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

Minister, I'm keen to get a bit of a clearer understanding about the transition that is going to be undertaken over the six months between when this bill is passed, we assume, and when it needs to come into effect. I was wondering if you could guarantee that all of the departments that are required to be involved in the implementation of this reform and the changes will be ready in sufficient time to not only be able to implement the changes by 1 July but also be able to implement the changes within the necessary government departments that will enable the sector to be ready to implement in full the proposed changes by 1 July 2025.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I thank Senator Ruston for the question. I also acknowledge the work that has gone on between her office and the minister's on this bill. Yes, I can give you that commitment. These changes have been developed over a period of time, as you are aware. There has been a lot of work put into not only supporting this legislation but also consultation with the sector and obviously across governments and agencies with the passage of this bill, and that's why it is important to get this bill dealt with today. We will be giving the certainty they need to implement the changes so that they are able to commence in full on 1 July 2025.

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

I'm interested to understand what other departments or agencies in addition to the Department of Health and Aged Care will be involved or be required to be involved in the transitional reform?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Obviously, there would be Services Australia. There will also be, I would expect, some central departments involved. This is a significant reform and they have been to date, so I would expect that would continue. The Aged Care Commission and the Department of Veterans' Affairs as well have all of been involved to date and that will continue.

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

Is there a costing allocated against the changes that will be required for each of these agencies? And where is that funding coming from?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

There's been some funding allocated for investment in the ICT in the department of health, as I recall. I'm trying to go back, so if I can find you more information on that, I will. I might come back to you to see whether we've made any other provision but, as far as central coordination and things like that would go, we would expect that to happen within existing resources, but there has been allocation, as I recall, for the IT support that's required.

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

In the last budget there was $1.2 billion allocated to ICT. What proportion of that ICT funding is allocated to the implementation of the reforms contained in this package?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I was checking some detail there. All of that $1.2 billion is allocated for the implementation of the aged-care reform.

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

So of that $1.2 billion allocated to the reform, how much is allocated to internal government ICT changes? And is any of the $1.2 billion available for external activities?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I am just checking the detail there. The $1.2 billion is for internal to government systems. Also, eligible providers will be able to apply for up to $10,000 to assist with the costs of any IT changes needed to prepare for 1 July. The department is currently finalising the arrangements for that grant opportunity, so providers will get that information in coming weeks. I'm checking if we can provide you with a global figure for that.

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

I'm taking from that answer we don't have a specific amount of money allocated to that grant program?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I'm trying to get that information for you. There would be.

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

So do I read into that the maximum amount of the grant will be $10,000 per provider?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Yes.

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

When is the expectation that this grant program is likely to be finalised sufficiently for the sector to be aware of it?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

As I mentioned, I don't have a specific date for you, but the advice I have is that the department is progressing arrangements for that, with further information expected to be published in the coming weeks. I would expect that that would mean this calendar year—that's the information I have—and the global figure is $10 million.

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

Senator Ruston?

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

I'm sorry; it's just that my brain is trying to work out how many ten thousands go into $10 million, and one would think it would be a thousand. Will there be eligibility criteria that will be allocated against that grant program? Can you give us an idea about who would be eligible for that $10,000 grant program, or is it anybody who applies?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

That will be all clear, through the grant opportunity guidelines, which would need to be finalised, but eligible providers would be Support at Home providers.

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

I'm keen to understand whether the department has any information around what they are expecting the likely cost to all providers—whether they be home-care or residential-care providers—of the ICT changes that each and every one of those are going to be required to undertake.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I don't think there is a specific figure. Providers will vary, I would imagine, in their existing capability and systems. This would be something that the transition taskforce would monitor. That has been set up. It's headed by Anne Burgess and it's having its first meeting next week, as a way of troubleshooting and responding to concerns that providers might have, at the earliest opportunity.

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

Can I just confirm: you said that it was only for Support at Home or the transition from home care to Support at Home providers, but somebody who is a residential aged-care provider is not eligible for this grant?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The grant program is designed to support the Support at Home providers. I think the rationale behind that would be that they are the ones facing the most significant changes, and that's why the government has provided $10 million to support providers to apply for those grants, up to $10,000.

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

During the inquiry process we heard from a number of providers, and probably the biggest issues—outside of the fact that they didn't have the information they needed to put in place the changes that they are going to be required to, under this new reform package—was not just the timing, in terms of the implementation, but also the costs that were associated with it. We heard from a number of providers—not just home-care providers but also residential aged-care providers—that they saw this as going to be a very significant burden, in terms of their ICT upgrades. In fact, during the inquiry we heard from one provider—and not necessarily the biggest provider in Australia, I might say—that they thought the cost of the ICT changes was likely to be around $4 million for their organisation alone. As to the $1.2 billion that was put aside in the last budget for the ICT changes, you've confirmed that is entirely for the implementation of the ICT changes required within government agencies for this reform. So the government's set aside $1.2 billion for that, but they've set aside $10 million to support only Support at Home providers with an amount up to $10,000. I'm very keen to understand the process that went behind the decision-making of the requirement for the government to need $1.2 billion for ICT changes. Does the government have any idea of what the quantum of the cost of ICT changes is going to be across the entire aged-care sector—home care and residential care and any other providers, stakeholders or the like—that are likely to be impacted from an ICT perspective? What is the total cost of the sector's ICT changes going to be on the basis that you believe that we need $1.2 billion to do yours?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The government will be building an entirely new system and new regulatory model and dealing with legacy IT systems to reflect the changes that are being brought in through these reforms. You're talking to the Minister for Finance. I certainly wished it wasn't a $1.2 billion ICT spend, but there had been some pretty detailed work done on the cost of that, including some assurance testing. That is what it is.

In terms of costs of providers, it is hard to give what it will mean per provider. I think the expectation is that the Support at Home providers will be the ones facing the most significant change. I understand that there will be uncertainty from providers as these reforms come in, but that's exactly why this transition taskforce has been established. As I said, it will be led by Ms Burgess and will meet for the first time next Thursday. This is exactly why the Minister for Aged Care has established this: to make sure that there's some real early stress testing and opportunity for people to provide feedback about the implementation of the reforms.

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

Am I to take from the response that I've just received from you that the department doesn't have any real idea of what the cost of ICT changes is likely to be on the sector? I note you made the comments about building an entirely new system and them being expensive and about the government being required to build an entirely new system. Aged-care providers are going to be required to build entirely new systems in order to make the changes that are coming. It's not just the government that's going to have to build these entirely new systems.

I want to be clear that the government does not know what the cost of ICT changes are going to be on the sector. I once again put that alongside $1.2 billion that has been allocated to government ICT and the clear recognition by the government of the massive change in ICT that's required to implement these reforms. That's going to cost them $1.2 billion. I'm interested to understand what the process was that the government or the agency have undertaken to determine that the support to the sector is only going to be $10 million against $1.2 billion. It's going to be restricted only to those people in the sector that provide one part of aged-care services—home care. To be really clear: the government does not know or have any idea what the cost of ICT changes is going to be on the sector?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I've just asked if there's any further information we can provide you on this. I think one of your earlier questions was: what is the cost per provider? I'm seeing if there's some more detail that we can get from the department in answer to some sort of expectation of costs. It is hard—based on the difference of capability, capacity, size and scope of eligible providers or aged-care providers—to give you a per provider figure.

I'm advised that in residential aged care the system works with providers reporting into the government system. That's why there isn't an expectation that there would be significant ICT costs for residential providers, because it's a reporting in program rather than them having to have a specific program. But, as I said, we would expect the taskforce to be responsive to concerns that are raised around this. If there is a further figure I can provide you that's of particular use for your information, we might need to come back to it. But I have sought that information.

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

Has the department, the minister or the government consulted with aged-care providers to get some sort of idea about the cost? Bearing in mind, and I take your point very clearly, that there is a huge range of different sizes and shapes and types of providers out there, I'm not expecting you to say, 'It's going to cost X for every provider.' Has the government consulted more broadly with providers to try to get an understanding of the scope of the quantum of the cost? I'm certainly not asking you to give me a cost per provider.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

There has been extensive consultation between the IT side of the department of health and providers, and they are continuing. I think the phrase is 'tech talks'. There has been regular and ongoing consultation around this specific matter.

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

I can dig through the inquiry where there was an extensive number of submissions provided where people were really concerned about the cost of ICT changes to their organisation, particularly as every cent that's spent on ICT is not a cent being spent on frontline services. I'm keen to understand, on that basis, how we can have a situation where you've consulted widely with the sector—we know at least one that said $4 million and you've come back and said, 'Up to $10,000.' If you're doing consultation with the sector, or 'tech talks' as you refer to them, then how on earth is that consultation actually flowing through into the decisions of government reflecting those consultations if you're providing $10,000 to a limited number of providers and providers are saying up to $4 million is what it's going to cost them for ICT? There seems to be a disconnect between the consultation and the decisions of the government in response to that.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

In further response to this, all I can say is the government is consulting. We do want to assist the sector with this transition. The transition taskforce no doubt will be dealing with this if providers come forward with this as a significant concern.

We think the grant program that has been established will help and assist providers who are facing the most significant change with the Support at Home program. Obviously that work is going to be ongoing. Part of it is actually landing this reform bill today so that there is certainty about the system that is being introduced, or how the aged-care system is going to look from 1 July, and that will allow people to concentrate and focus on any additional costs.

I don't have a global figure for you, but I am advised that Services Australia has engaged with software vendors this month on Support at Home and some key software systems that will be updated are used by many providers if that's of any help.

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

I understand Senator Tyrrell has a few questions. I'm quite happy to cede to Senator Tyrrell.

Tammy Tyrrell (Tasmania, Independent) Share this | Link to this | Hansard source

Thank you, Senator Ruston. Both the Royal Commission into Aged Care Quality and Safety and Dementia Australia recommend that all aged-care workers should undertake ongoing training in dementia care. I understand the requirement for dementia training is part of the rules, but those rules are still in consultation. Can you guarantee in this bill that ongoing dementia training will be required for all aged-care workers in residential facilities and for all those who provide at-home support?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Thank you, Senator Tyrrell, and thanks for the heads-up. Yes, the government recognises the importance of ensuring that ongoing dementia training is required of all aged-care workers. We will not be taking that requirement out of the strengthened quality standards.

Tammy Tyrrell (Tasmania, Independent) Share this | Link to this | Hansard source

Minister, older Australians living with dementia deserve a high level of care, and the workers who provide that care deserve investment in their professional development. I believe dementia care should be a mandatory unit at the Certificate III level. Will this government commit to setting a mandatory minimum level of dementia care for all aged-care workers in residential facilities and who provide at-home support?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I thank Senator Tyrrell for the question. The government does not currently mandate that personal-care workers hold a specific qualification type or level. The government does encourage all workers to undertake training to increase their skills, knowledge and confidence to provide safe, high-quality care to older Australians. There is funding available to support aged-care workers to obtain relevant qualifications, including the Certificate III in Individual Support, and aged-care providers are responsible for ensuring that they have a sufficiently skilled and qualified workforce through the quality standards. I can also confirm that government is preparing to commence consultation on the skills and training elements recommended for inclusion in the national worker registration scheme for personal-care workers that was recommended by the Royal Commission into Aged Care Quality and Safety.

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

Minister, the royal commission recommended that training protocols be designed for the sector. I'm wondering: have those training protocols been designed, and what progress has been made in terms of allowing the sector workforce to have access to those protocols?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I'm just getting you a more fulsome answer, but the quality standards will have ongoing and mandatory requirements around training for staff. The department and the safety commission are developing an integrated readiness plan to support the transition from changes arising under the Aged Care Bill. In terms of training, providers can expect resources and guidance materials specific to the changes. Workers will also be supported with tailored information and guidance, but there will be ongoing requirements, as I understand it, for ongoing training for workers. Our Fee-Free TAFE program will support more aged-care workers to obtain relevant qualifications, including the Certificate III in Individual Support, and those quality standards will further enhance and clarify provider responsibilities, including that workers are skilled and competent in their role, hold relevant qualifications and have relevant expertise and experience to provide quality care and services. The department will also be consulting on the English language proficiency and training requirement elements of the national worker registration scheme for personal-care workers by the end of the year.

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

How many people have entered the aged-care workforce as a result of finishing the Fee-Free TAFE courses that you are referring to? Do you have a number?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I will see if we can get that information from government. I do have a figure for across the NDIS and aged care. There have been 130,000 students take up the training in individual care, but that would not specifically be aged care; it would be across the NDIS and aged care. The other thing that has assisted with employment in aged care has been the increase in aged-care wages which have, as I understand from my discussions with providers, significantly reduced separation rates and attracted new staff to the sector.

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

Of that 130,000, how many have finished the course, and how many have taken up work after finishing the course? I understand it's NDIS and aged care combined, but I would be keen to know the rate of translation to people actually standing on the floor and helping to care for Australians?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I don't have the completion rates with me, but I'll see if we can provide them during the course of the day. I imagine some of those are currently undergoing training.

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

I'm not asking you to do this necessarily now, but I would be really interested to understand what the training programs are in relation to those people who are already working within the sector. You've given me some good examples of training outside of the sector, to enter the sector, but I'm keen to understand what the training programs are that relate to the recommendation of the royal commission on training protocols around people that are actually already working in aged care, to make sure that they are working in a manner that's consistent with the new?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Noted.

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

Following on, you've given a guarantee to the Senate that government is ready, in all aspects, for these reforms to be implemented on 1 July with sufficient lead time to enable the sector to be ready to start on 1 July. Does that certainty then flow on so that these changes have no impact on older Australians who are already receiving care?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The answer to that is yes. Obviously, all of these changes are designed around supporting older Australians, both those who are currently receiving care and those who will be moving into the aged-care system. I acknowledge the work that you've done, Senator Ruston, and the work that's gone into the inquiry—which had a very significant number of public hearings considering the time available and did a lot of work, including on the recommendations and the additional comments that were provided to that—to make sure that older people are at the centre of this discussion. I think the whole nature of the reform, and I'm lecturing to the converted here, is about making sure that older Australians get the care they need. The focus of the readiness plan will be on making sure that everyone, including those who are receiving care, is prepared for the changes arising from the bill.

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

I appreciate very much that the purpose of this bill is to make sure that older Australians are getting the kind of care that they should. But I'm keen to understand the certainty which the government is prepared to provide to all older Australians who are currently receiving home care or any aged-care services so that they will not be impacted negatively by these changes in any way.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The minister is absolutely focused on that. I certainly know of all of the work that she has done in consulting and working across the sector, so I'm very comfortable giving that guarantee. Obviously there's a lot of work that needs to be done to make sure information's available so people understand what's new, what's changing and what's staying the same. Providers, as well, will need resources to make sure that they are able to provide information to older Australians using their services. There will obviously be a continued focus on this through the aged-care transition taskforce as well which—I know I'm going to keep saying this today probably—has its first meeting on Thursday. That's really been established to make sure that we're doing everything we can, and that the minister is advised very early, not just from the department but from representation on that taskforce. The taskforce picks up obviously members of the department and the Aged Care Quality and Safety Commission. But when I look across there is the Older Persons Advocacy Network, Anglicare, the United Workers Union, the Council on the Ageing, UnitingCare Australia, the home implementation working group, a primary care expert and independent assurance. It really does pull in all of the stakeholders that will be required to provide independent advice to the minister about the transition and how it's proceeding. There is, in the words of the minister, 'stress testing' of how that implementation work is going, to make sure that, if there are issues, they are identified early and responded to quickly.

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

With the process that's being undertaken by the taskforce, will the taskforce be issuing statements after their meetings or be providing any broader updates that are publicly available in relation to their deliberations, concerns or recommendations to government?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I'm advised—and I don't want to get ahead of a group that hasn't met yet—that they have their first meeting next Thursday. My understanding is that what information is useful for the sector, for providers, will be determined by the transition taskforce. I would imagine that that would be one of the matters that they would deal with at their first meeting. Considering their role is transition and providing advice, you would expect information to flow from the transition taskforce.

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

Just to be clear on that, you said that the decision in relation to what information would be publicly available will be determined by the taskforce. Can you clarify that that means that it will be the taskforce itself? The taskforce that was originally set up that reported to government on the viability of the sector was chaired by the minister. What is the minister's role in this new taskforce?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The minister is not a member of the transition taskforce. The taskforce will be co-chaired by the deputy secretary of ageing and aged care group and an independent representative. The co-chairs will lead the meetings and guide the work. The minister isn't a member of it. Senator Ruston, if you believe it's important that the aged care transition taskforce provides information to the sector, I'm very happy—and I'm sure members of it would be watching this debate—to make sure that the members of the transition taskforce consider that and determine a response. I don't want to tell them what to do, and I don't think the minister wants to tell them what to do, but I think the point you raise is valid. We are undergoing an extraordinary change to aged care. The transition taskforce is being established to troubleshoot, stress test and provide information, and I would imagine that there would be publication of what it's doing and of discussions. I think it's up to the transition taskforce to determine what format that is in, but I'm sure the department will be able to pass on a view from those participating in this debate about the need to share information and be upfront.

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

Just to be clear, what I'm trying to understand is that the terms of reference and the powers of this particular taskforce will be such that it will be the body that determines what information is publicly available. There will not be any other process. I raise this because we saw, during the aged care taskforce, the members put under non-disclosure agreements as part of the deliberations of the taskforce, and we've seen an unusual use of NDAs happen on many, many other occasions. I certainly understand that when they're in commercially sensitive situations, an NDA is an appropriate thing to be used, but in the case of the deliberations of the aged-care taskforce it seemed like somebody was actually trying to make sure that the taskforce was gagged in terms of being able to speak about the things that it was deliberating on. I am keen to be assured, which you appear to be doing at the moment, that the transition taskforce will not be subject to a nondisclosure agreement in any way, shape or form, and it will be the taskforce itself that has power to make the determination as to what information is publicly available because it believes it's in the best interests of a successful transition to this new reform package. I note you said it will be co-chaired by the deputy chair of the Department of Health and Aged Care, so I am assuming that's Mr Lye. Who is the other co-chair, and what is the process in terms of determining what information will be publicly available?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The transition taskforce has quite a different job to the aged-care taskforce. The reason for nondisclosure there, Senator Ruston, as you would understand, was it was considering widescale reform of the aged-care system and so there needed to be put in place some element of confidentiality as people worked through some of what that looked like. They did, as I understand it, issue communiques out of that meeting.

The transition taskforce is a different arrangement, in which the reforms are settled—or they will be once we pass the bill—and will be working across the sector about issues that are arising as we work towards their implementation. There are no nondisclosure arrangements in place. It is a very collaborative arrangement. I leave it to the transition taskforce as to how they would like to update those interested about the work they're doing, but I would expect there to be some level of communication about issues that are arising and things like that. Again, I'm not the minister responsible and I don't want to tell the transition taskforce how to do their work before they've even met, but the fact that you've raised it indicates a level of interest in the work that it's going to be undertaking.

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

I wasn't suggesting that I was asking you to tell the taskforce their role and responsibility, I was just wondering how they were going to be told what their roles and responsibilities were and how they reported. You also made a comment in the previous answer that providers will need to provide resources to older Australians to understand the transition and how aged care is going to be delivered into the future after the passage of this suite of reforms today. In addition to the $10,000 grants that are being made available for ICT to homecare providers, is there any other financial support that is being considered for providers not just in terms of ICT but also in terms of the other requirements for transitions like providing resources to older Australians, training for staff and, more generally, the costs that are associated with change?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Providers can expect resources and guidance materials specific to the changes, such as booklets—including those in different languages and translated versions—updated guides, practical scenarios, system training where required, and tool kits to support communication engagement with their workers. As I said in an earlier answer, workers will also be supported with information and guidance.

The commission has recently consulted on the draft guidance material, audit methodology, and worker-specific guidance for the strength and quality standards, and guidance targeted at older people is also under way to help older Australians understand the strength and quality standards. There is a lot of work going into providing all of the information and resources that providers and older Australians will need in order to adjust or to go through the changes that will be implemented through this reform.

The commission recently released a draft guidance tool, which is a digital platform to navigate the guidance material based on the provider's service type, and a series of fact sheets for each standard as well. The commission recently released a draft guidance tool, which is a digital platform to navigate the guidance for material based on the provider's service type, and a series of fact sheets for each standard as well.

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

Is there any financial support being offered? You have listed a whole range of materials, which are great. But during the hearing we heard from many providers that a day of training was going to cost potentially hundreds of thousands of dollars, particularly for some of the larger providers, and there will be a significant retraining program needed for all of our aged-care workers, no matter what level that they operate at, whether it be very senior and registered nurses, right the way through to our lifestyle care support workers. They will all need to go through retraining. We heard, as I said, during the inquiry that hundreds of thousands of dollars would be the cost of one day of training, because, obviously, if you are taking people off the floor, you have to replace them on the floor. Does the government have any idea of what the costs to the sector more broadly will be for retraining and making sure that our care workers are up to speed with these reforms?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Obviously, the funding that is allocated to the aged-care system is growing, so the investment in aged care, which is in the order of multiple billions of dollars, is provided. You would expect, whilst some of the aspects of training might change slightly to reflect the new standards in particular, providers would already have allocations for training of staff. So there may be some adjustment, but I think there is an acknowledgement that the public funding going into aged care is increasing, and part of that is making sure that they are explaining what they are doing to their workers and to older people using their service. As I said in my earlier answer, whilst there will be updating to that, the department is providing all the resources and guidance material to providers to help them with that job. I might just check that. In a sense, that is my answer. We're not providing specific grants for implementation outside of the ones we have already discussed but we are investing more into aged care in general and we are backing that up with the resources that providers will need to reflect the changes both to their workers and to their clients.

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

To confirm, I am assuming you are not meaning that AN-ACC funding should be redirected to training costs?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I have been given the figure of $39 billion going into the aged-care system in 2024-25. The point I was making was that there is already significant investment going in, and providers are already having to make sure that their staff are trained. I would expect that reflecting the updated changes, which, in a sense are new, it is an existing responsibility of providers to do that. But in addition to that, we are providing a whole range of supporting resources and materials to assist providers with that change and they would, of course, be provided at no cost to providers.

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

You mentioned the $39 billion and we all know the investment by respective governments into aged care has been really significant, obviously reflecting not only an ageing population but also a desire to make sure older Australians have the dignified care they deserve as they age, and I don't think anyone in this chamber would disagree with that. In the $39 billion figure you just quoted, my understanding is that the provision of that is largely in relation to the funding of AN-ACC and the funding of home-care places—obviously the Commonwealth Home Support program—and all the necessary programs that are business-as-usual activities of the funding flow between the federal government and aged-care providers in response to supporting the older Australians they care for. So could you tell me: of the $39 billion, how much is business-as-usual, demand-driven funding, and how much is actually allocated to programs outside of business-as-usual funding?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I'll see if there's anything further we can provide to you, Senator Ruston, but, essentially, the administration costs and on-costs for staff and things like that are factored into the price by IACPA—is that the correct short—

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

IHACPA.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

IHACPA. In home care, as you would know, there's a certain amount that's allowable to be used for providers in, for want of a better word, administration and other costs. But I'll see if there's some way we can split that out, if that's the question you're asking.

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

No, I don't need you to split that out at all. I won't ask you to do that. What I'm keen to understand is: of that $39 billion that you referred to in your response to my question about the costs of things other than ICT, what component is not business as usual but is actually reflecting support for the sector for the changes that are involved in this bill? Is any of that $39 billion actually one-off funding with respect to this activity?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

GALLAGHER (—) (): Okay, I've got you. Outside of the grants that we've already discussed, no, but it would include—and I don't know how we'd separate this out—some of the funding for making sure all the implementation and guidance material and all of that is ready and provided. That would be through the department's operating budget, which would probably be separate to that.

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

I would just like a simple response about how much the department is spending on the implementation of these changes—not on the changes themselves, because obviously they have a separate funding determination, as related to the rules in chapter 4. I'm just keen to understand what the cost of the implementation of this reform is and whether it's contained in that $39 billion or whether it's somewhere else. For example, the $1.2 billion for the ICT changes that would be required for this reform must sit somewhere. Does that sit in that $39 billion? So it's about the cost of this reform to government in total.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Again, I'll see if there's anything more we can provide. That $39 billion is the funding for the provision of care. As to the costs that the department perhaps incurs through its operating budget, I'll see if there is a way of separating that out. I'm not sure, because, again, it's existing budget that's being reprioritised to implementing this reform. But I'll see if there is some way that the Department of Health and Aged Care is accounting for this in a way that provides you with that info.

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

Thanks. In the process of that, I would like to hear if there was any new appropriation that was specifically allocated against the implementation of this reform. Basically, in the same way as the $1.2 billion in relation to ICT, which is obviously a new appropriation in the last budget, have there been other new appropriations or redirecting of existing resources? I would like to have that information so that we can get an understanding of what the total cost of implementing this reform actually is.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

We will see. There wasn't any separate appropriation for that in the budget, but I will see if there is any way that the department is accounting for this within its existing resources.

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

Thank you very much, Minister. Does the minister or the department have any understanding of the broader awareness in the public domain about the changes that are coming in aged care?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I think the first important thing to do is to have the bill passed, because then that would allow more accurate public information and targeted information about the changes, which is all being prepared but obviously can't be finalised until this bill passes. This is that has been talked about over the last couple of years. I imagine there's a level of awareness for people using the aged-care system that there are changes afoot, but I agree that there needs to be much more extensive information provided once the bill passes. So I think that's part of the job today—to make sure that we are in a position to finalise that information both for providers and for individuals who might use the service.

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

Minister, is the government committing to a nationwide public education campaign so older Australians will be made aware of the changes?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

There is some work being undertaken, Senator Ruston, to reflect the points that you have made. We understand that there needs to be widespread and accurate information provided to people through a range of formats. Some of that might be through a general public information campaign, but it's also going to be very essential that we provide targeted information about the reforms to people who are currently using services, to those who might be coming into the system and to their families and carers.

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

Minister, you made the comment that you would provide information to those that are currently in the system. I was wondering if you could outline to me what the changes will be for those people that are currently in the system.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The information would be about the changes that we're talking about here through the bill. So those are the changes to the Aged Care Quality Standards, to what people can expect—to have a system based on the rights of the older person—and to the new regulatory model. All of that, I would imagine, would be part of an information challenge and an information task, including what it might mean for people going forward in the system, things like contribution rates and things like that—not for people in the system now. But that will be part of the challenge, and I imagine it would be an ongoing task.

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

To be clear, is the government committing to do a nationwide information campaign should the bill pass?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Yes. The form that that will take has not been determined. I can tell you there hasn't been anything go through the formal process, like the independent campaigns committee or anything like that. That has not happened. It's waiting for this, and then there will be further consideration. But, yes, we understand the need to provide national information.

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

There seems to be an awful lot that is yet to be determined and an awful lot that is waiting on the passage of this bill. Back to my original question: assuming that we are able to pass this bill today or soon—

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Sooner rather than later?

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

Well, I think we've just moved a motion in this place to make sure it does get passed one way or the other today. I'm keen to understand. Are you still absolutely convinced, given that you've said that you don't know what the grants program is going to look like—even though it seems to have bit of a rough definition around it—and you don't know what the communications program is going to look like, because we're waiting for the passage of this bill? I'm sure, if I asked questions on a number of other things, I would, once again, have a response that says, 'We're waiting for the passage of this bill.' I get that.

But, in the process of that, we still have a deadline of 1 July 2025 for this bill to be implemented. It seems to me that there's an awful lot that has to happen between the passage of this bill, which might happen today, and the implementation on 1 July 2025. You've given an ironclad guarantee that the government will be ready with sufficient time for the sector to be able to implement these changes so that older Australians are not negatively impacted in any way by these changes. You said that we're still waiting on just about all of the rules that are really fundamental in understanding what this reform is likely to look like for older Australians but, most particularly, in making sure that providers are in a position to implement the changes so that this is the most seamless and painless process for older Australians.

We all know that we want older Australians to have a rights based framework through which they receive their care, and we all agree about the importance of making sure that older Australians are receiving the dignified care that they deserve in their older years. Obviously, we have a very tight timeframe. We have a huge amount of information that isn't available to us yet. So I'm keen to understand whether the department has modelled what the level of risk of providers not being ready by 1 July to implement these changes is and what that risk looks like.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I think the focus of the department has been on implementing or getting ready to implement the changes rather than spend resources and time looking at what happens if things don't get done. I think the emphasis has been on how to put in place the new reforms. Obviously, getting this bill finalised is a key part of that.

I know how hard the department and the commission have been working in preparation for this. I know, in the sector more broadly, how much effort has gone in over the last couple of years. I know how hard the minister has been working and indeed, Senator Ruston, how hard you yourself have been working on this. A huge amount of information is already out there, and there's information that's currently before the chamber. This bill formalises and finalises the new aged-care system. There is a lot of preparation, pending the Senate's agreement to this, that is being developed but, of course, can't be finalised until the bill passes the parliament.

I don't know that I entirely agree with your point that there are a lot of things we don't know yet. I agree there is a lot of information that's to be provided, but I think the bill really sets out exactly how the aged-care system is going to work and what people should expect. But, yes, following the passage of this bill, I expect it's going to be a very busy six months for the Department of Health and Aged Care and stakeholders as they work to implement these important reforms.

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

I don't ask flippantly about the risk associated with this, because it was quite clear throughout the entire inquiry, where witness after witness after witness came in and said they were concerned about the lack of detail. I think we got a sense of a genuine preparedness and desire by the sector to make sure that they are ready and that the people they care for or are going to care for into the future are not negatively impacted by their inability to be ready.

I draw attention to this particular issue on the basis that we talked about ICT. That is probably, in a sense, one of the more mechanical things: the more resources you throw at it, the better the chance that you're going to be able to achieve it or achieve the timelines. But we know that there's not a lot of money that's going to be made available to this sector, and we know that, in the last report from StewartBrown, half of Australia's residential aged-care providers, as an example, were still operating at a loss or weren't making a profit.

So this may only be a small burden, and a little bit later I'll be keen to prosecute what you know and what you understand in terms of the impact of these changes on the sector. But there are a number of other things that still remain outstanding that will have a significant impact, particularly on home-care providers, not the least of which is that we're still not expecting the final determinations on pricing for Support at Home until February. So I ask the minister: do we have a firm date for when we will be guaranteed to receive the final pricing determinations from IHACPA?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I understand the answer to that is February.

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

The first or the 28th?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

There will be information provided in December for IHACPA to consider, with a final determination in February.

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

Will the advice that will be provided in February be the final determination of IHACPA, or is there a process that needs to occur within government following the IHACPA determination in relation to final pricing?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

No—I mean, other than the minister releasing the advice. The advice goes to the minister, and the minister then releases the advice.

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

There are multiple questions here. Will the advice from IHACPA be released? Is that the determining advice? Does the minister have any capacity to make any changes on the IHACPA advice? Does that mean that it's guaranteed to be released in February?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

As you know, Senator Ruston, it is an independent pricing authority. That is the reason for its existence—to do these matters independently. It provides advice to ministers, but there would be no expectation that there would be any delay in providing that information more broadly.

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

So the minister will receive the advice in February. I just need to clearly understand: what is the obligation following receipt of that advice for the minister to release that advice and to have it come into effect?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The advice I'm given is that the intention is that that advice would be out as soon as possible and that would be in February.

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

We'll hold the minister to that. I raise this because I am super concerned that the government and the department, particularly under quite extensive questioning and scrutiny over the last few weeks—whether it be through the inquiry or through the estimates process—have given us a bit of an impression that there's nothing to see here, everything's under control, it's all going to be fine and we need not worry about the transition arrangements that need to be put in place.

I don't think anybody in this place—I won't verbal you, Minister, but I think we all accept that this is a pretty significant piece of reform. It's absolutely necessary, and, as I said, we all support older Australians having their rights at the centre of the framework in terms of aged-care delivery going forward. That is something that I think we will all welcome very, very much when it occurs. But there remains a massive amount of concern out there in the public that we've been going along on this pathway to deliver this massive amount of reform without really having any clarity around what the transition might look like and what risks are associated with that transition.

I'll quote, word for word, some evidence that we received from Tom Symondson, the CEO of the peak aged-care providers body, when he gave evidence to the inquiry: 'The lack of detail on the rules is a very significant problem for us at the moment.' Since Mr Symondson made that comment, we have not really seen any more detail, and he made the comment that one of their main recommendations around the bill is sensible transition. What we are hearing today is that the department constantly says, 'Nothing to see here; everything will be fine,' and yet, when any questions are asked, the response seems to be, 'We can't do anything until the bill is passed.'

Your response, Minister, when I asked you about the level of risk, was that the department was not worrying about risk; it was worrying about getting the reforms implemented. Can I assume then that there's no contingency built in, in relation to what happens on day one if we find ourselves in a situation where there are some particularly unintended consequences of this largely-unconsulted-on piece of legislation?

I have to say: the inquiry was a fabulous process; it was, I think, one of the most worthwhile inquiries that I have ever been involved in, in order to give a say to everybody who wanted to have their say. We received over 200 submissions. We had some wonderful submissions from older Australians who were concerned about the changes.

One of those was from Hannah from Adelaide. She travelled all the way from Yankalilla, where she lives, to Port Lincoln to give live evidence at the inquiry because she felt so strongly about the arbitrary determination from the department as to caps on gardening and cleaning in home-care packages. We had heard, all the way through the evidence that we'd received, and through estimates as well, that these were determined because they had been estimated and there was some sort of consultative process around how these caps were determined. Hannah turned up and was absolutely fabulous and then, subsequently, she wasn't going to lie down; after turning up to the inquiry, she then prosecuted the issue through the media. She raised the very, very legitimate concern that the one-size-fits-all capping of things like gardening and cleaning is not necessarily going to be able to deliver the outcome we want for older Australians, and that is to keep them in their homes longer. We know that's what they want, but we also know that it's actually the most cost-effective way for taxpayers. Keeping people in their own homes not only keeps them happy, because that's where they want to be, but also is less expensive on the taxpayer in terms of the costs.

So Hannah raised the issue quite rightly. She lives in the Adelaide Hills, and those of you listening from South Australia know that the Adelaide Hills are unfortunately somewhat fire-prone in summer, so, for anybody with a property—not even necessarily a big property with a big garden—preparing for the bushfire season is going to take more than 1½ hours a month, even if they put all those 1½ hours into just one period of time to try and get ready for the bushfire season.

I just really wanted to give a shout-out, as much as anything, to Hannah, because she really, really did go the yards to make sure that we had the information, so that we could provide it to the government, so that they could see the fallacy that sat behind their determination on cleaning and gardening caps, because not everybody lives in the same sort of house; their family homes don't all look the same. Particularly when you get further out from metropolitan areas and go into regional, rural and remote areas, these challenges become quite a lot more exacerbated. So we were really pleased with the efforts of Hannah and others, but a particularly big shout-out to Hannah because she was prepared to go and speak to the media about this.

The caps on cleaning and gardening have now been lifted and people can use their home-care packages in a way that is going to deliver the outcome that they need to enable them to stay in their home. If that means, because of your particular condition, you may need more cleaning than the next person, or if you happen to be living, as Hannah does, in a bushfire-prone area, you will be able to use your package to make sure that your home is safe—and that's the most important thing here. We're not talking about an exhibition garden; we're talking about making sure that your property is safe and that sometimes 1½ hours of gardening a month won't achieve that. So I wanted to say thank you to Hannah. She was amazing—absolutely amazing.

To that end, I am interested in something. The decision has been made that cleaning and gardening will no longer be capped. Other issues were raised in relation to the service list for Support at Home. Two of them were the decision to contain things like showering in independent living as opposed to clinical care. I'm just wondering: on the basis of the evidence that we received during the inquiries around that particular issue, has any consideration been given to showering, as an example, or any other of the items that were contained in the prerelease service list being reclassified?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I am advised that the service list was agreed to with the opposition as part of the discussions on this bill. You're right; there have been some changes around the issues that Hannah advocated for, and I love hearing stories about people getting involved in the democratic process. It's the reason we're all in these jobs, really—to work with community members to improve systems and laws. That change has been made, but the service list, I am advised, has been agreed to. So we've got the clinical supports category, where there are no contributions, the independence category, where there are some contributions, and everyday living services, where there are obviously some other contribution rates. This has really been at the crux of some of the discussions around chapter 4 of the bill, which is about how we build a system where there are some contributions, if people can afford to contribute, but also how we build a system that is sustainable going to the future.

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

To be absolutely clear, as much as I'd like to think we were consulted at the kind of level of detail that you have just put on the record, Minister, we weren't. Our agreement is in relation to the categorisation of the service list. Particularly, I want to put on the record that we appreciated the fact that the government accepted our recommendation that no Australian would be asked to contribute more than half of their care contribution, but we were certainly not privy to the determination about what was on those service lists, which is why I'm asking about the showering. Can I take from what you've just said, Minister, that there have been no other changes to the categorisation of particular aspects of the service list, apart from the caps on cleaning and gardening?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The service list was released for consultation and feedback. Outside of the issues that you've raised, Senator Ruston, there have been no further changes to the service list.

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

Obviously, we're talking about Hannah's great advocacy on behalf of cleaning and gardening. But, in that consultation, I'm assuming that you would have also gotten the same sort of feedback that we got through the inquiry in relation to showering, as an example. I'll move onto other issues raised about the services in a minute. You responded to caps for cleaning and gardening. What was the rationale behind the decision to make those changes? Was it just Hannah's fabulous advocacy? Was the advocacy on behalf of those putting forward that showering, as an example, not be included in clinical care? Was their advocacy not strong enough? It certainly came through loud and clear in the inquiry that the inclusion of showering in the independence list was a raised as a great concern by many, many people who gave evidence.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I understand that it was a recommendation of the Aged Care Taskforce around that categorisation. In terms of the changes that we've made around cleaning and gardening, there was feedback. In addition to the feedback from the constituent that you raised, Hannah, there was feedback about more flexibility being desired in those areas, so we have responded to that feedback.

In relation to the showering issue, the advice that I have is that, if you are having two hours personal care or something in your home and showering were a component of that, it would be very difficult and complicated to pull that out as part of the overall care that you're being provided with.

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

I'm keen to unpack the service list. In terms of things like the pricing, first of all, we haven't seen the pricing yet, I assume. We will, hopefully, see the interim pricing in December. On transport, for example, is there a single price for transport? Is it a per-kilometre price? How, for example, do we determine how transport is built into somebody's package?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Transport is in the everyday living, if we talk about that in the service list. The specific pricing will be determined by IHACPA, so I can't give you any further detail on that.

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

I wasn't asking—

Glenn Sterle (WA, Australian Labor Party) Share this | Link to this | Hansard source

Senator Ruston.

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

Sorry, Chair.

Glenn Sterle (WA, Australian Labor Party) Share this | Link to this | Hansard source

I just want your microphone on.

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

That's alright. I should go slowly; it's going to be a long day. Minister, I wasn't asking you what the actual price was; I was just asking you if it is a single price, and then how that is determined. What have you asked IHACPA to price?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Sorry. We're just in a little bit of a tricky spot because, obviously, of all the work that's underway. It's currently a single price, but obviously that matter will be determined by IHACPA. I can't really be any more definite than that, because there is obviously this process underway in December that finalises things in February, but it is currently a single price.

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

I do really need to put on the record my concern about it being a single price, as you can probably imagine. I come from a regional area, and I would like to call out that, if the government has sought for IHACPA to price transport on a single price, that would demonstrate, I think, a lack of understanding about the real challenges that are faced by people who live in rural, regional and remote Australia. I also would note that there is a big difference between regional Australia, rural Australia and remote Australia. So I put on the record that we would be absolutely horrified if the determination came back from IHACPA that there was a single price in relation to transport. If there is any further information that you can add in relation to the direction that was given to IHACPA in terms of how you would like transport to be priced, I would appreciate that. But, if there is not, I'll move on to my next question.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

():  Thanks to the very helpful group of individuals sitting to my left, I am advised that IHACPA would be looking at loadings to deal with some of the issues you raise, so that is currently being considered. Obviously, there's the additional funding in thin markets that's being provided to ensure that we are accommodating some of those pressures, particularly in regional and rural Australia.

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

One of the other concerns that was raised throughout the hearing was around—obviously people don't know what pricing's going to come back with. What happens if the pricing is wrong?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

It's an interesting question. IHACPA has been doing this work, doing independent pricing, in hospitals and in residential care for a period of time. I'm not aware of their advice being wrong in the past, but essentially that's why it's advice from IHACPA. If the government were to consider that that advice was wrong, it's open to government to make other decisions. I don't believe that's happened to date, but that would be a safeguard that would be available should that need arise, if the government felt their advice was wrong.

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

I accept that IHACPA, before it became IHACPA, when it was the Independent Hospital Pricing Authority, had a great deal of maturity in its statistics that it was providing. I commend the independent pricing authority for what it has achieved, in terms of setting national efficient prices in the hospital setting, but it has been very recent that it has become IHACPA and included aged care in that determination. So we're talking about a reasonably immature data set here. The first lot of data that came from IHACPA, in terms of pricing, was only based on about four per cent of the market being tested in terms of developing that pricing. I'm interested to understand, in the current determination that IHACPA is undertaking, is there a requirement for a certain percentage of the market to actually be tested in determining those prices?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Thank you. My advice is that IHACPA obviously will be building up their capacity. They have released guidance or rules around seeking that information from providers so that all providers could provide their information. I'm not certain that there's a specific percentage that's required. But, yes, this will be built up over time. That's why we have independent experts, and they are consulting with the sector as well.

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

Can I move back to the service list? The first question is: could somebody give me a clear definition as to what is 'care management' and what is 'package management'?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Care management is around the individual and essentially what they're seeking from the care that's being provided, so it's all about them. Package management is, I think, the more administrative arrangements—invoicing and that kind of thing. It's what would probably classically be called administration costs.

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

In terms of care management, you said it's around the individual. What is it? Could you give me a broader example rather than just saying that it's around the individual. Give me a broader explanation of what's involved in care management. We've got a cap on care management now, so I am trying to understand what it is that we're capping here.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

It's really about how you work with the individual on what they want in their package. That's what care management is; it's the things the individual is seeking. I've just been through a similar process with my daughter at school. It's about how you set what supports are needed in order to deliver the outcome the individual is seeking; it's how you complete those kinds of discussions.

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

You said it's around what the person wants and around those sorts of discussions, so are we classifying care management so that it is only about discussions?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

It is that. Again, it's agreeing on what elements of care will support that individual. I'm also advised that in addition to that it's monitoring, helping an individual to change services, following up with people if needed and assisting if things go wrong.

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

Does the government see care management as a valuable proposition?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I would think it's probably an essential proposition, yes.

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

I'm keen to understand the rationale that sat behind the decision by the government in this particular package to halve care management charges, particularly when one of the things that was raised during the inquiry—we heard it on numerous occasions—was that there's often a lot of criticism around care management not being as valued and as embedded into peoples' packages as would deliver the best care for an individual so that their care meets their circumstances, particularly the circumstances of the community that they live in. What was the process that was taken to determine that care management fees were to be cut in half?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

It was a decision of government ultimately, but we'd obviously gone through quite a bit of assessment and consideration on this matter. The priority—and I think it's one that the opposition supports—is about making sure that every dollar spent in the aged-care system is maximised to the delivery of care. I'm not walking away from the fact it was a decision of government. I think the reforms outlined in the bill and the associated work that hangs alongside it are really about maximising every dollar into as much care provision as possible while allowing reasonable costs for those matters that you raise, like care management and package management. We believe we've got the balance right, but I don't think we apologise for trying to maximise that money going into the provision of care.

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

Minister, I would 100 per cent agree with you that we do need to make sure that we maximise the benefit to the individual. The whole point of this reform is to make sure that the person who is receiving the care is at the centre of the decision-making and that it's their choice and their control about the care they receive. That's the only reason we are standing here today—that choice and control to individuals. So I don't think we're in disagreement about that.

You've said it's a decision of government, and I respect that. governments have the right to make decisions. But what I'm trying to understand is that, if we're putting choice and control back into the hands of the individual, there are some people who will probably have some quite complex needs around their care. You made the comment around monitoring changing services, following up on services and assisting when things are not necessarily going right. The question is: what was the average care management fee that was being charged to date?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I think the maximum was 20 per cent; the average was 17 per cent. We're bringing that down to 10. I think the other important piece of information is that some of that was admin costs, which is now being built into pricing.

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

Can I get this clear: previously, the 20 per cent was care management and package management?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

My answer was incorrect—or the nod of my head was incorrect. I have been corrected by the experts sitting next to me. I'm advised that up to around 35 per cent of a package could be used for both care planning and package management. Of a package of $78,000, up to $15,000 could have been used for essentially those costs—which is a lot from a package of that size.

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

My understanding is that it is currently 20 per cent for care management and 15 per cent for package management. That 35 per cent is not able to be moved: you can't do 25 per cent care management and 10 per cent package management. They are discrete caps.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

They were, and they are, but I understand it is quite difficult to fully understand that there weren't things coming in and out of those.

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

Given the fact that the average care management fee that was being charged was 17 per cent, and it has now been dropped to 10 per cent, could you respond to the concerns around how, if you've got an average of 17 per cent and you've dropped it to 10, there must have been some reason why the government took the advice for it to be dropped from 20 to 10 per cent, given that the average was 17?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I think the government's decision really was about how to maximise the funding going to direct care, whilst balancing up reasonable costs for those other associated charges or costs for providers. I don't walk away from the fact that it's a government decision. I think the system that we are establishing here today will allow for efficiency in terms of those costs in packages and care, and this maximises the opportunities. I would say—I got this a fair bit, I'm sure the minister did, and I am sure you did as well—there was a lot of concern from older Australians about the money that wasn't lost but wasn't maximised for their own care provision. I had it raised with me a number of times about the package that was received and then the costs that were incurred for the administration of that package.

We have looked at this really carefully. The Department of Finance was involved, working with the Department of Health to try to land on a spot that we believe has reasonable costs but that maximises the investments going in for individuals in their care.

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

I'm interested to understand if the government, in halving the amount that could be charged for care management, believe that older Australians are not receiving the care management services that add the value and the quality of care that we all agree that care management is very important to provide. Do the government believe they were being overserviced or not receiving the service that they were supposed to be receiving? Halving care management—there must have been a reason care management was put in at 20 per cent in the first place, recognising the value proposition of managing somebody's package to such an extent that they really are getting the precision care that they need. What are the government saying in reducing it? As you rightly point out, Minister, we don't want to reduce the level of care that somebody is receiving, but we also are talking about this bill, which is about choice and control of individuals. We've established the fact that the government value care management in terms of making sure that we maximise the best and most effective care for the Australians who are receiving these packages. I'm keen to understand why the government made the decision to cut care management in half: what was the problem you were trying to solve?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Let me try to deal with this a bit more comprehensively than I have been able to do to date. One bit of important information is there is an extra supplement for people with individual needs—like First Nations individuals, care leavers, veterans and people who may be homeless. The work that I am advised the department has done on this is, rather than looking at it as a percentage or a set figure, in relation to what hours are needed to do that care-planning and package-planning properly.

If you look at the 10 per cent that allows for between one and six hours for someone who isn't getting that extra supplement per month in that planning, for the people who are getting the extra supplement in those other categories it equates to between two and seven hours per month. Providers' advice to government was that they needed between two and four hours. That's right in the middle. It means for someone on a very low-level plan, or with low-level needs, that that would be one hour, but if you have a person who requires a much higher level it that would be up to six hours a month in care-planning. Perhaps it is more useful to look at it in those terms, and in that way it fits within what providers are saying they needed, and maximises the care hours.

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

I will make the point that the more arbitrary decisions are made, the less choice and control resides with the individual who is receiving the care. At the moment, how many people self-manage homecare packages?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Quick answer: we will provide that information for you, Senator Ruston, and get you an accurate figure. You want the numbers of people who self-manage their home-care package? Yes. We will come back to you on that.

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

Previously, home-care providers were able to charge 15 per cent package management fees for back-of-house administration et cetera. I'm interested to understand how that is going to be treated going forward.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

That will be determined by IHACPA as a supplement through the Support at Home program. That would set the maximum price, and then you would expect that the market will determine what the charges can be and whether there's a range that sit below that.

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

In terms of determining the price of a service, how is IHACPA building the administrative cost into their pricing determinations? Previously you could charge up to 15 per cent for administration—if I'm correct—for package management currently. Could you outline the mechanism through which it is going to be contained within the price of the service? How is that working?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I understand that it is going to be contained in the price of the service and that there are consultations with providers underway now.

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

Even though we don't know the number of people who are self-managing—if you're self-managing, how does that then work for you? If you're buying a service and that particular service has to come from somebody who's registered to provide that service, that price has been determined in terms of its efficient pricing on the basis of the IHACPA determination. If IHACPA had built the cost of administration into the price of the service, we know from experience—as we saw with the pricing in the NDIS—that registered providers of services are obviously going to be providing those services at the prices that have been determined by IHACPA. How does that work for people who self-manage in terms of the charge that they will incur for a service when they're doing their own administration?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

There are still costs, essentially—even if you're self-managing your package—that are incurred. There's obviously the IHACPA price that will be set. I'm not sure if this answers your question specifically—I was trying to listen to some advice as well—but essentially providers will be able to be compensated for the cost of administrating the coordination of that care.

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

I don't know that that was the question I asked. Why don't I paint you a picture. Imagine there's a self-managed person who decides they want to get their lawns mown, their house cleaned or whatever and a person who has their package managed through a provider. On the basis of a uniform price for a service, which is determined by IHACPA, the self-managed person will pay the same price as the other person, but the person with a provider will be paying for the administrative costs. The first person will have to do their own administration because they're self-managing, and yet the price will be the same.

I'm trying to understand the fairness of incorporating package management costs into the price of a service. Does that not then put the person who is self-managing at a significant disadvantage? If it's at 15 per cent—which is currently what it is—in effect, we're saying that the person who's self-managed will be paying a 15 per cent higher cost for their service than the person on a provider managed package.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

I think I get where you're going, Senator Ruston. Your argument is that people who are self-managing their packages now and not paying those costs will incur some of that with the new arrangements. The advice to me is the department doesn't expect that to happen because the only way that would happen is if the provider starts adding that cost to what they were charging the care recipient, which is not what's happening now.

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

Can you explain to me how this works if you're setting a single price?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The IHACPA price will be the price cap, not the price.

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

With the greatest amount of respect, we saw what happened with the NDIS when you set a price cap—everyone went straight to the price cap. I'd be keen to understand what the rationale is and why you think that wouldn't happen here.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The advice to me is that the aged-care market is much more mature than the market was in the NDIS.

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

I have to put on record my great concern here. I have a very significant concern. This is no disrespect to IHACPA. They obviously have to cost by taking into account everything that is before them. If they're being asked to price in the cost of administration of a package under the conditions where somebody is having their package managed by a provider, of course, then that's what they're going to do.

But, for anybody who believes that history will do anything differently than what history has done forever, as soon as you give a single price, especially when you're talking about a single price, which is what we're doing—we are saying it is a maximum—history has always shown us that, if a provider of a service is able to charge a price because an independent government authority has set the price of it then there is an expectation that the person providing that service can charge that. We have seen that happen through the NDIS, and we've seen the subsequent challenges occur in terms of a market that has differential pricing depending on who you are.

I think it would've been well advised if the government had perhaps consulted more broadly around the way they've been treating care management caps and how they're treating package management fees. It seems to me here that people who are self-managing are likely to be impacted quite negatively by the change in the way that package management is administered within home care going forward. I'll be very keen, obviously, to see the nationally efficient prices that come out when we see the final determinations from IHACPA, but it is particularly concerning that we have made a decision in the full knowledge that history suggests that people will be charged more for a service than they need to be, simply because the market will move to that cap.

Before we move to the next session today, I want to ask about decision-making around the Commonwealth Home Support Program. We heard earlier this morning about $1.2 billion of IT changes from the government. The first question is: has the government factored in the ICT changes that will be needed to accommodate the likely 800,000 or more people that will be on Commonwealth Home Support Program packages in 2027, or will there be additional ICT changes required to facilitate the changeover from that program to Support at Home?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

Again, with my Department of Finance hat on, I would expect that all of the ICT needs that are required to implement the system are included in that $1.2 billion.

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

Thank you, Minister for Finance. Now, Minister representing the Minister for Aged Care, can you confirm that there will be no need for additional ICT changes to facilitate the transfer across of anybody from the Commonwealth Home Support Program in 2027?

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

The advice to government at the moment, certainly, is that the ICT investments of that money can accommodate the systems that are required to administer the new aged-care system. There are those grants that we talked about, which are a bit separate, but there are those in additional cost to that. I think this program is going to be tightly managed, including with assurance and all the rest of it, to make sure—these big ICT programs are inherently risky. I think all governments have experienced that with big IT spends. So it is going to be closely managed to make sure that it does the job it needs to do. But, certainly, the advice to government is that that was the funding that was required.

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

I can completely understand. ICT has a bit of a habit of doing this sort of stuff. I was more interested to understand whether, in the allocation of that $1.2 billion, there had been any consideration around CHSP or if it's the assumption that everybody is going to be on Support at Home so, when we get to 2027, CHSP will disappear off into the wilderness, anybody that was on CHSP will transition into Support at Home and there is no additional ICT requirement for Support at Home. It's just that those people are not necessarily coming across until 2027.

Katy Gallagher (ACT, Australian Labor Party, Minister for the Public Service) Share this | Link to this | Hansard source

It's included.

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

Right now, we've got 800,000 people on Commonwealth Home Support Program packages. I'm assuming that's a snapshot in time. Maybe there will be fewer by 2027 because some of these people might be coming into Support at Home et cetera. The minister, in her announcement in relation to the budget and this particular reform package, said that there would be 300,000 new home-care packages released over the next ten years. That would effectively be an additional 30,000 a year over ten years. Yet we've got 800,000 people currently, as we sit here, who are receiving aged-care supports through the Commonwealth Home Support Program. I'm interested to understand what the basis was behind the determination to release 300,000 packages over 10 years. I should say that's 30,000 packages a year. We've currently got—

Glenn Sterle (WA, Australian Labor Party) Share this | Link to this | Hansard source

Order! It being 11.15 am, the committee will report to the Senate.

Progress reported.