Tuesday, 8 August 2023
Inspector-General of Aged Care Bill 2023, Inspector-General of Aged Care (Consequential and Transitional Provisions) Bill 2023; Second Reading
The Inspector-General of Aged Care Bill 2023 is an important step in addressing systemic issues in the aged-care sector. I'm proud to be part of a Labor government that is leading its implementation. This office will have strong investigative powers and will be able to review the implementation of the royal commission's recommendations, which will be integral to undoing the negligence faced by the sector under the previous government.
For too long, this sector has been chronically underfunded and overwhelmed by demand. For too long, people have suffered substandard care. For too long, older Australians have been robbed of dignified and meaningful living. Let's not forget the consequences of this neglect on some of Australia's most vulnerable during the height of the pandemic. In 2020, some three-quarters of deaths from COVID-19 in Australia were in aged-care homes. Under the opposition, Australia had one of the highest rates of death in residential care in the world.
For nearly a decade, those opposite have failed to appropriately care for and value older Australians. The need for a strong, resilient aged-care system could not be more urgent. Right now, some 80 per cent of Australians use an aged-care program at some stage before their death. Within a decade, our nation will have more people aged over 65 than under 18. More significantly, by 2050 about 3½ million Australians will need access to aged-care services like residential aged care each year.
This bill and the creation of the Inspector-General of Aged Care office would not only play a pivotal role in righting some of the wrongs under the previous government but will also enable us to build a more resilient system for the future. It would drive improvement across the aged-care system by monitoring the government's administration of the aged-care system, calling out systemic issues, recommending improvements and providing a much-needed increase in accountability and transparency through reporting to parliament, including on the progress of implementation of the recommendations made by the royal commission.
I'm happy to support this bill, which is one of the many investments that our government is making into the aged-care sector. We're delivering a record 15 per cent pay increase for aged-care workers across Australia, establishing a new aged-care task force to review aged-care funding arrangements and develop options to make the system fair and equitable for all Australians, putting older people at the centre of residential aged care, assigning care places to people, introducing new initiatives for GPs to provide care to residents through MyMedicare, improving access to high-quality aged care for First Nations elders and boosting provider support and worker training to build care capacity.
This final initiative includes $2.547 million in funding to establish a peak body for Aboriginal and Torres Strait Islander aged care and ageing. This is in response to one of the other key findings of the royal commission into aged care, which is that the current system is largely failing Aboriginal and Torres Strait Islander people. The final report notes:
After a lifetime of experiencing marginalisation, discrimination, disadvantage and racism, the Elders and the older people descendent of the first inhabitants of this ancient land deserve better than this.
I couldn't agree more. It is a sad indictment of the system that the care needs of our ageing First Peoples are not being met.
Older Aboriginal and Torres Strait Islander people are significantly underrepresented in residential aged-care services, at under one per cent, but overrepresented in Commonwealth Home Support Program services and level 2 home-care packages. These trends are worrying, considering older Aboriginal and Torres Strait Islander peoples experience at least twice the burden of disease of other Australians. First Nations peoples faces social, economic and cultural barriers which prevent access to a mainstream aged-care services. These issues with access are made worse by our elders' additional vulnerability from higher rates of disability, comorbidities, homelessness and dementia. This also leads to a majority of our elders having a strong preference for culturally appropriate aged and disability care provided by Aboriginal services.
Recently I met with James Atkinson, CEO of the Aboriginal Community Elders Service, on this very subject. ACES is a not-for-profit Aboriginal community controlled organisation based in East Brunswick in Victoria. It provides residential aged-care facilities, programs and innovative and flexible, planned activity group programs which are culturally appropriate for Aboriginal and Torres Strait Islander elders. James and I spoke about the diverse indicators of a culturally appropriate service, such as having buildings suited to cultural activities and ceremonies, providing access to bushland gardens, including the local community in aged-care planning, respecting cultural traditions such as men's and women's business, employing Aboriginal and Torres Strait Islander peoples to provide care, which is particularly important as close to 10 per cent of Indigenous peoples in residential aged care speak preferred languages other than English, including First Nations languages.
Our communities know our issues. They have grown up in these areas for thousands of years. These are their homes and culture, and they should be genuinely engaged to provide culturally appropriate care. Given the anticipated increase in the demand for aged-care services from First Nations peoples, there is an urgent need for culturally safe services, particularly in regional settings. In response to this need, the Albanese government recently launched the National Aboriginal and Torres Strait Islander Ageing and Aged Care Council, NATSIAACC. The council will lead reform priorities for older Aboriginal and Torres Strait Islander people, embedding Closing the Gap targets in Aboriginal and Torres Strait Islander aged care. It will ensure access to support and care that is culturally safe, trauma aware and healing informed and that recognises the importance of our personal connections to community and country. It will develop ageing and aged-care policies which respond effectively to the needs of our elders and will facilitate access and participation at equitable rates. It will advocate for improvements in the ageing and aged-care sector which will benefit Aboriginal and Torres Strait Islander providers and elders. To sum it up, it will play a key part in closing the gap in health outcomes between Indigenous and non-Indigenous Australians.
Increasing health outcomes and life expectancy is not only a health issue but also a human rights issue. It is central to the empowerment of Aboriginal and Torres Strait Islander peoples. The creation of entities like the Inspector-General of Aged Care and the council reinforces this government's commitment to ensuring elders and older Australians can live a meaningful life with dignity and respect. Really it is about treating others how we want ourselves and our loved ones to be supported as we age. Aged-care service providers have a duty to provide high-quality and safe care in a compassionate way that maintains the wellbeing of older people. For far too long, the system has neglected this duty and it has been left to the whims of the market, which has failed to produce good outcomes in the residential aged-care sector. But our government is committed to transforming the system from the mess that we've inherited, whether it is by boosting the aged-care workforce, increasing transparency or increasing the quality of care for those who need it most. We're committed to independent monitoring, investigations and reporting of the aged-care system under the Inspector-General of Aged Care Bill.
Finally, we're committed to ensuring that elders ageing on country are front and centre of the government's response to the royal commission's recommendations. For too long, the aged-care sector and the workers who are integral to it were neglected and left behind by the former government. We have sought to end the crisis, and, since coming to government, we have not wasted a day. The Albanese government recognises your commitment to our country's most vulnerable, and we make a commitment to you that you won't be left behind again. Thank you for all that you do.
I rise to make my contribution on the Inspector-General of Aged Care (Consequential and Transitional Provisions) Bill 2023. The government's approach to this piece of legislation is symptomatic of their approach to the reform of the aged-care system since they came to government, because this piece of legislation should have been passed by now. The Inspector-General of Aged Care should have been a formal position by now, not an acting position as it currently is. It was supposed to come into force on 1 July. The bottom line with this legislation, as has been the case with so much of what Labor claims to have done since the last election, is that the reform process has effectively been delayed. It's way behind. They've kicked the can down the road a number of times, and I'll deal with that further in my presentation. Interestingly, one of the things that the Inspector-General of Aged Care will be required to do is to undertake at least two reviews of the Commonwealth's implementation of the recommendations of the royal commission, and yet their process to put this office in place itself is behind schedule. As I said, it is symptomatic of the way that the government has operated, despite its claims.
I might just respond to Senator Stewart's comments with respect to the very, very tragic circumstances of mortalities through COVID. There were 685 deaths in 2020, when we were still learning about COVID and the impacts that it might have on our communities, before we had vaccinations. In 2021 there were 231 deaths, while we were rolling out the vaccines. In our final period of government, in 2022, up to the March 2022 election, there were 1,499 deaths, tragically, as omicron took hold through the community and as the community opened up. But, in the next eight months, there were 2,652 deaths. There were more deaths under Labor—the deadliest winter of COVID ever—than there were in the 2½ years previously of the coalition. So I'm not going to be lectured by the Labor Party in respect of the management of aged care and COVID, particularly when they're demonstrating the record that they have to date.
When I think of the effort that went into keeping aged-care providers in local communities open during the pandemic, it's heartbreaking to see them falling over now due to Labor's ill-advised, politically motivated policy to bring forward 24/7 nurses, ahead of the recommendations of the royal commission. It's been over 30 providers already. The warning signs were already present in the pressures on providers like Southern Cross aged care at Bombala, which closed due to a shortage of nurses. I notice that Labor have done nothing, in the 12-plus months they've been in government, to restore that service in the Southern Highlands, despite the politics they played in the lead-up to the 2022 election. It seems quite trite to say, 'We warned you,' but we did. The department said at the time how many nurses were required. Labor played the issue hard in the lead-up to the election, demanding action, but have now fallen silent as providers across the country fall to the same problem. This time, it's of Labor's own making.
It's also preposterous that there is over $500 million in claims still outstanding for COVID outbreaks. Again, Labor made a lot of noise in the lead-up to the election, but, again, they haven't lived up to their rhetoric. Two years after the coalition presented the most comprehensive and significant funding response to a royal commission in history—at the time it was $17.7 billion, and by the election it was $19.1 billion—Labor still have not responded to a single recommendation of the royal commission. What they're effectively doing is implementing the decisions and the recommendation responses of the coalition. They want to criticise us, but, at the same time, they're implementing the recommendations and the responses to the royal commission that we tabled in May 2021, just a few months after the royal commission reported.
As I've said, tragically more senior Australians died from COVID in the first eight months of the Albanese government than in the whole 2½ years of the pandemic under the coalition, when we were still learning about the virus and before we had access to vaccines and antivirals. Outrageously, the fully vaccinated rate for senior Australians in aged care today has fallen to just 50 per cent. I recall Labor senators, in Senate inquiries and in this place, demanding to know the vaccination rate when it was in the high 80s and low 90s. Today, it's just 50 per cent. That wouldn't be so bad, except for the fact that Labor, in its first budget, scrapped a program which would have provided a nurse vaccinator in every aged-care facility across the country and paid for the training and the time off. That would have facilitated speedy vaccinations not just for COVID but also for flu and perhaps for RSV when the vaccine for that becomes available. Every aged-care facility in the country would have had at least one trained nurse vaccinator. Labor scrapped that program in its first budget. That was $50 million for aged care , for nurse vaccinators across the country, taken out of the budget. And they want to lecture the coalition about aged care!
The budget announced funding for a pay rise for aged-care workers. That is very much deserved, welcome and in fact essential for the sector. Let's not forget, though, that Labor tried to delay this pay rise. After campaigning alongside the unions for an immediate 25 per cent pay increase, Labor delayed the consideration of the Fair Work Commission, then applied to delay the implementation of the policy to suit their budget. Labor's priority wasn't their promise to aged-care workers; they tried to delay their pay rise.
On the other hand, Labor do deserve credit for the additional funding to develop the IT systems to support the reform process in addition to the funding appropriations in the March coalition budget. This is a very welcome move. Quite simply, without the development and effective implementation of IT systems, the reform process will not work. The data and information to drive the reform process and improve the operation of the sector won't be available and the reform will fail.
However, a closer look at the reform of aged care after a year of Labor shows an incapacity to make decisions and a net delay to the reform process, as I have indicated and as is demonstrated by this piece of legislation that should have been passed by now. The only real action since the election has been to pass legislation effectively proposed by the coalition before the election and activate decisions that had already been made. This government is really having problems making decisions. The star-rating system reporting on food, quarterly financial reporting, the new payment system and the independent pricing authority were all well on the way before the change of government.
Before the election, Labor, without any proposed amendments of their own, opposed reforming legislation on the basis of their now defunct 24/7 nurse promise and then ran it through the parliament after the election, largely in the same form but with a few detrimental changes. The first of those was the decision to remove governance requirements for Indigenous aged-care providers. During COVID and out of the royal commission we saw that one of the most significant indicators of the quality of care came back to governance. It showed up in all types of providers. It didn't matter if they were community, faith based, private or corporate; if there was a failure of governance, quality suffered. The question now is simple: why should Indigenous Australians be subject to a lesser level of governance than anyone else? Why is it in relation to Indigenous matters that we appear to be prepared to just look the other way? It genuinely does not make sense.
Next we saw the decision to delay the implementation of registration for workforce. Clearly driven by the unions and as payback for the union campaigns before the election, this decision not only delays an important reform but also imposes additional costs on the sector and, consequently, on taxpayers. The coalition proposal was to extend the existing workforce registration system used for the NDIS into aged care. It made sense given that approximately 30 per cent of home-care providers and a similar number of residential care providers also provide services to those on the NDIS. We were picking up one system that is already there, that has already worked and that people are already registered to. One form of registration across the care sector made sense, reduced red tape and reduced cost. If there's a problem with the NDIS system, fix it. Don't create the cost, time, complexity and delay of a second system.
Labor like to count off the recommendations of the royal commission but haven't really made any decisions on any of them. Reform of the home-care system has been pushed back beyond the next election. Workforce registration has been kicked down the road, as we have discussed. Just imagine the ruckus there would have been if it had have been us that had delayed these particular decisions.
Then there's the completely baffling decision to ask the aged-care sector to decide how much of an individual's income should be contributed to their own care. This is not a decision for the aged-care sector, particularly not for aged-care providers. Their most common refrain over recent years has been, 'Things have never been better in regard to aged care; just give us more money.' Of course they are going to want more money. The department has some very valuable data to support the decision that this is a job for government, not one to be subcontracted off to aged-care providers and the aged-care sector. On what basis should the aged-care industry or aged-care providers be deciding what proportion of someone's income should get spent on the provision of care? That's a job for government. If the government can't get that process right, what hope is there for the rest of the reform process? Just get on with it.
The task of reforming the aged-care sector was always going to be difficult and take time. We proposed five pillars over five years. Labor can't afford to lose momentum and start kicking the can down the road, as they've done so far so many times, and as, as the royal commission said, has happened in previous reviews.
The net effect of Labor coming into office has been to delay the progress of much-needed reform of the aged-care sector—and I don't think any of us disagree in respect of that—basically, because they hadn't done the hard policy work before the election and now don't understand how to make the reforms after the election. Labor said they wanted to put the care back into aged care, but now they're in government we hardly hear from them. They make data hard to find. And, to be frank, you really wonder how much they do care. Simply by looking at this piece of legislation, you see: the fact that they couldn't get the Inspector-General of Aged Care legislation passed in time for it to come into place by 1 July this year demonstrates how tardy they've been.
We all agree on the importance of the recommendations of the royal commission. That's why the coalition, as I've said in my presentation, brought down the most comprehensive and significant response to a royal commission in history. We can't afford for Labor to delay the process of the reforms.
I put the question that the second reading amendment as moved by Senator Rice, standing in the name of Senator Thorpe, be agreed to.
Question agreed to.
Now there is a second reading amendment that has been foreshadowed by Senator Ruston.
I move the second reading amendment on sheet 2052:
At the end of the motion, add ", but the Senate calls on the Inspector-General of Aged Care to consider the current workforce constraints facing the aged care sector as a priority".