However, unlike for healthcare services, when the pricing authority determines a price for delivering services in aged care, it will not be binding. They will only be able to advise the minister on pricing matters. Stakeholders have raised with me that they feel uncomfortable that the government could potentially veto the prices determined by the pricing authority. I would encourage the government to provide assurances to the sector that this won't be the case and that the prices set will cover the actual costs of delivering aged-care services.

Secondly, I would like to touch on the workforce. All of our systems of care are built on people. There is a hefty task ahead in creating both the funding model and the care workforce needed to ensure older Australians receive the highest standard of care they so desperately need. I'm pleased to see the government is moving ahead quickly with new laws that will require a registered nurse on site at every aged-care facility 24/7. But I'm concerned about our nation's ability to find the workforce and attract workers to the aged-care sector. I've seen in the news just this morning that hundreds of aged-care providers are likely to seek exemptions from the 24/7 requirement as they predict difficulties in being able to fill the shifts.

I've recently spoken with the Australian College of Nursing, who reminded me that the nursing workforce across the country is burnt out. The ANMF echoed the sentiment. Across back-to-back disasters, from the Black Summer to the recent floods to the multiyear global pandemic, nurses have been on our frontline, there to care for us in our times of need. It's my understanding that some nurses haven't been able to take their annual leave for over a year and a half. The most recent modelling I could find shows a projected shortfall of 85,000 nurses by 2025 and 123,000 by 2030. Nurses are leaving the workforce, limiting the pool of talent we have to supply the aged-care sector. But, more importantly, why would nurses leave any role to work in the aged-care sector, which is notoriously poorly paid? We need to ensure there is at least parity for nurses working in aged care with their colleagues in other parts of our health system. I know many work in aged care for the love of it, but we should not rely on this grace to ensure the sector is appropriately staffed.

These reforms are a great first step. However, I would encourage all of us to remain vigilant and to keep inquiring over this term of parliament on the state of our aged-care system.

Jess Walsh (Victoria, Australian Labor Party) Share this | Link to this | Hansard source

I too rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022. Firstly, I would like to point out the contrast between those opposite and the Albanese Labor government, because the contrast could not be clearer on the aged-care crisis. The former Liberal-National government neglected our aged-care system, and they did that for almost a decade. It was a system that was already in crisis before the pandemic started. It was a crisis that those opposite, when they were in government, chose to ignore until and unless it was politically convenient for them to finally address it. They claimed that their response to the Royal Commission into Aged Care Quality and Safety was a once-in-a-generation change to the sector. But actually it was a once-in-a-generation disgrace—a once-in-a-generation kick in the guts to dedicated aged-care workers, who deserve so much better, so much more, from their government.

We on the government benches know that good, secure jobs need to be at the heart of any response to the aged-care crisis. But the only thing at the heart of the response from those opposite when they were in government was delay. The only thing at the heart of their response when they were in government was neglect. Their bill to address some of the very critical areas of the aged-care system, which this bill also seeks to address, was introduced to the parliament in September 2021, but it wasn't until the final hours before the election that those opposite remembered it even existed. That was the level of priority that those opposite put on fixing the aged-care crisis. It wasn't until the final hours before the election that they remembered that their homework was due on the aged-care royal commission, and they didn't even get it done. What a disgrace. But what more did Australians expect from the previous government? When it comes to aged care, those opposite have never taken any responsibility. They've never acted with any sense of urgency.

This stands in stark contrast to the Albanese Labor government who, in our first week of the new 47th Parliament, are taking action that those opposite failed to take to protect the aged-care system. We have wasted absolutely no time when it comes to fixing the aged-care crisis. In our very first week in this new parliament we have introduced two bills to fix the crisis in this sector and deliver on our commitment to the Australian people that we will put the care, the dignity and respect back into the aged-care system.

This bill before the chamber implements a number of urgent reforms to funding, to quality and to safety in our aged-care sector. It introduces a new aged-care subsidy calculation as well as a code of conduct and banning order scheme. This bill extends the Serious Incident Response Scheme to aged care delivered in home settings and it addresses issues with the informed consent arrangements with respect to the use of restrictive practices in aged care. This bill strengthens the governance of approved providers and increases financial and prudential oversight. It enhances information-sharing across related sectors to enable proactive monitoring of cross-sector risks. All of this is about better protecting consumers and participants from harm.

This bill broadens the functions of the Independent Health and Aged Care Pricing Authority to include the provision of advice on healthcare and aged-care pricing and costing. This very important legislation that we are introducing in our first week as the Albanese government in the first week of the 47th Parliament will also improve transparency and accountability of providers by introducing a star rating system. That will be published for all residential aged-care services on My Aged Care by the end of 2022. That is a commitment that we made when we were in opposition, and we are getting on with it—hitting the ground running—and implementing it in government, because people want to see greater transparency and greater accountability amongst providers who are tasked with caring for our nation's most vulnerable elders and who receive federal funding to do that critical work. What the Australian people want to see is greater accountability and transparency when it comes to providers' actions with federal funding and when it comes to their actions in caring for our most vulnerable elders. As I said, information on the star rating system will be published for everyone to see by the end of 2022. That will allow senior Australians, their families and their carers to make informed decisions about their aged care. It will allow them to see how providers are performing and how they're using federal funds to provide quality care.

A number of the measures in this bill were included in the previous government's lapsed legislation. These are measures that we agreed with and that we recognised needed to be delivered. But, unlike the delayed and half-baked legislation that those opposite put forward that ignored the recommendations from the royal commission and ignored the real experts—our aged-care workers—our legislation will make serious improvements to the quality of care in the aged-care sector. Our legislation will ensure workers have their skills recognised and are given the opportunity to develop their careers. We'll do that by implementing a national registration scheme. That national registration scheme is part of the professionalisation of the aged-care workforce and it's a recommendation that I know aged-care workers around the country welcomed. It's a recommendation that was made in the royal commission's final report, recommendation 77. Lauren Hutchins from the Health Services Union told us that workers want this registration scheme. She said:

…we support a … registration scheme that actually invests in workers, in their professional development and in ongoing training, and that it's understood that it's an ongoing requirement of the job and acknowledged by the government as such.

Ms Hutchins went on to say that workers 'want their skills recognised and they want the opportunity to develop and participate in training.'

The Albanese government recognise the skill required to provide high-quality care in aged care, and with this bill we will deliver the ongoing training and professional development that these workers deserve, because we know that it is the aged-care workforce who are at the heart of our aged-care system and we know that there is no solution to the aged-care crisis without good, secure jobs for workers. You cannot provide quality aged-care services in this country without dealing with the workforce crisis that is at the core of our care crisis. Our aged-care workers have been telling us for far too long that they want to do a good job, that they value the residents who are in their care but that they just don't have the time that they need to care for the residents with the level of professionalism that they want.

We have a revolving door of aged-care workers in this country because the job is so undervalued. This is a job that needs to be professionalised. Aged-care workers need to be valued and recognised for their work. They need to be paid more. They need better training. This bill starts to recognise the value that we need to put on aged-care workers with this registration scheme. We know that there is no solution to the aged-care crisis without valuing the workforce, and our work here on fixing the aged-care crisis is just beginning this week.

In the last parliament, the Senate Select Committee on Job Security heard absolutely damning evidence of the prevalence and impact of insecure work in the aged-care sector. We heard that job insecurity and chronic low pay are the primary reasons that the sector is unable to meet its workforce and quality-of-care needs, and we heard that right from the coalface of the aged-care sector, from aged-care worker to aged-care worker who came and gave evidence about the conditions that they faced in aged care in Australia. We heard that over-reliance on insecure work practices has become an absolute business model in aged care. It's a business model which means that workers are left desperate, with little choice but to accept work across multiple employers to make ends meet. It's a business model which detrimentally impacts the quality of care for vulnerable people in the aged-care sector.

We heard from Ray Collins from the Health Workers Union, who told the committee at hearings in Victoria:

… it suits the business model to keep me as a worker lean and mean. You give me the minimal hours you can give me. You manipulate the hours and the workers to suit your dollar needs, not your care needs …

This is not how aged care should be run here in Australia today. Aged care should be run on the basis of good, secure jobs for the incredibly important aged-care workers who are the heart and the soul of our aged-care system. But insecure work is way too prevalent in aged care, and it takes the form of low pay and low-hour, part-time contracts. This is a system that provides flexibility for employers at the expense of the aged-care workforce. We heard too many stories from aged-care workers who are hired on part-time contracts with guaranteed hours as low as one or two hours per week, and any hours over that are just not guaranteed. Any extra hours that the workers are given don't attract overtime or penalty rates.

And then there's the issue of chronic low pay—low pay which, we heard, is a result of systematic undervaluation of care work as unskilled women's work. We heard from Professor Charlesworth, from RMIT University, who explained how gender discrimination has led to undervaluation and work insecurity in aged care:

This gendered nature of job insecurity is underpinned by a lack of value accorded to the work and the workers who perform it, which draws on a view of aged care as something women do for free and are therefore unskilled and is therefore not quite work.

This system of chronic low pay and low-hour contracts leaves workers desperate, in a constant limbo, not knowing how many hours they will work each week, not knowing whether they'll be able to afford to pay their bills and unable to properly plan their lives.

We also heard from workers across the sector about the impacts of insecure work on their health and on their families. Anu Singh, an aged-care worker and member of the United Workers Union, told the committee:

… apprehension, self-doubt, stress, unscheduled, instability. For me, these words altogether define the job insecurity that we actually go through all the time.

Taking jobs with low wages and a lack of stable hours is not a choice that workers are making, because it isn't a choice in aged care today. Insecure jobs are, all too often, all that's on offer for these workers. And without good, secure jobs, we aren't able to attract new workers to this critical sector.

There is a lot of work to do to fix the crisis in aged care. And what we know is that the workforce is front and centre in the aged-care crisis. One of the aspects of this legislation before the chamber is a very important registration system—recommendation 77 of the royal commission into aged care. It's one step that we can take to start aged-care workers on the journey to professionalisation. That's what the workers need and it's what the residents in their care need. This is a job that is providing the most important care in our society—care to our most vulnerable elders. What aged-care workers need is the support of their government, and that is absolutely what they will get from the Albanese Labor government.

Richard Colbeck (Tasmania, Liberal Party) Share this | Link to this | Hansard source

I rise with pleasure to make a contribution to the Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022—as has been indicated by other speakers in the chamber, an important piece of legislation. As has been noted on a number of occasions, it is essentially the same legislation that came to this chamber prior to the election, and, as Senator Rice quite rightly pointed out, was amended in this place—but with one amendment, which the then government didn't feel was responsible, which was an amendment moved by Senator Patrick for immediate 24/7 nurses in aged care. The reason we didn't accept that recommendation was it wasn't feasible and it wasn't responsible—not that we didn't support the concept of 24/7 nurses in aged care; we said that we did in our response to the royal commission. But it wasn't possible to make that occur straightaway.

That's why this legislation didn't complete in the last parliament. It should have completed in the last parliament, and the effect of the politics that was played by the previous opposition, the now government, is that important reforms to the aged-care sector have been delayed. That is the effect of the actions of the now government with respect to this legislation. It is important legislation. Aged-care providers have been delayed in having legislated certainty with respect to AN-ACC. AN-ACC is a game changer with respect to the funding of the aged-care sector in this country. It is the mechanism by which the resources can and will be made available to ensure, as we all want, that senior Australians can be cared for with respect, care and dignity—which is the title of the final report of the royal commission.

Many speakers have indicated the various elements of the bill, so I'm not going to concentrate on them all. But there are a couple of things that I think are extremely important, so I will focus on those. There are nine schedules in the legislation, and there was one schedule that was removed from the previous bill, which went to workforce screening and registration. I find it really difficult to accept and understand why that schedule was removed. The design of the workforce registration program was to make it as easy as possible, to prevent duplication, to make it as cost-effective as possible and to have a workforce registration scheme that worked across the entire care sector. The workforce registration scheme that the previous government wanted to put in place was the one that was being used for NDIS. It's already there. Why do we need to design a new workforce registration scheme? It's already being used across the country for workers in the NDIS. I go to Family Based Care in Burnie. They are providers of home care, they are providers of the NDIS and they are providers of veterans' care. Why should they have more than one workforce registration scheme within their business? They incur additional cost, and, as the principal funders of aged care in this country, the taxpayers bear that additional cost.

So, when the government's looking at their systems and where they might find efficiencies in the way that they operate, perhaps they could look at what the previous government was trying to achieve with the workforce registration program. It's something that's already there. Why do we need to build a new one? We don't. In fact, it would provide efficiency in the operation of our aged-care sector. There are about 4,000 senior Australians in residential aged care who qualify for NDIS. Those providers that have those residents who qualify for NDIS already have to have their workforce registered under the NDIS workforce registration scheme. Why should they have two? Why should we impose that cost—that duplication of effort and administration—on the Australian taxpayer by designing another one? Why would we do that? It doesn't make sense. The government should reintroduce the previous provisions that we had in this bill to ensure efficiency and ease of operation of business, so that this sector—the whole care sector—can operate so much more efficiently and cost-effectively in the interests of senior Australians, but, more importantly, in the interests of the Australian community, who are paying for this.

One of the new measures in the bill is the star rating system. That was slated to occur within the same time frame in the legislation, so I welcome the inclusion of the star rating system within this legislation. It was set to occur anyway, so it should happen. This does progress the legislation.

The other change that's been made, and this one genuinely concerns me, is in relation to governance. Schedule 5 introduces new government responsibilities for approved providers regarding membership of their governing bodies and the establishment of new advisory bodies on measures to improve leadership and culture. This is something that's not often talked about with respect to reform of the aged-care sector, but it is one of the most important things. If the corporate governance of an organisation isn't right, if the culture within an organisation isn't right, that has a direct impact on the quality of care that's being provided. We learnt some very, very hard lessons over the last two or three years through COVID, but can I say to you quite honestly and earnestly: one of the major lessons we learnt was that, if the clinical leadership and the corporate governance in an aged-care service were not good, the outcomes with respect to managing a COVID outbreak and managing the quality of care were bad for residents. So the element of this particular measure that concerns me the most is the exemption that has been put into this schedule for all Aboriginal community controlled health organisations. My question is: 'Why do the residents of an ACCHO deserve a lower level of corporate governance than every other Australian in aged care in this country?' It is a disgrace. It is a disgrace that this government is proposing to impose a lower level of corporate governance on ACCHOs than they will impose on every other aged-care provider.

We heard in this place yesterday two powerful speeches from two proud Indigenous Australians, both of whom care for their communities. I think it was a historic day. I think it was probably the first time that we've seen two first speeches from two proud First Nations women—a historic day. Yet, the next day, this government takes backwards the protection of Indigenous Australians in residential aged care by providing an exemption on governance.

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

What a joke!

Richard Colbeck (Tasmania, Liberal Party) Share this | Link to this | Hansard source

It's actually true, if you were prepared—

An honourable senator interjecting—

It's not in your talking points, I know. I know it's not in your talking points, but you're not prepared to tell Australians that this is the case. It's a disgrace that you believe that Indigenous Australians deserve a lower level of corporate governance over their care than everybody else. I would urge you all to go back to your minister and request that that provision be put back into the legislation. It should be. This is not a political point; this is a point with respect to the care of Indigenous Australians in residential aged care. They deserve the same governance.

As I've said, the quality of corporate governance and the quality of clinical governance in residential aged care have a direct correlation to the quality of care that is delivered to the people within those facilities. That is why we're all here. That is why we are debating this. We can argue over the politics of what happened before and after the election, and we will do that, but let's not forget that it was the coalition that called the royal commission, with all of the pain that it brought us as a government at the time. We called the royal commission, with all of the pain that it caused us. We have responded to every single recommendation from that royal commission. The then government responded to every single recommendation over 12 months ago, in the budget last year.

The new government has not yet responded to one of those recommendations. Where is the government's response to the royal commission? There is none. They announced a five-point plan in their address-in-reply—a five-point plan that started unwinding within 24 hours. It was supposed to include 24/7 nurses. We hear in the media this morning that there are now exemptions from that because the government has come to the realisation—which we already knew—that the implementation of that was an issue because of the supply of workforce. The plan included a promise for a pay rise which wasn't within the budgeted amount that they said it was. They don't know where the nurses are coming from, they don't know how many they need, and they haven't yet told us how much they're going to cost. I'll be interested to see whether it's in the economic statement this afternoon. We certainly expect to see it in the budget.

This piece of legislation is the second tranche of legislation in support of reforms out of the royal commission. It's not the first, as the government would like you to believe. It is the second piece of legislation that supports those reforms. It is an important piece of legislation. It should pass this place. But for the very reasons that I've mentioned in my contribution today, government members should go back and talk to their minister about protecting Indigenous Australians in ACCHO managed aged-care facilities around this country. They ought to go back and talk about a workforce registration program that already exists, rather than kowtowing to their union leaders, and save the sector some money and also save the taxpayers some money in the process, because it was a sensible and smart reform.

Sue Lines (President) Share this | Link to this | Hansard source

Thank you, Senator Colbeck. The time for this debate has now expired. You will be in continuation when the matter comes back.