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Thursday, 25 March 1999
Page: 3321

Senator WEST (5:26 PM) —I will open my contribution to the debate on Senator Chris Evans's motion by declaring an interest of 18 years nursing experience and membership of the two colleges of nursing in this country. I know that by the time I have finished the people who follow me are going to say, `There she goes scaremongering. She doesn't know what she is talking about.' I have to say that I do have some knowledge and therefore some right to enter into this debate. Certainly, the contacts that I have are my peers that are still within the profession: they are my sources of information. I can remember what it was like 20 and 30 years ago in the aged care area.

Senator Herron —It has changed.

Senator WEST —It changed. My word, it changed for the better. But what is happening now is that it is changing back to what it was before former Senator Giles's report in 1984. You want to have a read of that report. That is the sort of thing that we are heading back to. As we heard last night from Senator Gibbs, in Queensland the Churches of Christ are having a rearrangement of some of their institutions. They are basically getting rid of their enrolled nurses and their assistants in nursing and they will have health care workers and aged-care workers. And what are the qualifications that are required for aged-care workers?

Senator Quirke —Making money for Doug Moran.

Senator WEST —Senator Quirke, I think that your comment may not be totally factual, but it does certainly highlight a number of points. It can be about making money, or it could be about the fact that this government is actually winding back the amount of money available for nursing care. That is what keeps the patients well; it is what keeps their skin whole and entire and without blemishes and keeps their health status good. They are cutting back on that, it would appear; because aged-care workers are cheaper and they also have no need to have qualifications.

Let me remind people of what it was like 20 and 30 years ago. This is from the experience of my peers and colleagues in the industry. As registered nurses, they would go to work on an afternoon shift, often on a weekend, to discover that they had one or two new staff who were there as assistants. All of these people had to be shown, on the job, what to do and how to care for the patients. So not only was the registered nursed providing the care but she was also providing the education for the other staff that were with her. On a number of occasions it has happened to my colleagues that the person they were training—and the trainee may only last couple of days—would tell them that they had answered an ad for a job that morning for an immediate start as a cook or a cleaner, but because somebody had got there before them and had been given the job as the cook or the cleaner, they had been talked into being a care assistant to work with a registered nurse. That is what used to happen. People would wander in off the street and be given a job.

If we move down this path before us that is what will happen. There is no guarantee that a registered nurse or an enrolled nurse or an assistant in nursing will be employed. This is a major concern for anybody who is in the health care industry. This is not just about having the right number of bodies there, this is about the standard of the delivery of care that is given to people in nursing homes. The level of acuteness of patients in nursing homes these days has risen quite significantly.

In the days when I was nursing, anybody who was sick in a nursing home with things such as pneumonia, or who required a blood transfusion or any other acute care, was immediately transferred to the nearest acute hospital. These days, these procedures are being undertaken in nursing homes. I am told by people who are professionals in the area, with expertise, that blood transfusions are quite common and that they are even doing things such as hyperalimentation and dialysis. Nowhere 20 or 30 years ago would they even have considered doing things like that in nursing homes. Those procedures are now being carried out in these institutions. As the number of people with dementia increases in institutions, it becomes much better for the delivery of their care that they be kept in the same institution, in the same environment with the same carers. As I said, the level of acuteness of patients is increasing.

I have spoken to directors of nursing who have told me that they have had patients back in the nursing home some 24 or 48 hours after the patient has had surgery in an acute hospital on the fractured neck of their femur. This requires a high level of care as it is high dependency. Sure, the RCS will accommodate that, but what will not accommodate it is inadequately trained staff. You need more than just one registered nurse and an aged-care worker. You need people with enrolled nurse qualifications and assistant in nursing experience to be able to support and deliver that care.

We were also told by Senator Gibbs last night that the Churches of Christ in Hervey Bay and Maryborough are saying that the registered nurses will not be expected to take a lead role. I am wondering where we are going in terms of the legal responsibilities here and in terms of negligence. There is a duty of care owed to residents, and that duty of care is expected to be carried out by the average registered nurse or the average enrolled nurse or the average assistant in nursing. We do not know what the standards are for the average aged-care worker. It will not be the parliament that decides what the standards are; it will be a court of law that decides. The court of law will decide that the owner or the proprietor or the manager of that nursing home has a duty of care.

If something happens, and they are found derelict in that duty, they will be two parts down the path to being negligent. If there is damage to the patient, and if there is a direct cause of that damage, the nursing home will be negligent and so too could be the person who has provided that care if they have not been adequately trained. If the people providing the care have not got adequate training that is not an excuse. It will be judged and the people in the witness box will be expert witnesses who will be attesting to what should be the average quality of care that is provided to patients.

I warn people to think very carefully about this and I warn the government, because I think the government has left some loopholes in its legislation. The booklet it put out last year said that `the care may be carried out by a registered nurse'. I warn people to be very careful because there are legal ramifications in all of this. If the employer, the owner, is not providing adequately trained staff, they will be held negligent. We will find that out when we end up in coroners courts. If you are not going to have adequately trained staff, as we see is going to happen in Hervey Bay and Maryborough, you will end up with people in coroners courts, and that is a sad indictment.

The other thing that people need to remember is that we are 20 or 30 years on with improvements in nursing homes and aged care. The community is a lot more litigious now than it was 20 or 30 years ago, so take that as a warning. I am gravely concerned about these changes and this erosion of the standard of care that is being delivered to patients. When all else fails, the standard of care for patients has to be the primary consideration.

This change being mooted by the Churches of Christ is putting in danger, or destroying, the career paths for a number of enrolled nurses in particular. More and more these days, because of the increasing technology and the increasing complexity that is required in the provision of health care—

Senator Herron —Four people took voluntary retirement and the others were transferred.

Senator WEST —Senator Herron, you know as well as I about the need to maintain our practice standards so that we can maintain registration. These people will lose their rights to practice and their licence to practice. As with your profession, nurses are now having to keep their practice current. I would not be able to go back and practice in a hospital.

Senator Cook —On a point of order, Mr Acting Deputy President: undoubtedly Senator Herron—as a surgeon—is envious of nurses speaking out about conditions in hospitals, but he has been a persistent interjector during the course of this speech. He has an opportunity to be heard in this chamber and to be accorded the respect of being heard in silence. He is a responsible minister and knows that he is out of order by interjecting. I would ask you to advise him as a minister to be quiet and hear the contribution of Senator West.

Senator Herron —On the point of order: I hold nurses in the very highest regard; in fact six of my daughters did nursing. I have a very high regard for every nurse in Australia for the vocation that they hold. However, I respect Senator Cook's point of order and I will keep quiet.

The ACTING DEPUTY PRESIDENT (Senator Bartlett) —I thank all senators. Let us try and enable that to continue throughout the remainder of the debate.

Senator WEST —Thank you. I am glad that Senator Herron did interject because that just raises concerns with me about the fact that I thought that he, of all people, would have understood the need to have highly qualified and specialised nurses in the area that he works in, which is surgery—just the same as people in aged care deserve the same levels of care. This is the introduction—the first signs that we are seeing—of the downgrading in the mind of this government of the standing of those who provide aged care in this country.

This government is to be condemned for the attempted downgrading of the qualifications of people providing care. Allowing that to happen is appalling, and I have actually warned in the past that that could potentially happen through this legislation. Now we are seeing it happen, so I have been vindicated on that particular point. It is a disgusting thing; it shows a lack of care but it probably relates to the fact that these institutions are not getting adequate funding from the government because there is so much paperwork to be done. They are not getting adequate funding to undertake all of this, and this is the only way that the proprietors of nursing homes are actually able to cope.

The other area that I would like to touch on is the preliminary work that is being done by the New South Wales Nurses Association. It is a study that is unpublished at this stage, and it is going to be done over two years. But we certainly have evidence that they have been able to provide me with that indicates that the impact since the introduction of this act has been quite marked on institutions and aged care facilities.

Nursing groups have been told by the government that aged care funding will increase by 10 per cent. But this survey indicates—as I said, it is unpublished and it is preliminary—that only 4.5 per cent of the respondents believed personal care and nursing hours had increased as a result of new funding arrangements introduced under the act and that 42.5 per cent believed the new funding arrangements had led to reduced hours and changes in skill mixes. The information that has been received in this ongoing survey reveals that more than 40 per cent of aged care nurses have noted an increase in requests to perform work not directly related to care over the last 12 months. More than a third of respondents noted a reduction in the number of registered nurses employed in their particular facility over the same period of time and 32 per cent said there had been a reduction in the number of enrolled nurses. This bears out what is happening in another state.

More than half the respondents said there had been a reduction in the standard of care and 59 per cent noted a reduction in the number of overall care hours over the last year. That probably bears out Senator Woodley's point about his wife's experience of spending more time on doing paperwork than on doing nursing care. Fifty-six per cent believed they did not have the resources necessary to enable them to provide an acceptable standard of nursing care. Almost two-thirds claimed their workload had increased significantly over the last 12 months. Almost 40 per cent believed current staffing levels placed the occupational health and safety of nursing staff at risk. One-third of staffers claimed the risk had increased significantly.

You are going to see that blow out even more if you do not have properly trained staff. People coming in off the street will not know how to lift properly, how to manoeuvre the machines that are used for lifting or how to use the equipment and will therefore be a greater risk to themselves and to the patient. This is just the sort of thing this government said would not happen, and it is now becoming quite evident that it is happening. The nurses are also saying that they are undertaking increased unpaid overtime.

We have also had the story of a hostel being left understaffed. When a woman went to visit her mother there, she and other visitors actually ended up having to support the nurse that was on duty because she was feeling so stressed by the level of workload that had been placed upon her shoulders. Another person in the same place complained because her mother had been left stark naked for 45 minutes because somebody had been called away. These are all examples of the provision of poor care to patients, and I think that the government has to stand condemned. It was warned that these things would happen but it has chosen to ignore that warning and this is now happening.

I also have concerns about what is happening in rural areas because I am being told more and more by institutions in those areas that if they are small their viability is really in danger. There is also an anomaly in the Aged Care Act, which is affecting people in rural areas. I notice that there is an adviser in the box. I presume that the adviser has seen the letter from Ms Sue Irvine from Southern Cross Homes in Broken Hill, because it is in the article that has appeared in the Barrier Daily Truth of Friday, 12 March. It is an anomaly where a resident owns a home and has total assets—including the home—below $23,500.

Before people tell me that that is not possible, I suggest they go and visit Broken Hill, where in the last few weeks the city has been told that the mine will close in a couple of years and there is a number of very small old miners' cottages for sale at very low prices. But, if a person does not have a home and has assets below this amount, they are considered concessional and get $12 a day. People who have assets below $23,500, and that includes their own home, are not classified concessional. This is an anomaly. When it comes to trying to claim hardship provisions they cannot do it. The government needs to fix it—no bleating from anybody. This is something about which an aged care provider has been writing to the department and to the minister for some considerable time.

If a resident has total assets including the family home of less than $23,500 they cannot be considered concessional. The department advises that residents with total assets of less than $37,000 can apply for hardship provisions. However, if a resident has less than $23,500 they cannot be charged an accommodation charge. But, she has been told that the department cannot consider a hardship application if a facility has not charged an accommodation charge.

There is a wonderful little loophole and you have done nothing about it. This particular person, Mrs Irvine, has been writing to the minister for some time about this issue and nothing has happened. It is another area where this government is disadvantaging people living in rural areas, particularly those who are elderly.

The other concern that elderly and rural people may have is the cost of accreditation for small nursing homes and small hostels. The amount of paperwork required is very similar no matter what the size of the institution, but there is nothing there. The other question I would like to touch on is the length of time an institution that has failed certification is given before it is required to actually close its doors. I know of one that was failed last year and the patients are still there. They have been told that they might be moved out of the nursing home some time this year. It is a good question.

I see that my previous comment about loopholes and anomalies has prompted some action on behalf of the departmental officer in the advisers box. Maybe that has been fixed in the last week. Wouldn't that be wonderful?