Murray Watt (Queensland, Australian Labor Party, Minister for Employment and Workplace Relations) Share this | Link to this | Hansard source

The final report of the Royal Commission into Aged Care Quality and Safety was a damning assessment spanning five volumes summed up in one word: neglect. The report illuminated a systemically failing system where treating older people without dignity was normalised. The report highlighted a sector mired in crisis due to a lack of ambition. Most Australians were shocked by the findings of the royal commission. Commissioners pulled the curtains back on a macabre theatre that had been left to decay in the dark despite the best efforts of brave advocates. But others weren't surprised by its findings at all. The final report validated their trauma and painful lived experiences in black and white for all to read. The royal commission delivered a stern rebuke. It said that we as a nation had let older people down. And yet it wasn't just about the past or the present; it was also about the future—tomorrow, next week, 20 years from now and beyond.

Since the final report was tabled three years ago, 136 recommendations of the royal commission have been addressed, 58 of which are directly addressed today as part of the Aged Care Bill 2024. This moment marks the most impactful aged-care reform in Australia in 30 years. The Aged Care Bill delivers recommendation 1 of the royal commission: to introduce a new rights based Aged Care Act to replace the Howard era Aged Care Act 1997—a new act to put older people, not providers, at the centre of aged care.

Since the election of the Albanese government in 2022, we've worked hard to fulfil the mandate delivered by the royal commission. The very first act of the 47th Parliament was passing aged-care legislation responding to the royal commission. Its passage delivered a new funding mechanism for residential aged care, a sector-wide code of conduct, an expanded Serious Incident Response Scheme, and stronger provider governance. The Aged Care Amendment (Implementing Care Reform) Act 2022 came shortly after, delivering greater transparency, capping home-care fees and, most importantly, putting nurses back into nursing homes. The creation of an Inspector-General of Aged Care reinforced the Albanese government's commitment to being open with the Australian public about how aged care is administered and how it is being reformed. It demonstrated that we are holding ourselves to the same high standard that we expect of the sector. It made aged care more transparent, with star ratings for residential care, empowering older people and their families to make informed decisions. The addition of the Dollars to Care program and star rating profiles holds providers accountable for how they spend their budgets, and the Albanese government's $11.3 billion investment in a historic pay rise for aged-care workers is important as well.

These reforms have had a tangible impact on the lives of older people and the friends, families and workers who care for them. Right now, there is a registered nurse on site in aged care 99 per cent of the time in Australia. Older Australians collectively are receiving an additional 3.9 million minutes of care every single day, 1.7 million of which are delivered by qualified registered nurses. There has been a statistically significant decrease in the proportion of residents experiencing polypharmacy, antipsychotic medication use, falls that result in major injury, use of physical restraints, significant unplanned weight loss, and consecutive unplanned weight loss. Trend analysis for the most recent quarter shows that, for the first time, the prevalence of one or more pressure injuries is declining over time. We are also seeing improvements in the star ratings data, with fewer one- and two-star ratings and more four- and five-star ratings.

This is incredible progress, and I want to thank particularly the aged-care workers who have delivered this care. But there is more work to do, and our mandate continues. Since 1997, aged care has been in a slow state of evolution. Some changes have been far-reaching and others incremental. But, as Jim Carey, a 94-year-old aged care resident and members of the Council of Elders, said earlier this year:

When you're building something, the first thing you need is a good foundation, and right now aged care doesn't have a good foundation.

Jim's right. Aged care doesn't need a renovation. It needs a revolution, and that's what this bill and the other reforms of the Albanese government are delivering.

The primary focus of the 1997 Aged Care Act is the funding and operation of aged-care providers. It lacks purpose, values and mission, and it lacks a focus on people. We all have at least one person that immediately comes to mind when aged care comes up in conversation or on the news—a grandparent, a loved one, a neighbour or a friend. For me personally, it's my father, and so many others are in the same situation. The new rights based Aged Care Bill we are introducing puts older people and the services they need front and centre. It promotes positive attitudes towards ageing. It empowers people with choice and control in the planning and delivery of their care. It builds trust and confidence with strong regulation and complaints mechanisms that prevent mistreatment, neglect and harm from poor quality and unsafe care.

The cornerstone of this bill is a statement of rights underpinned by Australia's obligations under the International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of Persons with Disabilities. The statement of rights outlines what all Australians can and should expect from aged care—person centred care that is culturally safe and trauma aware, dignity and respect, individuality and diversity, independence, choice and control, dignity of risk and privacy. The rights of older people will be embedded in care delivery in the way workers are trained and in the way people talk about the care they receive.

We heard that rights need to be enforceable but also balanced. Including a statement of rights in this bill is not about opening the litigation floodgates; it's about empowering older people to have conversations about the dignified care they deserve. Under this bill, providers must take all reasonable and proportionate steps to act in accordance with the statement of rights. This is backed up by an enforceable registration condition that will make sure providers have practices in place to deliver care consistently with the statement of rights. In plain English, if a provider breaches the rights in this bill, the Aged Care Quality and Safety Commission will have tough enforcement actions at its disposal.

The bill also introduces a new model to embed supported decision-making across the care system. Supporting older people to make decisions for themselves for as long as possible is at the heart of this bill, recognising that, in a system that prioritises dignity and respect, the will and preferences of older people must always come first. As Rosemary, an 84-year-old aged-care resident, said:

We are still people even though we are in aged care and we have the right to live our own lives and be treated with respect and dignity.

The rights in the new Aged Care Act will give me more autonomy over my decision making and my daily life.

We have been contributing members of Australian society all our lives and we don't suddenly become inanimate objects when we enter aged care.

The royal commission was clear about the need to create a duty of care for providers which will hold them and the people in positions of leadership accountable when things go wrong. In line with their recommendations, this bill includes new duties on providers and a limited group of people in leadership roles. The duties mean that providers and responsible persons must not act in a way that puts older people in their care at risk or actually causes more harm. The duties are carefully targeted towards the most egregious conduct. Leaders who fail to fulfil their duty of care without reasonable exception will face significant civil penalties. Good people who understand the responsibility that comes with caring for older people should in no way be deterred from taking on positions of responsibility because of these new duties.

There are a number of other significant changes that this bill makes to the delivery of aged care to Australians. It brings together the complex, multiple entry pathways criticised by the royal commission with a single culturally safe entry and assessment pathway. It builds a stronger regulator and an independent complaints commissioner. It invests in and assists the workforce which is so critical to delivering the aged-care services that our elderly deserve and need in our country. It significantly adds to the support that older Australians will receive at home, because we know that older Australians want the freedom, support and choice to remain in home and with the community that they love. This bill also makes significant reforms to the finances surrounding aged care. These reforms are important. To deliver them we need a sustainable funding system, and that's what this bill will deliver through the amendments that it's providing.

In conclusion, this bill has the potential to provide a new and enduring foundation for the Australian aged-care system, from 1 July 2025 and for years to come. From then on, aged care will put the rights of older people first. The new Support at Home program will support all of us to live independently in our own homes for as long as possible as we age. The aged-care system will be fair and financially sustainable, with those who can afford it making contributions toward the cost of their own care. Older people will be cared for by skilled workers who are properly respected and fairly paid, and this bill puts high-quality, safe and compassionate care and services first. It implements a system of caring for older people living with dementia that incorporates contemporary, evidence-based care, and it delivers our election commitment for better, more appetising and more nutritious food, underscored by new food standards. We cannot realise this potential if senators do not come together and pass this bill, so I urge the Senate to support this bill to deliver the long-term, sustainable and high-quality care that older Australians deserve.

James McGrath (Queensland, Liberal National Party, Shadow Assistant Minister to the Leader of the Opposition) Share this | Link to this | Hansard source

The question is that the amendment moved by Senator Kovacic be agreed to. A division is required, but, because it's after 6.30 pm, it will be deferred till tomorrow. The debate is adjourned accordingly.