Ms GILLARD (10:26 AM) —Today is a good day to be debating in the House matters related to health and aged care because today, of course, is the day on which the Howard government's political spin about health has finally caught it out. In the last 24 hours, we have had three significant events happen in the area of health. The first, of course, has been the focus on dental care and Minister Abbott's frank admission that there is a major problem with dental care and that the Keating government's Commonwealth dental program was effective and did make a difference to reduce waiting lists—a thing that Minister Abbott admitted yesterday. Of course, it was the Howard government, when coming to office, that abolished the Commonwealth dental program. Since that time, the Howard government has tried to maintain the fiction that this was a program due to expire in the natural effluxion of time. That fiction, of course, is wrong.

The savings that the Howard government got from the abolition of the Commonwealth dental program are clearly shown across the forward estimates over the four years, so it is a program that ought to have been ongoing. Minister Abbott as of yesterday admitted that this has lengthened waiting lists for Australians. I think it is good to see the member for Throsby in the House when this matter is coming to the attention of the House because, on behalf of her constituents—many of whom are older Australians—she has been raising this issue consistently for people who now face five-, six-, seven- and eight-year waits for dental care. Minister Abbott's solution yesterday, proposed for a 13-year-old boy with a disfiguring dental condition who was probably going to have to wait until he was 18, 19 or 20 for treatment, was to appeal on Sydney radio for a private dentist to come forward and volunteer to do it for free.

Ms George —Charity.

Ms GILLARD —That is right: the solution that is being proposed is not government intervention but charity. This washing of hands by the Howard government, and particularly Minister Abbott, on the question of dental care is a disgrace. I think we should take the opportunity today to mark it in this House as a disgrace. It is time that Minister Abbott actually listened to himself and managed to start negotiations with the states about a Commonwealth dental program that would make a difference.

One of the things that most perplexes me about the Howard government's attitude to dental care is that across so many areas of policy we see huge interventions from the Howard government in things that historically have been considered the province of states—for example, the technical colleges promised at the last election. The government are always willing to do that if they see a political advantage. But in this area where Commonwealth responsibility is clearly specified in the Constitution the Howard government have done nothing.

Even if Minister Abbott's spin about washing his hands and averting his eyes as Australians stay on waiting lists is accepted, there is one area of dental care that this government cannot get away from no matter how much it squirms, and that is its responsibility for providing funds to train the appropriate number of dentists, dental therapists and dental hygienists. We know that there is a work force crisis in dentistry across Australia which is affecting our ability to provide public dental care as well as dental care in the private sector. For example, the OECD average for dentists is 56 dentists per 100,000 people. However, in the crisis area of the central west of New South Wales, the number of dentists is only 17.3 per 100,000. That ratio would be identified more with the Third World or developing world than with a First World nation like Australia. It is an incredible shortage. At places like Sydney University we know that the numbers being trained have halved and that the foreign students who are taking places in Australian dental programs under the full-fee paying arrangements are very likely to leave Australia at the end of their studies. This is a work force crisis centrally caused by the Howard government and unaddressed by the Howard government.

Before moving to the details of the bill before the House, I take the opportunity to record that I have been contacted about this dental crisis by a dentist in Bega. She has written to me to say that she is currently trying to fill a vacancy in her practice and is having great difficulty finding a dentist to fill the position. She blames this on the lack of dentists being trained. She can say from her experience that, when more dentists were trained, she could not find a government position because there were dentists around to take those positions, so she went to a rural area. She has been more than happy with her life in that rural area. But now, because there are not enough dentists being trained, there is nothing to cause someone who completes training to think about the option of going rural, because they will clearly get a job in the city. She questions why it has become so restrictive and so difficult to study and train as a dentist. I think they are very wise words and ones that the Howard government needs to respond to.

The issues surrounding the debate today are not just those that have been raised in the last 24 hours about dental care. We have had the Minister for Health and Ageing make the quite extraordinary admission that mental health services in this country are `an absolute disaster'—his words, not mine. That is one thing that Minister Abbott managed to get right. But what he has not managed to get right is to say that the Howard government bear some responsibility for this absolute disaster. And Minister Abbott bears more responsibility than most because during his time as health minister he has palmed off mental health to the parliamentary secretary for health as if it were a second-class and uninteresting area. Indeed, the only policy innovation in mental health that the Howard government have made in the time that Minister Abbott has been the minister for health was when they endorsed Labor's mental health policy during the last election campaign. That is another issue affecting the health and aged care sector that surrounds this debate today.

The third and final issue that surrounds this debate today is the news that people who have Medibank Private health insurance face restricted choices when they come to use that private health insurance. The one thing the Howard government could say for itself in the area of health is that it has been a good supporter of private health insurance. That is undoubtedly true. But it has not used that support in a way which ensures that people who hold private health insurance get value for money. Consumers of private health insurance are now increasingly being squeezed in a vice where their premiums go up every year without fail. Last year they went up by 7.9 per cent on average, and I will warrant that this year the average increase will be larger than that. Some people have paid for private health insurance for years and have maintained those premium payments in circumstances where it has been very difficult for them to do so in tight family budgets. When they turn around to use it, they are faced with out-of-pocket costs.

The House processed a bill this week which we fear might lead to increased out-of-pocket costs for medical devices. Today we see the news on the front page of the newspapers that Medibank Private is going to adopt a system where, if you want to go to your local private hospital and Medibank Private does not have a deal with that local private hospital, you will only be able to go there if you pay substantial out-of-pocket costs, perhaps in the order of $100 a day. So much for the rhetoric of choice. Even the Howard government's preferred policy area in health is one that they cannot manage effectively in the interests of Australian patients and consumers of private health insurance.

It is in that setting of crisis and unanswered questions that we come to debate the Aged Care Amendment (Transition Care and Assets Testing) Bill 2005 today. It is with some amusement, I must note, that this bill finally offers some incremental change in the crisis area of the interface between acute care and aged care, which figured in so much debate during the recent election campaign. We know that, because of the Commonwealth-state divide, the Howard government is in a position to go on underfunding aged care until the cows come home, knowing that older Australians who cannot find a residential aged care place will end up being picked up by state administered public hospitals.

Under our current Commonwealth-state arrangements, why does the Commonwealth care if state public hospitals are under increased stress and strain? The truth is it does not. It absolutely does not care that state public hospitals are under increased stress and strain. We have been in a cycle where aged care has been underfunded and state administered public hospitals have been picking up the load. Labor for a long time now has been pointing to the need to resolve this discontinuity in the Commonwealth-state divide and to get a better package of care for older Australians. In the election campaign that has passed we had a substantial and innovative policy to do that in the form of Medicare Gold.

There remains a challenge for the Howard government, who of course have been critical of Medicare Gold. They criticise Labor's policy solutions, but they are actually not the opposition or an academic think tank churning out pot shots at other people's public policy; they are the government and it is incumbent upon them to come up with a solution of their own that deals with the fact that $500 million to $600 million is wasted every year because frail aged people end up being accommodated in public hospital beds when they do not need to be there. They are still there because they cannot make the transition from the public hospital bed to a residential aged care bed because one is not available, or they got there because they were not receiving an appropriate package of care and they developed conditions which justified them being in a state-run public hospital—conditions they need not ever have developed if they had received an appropriate package of community or residential aged care earlier.

So there is $500 million to $600 million wasted every year and, of course, there is human tragedy. Why should any person, let alone an older Australian potentially in the last few years of their life, end up being stuck in an acute public hospital bed, which is not a fun place to be if you do not need to be there, or, even worse, end up suffering from medical conditions that were preventable and avoidable—and which need hospital care—if it could have been prevented through a better suite of government arrangements? The challenge for the Howard government is to resolve ultimately the problems with the acute and aged care interface that drive that waste of public money on the one hand and the human tragedy besetting older Australians stuck in the system on the other. To that primary challenge for health care policy in this country the Howard government has absolutely no answers of any substance and it contents itself with taking pot shots at others who might be trying to find those answers. That is simply not a good enough standard for the government to set for itself.

This bill actually represents the tiniest incremental change on this big public policy question. Of course, we never expect major steps forward from the Minister for Health and Ageing, because he wanders around the country indicating to all and sundry that he is opposed to health reform. His world view is that no matter how bad the system is he does not want to be reforming it. He just wants to sit and, presumably, wait for another portfolio to be allocated to him in due course during this parliamentary term. But, with a perspective of no health reform, which is the minister's stated view when it comes to health, it is pretty hard to come up with big solutions to big problems. Fortunately, despite the minister's attitude, in some way the system drives tiny changes itself, and today we are seeing one of those tiny but worthy changes. It is not going to go any way to fixing most of the major problems, but it is a tiny and worthy change and, given that, Labor is prepared to support it.

The bill amends divisions 42 and 44 of the Aged Care Act and is about improving the nature of the arrangements in place when someone is in residential aged care and then needs to receive transition care following a hospital stay. Despite the Howard government's, and particularly Minister Abbott's, complete lack of interest in fixing the acute aged care divide—and despite the minister's complete opposition to health reform—fortunately Labor states have been pushing and prodding the government to engage in the development of some transitional care for older Australians. So people who may be in residential aged care and develop a condition that needs hospital treatment are then able to go to a transition care facility—a non-hospital facility, though it is true to say some transition care facilities are located within hospitals—to enable their condition to be stabilised and for them to adjust to a new set of circumstances, if they have had a hip replacement or the like, before they go back to their residential aged care place. Whilst that is a worthy pattern of care for an older Australian, the financial arrangements that the Commonwealth provides to residential aged care needed some adapting to that pattern of care, and this bill is part of that adaptation.

What we find in this bill is a set of leave arrangements which ensure that, if someone is effectively on leave from their residential day care facility because they are receiving transition care following a hospital stay, the recipient's normal care arrangements remain and can be accessed by them following the period of transition care. Of course, this requires the provision of subsidies to the approved providers of their residential aged care. It stands to reason that, if someone is absent from their residential aged care place for a period of time whilst they are in transition care, the operator of the residential aged care facility, without any further subsidies, is not able to hold a completely non-remunerative place available. So they are likely to fill that place with another frail aged person, which then creates a problem when the frail aged person in transition care is ready to go back to their residential aged care facility. This pattern of payments that the bill deals with will enable residential aged care providers to maintain the open residential aged care place for the older person to come back to following their period of transitional care.

This policy response follows the government's response to the review of pricing arrangements in residential aged care, which of course was better known as the Hogan review. Out of that, a range of initiatives were funded, including the establishment of a national transition care program to address the needs of some older Australians who had been hospitalised. This bill amends the aged care principles to establish transition care as a specific form of flexible care for which an approved provider will be eligible for a flexible care subsidy. The bill establishes a new category of leave from residential care for the purposes of receiving flexible care. We understand that a subsequent amendment to the residential care subsidy principles will specify transition care as a form of flexible care for which leave from residential care is available and establish the maximum period of such leave available following a hospital episode.

The bill also extends provisions of the act that deal with the reduction of the residential aged care subsidy when a care recipient is on extended hospital leave. This will now also apply to a flexible care arrangement. As such, the subsidy will reduce once a care recipient has been in hospital and transition care for at least 30 days. Because the reduction in subsidy is achieved by reducing the classification level of the residential care recipient, this would make a transition care recipient normally in receipt of the concessional resident supplement ineligible under provisions of the act if they were reduced to the lowest applicable classification level. An exemption to this which currently exists for care recipients on long periods of hospital leave will be extended to include care recipients in transition care.

Apart from the necessary legislative amendments to achieve that purpose—a more streamlined interface between residential care and transition care—this bill also deals with the question of assets testing. As I think most members of this House would be aware, possibly from having received complaints from individuals about the system, under the current system assets assessments are undertaken by an approved residential care provider at the time a person is ready to enter residential aged care. Approved residential care providers may claim a concessional resident supplement or an assisted resident supplement from the Commonwealth based on assets information provided by a resident at the time they entered the approved facility. Approved providers may request a resident to pay an accommodation bond or an accommodation charge based on this information. This bill changes current arrangements by introducing a number of measures to enable the Secretary of the Department of Health and Ageing to conduct asset assessments for new residents entering aged care homes and to delegate this power.

Once again this follows recommendations flowing out of the Hogan review that the assessment of residents' or prospective residents' assets should be the responsibility of the Australian government rather than an aged care service provider and that this set of assets testing should be undertaken prior to entry into residential aged care. To achieve this result, whilst the formal power is vested in the Secretary of the Department of Health and Ageing, through a set of delegations the assets testing will actually occur through Centrelink and, in the case of veterans, through the Department of Veterans' Affairs. That set of delegation is contained in this bill.

Obviously these amendments are not ones to which Labor would object. Clearly there is merit in having the Commonwealth government through its agencies—which already generally, and particularly for older Australians, have such information relating to people's assets and income position—undertaking the relevant testing of the assets position rather than the residential aged care provider. So we will be allowing the quick passage of this bill through this House and it is our intention to support this bill in the Senate. Having said that, I would once again say that, whilst these are worthy amendments, these are small amendments which only go a tiny part of the way to resolving the substantial dilemmas flowing from the Commonwealth and state divide in aged care and the provision of acute care. All modern clinical practice indicates that transition care is very important in maintaining the health of older Australians. This bill recognises that, but currently the set of arrangements between the Commonwealth and the states really only recognise that in a very small way. We need a much more thoroughgoing examination and solution to the problems between acute care and residential aged care, and this bill only forms the tiniest part of the answer to that very substantial set of problems.