Julie Collins (Franklin, Australian Labor Party, Shadow Minister for Ageing and Mental Health) Share this | Hansard source

I appreciate the opportunity to outline Labor's position on these two bills. the government's Aged Care Quality and Safety Commission Bill 2018 and Aged Care Quality and Safety Commission (Consequential Amendments and Transitional Provisions) Bill 2018. Labor supports these bills; however, in saying that, we want to raise a number of concerns about not just this legislation but also the way the government has handled the quality and safety of aged care in Australia. As we heard over the weekend, the government has now called a royal commission into aged care and the safety not just of older Australians in residential care but of all of those receiving aged care services across Australia. More than one million Australians are currently receiving aged-care services across the country. I also acknowledge and thank the minister for facilitating a departmental briefing for me on this bill. That was very useful and I'm very pleased that we were able to do that. These bills, as many of you would know, are a consequence of the Carnell-Paterson review that was handed to government in October last year. That review recommended bringing together the functions of the current Aged Care Quality Agency and the Aged Care Complaints Commissioner. This was one of the 10 recommendations included in the Carnell-Paterson review.

The purpose of the Aged Care Quality and Safety Commission Bill is to establish the new commission, the Aged Care Quality and Safety Commission, from 1 January 2019. As we heard from the government, the new commission will be tasked with helping to restore the confidence of aged-care consumers in the delivery of aged-care services, given the context of recent public concern. We all know the context in which this review occurred and some of the terrible things that happened. With this new commission we want to provide a single contact point for aged-care consumers and providers of aged care in relation to the quality of care and regulation. The commission will be responsible for accreditation, assessment, monitoring, and complaints handling in relation to aged-care services and Commonwealth funded aged-care services. These aged-care services include all four areas of aged-care services, including residential aged care, home care, flexible care services, the Commonwealth Home Support Program and the National Aboriginal and Torres Strait Islander Flexible Aged Care Program.

The new commission will be led by a statutorily appointed Aged Care Quality and Safety Commissioner, who'll be advised by the Aged Care Quality and Safety Advisory Council. The commissioner will be appointed for a term of five years. The bill also establishes that the commissioner may seek and consider clinical advice. This would take the form of an expert clinical panel that would support the work of the commission. The second bill provides for the administrative matters required to transfer the functions and operations for the existing authorities into this new commission and provides for the continuation of appointments to the Aged Care Quality Advisory Council until the expiration of their current terms as new members of the Aged Care Quality and Safety Advisory Council.

As I said, we do support what this bill is trying to do. We absolutely do. In fact, we have been calling on the government to act on the recommendations of the Carnell-Paterson review and to act on the recommendations of a whole range of other reports that are currently before the government. We are really concerned that while the government has had this recommendation it's taken almost a year for this legislation to reach this place—October through to September. Really, in light of the concerns for the safety of older Australians, that's pretty unacceptable. I wanted to know why there'd been a hold-up and why this has been taking so long. I also understand that the Greens in the other place want to have an inquiry into this bill. I am concerned that that inquiry might hold up what is really important critical reform that needs to happen.

I want to make the point that Labor has not at any stage tried to impede the passage of this legislation or to delay it or to not cooperate with the government on trying to get these bills through or deal with this situation, because we understand how important it is for older Australians, their loved ones, their families and their carers to have some certainty and some confidence in the accreditation and safety of older Australians receiving aged care. We know that these bills are so important in restoring that confidence. We need to make sure that people have confidence in our system. Clearly, from the royal commission, from the Four Corners program, we know how bad some of those issues are. The royal commission will continue to deal with some of them, and I'm sure we'll see even more-harrowing sights than we saw on Four Corners last week over the next week and indeed throughout the royal commission. We want to make sure, and we'll cooperate in terms of the Senate committee, that that process is undertaken as quickly as possible and that there will be no further delays.

We also think that these bills are a missed opportunity for the government to give the commission stronger arbitrary powers, given the level of public concern in relation to some of the disputes people have with service providers. We don't want to see this become a toothless tiger. We think it is a shortfall that government didn't consider giving the new commissioner greater arbitrary powers to resolve disputes between consumers and providers in the aged-care system. We also want to put the government on notice that there must not be any changes to the current cost-recovery process and/or fees and charges to ensure the ongoing support for smaller providers. I did raise this in the briefing. I am concerned that some rural and regional providers are unable to pay the cost recoveries that are required for some of this process for accreditation and investigating complaints. We need to ensure that those providers are able to be sustainable, particularly in regional areas where options for consumers are limited. Although the advisory council is set to continue, I would also like to point out that the government has yet to fill three vacancies on this advisory council. I assume that as soon as the new commission is established they will do that as quickly as possible.

I also want to take this opportunity to put on record some comments about the Four Corners program that we saw last week, knowing that there is another one to come next Monday night. I want to say this to the staff who were brave enough to speak out: thank you. We understand how difficult it must be and that they don't want to put older Australians in jeopardy by speaking out. We also thank the brave family members who spoke out. We know how difficult it is. We also know that the majority of aged-care workers treat older Australians with dignity and try to deliver the highest possible care. But that is not always possible because there are simply not enough of those workers caring for older Australians. I want it put on the record: our thanks to the nurses, careers, doctors and allied health professionals who work hard to deliver for older Australians each and every day. It is not an easy task.

We recognise that every day around the country the majority of older Australians are treated with care and respect at residential aged-care facilities and in other aged-care services, but what we saw on the Four Corners program was totally unacceptable. Since that time, I have been inundated with reports from other concerned family members who are also telling me their stories of unacceptable standards of quality of care. I hope that this new commission, and the existing commission in the meantime, are able to deal with the influx of complaints that they are about to get and that they have the resources to be able to deal with that, because it is a very serious issue.

We are absolutely appalled by the images and stories that we saw on Four Corners. Like every other Australian watching, I was really actually quite sad and quite tearful when hearing these stories and seeing this crisis in our national aged-care system, particularly when seeing the standard of care that was delivered in some of the homes that we saw. We have always said we should judge ourselves as a nation by how we treat our most vulnerable. That includes older Australians. We cannot call ourselves a fair and generous country until we can ensure that older Australians have the love, care, respect, autonomy and control over their own lives to make choices about how they want to live. It is clear this standard is not being met in some homes and in some services around the country.

As I said, government has announced this royal commission since the introduction of these bills and since knowing about the Four Cornersreport. Indeed, they announced it the day before the Four Corners report went to air. I am concerned that the announcement of a royal commission, whilst we absolutely support it, might slow down progress. That is why we want to progress these bills and deal with them as quickly as we can, although without denying anybody the opportunity to speak and have their say.

The terms of reference for the royal commission need to be considered really carefully by the government. If you are talking about quality and safety in aged care, they do need to be broad. They need to be broadened—more than the public statements to date might suggest. In particular, they need to look at the long-term sustainability of the sector, the funding and the staffing. I don't see how you can have a discussion about quality and safety for older Australians in aged care if you don't have appropriately qualified staff in the sector who are paid well and who are trained well. Of course, we then need to have a discussion about how we fund that. The royal commission should also examine, in our view, the impact of the 2015 and 2016 ACFI changes. You don't fixed aged care by cutting the money available per resident. We think that that was a mistake.

We on our side of politics have been saying that the aged-care system is in a state of national crisis. Bill Shorten said that in May of this year. In the parliament we heard the minister actually have a go at us about that and have a go at our leader. The minister was, in fact, almost comparing it to elder abuse, which was quite disappointing. I know that the minister has since apologised for that. What is curious is how much the government knew about how bad the system was—yet they were willing to defend it and say, 'We don't need a royal commission. Labor was wrong to say there was a crisis.' This has suddenly changed in the last week. Of course, we're glad it changed and we're glad that these issues are finally coming to light, but it is disheartening when, for well over a year, we have been raising these issues about what a crisis the aged-care system is in. We weren't listened to and we were dismissed when we tried to raise these issues.

As I've said, there are more than a dozen reports with a whole range of recommendations currently sitting on the minister's desk. The government is claiming that it has acted on these. The government has cherrypicked some of these recommendations. It has not responded, for instance, to all of the recommendations in the Tune legislated review. Even by its own best admissions and the best, I suppose, long bows that it might draw, the government has only dealt with 18 of the 38 recommendations from David Tune's report. It has not implemented all of the Carnell-Paterson recommendations. This is obviously one of those that's still yet to be fully implemented.

There have been three ministers for aged care in five years. When you have three ministers and billions of dollars in cuts, and you have ignored a whole range of reports, reviews and inquiries into the system for years, it does make one wonder about how much accountability the government is going to have for what the royal commission does expose. Quite frankly, if these kinds of instances do come to light—like what we saw on FourCornersit does raise the question of who was in charge of the system. We know the issues with accreditation failures from previous inquiries. Clearly, there is a lot wrong in the aged-care system. There are systematic failures that people should have been aware of long before this royal commission was called. I think it has been totally unacceptable, and I think that those on the other side need to reflect on how we have got to the point where the government has called a royal commission into, essentially, how it has dealt with aged care over the last five years. I think there needs to be some accountability and some acceptance from the government of its failures in this regard.

We do not intend to hold up this bill, but I am going to be moving a second reading amendment in relation to this bill at the end of my speech. I want to talk about when we have tried to hold the government to account and force some people in the government, whoever they might be, to accept some responsibility for where we are today after five years in government. There has been a bit of debate about the billions of dollars in cuts to the aged-care system. It's not just Labor saying this; the government's budget papers say that this occurred. The minister wouldn't answer my question today. He obfuscated and, in my view, deliberately didn't answer the question in the way that it was asked and was not directly relevant to my final question. There is no doubt that the ACFI complex healthcare domain funding per resident in a residential aged-care facility has been cut as a result of the 2015 MYEFO and the 2016-17 budget. There is no doubt it is lower than it should be or would have been without those cuts.

As I said, it's not just Labor saying this; if you talk to the aged-care peaks and providers, they agree. Their assessments and analyses done on this say that there is an ongoing cut that adds up to almost $1 billion a year by the end of this year. They are saying there has been $3 billion cut from the system. Sadly, when you're talking about $3 billion out of a $17 billion or $18 billion budget for aged care, it is a substantial percentage and it impacts directly on staffing and quality of care. There's no way you can have a discussion about quality of care without acknowledging that it has an impact. We've had discussions, questions, leaks and debates in this place this week, but it is really quite disturbing that nobody on that side appears to understand that they have been in government for five years. They have essentially called a royal commission into aged care because they have mucked it up so badly that they need a royal commission to fix it. There is absolutely no other explanation for the royal commission being called.

When Labor introduced the Living Longer Living Better reforms in 2012-13 the changes were bipartisan. They locked in substantial growth in aged-care budgets for quite some time, but they also had a workforce supplement of $1.5 billion to go directly towards improving workers' salaries and training in the aged-care system to keep more people working in aged care and to attract people into aged care. That supplement was axed by the government and that money was absorbed elsewhere within the aged-care budget. That means we haven't done anything about workforce for some time. You cannot, as I said, have a discussion about quality and safety without talking about the workforce. The sector spoke to the minister, and eventually a workforce task force was established with John Pollaers as chair. He completed this work and handed the strategy to the minister in June this year, but it took until last week, and a further media release from me, for this document to be released publicly. The minister eventually said it should have been released publicly and apologised for the delay, but quite frankly how are we going to implement the recommendations of this task force now in light of the royal commission? I have not heard or seen anything from the government about an implementation strategy or funding for that. We have called on the government to implement the recommendations and thanked John Pollaers for some excellent work. We may not agree with every single tiny thing in it, but it is a good start and has been done with consultation.

The government needs to work with workers in the sector and their representatives in the unions to implement the strategy that is going to be required to meet the growing demand for workers. We know that programs like we saw on Four Corners are not going to encourage more people to work in the sector unless people can be confident that there is some impetus from government and officials to fix the system. We are talking about increasing a workforce of 340,000 people to over a million in the next 30 years. That is a very a significant number of people that need to be trained for, attracted to and kept in the aged-care workforce, and I just don't think that the government has focused enough on ensuring these workers are available and have the skills necessary to provide the quality and safety of care that is required for older Australians.

There has been a lot of discussion about the role of staff, particularly nurses and personal care workers. As I said earlier in my opening remarks, I think we need to look at the important role of allied health professionals in the aged-care setting, whether they be GPs, occupational therapists, physiotherapists, dietitians, podiatrists or others. A whole range of allied health professionals are important to how we ensure the safety and quality of services that are provided to older Australians. We all know the demographics. We know the number of people over 85 is rapidly increasing compared with younger age groups. It is projected to double by 2032. We know that will have a massive impact, as I said, on the number of workers available but also on how we fund the system going forward, which is why the future sustainability of funding needs to be seriously considered by the royal commission. We don't want to see the government not act, due to the royal commission, on the other things that need to be dealt with.

I have talked about the task force report, I have talked about the Carnell-Paterson report and I have talked about the David Tune report. It was good to hear the minister refer today to the Wollongong report on ACFI. Labor has been up-front. We think the Aged Care Funding Instrument that makes the assessment for residents in aged care is broken. I have said that for more than a year. The Wollongong report, again, has been sitting around for a very long time. I know more work is being done on it, but we need to progress these things much faster than is happening, because older Australians cannot wait until the end of a royal commission for some of these issues to be dealt with.

The home care waitlist is another issue that cannot wait until the government's royal commission ends. We now have 108,000 people, as at the March quarter, sitting on a waiting list. Some of those have no services at all and over 50,000 have no home care package at all. There are people currently today waiting on that waitlist for more than a year for a home care package. Indeed, sadly, I get reports all the time of people who die waiting. That's not unusual in aged care. I absolutely get that, but the stories from some family members are that they are just desperate to get their loved one a package; they just want to get their loved one some care.

The government needs to act on this waitlist. It cannot wait for the recommendations of a royal commission; it needs to do something about it today. In fact, it needed to do something about it six months ago, as I have said so many times in this place. So many of my colleagues on this side of the parliament have repeatedly called on the government to fix this waitlist, to do something about it. We have seen the government do a little bit. We got an extra 6,000 packages released, I think, in September-October of last year. In the budget, the government moved some money out of residential care and put it into home care to fund another 16,000 packages. There has been no evidence or suggestion from the government of when those 16,000 packages are going to be released. I have heard various reports that 3,500 were going to be released each year, and then I heard 8,000 in the first year. Quite frankly, the Australian public deserves to know how many of those 16,000 packages have been released. The June quarter data is now overdue. We still don't know what that looks like.

I just think the government needs to be much more transparent with people. Surely, if you are having a royal commission, you want transparency and honesty about what is going on in the system. So why delay a waitlist? Why not tell people where they are on the waitlist? Why not tell people how long they are going to have to wait for a package, rather than saying '12 months plus'? Twelve months plus doesn't help people plan. I know that the waitlist changes all the time and that people are exiting packages. They're going into residential care, to hospital or are becoming deceased, but people need a better idea of what '12 months plus' is, what the current wait time is. Surely, the IT systems with My Aged Care are at the point where people can get a better idea of how long they have to wait so that they can plan. Some people have been waiting for two years—12 months plus up to two years. That makes it really difficult for people to plan.

With this new commission and the safety standards, I am concerned about the services that people are receiving in their homes. Whilst we have seen some terrible things in residential aged care—we have seen the footage of some of the things that are happening in residential aged care—I am also worried about vulnerable, older Australians who are in their own homes. I am worried about what might be going on in those homes without proper oversight. I have had assurances from the minister that the new quality standards that were introduced applied to home care and that at the moment the commission is able to deal with complaints but that the new commission will deal with them in a much stronger way. When I hear stories about the increased number of accreditations for home-care providers—people who want to access essentially government money to provide services to vulnerable old people—I do become concerned about what their motivations are, how quickly accreditations are being registered and what might happen. I'm putting the government on notice: we will be keeping an eye on this, because we don't want to see a whole range of new providers, who are substandard providers, being accredited in a hurry and putting older people at risk in their homes with their services. We need to make sure that that process is extraordinarily robust and that the current systems in place are able to deal with that until the new commission comes on board.

As I said, I will be moving a second reading amendment. We support the bills and remain committed to working with the government and the sector to ensure that older Australians can age safely, happily and with dignity, but it does not mean that we will not call out the government when it is doing the wrong thing and it does not mean that we will not call out the government when it is slow to act. On that, I move:

That all words after "'That" be omitted with a view to substituting the following words "whilst not declining to give the bill a second reading, the House notes the Government's mismanagement of aged care reform".

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