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Thursday, 14 May 1987
Page: 3161


Mr PORTER(9.59) —A number of points raised during the second reading debate were responded to by a Government back bencher, apparently on behalf of the Minister for Community Services (Mr Hurford). One of the significant points that the Government has made in relation to the concerns expressed by the Opposition about the increasing complexity of Commonwealth Government administration of the nursing homes legislation, under both the Nursing Homes and Hostels Act and under the National Health Act, is that these provisions in themselves-and the Government admits this-will add significantly to the administration of the program. Administration at the Commonwealth level is becoming increasingly complex and detailed. During debate we raised the question as to whether the Commonwealth should continue to be so heavily involved in the administration of the program. It does not mean that funding to this area would be cut if there were to be a transfer to responsibility for the program to the States.


Mr Hurford —Not half. I mean, it has always happened. This is the way the Liberals camouflage their cutting, their rejecting of the--


Mr PORTER —This is extraordinary. The Government does not seem to understand. The Minister can get up and speak to this Bill if he wants, or will he let me speak?


Mr Hurford —I cannot, because I did not know about this and I have moved the third reading. So I cannot respond to you now.


Mr PORTER —It is quite extraordinary. The Minister has had three opportunities to speak to this Bill. He refuses to do so, but seeks continually to interject on me.


Mr DEPUTY SPEAKER (Mr Leo McLeay) -Order! The honourable member might get to the matter before the House.


Mr PORTER —The point is that the administration of this program is not as efficient as it should be. There is a great deal of overlap between the Commonwealth, the States and most of the voluntary organisations which provide the services. As I said, this legislation will greatly increase the cost of administration of the provision of aged care, both home care in hostels and in nursing homes. As was suggested by some Government back benchers, we would not in any way want to reduce the provision of aged care services to the elderly. In fact, we want to enhance it. But we want to get rid of the duplication and waste that is involved in the current administration.

As I said in my speech during the second reading debate, we will be considering ways in which we can go back to the recommendations of the report of a committee, of which you, Mr Deputy Speaker, were a member, which recommended that the administration of this program be handled by the States, by those closest to the provision of the services. As I said, we will be looking closely at making such changes to see whether we can reduce the administrative costs of this program and provide more opportunities for those closest to the people, that is, the State governments and the voluntary organisations, to meet the needs of people in the various regions. I made the point during my speech in the second reading debate that the needs of aged people vary between regions and between States. There ought to be greater opportunity for local authorities to meet those needs in the best way they see fit. I gave the example of two Victorian towns. One has a massive nursing home and the other has very little nursing home accommodation but a very extensive home care service provided out of the hospital. We want to encourage that sort of diversity.


Mr DEPUTY SPEAKER —Order! I remind the honourable member that in a third reading debate honourable members must stick to the specifics of the legislation. It is not a wide ranging debate like a second reading debate.


Mr PORTER —I accept your ruling, Mr Deputy Speaker. I am referring specifically to the increased cost of the administration of this scheme outlined by the Government to be $14m as a result of these changes in a full financial year. I am saying that there could well be better ways of handling the administration of this funding program that we ought to be looking at, encouraging more diversity in the provision of care for the aged, a most important subject. Rather than taking a blinkered view of change, we will be considering the recommendations of the McLeay report. Unlike the Government we are not going to rule them out, as the Government and Government back benchers seem to have done.

The most significant point made by some Government back benchers was that there is total freedom in the market now for health insurers and others to provide a full range of care, including nursing home care. The Minister for Community Services, as is his wont, interjected during my speech in the second reading debate, saying that what I was saying was quite wrong, that there was no limitation on the provision of nursing home care. That is an extraordinary statement.


Mr Hurford —By the Commonwealth.


Mr PORTER —If that is the case, I wonder why the Minister said in his second reading speech:

For higher cost homes whose residents may prefer, and are prepared to pay for- -


Mr DEPUTY SPEAKER —Order! The honourable member for Barker cannot advert to the second reading debate when we are dealing with the third reading of a Bill. He has to speak specifically to the matters that are in the Bill.


Mr PORTER —These are matters in the Bill because the matters in the Bill deal with controls on nursing homes. The discussion is as to whether there should be increased controls, as is proposed by this legislation, or whether there should be fewer controls. The Government says that there is no need to express concern about the level of controls because there is freedom in the market. Yet the Minister himself says:

For higher cost homes whose residents may prefer, and are prepared to pay for, higher quality and more expensive services, the Government has given in-principle support for the concept of fee exemption.

If we have to get- -


Mr Hurford —This is where the home is already going, where it has partly subsidised beds.


Mr PORTER —Oh! `Where the homes are already going', the Minister says. It is not partly subsidised beds because the Minister goes on to say: `This would involve exempting entire nursing homes'. It is not partly subsidised beds or some beds in nursing homes. The Minister is saying; `We, as a government, are looking at giving or have given in-principle support to the concept of fee exemption'. Why on earth is the Government looking at giving in-principle support to fee exemption if that avenue is already open to the private sector? Quite clearly it is not. The Minister, in his own words, has indicated the extent of government control over nursing homes. It is the most highly regulated and highly controlled area of health care delivery in this country. The Opposition is saying that, whilst we will not oppose this legislation, we will be reconsidering the whole gamut of aged care to see whether the Commonwealth should continue its detailed, regulatory control and whether those controls would not be better handled by States and local authorities.

As I said in opening my address on the third reading, the allegations by the Government are somewhat irrationally made. It alleges that because we are going to look at the administration of this scheme it means that we are going to walk away from care for the aged. This is a typically irrational statement from Government members in trying to make political capital out of care for the aged. We are not interested in that sort of thing.


Mr DEPUTY SPEAKER —Order! The honourable member for Barker is getting a little away from the matters contained in the clauses and Schedules of the Bill.


Mr PORTER —Mr Deputy Speaker, I have nearly concluded my remarks. We are not interested in playing petty politics with the aged; we are concerned about ensuring that the funds provided go to those most in need and that the programs for the delivery of services to the aged are as efficient as we can make them. Undoubtedly, there is enormous concern in the community about the current state of the provision of age care services. Almost no one is happy with the current arrangements. Nursing home proprietors complain about the level of Commonwealth regulation. Patients and the elderly cannot get into beds when they want to.


Mr DEPUTY SPEAKER —Order! I am really having difficulty allowing the honourable member for Barker to proceed along this line. Essentially he is making an extension of his speech on the second reading. The debate on the third reading has to be restricted to those matters contained in the clauses and the Schedules of the Bill. If he wants to relate what he is saying to the specific clauses and Schedule of the Bill, his is order; if he continues with a broader speech, he is not.


Mr PORTER —Thank you, Mr Deputy Speaker. The legislation quite clearly involves extending the controls over nursing homes. The final point I make is that already there is great discontent amongst the aged and those providing services for the aged about the degree of regulation and control, and I was saying that, interestingly enough, the Commonwealth has total control and yet no-one is happy. Those in receipt of the services are concerned that they cannot get appropriate services when they need them. Almost all honourable members in this debate have referred to the shortage of appropriate care for constituents in their electorates, particularly nursing home beds, when they need them. What we need to do is look at the more appropriate provision of aged care in this community, and that is exactly what the Opposition will be doing. We will not be hogtied to existing programs; we will be looking at a more efficient administration of the money that is available to ensure that the aged get better services certainly than those currently provided.