House debates

Tuesday, 1 June 2021

Bills

Appropriation Bill (No. 1) 2021-2022, Appropriation Bill (No. 2) 2021-2022, Appropriation (Parliamentary Departments) Bill (No. 1) 2021-2022; Second Reading

6:54 pm

Photo of Mark ButlerMark Butler (Hindmarsh, Australian Labor Party, Deputy Manager of Opposition Business in the House of Representatives) Share this | Hansard source

It was a pleasure to listen to the member for Swan undertake a 'this is your life' of his own career since 2007. Congratulations to the member for Swan. It's a great pleasure to rise and talk on the appropriation bills for 2021-22. This was an extraordinary budget in so many ways: a government has been able to rack up $1 trillion in debt and yet right through the budget papers there is the sorry reality for working families across Australia that, with $1 trillion of debt and $100 billion or thereabout in new spending, their wages will actually go backwards. Wages will actually go backwards over the next four years. It is just an extraordinary indictment on this government's budget—and probably no surprise, because we remember the former finance minister, who I think takes over as Secretary-General of the OECD this week, who pointed out that low wages and low wage growth were a deliberate policy feature of this government. We see it right through the biggest-spending budget anyone can remember.

The extraordinary thing about this budget, to my mind, is the complete lack of any fiscal discipline in the spending. I think everyone here in the parliament and across the community understands that stimulus spending required to get the economy through the pandemic recession, spending required to roll out the vaccine and suchlike, spending particularly associated with the emergency is going to be spending essentially borrowed and will be paid back when we get through this emergency, as we will.

But the extraordinary thing about this budget is the recurrent expenditure baked into the budget for which there is no fiscal discipline whatsoever. The breezy way in which the Treasurer essentially overturned four decades of fiscal orthodoxy in this country by putting in place big new spending programs—some of them quite worthy, and I'll talk about that—without any sense of how they would be paid for is just extraordinary. Gough Whitlam did it. Fraser did it. But since the early 1980s it has been a fundamental understanding in this place that, where there is recurrent spending—good, bad or indifferent—baked into a budget, the government of the day has a responsibility to tell the Australian people how it will be paid for. Bob Hawke took a Medicare levy to the people in 1983 and put that in place to underpin the fiscal sustainability of that wonderful reform. We did it more recently in relation to the NDIS.

The two big features of new spending in this budget were in aged care and mental health, two areas I'm quite familiar with. The last two substantial packages in both of those policy areas were put in place while I was the Minister for Mental Health and Ageing a decade or so ago, and I can tell you that, of the almost $4 billion of new measures in Living Longer Living Better, a big new aged-care reform package, every single dollar was offset. There was not a single new dollar of spending in that, because we understood that we needed to put in place a better aged-care system and be able to look the Australian people in the eye and say, 'This is how we are paying for it.' And that's hard. It's hard work going through a system, finding efficiencies that regear a system that at that stage was heavily geared towards residential care and gearing it more towards home care.

In the mental health package, about the same quantum as the package announced in this budget in nominal terms—not real terms; in real terms our package was bigger back a decade ago—80 per cent of that package was offset. These were hard measures that I had to wring out of the MBS system by changing the way in which GPs were remunerated for mental health plans and suchlike. None of it was easy and none of it was particularly popular, but I was able on behalf of the government to say, 'This is a new package of measures and this is how we are paying for it.' It's just extraordinary, to me, the breeziness with which the Treasurer has stood up and baked in quite considerable new spending into the budget, feeling no obligation to tell the Australian people how they will be paid for, because they will be paid for at some point.

I want to talk a bit about the aged-care measures that were announced a few weeks ago in the budget. I think everyone understands the depth of the crisis that aged care was experiencing—and still is experiencing because none of the announcements have actually changed the facts on the ground. As I said, 10 years or so ago the Gillard government put in place a very substantial body of reforms, under Living Longer Living Better, that responded to a very good Productivity Commission report that was the subject of deep engagement with the sector—with providers, with seniors' groups, with aged-care unions, with clinicians—over a period of about 12 or 18 months. Out of that we came up with a package that all players, if you like, within the sector were able to get behind.

It was a foundational reform. As I said, it shifted very substantially from an overwhelmingly residential care focus to home care. It tried to come to grips with some of those workforce issues that have bedevilled this sector for many, many years: poor pay, high turnover, variable training arrangements. It also came to grips with the growing incidence of dementia in our community broadly and in the aged-care sector in particular. It moved to a model of consumer-directed care so that the consumers and their choice about the services they received, and the way in which they received them, would lie at the heart of the system, replacing an overwhelmingly provider-centred model that had really characterised aged care since its inception in this country. This was really a parallel process of putting consumers at the centre of new models of social service in the aged-care system, which was an existing Commonwealth system, and the new National Disability Insurance Scheme, that the member for Maribyrnong—who is here—played such a central role in setting up.

These were foundational reforms. They were not expected to change the system, in and of themselves, but they were expected to regear the system to allow a decade of change that would ensure, first of all, that Australians receiving aged care through that decade, and now in 2021, were receiving the best possible care, but, just as importantly, that the system would be ready for the very big demographic shift that will happen when the baby-boomer generation starts qualifying or reaching the age where they start to use aged-care services. It's probably in the next five to seven years for home-care services and a couple of years after that for residential-care services. This is a very big lift in demand, and the sector is—and frankly even 10 years ago—struggling to deal with the existing demand from the pre-boomer generation. There is no way it is going to be able to deal with the boomer generation and the demand that that involves numbers-wise if it is not regeared.

As a foundational set of reforms it was intended to be followed up. It was legislated to be followed up by a five-year review in the middle part of the last decade. We'd lost government by then, unfortunately, but David Tune, a very highly regarded public servant, who had been secretary of the finance department when we were in government, was commissioned by—I'm not sure whether it was Tony Abbott or Malcolm Turnbull at that stage, probably Tony Abbott. He delivered a very good five-year report for the next stage of the reforms and that report went absolutely nowhere. The government did not act on a single recommendation from that report. Instead, the now Prime Minister, who was then the Treasurer, followed the report up with $1.7 billion of cuts in the 2016-17 financial year. So a sector that was already under enormous pressure had money ripped out of it by the now Prime Minister, then Treasurer. It was not redistributed elsewhere through the aged-care system but instead returned to consolidated revenue.

We also saw the growth of the Home Care Packages scheme, which was a scheme that we set-up through Living Longer Living Better. At that point, about 10 years ago, there were 60,000 Home Care Packages in the system—obviously not enough so in the 2012 budget we put in place arrangements to increase that through the decade and add 85,000 packages to that so that by the end of the decade there would be 145,000 packages as a base investment. We added 85,000 places to the home-care system in one budget, in 2012, and in the eight budgets after that this government added 50,000. So 85,000 in one budget and from this government 50,000 stretched across seven different budgets. That pathetic contribution disregarded the core of what older Australians want, which is the capacity to stay at home for as long as they possibly can—if at all possible, for the rest of their lives. It was disregarded by Tony Abbott, by Malcolm Turnbull and by the current Prime Minister. So we saw, unsurprisingly, home-care waiting lists blow out. Members—certainly those on this side of the Federation Chamber—know that they've been structurally set at about 100,000 people for years now. A hundred thousand people have been approved for a home-care package by an aged-care assessment team and are just not able to get it.

The Productivity Commission, in their most recent Report on government services, say that, on average, people are waiting for a level 4 package—the highest level of need, a substantial package of funding from taxpayers to the tune of about $55,000 a year—more than two years. Again unsurprisingly, and so tragically, people who need that level of care but don't get it either die waiting for it—and every single year thousands of older Australians die having been approved for a home-care package but not having received it—or have to go into residential care. The whole purpose of that scheme, to keep people out of residential care, is falling down because of a lack of investment by this government.

So we had a system in crisis that was pushed into even deeper crisis by the current Prime Minister ripping $1.7 billion out of it in the 2016-17 budget and MYEFO. Unsurprisingly, we saw the sorts of experiences, the travesties, that were first portrayed through the very brave Four Corners report on aged care and then revealed in the follow-up royal commission, which we finally dragged the Prime Minister kicking and screaming to. We heard about maggots in wounds, about 68 per cent of older Australians either malnourished or at risk of malnutrition. We heard people talking about the emergence of scurvy in the aged-care system again. There had been just appalling neglect—and that was the title of the interim report, Neglectof older Australians, who had built this community, worked hard, paid taxes, raised their families.

The royal commission, to their credit, set a very clear pathway out of that crisis and into a system we could be proud of. It's not easy, it's not cheap, it will take years to implement, but the pathway is clear. The package announced a few weeks ago does not keep faith with that pathway. It includes very poor transparency and accountability arrangements. Providers we saw through the royal commission and Four Corners, who in some cases—a minority of cases but egregious cases—were pocketing taxpayer funds to buy Maseratis, put into stock options and such like will be under no more pressure to make sure that the additional money the Treasurer announced a few weeks ago goes to care and not into their pockets. There were no additional accountability mechanisms of the type that were recommended by the royal commission.

The government have made insufficient effort to clear the home-care waiting list: 80,000 packages over two years to clear a home-care waiting list that's already at 100,000 and that we know, through demographics, is going to grow over the coming four years. They've done nothing about wages, in spite of the fact that everyone with even a casual understanding of aged care understands that poor wages, high turnover and variable training arrangements are at the core of the quality question in aged care, as they are in so many different parts of the social services sector which have essentially been outsourced, through the Commonwealth government, to private organisations.

Lastly, and most importantly, they've done nowhere near enough on ratios that were recommended by the royal commission, and have been recommended by experts for some time now, to ensure that a sufficient number of minutes of care are provided to people in residential care by people of particular qualifications. The most perplexing thing for me, I have to say, is that the government did not accept and implement the royal commission's recommendation that there be a registered nurse on duty 24 hours a day, seven days a week. To me, it's emblematic of the government's failure to follow the core recommendations of the royal commission: minimum minutes of care every day; minimum staffing ratios for registered nurses, enrolled nurses and personal care assistants, or assistants in nursing, as they're called in some jurisdictions; a proper effort to lift wages for some of the lowest paid but most important workers in our community; and more transparency and accountability from providers for the enormous funds that they receive.

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