Nita Green (Queensland, Australian Labor Party, Assistant Minister for Tourism) | Hansard source

At the outset, I want to put two things on the record. I think senators around this chamber have genuine care and concern for older Australians in ensuring that they get dignity in their later years; I'm not doubting that in any way. There was bipartisan support for the government's reforms, and we certainly want to continue in that way. Unfortunately, though, at the outset, I do need to make it clear that while the government shares the intent of this private senator's bill, the Aged Care Amendment (Restoring Human Override for Aged Care Needs Assessments) Bill 2026, we're not able to support its passage as it's currently drafted. We're concerned that, in practice, its provisions will be counterproductive and may not achieve what they set out to do. There is a lot of nuance when we talk about the way that these assessments are happening, so I am going to put on the record the information that Australians need to understand and know about how the government is progressing the most historical reforms in the aged-care system ever delivered and the most funding ever delivered to the aged-care system.

The integrated assessment tool that we're talking about today, also known as IAT, and associated classification and prioritisation mechanisms, are central parts to fixing a system that was previously slow and inconsistent, and, in too many cases—this is very important to understand—unfair to older Australians. It was unfair because they weren't getting the right assessment that they needed. It is part of a broader reform agenda that is fixing a system that was failing not just older people but their loved ones, aged-care workers and, indeed, all of those committed to the task of caring for those who have given us so much.

The Royal Commission into Aged Care Quality and Safety shocked Australians with its damning assessment of a failing aged-care system. The final report, tabled in parliament on 1 March 2021, made 148 recommendations calling for fundamental reform. Since coming to government, we've been getting on with the job of delivering those recommendations, putting in place the once-in-a-generation reforms that are needed to deliver high-quality, world-class aged-care services to the older Australians who built this community and to whom we owe compassionate care. But we know that generational reform is not a single moment; it is a long-term project. With the commencement of the new Aged Care Act 2024 on 1 November 2025, we've already seen many improvements to the way that care is delivered to older Australians, and this has meant that we are now providing more care to more people more quickly.

As of 31 March, a record 300,000 older Australians have access to an ongoing Support at Home place, and, with the delivery of an additional 83,000 places last financial year and another 32,000 to come this financial year, by the end of 2026-27, 420,000 older Australians will have access to Support at Home. This is almost three times as many older Australians as the number that had a home-care package in 2020. This is the volume that we are talking about. But we've also said that we will watch closely as these reforms roll out and will make adjustments to ensure that they are delivering what older Australians need. We've been really clear about that.

The IAT is about delivering a system that's efficient, accurate and fair. It shouldn't matter where someone lives or who does their assessment. Every older Australian should be treated equitably by our aged-care assessment systems. To deliver on that aspiration, design decisions have specifically been made to ensure that consistency, so that, for a given set of clinical characterisations, the assessment system produces the same outcome. This is what it means to bring together clinical expertise, of course, and consistent national rules to deliver more equitable outcomes. The explanatory memorandum to this bill states:

This Bill clarifies that the IAT functions in a supporting capacity only, and that the approved needs assessor retains authority to record an assessment outcome based on their professional judgment.

The bill itself says that an assessor's discretion may not be limited by the assessment tool or any other requirements prescribed by the rules.

As I said at the beginning, I understand the intent of the private senators' bill. But a broader, unfettered discretion for assessors to override the classification or priority assigned under the rules, as is proposed by this bill, would actually risk undermining fairness, and, importantly, slowing access to care for many of those who need it. This is a matter of debate. We take a different view from those opposite and those at the end of the chamber about the need for fairness in the system, and that is what we will be debating today. But, under the former Home Care Packages Program, senators will be aware that there was a high degree of assessor discretion in determining funding and priority levels, and what that actually resulted in was that people with very similar needs received very different outcomes depending on where they lived or who conducted the assessment. In 2024-25, for example, around 20 to 25 per cent of packages were approved nationally at level 4, but, in some jurisdictions, that figure was as high as 60 per cent. That variation created serious equity issues and had a direct impact on wait times for care.

We also saw the consequences of that inconsistency in the accumulation of large volumes of unspent funds across the system, highlighting the limitations of process based, subjective decision-making with an inadequate focus on fairness and consistency. By the time the new act commenced, $4 billion in unspent care funding was sitting in people's accounts—money that could have delivered more care more quickly to more people.

I want to be clear about this. The government understands and appreciates the intent of the private senators' bill. It's not that I think that Senator Ruston or other senators are not genuine in their concern for older people. But we are concerned that the consequences of these provisions would have significant cost implications. An early analysis from the Department of Health, Disability and Ageing is that the cost of these amendments to the act would be significant. The senators proposing this bill have not explained how these costs would be met within the aged-care system. We are also concerned that departmental advice also shows that the provisions could have major implications for wait times, blowing those out by an estimated five months. These concerns should not just be brushed away as if they are of little consequence. Wait times, the cost of aged care and where that money is spent are so important to older Australians.

There is a reason why the assessment system had to change from what it was before; I can't be clearer about that. There was an unfair system resulting in people not getting the care they needed. There is a reason why the rules that govern the process were decided and went through a robust parliamentary scrutiny process. There is a reason why the parliament agreed that these rules would be what they are, and a provision, as is included in this bill, to allow assessors to in any circumstances set aside what is prescribed by the rules decided by parliament will not deliver the equity that this system should be maintaining for older Australians who deserve dignity, equity and fairness.

Being a responsible steward of this system upon which so many older people rely means approaching changes like this in a careful and considered way. It means working together, hopefully in the same bipartisan way that we brought the new Aged Care Bill to this parliament, to deliver on the needs of those in our community. That's why the government has announced that it will establish a new legislated escalation option, so that outcomes of the aged-care integrated assessment tool can be changed in extenuating circumstances. This means that, in the same number of cases where a person's complex circumstances are not fully captured by the integrated assessment tool, under this new pathway their assessment can be escalated to the system governor and adjusted if necessary so they get appropriate care. This will provide practical, responsible protection without compromising the care of older people, and we'll use the parliamentary break to consult on what this will look like so it can be implemented.

We are willing to work together with those opposite, as we are with all senators in this chamber, to find a way to achieve the intent of this private senator's bill without the adverse consequences currently before us. This is what older Australians expect. When the royal commission report was delivered, it shocked Australians. It shocked Australians because we expect that older Australians who have lived their lives, paid their taxes and contributed to our communities and our economy are taken care of in the most dignified way—and that was not happening under the previous government. Those 143 recommendations from the royal commission need to be implemented, and the government has been working to do that.

We know this is a challenge. We know this is generational reform. But it is this government that has taken it on. It is this government that is delivering. We want to ensure that the expectations older Australians have of their government to meet their needs, to deliver on the recommendations, to make sure that the system is fair and equitable no matter where you live and no matter who does your assessment—those are the expectations that older Australians, and indeed all Australians, have of us.

Just to finish here, I understand there is a genuineness to the debate that will happen today. I don't dismiss the care and concern that anyone in this chamber has for older Australians. The government shares that concern, and that's why it's implementing these reforms. It's why we are making sure those 143 recommendations are implemented. That is why the government introduced the new Aged Care Bill. We brought it to parliament, parliament decided on the rules that would be implemented, and the system we've developed is making sure that the rules are implemented in a fair and equitable way. This bill would result in longer wait times in and higher costs to a system that cannot afford either.

So I want to say that the government will not be able to support this bill, but we are working incredibly hard to review the system to ensure that there is an escalation system in place. We will consult on what that looks like and bring that back after the break to ensure that it is legislated, hopefully with bipartisan support.