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Wednesday, 2 March 2016
Page: 2757


Ms HALL (ShortlandOpposition Whip) (10:08): Labor has a very strong record when it comes to aged care. The legislation we are debating today is building on Labor's Living Longer Living Better reforms that were introduced in the last parliament—reforms that really transform the way aged care works in Australia. This bill, the Aged Care Legislation Amendment (Increasing Consumer Choice) Bill 2016, is something that we on this side of the House will not be opposing, but it is really important to make a few points along the way.

The legislation we are debating comes from the 2015 budget, and it is the first part of a two-part process. This will change the way home care packages are allocated. Instead of being allocated to a provider, home care packages will actually be allocated to a person—a person who needs an aged-care package. It gives that person choice. The whole premise of the Living Longer Living Better package was that it was person-centred; it was about the person. By allowing the dollars for the package to go to the person, it gives them greater control over how that package is delivered. My only worries are that there probably has not been enough consultation around the change. I get a little bit concerned about the My Aged Care website and about it being the central entry point. There have been a few problems with that, and I think that the government needs to work a lot harder on fixing those problems.

The first stage of the change is addressed in this legislation we have before us. It will make sure that, no matter what happens, that home care package will follow the person—so that person, no matter where they are, no matter what they are doing, will be able to link into their package and purchase services where they are living. If a person moves from the Hunter to the Central Coast they will be able to purchase a package. There will be providers in areas, but that will not necessarily guarantee that a person who needs a package will be able to obtain one immediately, because those providers will have waiting lists of their own. And one of the big problems over the years, particularly in recent times, has been the waiting list and the waiting time—the time people are forced to wait before they can pick up a package.

Generally speaking, when a person needs an aged-care package, they need an aged-care package. There is great work that is done in both the Hunter and Central Coast. One of the most innovative programs that I have been associated with operates through the Hunter area health service: if an older person over the age of 70 presents at an accident and emergency department, there is a team there that assesses that person to determine whether or not they will need extra services, and whether they can go home and live independently and can care for themselves. If it is determined that a person needs extra services, then the nurse who is responsible for coordinating the package in that accident and emergency department will contact the relevant organisations, and the person will be linked in—from the hospital, not from the community. And they organise the ACAT assessment—and I think it is really important that I put on the record that part of the requirement for a package is that a person undergoes an ACAT assessment, where it is determined whether or not they need assistance, and what type of assistance they need, and then the package is built around them—and that is the person-centred part of the package. But now it is also ensuring that the person has choice.

There have been a few glitches with the changes that have taken place through the Living Longer Living Better reforms. A lot of those glitches relate to the fact that this government does not believe in talking to people. It is very focused on the, 'what I do, what I say,' approach to implementing any policy, and it has a pretty poor record in the area of caring for and providing services for older Australians. Look at its attack on the healthcare system. Look at the fact that it has put in place structures that will lead to a reduction in bulk billing. The removal of bulk-billing incentives from pathology and radiology services is something that will impact on older Australians.

It is sad that this government is also looking towards attacking people's pensions. It has introduced changes that have dramatically decreased the amount of money that old Australians are receiving, and that is really not good enough. I strongly support greater choice and putting that choice in the hands of the consumer. In saying that I emphasise that I have been visited by many of my constituents and their families who have wished to change providers and, due to the rigidity of the rules of the moment, have had difficulty with that. Improved choice is a very good part of this bill, and that has been strongly supported by COTA, the Council on the Ageing, an organisation that has advocated for older Australians for a very long time. COTA says this will lead to older Australians receiving better services, allowing them to remain in their homes longer.

Aged and Community Services Australia are a little more cautious. They believe that 'strong supports and safety nets' need to be maintained for disadvantaged older Australians. Unfortunately, that is something this government has not embraced. It does not understand that some people work very hard all their lives, contribute through taxes but at the end of the day do not have the same level of advantage that other Australians have. It is really important that the government does not forget those people—so a word of caution there.

This legislation also replaces regional ratios with a prioritisation process to take into account an individual's needs, circumstances and waiting time regardless of location. That worries me a little. I do not want to see fewer home care packages being made available in the area I represent, the Hunter. In the Shortland electorate 19.8 per cent of the population are 65 and older. I would hope that, because there is a greater proportion of older people in Shortland, more packages will be made available in our area. I would not like to see more packages being made available in the heart of Sydney because it is easier to deliver services there. Even in my local area I would not like to see packages being made available only in the population centres. The outlying areas in the Shortland electorate, such as Catherine Hill Bay and Nords Wharf, have traditionally had to fight harder for packages because care workers have to travel further. I know that some rural electorates require even greater travel than Shortland does, and I would hope that members of the Nationals in particular are arguing to make sure their constituents are properly taken care of.

The other aspect of the bill that I am concerned about is the length of time that people have to wait for assessments. We are constantly trying to speed up that process. A person who presents at an accident and emergency department and is taken into that stream is in an advantageous position because they can bypass some of the waiting time. On one occasion the family of a constituent contacted me because their mother needed to move to a higher level aged-care package. By the time the assessment took place she was dead. So waiting times are something we need to be very concerned about.

I also need to put on record problems with Human Services. Since Human Services has been involved in the system there have been significant delays in reconciling accounts, with Medicare taking up to three months or more to pay for services. This is not a direct criticism of the Department of Human Services. I understand how short-staffed they are because their staff has been significantly cut. But I also understand the implication of this delay in reconciling accounts.

This has been told to me by aged-care providers who operate aged-care facilities. The delay and the communication with human services have been less than optimal. There are problems in that area. There are problems with the long waiting times. There are also problems with the fact that this system was supposed to make it simpler for older Australians but in some ways has actually been more complex. With constant errors and misinformation given to older Australians, it is really not good enough.

This government needs to step up to the mark and remember that services are services. They are services to vulnerable older Australians. They are services that they look to the government to deliver to them. This is not about the government; this is about people, and the people that use those packages rely on them being delivered. Those people that deliver the packages rely on receiving payment for delivery. The change to give more control to older people is good, but there are a few things this government needs to work on.