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

I'd like to ask the minister a few questions before I move my amendment. Minister, could I get some clarification in relation to the budgeting around this particular measure? I note in the explanatory memorandum that there is an amount of funding, and I've asked the department, through questions, to explain to me how exactly the funding attached to the bill is going to be spent, but I haven't had a response yet. This is somewhat frustrating, given that the government are seeking for us to pass this bill despite the lack of information that has been provided in relation to the delegated legislation, which is so important to be able to understand exactly what is going to be required. Minister, can you give me some idea of what the funding allocated in your explanatory memorandum will be going to?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

The information I've been provided with is that—in accordance with the financial impact statement and the explanatory memorandum to the bill—the indicative financial impacts over the forward estimates of each of these measures are: for schedule 1, which involves the extra nurses who will be needed, $450.7 million; for schedule 2, which relates to capping home care fees, $1.2 million; and schedule 3, which relates to transparency and reporting, $8.1 million.

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

In calculating the $450.7 million that's been allocated for schedule 1—relating to the requirement for 24/7 nurses—what provision has been made for the likelihood of exemptions?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I'll just try and get some advice on that point. While I'm obtaining that advice, I'll just reiterate this point: it is disappointing to see the opposition continue to do what they did for 10 years—which is failing to deal with the need for 24/7 nurses in Australian aged-care facilities. As I said earlier, when I was talking about this issue in the run-up to the election, I found people were shocked that we don't have 24/7 registered nurses in aged-care facilities. It's very clear that one of the reasons for the range of appalling incidents that we've seen involving care in aged care is not bad staff but a lack of staff. It seems that the opposition continues to want to delay this important measure, which is about providing extra support for residential aged-care workers so that they can provide better care for residents. I've already acknowledged that there are challenges in implementing this in rural and regional environments, and that's why this government is putting more resources into fixing this situation than we ever saw from the former government. As I say, it's disappointing to see these ongoing delay tactics from the opposition when we finally have a government that wants to fix it.

The information that I have been provided with just now is that the government will be providing, overall over four years, $2.5 billion towards 24/7 and increased care minutes. We're introducing a 24/7 registered nurse supplement to support residential aged-cares services to employ extra registered nurses to be on site and on duty 24 hours a day, seven days a week. We'll invest $473.3 million over three years from 1 July 2023 in a new RN supplement that tops up Australian National Aged Care Classification care minutes funding to support smaller services to meet their 24/7 requirement. Initially, the supplement will be available to eligible services providing care to up to 60 residents. Services over this size will not receive the supplement, as their existing care minutes funding will be sufficient for providing 24-hour care, taking into account the previously announced funding increases and the additional $1.9 billion in Australian National Aged Care Classification funding in the budget to increase care minutes to 215 minutes, including 44 RN minutes, from 1 October 2024. This supplement will be available to eligible providers from 1 July 2023.

On exemptions, the government has considered feedback from the sector around current workforce shortages and will allow one-off 12-month exemptions to the 24/7 RN requirement for all services of 30 or fewer beds in modified Monash model 5 to 7 areas. This exemption is provided on the basis that small rural and remote services are likely to face the most significant workforce challenges in recruiting sufficient RNs to meet the requirement. Exempt services will not, of course, receive the RN supplement. We are taking into account the challenges that rural and remote services in particular will have in attracting workforce. Again, if we'd had a government at some point over the last 10 years that had been prepared to invest in workforce and prepared to build the skills of the workforce, then perhaps we wouldn't be having this problem.

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

I have a number of questions, and I absolutely don't want to delay the passage of this legislation, despite the false information you have just put on the record. In quite short answers, could you please advise: is the $450.7 million that has been allocated to schedule 1 one-off funding or an ongoing measure?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

It's an ongoing measure over the forward estimates.

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

I'm seeking clarification on your answer. The $450.7 million is for four years. Are you saying that this will be continued funding past the end of the forward estimates or a one-off allocation for the four years of this budget cycle?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Senator Ruston, as you well know, having been in government, the way governments structure their budgets is to provide funding for four years. Any decisions about future funding beyond the forward estimates are obviously made closer to the end of the forward estimates, but I can't see any situation in which we would walk away from this.

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

Will this funding go to providers who currently do not have an RN on-site, or will it be allocated more generally?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

The advice to me is that the money will be allocated on the basis of the modified Monash model level that I referred to earlier, but the funding will be provided both to services that have an RN now and services that don't have an RN, provided they meet that modified Monash model test.

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

Can I take it from that that modified Monash 1, as an example, will not have access to the $450.7 million, whereas more remote and inaccessible operators will get access to it? That is, it is entirely based on the modified Monash model and not on need.

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I'm taking advice as we're debating this, but to be clear, there are two issues. There is the one-off 12-month exemption that's provided, which applies to services of 30 or fewer beds in modified Monash model 5 to 7 areas. As to whether services in modified Monash model 1 areas, for instance, get extra funding, the answer is that if they have 60 beds or less then they would be eligible for that funding. So, it's possible that I misled you before. My answer earlier in reference to the level 5 to 7 areas was in relation to the exemption rather than the funding. I apologise for any confusion.

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

I'm keen to understand: in the determination of the expenditure of the $450.7 million for schedule 1, you've said that it's available to any provider with 60 beds or less. Could you advise on whether there is any mechanism within the determination that would differentiate between a provider who was struggling with the current workforce crisis or rewarding bad providers? We know that, sadly, we do have some of those out there. So, is there a mechanism that will actually determine the most imperative issue that is before us at the moment, which is workforce crisis versus rewarding bad providers?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

While I get some advice on that specific point, I might just give you a bit more information about how this supplement will work and who it will be paid to. The 24/7 RN supplement will be introduced from 1 July 2023 to support residential aged-care services to employ extra RNs to be onsite and on duty 24 hours a day, seven days a week. This supplement is targeted at small services—up to 60 residents—in recognition of the extra support these services need in order to deliver 24/7 RN coverage. The RN supplement provides up to $733,000 in funding per annum to rural and remote services in Modified Monash Model areas 5 to 7 and is paid at a higher rate to rural and remote services, recognising the increased costs in attracting nurses to work in rural and remote areas. The supplement is expected to be available to around 90 per cent of—I've never quite known whether you say 'triple M' or 'MMM'—areas 5 to 7 services, compared with under 40 per cent of more-metropolitan services in MMM areas 1 to 4. So, it will be eligible for both rural and urban, and it's more dependent on the size of the service.

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

Can I take it from that that the $733 million that you just referred to in the supplement is not actually contained in the explanatory memorandum as a cost associated with the bill—that you've only got $450.7 million, which relates to the support for the nursing homes to employ extra RNs? I'm just seeking clarification on what you actually just said. You said that the $450.7 million was to support facilities to employ extra RNs. So, what you've just said somewhat contradicts what you said before. You said it would be available to all facilities as long as they met the 60-or-below threshold, but what you've just said is that it is for them to employ extra RNs. Is the $450.7 million able to be used to provide extra RNs, even at facilities that already have 24/7 RNs?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

The advice I've received is that that supplement would be available to services that do already have 24/7 RNs in place, provided that they have 60 or fewer beds. That's in recognition that those smaller services, whether large, small, rural or urban, have additional difficulties.

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

Can I just quickly seek some clarification: we've got $450.7 million for schedule 1 of this bill, and you've just told me $733 million for the supplement. So, where is the $733 million currently allocated for in the budget? Where is the $450.7 million allocated in the budget? And what is the differentiation, in terms of what you're taking to me about, between the $450.7 million and the $733 million? Which is the supplement? Or are they both the same thing?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I'd been wondering where you got that $733 million figure from. What I said, unless I said the wrong thing—I was talking about $733,000 in funding per annum to rural and regional and remote services, not $733 million. That is per service. Just to repeat the point: the RN supplement provides up to $733,000 in funding per annum to rural and remote services in MMM areas 5 to 7, and it's paid at a higher rate to rural and remote services because of the increased costs that they will incur.

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

Moving on to the exemptions that exist under this particular schedule: can you please advise where you're up to regarding your current considerations about what would constitute an exemption under this legislation?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

This legislation puts in place a process to then create exemptions. Early consultation has begun. I'm advised an exposure draft of the exemptions will be finalised soon—it's currently being drafted—and there will be a consultation process on that exposure draft.

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

RUSTON (—) (): Do you think there's any possibility we could get a little more detail about when that exposure draft is likely to be available?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Early next year.

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

Clearly, you're not going to provide us any more advice around the process of what is in your mind in relation to general attempts to try and obtain a RN. Or can you provide us with more information on that?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

We're working out the specifics at the moment but the intention is to make it an open and fair process that treats particular facilities on a case-by-case basis. I'm sure Minister Wells will be more than happy to provide a briefing to you once the consultation process begins.

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

In relation to that, what communication, consultation and certainty have you given providers to date regarding how the exemption process will work? Or are you just going to leave them to wait until they see the exposure draft, or have you been talking to them? If you put out an exposure draft, we're not going to see the delegated legislation until April next year—that's what I was advised when I asked about this in committee. Where does that leave providers who will be frantically trying to seek an exemption and provide the necessary detail to you? I'd like to understand what communication and consultation have you provided to date to give certainty and security to these very important workers in our community.

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I'm advised there has been extensive consultation around these commitments already. I won't go through it in great detail, but there was general consultation conducted in relation to the government's election commitments around aged care that occurred with a range of groups, employers, union providers and carers through July and August. General consultation was conducted in relation to legislative amendments with a range of stakeholders from various perspectives through July and August. Specific consultation in relation to exemptions to the 24/7 RN requirement was conducted on 22 July with the funding reform working group. I could run through the members of that group; it essentially includes a wide range of providers and various interest groups. Again, there will be further consultation once we've drafted.

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

Can you put on the record how many regional providers the minister has visited, and how many rural, regional and remote providers the minister has discussed the exemption clauses with directly?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

TT (—) (): I'm not in a position to advise that here. I can say that some of the groups that were consulted about the exemptions on 22 July included the Aged Care Workforce Remote Accord, Leading Age Services Australia and a number of other large providers who have services in regional and rural Australia.

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

Minister, I would appreciate it if you could take that on notice and come back to me, maybe before estimates, as to how many rural, regional and remote nursing home facilities the minister has visited and consulted with.

Finally, on these exemptions, the information contained in the documentation we have suggests they are for one year. Is there an ability for those exemptions to be extended or renewed past that one year if it's determined the exemptions are still warranted?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

The advice is, yes, there would be capacity for those to be extended but they would have to reapply.

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

Moving onto probably the most important issue that the Australian care sector is facing more generally—that is, the workforce challenges—I would be keen to understand what data the government has relied upon to understand and to be able to quantify the current level of workforce shortages and, therefore, the impact this is likely to have on the ability of the sector to deliver on requirements of this bill?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I'm advised there are a range of sources of that data, including the departmental modelling.

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

Would it be possible for the data and the sources on which the government has relied in making its decisions around this to be made available to the opposition or to this chamber/

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I am very happy to take that on notice, in addition to the request about the minister's travels.

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

Has the government done any research since coming into government to reassess and stock-take the number of nurses currently in the sector? Because we do know there is quite a lot of pressure and stress, and a workforce that is highly susceptible to burnout from the conditions they have experienced over the last three years with the amazing job they did in dealing with COVID. Has there been any reassessment of the impact of the last three years on our nursing workforce and how that may impact on the ability of provisions of this bill to be implemented?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I'm advised we rely on the national workforce, health workforce report, the last of which was made public. We'll find out when that one was. There will also soon be another quarterly financial information report. I am not exactly sure of the exact title of that. It is due in October or November. We will have further information on that. I will again put on the record I welcome the fact that minister is interested in the workforce challenges facing the aged-care sector and I just wish she and her colleagues had been so focused on it in the 10 years they were in government.

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

Is the government expecting to rely on immigration to assist providers in fulfilling the requirements of this legislation? If they are, to what extent, and what kinds of numbers are they expecting to rely on from immigration and the time frame in which they believe they would be able to be accessed in Australia?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Yes, there will undoubtedly be an element of immigration required to meet the general workforce challenges of the aged-care sector, whether it be as a result of this legislation or because of the crisis in the aged-care workforce that was left behind from the former government, just as there is a workforce crisis in agriculture, in hospitality, in manufacturing, in construction and in every industry of the economy because of the failure of the former government to act. Immigration will be a part of it. I have seen the minister's announcement about work being done under the Pacific Australia Labour Mobility program to source workers for our aged-care sector in addition to other sectors of the economy, but that is in addition to the range of measures we have already put in place to train locals and to provide skilling opportunities for locals to work in aged care, again, which were never put in place by the former government.

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

So can I take it from that you have not modelled specifically the immigration requirement of 24/7 nurses? You just made a blanket statement around general workforce. Can you answer the following—

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I didn't say that.

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

Well, you sort of did. I will ask you another question: What is the current estimate number of nurses needed to ensure every aged-care facility in Australia has a RN on-site 24/7?

What is the estimated number of nurses believed to be required to meet the care minutes that will come into effect in October 2023, 40 minutes of care? Can I have them both separately? Do you have an accumulative total, because obviously some may well cross over into the other?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Again, first I would make the point that I never said there was no modelling around immigration. That is the shadow minister's decision to misrepresent what I said. What I am advised is that the estimated additional nurses required for 24/7 registered nurses in our nursing homes is 869, measured in terms of headcount.

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

Would you like to answer the other half of the question?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Would you like to repeat it?

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

There's the 24/7 nurses and also a requirement in October 2023 for 40 minutes of care—you referred to it in your second reading address. Forty care minutes. I'm just wondering if you can tell me how many additional registered nurses are required for the 40 care minutes. What is the collective total of those two things, which were coupled under the royal commission and which your government has chosen to decouple? I would like to know the coupled impact.

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I don't have that information to hand, but again I would say that, whatever number of extra nurses is required to deliver on this commitment, it would have been a hell of a lot easier if the former government had done anything about training nurses.

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

Would you be able to take that on notice? In the absence of you taking it on notice and providing that piece of information, which is absolutely essential, one can only assume that you don't know the answer.

Finally, I was wondering if there is any additional funding in the budget or contained in this particular bill that would go to assist nurse peak bodies and aged-care providers to upskill their current workforce of enrolled nurses or nurse practitioners.

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I'm certainly aware that part of the workforce plan here is to upskill existing workers and increase the participation of existing workers. I'm sure the shadow minister would be aware that there is a large number of aged-care workers who either work part time or casually, and there is certainly an opportunity there to increase the working hours for those who wish to do so. I may have to take on notice the details as to the cost.

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

I know Senator Pocock has a couple of questions, so in the interest of time, could you also take on notice and provide me with this advice. Will any funding allocated under the workforce training—or whatever element you're going to come back to me with—go to train and upskill enrolled nurses? Is the money ongoing funding or only one-off funding for upskilling? Are providers expected to provide their own ongoing funding in terms of this development? I'm very interested to understand what provisions have been put in place to ensure not just the attraction of additional workers into the sector but that existing workers in the sector are given the opportunity to upskill so they can try and assist in meeting the expectations of this bill.

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

My question goes to how the government will be monitoring for compliance with the 24/7 RN requirement when it comes into effect. After 1 July it will be the responsibility of aged-care providers to meet this requirement, and I understand the commissioner may have powers to sanction providers should there be breaches. How will the government ensure that providers are complying with this new responsibility? Specifically, what are the plans to communicate to those living in aged care and their families how they can also report breaches if they notice them?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Thanks, Senator Pocock, and again can I thank you for your cooperation with us in getting this legislation finalised and into the chamber. The Aged Care Quality and Safety Commission will be responsible for ensuring compliance with this new provider responsibility, just as it is currently responsible for a range of other regulatory measures. The commission will extend their existing risk-based and proportionate regulatory approach used to regulate other provider responsibilities to this new responsibility. Consideration is also being given to developing auditing arrangements that ensure that the registered nurse and care time data that facilities report is accurate. I think the second part of your question is: what would a resident or family member do if they were concerned that the requirement was not being met? I presume the answer is that they could make a complaint to the Aged Care Quality and Safety Commission.

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

Does the government have plans to inform aged-care residents and families that they can report after 1 July?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

There are already a range of activities undertaken to inform residents and family members of their rights to make complaints or raise concerns about the failure to meet regulatory requirements, and information is provided on how people can do that. This would come within the existing information. Whether it be a breach of this provision or a breach of existing provisions, information is provided to residents and families about how they can make those kinds of complaints. But I'm happy to follow that up with the department and make sure there is specific reference to this.

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

Through the inquiry process, the National Aboriginal Community Controlled Health Organisation raised that there currently isn't the Indigenous led workforce that can provide culturally appropriate care where it is needed. Currently, elders may have to move off country to live in aged-care facilities. There's no doubt that having more Indigenous aged-care workers and nurses would help provide more culturally appropriate care for these elders. Could the minister advise what plans are underway to ensure that the training of the next generation of Indigenous aged-care workers and nurses happens?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Thanks, Senator Pocock. You raise a very good point. I have been to an aged-care facility in remote Northern Territory and saw firsthand the particular issues and challenges that arise in providing aged care in those sorts of settings. There are existing training programs in place, but I'm happy to get the department to come back to your office with some more information about what more we can do. But you're dead right. It's a really important thing to have our First Nations people trained to deliver these sorts of services in community.

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

I have a couple of quick final questions. I'm wondering whether the department has modelled—or has taken into account or has any understanding of—the impact of the changes to the distribution priority areas that may make it more difficult for regional and rural providers to retain or obtain staff.

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I'll have to take that one on notice.

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

On that basis, it would be really good if you could provide in the response any evidence as to whether you believe it has or it hasn't and what that evidence might be. Are you considering a bonus or incentive for nurses to relocate to regional communities to help providers meet their requirements in this legislation, as opposed to the incentives that have been provided to providers to retain nurses?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

We're obviously at a fairly early stage of doing the workforce planning to deliver on this commitment. The money has been provided in the budget and consultation has begun. There are a range of measures that are under consideration, but I can't commit to one or the other at this point in time.

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

Finally, I want to understand whether the department has looked at, or is intending to look at, how technologies like telehealth could be used to support the current nurse workforce, noting the challenges particularly of the shallow workforces we're finding in rural, regional and remote Australia. I'm wondering whether any consideration has been given, or will be given, to supporting providers to use innovative technologies like telehealth to ensure that older Australians are able to get the care that is possible within the circumstances that they, often, wish to live in. I know a lot of people who live in rural, regional and remote Australia would prefer to stay in their own communities rather than move to places that may have a greater depth of service opportunity. So I'm just wondering whether any consideration has been given to using other types of technology and innovative approaches to ensure that service is provided without necessarily having to force providers to have 24/7 nurses when other alternatives may deliver the same outcome.

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I am certainly familiar with the benefits that telehealth can provide for health and aged care in regional settings. Senator Ruston, you may have seen that we actually provided significant new funding to extend telehealth services in health in general. We are giving consideration to what more can be done for telehealth specifically for older Australians. But I certainly wouldn't rule out doing that kind of thing.

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

On that point—and not necessarily specific to this bill—I am wondering whether the minister might seek for the department to provide me with advice about the expansion of telehealth services in the bush that are in the budget. The only one that I saw was the reinstatement of the loading on the psychiatric service. So I am wondering whether the minister could provide additional detail around the telehealth services in the bush that you just referred to. I am also wondering whether you absolutely committed to working with rural, regional and remote providers to ensure that we don't see facilities closed in an attempt try to meet the requirements of this bill and that you and the government will always act in the interest to ensure that facilities are kept open and the supports are provided to enable them to be kept open in a manner which delivers the appropriate care for the older Australians that rely on the services of those facilities.

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

We certainly will be consulting with those providers as we roll out this initiative. We will be working with providers to make sure that they can access the workforce that they need. What we will also do as a result of this legislation is ensure that older Australians living in rural and remote areas get the kind of nursing care that they deserve in rural and remote nursing homes—something, again, that was neglected by the former government. We are determined to fix that and make sure that all Australians get the aged-care services they deserve whether they live in the bush or in the cities.

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

It is great to hear that, though I find it somewhat astounding that that you voted against our second reading amendment—but there you go. Can you advise whether the $450.7 million, the $1.2 million and the $1.8 million that are contained in this bill are contained in the $2.5 billion election commitment that you are rolling out for aged care?

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

I am advised—and I will come back to you if I get this wrong in explaining it—that the measures included in schedule 1 form part of the $2.5 billion, because that was about extra hours and minutes for nursing homes, but that the measures included in schedules 2 and 3 are outside the $2.5 billion because they relate to transparency and other things.

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

So the $3 million or $4 million sits outside but the bulk of it sits inside? Maybe we can prosecute this more vigorously during estimates, but I am wondering what is included in the actual $2.5 billion—and I know you read it out earlier—and what additional funding sits outside the $2.5 billion that is contained in your healthcare commitments as part of the budget. If you don't have that information we will have to prosecute that further in estimates.

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

It might be better to explore this further at estimates. But, again, the $2.5 billion extra commitment was for extra hours and minutes of nursing care and other care. The matters that are in schedules 2 and 3 are to deal with other things, and funding has been provided to the department via the budget to do those other things.

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

I thank the minister for the answers that he has been able to give. Obviously, there is a lot more that needs to go through in terms of this bill. I reiterate the disappointment of the opposition that we don't have greater clarity around the really important aspects of this bill that will have such a huge impact on nursing home facilities across the whole of Australia, not the least of which will be the significantly disproportionate impact on rural, regional and remote communities.

So I look forward to seeing what you're going to come forward with in your delegated and subordinate legislation. We will certainly use the opportunity of the little time that you're going to be providing to us and the wider community to make sure that we are not having unintended detrimental consequences because of the fact that this has been rushed, and also because of the lack of transparency and, obviously, the lack of time that is going to be made available for these really important facilities that protect and support older Australians in their journey in later life. This is obviously a tick and flick that is being put in place to move forward an election commitment, with no regard whatsoever for the unintended consequences. But, as I said in my contribution earlier, the opposition is absolutely committed to making sure that we support any initiative that's going to support older Australians in their journey.

So we will not stand in the way of this legislation. In fact, we would have put in place this legislation, almost in its entirety. We probably just would have accepted the recommendations of the royal commission, which spent many, many months working with the sector more generally to understand the really significant nuances that exist across our aged-care sector. That's to make sure that whatever we put into this place and whatever legislation we enact takes into account all of those details. Instead, we see those opposite going for a headline. Yes, Australians do expect that people who are in nursing homes will have access to the appropriate nursing care. But in the pursuit of a headline, those opposite have absolutely failed to recognise that sometimes there are nuances that will mean that things need to be changed to meet the individual and unique circumstances that we find because we have such a large country and very shallow markets across our country. That's not what's happening here today, but we certainly won't stand in the way of improving the situation for older Australians who need the support and care of our many, many wonderful aged-care providers. We also will not stand in the way of making sure that anybody who is a bad provider, a rogue provider, is held to account and is not allowed to inflict the kind of devastating pain and impacts that we saw in some of the testimony during the royal commission.

I would urge those opposite, as they go forward in their aged-care reform—a reform that we're happy to be constructive about and support them with as they go forward with that reform—is, please, not to apply a one-size-fits-all model to this. That appears to be what they're intending to do with this bill and with the bill they've pushed through this place more recently. I would urge them to make sure that they actually take a little bit more time and pushing a little bit more investment and effort in making sure that they understand the nuances of what is a very, very important sector for Australians. It is absolutely important, as we see with our ageing population, that we support the journey of older Australians—that we put them in the centre of every single piece of our decision-making. This should not be what the government wants, what the bureaucracy wants or even, for that matter, what the providers want. What we need to do is invest in the opinions, wants and needs of older Australians, making sure that those are the seminal points when we make decisions about what we intend to do. Those opposite need to listen to the voices of older Australians and not to their own voices.

On that note, as I said, the opposition will be supporting the government in moving forward on this important piece of reform, despite the reservations that we have about the way this has been handled. By leave—I move amendments (1) and (2) on sheet 1677 together:

(1) Schedule 1, item 2, page 4 (after line 5), at the end of paragraph 54-1A(4)(a), add:

(iii) in considering whether the provider has taken reasonable steps, the Secretary must consider whether the provider will undertake reasonable measures to provide the highest level of clinical care with the available workforce, which may include measures for the support of clinical care by enrolled nurses and through telehealth consultations with registered nurses (within the meaning of the Health Insurance Act 1973); and

(2) Schedule 1, item 2, page 4 (after line 23), at the end of section 54-1A, add:

(6) In this section:

en rolled nurse means a person who is registered under the National Law (within the meaning of the Health Insurance Act 1973) in the nursing profession as an enrolled nurse.

telehealth consultation means a consultation conducted (other than in person) by videoconference, telephone or other technology.

Andrew McLachlan (SA, Deputy-President) Share this | Link to this | Hansard source

The question before the committee is that amendments (1) and (2) on sheet 1677, as circulated by Senator Ruston, be agreed to.