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Thursday, 5 December 1985
Page: 3074

Senator PETER BAUME(8.44) —The Home and Community Care Bill and the Bill that is being debated with it set up a new framework for community care services in Australia. The main Bill establishes the framework for the home and community care program which was announced in August 1984 by the Government-that is some 15 months ago. The Opposition is not opposing either of these Bills, which if they are implemented with good will and fairness, can go a long way to achieving some important social goals. In this country we have, for some years, wrestled with the problems that many people who need long term residential care have not been able to obtain it and that many people who really need something other than long term residential care have been condemned to that kind of care because there is nothing else available for them. The purpose of the Bills before the Senate is to put in place a new arrangement which might allow the better realisation of a desirable balance of goals.

The home and community care program is to be a joint Commonwealth-State program and, like most of these programs, will be funded under section 96 of the Constitution. That is always a matter of some note to those of us who are federalists, but in any event we have used section 96 for community care services in this country for some 30 years, and this is nothing new. The program is to assist State and local governments and non-government organisations which will be providing basic community support and maintenance services, particularly for those who are aged or disabled and who need long term care in the community.

The Government has announced that the services provided under this legislation are to be targeted to aged or disabled people to minimise premature or unnecessary admission to long term residential care. One of the problems which may be raised in relation to the HACC program is that some who presently offer services which are not to be targeted may fear that they will be losers under the new program. I will come back to that in a moment.

The Bill contains a Schedule with a model agreement and it is hoped that most of the States and the Territories will sign that agreement. It sets out the terms and conditions and the scope of the program. It is my understanding that two States so far have signed.

Senator Grimes —Three and the Territory.

Senator PETER BAUME —Three States and the Territory have signed, so there is already a degree of compliance between the parties. The Schedule also sets out the levels of funding and growth for the program. It is my understanding that the program provides for growth of $10m on an unmatched basis for those signing States; $25m in 1985-86 on a matching basis, a $3 to $1 basis; and $30m in 1986-87 on a different matching basis, $2 for $1. Further growth funds have been promised for later years. It is a quite complicated funding formula.

The second, accompanying Bill amends the four existing Acts which have delivered community care over the last few years; that is, the Delivered Meals Subsidy Act 1970, the Home Nursing Subsidy Act 1956, the States Grants (Home Care) Act 1969, and the States Grants (Paramedical Services) Act 1969. I remind honourable senators that all of those Acts were enacted by Liberal governments. The present Government is not eliminating these Acts; it is trying to consolidate and extend them into the new program. The Opposition parties introduced the original programs and we are now keen to see the Government extend them in the way it proposes. The second Bill provides that those four Acts will cease to apply in those States which choose to join this new agreement, but those States which do not join the agreement can continue to offer services under the old Acts and continue to be funded at 1984-85 activity levels-I take it from the Minister for Community Services (Senator Grimes) that that is correct. So there could still be some money growth for the non-signing States, but no real growth in activity under the existing Acts. The Government has said that no new approvals will be given and no growth funds will be available to non-signing States.

The reason why these changes were necessary is that the whole program area has represented an unsatisfactory interface between the long term residential care needs of the community, which are funded generally by the Commonwealth; the community care of the aged and the chronically disabled, which have tended to share funding; and the acute support and care functions, often providing for people who have been in the acute care hospitals, which are programs funded, or intended to be funded, generally by the States. It seems that some States have used funds from the existing four community care Acts to support mainly acute, post-acute or palliative care and to support families in crisis. There is no doubt that those people need care, but by taking this route the States have shifted costs from themselves to the Commonwealth and in the process have shifted from the community into residential care some people who would not otherwise be there. The shifting of costs from the States to the Commonwealth is a game as old as federation itself. To the extent that that has been happening and the program goals have not been met, we can do nothing but applaud the intention of the Government in trying to propose these new arrangements.

It seems that the States have saved calls upon their own Treasury, that too little of the money has gone to the support of the aged or chronically disabled in the community and that the result has been that avoidable long term admissions to residential care have occurred. That is really not in anyone's interests. We have seen the States minimising their own costs and maximising the costs being borne by the Commonwealth. That is bad enough, but in the process the people for whom the program is intended have not been benefiting as they should have done.

The new arrangements could result in growth funds flowing more towards the aged and disabled and the Opposition would be pleased if this happens. We would see the new arrangements restricting the capacity of States to use what one might call the `new' HACC money to augment their own acute support services. It would be my hope that the States would continue to offer full acute care services, but that they would start to do it from their own resources and would not look to the Commonwealth to fund what are essentially their acute care, post-acute care and palliative services, which are properly State functions.

The Minister's office has made it clear to me that existing programs would be allowed to continue. So it is not a question of dispossessing what is already going on; but, insofar as the programs are going to expand, they would expand more in the direction for which the original States Grants Acts in 1969 and 1970 were put in place.

One concern that has been expressed by a number of groups is that both the HACC program and the Handicapped Persons Assistance Act exclude psychiatric problems as qualifying people for new service provision. The Minister may care to clear up the concerns which people have got in this area. Further, whatever HACC does provide it is clear that there will still be large areas of unmet need which will be unsupported by anyone. For example, HACC has failed to pick up many of the new proposals contained in the recommendations set out clearly in `New Directions'. Those may be matters for the future. But it has long been a policy objective of the Federal coalition of the Liberal and National parties to promote measures to assist people to live independently rather than in institutions. To the extent that this legislation seeks to achieve that goal, it has the support of the coalition. If the Bill does work to achieve those objectives and to assist in the better operation of the original Acts, we will applaud it.

It seems to me that the States will have two choices: The first choice is to carry on under the existing arrangements, under the existing four Acts, at the same activity funding level, but with no access to growth funds. The second choice is to sign up under the new arrangements, submit themselves to joint decision-making to a greater extent than they have, but to gain access to significant new growth funds to meet some of the outstanding and unmet needs, but to do so within new Commonwealth guidelines. That is the choice facing the States. To the credit of the Commonwealth, it has left the States with that choice and left them free to decide which road they wish to take.

The Minister tells me that three States and one Territory have already signed. I hope the other States will choose to do that; but the choice will rest with the States. If that is the case, we would have no objection to the legislation. Obviously concern has been expressed and some of those who have been providing acute care, post-acute care or palliative care are fearful that they are, in some way, going to be under threat. For example, I was aware that a meeting was held on Friday, 29 November, at the Queen Elizabeth Rehabilitation Centre-I suppose that is in association with Royal Prince Alfred Hospital-and was preceded by a poster calling for community action to ventilate people's concerns. But that is not surprising because that is a post-acute care service.

One of the problems which the Government will have is to sell what it is doing and to minimise the sense of threat which dedicated people have had as they offer services already available. Concerns have also been expressed by the Blue Cross Nursing Association in Brisbane. It is concerned that because it may not be offering a long term community support service of the kind we talked about earlier, its funding may be under threat. But if I have understood the program correctly, present activities will continue to be funded. The growth money will be directed towards the objectives which the Government has laid down for the support of people.

Against that background, I thank the Minister for the access he has given me to advice from within his Department and I thank his advisers for the time they were able to spend on this matter. I think this proposal will build upon the original intention of Liberal and National governments to promote the long term support of people in the community. If the program can do that, it has our support and we wish it well.