Senate debates

Monday, 10 September 2018


Aged Care (Single Quality Framework) Reform Bill 2018; Second Reading

5:15 pm

Photo of Helen PolleyHelen Polley (Tasmania, Australian Labor Party, Shadow Assistant Minister to the Leader (Tasmania)) Share this | | Hansard source

I appreciate the opportunity to outline Labor's position on the government's Aged Care (Single Quality Framework) Reform Bill 2018. Labor supports this bill. However, in saying that, I would like to reiterate a number of concerns I have raised and that my colleague the shadow minister for ageing has in fact raised in the other place. The bill amends the Aged Care Act 1997 and the Australian Aged Care Quality Agency Act 2013 to make provision for a single set of aged-care quality standards that will apply to all aged-care providers under the Aged Care Act. The bill will also vary the functions of the chief executive officer of the Australian Aged Care Quality Agency to reference the Aged Care Quality Standards. Currently, there are standards that cover three different areas of care. They include four standards for residential aged care, two standards for home care and two standards for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program quality review. The new single set of standards will apply across all areas of care and will be effective from 1 July 2019. This is an amended date as there were concerns from the sector that the original start date of 1 July 2018 would give stakeholders and providers little time to do the necessary preparatory work. The new standards will focus on quality outcomes for consumers rather than providers and processes and have been driven by the sector and other stakeholders since 2015.

As mentioned earlier, Labor has a number of concerns. First is the length of time it has taken for the government to introduce legislation into the parliament. This was a 2015-16 budget measure. Secondly, the explanatory memorandum outlines that the bill amends the Freedom of Information Act 1982 to ensure that documents containing protected information acquired by the quality agency in the course of its functions are exempt from disclosure. As the shadow minister has already highlighted in the other place, Labor is concerned that the consumer may suffer as a result of this FOI amendment. We don't want to see important information being kept from consumers, so that's why Labor will closely monitor this change.

I would also like to raise the review of the National Aged Care Quality Regulatory Processes, also known as the Carnell-Paterson review. The report of this review was handed to the government on 20 October last year. The review made 10 recommendations, one of which was to establish an independent aged-care quality and safety commission. The government adopted this recommendation back in April last year and Labor understand the legislation for this will be introduced into parliament for debate soon. I would also like to acknowledge that the minister offered a briefing to Labor on this legislation. Of course, Labor welcome this announcement, but we are concerned the government has not given consideration to the delivery of care across multiple settings.

Before I go further, I want to put on the record our thanks to the nurses, carers, doctors and allied health professionals who work hard to deliver care to older Australians each and every day. Labor recognises that each day around the country the majority of older Australians are treated with care and respect at residential aged-care homes. I've visited so many right around this country and to see the work that's done on a daily basis, as I said, with care and respect is something that we can be proud of—although there are some that don't meet those standards.

What hasn't been at the forefront of any discussions are the protections for people who choose to age at home. With a growing number of older Australians choosing to age in their own homes those protections should be stronger—whether the care is being delivered in residential aged-care homes or in the family home. The minister's announcement seemed to be very focused at those providers delivering care in a residential aged-care environment. The shadow minister for ageing has written to the minister on this very issue, and there has been a commitment given by the department that the government will ensure the same quality care that is delivered in residential aged-care homes is also provided in the homes of those who choose to receive care as part of their home care package or the Commonwealth Home Support Program. With this new agency not due to begin until 1 July 2019, the government has much work to do to ensure it gets this commission right.

I want to spend a little time on the government's 2018-19 budget measures. You only have to look at the government's most recent budget to understand that those opposite have not put the best interests of older Australians front and centre. Why do we know this? Because there was not one new extra dollar for Australia's aged-care system in this year's budget—not one. What the government has done is pretend to give new money to aged care. But the reality is that there aren't any additional funds for the aged-care sector. This is after the Abbott and Turnbull governments cut aged-care funding by billions of dollars over the last five years. Collectively, these governments, in every budget, have cut aged-care funding. We have seen funding cuts to the Aged Care Funding Instrument and funding cuts to residential aged care. Billions of dollars are now no longer flowing to support older Australians in residential care.

It is now clear that the build-up to the budget and the government's rhetoric around aged care and home care did not match up with what was finally announced. It was overpromised and underdelivered. In the lead-up to this year's budget, we saw the government begin to frame its measures around aged care, particularly the support it would give to older Australians choosing to age in their own homes. Even the health minister, Minister Hunt, said on 6 May that this would be a good budget for aged care. He said: 'It's going to be a very good budget for health and for aged care in particular.' That was at a doorstop on 5 May this year. There were also big figures leaked to the media: '$100 billion', the government led with. On closer inspection of the $100 billion, it also became evident that this was not an increase of funding across the forward estimates. No new money here. The $100 billion was already in the forward estimates. And the minister, back in April 2016, confirmed this publicly.

Closer to the budget there were more reports that the government would be investing 'new money' into the home care packages. But this never happened. It was all just political spin. This mirage made by the government was something it could hide behind—because, quite frankly, the three ministers responsible for aged care since 2013 have done nothing over the past five years. What the government did in its budget was to simply cut money from residential aged care to pay for the home care packages. So after all the rhetoric by the then Treasurer and now Prime Minister, and the other minister, it turns out that there is in fact no new money at all in the budget for the funding of in-home care and residential aged care. The now Prime Minister was in charge of the budgets that were slashed under his watch, and that funding was taken away from this important sector.

In his first year as Treasurer, he tried to rip almost $2 billion from the care of older Australians. One of his first acts as Treasurer was to slash almost $500 million from aged-care funding in the 2015 MYEFO. He followed this with an even bigger cut of $1.2 billion from aged-care funding in the 2016 budget. Even as the waiting list for home care packages blew out to more than 108,000 Australians, his latest budget did not deliver one new dollar for funding to aged care. For all the claims of a baby boomer budget, the now Prime Minister again cut funding from residential aged care to try and fix the growing crisis in home care the Liberals created. Clearly, he and the Liberals cannot be trusted to ensure older Australians get the aged-care services they need. They used smoke and mirrors to pretend there was a plethora of money being allocated to aged care. The government overreached, under-delivered and let down our most vulnerable Australians.

As I mentioned earlier, this government has a proven track record of cutting funding and underinvesting in aged care. Over the past five years, the Abbott-Turnbull government has slashed billions of dollars from aged care and is solely responsible for the growing list that exists for in-home care. The Prime Minister and minister can no longer put their heads in the sand thinking that there is nothing more to do in aged care. It is extremely disappointing the government did not use its budgets to invest in the care that older Australians deserve. Older Australians need the government to act.

That brings me to a really urgent issue: the home care package waiting list. The only thing this government did before the budget, and we welcomed this, was create an additional 6,000 level 3 and 4 home care packages—no new funding, just a change of ratio. These packages were allocated by the end of December 2017. But then the government decided to be too clever by half. It reused the 6,000 home care package figure to bolster its budget announcement. The government promoted 20,000 additional packages in the lead-up to the budget, but what it had done was count the 6,000 already in the system. So, really, the announcement is only 14,000 home care packages. Funding just 14,000 new home care aged packages over four years was nothing but a cruel hoax. Three thousand five hundred places a year isn't even enough to keep pace with demand. It's particularly cruel after promising older Australians it would address the waiting list.

Even the Minister for Aged Care was forced to admit what we already knew: the home care packages announced in the May budget won't come close to solving Australia's aged-care crisis. Responding to whether or not the new home care packages announced in the budget would be enough to stave off the crisis, the minister could only say that the government would have to consider new measures: 'It will be the status quo for a short period of time, and then we will start to look at a range of other interventions that will reduce that wait list.' That's the Minister for Aged Care, Ken Wyatt, on Sky News on 15 May this year. In the meantime, we waited more than three months for the minister to release the data for the March 2017 quarter. Why did he delay releasing this data? The waiting list has increased. There are now more than 108,000 older Australians waiting for a home care package. Of great concern is that more than 53,000 older Australians have no home care package at all. What is this government doing?

There are other questions that I would like to put to those opposite. How many of the 14,000 home care packages included in the budget have been allocated? Are any of the 14,000 home care packages from the budget already allocated, therefore distorting this recent release of quarterly data? When will the minister be releasing the June quarter data due, as it's due at the end of this month? As you can see, this government is inept when it comes to driving aged-care reform and funding residential and home care services. The shadow minister for ageing and Labor members have been pressing the government to fix the home care package waiting list for over a year. The time to fix this crisis is now. The government created the aged-care crisis, it has ignored the aged-care crisis and its budget failed to fix the aged-care crisis. The government needs to apologise for overpromising, underdelivering and failing older Australians yet again.

In conclusion, I really do want to emphasise that Labor will be monitoring how the government drives the necessary work to deliver on this quality framework. Given this government hasn't had a good track record when it comes to reforming aged care, we are today putting them on notice that they must make these new standards work. We want to see some action when it comes to introducing this quality framework. We also want to see a commitment from the government to do the necessary work to deliver on their announcement to establish an independent aged care quality and safety commission. I would also like to take this opportunity to express our continued commitment to working with the government and the aged-care sector to ensure older Australians can age safely and happily whether it is in a residential home or their own home.

5:30 pm

Photo of Rachel SiewertRachel Siewert (WA, Australian Greens) Share this | | Hansard source

Today I rise to contribute to the debate on the Aged Care (Single Quality Framework) Reform Bill 2018. This bill amends the Aged Care Act 1997 and the Australian Aged Care Quality Agency Act 2013 to enable the introduction of the aged-care quality standards. This single set of quality standards will replace the four current sets and will apply across all aged-care programs. The standards themselves will be enacted via delegated legislation and will come into effect on 1 July 2019. The Australian Greens support the introduction of a single set of quality standards, which is a measure from the 2015-16 budget. The standards will eliminate some of the complexity currently within the aged-care system and provide clarity to consumers about what they can expect. The standards also shift focus to consumers and will hopefully lead to improvements in the quality of care provided. We certainly need to ensure that.

The quality of care being provided to older Australians by some care providers has, in recent times, been substandard. We've seen that from the numerous inquiries, in particular the numerous inquiries into the absolutely appalling situation that we saw at Oakden. Those inquiries include the Senate inquiry that I chaired, and I'll come back to that in a minute. There have been occasions of, quite frankly, shocking care, which are very regularly reported on in the media. During the Senate inquiry into Oakden, it highlighted not only the shocking care but some of the gaps in our current regulatory process. In my opinion, it highlighted the failure to properly enforce the existing regulations at the time and the standards that were operating at that time.

It's essential that this situation is rectified. We need to stop seeing these repeated appalling circumstances where older Australians are not receiving the care that they should be receiving. The community expects very high standards of care for older Australians. Changes such as these, in this framework, go some way towards strengthening the protections that are in place and ensuring that we have adequate standards for consumers. When we talk about 'consumers', these are residents in aged care or people receiving aged-care services. We need to ensure that we have adequate standards for them.

While the standards themselves will follow later, the final draft is now available online and consists of eight standards. I'm aware that this process has been through significant cycles of consultation. Each standard has a consumer outcome, has an organisation statement and contains requirements for an organisation to demonstrate adherence to the standard. Each provider will only be required to meet the standards that correspond to the care they provide and the environment they provide it in.

We note that the Department of Health published a summary of submissions it received in response to the first release of the Draft Aged Care Quality Standards last year. Two of the broad themes identified by the department were concerns relating to staffing levels in aged-care services and concerns regarding the capacity of the National Aboriginal and Torres Strait Islander Flexible Aged Care Program providers and voluntarily run organisations to comply with the standards. We share these concerns and particularly encourage the government to work with smaller providers that have limited capacity during the transition period.

I will note here that in the budget of 2018-19 the government announced that it would provide $50 million to residential aged-care providers to help them transition to the new standards. That's residential aged-care providers assistance, as we understand the measure, to provide them with the capacity to transition, which in itself I think is good. However, the question must be asked as to why it is only residential aged-care providers, when I've just articulated that this extends to other programs. I'm particularly concerned about the Aboriginal and Torres Strait Islander Flexible Aged Care Program, which is commonly called ATSI Flexi. Those providers will need some assistance, as do other providers. So, I have a question mark there, and I'll put on notice that when we're in the committee stage I'll be asking the government about that and whether there will be some extra funding or whether the $50 million is in fact available to other service providers. I think that's a particularly important question.

While there has been wide support for a single set of quality standards and for the draft standards, we acknowledge that some providers and consumer groups have expressed concerns. For example, National Seniors, who took part in the consultation process, recently said:

… we’re pleased to see several indicators in the standards that directly relate to people in home and residential aged care. The standards require providers to have processes in place to identify needs and deliver aged care to meet them. These process standards are intended to focus on the end user.

But how will the process standards operate in practice? They don’t measure the outcomes experienced. They simply insist a provider has a certain process in place. The focus on process may not improve outcomes without adequate resourcing. What’s also needed is sufficient and appropriately skilled aged care staff to meet the identified needs of the people they are looking after.

They went on to say:

National Seniors is sceptical about the capacity of providers under the current funding and regulatory arrangements to meet the proposed new standards and improve outcomes for those they care for. Changes to standards alone won’t drive improvements in quality. Calls for more and better trained aged care workers are increasing. A recent National Seniors research report of home care found almost 40 per cent thought "things could be done better".

And National Seniors have made several points in their comments here relating to the issues around staffing and the workforce.

We know that there's a lot of work being done on the workforce, but I can't stress enough how important it is that we ensure that we have in place a workforce that is appropriately qualified and that we have enough, with the demands that we're facing—not just residential aged care, which a lot of people focus on; there are a lot of other aged-care and older-Australian services that need a well-supported, trained workforce. I know that Senator Hinch will be addressing that issue, and he's circulated some amendments around ratios. I'll have more to say during the debate on those amendments but will flag that the Greens do support the concept of ratios, However, it's not simple, because, depending on the acuity—for example, if you're talking about residential care, if you're talking about the acuity of the residents—we know that more and more people are staying at home longer, which is very strongly supported by the community. But that means people are frailer when they go in, so you may need a different ratio than for those who aren't as frail. When you're talking about dementia, it depends on the model that you use for care for a person with dementia. Of course, we know there are a large range of types of dementia, and that will have a bearing on the ratios needed to be used.

I also want to just focus very briefly on the issues around support for people who are homeless and in residential care. In 2013, when the new Living Longer Living Better amendments came in, the government of the day—I'll give them their due for this—made sure that there was a homeless supplement as part of that process. The Greens negotiated that with the government, and I was very pleased to see that supplement put in place. Unfortunately, that supplement is not keeping up with the cost of care. There are providers that specialise in providing residential care for homeless people, which demands a particular type of care. For example, most people who are homeless and who are successful in finding residential care don't have a relative who can take them out if they need a specialist appointment. They don't have relatives who sometimes supplement or provide additional things for them. They can have complex and difficult behaviours, particularly those who have been long-time homeless. In fact, that may be related to why they were homeless in the first place. That all demands extra resources from the provider. So I urge the government to once again look at the aged-care supplement, because the figures that I have seen from those who are providing home care to people who were homeless show that they can't make ends meet—increasingly, they're further and further apart, to the point where those providers are also going to end up in crisis. We've seen recently that 40 per cent of residential providers are not making money or are not considered viable, and we have some very strong concerns there.

I also just want to touch very briefly on the issues around Aboriginal care. I was very pleased to see the changes that were made in the budget to ATSI flexi. We have to think very differently about the provision of aged-care services for many of our First Nations people. They need different sorts of residential care and different sorts of home care, so I think we need to be making sure that we are being as flexible as the term 'flexible funding' implies. But there is quite a long way to go there, and I'm aware that there are continuing housing problems. I'm not going to go into the whole remote housing issue per se, but I know of a number of providers who are still having trouble housing their staff. How can you provide quality care if you can't attract the staff because you can't accommodate them? We need to make sure that we are supporting these providers as much as possible.

This bill also makes an amendment—as I think I heard Senator Polley say as I came into the chamber—to the Freedom of Information Act 1982 to make protected information exempt from disclosure under the FOI Act.

The Greens do support this bill. We do think these are important reforms. We take on board the criticisms that have been made. I just articulated some from the National Seniors. The Combined Pensioners and Superannuants Association, the CPSA, has been quite critical as well, arguing that the 'new standards will hollow out an already insufficient system' and are not sufficiently prescriptive to ensure quality care. A part of the reforms being made is the new commission, which the government has made a commitment to. It will be bringing in legislation around that shortly, and obviously that is also critical to how this new commission will operate. I agree that there are some very, very critical issues in aged care in Australia—not just residential care but also home care. We know that the waiting list is outrageously long.

I know that there's a continuing need for the injection of funds. I know, having just spent last week talking to aged-care providers in a committee inquiry, that there are very serious and significant issues facing the viability of residential aged care and also home care—in particular, that there are more reforms to come with CDC, consumer-directed care, and further reforms along those lines to residential aged care.

I agree that there are continuing issues and that operationalising this framework is quite difficult in the circumstances, and so I agree with their comments. I will note, however, that COTA Australia has welcomed the consolidation of the four existing sets of standards and acknowledges the considerable work that has been undertaken to develop simple, relevant, meaningful and measurable standards. We also support bringing the single quality framework into being, and so we do support the concept of this legislation. Next is operationalising it, and there are a whole lot of other levers that we will need to pull to make sure we have a quality aged-care system.

We will be supporting this legislation and we look forward to debating Senator Hinch's amendments in Committee of the Whole in the not-too-distant future.

5:46 pm

Photo of Catryna BilykCatryna Bilyk (Tasmania, Australian Labor Party) Share this | | Hansard source

Mr Deputy President Williams, what is Australia's fastest-growing industry? The answer would actually surprise many people—or maybe not, given that the Aged Care (Single Quality Framework) Reform Bill 2018 we are currently debating is the context. If you guessed aged care, you were right.

Let me give a few statistics that show just how large the aged-care industry is and how quickly it's projected to grow into the future. The aged-care industry in Australia has an annual turnover of more than $20 billion and it employs more than 350,000 workers. These staff deliver services to over one million elderly Australians through more than 2,000 service providers. The government's 2015 Intergenerational report predicts that the number of Australians aged 65 years and over will increase from 3.6 million to 8.9 million by 2055, and the Department of Health estimates that the aged-care sector will need to expand its workforce to almost a million people by 2050.

I can appreciate the significance of giving older Australians the support, care and dignity they deserve in their retirement. I think we've all got the approach that people should, without doubt, be able to retire and go into an aged-care facility, if they need to go into a facility, and to age with dignity and with grace. As a senator I have visited a number of residential aged-care facilities, including a recent visit to Bishop Davies Court in Kingston with the federal member for Franklin, Julie Collins. Of course, Ms Collins was visiting in two capacities—as the local federal member and as the shadow minister for ageing. I know that Ms Collins, the shadow minister, regularly visits aged-care facilities not just in her own electorate but throughout the country. I have to congratulate her on her hard work, her consultation with the sector and her strong advocacy for older Australians—

Senator Polley interjecting

as I congratulate—don't jump the gun, Senator Polley!—my Tasmanian colleague Senator Helen Polley on assisting Julie Collins in that process. I've been to a number of aged-care facilities with Senator Polley as well over the past few years. They work together to make sure that older Australians get the best possible care that they deserve.

When I visit aged-care facilities, I'm always impressed by the professionalism of aged-care workers and their dedication to the care of their clients. It's a challenging and demanding job but one that can also be quite rewarding. They're not highly paid jobs, when you consider the work they have to do, but, no matter how dedicated, how caring and how professional aged-care workers are, they're labouring under an aged-care system that is suffering from the savage cuts of the Abbott-Turnbull-Morrison government.

We don't expect any better under the prime ministership of Mr Morrison than what we've had under the previous prime ministers, Mr Abbott and Mr Turnbull. And we haven't forgotten that Mr Morrison has been Treasurer for the past three years and has been the architect of some of the worst policies of this government, including its aged-care cuts. One of his first acts as Treasurer was to slash $500 million from aged care in the 2015 MYEFO. This was followed by a $1.2 billion cut in the 2016 budget. In total, Mr Morrison, as Treasurer, has ripped almost $2 billion from aged care.

Labor will be supporting the Aged Care (Single Quality Framework) Reform Bill, but this bill will not address the government's abysmal record when it comes to providing for the care needs of older Australians. This is a point I'll return to later, but first let me turn to the provisions of the bill. Under the current quality framework there are eight different standards across three areas of care. These include four standards in residential aged care, two standards in home care and another two standards for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program quality review. Should this bill pass, a new set of standards will apply to all aged-care providers from 1 July 2019. The bill will also vary the functions of the chief executive officer of the Aged Care Quality Agency to reference the Aged Care Quality Standards.

I understand that the new standards are being developed in consultation with the aged-care sector and that the date they will come into effect was postponed to allow providers more time to prepare. A positive aspect of the new standards is that they shift the focus from provider processes to quality outcomes for consumers. While the result is positive, the government has been working on the standards since 2015 and it is unfortunate that it has taken so much time to get this legislation into parliament. Despite the amount of time the government has taken to progress the standards, it has taken until June this year for the shadow minister to have a briefing on the bill.

As well as the delay in getting this reform to parliament, Labor is concerned about the freedom of information provisions in the bill. The explanatory memorandum states:

The Bill also amends the Freedom of Information Act 1982 (the FOI Act) to ensure that documents containing protected information acquired by the Quality Agency in the course of its functions are exempt from disclosure.

Very little detail is provided about what types of documents and information will be exempt. I understand that the shadow minister, Julie Collins, is seeking further clarification about this, but it does raise concerns about whether consumers will be able to get the information they need from the quality agency's investigations.

While not part of this bill but related to it, we welcome the government's announcement in April that it will agree to the Carnell-Paterson review recommendation to establish an Aged Care Quality and Safety Commission. We are concerned, however, that the announcement seems to be very focused on the residential aged-care environment rather than giving consideration to the delivery of care across multiple settings. Delivery of aged care in the homes of older Australians is growing and those consumers deserve quality care and protection from failures, too. We look forward to hearing how the government will integrate home care into this newly established commission.

Whatever reforms the Morrison government delivers to improve the quality of aged care they will not come close to making up for the billions of dollars they have cut from the system while in government. Despite talking big on aged-care spending, the 2018 budget was a huge disappointment. On 6 May the health minister said in a doorstop interview that the 2018 budget would be, 'a good budget for health and for aged care in particular'. This was followed by leaked reports of a $100 billion investment in aged care and reports of an investment of new money in home care packages. Well, that was a cruel hoax, a cruel hoax on older Australians. The government overpromised and underdelivered once again. In fact, guess how much additional funding the government provided in net terms for aged care in the last federal budget? Was it millions? Was it thousands? No, it was a big fat zero. Every new initiative they announced in aged care was funded by cuts to other areas of the system. This follows a cut to aged-care funding in all four of this government's prior budgets. The severity of the cuts of the Abbott-Turnbull-Morrison governments over five years and their lack of action in restoring funding has left us with an aged-care system that is in crisis, with rapidly growing waiting lists.

In terms of home based care, we know that in December last year more than 100,000 Australians were on the waiting list for home care packages! The government provided only 14,000 home care packages in the last budget and that was funded by money taken from residential aged care—that's 14,000 places over the forward estimates or a measly 3,500 places a year to address a waiting list that grew by 20,000 in the last six months alone. The latest data released now shows that 108,000 Australians are waiting for home care places, and they include 88,000 Australians with high needs, many of whom are living with dementia. The waiting list is so long that people eligible for level 3 and 4 packages are waiting more than a year.

I know the impact this has on older Australians because I have people contacting my office saying they have been waiting for months for a package for their parent or grandparent. My office has heard from people who have put their lives on hold to provide the care needed by their loved ones, even though they've already been assessed as being eligible for a package. And those are the lucky ones, who have family to look after them. How on earth does any Australian in need of home based care live, if they cannot get an aged-care package? We're talking about help with basic tasks like showering, transport, gardening and home maintenance, shopping and preparing meals. Can you imagine trying to perform these basic tasks yourself when you can't get the help you need to do them? I can appreciate these people's frustration and their desperation. But, try as we might, there is little that I or my office can do to help them, because the funding and the packages just are not available. The problem will not be fixed until the government acts.

Many older Australians on waiting lists may not survive long enough to see their package delivered. The waiting list of 108,000 people, which has grown again, is only the March quarter data, which the government has been sitting on for months. Key data has been removed from the report, including a state and territory breakdown of the figures. We know, from previous data, that there were 2,474 Tasmanians waiting for a home care package. We are still waiting for the June quarter data, which was due for release at the end of August. The fact that the government once again is sitting on this data indicates that the picture is likely to be as bad as that painted by the March quarter data, or even worse. The government must release this data immediately. After all, for the government to be accountable for solving the problem, the Australian public need to know, and they deserve to know, the full extent of it. When the Minister for Aged Care, Mr Wyatt, was asked whether the home care packages announced would be enough to solve the crisis, he told Sky News: 'It will be the status quo for a short period of time and then we will start to look at a range of other interventions that will reduce that list.' That interview was on 15 May, and we are still waiting—still waiting to hear what these so-called other interventions are or what the minister defines as a short period of time.

Turning to residential aged care, the situation is quite dire there as well. Independent analysis estimates a reduction of more than 20,000 residential care places over the next four years because of the Abbott-Turnbull-Morrison government's cuts. Just let that sink in a bit—a reduction of 20,000 places at a time when our population is ageing and we're going to need greater, not less, access to aged care.

This is a government that can somehow find $80 billion to give away in tax cuts to big business, including $17 billion for the big banks, but can't find one extra dollar to invest in care for older Australians. As Senator Polley said earlier, it's atrocious.

While the government is sitting on its hands, there are several aged-care reports piling up on the minister's desk, waiting to be acted on. I could name, for example, the Applied Aged Care Solutions report, the Living Longer Living Better five-year review, and expert advice about how to fix the Aged Care Funding Instrument. In relation to the Living Longer Living Better review, the government is yet to respond to 20 of the 38 recommendations, despite having had the report since December last year. As Labor have said before, the Aged Care Funding Instrument is broken, and yet we've heard not a whimper from this government about how it proposes to fix it.

While we support this bill, it's not good enough for the government to just expect quality standards from the aged-care sector. It's not good enough for them to just assess those standards. The government needs to provide the aged-care sector with the funding it needs to actually deliver on those standards. You cannot separate aged-care funding from quality and standards—they go hand in hand.

Unlike those opposite, Labor in government has a proud record when it comes to delivering aged care. Our Living Longer, Living Better reforms were a significant long-term investment in quality aged care, a $3.7 billion package over five years. And those reforms had bipartisan support until, sadly, the current Liberal government started cutting billions from aged care. Labor's reforms included an integrated home support program, more home care packages, greater choice and control through consumer directed care, fairer means testing arrangements for home care packages, funding to help carers access respite and other support, funding for more residential care facilities to be built with a focus on services in regional, rural and remote areas, trialling of consumer directed care in residential aged care, strengthening the means testing for residential care by combining the current income and assets tests, establishing a new aged-care financing authority, improving the aged-care funding instrument, $1.2 billion to strengthen the aged-care workforce, funding to support consumers in research and funding to ensure better health connections through complex health care, multidisciplinary care and service innovation.

The Morrison government owe older Australians an apology for their abject failure to deliver aged care for those who need it. They should apologise for the growing waiting lists and the billions of dollars in budget cuts and for their undoing of Labor's significant investment and once bipartisan approach in government. Former Prime Minister Turnbull owes aged-care workers an apology for his criticism of their work and for telling them they should get a better job. What is it that Mr Turnbull thinks makes aged care not a good job? What better job does he suggest aged-care workers get? What kind of message is the former Prime Minister trying to send to the prospective recruits of the almost one million strong aged-care workforce that Australia will need in the few decades to come? What was he saying—'Don't bother applying because it's not a good job'? Should they work as investment bankers in the institutions that the Liberals want to give a $17 billion tax cut to?

I think this comment speaks volumes about this government's attitude towards aged care, and this attitude goes a long way towards explaining why there has been significant underinvestment in this sector. Mr Turnbull's definition of a better job may not be the same as that of aged-care workers. I am sure many of those workers believe that they have the best job, where they get the opportunity to support elderly Australians and to provide them with dignity, respect and quality of life. I'd be interested to hear what the current Prime Minister, Mr Morrison, has to say about his predecessor's comments and whether he stands by them. I have a message for senators opposite: aged-care workers don't need a better job. What they need is a better government. They need a government that not only stands up for aged-care workers but will also stand up for older Australians.

It is not just the government's cuts to aged care and this slight against aged-care workers that has shown the government's contempt for older Australians. This is also the government which has tried to axe the energy supplement for two million Australians, including 400,000 age pensioners. This is the government which is trying to force Australians to work until they're 70—the oldest retirement age in the developed world. A single, quality framework is a worthwhile reform, but if Australians want quality aged care they need a government that respects older Australians and is willing to invest in quality aged care. They won't get that from those opposite, because those opposite are not focused on older Australians. They're not focused on supporting the work of our dedicated aged-care work force. The only jobs they're concerned about are their own. Their only focus right now is on their own internal squabbles and personal ambitions. We know the circus isn't over. We know that. If Australians want a government that truly cares about older people, they're not going to get it from the current government or from the current Prime Minister, who as Treasurer was the architect of many of their cruel cuts to aged care. If they want a government that cares about older Australians then they need to elect one, and that should be a Shorten Labor government.

6:04 pm

Photo of Brian BurstonBrian Burston (NSW, United Australia Party) Share this | | Hansard source

I rise to speak on the Aged Care (Single Quality Framework) Reform Bill 2018. The recent debate on euthanasia in this place highlighted the need for an improved aged-care sector in this country. According to the last census, the median age in Australia in 2016 was 38, up from 37 in 2011. According to the Australian Bureau of Statistics, one in six Australians is now aged over 65, compared to one in seven in 2011 and only one in 25 in 1911. In addition, 2.1 per cent of Australians are over the age of 85. That's 84,000 extra residents aged 85-plus since the last census. There were 3½ thousand people aged over 100.

Everyone knows that our population is ageing, and we need lawmakers to ensure that those looking after our elderly and frail have the legislative framework to provide the best care possible. Anyone who has or has had a loved one in aged care, and any senator in this place who has had dealings with constituents about problems in the aged-care system, knows the system is broken. There isn't enough time to go through the aged-care scandals throughout New South Wales, but I will highlight just three that occurred less than an hour's drive away from my electoral office in Lake Macquarie.

In 2016 a woman was found with maggots in her mouth at a Raymond Terrace nursing home the day before she died. A Port Stephens woman, Jayne Carter, raised serious concerns about the standards of aged-care facilities after she was told by staff at the Opal Raymond Terrace Gardens nursing home that they had found maggots in her mother's mouth.

In 2013 Lateline reported on a 91-year-old grandmother, Paula Javurek, who was in a New South Wales nursing home that was supposed to deliver high-level care. Her daughter, who was a nurse and healthcare lecturer, was horrified when she found her mother with exposed, raw ear cartilage due to a lack of turning and with one of her arms immobilised after staff botched injections. Ms Javurek had survived Nazi concentration camps and was tortured and raped after being captured during the war. Her family told the nursing home only female staff should wash her because of residual trauma from war-time assaults, but the family has since counted 70 times when male carers washed Ms Javurek, who tried to fight them off. According to her daughter, her mother often used to say she would be better off being in a concentration camp than where she was. After finding their grandmother shivering from cold and suffering from undiagnosed pneumonia, Ms Javurek's family took her home. A week later she died.

In 2011, nurses were sacked from William Cape Gardens nursing home on the Central Coast in New South Wales for depriving a dying man of food and photographing residents genitals in a game called 'the genital Friday club'. The horrific treatment at William Cape includes claims that three nurses told an elderly woman with dementia that her husband was having an affair with her best friend while she was in care. A whistleblower told TheSunday Telegraph that when food was withheld from an elderly man the nurse allegedly said, 'He was going to die anyway. This way it would make it easier.' Staff were forced to sign a confidentiality agreement over the scandal. The whistleblower said 'the genital Friday club' had been going on for some months and was known of by quite a few members of staff. A second staff member said at least one nurse took photographs of elderly residents' private parts on an iPhone and asked colleagues to guess who they belonged to.

These scandals must stop. Pressures in the aged-care sector are skewed towards cost cutting and profit. Too often this is at the expense of care. It seems that any good care is occurring in spite of the system, not because of it. We need an aged-care system where good care is provided because of the system and not in spite of it, and where care is the best that can be provided with the resources available.

A few years ago an independent volunteer consumer based advocacy group, Aged Care Crisis, was formed to provide a consumer voice for aged-care residents and their loved ones. According to Aged Care Crisis, one of the most significant factors in providing quality residential aged care is ensuring that there are sufficient skilled staff on hand to provide that care. Many people who contact Aged Care Crisis are shocked to learn that there are no mandated minimum staff-to-resident ratios in aged-care homes across Australia. The Aged Care Act 1997 has little to say about staffing. In fact, only two lines are allocated to this, the most vital aspect of care provision—that there must be an adequate number of appropriately trained staff.

As a direct consequence of this lack of required standards in staffing, managers who are under pressure to meet their profit targets do so by reducing staff, placing vulnerable residents at risk. Nurses and carers frequently report that they are not able to care for residents properly given the conditions and time constraints imposed upon them. It is clear that providers of aged care genuinely strive to operate with as few staff as possible. Incredibly, Aged Care Crisis also found that in some cases no staff were rostered on for considerable lengths of time.

We have mandated staffing levels in childcare centres, kindergartens, schools and hospitals. They too cater for people with different levels of need in different locations but still manage to set a safe minimum staff-to-client ratio. Aged Care Crisis further stated:

This lack of mandated minimum staff/resident ratios has seen the exodus of experienced nurses from aged-care homes, particularly private-for-profit homes.

Those staff who remain find that they can no longer meet their responsibilities to residents in the available time and that resident care is compromised. Most settings which care for vulnerable individuals—for example, hospitals and childcare centres—operate within mandated staff-to-person ratios. It is intolerable that frail, older people do not have this protection.

It is my understanding that, if you are residing in a nursing home in New Jersey in the United States, the nursing home owners there are required by law to provide you with information on the number of staff involved in direct patient care and to publicly post information that details direct resident care staffing levels within their facilities. They're also required to report daily staffing levels via a web-based system through their department of health. The law also requires that the department makes this information available to the public on a quarterly basis. Being an informed consumer and armed with this and other publicly available information, family members and residents are better equipped to make informed decisions about the care of their loved ones. There are no such levels of transparency or accountability to allow anyone to do similar here in Australia.

In every hospital coronary care unit or intensive care unit in Australia, staff are required to be specially trained in that area and to ensure that high standards of care are maintained. The same principles should apply in aged care. More specially trained staff are urgently required within the sector. To be effective, this commitment to training must encompass continuing education and ongoing professional development.

I share the Aged Care Crisis's alarm with the continuing reduction in the numbers of registered nurses who work in aged-care homes. More and more homes now rely on having a registered nurse on call rather than on site. This is despite the fact that the level of care needed by residents is higher than ever before. The ongoing reduction in the numbers of registered nurses has had a significant impact on the quality of care being provided in aged-care homes. This is one reason why residents must be placed in hospital when they require treatment for even minor complaints, and that increases waiting times in hospitals. Age Care Crisis advises that they receive feedback from carers about the increased responsibilities which they are given and for which they may have no or insufficient training.

The government and this parliament need to address the crisis in aged care as a matter of urgency. I will support any bill or amendment that will improve our aged-care sector. However, if I believe it will put further pressure on our system, I will vote against it.

6:13 pm

Photo of Chris KetterChris Ketter (Queensland, Australian Labor Party) Share this | | Hansard source

I rise to speak on the Aged Care (Single Quality Framework) Reform Bill 2018. If there was one area of government policy which one would have thought required bipartisanship it is the care of aged Australians. I think this an aspect of the debate that is being neglected at the moment.

On this side of the chamber we are passionate about our aged-care sector. I have no doubt that on the other side there are people who care about this issue, but the evidence is that this government has presided over an aged-care crisis for five years, which includes not only a crisis in the residential system and the home care system but also a crisis in relation to the workforce. This government is doing nothing to address the crisis in our aged-care workforce. So we all need to be committed to improving the aged-care system. It is one thing to talk about standardising the quality framework across the various parts of aged care; that is important, but I would suggest that the average Australian is more concerned about whether the standards can actually be delivered for their loved ones out there in the sector.

We on this side of the chamber have a track record in relation to bipartisanship. In the previous Labor government there was a lot of consultation involved and there was a hand extended to the other side to get involved in policy formulation. I understand that our Living Longer, Living Better reforms were the result of attempts to bring bipartisanship to this sector. We delivered our $3.7 billion Living Longer, Living Better reforms in our last term in government. For the benefit of those listening to this speech, I just want to recap some of the aspects of that $3.7 billion program.

It included $955.4 million to help people stay at home through an integrated home support program; more home care packages with new levels of packages; greater choice and control through consumer directed care available across all new home care packages; fairer means testing arrangements for home care packages; $54.8 million to help carers access respite and other support; $660.3 million to deliver better residential aged care through more residential care facilities to be built; supporting the viability of services in regional, rural and remote areas; trialling consumer directed care in residential aged care; strengthening means testing for residential care by combining the current income and asset tests; establishing a new Aged Care Financing Authority and improving the Aged Care Funding Instrument; $1.2 billion to strengthen the aged-care workforce; $39.8 million to support consumers and research through empowering consumers through advocacy; better connecting the lonely and socially isolated; improving the knowledge of older peoples' care and support needs; and $80.2 million to ensure better health connections through complex healthcare multidisciplinary care service innovation. So it was a comprehensive package.

We invite those opposite to steal our policies from time to time. Unfortunately, that doesn't happen often enough. But we do have a proud record of investing in aged care, in our seniors and in age pensioners. But that is no surprise to anybody who has an interest in support for communities: people would know it was Labor that legislated for industry superannuation, it was Labor that legislated for the Medicare safety net and it was Labor that began the National Disability Insurance Scheme. I want to take a brief moment here to pay tribute to the phenomenal work that the Hon. Jenny Macklin did in conceiving the scheme along with our federal Labor leader, Mr Shorten.

Labour supports measures intended to make later life better for Australians. They have earned it. That is why we are supporting this bill, which amends existing acts to provide for a single set of Aged Care Quality Standards to apply across aged-care providers and the Aged Care Act and varies the functions of the CEO of the Aged Care Quality Agency to reference the new standards. The new standards will come into effect from 1 July next year and will cover three different areas: residential aged care, home care and the National Aboriginal and Torres Strait Islander Flexible Aged Care Program quality review.

However, I do want to point out some of the concerns that we have in this area. The government has dragged its feet on these reforms, as it has in so many other important reforms—payday lending, banking accountability and superannuation just to name a few. It is Labor who has had to drag this government kicking and screaming to these reforms. These particular reforms that we're considering today have been talked about since 2015. But it is only now in 2018, three years later, that the government is bringing them to the parliament. Perhaps if this chaotic government spent less time on shuffling the deck chairs and infighting, Australians—particularly older Australians in need of care—would get the attention and respect they deserved. Labor also has concerns about the extension of the Freedom of Information Act 1982 to exempt some documents from disclosure. With scant details on what these exemptions would be, Labor has ongoing concerns about the transparency and truthfulness of this government. I will touch on that a bit later on.

As I've indicated, we have an aged-care system in crisis. There are significant challenges ahead of us in this industry. We have 2.49 million people, or over 10 per cent of Australia's population, who are aged 70 or over as at the 2016 census date. By around the year 2050, I think that proportion is set to double. Around 20 per cent of the population will be aged 70 or over. As at 30 June this year, over 200,000 people were living in residential aged-care facilities. We know that this is a sector that requires a lot of government support; $17.4 billion was spent by governments on aged care in 2016-17 and 69 per cent of that was for residential aged care. We know that women outnumber men in aged-care services two to one. That is because women live longer and have higher care needs. On average, people spend 2½ years in permanent residential care, just over 1½ years in home care and one month in respite care. Aboriginal and Torres Strait Islander people account for less than one per cent of all people in permanent residential care and four per cent of people in home care. These statistics just illustrate the size of the issue that we are dealing with.

In delivering our landmark aged-care reforms, the Living Longer Living Better package, Labor acknowledged a number of challenges in the aged-care sector. These included the matter of choice. We recognised that older Australians often preferred to age at home. We provided more support to enable them to make that choice. We recognised inequities in the cost of residential aged care and took steps to ensure more protection for the most vulnerable. We recognised that volunteer carers, a critical part of our aged-care system, needed more support. We strengthened links between aged care and the wider health system, particularly with a view to improving support for the increasing number of Australians diagnosed with dementia and Australians requiring palliative care.

A key feature of our reform was to recognise and take steps to address the workforce pressures in the aged-care system—namely, the need to attract and retain trained, qualified staff in the sector. I think we need approximately three times the number of people we currently have working in our aged-care section. To this end, Labor committed $1.2 billion over five years for an aged-care workforce productivity strategy, including a workforce compact to improve wages across the sector. Those opposite will recall that in 2013, almost immediately upon attaining government, this was one of the very first measures that the Abbott government sought to scrap. I will be coming back to this later when I talk about the dismal record of those opposite when it comes to appropriate wages for the workers in our country who look after our most vulnerable people.

Continuing with the challenges that we have in this sector, the issue of dementia is first and foremost. Most people nowadays have a family member or know of a friend, a work colleague or an acquaintance with experience of dementia, whether it's age related or the tragedy of younger onset dementia. I want to echo the words of Mr Shorten, who said in November last year that 'tackling dementia will be a defining health and aged-care challenge of the next generation' and that it is 'our generation's duty' to get started on it. In what was a seminal speech, Mr Shorten identified that this is a matter which has touched him quite deeply, and I think he has a genuine concern about this particular issue. He pointed out in a recent speech that a NATSEM report has estimated that dementia costs Australia over $14 billion a year. The same report found that even a five per cent reduction in the number of people with dementia over the age of 65 could lead to savings of $120.4 billion in less than the next 40 years. However, if we hold to our present course, more than 500,000 Australians will have dementia by 2025 and more than a million of us by 2050.

One in three Australians born today will eventually be diagnosed with dementia. Already this year, for the first time, dementia is now the leading cause of death for Australian women. Within the next five years, it will be the leading cause of death for all Australians. This means that we need better standards and training for residential facilities and for in-home care, and we support the elements of this bill that address that. It's estimated that 70 per cent of people in residential aged care have dementia, so everything we do in aged-care policy has to link up with dementia policies. Senator Burston touched on some of the reports of elder abuse or substandard aged care that have occurred and that we hear about all too often in the media. Unfortunately, it's possible that they're the tip of the iceberg. This goes to the issue that we do have a crisis in this sector. Mr Shorten noted that addressing this issue is within our grasp. We do have the resources and the capacity to deal with it. We just need to be better at utilising those resources.

I don't need to tell you this, Mr Acting Deputy President Williams, that the challenges of dementia care are amplified in rural and regional Australia. In February this year I instituted, in this place, a Senate Economics References Committee inquiry into regional inequality. The terms of that inquiry are deliberately broad to allow us to examine a whole range of drivers, including health and aged care. Last month, on 29 August, the committee held its first public hearing in Emerald in Central Queensland. I want to take a moment to make reference to a submission that we received from Mrs Gai Sypher to the inquiry. The focus of her submission—and she appeared before us as a witness—was the unsustainability of the aged-care industry in regional and remote regions based on the current business-driven model.

Mrs Sypher is most familiar with the Central and central-west Queensland examples. In her submission she stated that an examination of the data shows that access to residential aged care in remote and very remote communities is extremely limited and that private providers are not found in locations that operate on marginally sustainable business models, such as those you find in remote or very remote communities, so consumer choice is constrained and there is more of a need for legislative requirements and regulation to guarantee access to residential and community based aged care at an acceptable level. Mrs Sypher told us that aged provision in rural and remote areas may be limited to one or two providers who have less need to compete for custom through marketing or self-promotion than their metropolitan counterparts.

Mrs Sypher's recommendation is that it will be important for service providers to collaborate and innovatively develop models of care that will work in rural and in remote areas. She's advocated on behalf of aged people to the federal government to consider all these sorts of things. I wish there was some evidence that the government is taking on board some of these ideas.

Sitting suspended from 18:30 to 19:30

I was speaking about some of the regional challenges associated with our aged-care sector and, in particular, the workforce for the aged-care sector. But, with every challenge, there is an opportunity for regional Australia, and I think that it's important to note that TAFE—which has, for so long, been neglected—provides that opportunity for filling the gap, for training for our aged-care workforce.

Labor is committed to revitalising this long-neglected sector. I've seen this firsthand on my recent visits to regional Queensland, to the Roma campus of TAFE. They have outstanding nursing training facilities there. Unfortunately, they're not being utilised to the extent that we would like them to be, but they are outstanding facilities and I'm sure that they will find students for that campus. I also saw the Townsville campus of TAFE last week. They also have very good facilities. I'd like to commend the Queensland government for injecting $26 million for a new building which is being constructed there at the present time. A couple of weeks ago I visited the Mount Isa campus of TAFE, where they provide courses in relation to health and aged care. It's so important that this training be delivered in regional Australia so that we can have opportunities for regional Australians to age in their locality.

But, in order for us to realise the opportunities that exist with these challenges, we do need a federal Labor government. Even before the chaos of this Liberal-National government claiming another Prime Minister and paralysing positive reforms, those opposite had already started to wreck Labor's aged-care reforms, ripping $2 billion out of aged care and cutting the $1.2 billion Workforce Compact fund.

Unfortunately, the new Prime Minister has not acquitted himself well in this space. In fact, I would argue that he's failed his first test because he has not included aged care in his new cabinet. So this does not give us a great deal of confidence that this issue of aged care and the crisis which is confronting the sector are going to be addressed by this government. In one of his first acts as Treasurer, Mr Morrison slashed almost $500 million from aged-care funding in the 2015 MYEFO. As other speakers have said, we have 108,000 Australians on the waiting list for home care packages, and the latest budget did not deliver one new dollar of funding for aged care. What's most concerning to me—and I think Australians would be concerned—is that, of the 108,000 Australians waiting for home care packages, 88,000 older Australians are waiting with high needs, many with dementia. That is a crisis in anyone's language.

Labor believes in a helping hand for those who need it most. We follow through with our values by investing in affordable health care, education and fair pay for fair work, especially for those workers caring for our most vulnerable Australians. Now more than ever we need a Labor government to restore the balance of fairness in Australia.

7:34 pm

Photo of Derryn HinchDerryn Hinch (Victoria, Derryn Hinch's Justice Party) Share this | | Hansard source

This is going to sound like a broken record, but the whole issue of the way we treat older Australians has sounded like a broken record for years, even decades. I preached the mantra on radio and television for years that the only difference between uncaring politicians and old people is that they, the old people, got there first. At a nurses' rally in Bill Shorten's electorate, recently, I made that point again. But I also pointed out that, since I jumped the shark and was elected to Canberra, I'm now not only a politician; I'm also old.

In recent weeks, while parliament was in recess, I spent a lot of my time in rural and regional Victoria—Ballarat, Ararat, Horsham, Echuca, Shepparton and Colac. I even swung by a place where I spent some time in 2014, called Langi Kal Kal Prison. I met a lot of disillusioned Liberal voters, upset with what even the new Prime Minister, Scott Morrison, has described as a muppet show. I made a point of visiting aged-care centres and nursing homes. I almost committed the ultimate political sin of delaying the start of the bingo game in Horsham! As I pointed out, I'm old enough to remember when the game of bingo was called housie-housie. At the Ararat Hotel I met six former registered nurses celebrating with a get-together. They all agreed with me when I started talking about ratios for RNs and carers in nursing homes and aged-care centres. Some of them are fantastic, but many of them, sadly, are not.

I mentioned Langi Kal Kal Prison. Now, something's really out of whack in the way we treat our elderly when the average spend per day on food for residents in aged-care centres is $6.08. I pointed out earlier my extensive jail experiences, and that is less than I received daily as a prisoner. At Langi Kal Kal I received nearly $10 a day for food, and we received all the free milk we could drink—litres and litres of fresh milk daily. One other prisoner in my block, of Middle Eastern extraction, would turn about nine litres of milk into yoghurt and cottage cheese to share with us.

But back to the main issue of staff ratios for nursing homes and aged-care centres: I will be moving an amendment to this bill, on sheet 8448, which would introduce the concept of a minimum staffing standard for Australian government funded aged-care residential facilities. The amendment would require that the task of calculating a safe and specific ratio, including variables such as day and night shifts, higher- and lower-care residents, and metropolitan and rural and regional areas, would be undertaken by the Department of Health in consultation with the aged-care sector and included in the quality-of-care principles. The concept of a mandated ratio of skilled staff to care recipients in Australia's aged-care residential facilities is at the centre of the Australian Nurses and Midwifery Federation's Time to Act for Ruby campaign. It also has the public support of MPs and senators from the ALP and the Greens and some crossbenchers. Going public so far are: me, Senator Richard Di Natale and some members from the other place—Chris Bowen, Terri Butler, Milton Dick, Mike Kelly, Justine Elliot, Cathy O'Toole, Susan Lamb, Julie Owens, Susan Templeman and Graham Perrett.

The ABC reported today that a petition with close to 230,000 signatures will be delivered to aged-care minister Ken Wyatt on 14 September calling on him to mandate staff-to-resident ratios for all aged-care facilities across Australia. That's the way it should be. The real experts—the passionate and compassionate experts called RNs—demand better staff-to-resident ratios. I mentioned earlier how an RN in her 40s came up to me recently, in Shepparton, in tears. She told me she'd just quit her job because she'd get home at night and would start to cry because she knew she had not done a great job as a nurse that day: she had neglected patients because she just didn't have the time to properly do her job. That is shameful in Australia in 2018. Things must improve, and only we can force this to happen. I'm old enough to remember the kerosene bath scandal in Melbourne some decades ago. Sadly, while we're not back there, some of the practices in understaffed facilities across this country are Dickensian.

7:39 pm

Photo of James PatersonJames Paterson (Victoria, Liberal Party) Share this | | Hansard source

I rise to make a brief contribution to this debate on the Aged Care (Single Quality Framework) Reform Bill 2018—comforted in the new knowledge I have that Senator Hinch's calcium needs have been well taken care of in recent years! And I contribute to this debate both as a government senator and as the husband of someone who works in the aged-care industry and is very passionate about quality in the aged-care industry. For the record, I don't support and I don't think it is wise to have staff ratios imposed on the aged-care industry. It's an incredibly blunt instrument that will drive up costs and stifle innovation in the sector, and is not the most direct and delivered way to improve quality.

The bill contributes to the implementation of the government's 2015-16 budget decision to work with the sector to develop a new, unified quality framework including a single set of consumer focused quality standards which will apply across all aged-care programs. The bill makes provision for a single set of aged-care standards, to be called the Aged Care Quality Standards, to apply to the providers of Australian government funded aged care. The single quality framework places consumers at the centre of their care and focuses on giving people greater choice and flexibility. It is part of the reforms being progressively implemented in aged care to create a competitive market based system where consumers drive quality and red tape is reduced for providers of aged care.

With these amendments, provision will be made for the same set of quality standards to apply across all types of aged-care services for the first time. The introduction of new standards will reflect contemporary evidence and community expectations of the quality of care and services, with accreditation standards being updated for the first time in 20 years. The standards were co-designed with the aged care sector, including a technical advisory group made up of consumer groups, service providers, academics and experts in the development of aged care or health standards. The Department of Health has also consulted widely with individuals and organisations with an interest in aged care, including in urban, regional, rural and remote areas. The Aged Care Quality Standards are an important part of the broader aged-care regulatory framework. They promote consumer confidence that Australian government funded aged-care services are safe and of consistent quality by setting out our core expectations that apply across all services. This bill is an important part of the government's reforms to promote quality aged-care services that focus on outcomes for consumers.

7:42 pm

Photo of Tim StorerTim Storer (SA, Independent) Share this | | Hansard source

I support the intent of the Aged Care (Single Quality Framework) Reform Bill 2018 but the question is: will it produce the results claimed for it? Whether enough money has been provided in the budget to provide the quality and variety of care that people and their families deserve is questionable. The last budget allocated $5 billion to aged care but, since 2013-14, the sector has been subject to cuts totalling $3 billion, and 100,000 people remain on waiting lists for aged care. That said, public funding of essential services such as aged care should be provided with appropriate quality-control conditions. This legislation is a step in the right direction.

The streamlining of standards across all areas of care, and the increased focus of personalising care to the needs of individuals, is a positive step. However, in my review process, I have noted that major aged-care groups have a range of concerns about whether it will actually deliver better results. For example, National Seniors has raised the concern that funding models should take staff training and composition into account in order to deliver quality aged-care services. They say the quality of care is a function of the quantity of staff available and the mix of skills. Another noted concern is that the needs of care recipients are changing. One in two people who enter residential care has some form of dementia, and people are typically frailer and have more health issues. Increased focus should be given to adequately training our aged-care workforce to adapt to those changing circumstances.

It seems to me that those concerns are partly answered in the amendment put forward by Senator Hinch, which provides for a review process into the idea of a ratio between staff and care recipients. This amendment seems to meet the noted concern about ratios being a blunt instrument by providing for variables on day and night shifts, higher and lower care residents, and differences between metropolitan, rural and regional areas and so on. For those reasons, I encourage the Senate to support the Hinch Justice Party amendment. Thank you for the opportunity to speak.

7:44 pm

Photo of Linda ReynoldsLinda Reynolds (WA, Liberal Party, Assistant Minister for Home Affairs) Share this | | Hansard source

I too rise to speak on the Aged Care (Single Quality Framework) Reform Bill 2018. Before I go into the specifics of the bill, I'd like to first of all congratulate all senators in this place for your support for this important bill and for the bipartisanship, if not multipartisanship, you have all shown. I think it does demonstrate, particularly with the issues that we've had in the last couple of weeks, that as a parliament we can still come together and debate robustly but also very constructively. Nothing is more important than doing so on this particular bill. I would like to congratulate my friend and my colleague—the minister, Ken Wyatt—for his tireless commitment to supporting the most vulnerable in our community. The introduction of this bill is another important step in strengthening the cop on the beat for our most vulnerable in aged care.

That said, I was a little saddened to hear those opposite saying in one sense how bipartisan it was but also continuing to peddle some untruths about the situation of the Morrison government and, in fact, the coalition government over the last five years. I'd like to specifically rebut some of the more blatant things that were incorrect that were said. Just because you said it several times in the debate this evening does not make it true. I'd like to put on record the facts. The fact is that every year under us home-care packages have gone up, residential care places are up and every year aged-care funding has actually increased—despite what those opposite keep asserting. Today, more than 1.3 million senior Australians are accessing some form of support in the Commonwealth aged-care sector.

There haven't been cuts, as we have heard from those opposite tonight. In fact, under the coalition government, since elected, aged-care spending has increased on average by 6.1 per cent each and every year we've been in government. I will say that again, because those opposite keep talking about funding cuts. The fact is that aged-care spending has increased by 6.1 per cent every single year of our government. This year alone, the Morrison government is providing record aged-care funding of $19.8 billion, which is $5.5 billion more than what Labor provided in their last year of government. It equates to an additional 14,000 high-level home-care packages over four years at a cost of $1.6 billion, which is on top of the 6,000 high-level packages already released this year.

I'll now come to the bill itself and what this bill is actually about. The Aged Care (Single Quality Framework) Reform Bill 2018 contributes to the implementation of the Australian government's 2015-16 budget decision to work with the sector to develop a new, unified quality framework that includes a single set of consumer focused quality standards that will apply across all aged-care programs. This bill also lays the foundation for the introduction of a single set of aged-care standards, to be called the Aged Care Quality Standards, to apply to providers of Commonwealth funded aged care. The single quality framework places consumers at the centre of their care and focuses on giving people greater choice and greater flexibility. It is part of the reforms being progressively implemented in aged care to create a competitive, market based system where consumers drive quality and where red tape is reduced for providers of aged care. By providing for a single set of standards that apply across all aged-care programs, the amendments are intended to, once implemented: drive improvements to the quality of care delivered to all older Australians; decrease the regulatory burden on aged-care providers; and encourage innovation, excellence and continuous improvement, which are so important in all sectors today.

Currently there are four sets of quality standards that apply to providers of aged-care services. The first one is accreditation standards, which apply to residential aged-care services and some form of flexible care. The second is home-care standards, which apply to home-care services, Commonwealth home-support program services and some form of flexible care. The third is transitional care standards, which apply to providers of transitional care. The fourth is the National Aboriginal and Torres Strait Islander Flexible Aged Care Program quality framework, which applies to providers under that program. With these amendments, provision will be made for the same set of quality standards to apply across all types of aged-care services for the very first time. The introduction of new standards will also reflect contemporary evidence and community expectations of the quality, care and services, with the accreditation standards being updated for the first time in 20 years.

The Aged Care Quality Standards will also be enacted through amendments to the Quality of Care Principles 2014, issued by the minister for aged care under the Aged Care Act 1997, which is consistent with the manner in which the current accreditation standards and home care standards are issued. Principles are subject to parliamentary scrutiny and also to disallowance, meaning that the final content of the Aged Care Quality Standards will be able to be transparently reviewed by the parliament. Additionally, a single set of standards will increase consistency across aged-care services, and it will also make it easier for consumers and their families, carers and any other representatives to make choices about care and services, including as care needs change. Not only will the standards focus on quality and safety for consumers, they will also encourage providers to offer care and services that promote quality of life and wellbeing by placing greater emphasis on consumer choice and identity and by partnering with consumers in their care.

The Aged Care Quality Standards will be made under the reforms to this bill. They have been developed through significant consultation as well as through co-design with the aged-care sector. The Department of Health has undertaken research and consultation with the public, the aged-care sector and other government organisations. A standards technical advisory group was also established by the department. The Australian Aged Care Quality Agency is developing guidance and also educational material to support assessment of the standards and has conducted field testing of the draft set of standards. Additionally, in October 2017, the government released the Review of national aged care quality regulatory processes, which included recommendations regarding the content of aged-care quality standards. These recommendations are being addressed through the new Aged Care Quality Standards.

This bill also makes amendments to the Australian Aged Care Quality Agency Act 2013 to provide the chief executive officer of the Australian Aged Care Quality Agency with the power to accredit residential aged-care services and also to conduct quality reviews of home-care services in accordance with the requirements of the new Aged Care Quality Standards. The chief executive officer of the Australian Aged Care Quality Agency will also have the power to assess the quality of flexible care services, Commonwealth Home Support Program services and National Aboriginal and Torres Strait Islander Flexible Aged Care Program services through a specification instrument to be made by the minister for aged care.

The bill also makes amendments to the Freedom of Information Act 1982 so that protected information is exempt from the provisions of that act. Protected information is information collected by the Australian Aged Care Quality Agency in the course of its functions that is either personal information or information that relates to the affairs of the approved provider. The Australian Aged Care Quality Agency Act 2013 already contains criminal penalty provisions for the unauthorised disclosure of protected information.

The Aged Care Quality Standards are an important part of the broader aged-care regulatory framework. They promote consumer confidence that Australian government funded aged-care services are safe and of a consistent quality by setting out core expectations that apply across all services. This bill is an important part of the government's reforms to promote quality aged-care services that focus on outcomes for consumers. Again, I thank all in this chamber for their support and engagement on this bill, and I commend the bill to the Senate.

Question agreed to.

Bill read a second time.