Marielle Smith (SA, Australian Labor Party) | Link to this | Hansard source

I rise to speak on the matter of public importance. I do so because, like colleagues on this side, I recognise that Australia's aged-care system is broken. It is broken because of years of inaction and cuts by the Liberal government.

This week, we've marked the anniversary of the announcement of a royal commission into aged care. I note that my colleague, Senator Scarr, was insistent that there was nothing wrong with the aged-care system. Well, why did we need a royal commission? This is a royal commission we so desperately need because our aged-care system is in crisis. After extending the reporting date of the royal commission on Friday, it is vital that this Liberal government acts on what we know is broken today. We cannot wait until November 2020 for action, because 120,000 older Australians are waiting for aged care at home, with waiting times now of more than two years for the highest levels of care. A week does not go by without another disturbing account emerging about the mistreatment or neglect of older Australians in residential care.

Like so many other South Australians, I was shocked and appalled at some of the horrific revelations of abuse and poor care of elderly people in care in my state. But this problem has not been confined to South Australia; the royal commission has already heard devastating evidence of mistreatment and neglect across our country. We have heard witnesses give evidence suggesting there are regulators paying lip-service to the welfare of the elderly and who are so desensitised to poor care they're allowing these nursing homes to stay open. Only last month a home on the Gold Coast closed due to a dispute over money, which left nearly 70 elderly residents homeless—an issue that my colleague, Senator Watt, has been more than vocal on. I note the government is yet to examine whether cuts to residential aged-care funding have contributed to the closure of this place. Disturbingly, we've seen reports that a number of other aged-care facilities in Queensland are at a risk of closure due to insufficient federal funding.

The royal commission has heard evidence about one home in Sydney which repeatedly failed dozens of standard inspections over 12 months, at one point only meeting 10 of the 44 standards on quality and safety. We have heard horrific reports regarding malnourishment, neglect, medication mismanagement and abuse incidents in some aged-care homes around our country.

There are things this government can act on now, starting with our workforce. We know that there aren't enough aged-care workers and that they aren't paid enough. Australia is far from having the workforce that is required to care for our ageing population. In 2015-16 almost 240,000 people received permanent residential aged care. The proportion of people aged 65 years or over is projected to increase from 15.3 per cent in 2017 to 22 per cent in 2061, when one in 20 people will be aged 85 years and over. The frailty of residents is also increasing, as people are being admitted at an older age with multiple morbidities. We have seen too much blame placed on aged-care staff for what are systemic, long-term issues mainly caused by funding cuts, poor management, a lack of transparency and accountability and a lack of willingness by the Liberal government to tackle real reform. In fact, it was only last year when former Prime Minister Malcolm Turnbull said that aged-care workers could always aspire to a better job. Let me be very clear: aged-care workers deserve our respect; they do not deserve to be berated. Aged-care workers and their unions have been screaming out for reforms and resources, a call that has been completely ignored by this third-term Liberal government. They desperately need these resources so they can continue to do the best job they can for their patients and their residents.

The crisis in aged care is a failure of public policy, and, like so many other policy failures under this government, it was not inevitable. It did not have to happen, but it has happened because of this government's hopeless record of inaction and cuts over the last six years. It has happened because of the Prime Minister's cuts to aged care that have contributed to the broken system. And, remember, he was the architect of these cuts. The government has been asleep at the wheel for six years, with four ministers and billions of dollars ripped out of our aged-care system.

In the meantime, the aged-care system lurches from one crisis to another. We've had review after review ignored, with recommendations for fixing Australia's aged care system left to collect dust in different ministerial offices. It is shameful that, in a wealthy country like Australia, older people are not getting the care they need. I spoke to many, many older Australians during the campaign. Some were weeping, begging us to fix this disaster. The government must do better now to ensure older Australians get the quality aged-care services that they deserve, because older Australians and their loved ones cannot wait any longer.

It has been six years since the Liberals formed government. What can we celebrate? Actually, it's hard to think of much at all that they have done well when it comes to aged-care reform, because they don't have a genuine reform agenda. Crisis by crisis, we have seen policy on the run. Clearly, this sector and the people who rely on it are not prioritised by this government. We can see this simply in the fact that they are on their fourth aged-care minister in six years, and this minister is not considered significant enough to be in the cabinet, even though there is a royal commission currently underway. Since the Liberals have been in government, the policy and reform void in this policy space has been startling. Let's start with home care: 120,000 older Australians are waiting for their approved home care package. That is not good enough. In fact, it is just totally unacceptable. More than 16,000 people have died while waiting for their approved package, and 14,000 have had to enter residential aged care because they could not stay at home waiting for care that wasn't there—talk about a policy failure. Others enter emergency departments or the hospital system due to their increasing care needs. Not only is there a distinct lack of packages available, there's also the increasing length of time older Australians have to wait for their approved home care package. Many people approved for the highest level of home care are now waiting more than 24 months to receive their approved packages. Make no mistake, this waiting time is a crisis. Figures included in the most recent government report clearly show that there are more people on the home care package waiting list than there are packages in the system.

For years, Labor has been calling on successive Liberal governments to fix the home care package waiting list crisis. We know Australia has a growing ageing population. We also know that more Australians are choosing to age in their own home. They should be able to make that choice. The former minister admitted last year that he needed to intervene. Did he? The next quarterly report on the number of older Australians waiting for care has just been released, and given the seriousness of issue I hope there is no further delay.

The government's track record of inaction continues when it comes to dozens of other reports as well—reviews and inquiries that have been gathering dust on the desk of minister after minister. More than two years ago the Australian Law Reform Commission's final Elder abuse report was tabled in the parliament. Forty-three recommendations were put to government by the Law Reform Commission, the majority of which still have yet to be actioned or fully implemented. Last week it was two years since the report of the Tune review was tabled in the parliament, an important review that gave the government a pathway forward about how to address a number of critical issues impacting on the now broken aged-care system. Thirty-eight recommendations were put to government, many of which still have yet to be fully implemented. In question time today the minister said he was working through them, but it's not good enough.

Last week also marked a year since the minister announced the release of the A Matter of Care workforce strategy, which included 14 actions to address current and future workforce challenges. How many of those 14 actions have been addressed? To date none have been fully implemented. What a disgrace this is, when we know there aren't enough aged-care workers now to care for older Australians, let alone those that will be needed to provide this care over the next decade. And in less than a month it will be two years since the Carnell-Paterson report into regulatory processes was handed to the government. This report has 10 recommendations, many of which, yet again, have yet to be fully implemented. What we have seen over and over are policy failures under this government—policies that are failing older Australians. This government has turned its back on older Australians. It needs to do more. It needs to fix the crisis in aged care.

Dean Smith (WA, Liberal Party) | Link to this | Hansard source

I'm a little delighted to come into the chamber this afternoon to talk on this matter of public importance—a little delighted because I'm surprised that Labor continues to proffer this gross mistruth that there has been a reduction in government spending in aged care—just untrue. And I'm not going to ask you to believe me; I'm going to ask you to believe the Australian Broadcasting Corporation, and I'll come to that in a moment. The second reason I'm only a little delighted to come into the chamber is it seems that Labor senators are keen to ignore the coalition government's very strong record when it comes to delivering on aged-care achievements.

To start, let me provide a quick overview before I demonstrate why the ABC doesn't believe what Labor says this afternoon about aged-care funding. At a higher level, let me put on the record that since the coalition government was elected aged-care spending has increased every single year. It's increased on average by $1 billion of extra support for older Australians each year. Aged-care funding continues to grow, with the government investing an additional $7 billion in aged care over five years. The Morrison government is delivering record investment across the aged-care system over the forward estimates. Funding has increased from just $13.3 billion in 2012-13, Labor's last year in office, to $21.7 billion in 2019-20, to an estimated $25.4 billion in 2022-23. Under our plan aged-care funding will almost double from what it was in the last year under Labor.

Just as importantly, when Labor had an opportunity in the lead-up to the 18 May federal election, what did they say about aged care? The country was looking at Labor and it was looking at the coalition. Many Australians would have been thinking about the various policies on offer from the coalition, from Labor and from other parties. What did Labor say to Australian electors in the lead-up to the 18 May federal election? When the whole country was looking at Labor to understand what its aged-care priorities were, Labor provided no additional funding in its costings for home care places or any additional funding for aged-care quality, workforce or residential aged care. When the whole country was preparing to go to the ballot box and was thinking about a variety of issues and the various policy positions of Labor and the coalition, you would have thought that would have been a good time for Senator Brown from Tasmania or Senator Ciccone from Victoria to put on the public record what their position was with regard to additional aged-care funding, but they provided nothing.

Let's have a quick look at what the ABC said when it examined for itself, last year in September, claims from Bill Shorten that the coalition was cutting aged-care spending. Senator Brown, I know you're not supposed to interject but on this occasion we might be able to excuse you. What did ABC Fact Check say about Bill Shorten's comments? 'Misleading' is what ABC Fact Check said. The claim from Bill Shorten was, it said:

Australia's aged care sector has come under close scrutiny in recent weeks following concerns that some providers have placed profit before the welfare of the elderly.

We heard that in Senator Smith's contribution—Senator Smith from South Australia, not Senator Smith from Western Australia. The ABC went on to say that this is what Bill Shorten, the former Leader of the Opposition, said in the House of Representatives:

Why, when he was treasurer, in his first budget, did the now Prime Minister cut $1.2 billion from aged care? How did cutting $1.2 billion from aged care support the dignity of vulnerable older Australians?

That's what Bill Shorten said to Scott Morrison, who, in September last year, was Prime Minister. What did ABC Fact Check say? It said:

In making his claim, Mr Shorten specifically referred to Mr Morrison's first budget as treasurer, which was for 2016-17. As previously mentioned—

in the article—

that year the government announced $1.2 billion of "efficiencies" (partly offset by more money in the budget for regional aged care and information services).

That announcement followed a $2.5 billion increase in the expected cost of the Aged Care Funding Instrument (ACFI), the main Commonwealth funding mechanism to subsidise aged care service providers, since the budget update just six months earlier.

According to Budget Paper No. 2 (page 101)—

Senator Brown, that's Budget Paper No. 2 page 101—

"This measure is part of the Government's response to the continued higher than expected growth in ACFI expenditure, which has increased by a further $2.5 billion over the forward estimates since the 2015-16 MYEFO …

That doesn't sound like a cut in aged-care spending. That doesn't sound like one, and it's not one. 'Misleading' is how the comments of the then Leader of the Opposition Bill Shorten have been characterised. We heard nothing about that in the contributions of Labor senators this afternoon. If we are going to have a debate about aged care in our country, then it should at least be an honest one and it should at least be a factual one. The challenge is for Labor to focus on the facts, present the real story and then offer up their solution. But what we've heard this afternoon is a false story not based on facts, and we haven't heard any solutions.

In contributions from others this afternoon, it's also been suggested that the government has got no achievements to demonstrate in the aged-care policy area. They say, 'Oh, you've had so many ministers, isn't that terrible.' Well, actually, the former minister just became a cabinet minister and is the Minister for Indigenous Affairs. That demonstrates competency, not incompetency. So let me just talk about the 22 achievements that the coalition government can lay claim to. I suspect that, in the next two minutes, I won't have the opportunity to get through all 22, but Senator Brown, you're welcome to come and take my speaking points. If I can only get to 10 or 12, you're welcome to take the other 10!

Where should we start? Let's start at the top. Achievement No. 1: the coalition has invested $2.2 billion since the 2018-19 budget into home care packages to support more Australians to remain living in their own homes for longer. That is a good outcome. That is a good achievement. That is necessary. That is what the Australian community is telling us. There's been a 25 per cent increase in access to home care packages in just one year. Achievement No. 2: the coalition has released 14,275 new residential care places, including 13,500 residential places and 775 short-term restorative care places. That is achievement. That is success. That is delivering on the aged-care needs for older Australians.

Achievement No. 3: the coalition has allocated $60 million worth of capital grants for infrastructure works in rural and remote areas. As a regional senator, this is critical. Aged-care homes across regional areas in our country do need more support in order to build the infrastructure to support the provision of aged-care services. If you want to have a really important debate about aged care, if you really want to think about the future of aged care and have a proper policy discussion about what the urgency is and what really needs to be done, then it's absolutely about how we make sure that older Australians living in rural and remote areas across our country can stay close to their families and get aged-care support in those rural and remote areas. That is an important policy discussion. I haven't heard that from anyone on Labor's side yet.

Achievement No. 4: the coalition has established the new independent Aged Care Quality and Safety Commission. Achievement No. 5: the coalition has implemented new consumer focused Aged Care Quality Standards arrangements. Achievement No. 6: the coalition has put in place a new single Charter of Aged Care Rights, covering 14 fundamental protections for all aged-care programs for safe, quality care to independents. That's six achievements of at least 22. I could go on— (Time expired)

Carol Brown (Tasmania, Australian Labor Party, Shadow Assistant Minister for Infrastructure and Regional Tourism) | Link to this | Hansard source

I stand to address the Morrison government's record of inaction and cuts to aged care over the last six years—cuts that have directly led to the national aged-care system being broken. What we just heard from Senator Dean Smith, Western Australian Liberal, was a very, very lacklustre contribution. In fact, that contribution was essentially a contribution of distraction. Even though he says the federal government have all these achievements—and there's the fact that they just rotate ministers in aged care—he spent at least seven minutes attacking the Labor Party. We have not been in government for six years. They have presided over a royal commission—seriously!

Dean Smith (WA, Liberal Party) | Link to this | Hansard source

On a point of order: perhaps I was mistaken—I thought you were listening to my contribution!

David Fawcett (SA, Liberal Party) | Link to this | Hansard source

Senator Smith, that is not a point of order.

Carol Brown (Tasmania, Australian Labor Party, Shadow Assistant Minister for Infrastructure and Regional Tourism) | Link to this | Hansard source

Look, I'm going to have to change my assessment about his contribution to being just sad, sad, sad. It was a very sad contribution, and, look, he's leaving! Of course—I'd leave too because—

David Fawcett (SA, Liberal Party) | Link to this | Hansard source

Order! Senator Brown, you know it's disorderly to draw the attention of the chamber to the fact that another senator is leaving. Continue your speech. You have the call, Senator Brown.

Carol Brown (Tasmania, Australian Labor Party, Shadow Assistant Minister for Infrastructure and Regional Tourism) | Link to this | Hansard source

I really appreciate your intervention there, Mr Acting Deputy President, because I know that Senator Smith, if he truly wanted to get through all the achievements that he says that the federal government have achieved, would have started with them. But of course he doesn't want to talk about the fact that Prime Minister Morrison was actually the architect of the cuts to aged care.

Monday was the anniversary of this government's announcement of a royal commission into aged care. The anniversary is marked by the tragic fact that every part of Australia's aged-care system is in crisis. On Friday, the Morrison government extended the reporting date of the royal commission to November 2020. But we cannot wait. Action needs to be taken. Action needs to be taken now to fix what we know is broken today. But the Liberal government, the coalition government, doesn't even rate aged care as a priority. How do we know this? We know this because the Liberal government is on its fourth aged-care minister in six years. It is such a low priority that the aged-care minister is not considered important enough to be in cabinet, even though there's a royal commission on aged care happening right now.

Meanwhile, we know the facts, as Senator Dean Smith likes to highlight, are that 129,000 Australians are waiting for approved home care packages and around 75,000 are waiting without any care at all. The waiting list has grown from 88,000 to 129,000 over the past 18 months alone. This is totally unacceptable. Equally unacceptable is the tragic fact that more than 16,000 people have died waiting for an approved package. The federal government, the coalition government, need to hang their heads in shame. Sixteen thousand people have died waiting. Fourteen thousand have had to enter residential aged care because they can no longer stay at home waiting for care packages, and many older Australians enter emergency departments or the hospital system due to their increasing care needs.

For the highest level of care, waiting times are now more than two years. Think about it. Think about your aged parents having to wait for the highest level of care for more than two years. That is what this government has presided over. Think about that. This government needs to be ashamed— (Time expired)

Rachel Siewert (WA, Australian Greens) | Link to this | Hansard source

I rise to contribute to this discussion and debate on the Liberals' record of inaction and cuts which over the last six years have led to Australia's broken aged-care system. We've had a series of coalition senators stand up in the chamber today, articulating some of the things that they have done, but the fact is we still have a system that is failing older Australians. We have heard about the terrible abuses that have been occurring in our aged-care system, through the Royal Commission into Aged Care Quality and Safety. The coalition are the ones who had to set up the royal commission because they haven't been able to fix the system.

There has been a lot said about a number of issues, but one of the areas that I don't think have been getting much attention during this debate is clinical care—actually looking after older Australians who are in residential care. The Senate Community Affairs References Committee, at the very end of the last parliament, did an inquiry into the effectiveness of the aged-care quality assessment and accreditation framework for protecting residents from abuse and poor practices, and ensuring proper clinical and medical care standards are maintained and practised. The final report of that committee, which was not that long ago, found that there is one overarching failure which underpins the systemic flaws in aged-care services, and that is the lack of appropriate regulation of clinical care standards within residential aged-care facilities—and this is still the case. I was quite shocked during that inquiry to hear providers say that they aren't responsible for clinical care. Well, who is responsible for clinical care in our aged-care system? You would think that addressing this would be very high on the agenda. There are gaps in the current framework for the delivery of clinical services in aged-care facilities, and these, too, often result in poor clinical care for older Australians in aged care. That was one of the findings in our report.

The inquiry highlighted how much needs to be done to promote a higher quality of care for people living in aged-care facilities. We found that the sector needs person centred regulation to achieve person centred care. The lack of clear lines of responsibility around who has the ultimate duty of care towards residents remains a barrier to implementing the person centred care approach—that's what we found. We found that aged-care facilities ultimately hold a duty of care to all residents and are the last line of defence. Now, you'd think this would not be controversial, but apparently it is. If we haven't solved this issue, there's no way that the government can claim that residential care and aged care in this country is on track and all okey-dokey, because it simply isn't. If we are still having a debate about that and it can't be guaranteed, we are not hitting the mark.

The committee recommended that the government clarify that residential aged-care providers ultimately hold a duty of care to all residents. We should be supporting aged-care facilities and driving them to ensure that there is continuous quality improvement, which supports early intervention to manage problems before they become compliance issues. These are issues that absolutely need to be dealt with.

There has been discussion today about home care places, where we still have such a massive waiting list. Yes, there were changes there, but what has been very clearly articulated is that we have a growing list of people waiting for care. We also have people who are receiving inadequate levels of care because the system, again, is not working. We have inadequate assessment processes. We have people who have been assessed for care that's at too low a level. We have people who have been assessed for care at a higher level but who aren't able to access services to deliver that higher level of care, at levels 3 and 4, so they're not using all of their packages. There's money that is not being used to provide care for those people. So at the same time that we have people who are not receiving the level of care they need—129,000 on the waiting list—we have people who aren't using all of their level 3 or 4 packages because they've determined that they don't actually need some of that care at the moment. The rumour going around is that people are assessed at a higher level because the assessors think it's going to take them a while to access that level. They're then on a higher level of care than they perhaps need. Or perhaps it's that they're saving money to use later, or they can't actually get the services they need, depending on where they are living. The point is that there's a whole lot of money that's been allocated that is not then being made available to help people who are on the waiting list and need care. It is absolutely clear that that needs urgent resolution.

Let me come to the workforce. We know that we are not providing enough care for residents. We're averaging only around 2½ hours of care, when we need at least four hours and 18 minutes for proper provision of care support for people in aged care. We need the workforce to be able to provide that care. We need a workforce that has proper ratios, with staff appropriate to the needs of particular residents. We need to resolve that issue now. We need more funding, for a start, to be committed to aged care to support a larger workforce so that they're able to provide more hours of care to meet residents' needs. We need a vast injection of resources and funding for that, but also to make sure that we actually have the workforce there to provide that care. We are not doing enough in this country to ensure that we have people who are able to provide that level of care.

One of the issues that I have been very passionate about in this place is mental health in aged care. I was very pleased when the government finally listened to calls for funding to be provided for residents in aged care so that they could access mental health services, because they weren't able to access the Better Access—sorry, I'm using the word 'access' a lot, but the fact is the program is called Better Access and residents in aged care were not able to access that particular program.

Funding has been allocated—not enough—but what we're now finding is the provision of that mental health support is varying across the country. The funding has been given to the PHNs, and the PHNs, in their wisdom, have decided on multiple different approaches as to how that care is being provided. There are various trials being done; there are various ways providers can access those funds. I'm not at all—not at all!—reassured that every resident in an aged-care facility who needs to access mental health support and care is in fact able to access that care. I've spoken to people around this country and, as far as I can tell, from the conversations I've had, that service is not being adequately provided.

I'd like to quickly touch on the fact that we have a massive service provider in this country, Bupa, that has not been meeting, in many of its facilities, the standard of care that we expect in this country, and this government has overseen that. I know the government are now meeting weekly with them, but this system has been in operation while the government have supposedly been doing all those other reports that the coalition senators have been talking about—'they've done this, this and this'. Well that has not stopped one of the major providers of residential care in this country from being unable to guarantee top quality care at every one of its facilities. We know there have been compliance issues and accreditation problems for a number of the facilities. That should not have been allowed to occur. If this system was working, we wouldn't have that situation in this country.

So the government may have been doing some stuff, and I give them credit for doing that, but it's simply not enough. It is not enough, because we still have a failing aged-care system. We have people who are not able to access home care, we have people who are not receiving the standard of care we expect in this country and we have the very fact that they still can't make sure providers can guarantee they provide and are responsible for their duty of care for their residents and for providing clinical self-service. (Time expired)

Claire Chandler (Tasmania, Liberal Party) | Link to this | Hansard source

Thank you, Senator Siewert, for your applause for this government and its work in the mental health space with regard to aged care. I will keep that applause; it will warm the cockles of my heart.

Rachel Siewert (WA, Australian Greens) | Link to this | Hansard source

Take the criticism that goes with it!

Claire Chandler (Tasmania, Liberal Party) | Link to this | Hansard source

I was about to say there were a few other things that you said that I didn't necessarily agree with, but the applause is much appreciated.

This government, the Morrison coalition government, is delivering record investment across the aged-care system, and, in rising on this matter of public importance tonight, I would like to commend the efforts of the aged-care minister, Richard Colbeck, who is one of my colleagues from the great state of Tasmania. Senator Colbeck has been doing a fantastic job in his new role, and I'm sure many Tasmanians are very proud of him.

Just as it is for Senator Colbeck, the aged-care sphere is an area close to my heart, as I'm sure it is for so many Australians as we anticipate or dwell upon ensuring that we have a robust system in place that will look after our parents and our grandparents—and even ourselves when the appropriate time comes. Certainly in my case, it is something that my family have had to contemplate in recent years, with my late grandmother going into an aged-care facility. That obviously opened my eyes to some of the opportunities for improvement that exist in this system, and this coalition government are certainly committed to seeking out those opportunities for improvement and increasing funding in these vital areas, because we know that more can be done to strengthen this system.

And that's why, since this coalition government was elected back in 2013, aged-care spending has increased every single year. On average, we've added $1 billion of extra support for older Australians each year, and funding only continues to grow. In addition to this, the Morrison Liberal government is committed to improving aged care for all senior Australians, and that's why the Prime Minister called the Royal Commission into Aged Care Quality and Safety. Certainly in this chamber today we've heard a lot of commentary not just about this issue but about the family law committee that's been proposed as well, and it bothers me that a lot of the rhetoric has been caught up in rejecting further forms of inquiry because we might already know what the problems are. These are incredibly complex issues that are facing Australia, and I think it is only right we as a government should investigate them fully and should be able to understand the many nuanced issues that exist, particularly in family law. I was disappointed to hear that rhetoric regarding the committee today. This is why we've called the Royal Commission into Aged Care Quality and Safety; it is so that we can in an appropriate forum uncover all of the issues that we have to deal with.

The contrast to Labor, quite frankly, couldn't be more stark. Labor at this election provided no additional funding in their costings for home care places or any additional funding for aged-care quality or workforce or for residential aged care. In contrast, our record in aged care, I believe, stands for itself. That's why older Australians resoundingly voted for the coalition government on 18 May and resoundingly returned this government, as Senator Scarr said in his contribution to this motion earlier this evening.

The Morrison government is delivering record investment across the aged-care system over the forward estimates, from $13.3 billion in FY 2013 under Labor, growing to $21.7 billion in FY 2020 under a coalition government and to an estimated $25.4 billion in FY 2023. Our recent track record in improving aged care, including since the royal commission was called, is extensive, and my colleagues tonight have cited a number of different initiatives that we've introduced. I'm certainly not going to go through them all tonight, because our time is expiring, but I would like to assure the Senate and assure the Australian public that the Morrison coalition government takes this issue very seriously. That's why we've called a royal commission. That's why we're making record investment into the aged-care sector.