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Wednesday, 20 June 2007
Page: 151


Mr JENKINS (6:55 PM) —I am pleased to rise to speak to the Aged Care Amendment (Residential Care) Bill 2007. As has been indicated in earlier debate, the amendment to the Aged Care Act 1997 is to introduce new arrangements for the way in which subsidies will be allocated for residential aged care through what is to be called the Aged Care Funding Instrument, ACFI. This is designed, quite appropriately, to reduce the amount of documentation generated within the facilities that is needed to justify the funding classification of each resident.

Anybody that has visited an aged-care facility would have heard the concerns expressed by those delivering care to our elderly about the bureaucratic burden that is placed upon people who would rather be involved in the professional care of those in their charge. Any extent to which that administrative burden can be reduced is to be lauded. The trials of the ACFI have been very positive in reducing administrative problems. It is a much more efficient system in getting agreed classifications between the provider and the department and has, therefore, led to fewer reviews of classifications. Simply put, there appears to be, on the basis of the trials that were undertaken, a great deal of hope that this will deliver what was promised by those that formulated it.

Regrettably, this is only part of the story. Those that have listened to this debate can see that aged care continues to be an area of public policy that is characterised by ideological debate. Those opposite who have entered into this debate have simply indicated their belief that the government’s ‘success’ in aged care is based on the amount of money that has been spent in this area. I often decry the way in which the Howard government has continually thought that the way to solve anything is to just throw a bucket of money at it. If members opposite indicate that the Howard government has achieved something in aged care simply on the basis of the amount of money that has been allocated to it, we have a long way to go to get proper public policy formulation. I tried to get an indication of what the government thinks it should be achieving in residential aged care. As has been indicated earlier in the debate, the best indicator—and the indicator that is used—is the number of places per hundred thousand of the population aged 70 and over. As indicated, the objective that the government has set is 88 places per 100,000 people aged 70 years and over.

In the second reading speech we did not hear mention made of that by the Assistant Minister for Health and Ageing when he introduced the bill, and throughout the whole of this debate I have not heard those opposite mention it. Mr Deputy Speaker, you might well ask: why is that so?

Simply put, the real problem is that if we use the census of 2006 as a basis for looking at what has been achieved we find that, based on the 88 per 100,000 aged 70-plus, there is a shortfall throughout the nation of 2,735 operational places. The target is said to be 174,289; there are 170,416 operational places. There has been no mention in this debate or in the budget papers of how far the government expects to move towards that target as a result of this year’s budget. As of the December 2006 census, it stands at 86.6 places per 100,000 aged 70-plus. There is an obligation when we are debating important areas like aged care to be up-front in explaining to people why that bucketload of money does not equate to a result nearing an outcome that the government has set. If you go to the budget papers and the portfolio budget statements for the Department of Health and Ageing, you find that they do not mention the 88 places per 100,000. On page 93 of Budget Related Paper No. 1.12, under the indicator ‘provision of operational aged care places’ in the column ‘reference point or target’, it says that there has been progress towards meeting the target of 113 aged-care places per 100,000 persons aged 70 years and over, with the provision of 108 operational places nationally by 30 December 2007. They have that lower target for the midpoint.

As has been indicated in the debate, because we have high-care and low-care places—the old nursing home and hostel places—all banded into one, there has been a bit of an out for the government in the way in which it has allocated those places. If we look at the Australian Institute of Health and Welfare report that was made public last week, we find that 69 per cent of residents as at 30 June 2006 would have been classified as requiring high care. The government’s ratio for their 88 residential places at that point in time was 48 low-care places and 40 high-care places. Recently, acknowledging that they have problems because they are well over that ratio with 69 per cent requiring high care, they have amended that to 44 low-care places and 44 high-care places. But that clearly does not reflect the requirements of older Australians for particular types of residential aged care. These classification tools are reflecting that need.

In fact, when the new ACFI is put in place it is agreed that we will have more accurate knowledge of what is really required. Is there to be a fudging of the way in which new places are made available so that they are not available on the basis of need? There is a difference between having a funding requirement attached to the person who is going to be using the service and the capital requirements of those who will be providing the service. That should be something integral to the way things are explained in a debate like this. If a hymn sheet is going to be handed around to all those coalition backbenchers for them to come in here and praise the government on the basis of how much money is being spent, they really should be asking of those who provide that information: ‘What outcomes will these measures deliver?’ When we look at this new classification tool, one of the missing ingredients is how much each classification level is going to attract. When we have problems like that in important areas like this, I find it very strange for the government to expect providers to make important business decisions.

This is a government that comes in here and says that it is only the coalition that understands business, that it is only the coalition that knows about the way that those things are run. You do not have to have great knowledge to know that if a business is not going to be told its expected income, it is going to have great difficulty in forward planning. So, at this stage, if the bill goes through the House, those providers will still be awaiting the detail that the department has indicated will be provided soon.

The other aspect is that we have had the benefit of the inquiry of the Senate Standing Committee on Community Affairs. The report of the inquiry made a suggestion of three amendments to this bill. The Labor Party have indicated that we would expect that the government would agree with the need for amendments in these three areas. The first area, whilst it is only minor in its application, is the high-dependency care leave, where there is the ability for more than one residential care subsidy when a resident is moved temporarily—usually from low care to high care and the like. There are only about 20 applications of this ilk a year, and this is a very minor thing, but the fact that this is not going to continue under the new classification is a cause for concern. Labor believe that it should be reinstated.

The second matter is the lack of clarity about what the circumstance may be in applying this new classification tool. People within the sector might have a significant loss of funds. Labor believe that an amendment should be implemented that requires the minister to determine a reasonable level of reduced subsidy. As in all things, it is proper in public policy implementation that there be a transition that allows those affected to make adjustments. The other aspect is that whilst we are hopeful, on the basis of the evidence arising out of the pilot, that this new Aged Care Funding Instrument will deliver results that lessen the amount of administrative effort and more accurately indicate the needs of the older person receiving the service, this should be reviewed in 18 months time. Labor indicate that we will require a formal review within the 18 months of implementation. Those three suggestions are not things that the government should really be in opposition to, and I hope that they will see their way clear to agree to those amendments. That will assist in the way that the new aged-care instrument is implemented.

I spoke earlier about the problems that we have with the actual outcomes. The electorate of Scullin is part of the northern metropolitan area of Melbourne. The electorates of Batman, Calwell, Jagajaga, Melbourne, McEwen, Scullin and Wills—or parts thereof—are also part of this region. There is a shortfall of 257 beds in the northern metro area. What has to be remembered—and I do not mind reminding those opposite because we have to put up with the Treasurer reminding us, based on his Intergenerational Report—is that there is an ageing of the population. I understand the government have got a bit of a problem because, as each six months of their census goes on, there are a lot more people who are getting into the age group of 70-plus. So there has to be catch-up based on that demographic shift which will not produce a movement in the ratio, and those are the things that we have to be careful of.

If we study the decline from when this government inherited an oversupply of places, based on that ratio, to there now being well under enough places, we see there is a problem. I must say—and I try not to be too churlish about this—that there comes a time, when they have been in office for over a decade, that a government simply cannot blame the opposition for the lows and say that they inherited a system that had deficiencies and the like. We can have the debate about whether that is the case. I think that we are on pretty solid ground and can indicate that that is a debatable point that they would put. But, if they are going to put that in the coalition backbenchers’ kits, let us get realistic—11 years down the track, the situation is all of the government’s making if they have had a problem keeping a steady eye on this portfolio.

I think that earlier in the debate the member for Gorton indicated that there has been a revolving door method of selecting ministers, and many of my colleagues have said that about the public attitude of the present minister. I would like to hope that it is not really true. But, basically, it is believable that, having reached the ministry, which he strove so hard to achieve,  now, when given this portfolio, he thinks it is a bit beneath him. One of the other things that I think characterises this debate is that there is perhaps no area of public policy where members of this place can be so attuned with those whom they represent than aged care—in discussions and, as the honourable member for Chisholm indicated, because so many members of this place have been involved through family in placing people into aged-care facilities or thinking of a way in which they could appropriately look after elderly relatives, whether it be through aged care or community packages.

The other nonsense that I heard during the debate was that because we on this side were concentrating on the matter that was before us, which was residential aged care, we saw that as the only appropriate way of looking after elderly people. People who are fair judges of the way in which there were movements under the Hawke-Keating years on aged care know that there was a rapid movement into programs that enabled older people to stay at home and there was a rapid movement to understand that ageing ‘in place’ was the appropriate way to go with aged care. So when the Howard government put that policy in place, there was no disagreement.

So let us not have this nonsense that this side of the place thinks that residential aged care is the only way to go. Remember that it was Victoria, through its state programs, that led the way with the HACC Program. The member for Gorton, because of his experience with municipal employees, knows that it was the Victorian local government that was closely involved in the way in which HACC Programs came into place, and Victoria led the nation. In the Hawke-Keating years, the success of what was happening in Victoria was very much borrowed. That has now moved on to the types of community packages, and the HACC Program, that are available to assist older Australians to stay at home or to not have to be shuffled between institutions and the like.

The other thing that I have to say in the context of this debate is that I get a little tired of the dismissive attitude towards Medicare Gold. There has never been a debate about the fundamental principle that was being put forward by Labor with that policy. People can have their arguments about the way that it might have been presented or the fact that they thought that the figures were not there and things like that, but aged care and the way in which it impacts on primary health care right through to tertiary health care of old people and their residential requirements begs for governments at both federal and state levels to come together to make the provision of services for older Australians that go to their health concerns seamless. That is what Medicare Gold was about.

Even people on the coalition side in this debate have indicated their understanding that some people have been classified as requiring residential aged care but, because places are not available and because of the waiting lists, are in hospital in acute beds. Regrettably, people describe these people as bed-blockers, and, emotionally, I know that that is wrong. But the simple fact is that having a person awaiting a residential aged-care place in an expensive acute bed does not make sense. It is not good public policy, and anything that can be done to avoid that situation is worth consideration and debate. Before people say, ‘There goes the member for Scullin; he wants Labor to have a Medicare Gold policy,’ I say that what is required is a proper debate— (Time expired)