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Wednesday, 10 October 1984
Page: 2036

Mr LEO McLEAY —On behalf of the Standing Committee on Expenditure, I present the Committee's report entitled 'In A Home Or At Home: Accommodation and Home Care for the Aged-A Follow-up Report', together with the minutes of proceedings, transcript of evidence and submissions authorised for publication. I also present another report, being a report that the Committee has been unable to complete its remaining inquiries.

Ordered that the reports be printed.

Mr LEO McLEAY —by leave-On behalf of the Standing Committee on Expenditure, I have just presented a report of the Committee entitled 'In A Home Or At Home: Accommodation and Home Care for the Aged-A Follow-up Report'. I suppose it is somewhat fortuitous that this report has come down just after we have debated a matter of public importance on the aged. In 1982 the Committee published a report on accommodation and home care for the aged. The recommendations made by the Committee at that time were directed towards removing major problems and anomalies in the imbalance between institutional and home care and directing Commonwealth government assistance for health and welfare to those in greatest need. The Committee is concerned that its recommendations should not suffer the same fate of earlier major inquiries on care for the aged, from which little action resulted. We have just heard in the debate on the matter of public importance of the problems relating to previous reports over many years. This said, the Committee neither demanded nor expected the achievement overnight of significant improvements in the provision of accommodation and home care services for the aged.

The aims of the follow-up were to report on developments in areas on which the inquiry made recommendations; reasons for lack of progress in areas where there had been no significant development; and the current status of the recommendations in the light of present policies, progress in implementation and likely trends in future policy and program formulation. The follow-up report, in essence, is an inventory of developments over the past two years. During the period there has, of course, been a change of government. I am pleased to see that the Minister for Health (Dr Blewett) is in the House this afternoon, having just spoken on the matter of public importance. The intention of the Labor Government towards the delivery of services for the aged was set out in the letter of the Prime Minister (Mr Hawke) which established a working party on aged care policies. The Prime Minister stated:

It is important not to inhibit longer term rationalisation by continuing the piecemeal approach that has long been a characteristic of Commonwealth policy on aged care.

The Expenditure Committee viewed the restructuring of programs and funding arrangements as a short term objective. These changes were to provide for a reduction in the number of programs; responsibility to be brought under one Minister; modifications to financial arrangements so as to remove disincentives for the expansion of home care services; similar forms of control over all categories of program expenditure; and a reallocation of resources between institutional and community care. Developments to date have occurred in the provision of community care, nursing home care and housing and in needs-based planning.

With respect to community care the Government announced in its 1984-85 Budget that it intended implementing a new home and community care program which will consolidate some existing community care programs as well as incorporate new initiatives. The aim of this program is to provide a more comprehensive range of integrated community services and is consistent with the Committee's recommendations. Perhaps the most significant departure from the Committee's recommendations on community care programs relates to funding. The Committee recommended that such programs be funded through a grant without matching conditions. The Government has indicated that the home and community care program will be cost-shared with the States and Territories. The Committee remains unconvinced that cost-sharing arrangements are conducive to the further expansion of community care services, particularly when one considers that nursing home programs are wholly funded by the Commonwealth. The Committee is of the firm view that the nursing home program and the community care program should be funded on the same basis so the State agencies do not get to make financial choices which may not be in the best interests of the aged population.

Although the Government has not yet established a nursing home care program, a major reorganisation of the provision of nursing home care has been foreshadowed . A program grant system for nursing homes has also been foreshadowed by the Minister for Health. Recommendations relating to nursing home growth have been addressed in the issuing by the Minister of new guidelines in May 1984. Revised strategies for accommodation requirements of the aged should promote better targeting of funds to those persons most in need and result in improved administration. The approach to welfare set out in the 1983 accord emphasised a needs-based approach to welfare and social services and the development of greater negotiation and consultation with consumers, service agencies and other tiers of government. The implementation of the home and community care program should achieve a significant move, towards needs-based resource allocation recommended in the Committee's 1982 report.

The Committee also recommended two measures to protect clients' interests: A requirement for public reporting about non-government nursing homes, and the establishment of aged care tribunals in each State. The Committee notes with disappointment that no action has been taken on these recommendations at the Commonwealth level. Action has been taken to establish complaint receiving bodies in New South Wales and Victoria and the Committee is anxious to see that these are set up in other States and particularly by the Commonwealth. Since the Committee first reported, administrative changes have occurred in portfolios which administer various aged care programs and others have been mooted, such as the creation of a community care department. In the limited investigation associated with this follow-up, the Committee has not, however, formed a firm conclusion as to the most appropriate location for responsibilities for the aged . Nevertheless the Committee strongly reiterates its view that there should be one Minister who is seen to have prime responsibility and from whom the Government can seek comprehensive advice on overall assistance for accommodation and care for the aged. The Committee also believes it is important that responsibility should rest with one Minister for the purpose of public and parliamentary accountability. The Committee recommends that the Government give urgent consideration to this recommendation.

The Committee, in recognition of the administrative changes that would be required to bring about the consolidation of programs in one ministry, considered that it would be necessary to establish a special unit charged with this task. The Committee recommended that an office of care for the aged be established to develop a national policy on how best to provide assistance to meet the accommodation and home care needs of the aged. The Committee considered that the existence of an office of care for the aged would facilitate the development of a national policy and enable basic issues to be tackled. This office would have a pivotal co-ordinating function and thus reduce the scope for unilateral actions which might cause fragmentation of programs, further confuse policy direction and give priority to short term expedients to the exclusion of longer term policy formulation. The Committee was very much taken with the Prime Minister's statement that:

It is important not to inhibit longer term rationalisation by continuing the piecemeal approach that has long been a characteristic of Commonwealth policy on aged care.

The Committee is disappointed that its recommendation has not yet been taken up. The Committee considers that the lack of such a co-ordinating mechanism will reduce the impact and effectiveness of recent fine developments in the provision of aged care services. The Committee urges the Government to give priority to the establishment of an office of care for the aged.

The Committee concludes that measures implemented to date evidence the beginning of a reallocation process to match the needs of specific clients with the appropriate level of care. It is the hope of this Committee that consideration will be given to the implementation of other recommendations outlined in the 1982 report but not yet acted upon, particularly those recommending the establishment of an office of care for the aged and the placing of responsibility for aged care programs under one Minister.