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

The coalition acknowledges that the Aged Care Amendment (Implementing Care Reform) Bill 2022 continues in part the work of the fundamental and generational reform of the aged-care system to ensure it meets the needs of senior Australians both now and into the future. However, this bill is also an election commitment tick and flick. The bill is rushed, it lacks detail and it ignores the unique circumstances faced by rural, remote and regional Australia. This bill ignores the importance of good legislation.

The opposition will continue to work constructively with the aged-care sector, older Australians and their families, and the government to collectively address the many challenges that lie ahead, including the changing and the expanding expectations of aged-care services, the legacy of COVID and Australia's ageing population. The task before us is to maintain and sustain an aged-care sector that meets expectations, is affordable to those who need it and is equitable whether you live in Sydney, Mildura or Kununurra. We must ensure that the people this sector aims to support and their quality of life are at the centre of every piece of our decision-making.

Whilst the coalition supports the intent of this bill, it is very inadequate and suboptimal. It neglects to recognise many important and substantial consequences, because it has been rushed and doesn't even try to address the concerns of stakeholders about the severe lack of workforce and the uncertainty of what might be contained in the delegated legislation. This implementing care reform bill contains three schedules amending the Aged Care Act 1997; however the opposition is disappointed with the incredible lack of detail—details missing from this very important piece of legislation.

In government, the coalition called the Royal Commission into Aged Care Quality and Safety to ensure our oldest and most vulnerable Australians receive care that supports and respects their dignity and recognises the contribution that they have made to society. We responded to the recommendations of the royal commission by investing $19.1 billion to improve aged care and fund new home-care packages, respite services, training places, retention bonuses and infrastructure upgrades. Schedule 1 of this legislation goes to the heart of a very significant recommendation of the royal commission, recommendation 86.5, which states:

… from 1 July 2024, the minimum staff time standard should require at least one registered nurse on site per residential aged care facility at all times.

The opposition supports the implementation of the recommendation for a nurse on site 24/7 in every aged-care facility, in line with the royal commission's recommendation, as we know the workforce challenges the Australian care sector is facing. This is particularly acute for registered nurses.

Considering this schedule is not consistent with the time frame recommended by the royal commission and noting the current workforce shortages experienced across Australia, the opposition has concerns about the impact of the expedited time line on the broader healthcare sector. The new residential aged-care staffing targets are ambitious, and achieving them is going to be challenging, especially for small providers and rural, regional and, especially, remote providers. However, in the broader current climate of worker shortages and record-low unemployment, the whole sector will face significant difficulties employing and retaining the critical staff to continue to support our older Australians.

Despite these undeniable factors, the government has just looked at a few inner-city aged-care providers and has blatantly ignored a whole range of factors that the royal commission took into consideration when they suggested their time line. This conflict with the royal commission's recommendations is the reason the opposition is concerned by the one-size-fits-all approach in this legislation. We know that aged care comes in all shapes and sizes, issues vary from location to location and facilities have residents with varying levels of acuity of care needs. I note the testimonies to the Community Affairs Legislation Committee hearing into the bill and that many witnesses, including aged-care peak bodies, providers and advocacy groups, anticipate that accessing additional registered nurses will be difficult, if not impossible, within the time frame designated in this bill. The written submissions of the National Aboriginal Community Controlled Health Organisation stated:

There is a risk that many services may need to close, or that providers will leave aged care, especially in areas where there are no other services available. There is a known undersupply of health and care staff across the sector - in aged care, this includes registered nurses. The aged care industry needs adequate time to recruit and train additional staff.

Without clear advice and direction from the government, it is unclear how providers, including Aboriginal and Torres Strait Islander providers and those in rural, regional and remote Australia, will be supported to ensure that their aged-care services are not forced to close due to this accelerated requirement. Although acknowledging the government's amendments moved by Senator Pocock, they really do nothing to address the opposition's concerns about the lack of key information and the impact on rural, regional and remote nursing homes and the Australians who rely on them.

Another issue that has been raised by numerous aged-care providers is the matter of enrolled nurses and the potential impact of them of the strictly prescribed requirements of care minutes within recommendation 86 of the royal commission. Enrolled nurses are an absolutely critical part of Australia's aged-care workforce. They provide essential care to older Australians, they support registered nurses and they can assist administrative staff in the work that they have to undertake. Given the time frame that the government has set in this bill for aged-care providers to achieve having a registered nurse on site 24 hours a day, seven days a week, and noting that many providers remain anxious regarding that exemption and what the clauses will be, we call on the government to give consideration to the role of enrolled nurses in this time period.

The refusal of the government to provide details about subordinate legislation is not only concerning, as it avoids parliamentary scrutiny, but has been highlighted as a key issue for aged-care providers and other stakeholders. The government must provide answers to significant questions that remain unanswered, particularly surrounding this exemption clause, on which they have to date been completely silent. For example, what exactly is the exemption mechanism that will be detailed in this delegated legislation? When will the delegated legislation be available for the sector to be able to see? Will the delegated legislation be consulted on? When? Who will be eligible for an exemption? For those not eligible for an exemption, what are the penalties for non-compliance? All of these are very important questions for the security of the aged-care sector to go forward with certainty. They have been unanswered by this government, and yet it still wants to push this piece of legislation through this morning.

The opposition is particularly concerned about the possible additional burdens and requirements that will be placed on regional, rural and remote providers if the exemption clauses are not adequately defined. We note the unique circumstances of rural, regional and remote providers due to their geographical locations and the burdens that they are facing in finding additional workforce or competing with other sectors, like hospitals, for the workforce to meet the requirements that will be set out within the time frames in this bill.

These concerns were particularly shared by NACCHO, who said:

In order to meet the recommendations of the Royal Commission and the National Agreement and ensure Aboriginal and Torres Strait Islander people receive aged care from the most appropriate organisations, consideration must be given to alternative staffing models for services in urban, regional, rural, remote and very remote locations.

The cost to providers of a poorly drafted exemption clause has the potential to be significantly detrimental, especially since the detrimental changes in July to the distribution priority areas. Regional providers are now finding it extremely difficult to attract and maintain a steady, reliable workforce as qualified health professionals and their staff relocate to urban areas. It remains unclear whether the subordinate legislation will consider the acuity of care required by individual facilities in its implementation of the requirements for a registered nurse to be on site at all times. I note testimony from Dr Nicole Brooke, the Chief Executive Officer of the Australian Community Industry Alliance, who said:

The other problem is that, if you have one registered nurse for a whole facility, you're not defining the level of experience suitable to the level of acuity in those residents. You can have one registered nurse who's a new graduate and has been out—

in the community—

for two weeks, and that will still fulfil that requirement. But the level of acuity … with … palliation, dementia and delirium … isn't going to be supported by an inexperienced nurse or a nurse who's not familiar with the residential aged-care facilities …

The government must advise whether they will stipulate specific nursing requirements for services who care for residents requiring a very acute level of care. The government must advise the public if they are considering mobilising enrolled nurse personnel for situations where those personnel can be utilised. Instead of clear and concise articulated solutions to these issues, all we have had from the government is a talkfest, solution-less jobs summit.

In recognition of our concerns, the opposition will again seek to move an amendment to ensure that the draft subordinate legislation is presented to the parliament prior to the start of the schedule to allow providers the time to consider and consult on the proposed exemption clause.

Schedule 2 of the bill enables the government to cap charges that approved home-care providers can charge care recipients and removes home-care providers' ability to charge exit fees. In government, the coalition implemented for the first time a requirement for information to be published relating to the median prices charged for home-care services to support older Australians and their families to make more informed decisions on home care and the associated costs. We began the process of providing greater accessibility of information not only to assist with informed decision-making on home-care services but also to put downward pressure on home-care prices.

We support the government's continuation of our reforms to support older Australians to access important home-care services, allowing them to remain independent in their homes for longer. The government has also not provided clarity regarding who will set home-care caps and how the relevant deputy secretary of the department will work with the Independent Health and Aged Care Pricing Authority to decide what the relevant price cap is. There is also a lack of certainty regarding how much discretionary power the decision-maker will have for setting the home-care fees and whether this will be formulated using evidence based advice.

Schedule 3 of the bill requires the Secretary of the Department of Health and Aged Care to publish information in relation to the operation of aged-care providers, with the aim of further increasing transparency on aged-care services to allow Australians to make a more informed decision on aged care. The publication of additional information to increase sector transparency and to increase consumer understanding of the sector is supported by the opposition.

We're happy to see the government continue our reform work in this area. However, it must noted that, like schedule 1, the details of this schedule are subject to delegated legislation that has not been released by the government. Therefore, there are still questions regarding what exactly will be required to be published. We are calling on the government to ensure that, when amending the quality of care principles, they note that, of all aged-care homes who currently do not have a registered nurse on site at all times, 53 per cent are in rural, regional and remote areas, and 46 per cent of them are small providers. We're introducing amendments to ensure the government, who were elected on a platform of transparency, provide the necessary information to allow for adequate parliamentary scrutiny of this bill and its delegated legislation, and to ensure that providers are genuinely supported and not just another headline to fulfil an election promise.

Furthermore, the opposition will move an amendment to have an enrolled nurse on site and an RN on Telehealth 24/7. This will be a feasible option for some low-acuity providers or regional providers who are currently unable to attract a steady RN workforce despite ample and genuine attempts to do so.

The opposition strongly supports continued improvement in the aged-care sector and the care provided to older Australians; however, this bill is nothing more than a slap in the face for transparency. Furthermore, the opposition will move an amendment to require the secretary, when considering whether the provider has taken reasonable steps to ensure that the clinical needs of the care recipients in the facility will be met during the period for which the exemption is in force, to consider whether the provider has established reasonable measures to ensure the highest level of clinical care with the available workforce will be provided, which may include measures for support for clinical care by an enrolled nurse and through telehealth consultations with a registered nurse. This would not change the overall standard that the provider needs to take reasonable steps to ensure clinical needs are met.

Current workforce constraints and the extreme reliance in this bill on delegated legislation, the details of which have not been released by the government, is disrespectful to the aged-care sector and remains a serious concern for the opposition. Notwithstanding the very serious concerns the opposition have about this bill, we will always support improvements to care for older Australians and, therefore, we will be supporting this bill in the Senate.

I move:

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

(a) notes that, of the aged care providers who do not currently have a registered nurse on site, and on duty, at all times, 53% are based in regional and remote areas and 86% are small providers; and

(b) calls on the Government to ensure that, when amending the Quality of Care Principles to make provision for an exemption to the new responsibility relating to registered nurses, the disproportionate impact on providers in regional and remote areas, especially small providers, is taken into account".

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

I am very pleased to rise today to support the passing of the Aged Care Amendment (Implementing Care Reform) Bill 2022. It's an important bill. It adds to the aged-care framework to ensure that we are providing appropriate care for older Australians. It's consistent with the principles that the Greens bring to aged care, where we believe that the federal government must play a central role in the funding, regulation and support of high-quality aged-care services and that older people should be able to access health and aged-care services as soon as they need them. We want to see a high-quality, affordable aged-care system characterised by quality support, nursing and personal care, whether that is in someone's own home, residential care or hospital. We also believe that this should be provided on a not-for-profit basis. This legislation doesn't go to that, but those are the aspirations of the Greens going forward.

We welcome the scrutiny that this legislation received through our Senate Community Affairs Legislation Committee inquiry process and believe that there was a lot of important information that in fact influenced this bill and also influenced how this legislation is going to be implemented in terms of things that will be in the delegated regulations down the track.

We heard clear evidence through the inquiry process that advocates want this commitment to nursing requirements implemented. We note that it was, indeed, a recommendation of the royal commission. We note that the timing has been brought forward from the royal commission's recommendation but that the sector overall supports bringing this forward.

The Older Persons Advocacy Network said:

OPAN strongly supports the requirement that Registered Nurses must be on site and on duty at all times (that is, 24 hours each day, 7 days each week).

While we acknowledge that the Royal Commission into Aged Care Quality and Safety recommended one registered nurse be on staff for both morning and afternoon shifts (16 hours per day), increasing to all day from 2024. OPAN believes a registered nurse should be available 24 hours per day as soon as possible rather than delaying implementation. The increasing health complexity and comorbidities of older people entering residential aged care requires a corresponding need for staff with the right health and medical skills to provide support. We know that health related incidents don’t just happen in the day time.

Similarly, the Council on the Ageing said:

This measure strengthens national minimum staffing standards in residential aged care and brings Australia into line with similar regulations in other countries.

Nurses play a vital role in aged care in partnership with allied health professionals, lifestyle coordinators and well-trained personal care workers.

COTA Australia has long supported the principle of ensuring the right skills are available in the right setting and at the right time, within each staff member’s professional scope of practice.

So we welcome this legislation. We are glad to see it being brought forward by the government and look forward to seeing it passed by the parliament.

I also want to thank the Australian Nursing and Midwifery Federation for their crucial advocacy and commitment on this issue. I met just yesterday with a delegation of nurses who were here to advocate for this legislation. I heard about their experiences of working in walk-in centres and aged-care homes, and in providing palliative care and a range of other types of care. One of them, Glenn, began his nursing training in 1978, so he's been in the field for a long, long time. One of the things he said to me yesterday stuck with me. He said the No. 1 thing that was going to make a difference to the older people he cares for was having more eyes, more feet and more hearts on duty.

Another nurse, Steph, talked of being a nurse in aged care, rather than in hospitals, even though the pay was less. I asked her why—why had she stuck with working in aged care? She said she really enjoys and appreciates the opportunity to work with older people at the end of their lives. She said she's not in it for the money; she's there because she cares.

This delegation of nurses, however, talked about nurses walking away from the job because, at the moment, the job is just too much; the stress, the overwork and not having the support they need are not what they signed up for. We have trained nurses across the country who are at the moment deciding they just cannot cope with the extra stress of being in the job, who are off doing other things. This is a critical part of addressing the workforce shortage of nurses that we face in Australia: actually bringing back into the profession those trained nurses who are currently working in other fields because they don't feel that they are being paid appropriately, that they are valued and that the job is sustainable for them in the long term. The nurses I spoke with yesterday talked of just not having the time to do the work that needs to be done when they're on the job. Clearly, increasing nursing staffing levels in aged-care homes is going to make a vital difference to people around the country, so it's really important that we enable this framework to be established.

This, of course, goes to the critical issue that Senator Ruston was just talking to. We know that, as part of implementing this framework, providers around the country, and especially in rural and regional areas, are going to need more nurses. We know that that is the fundamental issue, the tension, of introducing this legislation now and the time line it's being introduced on. Having more nurses around the country and putting in place a framework that requires that is a good thing, because nurses are providing crucial care and, as a country, we should be providing the best care possible for older Australians. But at the heart of the concerns that have been raised, particularly by regional and rural providers, is how providers are going to attract and retain staff when these reforms come into effect. Obviously, a crucial part of this legislation, and any exemptions to be put in place if providers, despite their best efforts, are not able to attract staff, is going to be in delegated legislation. In particular, that delegated legislation is going to lay out what those exemptions are. We too would have preferred to see more detail in this legislation, but at this stage it's a question of weighing things up: do you pass this legislation now or do you wait to see more detail in the delegated legislation? We recognise it's an important issue but believe that, on balance, it is much more important to get this legislation passed now.

I want to let people know that we are going to be scrutinising the delegated legislation very, very closely. I really look forward to working with the government as the delegated legislation is developed. I really look forward to ensuring that people across the sector, from the nurses to the providers to the community, have the opportunity to provide input into that delegated legislation to make sure that the framework the delegated legislation provides can best be implemented to support older Australians. So we are going to be looking at it really closely. And I'm confident that we will be able to work with the government, and that the government is going to be able to work with providers, workers and, most importantly, residents, to make sure the delegated legislation is appropriate.

Fundamentally, the issue with rural and regional facilities being able to access staff comes down to how many people are in the workforce. To tackle that we need to address the underlying issues about the pay and conditions the workforce is experiencing. We need to create an aged-care sector where nurses really do feel that the work they're doing is sustainable, that they're being paid well and that they're being valued and rewarded. We look forward to seeing the outcome of the Fair Work Commission's review into the pay levels of aged-care workers. As you know, the Greens are supporting a 25 per cent increase in pay levels for aged-care workers. Across the board, we need to be improving the pay and conditions of workers in the care industry so that it does become an attractive career path for more people and so that it does become a field where people feel they can work in sustainably—like Glenn, who has been in it since 1978—and so that it brings nurses back into the workforce who at the moment feel burnt out, who don't feel supported, who feel underpaid and who feel that there are other things they would prefer to be doing.

As we talk about the importance of implementing the recommendations of the royal commission and improving care for older Australians, there are a number of other points I would like to raise that we will keep on advocating for and that aren't being addressed in this bill. I look forward to continuing to work on them in the context of the complete review of aged-care legislation that is also underway. The first is the use of restrictive practices, which is something that my predecessor in this portfolio in the Greens, Senator Siewert, pursued relentlessly. I intend to continue focusing on that. I want to thank the advocacy groups around the country who have raised that issue with me. Nobody's human rights should be undermined for corporate profit, and this is something that we will keep on fighting for. I'm disturbed that since the royal commission showed the inappropriate overuse of restrictive practices—the royal commission highlighted it as a key issue—the data so far has shown that there hasn't been any reduction. So it's something that clearly needs to have ongoing attention paid to it.

The nurses I spoke to yesterday, when I was talking about restrictive practices, also noted the massive link, the correlation, with the size of the workforce and the importance of having enough people to actually be able to work with older residents so that it's not just the quick fix of restrictive practices. Often, despite their best efforts, they're without the workforce that's able to sit down and talk through issues with residents suffering from dementia and to give them that sense of being heard and being supported. Those restrictive practices are something that they then fall back on.

The other issue that I've consistently raised is allied health, and I continue to do so. It's reflected in the second reading amendment that's been circulated in this chamber. This legislation is addressing care minutes for registered nurses—it's a really important issue—but we remain concerned that the changed legislation now is not giving the same level of support to allied health professionals. We need to be ensuring that allied health is given the support and the serious attention it deserves, because the care for older Australians is genuinely multidisciplinary and is determined by a team approach. When all allied health professionals are there, residents in aged-care facilities, and older Australians in general, can access the levels of allied health care that they need and that they deserve.

Finally, I would like to make the point that there are a number of recommendations in the royal commission's final report that relate to palliative care—in particular, recommendation 80. That focuses on ensuring that dementia and palliative care training are available to everyone in the aged-care sector. Given that context, it's extremely concerning that we understand the work of the palliative care peak body is at risk due to funding cuts. That's an issue I'm going to be examining closely in Senate estimates.

In conclusion I would like to thank Minister Wells's office for their close engagement on this bill and the work that they've done in bringing it to the parliament. This is a piece of reform that has been a long time coming. It is going to make a crucial difference to people's lives. I would also like to thank Senator Ruston for her close engagement on this legislation, her work with me and her advocacy for the sustainability of smaller providers in rural and regional Australia, who are such a critical part of our aged-care system.

This is important legislation. We want to see it passed, and we want to see it passed today. It needs to be passed today to be supporting older Australians. We have a second reading amendment reflecting our advocacy on restrictive practices and allied health care, which are issues I will continue to engage on. I am very pleased to be able to share the Greens support for this legislation. We hope it will be passed by the Senate today.

Slade Brockman (WA, Liberal Party) Share this | Link to this | Hansard source

I rise to make a relatively brief contribution today on the Aged Care Amendment (Implementing Care Reform) Bill 2022. Senator Ruston has outlined the coalition's position on this bill. I foreshadow that I will be moving a second reading amendment. Senator Ruston did describe it in part, but I will also talk through it.

I just want to pick up some of the comments from Senator Rice. I have no doubt about her commitment in this space, but the challenges facing particularly smaller rural and regional providers are so fundamental. I've visited so many providers with relatively low numbers of people in their care. They are just struggling. The number in the centres varies, but there can be as few as eight. But centres in regional areas with numbers in the 20s and 30s are struggling in a very fundamental way. They find it extraordinarily difficult to find staff. When they can find staff they are often poaching them from the local GP or the local hospital. So placing a new requirement on these small rural and regional centres has the potential for centres to reconsider their operation. This is why the opposition is so keen to see the regulations that underpin the vast bulk of the changes embodied through this legislation.

Centres are struggling at the moment. In so many country towns in WA they can't even find a house for health professionals, let alone find the actual professionals. In towns up north in WA that I visited recently nurses are working on fly-in fly-out rosters. They can't attract nurses to live permanently in those towns. The challenges are manifest. That is why the exemption clauses in the subordinate legislation are so important. That's why the coalition are so keen on seeing those clauses prior to this legislation being implemented. As I've said, we would like to see a copy of those draft recommendations to parliament as soon as practical. That is what would allow us to be certain that those smaller rural and regional centres in particular are not going to be adversely impacted.

I think it's important to note that our nursing community have worked tirelessly over the last few years. The pandemic has been an extreme challenge particularly for aged-care providers and right across the healthcare sector obviously. The support that nurses have provided to older Australians in aged-care homes has been absolutely outstanding. Nurses stood up when it mattered most to protect our older Australians. We know, having gone through those times, that we will always—and I know this place on many occasions did so—state our gratitude to the work of nurses in particular as well as all health professionals.

In responding to the aged-care royal commission in this bill, we are seeing a time frame that isn't consistent with the royal commission's final report and something that does potentially have some negative impacts, particularly on those rural and regional providers I spoke about earlier. I will now end my remarks there, and I will formally move my second reading amendment.

David Fawcett (SA, Liberal Party) Share this | Link to this | Hansard source

We'll get you to move that later, after the first one has been dealt with. Senator Pocock, you have the call.

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

Thank you, Acting Deputy President. I rise to speak in support of the Aged Care Amendment (Implementing Care Reform) Bill 2022 and would like to start by echoing Senator Brockman's acknowledgment of nurses and what they have done for our communities across the country during the pandemic. They are some of the heroes of the pandemic. They have worked tirelessly, many to the point of burnout, and they continue to deal with massive workloads, burnout and low pay. This is a welcome first step to acknowledge that and start to put things in place to ensure that not only nurses are better supported but also people in aged care are better supported. I'd like to acknowledge the work of the ANMF and the registered nurses in the gallery today.

Much has been said about our aged-care system in this place since the aged-care royal commission, and rightly so. We've heard the stories of senior Australians being left to die without dignity in the very places that are meant to look after them. We've heard stories of pain, heartbreak and anguish. We may never know the full extent of the suffering that has taken place in aged-care facilities across the country over the past couple of decades, but we do know what the way forward needs to look like.

The aged-care royal commission gave us the blueprint for reform and laid out what is needed to ensure residents receive high-quality care in aged-care facilities. This bill achieves part of that vision. Principally, it enacts the requirements for all aged-care facilities to have a registered nurse on site and on duty 24 hours a day, seven days a week. This requirement would come into effect on 1 July 2023. This actually goes above and beyond what was recommended in the royal commission, but I know it is a commitment that has been welcomed widely by older Australians and advocates across the country. Simply, having a registered nurse available in every aged-care facility at all times will lead to better health outcomes for residents. It will ensure there is better monitoring of the health of aged-care residents. It is hoped that we will see fewer people transported to hospital for issues that would otherwise be prevented through early identification and intervention.

I want to echo what I've heard from aged-care advocates and those that work in aged care: one nurse should be the bare minimum. This bill does not put a cap on the number of nurses required in aged care; it sets a minimum standard of at least one nurse, 24 hours a day, seven days a week. There will be nothing preventing providers from employing more than one nurse, and I hope these decisions will be made based on the needs of residents over any other factor.

Throughout the inquiry, I heard concerns about how the exemption framework was established by this bill. On the bill's first reading in the House, it contained no safeguards for the granting of exemptions. It allowed the government, without limitation, to write and then enforce their own rules in exempting providers from the RN requirement. Technically, it would have been feasible for the government to exempt providers indefinitely from the requirement. I did not think that that was appropriate. I was pleased to work with the Minister for Health and Aged Care to move amendments to this bill that strengthened the safeguards.

This bill now contains some important provisions that limit the government's ability to provide exemptions, in line with what was intended by the royal commission. Any exemption must now be time limited and cannot exceed 12 months without review. The need for exemptions may differ markedly across the country. I acknowledge the challenges of regional and remote areas as highlighted by Senator Ruston, Senator Brockman and many others in this place.

Some providers may initially require more time to recruit the necessary workforce, and, in this instance, a longer exemption may be required. Some facilities may have a limited workforce, and, if one nurse were to become sick, an exemption may then be needed for a short period. Therefore, I think it's important that there is flexibility in the time limits provided, but none should exceed 12 months without looking at whether circumstances have changed for that facility. Importantly, the government will now also be required to consider the safety of aged-care residents in granting an exemption and whether alternative arrangements are in place to keep people safe and healthy during that period. Finally, all exemptions will need to be published in full view of residents, their families and aged-care watchdogs. This will provide another accountability mechanism to ensure the exemption power is not being overused.

Cumulatively, these changes ensure that the one-RN requirement cannot be watered down. If we're going to make this a minimum standard, then it should apply to every facility in the country. We should not be setting different standards based on postcodes. Those living in regional and remote areas should be entitled to the same standards of quality and safety in aged care as those living in the major cities. There is no doubt that, for some providers, recruiting and retaining an appropriate workforce to meet this requirement may be very difficult initially, but the exemption framework will assist with this.

This also speaks to a broader issue around the availability of skilled nurses across the health system and how we attract and—importantly and crucially—retain them. It seems to me that there's been an undervaluing of nurses for some time now, particularly in aged care. I've heard many stories of aged-care nurses moving to other places, like the NDIS, simply because they're being paid more and they have fewer patients to deal with. We're now realising what a precious resource nurses are and how much catch-up work we need to do to value them.

I implore the government to look at this holistically and consider how we are training, recruiting and retaining highly skilled nurses in all corners of our health and aged-care systems. I thank the minister once again for her collaboration on this bill. This is not the end of the road when it comes to reform, and I look forward to working with the government on continued reform that will improve the lives of people in aged care across Australia.

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

I'd like to thank all senators for their contributions in this debate on the Aged Care Amendment (Implementing Care Reform) Bill 2022. This is a really important bill that delivers on some key election commitments of the Albanese government, so we're very pleased to have this legislation before the Senate so early in the term. More importantly, this bill will also deliver the care that our older Australians need and the support that our aged-care workforce deserves.

At the outset, I'd like to thank officials from the ANMF who are in the gallery today and Glen O'Driscoll, an aged-care nurse who I know has been very involved in the discussions around this bill. Thank you for representing the many thousands of nurses who work in aged care and have needed, for a long time, a government that backed them and provided the support that they deserve so they can fully care for our older Australians, and thank you for your participation in this really important bill.

As I say, this bill makes important practical changes to the delivery of aged-care services and provides greater transparency on what funds are being used for. The measures in this bill put the quality of care and safety of older Australians first, just as the Albanese Labor government has committed to do. The bill introduces a new responsibility for approved providers of residential aged care and of specified kinds of flexible care to have a registered nurse on site and on duty at every residential facility 24 hours a day, seven days a week, from 1 July 2023. This will save thousands of unnecessary trips to hospital emergency departments and will ensure that older Australians living in residential aged care have access to the nursing care they deserve.

I remember talking about this policy in the run-up to the last election, and I think most Australians were shocked to learn that there was no requirement for residential aged-care facilities to have a registered nurse on duty 24 hours a day, seven days a week. Unfortunately, that was one of the legacies left by the former government's regulation of aged care, and it's one of the factors that contributed to some of the appalling incidents we saw in aged-care facilities around the country.

I know very well, from spending time in aged-care facilities, that the staff there work incredibly hard but just haven't had the resources that they need to be able to provide the care they want to provide residents of aged-care facilities. The change we're making in this legislation will go a long way to doing that.

I note that some of the contributions from opposition senators questioned the ability to deliver on this promise in rural and regional areas. That is a serious issue, and I noticed Senator Brockman talking about the difficulty that rural and regional providers have in obtaining staff and housing. I've got to say: this is exactly the problem that has arisen as a result of 10 years of neglect of the aged-care system.

For an opposition senator to now be saying that we can't do what we need to do for our older Australians because of problems in skills and problems in housing—well, I'm sorry, but the opposition had 10 years to do something about these issues and failed to do so. We finally have a government that is prepared to make the regulatory changes required and back it up with real resourcing, to fix the problems in the aged-care system that the last government left for 10 years.

We are conscious that there are massive skill shortages in the aged-care sector, and they have grown over 10 years of doing nothing by the former government. That's why we have already established a wide range of programs to support providers to attract and retain staff. These were things the former government never did in the 10 years that they had to do something about this.

For example, the Workforce Advisory Service is available to assist providers attract, retain and build the skills of their workers. Subsidised vocational education and training places are widely available to train personal care workers, and the Rural Locum Assistance Program supports providers with recruitment challenges. Initiatives specifically aimed at nurses include a transition to practice in aged care for newly graduated nurses, scholarships and the nurses' retention payment, and local guidance is provided through the department's regional stewardship network.

Another thing that the former government failed to do in the 10 years that it was in power was do anything about the wages of aged-care workers. They wouldn't even take a position when the case was taken for the wage rise that aged-care workers were seeking. I was incredibly pleased to see the Albanese Labor government make a submission to the Fair Work Commission in support of increased wages for aged-care workers, and, of course, we have committed to funding the outcome of the case.

Rather than the hand-wringing that we see from some members of the opposition, saying that this is all too hard and can't be done, this government is actually stepping up to the plate and doing things that the former government didn't do in the 10 years they had to do something while in power. We're serious about fixing the skill shortage in aged care. We're serious about making sure that older Australians get the care that they deserve. That's why we're introducing this bill and making a lot more resourcing available to the sector.

We acknowledge that there are going to be challenges in some rural and regional environments, and that's why this bill sets up a system to provide exemptions for the rare cases where this requirement can't be met and the process for that to be worked through between the department and individual providers. We acknowledge that it's going to be a challenge, but we're putting significant resourcing into this to back up this commitment. Again, that's something the former government failed to do in any one of its 10 years in office.

Beyond the provisions about 24-hour nursing, from 1 January 2023 this bill also introduces powers to enable the government to cap administration and management charges for older Australians receiving a home-care package and removes the ability to charge care recipients for ceasing care. There is currently little transparency in how providers set their prices for care and package management, and there is no cap on how much they can charge.

The royal commission heard that some providers were charging up to 50 per cent of home-care package funding for administration and management. The bill will provide the means to ensure high levels of administration and management charges reduce, to stop the rorting and to make sure that the maximum amount of funds instead go directly towards meeting people's care needs. Again, this is something that should have been done by the former government, but it's taken the election of a new Labor government to actually make change on this front.

Finally, the bill will also include amendments relating to the transparency of providers' financial information and other valuable information about providers' operations. This will empower older Australians and their families to make more informed choices about their care and will make transparent to taxpayers how aged-care funds are being used.

In wrapping up, the Minister for Aged Care would also like to take a moment to acknowledge and thank the Senate Community Affairs Legislation Committee members for their time and contributions in the consideration of this bill and the subsequent report. The minister wants to reassure those who have taken the time to participate in these processes that we've heard you and the issues you've raised. As a result, the government moved a number of amendments which clarify some points which would otherwise be in subordinate legislation.

The minister would like to thank Senator David Pocock and his office for their productive engagement on these amendments, as well as all members and senators who have engaged with the minister and her team.

The government acknowledges comments raised during the inquiry process around ensuring appropriate levels of consultation for the delegated legislation. We agree that there should be consultation about the detail, and there will be.

In relation to the recommendation made by the Australian Greens in the inquiry report, the government consulted broadly, during the drafting of both the Aged Care and Other Legislation Amendment (Royal Commission Response) Act as well as this bill, including with aged-care providers and allied health specialists. The government supports robust consultation and will continue to consult with the sector and invite commentary on subordinate legislation moving forward.

We also acknowledge recommendation 4 made by Senator Pocock in relation to introducing a review mechanism for exemption decisions. We agree and the Quality of Care Principles 2014 will be amended to provide for a decision of the secretary to grant an exemption to be a reviewable decision for the purposes of the Aged Care Act 1997 in accordance with existing provisions around reviewable decisions.

The government is committed to driving meaningful aged-care reform and will continue to work through the details with the sector, unions, older Australians and our colleagues in this chamber and in this parliament. We want to do this reform once and do it well for a lasting, positive impact on people's lives, and that will require us all to work together to make that happen. Again, this bill is another step towards fixing the terrible problems that were left to us and left to Australians in the aged-care system by the Liberals and Nationals. This is a very good piece of legislation and I encourage all senators to support it.

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

The question is that the second reading amendment moved by Senator Ruston be agreed to.

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

I move:

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

(a) notes that:

(i) the Royal Commission into Aged Care Quality and Safety called for the use of restrictive practices in aged care to be based on an independent expert assessment and be subject to ongoing reporting and monitoring, and

(ii) a lack of legislative provisions to ensure aged care residents can access adequate and appropriate allied health services may reduce the level of care they receive, with clear implications for their health and wellbeing; and

(b) urges the Government to ensure that its response to the Royal Commission includes urgent action to reduce the use of restrictive practices and to ensure that allied health care is appropriately funded".

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

The question is that the second reading amendment moved by Senator Rice be agreed to.

Slade Brockman (WA, Liberal Party) Share this | Link to this | Hansard source

I move the second reading amendment as circulated in my name on behalf of the opposition:

At the end of the motion, add "and further consideration of the bill be made an order of the day for 2 sitting days after a draft of legislative instruments relating to both of the following matters are laid on the table:

(a) exemptions from the responsibility relating to registered nurses (proposed section 54-1A); and

(b) information about aged care services that must be made publicly available (proposed section 86-10)".

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

The question is that the second reading amendment as moved by Senator Brockman be agreed to. I remind senators that once I have called the tellers, you need to be sitting still and not standing.