Monday, 21 June 2021
Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021; Second Reading
The royal commission has made the clear case for reform in aged care in Australia, and the government is determined to ensure that senior Australians receive safe aged-care services of good quality through record funding of $17.7 billion over the next five years. Today I am speaking on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, because aged care is one of the most important and urgent reform priorities for the government.
I emphasise 'reform' because simply increasing funding will not automatically deliver the care and safety improvements required in the sector. The government committed to these reforms in March, following the release of the royal commission's final report. The first stage of reform will address three key areas. The first area is strengthening legislative requirements on the use of restrictive practices. The second area introduces home-care assurance reviews and the third repeals the legislative requirement to have the Aged Care Financing Authority.
This bill amends two acts: the Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act 2018. As an overview, these changes will achieve the following: the terminology will be brought into line with the disability sector, so the term 'restraint' will be replaced with 'restrictive practices'. Restrictive practices will be governed by requirements that are both stricter and clearer, and must be met by approved providers. This will provide better protection for aged-care recipients. The Quality of Care Principles 2014 will be used to proscribe new requirements on approved providers when using restrictive practices. Noncompliance with the new requirements for restrictive practices will be dealt with by the expanded powers of the Aged Care Quality and Safety Commissioner. That will include the ability to issue a written notice, and a civil penalty will apply for failure by a provider to comply with a written notice.
Home care will be subject to greater scrutiny, including the implementation of an annual program of assurance reviews for approved providers. This will improve the integrity of home care and increase oversight of home-care charges. The intent is that the oversight promotes better value for money for the government and of course for care recipients. Home-care assurance reviews will support improvements in three key areas: they will monitor home-care delivery and administration to ensure they're effective and, indeed efficient; continuous improvement and policy development; and informed further education of approved providers in relation to their responsibilities.
Greater transparency will be an important tool of reform under this bill, which should improve both the outcomes of and confidence in the aged-care system. The Secretary of the Department of Health will now have the power to do the following: require approved providers and their employees to provide information for the purpose of program assurance; publish information about providers who do not comply with notices to produce information; and prepare and publish reports on the assurance reviews.
We know that many Australians wish to live in their own homes for as long as possible, and that is happening. The government is committed to affordable, value-for-money home care and extra home-care packages. The combination of program assurance and funding will support that very objective.
This bill provides for a new non-legislative advisory group to replace the Aged Care Financing Authority, known as ACFA. The new advisory group will commence from 1 July 2021 and provide advice to government on aged-care financing issues. To facilitate that change, the ACFA requirement is removed from the act.
The government is pursuing generational change of the aged-care system. This bill is part of the more comprehensive five-year reform process, with five key pillars. I'll outline what they are for those listening at home who want to know what the five key pillars of reform are. They are: home care; residential aged-care services and sustainability; residential aged care quality and safety; workforce; and, of course, governance. Many people in Moncrieff and across Australia will be interested in further details on the reform process and the bill that I just outlined. I'll now delve into some of those details.
The time frames for the reforms are as follows. On 1 July this year, new restrictive practices regulations will commence. That's straight away. That's in couple of weeks. On 1 November 2021, this year again, the home-care assurance reviews will be implemented. The Aged Care Financing Authority will be abolished by the assent of the bill itself.
The royal commission identified abuse associated with the unregulated use of restrictive practices. The reforms delivered by this bill in relation to restrictive practices are therefore one of the very important ways that this government is acting to protect aged-care recipients. The bill will deliver reforms in the following ways: it will strengthen and clarify provider responsibilities concerning the use of restrictive practices; it will strengthen the emphasis on aged-care recipient rights and the delivery of person centred care, which is so important; and it will require providers to only use restrictive practices as a very last resort following the employment of alternative behaviour-support interventions.
It is important to point out that, whilst the terminology of restrictive practices is being harmonised across aged care and the NDIS, which means it will be the same, the authorisation processes remain different, for good reason. Under the NDIS arrangements, each state and territory is responsible for the authorisation of restrictive practices in accordance with relevant state and territory legislative and/or policy requirements. The different authorisation processes reflect differences in the likely care needs. In disability care, for example, the care recipient is more likely to have stable needs. In an aged-care setting, fluctuations in care needs and deterioration of various conditions are far more likely.
The arrangements for informed consent will be clarified and strengthened by this bill. The legislation also recognises that state and territory legislation specifies who can consent to the use of restrictive practices for a care recipient and who cannot consent because of physical or mental incapacity. The government is not seeking to harmonise consent arrangements across states and territories with this bill. This will be considered in the longer term and with consideration given to harmonising consent arrangements across care and support sectors, including the disability sector.
The bill doesn't prohibit restrictive practices. It makes them a last resort for the safety of staff and especially for care recipients. In relation to restrictive practices, this is what the bill will deliver: clarity that other interventions must first have been utilised or excluded as not suitable before resorting to restrictive practices; the requirement that restrictive practices only be used in a way that supports good clinical practice and provides safe and improved care for care recipients; and the prohibition of the use of restrictive practices as a method of punishment or as a substitute for inadequate resources.
Further, this bill also makes the use of restrictive practices outside the circumstances permitted by legislation reportable under the serious incident reporting scheme. It does not expand or authorise the use of restrictive practices where it is otherwise unlawful. They are very important points. It provides the Aged Care Quality and Safety Commissioner with the power to issue a written notice if a provider does not comply with its responsibilities relating to the use of those restrictive practices. It provides a civil penalty for breach of compliance with a written notice. This tough, but fair, measure is the first time a penalty has been implemented for those particular circumstances, should they arise. It is not overregulation, because we're preventing abuse. This bill is helping to prevent abuse. Approved providers of residential aged care are already required to minimise the use of physical and chemical restraint in accordance with part 4A of the Quality of Care Principles 2014. The government is clarifying the legislation to avoid confusion and to strengthen compliance.
As I've outlined, the bill will improve aged-care quality and safety in direct response to recommendations of the royal commission. The government will go further by appointing a senior practitioner to the Aged Care Quality and Safety Commission in 2021 this year. That appointment will lead an education campaign for the aged-care sector and general practitioners to minimise the use of restrictive practices, and provide senior Australians and their families with an independent review mechanism to ensure aged-care providers are complying with their legislative obligations.
As I mentioned earlier, the Morrison government is extremely supportive of the desire of many Australians to remain in their homes for as long as possible as they age. The government is cognisant of the quality and safety of home care and the value that care recipients and the government obtain from investing in that home care. Home-care assurance reviews are therefore very important. There has been understandable community concern that some providers charge unreasonable admin fees. To address these community concerns and to protect the integrity of this significant government investment—as I said, $17.7 billion over five years—the government is implementing further oversight through home-care assurance reviews.
This bill is part of a comprehensive reform process that is focused on respect, care and dignity for older Australians. The Morrison government is investing an additional $17.7 billion of funding into the sector—I've said it again for a third time—in response to the Royal Commission into Aged Care Quality and Safety. We are determined that this reform will deliver the high quality of care that Australians deserve. It will ensure the safety of those care services. It will ensure more control and choice for Australians regarding their care arrangements and that those care recipients are treated with dignity and respect.
Even if this issue related to the care of one Australian, how we treat one aged person, it would be a test of our decency as a society. The scale of the aged-care system underscores the importance of that test and quantifies the significant resources needed to address the dramatic improvements required. Just consider that around 1.3 million Australians access aged-care services today. There will be more than seven million Australians over 65 by the middle of the century. The Morrison government's investment of $17.7 billion over the forward estimates will include an annual figure that will reach $5.5 billion by 2023-24. Whilst these large figures demonstrate that the investment by the Morrison government is commensurate with the scale of this challenge, it's important to understand that we're also moving with urgency, as is appropriate. In calling for and responding to the royal commission, at each step the Morrison government has sought to address the immediate priorities to improve the aged-care system, investing $552 million when the royal commission was first established, $537 million at the time of the interim report, $132.2 million in direct response to the COVID-19 special report and $452 million for immediate priority actions in response to the final report, Care, dignity and respect.
Of course, this is not just a government response. Providers and the workforce will be our partners in reform of our aged-care system, as they must be. As I mentioned previously, the reform responding to the commission will be shaped by five pillars, with significant funding for the improvement of each of them. I'll outline them quickly.
Pillar 1 is $7.5 billion in home care, with $6.5 billion for an additional 80,000 home-care packages. This is good news for older Australians. With these additional 80,000 home-care packages, 40,000 will be released in 2021-22 and 40,000 in 2022-23, which will make a total of 275,598 packages available to senior Australians by June 2023. Key pillar 2 is $7.8 billion for residential aged-care services and sustainability, which is also a very important pillar. I won't go through all the dot points I've got here because I see I'm always running out of time speaking on these bills. Pillar No. 3 is $942 million for residential aged-care quality and safety, which is a very important part of the reform. Pillar 4 is $652.1 million going to workforce, those important training places, with $228.2 million to create a single assessment workforce to undertake all assessments that will improve and simplify the assessment experience for senior Australians as they enter or progress within the aged-care system. An additional $135.6 million is to provide eligible registered nurses with financial support of $3,700 for full-time workers and $2,700 for part-time workers. Pillar 5 is $698.3 million that's going into governance to ensure that there is good governance for the National Aged Care Advisory Council, a Council of Elders, and work towards the establishment of a new Inspector-General of Aged Care. Going forward, the drafting of a new Aged Care Act over the next two years will seek to embed the Morrison government reforms that I've just outlined for the House into the aged-care sector.