Claire Moore (Queensland, Australian Labor Party) Share this | Hansard source

When I saw the notice of motion on aged care in the Red today, I became quite excited. The title referred to challenges in aged care and I thought that this would be a great issue to debate. We would be able to have a responsible discussion about it in this place and look at all the things that we know we should talk about in terms of future aged care in our community. I was drawn to going back to the report of the community affairs committee that you and I were on, Mr Acting Deputy President Humphries, in 2005: the Senate Standing Committee on Community Affairs References report entitled Quality and equity in aged care. I was hopeful that the people in the aged-care sector had looked at the 51 recommendations that came out of that inquiry.

Senator Adams and I worked closely together on that committee, and I was interested in her comments, which were strongly backed up by Senator Barnett, that we were waiting for the Rudd government to respond to the Senate Standing Committee on Finance and Public Administration report of April 2009. Those of us who were on the 2005 committee waited two years and five months for the then government to respond to that report. I can give a clear commitment that it will not be two years and five months until we have a response from this government on where we are going. However, we need to ensure that we work effectively in what are the significant challenges in aged care in this country.

After my excitement at seeing this notice of motion, and the opportunity it provided to look at the challenges of aged care, I read it through. I got to the words ‘We give notice .. and move that the Senate’ and I thought that it was all going really well. When I got to the first point of the motion, which states, ‘Australia has an ageing population’, I was thrilled to think that we had a point of agreement. We agree on the documented information which has developed through the responsible research models in this country that are looking at what our demographic future is.

You may remember, Mr Acting Deputy President, that in one of our committee inquiries—I am not sure which one—we had evidence from a research body which talked about the coffin-shaped graph, which I felt at the time was perhaps an unfortunate title for the area we were talking about. In a very clear and graphic way, it showed us the demographic position of our Australian population at the moment and into the future. As we were encouraged to by that group, we could see the bulge of birth rate through the middle years and into the future. A number of senators have pointed out—and I think as much as possible we should try to keep to where we can agree—that today we have about three million people in our community who are over 65 years of age. The year 2050 may seem a long way away but, in the research patterns we are looking at, it is not that far. When we look at generational increase, by 2050 the number of over 65-year-olds will have doubled to more than 7.5 million and will be 22.2 per cent of the Australian population, according to the current projections of our health system.

People over 70, given the kind of work we are doing to ensure we stay fit and healthy and increasingly active in the workforce, now number about two million, and that is projected to triple to more than six million by 2050, or 16.9 per cent of the population. Over 85 is a fine age. In Australia we have people living to great ages. Now we have around 400,000 people who have reached the age of 85 or over. By 2050, and this is based on what we know at the moment from our health systems, that is expected to quadruple to 1.6 million people, or 4.6 per cent of the Australian population. It is self-evident that our population is ageing. There are great programs operating in our communities, particularly at the local government level, to encourage people to remain healthy and fit. There would be an expectation, if we have such an ageing population, that we will be needing more effective, more responsible aged-care services. So with the notice of motion, I thought I could agree with the fact that:

Australia has an ageing population—

and I went on to agree with:

which will cause a significant increase in demand for aged care services over the coming decades—

yes, yes—

including aged care facilities.

Yes, we were together, as one, and I thought once again here we are looking at the challenges of aged care. So we created the scenario: we agree that there is an ageing population but not just in Australia. One of the things we need to accept is that through most of the developing world there is an acknowledgement that people will be living longer. The kinds of issues we are discussing in Australia are shared by most of the developing nations. Part of the research and the development of technology and training packages can be shared internationally. Through some significant work, particularly at centres of excellence in some of the universities in this country, we are sharing knowledge. On that point, I think we can continue to agree. Feeling quite confident, I then moved on to point (ii):

the Federal Government has direct responsibility for the provision of aged care, while the states have responsibility for a range of matters, including the provision of education.

I can be pretty certain that I can agree with most of that as well. We know that aged care is a shared responsibility. It is across governments—but not just across governments, because aged care, as we well know, also depends on the direct involvement of business, industry, community organisations, all of us and, most importantly, family, an element which I know has been picked up in previous discussion but continues to be important in the discussion into the future.

In Australia, we do not have a particularly strong history of extended family care. Some cultures do. In terms of looking after aged people, there has been a revised interest over the last 10 to 15 years in keeping people within their home environment and their family environment. We have seen people making family plans on that basis. So, yes, we can accept that there is a shared responsibility in decisions about aged care. One of the things that we do know now much more than in the past is that there is a strong responsibility for individuals to plan their own futures.

In one of our previous inquiries looking at the focus of social welfare into the future, part of the evidence was that people are now looking more clearly at self-funding their futures. That came up very strongly in the issues of superannuation. So with respect to part (ii) of the notice of motion I thought yes, while there could be discussion around who has responsibility for particular parts, I am doing well. We are agreeing on (i) and (ii), and that is not even to take into account the first point, which is to say that there is a notice of motion—and I agreed with that as well. I was becoming encouraged at this point. Then I went to the opening phrase of (iii):

the Rudd Government—

and I felt, having seen who put the notice of motion on the Notice Paper, ‘Hang on, this is where there could start to be a point of difference.’ Indeed, when I read on it said:

has failed to do anything to tackle the capital funding crisis in the aged care sector.

I felt almost immediately a lack of agreement. Whilst I totally feel that we need to look at the challenges in the aged-care sector, anything that starts with ‘failed to do anything’ made me think that this could well be moving from a discussion looking at the challenges of aged care in our community to what Senator Siewert referred to in her contribution as our well-known process of buck-passing and politicisation of the issue. I thought: why do this, when we know as a community, when we know as a parliament, that, in the ordinary processes in this place, there needs to be work done on aged care—no-one denies that—yet we automatically lift the issue for discussion into allegation and buck-passing, bringing in an element of politicisation and taking away from the aspects of where we need to move forward?

There is no doubt that there needs to be changes in our aged care system. No-one denies that. Through the processes of our series of committees on this issue, both within the Senate Standing Committee on Community Affairs and the recent Senate Standing Committee on Finance and Public Administration chaired by Senator Polley, I did a quick calculation that there are over 100 recommendations looking specifically at aged care. There is no element that says that there does not need to be changes.

In fact, the National Health and Hospitals Reform Commission, which is the latest group looking across the board at our whole system in this country, has its own section on increasing choice in aged care. I know that they did enormous work led by Dr Christine Bennett, and I trust that as part of their research process the members of this commission were able to look at some of the work that had been done through the various Senate committees. I think they must have. When you read their 11 recommendations—our previous committees had over 100 recommendations, so I think they were quite restrained when they came up with 11—you see that they are identifying the same kinds of issues that we had done, whether when we as the Labor Party were sitting on the opposition benches and talking about this issue with another government or vice versa. They came up with similar issues:

We recommend that government subsidies for aged care should be more directly linked to people rather than places.

That seems to be one of the core issues about which we are most concerned. I think I have heard a number of contributions this afternoon which are focusing on the issue of places. Ministers of all flavours release media releases when they are talking about the allocation of rounds and how many places are available at different times. I can go back to Google, that marvellous system, and find media releases that go back into the ’80s talking about aged care places that are going out. It is a positive time when there is funding and allocation of aged care places, but  I have always thought it would be more positive if we tried to link that placement process to individual need and people. The National Health and Hospitals Reform Commission have led here and their No. 1 recommendation is:

We recommend that … aged care should be more directly linked to people rather than places.

That reflects what we have been saying in our previous ideas. It also goes on about the whole idea of accommodation bonds and alternative options for payment. This was a particularly vexed issue in our recent inquiry. I think it was probably a hotter issue than it had been in previous inquiries in which I have been involved. That is an ongoing discussion. I am surprised, Senator Cormann, that one of the challenges in your dot points here was not on that, given the interest that people put into this process. I think that is one of the things that will continue to be an issue. If you look at the Hansard coverage of our previous inquiry you will see that a lot of time was taken up with people discussing that issue.

We also consistently talk about information sharing. I heard previous speakers talk about the fact that at the time when people are seeking aged care help it is often when they are at their most vulnerable and stressed. The whole process becomes so confusing and challenging. People are not able to make the clearest choices and are often lost, despite the wealth of information support that we have. One thing that the previous government and our current government have agreed on is the need to provide effective support information services through the various care links and other organisations. That has been a positive process. People have been getting more access to support so that when they are faced with making these choices they have more information on which to base their decisions and also more security in the choices. Nonetheless, the health reform process has determined that there needs to be more of that so that we can have more confidence that people know what options are available.

Another concern is that when we talk about aged care there seems to be a presumption that we are only talking about aged care facilities and people going into them, whatever they are called. That is not true and I know that Senator Adams referred to the growing number of principal in-place home care positions that are there. Our government has said on many occasions that we believe it is a very important aspect of aged care and there should be more focus on that.

It is not a contest. It is not a competition between someone going into an aged care facility and someone being able to live independently, with support, in their home. I think we should not be talking about having to make that either/or decision. We should be talking about having a more flexible process with a focus on people, so that people are the centre of the discussion and that they can make effective personal choices across a range of options, and these should be funded effectively.

I would think that we would have a degree of agreement on that as well; certainly on the health reform process which is currently up for community consultation. The document has come out, been presented to the minister and now made public. They say that it is the culmination of 16 months of discussion, debate, consultation, research and deliberation; all those things that we know go on. But the important aspect now is to work with the community to see what recommendations will go to government for decision.

Within that process the issues around aged care must not be forgotten. Amidst all the discussion about health reform I do not believe that the area of aged care has received the amount of consideration and public attention that it deserves. I did a quick look at the media coverage of the health reform package and there was not much mention of aged care at all. So one of the responsibilities we can share and can agree on is that it is part of our job to see that these 11 recommendations around aged care do have consideration and are part of the public debate.

I was feeling okay. I knew that there was a bit of a political motive behind this whole notice of motion, but, disappointed as I was that this was the case, I was working through it. And then I got to dot point 4. I was quite stunned by No. 4. It actually said:

The Rudd government—

It is another dead giveaway when the dot point begins with, ‘The Rudd government ...’. And when it has been put forward by Senator Cormann you have to be careful. That dot point went on to talk about reckless and irresponsible action. I was a bit stunned by that but I thought I had best read ahead to make sure I could do all my preparation and get my research ready.

I found dot point 5 and then I worked past ‘the Rudd government’ again and I got to the verb this time, which also caused me a bit of concern. I got to the verb ‘to waste’ and that made me upset. But then I thought, ‘Great, we’re moving on to what we’ve been getting regularly at question time for the last few days: another attack on Building the Education Revolution program.’ Then I realised—it took me a while because sometimes I have to think more slowly and go through it; it could be my increased age—that this was not a motion that was looking at the challenges of aged care in our community, although it led with that title. Once again it was a way to have a political debate in this place—to restate the philosophical approach that people in this place have to various decisions that have been made by government.

You might realise that I am taking a particular line in this debate, but one thing that truly disappoints me is that, by the nature of the way this motion has been developed, we have a form of contest between money being granted to schools and education and money being granted to aged care. Whilst we know that there are always debates about various decisions and priorities in government, to have created such a division in this motion is not a progressive debate. There has been a decision by government to focus money on an infrastructure process in education but that is being presented as a waste and it is being contrasted with some way of spending money on infrastructure in aged care. It is, once again, an attempt to have a political argument. So be it; but do not pretend that that is part of a focus on the all-too-real need to look at an effective process in our aged-care sector. That, in itself, is worthy of consideration and is something that we should work on in this place, without creating any kind of false impression that because money is being spent on education it is being wastefully spent there rather than on aged care. We can continue looking at the challenges of aged care. We encourage people to look at the National Health and Hospitals Reform Commission, but do not make it into a simple political argument.