Tim Wilson (Goldstein, Liberal Party) Share this | Link to this | Hansard source

It's a pleasure to be able to speak this evening, particularly on the issues facing aged care following the royal commission on aged care. I don't think I would be alone in this chamber and elsewhere in saying I haven't had the chance to read the full volumes of the report, but we all know that, from what we can read so far, it is sobering reading. The reality is it confronts us and holds a mirror up to the sector and should disturb us all. But we also need to acknowledge there are many good people who operate, manage, own and run aged care and support people in aged care across Australia. The point of the royal commission was to put sunlight onto the system to make sure that those who are vulnerable and need assistance and care get it, and that where there is wrong it is righted, to respect the contribution of those who contributed. It also highlights concerns of neglect. Last weekend, I was in Highett, in the wonderful electorate of Goldstein, doing a listening post. One of the most passionate local residents who came to speak to me raised a specific concern about aged care and what was to be done about it, not just following the royal commission but as part of making a sustainable system for Australia. Every Australian should have the opportunity to live a life and retire with dignity after a full contribution to the fabric of our nation, particularly at the most vulnerable stage, with care, support and compassion, so that they can live out their days with dignity. This is an essential part of the generational contract which builds the strength of our country.

Through two years of testimonies from 641 experts, residents and families and more than 10,000 submissions, the royal commissioners heard how the aged-care system is failing catastrophically to meet the structural challenges of our ageing society. Too many older Australians are sitting on wait lists, unable to access the care that they critically need. There is misallocation of capital. We have centralised, uniform services that don't always mean that people receive the care they need. Many are being unnecessarily forced out of the comfort of their homes and into residential aged care simply because the system was too slow to respond to their less financially burdensome needs. Inadequate training of aged-care staff and the underavailability of professional medical assistance is leading to an oversubscription of psychotherapeutic drugs, misdiagnosis, medical neglect and premature deaths in care. That is against the backdrop of significant challenges with the number of people going into aged care with dementia and the support and assistance they need.

Highlighting the vulnerability, from 2019 there were 5,780 allegations of assault at the hands of staff members, corrupting the ethic of dignity and respect, which should sit at the heart of the aged-care system. The consequences are fundamentally human in nature. The commissioners were quick to illustrate in their report that our failing aged-care system is directly linked to profound and unprecedented demographic challenges. Rising life expectancy and medical breakthroughs are swelling the ranks of our older population, absolutely, and in relation to working-age Australians. It is projected that the number of Australians aged 85 will increase from just over 500,000 in 2019-19 to 1.5 million by 2058. This means there are rapidly growing numbers of Australians in need of care for longer periods and in need of care for more complex health conditions associated with longer life. Meanwhile, there is a relatively small number of working Australians providing the income tax revenue that subsidises aged care. As the system exists today, the federal government is the primary investor of $27 billion spent in the 2018-19 years. Some $20 billion came from the federal government. The Parliamentary Budget Office predicts that, over the next decade, federal government spending on aged care will increase by four per cent per year, which is well above the 2.7 per cent increase predicted across all other areas of government spending at the same time. The Morrison government is already investing significant money in aged care. We know that money is a critical part of the system, but what also matters is the outcomes of the investment that is being made, to make sure that Australians get the support and assistance they need. We should not accept poor standards. We need to make sure that the standards that operate deliver outcomes for those who are vulnerable.

There are, of course, significant consequences from the challenges of capital in the sector. First, aged care has to evolve into a ration based system which has limited capacity to meet individual needs; the provision of services is shaped by the scarcity of available funding, meaning that many are left on wait lists and those with high-cost needs are provided inadequate service; and the system therefore lacks flexibility for some people; particularly those from diverse back grounds, whether they be culturally or linguistic differences or veterans and people from the LGBTI community—to name some. Everyone is different. People are complex, and rigid, uniform and centralised systems will not comprehend the sensitivities of aged care. Often this not only fails to deliver care but also creates more suffering in the system itself. We need to always be mindful of that, particularly when we are talking about Australians in one of the most vulnerable stages of their life.

The report noted that smaller services performed better than large centres because they had more capacity to focus on individual needs. The success of those environments should inform our approach towards reform. We also need to make sure that the governance model hasn't lowered standards and allowed failings to go unnoticed and unresolved. That is why the report recommends a new rights based approach which establishes obligations to deliver high-quality, safe and timely support in care with choice and control. That is of critical importance.

When I go out and speak to people in the community about aged care, there is a diversity of attitudes which are heavily informed from their own life experience. If you talk to people who have had a good experience with aged care, as many residents of the Goldstein electorate have had—and we're home to some of the largest private aged-care providers—the overwhelming majority say that the experience is good, though people faced particular challenges during the COVID-19 period due to access and, of course, what happened when there was a COVID-19 outbreak. As we know, 95 per cent of the aged-care deaths that occurred over the past year occurred in Victoria because of the consequences of community transmission. But, of course, there are other people who saw their family members be deceased because of the lack of access that people had. That was particularly challenging in a situation where people didn't get the chance to see their loved ones before they departed. No matter what side of politics, we all share a compassion for families who never got that last moment—or who may have got it through a form of transparent glass.

Sadly, though, there are also people who want to use a discussion around aged care for some sort of ideological agenda. I really want to stress how damaging this is, because aged care has private providers. A lot of them are community based organisations who operate privately but receive government money. I don't seek to demonise any of those, whether they are community based providers or those who we have needed to invest in the system to build the capital so that, when people go and seek out an aged-care service, it is available to them. We've seen failings in different parts of the sector and for different reasons. I outlined the failure of being able to ensure that people have individual care needs based on their ethnic or religious background or, of course, their sexual orientation or gender identity. Aged-care homes that have been well intentioned and motivated by a mission to support people from their community have often lacked the capital, which has meant that they have had to sacrifice services to keep their operations going—and that has a consequence too. Where you see a private operator that is a commercial operator that misallocates capital away from service provision that is a problem in itself.

The challenge before us in developing an aged-care system that sustains people for the 21st century is not to pursue ideological agendas; it is to understand the care that people require and how we meet those needs. Sitting behind are much broader discussions around the sense of responsibility that we have between each other as part of a culture and a society of mutualism. Where there is capital, the government can play a role. But where there is capital required for capital investment, there is simply no reason why the private sector—whether charitable, commercial or other—cannot be part of the system, to grow the system, so that when you need aged care and support and the home it is there for you. Similarly, when it comes to management, it often comes down to the costs of the individual and their responsibility and contribution.

When it comes to the service provision, particularly around health care, what operates inside an aged-care home should be the same as what occurs outside the aged-care home, where taxpayers have a responsibility to support each other. Ultimately, it's a debate about responsibility: who is responsible for which section to make sure people get the assistance they need? Individuals have a responsibility, families have a responsibility, companies have a responsibility, and of course the taxpayer has a responsibility as well.