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Thursday, 5 December 1985
Page: 3077

Senator GRIMES (Minister for Community Services)(9.07) —in reply-I thank both those honourable senators who spoke and those who did not speak for their support for this legislation. The legislation has been a long time coming. The planning and the negotiations in fact have been long and tedious, and in some cases have not yet finished. I certainly owe a very great debt of gratitude to the public servants in my Department of Community Services, to those in the Department of the Prime Minister and Cabinet, to those in the Department of Finance and to those in the State departments who have worked long and hard on what has sometimes been a very tedious and very difficult task.

To take up Senator Harradine's point, I suppose if I had any aims or a dream in this area it would be that one day we would have in this country the provision of adequate services for people who need them for post-acute care, for palliative care, for people who have psychiatric as well as physical disorders, for disorders of the aged and other disabilities. They would be also that we have those services provided on a community basis to people either in the home or in a home-like atmosphere, wherever they can be delivered: Firstly, to ensure that they get the care that they need; secondly, to ease the lot of those individuals, but primarily those women in the community, who have borne the burden over the years of looking after relatives who are disabled, ill or aged in their homes; and, thirdly, to ensure that as few as possible of our citizens end up in large institution-type care, frequently of an impersonal nature, no matter how well they are cared for, no matter how hard the people caring for them work in those institutions, and no matter how well-intentioned they are. We are inhibited from developing such a utopia, I suppose, by basically two things. The first, obviously, is a lack of funds. The cost of producing such universal services is considerable. I do not think it is impossible but it is considerable. The cost of producing such services to run in parallel with the present predominance of institutional services that we have is very large. But we still need to do it so that we can eventually effect that transfer from the emphasis on institutions to the emphasis on home care.

The second thing that bedevils us is history. The negotiations have been bedevilled a lot by history. We are a federation in which the States have had certain responsibilities, some of which were adverted to by Senator Peter Baume-and I will talk about them in a moment. The Federal Government, through the legislation we are replacing or co-ordinating here tonight, has been involved in the delivery of services. To a very small extent, compared with what happens in other countries, local government has been involved. I think our path would have been much easier if local government in this country had had a tradition of involvement in the sorts of services in this area as it does in some of the social democracies of Western Europe. A very large group of non-government and voluntary organisations provide the bulk of the care on the ground.

I decided very early that to attempt to step from where we are now into that utopian situation would cause disaster. Such a move would also cause considerable problems for the Federal Budget. Senator Peter Baume was perfectly right when he said that it is in the inherent nature of our federation that whenever we try to do anything our colleagues in the States will do what they have done since Federation-they will attempt, without any ill will, to transfer the cost of their programs to the Federal Government.

Senator Peter Baume —There is a fair amount of cynicism there.

Senator GRIMES —Not cynicism-it happens and it is happening now. It was for this reason that we decided that the predominant services that we would provide under the home and community care program would be for aged and chronically disabled people. We decided that psychiatric services would be excluded for the moment unless they already came under the program or unless people with psychiatric disturbances needed to come under the general HACC provisions. We also decided that the services for families which some States had provided would similarly be excluded at present. But I would hope that in the long term-some time when Senator Peter Baume, Senator Harradine and I have gone from this place-that there will be an evolution of this program so that we can get to that utopian situation.

Quite frankly, we were faced with a situation of great de-institutionalisation throughout the States in the psychiatric area. I agree with what happened. However, for us to attempt to pick up the community services to care for those people who are coming out of psychiatric institutions--

Senator Peter Baume —Doesn't it happen to shift costs to the Commonwealth?

Senator GRIMES —It would have shifted costs to the Commonwealth.

Senator Peter Baume —Doesn't it do so anyway?

Senator GRIMES —No, it would have spread our services and facilities too widely. So we thought that we would walk before we ran, that we would take the first step that we have taken in the HACC program.

As Senator Peter Baume said, the agreement has been signed by three States and the Northern Territory and I have no problem with my colleagues in the Australian Capital Territory. I am confident that two other States will sign pretty soon. One State may take a bit longer, if it is going to sign at all. But we also realise, and I realised in my dealings with the States in these service areas, that to attempt to hang around until one can get the agreement of every State is just impossible. In fact, the best way frequently to get the agreement of all the States is to get the agreement of a couple of States which are willing to have a go and demonstrate that it can be done and then the others will follow as a result of pressure from their electors.

Incidentally, Senator Peter Baume mentioned the meeting at the Queen Elizabeth II Rehabilitation Centre in Sydney on 29 November. That was not in fact a meeting of people who wanted acute care incorporated in the legislation. It was a meeting of non-government organisations which had been involved in negotiations on the home and community care service and which were getting impatient with our State colleagues. The meeting was held to ginger the State into hurrying up its negotiations with the Federal Government. I understand it was a very lively and successful meeting. Of course, this program is a fairly modest one. Senator Harradine is right. It is no good our pretending that the money that is going in now, with the built in minimum increases of 20 per cent later on, will solve the problems we have. We have a very severe structural problem in this country. We have concentrated on two forms of care-nursing homes for the aged and disabled, and institutional-type nursing homes, and if one could not get into a nursing home or institution of that type, one stayed at home. We had hardly heard of respite care beds until the last few years. We are ensuring that respite care beds are provided in nursing homes and hostels for the aged and in the smaller institutions for the disabled in the community. They are vital if we are to keep people at home as much as possible.

Although we have concentrated on these nursing homes and we have one of the highest proportions of nursing homes-we spend probably as much per capita as do most countries on nursing homes-we have neglected very badly the provision of home care and home services. We do not have a very good infrastructure to build on, and the infrastructure that is in place is unco-ordinated and incoherent. States are doing things, non-government organisations are doing things, and various Federal departments are doing things. Sometimes they cut across each other. Sometimes even within the one government, one department does not know what the other is doing. This is an attempt to get co-operation between the various levels of government and the non-government organisations and some overall co-ordination of the development of the programs so we can see our way clear in the future to develop community services of the type that I think our people deserve. In the long run it will sometimes be more economically efficient. In the long run, sometimes, in regard to some disabilities it will be more expensive but it will certainly be socially more efficient and we will have a better form of service than we have had in the past.

Senator Peter Baume raised the matter, which I think I have dealt with, of psychiatric services and the disquiet felt by some people dealing with psychiatric patients. I pointed out that mental services of this type are essentially State responsibilities and have always been State responsibilities. For some reason the States have always guarded these responsibilities very closely. The Commonwealth is not now in the position to substitute for these services, but I emphasise that people with psychiatric disabilities, people with specific disabilities or members of specific disability groups, have access to HACC services if they are otherwise assessed as being in need of these home and community care services and these services are not being used as a substitute for State services. That is quite clear. I think the people in the area of mental illness understand this. They may be impatient, they may have hoped that we would step straight into this area, but I do not think we will do so for some time, until we establish things.

Senator Harradine talked of a couple of specific programs which have been mentioned in the discussion on home and community care services and which we are developing with the States at the moment. We are presently looking with the States at different transport service programs, which is a new type of service in this country. These programs will be not only for people in remote areas, although it is obviously important for them; they are also of importance for people in urban areas who have great difficulty in our urban sprawl with our public transport systems. We are presently considering the use of taxi vouchers or transport voucher schemes. Any new schemes of this type will be monitored closely. I will certainly be happy for any of the officers in my Department who have been involved in this area to talk to Senator Harradine about them. In regard to the no-growth services, we agree with Senator Harradine that we need to assess where the present funds are going, who is getting those funds, for what purpose they are getting them, and in particular what the need is, before we start to determine where we will spend large sums of new funds in these areas. There is a huge area of unmet need with regard to not only disability but also post-acute care and all the areas that were mentioned by Senator Harradine and Senator Peter Baume. If we could solve that unmet need by throwing in large sums of money and expecting services to bloom out of the ground, we would do so; but we would fail for certain, and we know it. So by carefully monitoring it and planning where we are going, I think we can succeed in the long run.

Senator Harradine brought up one more worry which I think is extremely important; that is, that if we get so obsessed with planning and with only taking steps forward where we can see quite clearly that we will not fail we are likely to have the problem of so much over control-so much excessive bureaucratic control-that people will get fed up and will not want to be involved in these services. For this reason, we have felt it terribly important to involve the non-government organisations and the local community organisations as much as possible in the planning. In the future I see as the ideal situation the local and non-government organisations, with a little assistance at Federal and State levels, being in a position to have a much greater part in the development, planning and administration of programs than they now have. In some ways, that would be a bit of a step into the unknown, but it is a step that I believe we have to take. We cannot go on, as we have in the past, with State governments, the Federal Government and non-government organisations going in all directions and not taking note of what each other is doing. We cannot go on, as we have in the past, plugging the gaps when we see them every now and again and not looking at some sort of coherent program to examine the needs of our population. I do not think we can go on, as we have done in the past, largely ignoring the potential which exists in the local government organisations in this country.

Local government should be a very effective form of government for the delivery and development of services of this type. In the past, local government in this country has been largely concerned-with some exceptions in Victoria and probably Western Australia-with building subdivisions and drains and not with providing directly services for people. I believe that the only way we can change that is to create an atmosphere where the sorts of people who are interested in these services and in their development will feel encouraged to get into local government. We cannot expect local government to change before we give it the capacity to do so. I think we have to demonstrate to it what is possible, and people such as those I have mentioned will get into local government and change it.

Senator Vigor —You have got to give them funds too.

Senator GRIMES —Of course we have to give them funds, but this community is full of people who have the capacity, the desire and the capability to help less advantaged citizens. They have demonstrated that capacity time and again. They have demonstrated it daily, as Senator Harradine said. Sure, they frequently need funds but, equally, they frequently need advice and a little assistance on how best to go about things. Above all, in many cases, they need a break every now and again so that they do not suffer the burn out, the depression and the terrible strain and stress that they can develop. Of course they need funds but they also need the capacity to utilise those funds and to learn how best to help one another.

We cannot solve this problem by my suddenly getting from the Government $1,000m or $2,000m and chucking it out into the commun- ity without knowing where it will go or how it will be spent. We can utilise the strengths and knowledge of people who are in the community, and, I hope, in the future we can utilise the latent capacities which exist in local government and, perhaps, we will get a system of services of community care of which we will all be proud. We will provide not only a system which is more economical but also services which are much better and more appropriate to the needs of the people.

I see this very much as the start of a long evolutionary road. I thank honourable senators for their support and good wishes. I thank all those who have helped me in starting off on this road. I wish everyone who will travel down it a little further considerable success.

Question resolved in the affirmative.

Bills read a second time.