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Wednesday, 9 November 2016
Page: 2391


Senator SIEWERT (Western AustraliaAustralian Greens Whip) (18:08): I move:

That the Classification Amendment (CHC Domain Scores) Principles 2016, made under the Aged Care Act 1997, be disallowed.

Thirteen sitting days remain, including today, to resolve the motion or the instrument will be deemed to have been disallowed.

I move this disallowance motion on the Classification Amendment (CHC Domain Scores) Principles 2016. This is an instrument that has implemented changes to certain scores in the scoring matrix. I am sorry this is so complicated, but for those who are not necessarily au fait with such intricacies this is about aged-care funding. It is about the complex healthcare domain within the aged-care funding instrument; henceforth, I will call that ACFI. This tool is used to fund residential aged care. The changes to the scoring matrix affect the level of funding for the complex healthcare domain for new appraisals or reappraisals of existing residents. The ACFI tool is about how much funding—that is the bottom line—residents in aged care get. It is a tool that looks at all the different issues that need to be addressed while someone is in residential care. The instrument that I am seeking to disallow is around the funding that is available for the complex healthcare domain for a resident in aged care.

The changes to the matrix downgrade two of the categories in the matrix. Ansell Strategic has produced modelling on the ACFI changes for UnitingCare Australia, Catholic Health Australia, and Aged and Community Services Australia. The summary findings provide that the July 2016 ACFI changes will result in facilities receiving $1,890.70 less per annum per resident. I must admit that it is quite complicated, because there are a series of changes that either have been made or are proposed to be made to the ACFI instrument; hence, the referral to the time when some of these change will come into effect. Some of the other changes will into effect in January and at other times. This one came into effect in July 2016. The instrument was registered on 17 May this year, and the changes came into effect on 1 July this year. The changes contained in this instrument will apply until 31 December this year, at which time the new complex healthcare matrix—just when you thought it could not get any more complicated, it has—is set to come into effect.

The changes to the scoring matrix are one of a number of changes, as I said, to the ACFI that were included in the 2015-16 MYEFO changes and also in the 2016-17 budget. Collectively, the changes to the ACFI will cut $1.6 billion in funding from aged care. The modelling by Ansell Strategic shows that these cuts will in reality reduce funding to the sector by more than $2.5 billion or by $6,655 per resident per annum. Many providers and aged-care residents across the country have raised concerns with me about the impact that these cuts through the ACFI will have. Changes to the complex healthcare domain will impact on people suffering from chronic pain, degenerative diseases, severe arthritis and complex wounds. UnitingCare Australia has said of the cuts:

The changes will put increased pressure on the public hospital system if the viability of residential aged care service providers is threatened …

They were also very concerned about the disproportionate impact on services in regional and rural Australia.

The Senate is also conducting an inquiry through its Community Affairs References Committee into the aged-care workforce. When we talk about the aged-care workforce the ACFI cuts come up, because they have direct implications for the workforce. Again, I am not seeking to pre-empt any of the findings or anything like that from the workforce inquiry that I am chairing and that Senator Polley, who will be speaking shortly, has been very active on. Some issues in that inquiry have crossed over, as I said, to ACFI, because workforce issues relate in part to funding. While we have been holding that inquiry, this issue has come up. I would like to read what some of the witnesses have said in that inquiry. Just last week in Tasmania—

Senator Polley: In Launceston.

Senator SIEWERT: Yes, we were in Launceston. Ms Murray, an aged-care worker, was a witness at the inquiry. She told us of her experience:

At my facility, when those cuts came we lost three hours a day of nursing hours . For the 98 residents that we are required to oversee on every shift—one RN per 98 residents, every shift—we now have 15 minutes to hand over—

This is when shifts change and they have a period of time to talk about each patient to the new shift coming on. That was explained to us during the process—

we used to have additional time—for two RNs to get together for complex problem solving. I am not aware of the exact figures on how many hours for enrolled nurses were lost but there were a few as well as the ECA. The whole roster has recently been restructured so that the care workers' hours have gone down quite a lot. At the end of the day, this impacts on the time that the registered nurses have for doing wound care and, as mentioned previously, residents waiting for the bells to be answered and things like that from the ECAs.

I could spend the whole of my time talking about the evidence that we received from people during the inquiry about the impact of the funding cuts.

When Ansell Strategic was doing their survey and analysis, some of the quotes that they received regarding people's concerns about these cuts included: 'As we approach person-centred care, we would like to be able to continue to provide holistic care for our residents and continue to do what we have always done. However, we are required to strategically think and structure our facility to remain viable in the future. The funding changes are likely to cut care hours.' In fact, we just heard that they have and, of course, future cuts are likely to cut them even more. Another comment that was made was: 'We'll be sending more residents to hospital and not providing complex treatment in their own environment. We will reconsider admitting potential residents with complex needs.' Another was—and this came up during our most recent inquiry as well: 'Our physiotherapy program is the core of our Living Longer Living Better initiative for our residents. To cancel this program would be catastrophic for our residents, impacting pain management, mobility, independence, continence—to name just a few unacceptable outcomes.' Another was: 'My major concern is the viability of our small rural residual care facility in the future with these ongoing cuts. We are not a large care provider and, if we are forced to close, our small rural community would have to send their elderly away from the district, community support and family.' You get the picture. People are deeply concerned about the impact of these cuts.

Ad hoc tightening of ACFI is about government saving money and not genuine reform. These cuts will hurt some of the most vulnerable older Australians in care. The sector has also raised concerns about the lack of consultation and transparency in the cuts that the coalition plans to make to aged care. These concerns highlight the need for a full cost-of-care study, which the sector has been calling for for a long time. Such a study needs to be fully consultative and engage with the sector. At Senate estimates there was evidence given regarding the government's recent consultation through the sector, notably after the cuts had been made. They are more about the cuts that were in the 2016-17 budget. Also, they talk about the need to start sharing some of the modelling that relate to the ACFI cuts. This is welcome news. However, given the quantum of the savings that is not up for discussion, the quality of care and the availability of care into the future will still be compromised because, as I said, what is being discussed is not all of the cuts that are being made to ACFI.

At this point I would like to put on record my disappointment that, in fact, we have not been able to have an inquiry into the ACFI funding instrument and the cuts that are proposed. I think that is a particularly important thing that we should be doing. One of the 2016-17 budget measures—specifically the halving of indexation for the complex healthcare component of ACFI—has been implemented through the Aged Care (Subsidy, Fees and Payments) Amendment (July Indexation) Determination 2016. That is a separate instrument that we could have tried to disallow. We purposely have not as that instrument included indexation to the activities of daily living and the behaviour domains of ACFI, and we did not wish to disallow that particular instrument, although part of it has had a negative impact.

One of the related MYEFO changes—specifically the strengthening of compliance for residential care funding at a saving of $61.9 million over four years—was passed with a tranche of other measures in the Budget Savings (Omnibus) Bill 2016. However, today senators in this place have an opportunity to disallow the changes to the scoring matrix for the complex healthcare domain within the aged-care funding instrument, ACFI. I would encourage you to please consider doing this. Australia's population is ageing and we need to make sure that we are providing quality care for older Australians. We need to develop innovative and creative solutions to the challenges but ensure that we are providing proper funding and enough funding to meet the needs of older Australians into the future. We do not want to see the level of care being provided to residents with complex healthcare needs suffering due to the government's changes to the scoring matrix. The government's cuts are going to hit the sector hard and are hitting the sector. We have evidence around that from the Senate inquiry that is looking into the workforce, as I mentioned earlier. This adds further uncertainty to the sector. These cuts have not been properly scrutinised and they are going to have an effect.

Rather than taking a swing at the aged-care funding instrument, the government should undertake a full cost-of-care study and proper review of ACFI. Nobody is denying that ACFI should not be reviewed. It is a complex instrument. It has been in place for quite a long time and it is due for a review, but do not do that on an ad hoc basis. This would inform funding decisions into the future. The government are currently talking to the sector. That is too late. They should have been doing it beforehand. They still have not handed over all the documentation and the modelling upon which they have made their funding decisions—in particular, the cuts that were going to be made through the 2016-17 budget. Although the government are prepared to look at other measures instead of further cutting and further changing the complex healthcare domain, there is still the same quantum of cuts, so that funding still has to come out of aged care. There are a number of alternative approaches they could have taken. They chose not to. This instrument does affect patient care. We do not think it should go ahead. We think the government should be taking a different approach. They should be more consultative and develop a process that will see the sector viable and sustainable into the future, not suffering cuts every couple of years when the government decide they want to make some funding available for something else. We do agree with the government that we do need to make sure that we are spending money wisely. There is no doubt about that. We do agree that ACFI has probably outlived its usefulness and needs reform. We think we also need a cost-of-care study to understand what the true costs of care are.

We urge the Senate to support this disallowance motion and to continue to work with government to find a way forward for the reform that is agreed across the board we still need to see. Even though we have seen changes to Living Longer Living Better, which have made significant progress, there is still more reform that needs to be done, and that includes looking at the ACFI instrument and how that can be reformed. I urge you to support this disallowance motion.