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Social Security Legislation Amendment (Improved Support for Carers) Bill 2009

CHAIR —Welcome. As departmental officers you will not be asked to give opinions on matters of policy, though this does not preclude questions asking for explanations of policy or factual questions about when and how policies were adopted. I also ask the senators to remember that same advice. We have your submission. Thank you very much. If either or both of you would like to make an opening statement before we go to questions, please go ahead.

Ms Emerson —I would like to make a small opening address. Basically, the Social Security Legislation Amendment (Improved Support for Carers) Bill 2009 makes amendments to the Social Security Act 1991 and the Social Security Administration Act 1999. In particular, it sets out the new and revised circumstances in which carers can qualify for carer payment in respect of a child aged under 16 years. The bill is the first part of the government’s response to the report of the Carer Payment (child) Review Taskforce, Carer payment (child): a new approach. I know that has been referred to a number of times this morning. I have a copy here if you need one. The task force was asked to examine the eligibility criteria for carer payment (child), as it is commonly called, and to consider the effectiveness of the payment in providing a safety net for carers of children with severe disabilities or medical conditions. The review was commissioned by the government in response to concerns raised by carers in the community that the current payment eligibility requirements were too stringent and, therefore, financial support was not going to the people who provided care and were most in need.

The report was delivered in November 2007 and publicly released in February 2008. The task force found that many carers were, in fact, ineligible for carer payment (child) because of its overly complex and restrictive qualifications. It went on to make 32 recommendations covering, significantly, a range of matters around improved financial support through changes to carer payment (child) qualifications but also went on, importantly, to talk about increased recognition for carers, increased support for carers to participate in the workforce and better support for carers more generally through improved service delivery. This bill specifically addresses the first group of recommendations, which relate to the qualification requirements for carer payment in respect of caring for a child under 16. The amendments will improve income support and supplementary payment arrangements for carers of children aged under 16 with severe disabilities and severe medical conditions. Amendments relate to both carer payment and carer allowance and they include the new qualification criteria for carer payment in respect of a child under 16, amendments to the qualification requirements for carers of children with terminal conditions, more generous arrangements for carers of children in hospital and automatic qualification for carer allowance based on a qualification for carer payment in respect of a child under 16.

The most significant reform, which has been mentioned quite a number of times today, is the introduction of a new assessment for carer payment in respect of a child under 16. The assessment will recognise and assess the total care load of the child, the care required by the child and the care provided by that carer. The new assessment, which will be known as the Disability Care Load Assessment (Child), will be used to determine whether the person has a qualifying rating under the new qualification criteria. Overall, the amendments will enable a carer to qualify for carer payment on the basis of care provided under different circumstances: a child with a severe disability or severe medical condition, two or more children each with a disability or medical condition, a disabled adult and one child or children each with a disability or medical condition, a child with a terminal condition, and two or more children with disabilities or medical conditions in an exchanged care situation. The amendments will also extend access to carer payment to carers providing care to a child or children with disabilities or medical conditions on a short-term or episodic basis. That is the thrust of what we have tried to present to you.

CHAIR —Mr Francis, do you wish to add anything legal at this stage?

Mr Francis —No, thank you.

Senator SIEWERT —I want to go to the assessment tool first. I know that you are surprised! First off, you obviously heard from the previous witness—though all witnesses have raised the issue—that they have not been consulted over the assessment tool. They want to have a look at it. I have a series of questions about whether you have a draft and if the committee can see a draft. It is a legislative instrument and we presume that that is going to need to be dealt with as this legislation comes in, so you presumably have a draft.

Ms Emerson —We have just received the first draft from the drafters. I had a very quick look at it this morning and there are one or two obvious errors that we will correct immediately, but we will be able to make a copy of that available to you—presumably within 24 hours, if that is all right.

Senator SIEWERT —That would be very much appreciated.

CHAIR —Who are the drafters?

Mr Francis —The Office of Legislative Drafting and Publishing.

CHAIR —So it is being done in house.

Mr Francis —No; by the Attorney-General’s Department.

CHAIR —It is being done within the government—

Mr Francis —Yes, it is.

CHAIR —It is not being tendered out.

Mr Francis —No.

Ms Emerson —The drafting itself is being done by government. The development of the tool itself—so the questionnaires that go to it—has been done under consultancy arrangements. Would you like me to talk about that?

CHAIR —That would be very useful.

Senator SIEWERT —Yes, that would be appreciated.

Ms Emerson —FaHCSIA contracted the Centre for Health Service Development at the University of Wollongong to develop the assessment of care load questionnaire. Basically we took the recommendations from the task force and the other comments that had been made in response to that and went to them with that task. The questionnaire was developed in consultation with carers and paediatric medical and allied health professionals. It was piloted with over 1,200 carers of children with disability and medical condition. A targeted group of paediatric medical and allied health professionals were also involved, providing expert advice on the development and scoring of the assessment of care load questionnaire. Perhaps Joan Hughes may not have realised there was a representative from Carers Australia in that, although they were from the New South Wales branch, Carers New South Wales. We thought it was very important to ensure that that other perspective, as well as technical input from paediatric and medical specialists, was available. That expert reference group has been an important informant in the development of the tool.

Senator SIEWERT —Could you clarify who was on the expert reference group?

CHAIR —And how it was appointed.

Ms Emerson —Do you want me to give names or just positions?

Senator FIFIELD —Both.

Ms Emerson —The participants in the expert reference group included Associate Professor Dinah Reddihough, the Director of the Department of Child Development and Rehabilitation, RCH Victoria, who is a paediatrician whose area of expertise is development; Dr Jacqueline Small, a paediatrician at the Disability Specialty Unit at Westmead Hospital, New South Wales who has paediatrics expertise; Jane Galvin of the Paediatric Rehabilitation Service, again from RCH in Melbourne, who is an occupational therapist; Megan Kentish from the Queensland Paediatric Rehabilitation Service, who is a physiotherapist; Ken Packenham, a psychologist; Monique Berger, whose area of expertise is nursing; Robyn Tate from the Rehabilitation Studies Unit in Sydney, whose area of expertise is around tool design and these sorts of measurement issues; Colleen Sheen from Carers New South Wales, who is located in Sydney; and Jenny Pearson from Jenny Pearson and Associates, who is a consultant to my department, has been involved in the development of a number of related tools over time, including the child disability assessment tool and the adult disability assessment tool, and was a consultant to the task force. That group was a key group.

Senator SIEWERT —So there was one representative of carers on the expert group.

Ms Emerson —That is right.

Senator FIFIELD —Was there any confidentiality requirement or agreement with the participants on that expert reference group? Sometimes the Commonwealth requires people who are advising it on particular projects to sign a confidentiality agreement.

Ms Emerson —Not in this case. This was a consultation that was done in conjunction with the consultants, the Centre for Health Service Development.

Senator FIFIELD —So there would not have been anything to prevent the participants in that group from going outside that group to seek input.

Ms Emerson —No, there would not have been.

Senator FIFIELD —To ask a straightforward question, why wouldn’t a copy of the draft questionnaire be sent to the national peak bodies such as Carers Australia and National Disability Services for their input? It is good to have individuals who are appointed in their capacity as individuals to an expert reference panel, but why wouldn’t you as a matter of course submit that sort of draft document to the relevant peak bodies?

Ms Emerson —That is a good question. We went through a fairly robust process under very tight time frames. Some additional steps, if we had more time, would have been to engage a broader group of carers. The reassurance we had was that 1,200 carers—so people who provide care—gave very direct input both in completing the form and in their comments on a feedback sheet which was then looked at by the expert reference group. That is the sort of process that we went through, which is probably a bit more technically oriented. There was certainly no deliberate exclusion of those other groups.

Senator FIFIELD —But in terms of lack of time, isn’t that just a matter of popping it in the post or sending an email to those sorts of groups?

Ms Emerson —I do not know that it is quite that simple, because if there has been a development—

Senator FIFIELD —That is fine, but if you have a draft document you take a photocopy, stick it in an envelope, stick a stamp on the front of it and send it off, unless there is something more involved.

Ms Emerson —To ask them for their opinion—okay. That is fine. That is a perfectly reasonable thing to do.

Senator FIFIELD —That is right. Exactly. You have got it in one—to ask their opinion. We heard a number of instances from NDS and Carers Australia today concerning things which they think should have been considered but which were not.

Senator SIEWERT —Or we do not know.

Senator FIFIELD —Or we do not know. But there is an easy way around that, and that is to give them a copy.

Ms Emerson —I am hoping that when we are able to table the instrument it will show that some of those concerns that were raised will cease to be concerns—but that will be a judgment for you. There was extensive testing and a strong evidence base used by the Centre for Health Service Development, which looked at tools internationally. It was not that they looked just at what we currently want and do here in Australia. They did some extensive research to inform the development of tools. That is what they tested with carers themselves and with the expert reference group. We have a reasonable degree of confidence, but certainly—

Senator FIFIELD —That is all good, but after that process the secretary of the department might be interested in having a look at it and he might say, ‘I can’t believe it. How could we forget this?’ You need that kind of input. Even if people have not been formally involved all the way through the process, it is still good to give people the opportunity to say, ‘Hey, have you thought about this?’

Senator SIEWERT —More importantly, we have to vote on this legislation. We have a range of stakeholders talking to us and saying, ‘We haven’t seen the instrument. We may have concerns.’ We are supposed to be passing this bill, the legislative instrument, and we do not know whether it serves the purpose. I appreciate that you have said that you will give us a draft. We now have to get back the comments from those stakeholders to see if they are happy. Yes, you are giving us a draft, but we do not know that the carers and the people who have used the questionnaire are happy with it. We will have a draft instrument, which I appreciate has gone out and carers have used, but we do not know that they are happy with it. Until we hear back from the stakeholders, my party certainly will be saying, ‘We want to talk to the stakeholders. We want to know that they’re happy with this instrument.’

Ms Emerson —The feedback from the reference group was very positive in the last run-through of the questionnaire.

Senator SIEWERT —The reference group has professionals on it that I really value—

Ms Emerson —And Carers Australia.

Senator SIEWERT —And Carers Australia. But that is one representative of carers and a lot of professionals, who, with all due respect, also take a different view sometimes from carers. Before I can make a decision on this legislation, I certainly need to know that people are in fact happy with that legislative instrument. It seems to me it is the key to this legislation. That tool is very important to this legislation. In fact, all the witnesses we have had to date have made that point. I am not doubting the fact that professionals are happy with it. What I am concerned about is making sure that the people who operationalise this—that is, the carers—are also happy with it. That is why I am concerned that it has not yet been out to the peak organisations.

The other thing we know is that carers are busy caring. They are full-on doing the caring, and that is why, particularly for carers, peak organisations are so important. They pick up the load of looking at these things for carers, who do not have time.

Ms Emerson —I think that is why we were surprised we got such a good response rate from the invitations we sent out to carers. As I said, over 1,200 people completed the form and gave us comments both on the form and on a feedback sheet as well in the generic way.

Senator SIEWERT —With all due respect, a lot of people sitting on that side of the table have said, ‘Yes, we’re consulted’, but when we actually talk to the people—and I am not disbelieving you—they say, ‘Well, this is the degree to which we were consulted. We weren’t happy with the consultation but, yes, we were consulted.’ You learn to be very cynical in this job.

Senator HUMPHRIES —Is the determination a disallowable instrument?

Ms Emerson —Yes, it is.

Senator SIEWERT —On this point, we are better off seeing it now so we do not have to disallow.

CHAIR —I think it is better if we just keep it on the same point and everyone can jump in. Ms Emerson, you did not tell us how these people were appointed.

Ms Emerson —They were actually targeted by the University of Wollongong as a group of representatives and experts.

CHAIR —Was it part of their consultancy to determine that?

Ms Emerson —That is right.

CHAIR —I am interested in all these areas, but one in particular is having a representative from the New South Wales branch of the carers association without advising the national group that that was going to be done. I think that, in terms of protocol, that is a very dangerous precedent for any organisation. If someone is there representing the group, if they are there as one person representing carers, that is an interesting concept in itself. But if someone is there representing Carers Australia with that being the process—

Ms Emerson —I think, firstly, people were invited in because of their individual expertise and ability to provide a perspective not necessarily representative of a complete organisation. I was a little bit surprised actually that Carers Australia did not realise that that was done. That was probably remiss of us in our communications.

CHAIR —It is a significant protocol issue.

Ms Emerson —It is. They are a federation and I made an assumption. I am sorry about that and I will be apologising to Joan after this.

CHAIR —Thank you.

Senator SIEWERT —The point, obviously, is that it is hard for us to now have a discussion about the assessment tool when we have not seen it. But what happens from here? If the stakeholders have comments on the tool, what process are you going to carry out to ensure that they are taken into consideration? Have you got a process now for consultation with the stakeholders beyond the experts? The ones we have just been talking to, for example, have all expressed deep interest in the children and all want to see it. They are obviously going to want to comment on it. They may say it is fantastic, but what process have you got in place to make sure that happens?

Ms Emerson —We were planning to do an evaluation starting basically on day one of how effective the tool was, including consultation. When you are implementing a new system, you have the issue of having to get forms out, systems built and a whole range of things locked into place to take effect on the date the legislation comes into effect. The most effective way we thought we could handle any feedback if there were any really significant issues—and it could happen—was with some manual work-arounds as an interim remedy and then look to some fundamental changes. But we were quite optimistic that what we would be able to do is see how effectively the tool was operating over the first three, six and up to 12 months and look to tabling another version of the tool as an instrument in the future to remedy any issues that came out of it. Essentially, it was a combination of having some confidence in the work that has been done on the tool to date and having a fall-back plan, if there truly was something that looked significantly wrong, to be able to remedy that on the systems side through some sort of manual intervention, working closely with Centrelink, and doing some emergency redrafting. That was the basic plan.

Senator SIEWERT —I realise that is post implementation. I am thinking of the draft that you are going to give us hopefully within 24 hours. Have you got a consultation process in mind for at least consulting with the peak organisations prior to it being tabled?

Ms Emerson —What we were hoping to do is meet with key stakeholders and take them through that instrument, explain to them how it operates, because it is quite complex, and also use that as a more general information opportunity. We are also talking about proposed legislation. Sometimes it is a little bit difficult to have those discussions when it is something that is proposed as opposed to something that exists. That was the plan between now and when the instrument is tabled—that we would have those discussions, including with the Australian Association for Families of Children with a Disability, Carers Australia and a number of others that we have been in contact with on other related issues. The lead-up into that period was going to be like that.

Senator SIEWERT —Can I take you through a few of the points NDS raised about what they think should be in the assessment. You commented before that you think they had been taken up. Can I take you to those points to see if they have been included in the tool? I am trying to get a degree of confidence about this.

Ms Emerson —Yes.

Senator SIEWERT —Is geographical location and the impact of living in rural and remote areas included?

Ms Emerson —I think that issue gets dealt with in terms of some questions around the amount of travel to medical appointments and the like.

Senator SIEWERT —What about respite for family support?

Ms Emerson —The tool itself mainly focuses on the care provided, the care needed and the care provided by a particular carer. A lot of those things are constant irrespective of where you live, but often it is access to medical practitioners and other allied health assistance.

Senator SIEWERT —There is respite. Family support can be impacted. We have been talking about psychological impacts and things like that. Being in rural and remote areas would certainly increase those pressures if you were struggling without access to the sorts of services that are provided in metropolitan areas. Besides the travel, is that included?

Ms Emerson —The care load actually looks at what the carer provides. It does not look at the emotional or psychological impact on the carer.

Senator SIEWERT —As you would know, all the submissions want those issues included in the assessment tool. ‘Carers ability to access support services, networks and structures both formally and informally.’ By the sounds of things those are not included.

Ms Emerson —No, they are not.

Senator SIEWERT —’Whether the child has received appropriate aids and equipment such as wheelchair or lifting assistance.’

Ms Emerson —Whether they have received those things?

Senator SIEWERT —Yes.

Ms Emerson —It takes into account what the carer provides. If they have not received those things, there will actually be a greater care load for the carer which is a horrible situation but probably a fact for some people. It deals with it from the other direction.

Senator SIEWERT —’Whether a child needs additional care when growth or other changes occur either episodically or longer term.’

Ms Emerson —Those become issues of whether somebody who perhaps did not previously qualify because of a change in a child’s condition may now qualify. That is where people can actually apply for payment under this payment.

Senator SIEWERT —They would qualify in some circumstances under the episodic or short-term provisions?

Mr Francis —If they were already qualified they would continue to be qualified.

Senator SIEWERT —I appreciate that, but I think the point is that Ms Emerson was saying that if they did not qualify earlier and there were some changes they would qualify under the episodic provisions.

Ms Emerson —Yes. You would get assessed at the time when the episodic conditions were quite high and there would be certification that that could occur again. A treating health professional would be asked to estimate whether that is a likely scenario. That is how it would work.

Senator SIEWERT —’The impact of challenging behaviours and mental health issues and the level of care required.’

Ms Emerson —Of the four domains in the questionnaire, two of them are behavioural, including to do with the child’s own behavioural issues and the amount of intervention, supervision, prompting or whatever is required by the parent on a regular basis.

Senator SIEWERT —It seems to me that the issues around support services, networks and structures are not included and the issues around psychological and emotional impacts are not included either—is that right?

Ms Emerson —Those things are partially picked up, especially around the access to support services, in that really so much more of the care load actually does fall on the carer and that is recognised within the instrument. So to that extent that is picked up.

Senator SIEWERT —Obviously we will have to have a look at the instrument once it is tabled.

Senator HUMPHRIES —I want to follow up on the issue about the psychological impact of caring. Why shouldn’t that be included as a criterion if we are now shifting the focus from the description of the condition to the position of the carer?

Ms Emerson —The fundamental purpose for the payment is to assist people who are unable to participate in the paid workforce because of their caring load. If there is a significant care load involved, it will get picked up. It is very difficult to both conceptualise and measure the psychological impact of caring other than to recognise it. Did you have anything specific to suggest?

Senator HUMPHRIES —You have a need to assess the child or the person being cared for by a health professional. It seems to me that it would be possible for an assessment to be made by a psychologist or a psychiatrist if there were an issue there of a carer as well. I am sure you have encountered—I certainly have—lots of people for whom the burden of caring is a very onerous, very distressing one. I would hate to think that, because of the nature of the impact on these people, they would be excluded from payments because they could not demonstrate, or be invited to demonstrate, the level of that impact on their lives.

Senator FIFIELD —National Disability Services raised the issue of how broadly the phrase ‘treating health professionals’ is defined and whether it would include a speech pathologist, occupational therapist and psychologists. I understand that the categories that fall under ‘treating health professionals’ will be determined by the secretary. Can you advise the committee how broadly that phrase will be interpreted?

Ms Emerson —The intention of the proposal is that registered nurses, registered psychologists, physiotherapists, occupational therapists and, in geographically remote areas, Aboriginal health workers who are involved in a child’s treatment and care will be able to complete their professional questionnaire. It is quite deliberately intended to provide greater access to an appropriate treating medical health professional who knows the child and is accessible to the family.

Senator SIEWERT —The issue that was also raised there was multiple health professionals being able to fill out the form. Is that possible, as well—so you do not just pick one? The point is that one may not have all the professional competencies across the board because there may be multiple issues involved.

CHAIR —All the appropriate knowledge.

Senator SIEWERT —Yes, all the appropriate knowledge.

Ms Emerson —There is nothing to stop collaboration. I think we would ask, though, for a single treating health professional to sign the form in terms of a practical administrative thing for Centrelink to be able to deal with a form as opposed to multiple forms. But with regard to multidisciplinary teams who actually work with children, I think that, in practice, we would probably ask someone to take the lead but certainly to collaborate and consult would be fine. The questionnaire should be able to lend itself to that quite readily.

Mr Francis —The instrument is drafted such that if the secretary is not satisfied that the appropriate care load is represented through the questionnaire, the secretary can ask another treating health professional to do the questionnaire again. So there is an opportunity for the secretary to make a judgment before a benefit is given.

Senator FIFIELD —Do treating health professionals include physiotherapists?

Ms Emerson —Yes, they do. I will just add a point about the previous question that Senator Humphries was asking. In the disability care load instrument, we give an opportunity for the carer to describe the impact that the child’s behaviour, disability or special needs have on them and how that impacts on the everyday care that they provide. That can be a trigger for a complex assessment team to take some further interest in the case if there seems to be a discrepancy between the measurement of care load and the fact that someone has described the impact on their life as very significant. I was trying to answer before about the psychological and emotional impact. While we do not specifically have another tool which measures that, there is some fail-safe—some sort of device within the questionnaire—which allows it to be identified and could be referred to the complex assessment team.

Senator HUMPHRIES —But that reference to a complex assessment team would be an assessment of the child or the person being cared for, wouldn’t it?

Ms Emerson —No, that is to do with the actual care. The intention is that there will be some flexibility for the complex assessment team to be able to add a small number of points into the rating in these cases where the evidence of the tool does not seem to align with the intensity of the impact on the carer.

Senator HUMPHRIES —That is reassuring. Thank you.

Senator SIEWERT —Another point that has been raised on the assessment process is about when a child moves to adulthood. I think you were here for the last session, when we were talking about how there seems to be consensus amongst the carers—hardly surprising—that, in fact, the carer payment (adult) assessment tool should be consistent and that there should be a smooth transition from child to adult. The chair will ping me if I ask a policy question, but I am going to give it a go because I always do—and then they ping me. Where are we in terms of making that transition smoother? You will have heard all the evidence before—it is not exactly new—about people’s concerns about more filling in of forms as a child turns 18; in this case it is 16, and then you go through it. There is this issue, again, around when they leave school et cetera—if they are in school.

Ms Emerson —I will make a couple of points, if I may. The first one is that one of the reasons the task force felt strongly that carer payment (child) was not reaching the right group was the large group of people who became eligible at age 16 under carer payment in respect of a child over 16 compared to those who were becoming eligible below that age. One of the reasons is that the ADAT, which is the fundamental tool to assess the payment in respect of adults being cared for, is much closer to a reflection of care load. It is a functional assessment; it is not a medical model. It actually looks at what functional capacity or needs you have for assistance. One of the basic drivers here was to make the assessment for the child much closer to that, so in essence the overall nature and underpinnings of the reform are to ease that transition.

But there are also a couple of other points to make in relation to this. The amendments proposed enable carers to continue to receive carer payment for up to three months after the child turns 16. This is a fundamental issue about how long it can take you to realise, ‘Oh, there are different rules; I need to get an appointment and a new assessment.’ So there has been a quite deliberate window opened up. Instead of having to do it before the child turns 16, there is now time after the child turns 16 to be able to look at the new world. This will give carers a longer period to get that assessment done. The care receiver will then have to be assessed under the adult disability assessment tool before they reach the age of 16 and three months, and the payment will continue without cancellation through that period.

This amendment, however, will not apply to grants provided on a short-term or episodic basis or for a care provider to a child with a terminal condition; there are some different rules around that. Qualification for carer payment for care provided on a short-term or episodic basis may continue for the duration of the term or the episode, so even if the care receiver does turn 16 then they still get it for whatever period. So, if the doctor said, ‘This is a five-month thing,’ they will get the full benefit even if they turn 16 the day after. They would be able to get it for the five months without any requirement there.

Senator SIEWERT —Does that apply to the terminally ill or is there something slightly different there?

Ms Emerson —It is actually a bit more generous again in the case of the terminally ill. In relation to children with a terminal condition, carers will remain qualified for carer payment until the child turns 18 providing the grant was made prior to the child reaching the age of 16 and that the carer and the care receiver continue to meet the other qualification requirements. It takes it through to age 18 which is two years further on.

Senator SIEWERT —I take your point that the adult assessment process is nearer to the objectives that are trying to be achieved. I am sure that the carers who are making the submissions are aware of that. Of course we have not seen the instrument yet, so I cannot comment—but are you confident that people will be much happier with the alignment between the two?

Ms Emerson —The evidence we have seen suggests that it would be much more closely aligned, but we will be looking at that issue carefully over the next six to 12 months as well because we will be doing some further refinements to line up the tools between carer allowance and carer payment. We will also be looking at that transition period.

CHAIR —Can you currently line them up for us in terms of a comparison of the tool that is used for adult assessment and the proposed tool for children so that we can actually see how they compare?

Ms Emerson —They are different tools. I do not have that analysis to the level of detail I suspect you might be seeking, but we could certainly provide something to illustrate the issues. What is your time frame?

CHAIR —We report on 7 May. This is an ongoing issue, so as quickly as we could get that.

Ms Emerson —We could try to provide you with something this week.

CHAIR —It is just that it has come up consistently in the evidence and it is about the whole area of the issue of assessment and the fact that we are now looking at a wider issue of care. I would like to see a comparison of how they operate.

Senator SIEWERT —With respect to the terms of the definitions for example the Carers Victoria and Palliative Care Victoria made a point about the definition of ‘constant care’ and ‘personal care’. Presumably, the instrument will also have definitions of those terms?

Mr Francis —‘Constant care’ is not defined in the act but it is the term which has been used for the present qualification provisions so it is understood both by the department and the tribunals as to what that means. Essentially, it has been defined in the guide as ‘personally providing care on a daily basis for a significant period during each day’. That significant period has to take you out of employment, so you would have been working at approximately eight hours a day. That is probably an unfortunate way of putting it, but it is to represent that you are going out of employment. It is undefined and so is ‘personally’ but that relates to the person who is actually undertaking the care. The carer payment reflects to that person.

Senator SIEWERT —In response to the question they are asking, will it be the currently used and assumed definition of ‘constant care’?

Mr Francis —That is correct.

Senator SIEWERT —Is that the same with ‘personal care’?

Mr Francis —That is correct as well.

Senator SIEWERT —I think that is all the caseload questions I have. I would like to clarify the question that came up at the end of the Carers Victoria submission about evidence around hospital care. They asked whether it is for continued eligibility or payment. Your submission says it is for payment.

Ms Emerson —That is correct.

Senator SIEWERT —I wanted to clarify that.

Mr Francis —Payability rules continue, so if the person was qualified and in payment. As long as the payability rules which deal with income and assets do not take them out of the payment, they would continue to be paid while they were hospitalised.

Senator SIEWERT —You say in your submission, ‘Centrelink will undertake reviews after the child has been in hospital for a continuous period of 12 weeks to assess if the carer is still providing care’. What process will be used for that assessment?

Ms Emerson —I understand it is what I would consider a ‘light touch’ assessment. It may be as straightforward as a phone call from Centrelink. It is not a full assessment. It is literally a follow-up by Centrelink to make sure that the situation has not changed. It is supposed to be not too intrusive but just checking.

Senator SIEWERT —I am going to policy again, and the chair will ping me, but in terms of the issue of consistency between child care in hospital and adult care in hospital, what is the reason for not aligning those two?

Ms Emerson —The issues that were addressed were the special issues relating to a child under 16 and the complexity around what is often the parenting role as well as the caring role and that caring relationship. So it was specifically looked at in the context of children under 16. It paid respect to the task force recommendations around that.

Senator SIEWERT —You will obviously be aware that there is a great deal of concern in the caring community about the provisions around the care of adults in hospital as well. Many of the issues you just mentioned are very similar for carers of adults as well.

Senator HUMPHRIES —I have a couple of questions about shared care. We heard in the evidence that the new arrangements provide that a carer payment can be split between two separated parents if they are caring for two children with disabilities but not if they are caring for a single child with disabilities. Is that an accurate description of the policy, and why is there a provision for one child but not two?

Ms Emerson —The issue around exchanged care was to recognise that in some families there are a number of children with a disability. While each parent, while separated, has a continuing care load, it is sometimes for a different child. In the past, those people were precluded from qualifying, because it was a different child. So the exchange care provisions were really to remedy that anomalous situation. The issue of shared care remains somewhat problematic because, as I think Dr Ken Baker mentioned, a full careload, reaching that intense qualification, would possibly not be realised by all people in a shared care environment. It would by some. Certainly in conjunction with the 63-day respite rule and other aspects of qualification, some shared care arrangements, one parent certainly would be able to qualify for carer payment. But, more realistically, if there was actually 50-50 shared care for one child neither parent would qualify under the proposed arrangements, because neither of them would be providing continuous personal care or meet the qualification.

Senator HUMPHRIES —But what if we establish that the child has a level of intensity of need; for example, supposing there were two parents in the one household and one parent stayed at home to provide care while the other went off to work. If there were an arrangement where a child’s care is shared between two households, and if the parent concerned had to provide care and could not work for the period that that child is in that one household, why shouldn’t they qualify for half of the payment? Let us say that the care of the child is split 50-50 between the two parents. Why shouldn’t the parent who stays at home to look after the child receive half of the payment for that period of care?

Ms Emerson —As far as I am aware, you cannot split an income support payment. Would you like to comment further?

—The present rules require constant care, and the proposed rules require constant care. It is at that point that, in exchange care situations, you have problems. That is why the proposed legislation has been drafted such that you would have two children, so if both of them had severe disability you could exchange those children and they could continue along those lines. Beyond that, it is the requirement for constant care that has always been our problem—that if a person is chopping from one household to the other, the care could not be said to be constant to the person receiving the payment.

Beyond that, it is the requirement for constant care that has always been our problem—that if a person is chopping from one household to the other, the care could not be said to be constant to the person receiving the payment.

Senator SIEWERT —In proper care though, obviously, you have two parents who cannot work.

Mr Francis —I accept the proposition that you are putting.

CHAIR —This situation has been a tell-all for many, many years.

Ms Emerson —Yes.

CHAIR —This issue has been struggled with by various departments for a long time, but, as you are saying, the rationale is focused on the person receiving the care. That is not saying that it is right, but we have been struggling with it for a long time.

Ms Emerson —So, if those parents are precluded from work because of their unavailability for that work every second week, for example, obviously Centrelink would look at whatever other assistance can be provided, but it would not be carer payment under the current proposition.

Senator SIEWERT —And they are also discriminated against under the income support process, too, because only one parent becomes a principal carer.

Ms Emerson —That is correct. Care allowance can be split between parents so that the supplementary payment can be split, but not carer payment.

Senator HUMPHRIES —On a related question, people have raised the issue of where the shared care is not between the two parents but between a parent and another person; for example, a grandparent. You have a swapping around arrangement and if both of the carers are not employed because they are sharing the care, philosophically why shouldn’t both be able to claim the carer payment?

Ms Emerson —It is the same answer in that situation as well.

Senator SIEWERT —It is only where you have two children involved.

Ms Emerson —It is only when you are actually providing constant care to a child. It does not matter if it is a different child; that is what the exchanged care was trying to redress—an anomaly where, even if you had full-time constant care, you were not able to get carer payments.

Senator HUMPHRIES —But this is the same arrangement between two parents, where, under your proposals you qualify for the payment to be made to both parents because they are constantly caring for one child. Instead of a parent, you now have a grandparent, for example. So why shouldn’t that grandparent qualify for the payment?

Mr Francis —Could I ask you to clarify that again. I may be off the point, but two people can qualify for the care of one child. If you look, for instance, at a child who has a severe disability or severe medical condition and you look through the qualification provisions, you will note that the treating health professional could say that more than one person is required to look after the child, so both people would be in receipt of carer payment. There would not be a split payment, as you have said. Does that take you some distance along where you are going?

Senator HUMPHRIES —Are saying that the two people living together could each receive a full payment?

Mr Francis —If they both qualified, then yes.

Ms Emerson —And if the intensity is such that it does require two carers.

Senator HUMPHRIES —All right, but that is not quite the same situation. You have two parents who are living apart and who constantly have the care of one of those two children. In those arrangements, under these proposed reforms, will each parent be able to receive a full carer payment? Is that what you are saying?

Mr Francis —As long as the constant care is provided.

Senator HUMPHRIES —And the child qualifies because of the  intensity of care. Okay. In exactly the same arrangement, but you take out a parent and put instead a grandparent in place, why shouldn’t the grandparent also receive the carer payment?

Ms Emerson —I think I lost the scenario part way through because I was getting two different scenarios in my mind.

CHAIR —Ms Emerson, it is the issue that Carers Australia have raised about the fact that under the current system it seems to be restricted to parents.

Ms Emerson —Is this specifically about the exchanged care notion, where there are two? I have got one nod one way and one nod another way; that is why I am getting a bit confused.

Senator SIEWERT —I thought your scenario was that it was not the exchanged care. It is two people caring for the same child but not necessarily living together.

Senator HUMPHRIES —That is right. We are putting forward several scenarios, but let’s forget about the previous ones. I want to take the example of where two children, both with severe disabilities, are shared between two parents so that there is always a child in both households being cared for and both parents qualify, under your proposals, for a full carer payment each because they are both full-time occupied in caring for one of the two children of the former marriage. Let’s say that in that arrangement you take out a parent and put in a grandparent instead, which is a conceivable situation. Suppose that a court, for argument’s sake, orders what used to be called ‘custody’ of a child to one of the two parents and that it is exclusively in the hands of, say, the mother, who wants to share that care with her mother. Why shouldn’t the mother and the grandmother have a full-time carer payment when they are swapping about?

Ms Emerson —That scenario is slightly different to what I thought you were going to say. If one of those parents wants to share the care load that normally would have qualified them by solely providing that care then they may lose eligibility because they themselves would not be providing a care load of sufficient intensity. Say mum’s mum was providing the care and dad was providing the care on an exchange basis—that is a slightly different scenario. But the one you just spoke to was mum and grandma assisting each other to provide care load and dad also providing care, under which mum and grandma will not both qualify.

Senator HUMPHRIES —That was not what I was proposing. Let’s go back to a simple arrangement. Mother and father separated. They have two severely disabled children. They come to an arrangement whereby one parent will have care of one of the children all the time and the other will have the other child, and from time to time they will swap over. So at any given point in time each parent will have one of the two children under their care. Because it is constant care they are both entitled to a full carer payment each. That is your reform: they are both entitled now, under these new arrangements, to a full carer payment each. But take that scenario and, instead of it being mother and father, it is mother and grandmother, say. It is exactly the same arrangement—swapping over the children every so often—but each is full-time occupied in the constant care of that child. Why shouldn’t both of those people, the mother and grandmother, be entitled to a carer payment?

Ms Emerson —The way that it is proposed to identify the caring arrangement that is in place is to use a registered parenting plan or a parenting order which is enforced and which outlines the carer arrangements. I would have to double-check for you whether a grandparent under these conditions would be able to be one of those parties. I am not sure that they can.

Senator FIFIELD —A parenting plan is something which is voluntarily submitted to by the parents and registered by the court. Two parents could draw up a parenting plan that had the mother with one child and a grandparent with the other, swapping as Senator Humphries outlined. You can pretty much put in a parenting plan, which is voluntarily submitted to and registered with the court, anything you want.

Senator HUMPHRIES —And if the court is prepared to sanction that as an arrangement for the care of the children, why shouldn’t the carer payment be available to both carers?

Ms Emerson —The draft legislation specifies that a person has to be a parent to be a party in this.

Senator HUMPHRIES —We are aware of that. The question is: why shouldn’t it be a grandparent? Why shouldn’t we recommend to the Senate that it should amend that arrangement to allow for a grandparent or other relative to be eligible for that payment?

CHAIR —If the tool used is the parenting agreements—

Senator HUMPHRIES —Yes, that is a reasonable test.

CHAIR —Not wishing to change that element, just who is in there.

Senator HUMPHRIES —That is right.

Ms Emerson —Once again, we have responded to the task force recommendation, and that was their specific recommendation—but that is perplexing.

Senator FIFIELD —You have a new recommendation today from Senator Humphries!

CHAIR —Are there any other questions?

Senator FIFIELD —Yes. Just on Senator Humphries’s point: is that something that you can undertake to put to government to consider?

CHAIR —It is not the department’s role to do that, Senator Fifield. We could put that to them.

Senator FIFIELD —Sorry. We can certainly do that, but the department can also flag internally that the issue has been raised.

Ms Emerson —Of course we will, yes.

Senator FIFIELD —Obviously it is for the government to decide what they do to that. I have just a few basic questions to start with. In what year did the carer payment first come to be?

Ms Emerson —I do not know that I have done my study on that question! I will have to come back to you to tell you the precise time, but I think it was the late nineties.

Senator FIFIELD —If you could come back with a date—

Ms Emerson —I usually bring my history of the carer payment with me, but I did not today.

Senator FIFIELD —Thank you; that would be good. And could you check if that was another iteration of something which previously existed—

Ms Emerson —It was.

Senator FIFIELD —and what that was? And the same with the carer allowance?

Ms Emerson —Certainly.

Senator FIFIELD —Thank you.

Ms Emerson —I have actually got a reference in our task force report, if that is useful to you. Would you like me to just double-check that for you?

Senator FIFIELD —Thank you.

Ms Emerson —Pre 1997, there was call for a payment like the carer payment—certainly the carer payment (child). It is quite a long history. Maybe, if I table it, it might be simpler.

Senator FIFIELD —Okay.

Ms Emerson —We can take a photocopy and table it, if you like, but it goes from the spouse carer pension back in 1983 and, working through, there are literally probably two dozen major milestones that you would be interested in.

Senator FIFIELD —That would be good. I like the history. I like to know the antecedents of what we are dealing with. And that also has the history of the carer allowance and whatever was before it, or just the carer payment?

Ms Emerson —I think most of it is covered in there. I will double-check. I will get it to you if we do not have it there.

Senator FIFIELD —Thank you for that. We were talking earlier this morning about the carer payment adjustment, which some of our witnesses made reference to. When did that come into being? I think some of the witnesses said it was a pilot of sorts.

Ms Emerson —No, it was an interim ex gratia payment. That was how it was characterised. It basically came into effect on 1 July 2007, but with effect going back to probably about 1 January that year because it related to incidences that had occurred since 1 January 2007.

Senator FIFIELD —Okay. And this interim ex gratia payment or access to it ends at the end of 2009?

Ms Emerson —Yes. The current arrangements are that it goes through until 1 December 2009, and the government is currently looking at what future arrangements should be in place to assist parents in those circumstances.

Senator FIFIELD —It is $10,000 one-off?

Ms Emerson —It is ‘up to’, and so it does vary quite a bit. The average grant currently is around $6,900.

Senator FIFIELD —Who assesses the level?

Ms Emerson —There is an independent expert panel that looks at every application and the individual circumstances in the case that is made for that individual family.

Senator FIFIELD —So the carer payment being used for episodic incidents is not intended to be a replacement of sorts for this interim ex gratia payment?

Ms Emerson —Access to short-term and episodic payment I think will assist some families who are in that position because it is aimed currently at people who are not in receipt of income support, and they cannot qualify for it. Certainly some people might find their situation assisted by the access to short-term episodic, but it is often different.

Senator FIFIELD —It is different. You may not know or may not be able to say, but has the government stated that they do have the intention of having something replace the carer adjustment payment at the end of 2009?

Ms Emerson —Last budget—

CHAIR —That is a question for government.

Senator FIFIELD —I am just asking if the government has actually stated it so the officers can explain what the existing policy is.

Ms Emerson —Last budget the government did say that they would put aside $20 million over four years to look at this group.

Senator FIFIELD —Sorry?

Ms Emerson —The last budget had an announcement which said that the government would put aside $20 million over the four-year period that was projected in the forward estimates.

Senator FIFIELD —So there is money in the forward estimates for something which would take over from the carer adjustment payment?

Ms Emerson —There is money in the forward estimates for this group, yes.

Senator FIFIELD —For something to be determined?

Ms Emerson —Yes. At the moment, it is extended through to the end of December, and the future is being looked at.

Senator FIFIELD —Have the government stated whether they will announce before the expiry of the carer adjustment payment what will replace it?

Ms Emerson —There has been no announcement like that.

Senator FIFIELD —Okay. The figure of 19,000 in your submission is the anticipated number of people who will be eligible for the carer adjustment payment as a result of this legislation; is that right?

Ms Emerson —It is people who would be eligible for carer payment.

Senator FIFIELD —Sorry. That is what I meant—’carer payment’. The composition in your submission is, I think, 13,500 on some other sort of income support who will be expected to transfer across to this and leave whatever income support they are on.

Ms Emerson —Yes.

Senator FIFIELD —Are you able to give us a breakdown of that 13,500 as to the proportions of other income support that they are on?

Ms Emerson —In general terms, we have thought around 78 per cent have come from parenting payments, both single and partnered, about 20 per cent from Newstart and probably around two per cent from the disability support pension.

Senator FIFIELD —What percentage from Newstart, sorry?

Ms Emerson —Twenty.

Senator FIFIELD —How have that figure of 19,000 and those percentages been determined?

Ms Emerson —They are estimates—

Senator FIFIELD —Sure.

Ms Emerson —from a number of different sources, including the ABS survey, of the number of children who are likely to have profound or severe disability and core activity limitations by their income profiles. Also it includes the number of people who were eligible or who qualified as a carer when they were aged 16 for the adult forms of payment versus the number who did not. There are also some estimates around potential access to short-term episodic payment and some of those exchanged care situations. There is a very small number involved in those. It was an amalgam of a number of those estimates put together which got us that sort of number.

Senator FIFIELD —Can you tell the committee what the net effect to the budget will be of this legislation passing, what the costs are and any savings, based on the estimated 19,000 figure?

Ms Emerson —The figures I have in front of me will not give you the detail I think you are asking for in that question. Can I take that on notice, because there were figures produced last budget that gave the total impact but they also included the Centrelink administration costs. Can you just clarify again what figure you specifically want?

Senator FIFIELD —Sure. Could you give us what the effect on the budget is of this legislation in net terms, what the costs are and any savings.

Ms Emerson —Certainly.

Senator FIFIELD —It has been put to me that there has been a significant increase in applications for and people being granted the carer payment since the start of the year, and that one explanation is that, with rising unemployment, a number of people are looking at their domestic situation, realising that they could be eligible for the carer payment and managing their home circumstances accordingly. In other words, there are a number of people who are opting to go onto carer payment rather than Newstart. So, firstly, has there been a spike in uptake of carer payment since the start of the year? And do you have any advice as to whether that is partly a function of a rise in unemployment?

Ms Emerson —The information I have around the trends in carer payment is that there has actually been annual growth of around 12 per cent. So it has been a growing payment anyway. I am not aware of a specific spike since the beginning of this year. However, the analysis that has been done has attributed the continuing growth in carer payment numbers to factors such as the demographic changes—obviously, the ageing of the population—and associated increased incidence of people with disability requiring care; greater public awareness of the payment, which has been very much the case over the last two or three years; the increase in the numbers of people with disabilities and medical conditions being cared for at home, which is sort of a societal trend; increased recognition by people of the caring role they perform and, again, I think you are probably aware of the work of Carers Australia and others doing a lot to raise the profile in this area; and the liberalisation of the qualification criteria for carer payment, including increasing some aspects—so, for instance, the 25-hour rule used to be a 20-hour rule and before that a 10-hour rule. So over time there have been some more liberalisation of what sort of qualification is required. And there were some major changes in 2006 around children with really significant behavioural and psychological issues that, again, opened up that payment to some people who had not previously been able to access it.

Senator FIFIELD —Are you able to take on notice whether any part of the increase in the uptake of carer payment is a result of rising unemployment? I appreciate that that is probably an extremely difficult thing to try to determine and quantify but, nevertheless, could you take on notice whether you can provide any advice in that regard.

Ms Emerson —I think the lag effect might preclude very much in-depth advice being available to you on that one.

Senator FIFIELD —Sure. I am not sure if you were here or tuned in back in the department when Carers Australia were giving evidence, but they very kindly offered to assist in providing training to Centrelink—and I appreciate you are not Centrelink—in relation to carers and some of the issues they face, to better equip Centrelink staff for dealing with people who are seeking advice. Is that something which the department would be prepared to explore?

Ms Emerson —We will talk to Centrelink about that. I think they usually welcome overtures from Carers Australia, and they have quite frequent interactions with groups. I think the reference and training tools that they are developing probably have aspects of what Carers Australia were asking for. So we will take that up with them. I think it is an excellent suggestion.

Senator FIFIELD —Great. Thank you.

Senator SIEWERT —The issue that was raised about episodic and short-term qualification, Carers Victoria made a point about wanting to keep the qualification period open for two years—not necessarily the payment—in case the same point comes up again, because it is episodic care. Is that included in the legislation already?

Ms Emerson —I think it is.

Mr Francis —It is by implication rather than actually specifically being there. Because you could qualify so long as the care is likely to last between three to six months, then you would come back and put in a shortened application if you are one of those people who are having an episodic care requirement.

Senator SIEWERT —That is the way I was interpreting it, but obviously it is not clear because of the questions that the carers are asking. It may be something that we will seek to clarify.

Ms Emerson —It will probably be handled in how the process will work more than in the legislation per se. It will be how the forms and the information are available from Centrelink.

Senator SIEWERT —Is that something you could cover in the forms? In the form there would be the information, and, if it is previously supplied for the same illness—basically, you are having an episodic event?

Ms Emerson —The idea was that they would not have to go through a full care assessment, but have an abridged one just to basically assure that other circumstances remain the same and that you still qualify under income and assets and everything else. That is the intention. I will check where that is made clear for potential applicants.

Senator SIEWERT —That would be appreciated, thanks.

CHAIR —I just want to clarify that we are going to get the instrument with the questionnaires attached.

Mr Francis —The instrument is presently drafted with the questionnaires attached.

CHAIR —So we will get a copy of the two questionnaires as well?

Mr Francis —Yes. We will have to tidy that up and remove some stuff out of it—that is, questions from the drafters to us.

CHAIR —So it is the whole kit?

Mr Francis —Yes.

Ms Emerson —The questionnaire does not look exactly the same as the questionnaire that is going to go to a carer to complete because it does not have all of the instructions and things like that in it.

CHAIR —But it is the basic stuff you have there now.

Ms Emerson —Yes.

CHAIR —The second point is to do with the training aspect. We will be asking Centrelink for their training documents. That question will go to them today to see what happens. The other issue is about training and advice to the people filling in the forms, in particular the professionals. Is there going to be a full kit available that explains to them their responsibilities, their duties and explain the new process? And, if so, who is doing that?

Ms Emerson —There is certainly information being developed as part of the suite of questionnaires and the claim kit. That is being done at the detailed level by Centrelink, but with us obviously—

CHAIR —Who is writing the information? One of the ongoing issues in this area is the information for the people filling in the forms—not only the applicants, but also the people who are responsible in the professional groups. It has been an ongoing issue and it was raised in a couple of the submissions, concerns about that knowledge and awareness and the fact it has not been done well. Who is actually responsible for drawing up the kit, the information that goes to the professionals to help them do their professional assessment?

Ms Emerson —My department will draw up a specific kit for this particular set of initiatives that have new arrangements in place, and we will be developing that and providing some training to training health professionals. The regular instructions that go with the claim forms themselves are developed by Centrelink with input from us. They do the wordsmithing and layout of forms.

CHAIR —When are they due?

Ms Emerson —They are currently in development.

CHAIR —It was raised by several of the witnesses, both in their written submissions and in their evidence, and their concern hinges on these kinds of details. It is not only the kit that we are talking about, the questionnaires and so on; it is also the stuff that goes with it. I feel that we have a gap in not having that available to us as well, and I am worried about when we will be able to see that. Who is writing it? On whom is it being tested? Where is the advice coming from? What is the process that goes around that? If we can get information on that, that would be very useful.

Ms Emerson —And the specific questions themselves that the carer completes around the care load assessment, and the impact on them, those have been the questions that have been developed in detail with the consulting studies expert committee.

CHAIR —With the University of Wollongong.

Ms Emerson —They have a particular status, if you like. Then there are some issues around the introduction to that form and the more general forms, which are to do with general qualifications, to do with income assets and the like. Obviously, they are Centrelink. You will find within that there are a number of strands of activity that might have slightly different responsible—

CHAIR —Can we find out who is doing what?

Ms Emerson —Yes.

CHAIR —And availability dates and when we can see them? It remains a great unknown for the people who have given evidence. Before the department leaves, do we have anything else to place on notice? We will be providing our questions in writing to you, but I am just double-checking whether there is anything else that we wanted FaHCSIA to follow up. As there is nothing, I thank you very much.

Committee adjourned at 12.41 pm