Ged Kearney (Cooper, Australian Labor Party, Shadow Assistant Minister for Health and Ageing) Share this | Link to this | Hansard source

Labor actually supports the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. I'd like to indicate that Labor will be supporting the passage of this bill, although I also foreshadow that at the end of my remarks I'll be moving a second reading amendment. We want to be clear that the government's response to the royal commission's final report falls short of solving a number of key issues within the aged-care sector and it fails to deliver enduring improvements and reforms for the long term. This bill will make urgent amendments to the Aged Care Act to implement three measures in response to recommendation of the Royal Commission into Aged Care Quality and Safety and, in the case of restrictive practices, in response to the independent review of legislative provisions governing the use of restraint in residential aged care. The first key change in the legislation is around the overuse of restraints in aged care. The changes proposed in this bill will strengthen legislation on the use of restrictive practices and restraints. These changes are welcome and, as the Royal Commission into Aged Care Quality and Safety identified, much needed. Restrictive practices have been a serious issue in aged care for decades. The royal commission noted:

The inappropriate use of unsafe and inhumane restrictive practices in residential aged care has continued, despite multiple reviews and reports highlighting the problem. It must stop now.

The excessive use of physical and chemical restrains in residential aged care robs older Australians of their dignity and autonomy in their final months. It has been distressing in my own career to have seen older people tied to chairs and locked in with tables that click in around them or to have them heavily sedated overnight where they soil themselves and where these drugs exacerbate confusion. In the final three months of 2019-20 residential aged-care services made 24,681 reports of intent to restrain and 62,800 reports of physical restraint devices.

This bill will make a number of important changes with regard to restrains and restrictive practices. It will clarify the definition of 'restrictive practices' in the Aged Care Act so that it is in line with the NDIS definition and ensures that all restrictive practices that limit the freedom of movement of an aged-care resident are included. It will expand the Aged Care Quality and Safety Commissioner's ability to respond to breaches of approved aged-care providers' responsibilities in relation to restrictive practices, with new abilities to issue written notices and make applications for civil penalty orders. It provides that the Quality of Care Principles set out clearly when an aged-care provider is able to consider the use of restrictive practices—importantly, only ever as a last resort. This bill should improve the regulation of restrictive practices in aged care. However, Labor notes that it falls short of the royal commission's recommendation for the introduction of independent expert approval for the use of restrictive practices.

The second key change is the introduction of assurance reviews. This bill allows the secretary to conduct home-care assurance reviews to inform continuous improvement of home care. This is welcome if they do as described and increase the effectiveness, efficiency and transparency of the home-care system. It is disappointing that the government hasn't followed more closely the recommendations from the aged-care royal commission to increase transparency and accountability measures. We know there are many aged-care providers who are doing amazing work and who are dedicated to the health and wellbeing of those in their care, but we also know that there are far too many providers who are not.

While the government likes to appear tough on rogue providers, when you dive into the details of its response to the royal commission, so often it turns out that it's letting those providers do what they want. Given that there are around 928 home-care providers operating in Australia, not all providers will undergo assurance reviews. The Health Services Union noted in its submissions that the bill does not go far enough to achieve these objectives in practice and recommended that assurance reviews be carried out on a regular basis and then be published. Labor are committed to doing things differently. We want to see a transparent and accountable sector—a sector where bad providers are not allowed to run riot and do what they please, as this government has let them do for so long.

The third key change is the replacement of the Aged Care Financing Authority. The government agreed to establish an advisory group to replace the ACFA which will commence operations from July 2021 to ensure that the government continues to receive advice on financing issues in the aged-care sector. A new advisory body will be established to provide advice to the government on aged-care financing issues.

There is no urgency, however, about any of the government's response to the royal commission. This bill and its changes around the rules on the use of restraints and restrictive practices is welcome, but we must stop and ask: Why is this the only legislative action that this government is taking right now? Why is this the only bill that we're seeing months after the royal commission handed down its final report? Considering that we've just had the Royal Commission into Aged Care Quality and Safety, which produced an eight-volume report that told us just how bad the crisis is in aged care, where is the sense of urgency to fix all of the problems identified in that report? Where is the sense of urgency to improve the level of care that older Australians are receiving? Why change the habit of a lifetime? The government has neglected aged care and older Australians for eight years. Don't just take my word for it. The royal commission perfectly described the government's approach to aged care in its final report:

At times in this inquiry, it has felt like the Government's main consideration was what was the minimum commitment it could get away with, rather than what should be done to sustain the aged care system so that it is enabled to deliver high quality and safe care.

That is absolutely damning.

The Prime Minister has neglected older Australians in the aged-care system for eight years, and it's a national disgrace. But, despite the royal commission's damning words, it seems the government will continue to do the minimum they can get away with. The last eight years of neglect by this government have shown that another three years won't make a difference. Their response to the royal commission and the aged-care crisis falls far short of what it should have been. It fails to deliver enduring improvement and reforms for the long run. They fobbed off, delayed or outright rejected key recommendations. Their response to the aged-care royal commission claims that they've accepted, or accepted in principle, 126 of the commission's 148 recommendations, but, even when they say they've fully accepted a recommendation, it doesn't actually mean they're going to implement it in full. When you look at the detail in their response, times are pushed back—sometimes by years. Key sections of recommendations are often excluded. Sometimes they say they've accepted a recommendation and their response doesn't even pretend to match it. Now, that is a weird definition of 'accept'.

Let's look at the key areas of concern. Firstly, nothing will change without reforms for the workforce. There is nothing to improve wages for overstretched, undervalued aged-care workers, and, critically, there is no plan to ensure real accountability and transparency of funding. There's nothing that seriously reforms the system to see exactly where the money goes. There's no change to auditing requirements to stop money being funnelled away to Maseratis or offshore tax havens or secret family trusts while residents suffer malnutrition, lie in soiled beds and have deep, deep wounds, some of which, as we've seen, have maggots in them. They're gifting $3.2 billion to providers, with no strings attached to ensure that this goes to actual care and better food, not management bonuses or new office fit-outs. They've promised 80,000 extra home-care packages for a waitlist of 100,000 people, which is growing. The maths just doesn't add up. Australians want to age at home, but they need those packages to do it. They've ignored the recommendation to require a registered nurse to be on duty 24/7 in residential care, which we know is core to improving care. Their approach also shirks the main increase to mandatory care requirements in residential aged care. Staffing levels are central to the quality-of-care problems. Why call a royal commission and then effectively ignore most of its key recommendations?

It comes back to trust. Older Australians, their families and the workers that care for them can't trust the Prime Minister to fix this broken system. He's responsible for the aged-care system. His government is responsible for the $1.7 billion in funding cuts from when he was Treasurer. The Prime Minister hasn't learned, because his response to the aged-care royal commission is the minimum he thinks he can get away with—and not a single issue is actually fixed.

Right now we are seeing the impact of this government's neglect of aged-care residents and aged-care workers in real time in my home state of Victoria, as we emerge from our fourth lockdown, where there were cases in aged-care facilities. Last year, as we, sadly, know too well, 655 Victorians died tragically in my state in aged care. Back in February, the Prime Minister promised us that aged-care residents and workers would be vaccinated by the end of March. It's now June, and this still hasn't happened. Minister Colbeck, the Minister for Senior Australians and Aged Care Services, told us that he is 'comfortable' with the pace of the vaccine rollout—comfortable. Well, I would like to tell you that the residents in aged care are not comfortable with the vaccine rollout. Many of them are fearful. No aged-care worker is comfortable with the pace of the vaccine rollout. They are fearful. The government totally gave up on trying to vaccinate the workforce. They said to the workers: 'We can't do it. It's too hard. You can go off and do it yourself and find a GP who can do it for you.' Then they actually had to survey aged-care staff to find out if they'd been vaccinated! The fact that this is happening again is an unmitigated act of total negligence by the federal government. These are people who care for our older Australians every day. They are in and out of those homes every day, and this government doesn't have a plan to vaccinate them. All of this is squarely on the federal government's shoulders. It is their responsibility, but, if you listen to them talk about it, you'd be unable to tell. Right now there is no plan, there are no targets and there is no urgency.

To summarise, while we welcome the changes in this legislation, the government's response to the royal commission falls short of solving a number of key issues within the sector and fails to deliver enduring improvements and reform for the long term. Accordingly, 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:

(1) notes the:

(a) systemic, ongoing failures in Australia's aged care system as evidenced by the Royal Commission into Aged Care Quality and Safety, including, but not limited to, the use of restrictive practices and restraints in aged care;

(b) inadequacy of the Government's response to the Royal Commission into Aged Care Quality and Safety, including delayed and diminished legislative action on key issues and recommendations; and

(c) Government's failures in protecting aged care residents and workers due to their poor management of COVID-19 outbreaks in residential aged care; and

(2) calls on the Government to explain, as a matter of urgency, their plan to fully vaccinate aged care residents and workers."

Graham Perrett (Moreton, Australian Labor Party, Shadow Assistant Minister for Education) Share this | Link to this | Hansard source

I second the amendment and reserve my right to speak.

Katie Allen (Higgins, Liberal Party) Share this | Link to this | Hansard source

All Australians deserve to age with dignity and respect. That is at the core of the reformation that is happening under this government. No-one is hiding from the fact that this has not always been the case. That's why our Prime Minister called for the royal commission into aged care as one of his first acts as Prime Minister. Some of the stories we've heard through the royal commission have been shocking. They've been really difficult to hear. But we now have to act on reformation to ensure that we improve the lives of those in the aged-care system.

The Morrison government is committed to reforming the aged-care system, and to do this we have to respect that senior Australians need tailored, individual approaches. This bill would deliver the first stage of the aged-care reform program in response to the royal commission. The health, safety and wellbeing of senior Australians is of the utmost importance. It is driving our plan for generational change. The Morrison government's comprehensive response to the royal commission is driven, through the lens of five broad pillars, by the principles of respect and care. Those pillars are: home care, residential aged-care quality and safety, residential aged-care services and sustainability, workforce, and governance. I will address each of those points.

First, senior Australians want to remain independent and in control of their life. Living at home allows them to do that and to stay connected to their community. That is why investment in home-care packages, as we are doing as a government, is so incredibly important. The government is providing $7.5 billion to ensure 80,000 new home-care packages are brought online. This is what the community wants. This is what senior Australians want. It's what we should all want. It will provide increased support for informal and family carers and support for senior Australians to find the aged-care services they need, provide increased Aged Care Quality and Safety Commission checks and provide transparency pricing to ensure value for money. The My Aged Care website and contact centre will continue to be a key entry point to help those who are ageing and their carers navigate these complex systems.

Residential aged-care services and sustainability is the second pillar. Around 204,000 senior Australians live in residential aged care each year. The government will invest $3.9 billion over the next four years to increase frontline care, and from July 2021 there will be a new government basic daily fee supplement of $10 per resident per day, which will give immediate support for providers for the services that they provide, such as food, nutrition, linen and cleaning. There will also be a new funding model for residential aged care, which will enable transparency, and independent assessors will resolve fairer aged-care support for all residents.

Residential aged care quality and safety is the third pillar of the reforms this government is leading. This will help strengthen the Aged Care Quality and Safety Commission to further protect senior Australians. The government is investing $231 million to: enable the commission to do 1,500 more site audits; enforce regulation of physical and chemical restraint use; expand the Serious Incident Response Scheme into home care, which is being passed into law here in this House; and increase funding for the Dementia Behaviour Management Advisory Service and the Severe Behaviour Response Teams. These are all incredibly important not only as Australia becomes an older demographic but also as we see more people developing dementia, because we are all living longer.

Primary care support between aged-care and healthcare systems is an incredibly important link to make. We know aged-care residential settings look to their local hospitals and their local GPs for the healthcare support they need. As Australians age better at home longer, we are seeing the residential aged-care settings have participants who are older, frailer and with more chronic diseases. As we saw last year, never has it been more important for that connection between residential aged-care settings and their local healthcare providers. The government is providing $365 million to boost the Aged Care Access Incentive and to increase GP face-to-face care. It will also provide for expansion of the Greater Choice for At Home Palliative Care pilot and better support for primary health networks and telehealth services. This is a great reform, because we know that telehealth is a great way for people to connect when they are frail and don't necessarily want to go to their GPs but GPs are busy and might not be able to get to the aged-care facility in time. These initiatives will also produce better data and evidence for workforce planning, because, as we go forward, we know there is increased demand for services and we therefore need to train people, ready for the next stage of increasing our workforce.

That leads me to the third plank in these aged-care reforms—that is, the workforce. The Australian government is growing the home-care workforce by 18,000 new personal care workers, with $135 million to provide additional financial support and incentives for registered nurses. We want to incentivise nurses to enjoy caring for older Australians, and to recognise that with regard to our incentive payments. We want to grow and upskill the workforce, and increase places in the Aged Care Transition to Practice Program and the Aged Care Nursing Scholarships program. We want to fund 33,800 training places for more personal care workers to gain a Certificate III in Individual Support for ageing, and we want to give palliative-care and dementia training to workers. We know that 50 per cent of those in aged-care facilities have some form of dementia, and every worker in those workplaces needs to know how to deal with that special need.

Lastly, we need to look more at governance. There is a new consumer focused aged-care act which will underpin these generational reforms. The Australian government will invest $30 million to support aged-care providers to improve their governance and meet stronger legislative obligations. There will also be a new inspector-general of aged care to provide independent oversight, and older people will have a voice through myriad ways, including the council of elders and a new aged-care advisory council. These pillars are helping to shape our response to a very important issue not just for us but also for the future.

One of the first steps we need to see addressed is the use of restraints in aged care. The bill before us clarifies the requirements that approved providers must meet in the use of restrictive practices. This is an important step in eliminating inappropriate use of restrictive practices, and it is through these tighter requirements that we will be able to ensure providers are providing the best care.

There are many new powers that the Department of Health requires to ensure the safety of those in aged care, but this bill also repeals the requirement for the minister to establish the Aged Care Financing Authority, known as ACFA. It also commits to the new budgetary outline, which I have outlined before. We are investing $3.9 million, as I've said before, in the number of care minutes for residents in aged-care facilities, mandated at 200 minutes per day. That is a very important initiative.

The bill before us is the first step in the government's five-year, five-pillar aged-care reform plan, addressing home care, residential aged-care services and sustainability, residential aged-care quality and safety, workforce and governance. We understand that the world is ageing around us. We all are going to age, because the alternative is something not worth thinking about!

Llew O'Brien (Wide Bay, National Party) Share this | Link to this | Hansard source

The debate is interrupted in accordance with standing order 43. The debate may be resumed at a later hour. The member will have leave to continue speaking when the debate is resumed.