Press Conference - Parliament House, ACT

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25 Nov 2019
Prime Minister

PRIME MINISTER: Good afternoon, everyone. One of my first acts as Prime Minister was to call a Royal Commission into the aged care sector. And also to look specifically at the issues of young Australians who find themselves in aged care facilities around the country. I said at the time that I believed it would be a very uncomfortable exercise for all Australians as we listen to the stories and were shocked and disturbed at the treatment of our older Australians in their moments of greatest vulnerability. I think there are few families around the country, my own included, who are not unfamiliar with the difficult decisions that are made about relatives and loved ones who are placed into aged care facilities, whether those are residential facilities or they're accessing in home care. It's a very sensitive issue. And rightly so for all Australians. And in commissioning the Royal Commission, my intent was to ensure that we could shine quite a bright light, that we could learn deeply from the experiences and the practices that the Royal Commission was able to identify, and to assist us to deal with an issue which is not new. The Royal Commission's interim report, has talked about settings and processes and issues that are not new, that go back over many administrations, over a long period of time. But it befalls to our Government to be able to address the issues that are being identified out of the Royal Commission. And as we've had the interim response report from the Royal Commission, it is now our task to provide an immediate response to that Interim Report, as I promised I would do before the end of the year. Addressing the specific issues that they highlighted in that Interim Report. These responses together do go to those matters.

But I want to stress again that what we really need to establish above and beyond everything else is a culture of respect for older Australians. That this cultural change that has once again been highlighted I think by the Interim Report of the Royal Commission, that requires a broader response than just from governments, it is something that goes to each and every Australian home and family around the country. And so we will do our part as part of making that shift in that culture and also to do the practical things that are necessary now. Of course there will be further responses that will be made in this area. There’ll be further responses in the Budget. There will be further responses in respect of the final recommendations of the Royal Commission or other matters as they arise. Today's announcement is our immediate response to the matters that were highlighted by the Interim Report of the Royal Commission.

So let me run through these, there will be an additional funding package of $537 million provided to the health portfolio. That will address three priority areas. The first is investing just under half a billion dollars for an additional 10,000 home care packages. Secondly, there's just over $25 million to improve medication management programs to reduce the use of medication as a chemical restraint on aged care residents and at home. There will be $10 million for an additional dementia training and support for aged care workers and providers, including to reduce the use of chemical restraint. And there will be additional funds, just $5 million to help meet new targets to remove younger people with disabilities from residential aged care and I stress that funding is in addition to the funding that already exists within the National Disability Insurance Scheme which I'll ask the Minister to speak of directly.

Now this work in terms of addressing the issues that were highlighted in the Interim Report of the Royal Commission, reflects work that is already under way and has been for some time now. Already we have increased the number of In Home Care Places by 44,000 since the 2018-19 Budget alone. At a cost of some $2.7 billion, including today's announcements. Already we have seen the number of young people in aged care facilities fall from 6,287 to 5,606 on the most recent information and there is further work to do there and the Minister will set out the works that we have in train to also address that goal. But before handing over to the Health Minister, I want to assure all Australians that we will deal with these issues as you would if you were standing in my shoes today. I know quite precisely the sorts of things that you are thinking about at the moment when it comes to the treatment of your loved ones in aged care. My family is no different to yours in that respect. And so I have a very deep understanding of the difficult decisions that you're having to make, the conversations you're having to have with the partners, husbands, wives of those loved ones going into care, other siblings. This is hard. And you just want to be assured that they're going to get the care. I want that as much for your family as I want it for mine. I want the response of our Government to have that same level of deep care and responsibility. Greg.

THE HON. GREG HUNT MP, MINISTER FOR HEALTH: Look, thank you very much, Prime Minister. Firstly to acknowledge the work of the royal commissioners. They have fearlessly examined the challenges that Australians face in providing for their later years. I acknowledge both Commissioner Briggs and particularly Commissioner Tracey who passed away. And he worked until his very latest days, whilst he was facing a terminal condition. He was determined to finish this report. In a way this Interim Report is his legacy. So I particularly want to acknowledge and thank them for that and for the fearless but constructive way in which they've gone about it. The Interim Report sets out as the Prime Minister said, three initial priorities. They are findings as opposed to recommendations, but we have acted on those priorities and findings. Firstly in relation to home care, we accept the views of the royal commission that there needs to be a fundamental reform to unify the home care and home support programs. That is a long-term reform which will bring about a very significant change. Tailored care for our older Australians, whether it's in home with lower needs or in home with higher needs. And we're going through a fundamental change already but this is an absolutely indispensable step forward to make this home care system something which will address the needs of every senior Australian. Secondly, as part of that, there is the immediate provision of 10,000 places. And those places are about ensuring that there's additional care and that is tailored to meet the capacity of the work force to expand. The commission was very, very clear on this, as was a previous royal commission about the need to expand the work force in line with the capacity for safety and quality and that's been a very important part of our deliberations on that front. And then as we do this we will also have a single assessment process. That then brings me to what we're doing in relation to dementia and medication management. The commission found there had been medication management used as a form of chemical restraint in circumstances. We immediately acted on the day of the report to have the safe and quality use of medicines raised through the COAG Health Council to be a national health priority for the first time. Now we are moving as of the first of January, to ensure that the medicine Risperidone is only available for a 12-week period without a subsequent approval. This is a very, very important step forward. Risperidone has been identified as an anti-psychotic which has been the subject of overuse and over prescription for chemical restraint purposes. We have worked with the PBAC, with the AMA, the College of GPs and with other parts of the medical and health profession. This will provide a break, a restraint and an oversight on the use of antipsychotics in our aged care homes to protect our residents. As well as that, as the PM mentioned, there will be $25 million for medication management to ensure more frequent medication management and $10 million to support the training of dementia workers in terms of aged care. So it will support them, be able to better provide for, better care for, and better take care of our senior Australians with dementia. Minister Robert will address in more detail what we're doing with younger Australians in aged care but the bottom line is that we're accepting the three goals which the royal commissioners have set out as being the new targets which Australia should embrace.

PRIME MINISTER: Thank you. Richard?

SENATOR THE HON. RICHARD COLBECK, MINISTER FOR AGED CARE AND SENIOR AUSTRALIANS, MINISTER FOR YOUTH AND SPORT: Thanks, PM. Just in respect of the new home care packages, as the Prime Minister and Minister Hunt has indicated, there's an additional 10,000 packages that will become available, commencing from the first of December this year. 5,500 packages in the first year. And that's at a cost of just under $500 million. So significant investment. And the additional work we're doing with respect to training staff and providing assistance for people in crisis with dementia care is also going to be extremely important. That's $10 million going to some existing programs that are currently receiving about $37 million a year. So that will bolster that work which builds on the work that we're already doing. And it's important to note, as the Prime Minister has, that we have put an additional 44,000 home care packages into the system since last year's Budget, at a cost of $2.7 billion. So not only do we recognise the need to act off the back of the Royal Commission's Interim Report, we have recognised that for a period of time. When we came to Government there were about 60,000 home care packages in the system. This additional investment will bring the figures for this year to 150,000. That is a significant increase in the capacity of the home care sector and the Royal Commission did note that the demand for home care packages has increased significantly as we've put additional capacity into the market. So just flooding the market with additional packages is not something that they recommended we do. But they said we wanted additional capacity and they did point to the need they do a couple of things. One is reform the way, change the way that the home care was delivered. But also to bring into place the single assessment process which prevents people cycling through a number of assessments as they require delivery of their home care packages.

PRIME MINISTER: Thank you, Richard. Stuart?

THE HON. STUART ROBERT MP, MINISTER FOR THE NATIONAL DISABILITY INSURANCE SCHEME, MINISTER FOR GOVERNMENT SERVICES: Thanks, PM. As the Prime Minister says, the Government has fully embraced the interim recommendations of the Royal Commission in terms of meeting the younger persons in residential aged care targets who by 2022 no younger person under the age of 45 and no new younger people entering aged care and everyone out of aged care under the age of 65 by 2025. If that is their choice. The vast bulk of younger people in residential aged care are NDIS participants as of the 30th of June, 3,788 of them. They all have individual plans. A task force or joint agency task force has been set up between the Department of Social Services, the NDIA and Health to action these strong commitments and goals of removing younger people out of residential aged care. There are 40 staff already in there growing in the coming months to 80. We'll be working with all sectors of the economy, including service or specialist disability accommodation providers and providers of supported independent living to ensure these targets are met. Pleasingly, the last two years we've seen 11% reduction of Australians or younger Australians in residential aged care. In the last two years we've seen a 22% reduction in the quarter by quarter number of new people entering. So the work the Government is doing, and especially the NDIA, is starting to work and I'm looking forward now to finalising, in line with the Royal Commission recommendations.

PRIME MINISTER: Thank you. Now I’m happy to take questions. Obviously this is an initial response. There is more to be done and more will be done. Let’s go to this announcement and then other matters, Phil?

JOURNALIST: Just asking in terms of the Budgetary impact, you announced the infrastructure spending last week and now the home care stuff today, you’ve announced the drought funding, is that a it now for significant new infrastructure in the MYEFO?

PRIME MINISTER: Well MYEFO will be in December and you can tune in then. These are the substantive items as you would expect them to be. MYEFO process hasn’t fully completed as of yet and ERC continues to meet and we'll continue to work on a range of issues but all of this will obviously be reconciled in the midyear statement. Mal?

JOURNALIST: Prime Minister, are there any further measures that might be appropriate to guarantee the financial stability of homes for the aged? There are some concerns that their viability in some areas and I think Mr Robert would be very aware of this, might be going down the gurgler. Is there anything the Government can do further?

PRIME MINISTER: There are some measures that we are currently working on with the Minister. Richard, you might want to comment on this. We're aware of specific cases where these viability questions arose. And we also need to acknowledge this is a sector that's also going through a lot of change. One of the most obvious findings, not just of what the interim report of the royal commission has determined, but frankly what is well known in the sector. Is that people when they're going into aged care now are going in for a shorter period of time. This is residential aged care, and requiring a much higher level need of service, dementia and so on. And so the funding and structure of these commercial centres and not for profit too, by the way, obviously is impacted by that change in how demand is finding its way into the system. A lot of facilities have been built on longest stay, lower care requirements. People off sometimes not choosing not to take those places up and stay at home and get an in home care place. So it's a sector going through a lot of structural change, as you'd expect. That's largely because of the choices Australians want to make. Let's not lose sight of this. The Government's job is to ensure that we're facilitating the choices that Australians want to have as they grow older. As their health care needs change, as their support needs change. It's not to run an institutional system. It's not an end in itself. The purpose is to help people with the choices they want to make about their future. And that means there’s some adjustment that takes place, that we have some measures that we think can assist individual circumstances but we are very cautious that we don’t set any negative incentives in how we might accommodate that. Richard?

MINISTER COLBECK: Just a couple of things, to make the point that today's announcement is very much about a response to the Royal Commission report, not about other things. So we're specifically responding to what the Royal Commission talked to us about in their interim report. Secondly we are also working at the moment on a new methodology for the remuneration of aged care facilities. So they've been paid under an instrument called ACFI that's been in place since about 2008. That's generally recognised as not being fit for purpose any longer. So we are now trialling a new model. That trial starts this week. It will be completed by the end of the first quarter next year. And that changes the way that we recompense aged care facilities much more on the basis of assessing the care needs of the individuals and then making payments to the facilities on that basis. So that's a new process that we're going through. And we will look to progress that so that we can bundle that in with other reforms as we get closer to the end of the Royal Commission process so that there is a larger single set of reforms that are going through. We're obviously aware of calls that have come from other parts of the sector right now. And as the PM, we're working on some options as to how we might handle those things on a specific business by business basis.

JOURNALIST: Just on getting the younger people out of residential homes, you said there was about 5,000 still in. What do you anticipate, would you, are you hoping to get the bulk of those out in the next year or will it sort of being evenly staged up to 2022?

MINISTER ROBERT: The targets we have agreed with the Royal Commission, which are their interim targets, is that all those under 45 – it’s about 170 Australians - out by 2022 and no new Australians going in, which means extensive work with ACAT as well as providers. And then ensuring the rest or the bulk of other Australians are out by 2025, where it is their choice to do so, noting that under the NDIS participants have choice and control. So there will be circumstances where younger people may wish to stay. A classic example would be a middle age Australian, with disability, who wants to stay with mum who's in a nursing home, would be a good example of where they may exercise that choice and control to stay.

PRIME MINISTER: It is also worth making the point, though, I think, Stuart, there are those who are in facilities that are in palliative care as well. There are a number of those. Those arrangements are obviously very sensitive. So when you look at this issue of younger people in aged care facility, not everybody is in the same set of circumstances. And what we want to do is respect the circumstances they’re in, and empower families to make choices and individuals more importantly to make choices about where they would like to be.

JOURNALIST: So where will they go? The 5,000 young disabled people from – will they go into other institutional care? Or will they go home?

MINISTER ROBERT: 3,788 are in 1,416 facilities across Australia. So we are working with disability providers and specialist disability accommodation providers to house them. So for example we right now have 3,500 specialist disability accommodation SDA houses. An increase of 89 per cent from last year, with 990 registered providers to build. So we will be working with all those 990 to identify bespoke housing options, to line up with bespoke NDIS plans that each of those participants have. In line with what the Prime Minister said remember there is 372 Indigenous Australians over the age of 50 who are currently in aged care. 11 per cent are in palliative care as well. So whilst the bulk is NDIS, it’s not the total.

PRIME MINISTER: There is a lot more investor interest going into the development of disability accommodation, particularly for young people. The Youngcare model, you have heard me talk about many times before, we have just been introducing taxation incentive arrangements that will support that type of investment. Because where you have an income support system going into disability care as well, that provides obviously a revenue stream for people's residences, which is something that investors can then go and develop those properties. We're seeing some, I think, fantastic interest in that. That's going to grow into the future, which is tremendous.

JOURNALIST: Prime Minister, what assurances can you give Australians that its political system, its very Parliament, hasn't been infiltrated or sabotaged by Chinese operatives?

PRIME MINISTER: I will come to that. I want to make sure we’ve addressed all the aged care issues that people would like to raise?

JOURNALIST: In the report there is a great deal of emphasis on chemical restraint. You are talking about training people to stop the misuse of chemical constraints. Is there any aspect of policing to ensure the - reassure the public that chemical restraints will actually be – or the misuse of them - will be detected in institutions?

PRIME MINISTER: Greg did you want to answer that?

MINISTER HUNT: A very important part of the medication management is ensuring that there is monitoring. So, what we see is, of course, that each person has a different medication regime, and dementia, by its nature, in some cases can lead to behaviours related to self-harm, or uncontrollable physical violence. What we have to do is two things. One is to ensure that a person is able to get the right medication for them, and that's where we have both the medication regime for individuals, which is $25.5 million going into that, and then, secondly, where we now specifically have for the first time the authorisation for any extended period beyond 12 weeks of anti-psychotic use of Risperidone. So that is an external verification program. That's been quite a challenge for some in the medical community. But I want to thank the AMA and College of GPs for their support. It is a big change. But they have accepted and embraced it.

JOURNALIST: You have said today on this announcement obviously on the Interim Report, there is more to do. Obviously, the Government has to get the final report of the Royal Commission. I’m interested in general terms whether or not - given you have said today the aged care sector is in a period of transition - and the Minister mentioned there's a change to the funding model. Do you see the Government at the end of this process looking at the same aged care system that exists today and tweaking it here and there, topping up funding here and there, or do you envisage the Government will propose something quite different from what exists today?

PRIME MINISTER: Well, what I envisage is over the next 12 months the Royal Commission will do its job and I think the Royal Commission will establish, I think, a very strong cause for action and will guide us very significantly in the scale of that change. What I can assure Australians is we're up for that. I wouldn't have called this Royal Commission if I wasn't up for dealing with the - what I knew would always be the significant ramifications of what would come forward. I think it is necessary to have the Royal Commission process, which I think sets the ground for making that sort of scale of change. How large those changes are, it's too early to say. But one thing I won't do is proceed in an incautious way. What we need to do is, I think, be informed by the advice we're getting. We're already investing a billion more in aged care every year. We’re already doing that. I mean you heard the figures from Richard. From 60,000 in home care places to 150,000 on our watch. The demands will change too. We need to understand that into the future. And the training and skills requirements of those working in the sector, and where - that is a huge part. If it was just as simple of funding a whole bunch of new places and everybody would be alright, well, that’s not what we're faced with. Because the system itself has to be able to gear up to respond to those challenges and we need to make the changes to the system so it can actually absorb and make best use of this new support. So, I echo what Greg said in thanking the commissioners. They are doing what I asked them to do, and that is to set the platform, to ensure that we can have lasting change for a new generation.

JOURNALIST: PM, it is time for security vetting of MPs and Ministers?

PRIME MINISTER: On what basis?

JOURNALIST: On the basis of allegations that Chinese and perhaps other overseas interests are trying to influence and infiltrate our Parliament?

PRIME MINISTER: What Australia has done under our Government is to strengthen the legal regime, to strengthen both the integrity and capacity of our intelligence and our law enforcement agencies, and to ensure the Government is informed through the National Security Committee on the impacts of foreign interference like no government has ever been advised and informed before. Significant investment, significant legal reform, significant resourcing, finding the best people in the world to do these jobs, and keep us equipped to keep Australians safe and to protect the Australia that we love - that's the assurance I give Australians.

JOURNALIST: Are you surprised at how aggressive the Chinese Communist Party has been in its attempts to interfere in our democracy?

PRIME MINISTER: Well, I will make a more general comment. I mean, a range of allegations have been made. The Director-General of intelligence - of sorry - ASIO has issued a statement, which says that these matters were already under examination and that will continue. So I'm not going to draw any conclusions about that one way or the other, as is appropriate. What I can say is Australia is not naive to the threats that it faces more broadly. And I mean more broadly. More broadly. And that's why we strengthen the laws, that’s why we increased the resources, that's why we established the Department of Home Affairs to bring together all of this in a single portfolio, to ensure Australia was in the best possible position to deal with any threats that come our way broadly. Or specifically.

JOURNALIST: These laws have been in place for 18 months now. You talked about the resources. The former Director-General of ASIO raised the point in his farewell annual report that it's going - foreign interference is going on at unprecedented rates. When we are we going to actually start seeing some arrests, some expulsions of diplomats and what not?

PRIME MINISTER: Well one has already, one had his visa cancelled and he wasn't allowed to return to Australia quite recently. That happened under our watch. I'm not sure if you're familiar with that case. But what I am referring to is that the resources and the regime has been put in place to do its job, and any improvements, any additional matters that we would need to look at, on the basis of advice to address that, and the government would obviously - based on our record and our form - we would do that. So, these laws and these resources - and these institutions - are world-class. I mean, when I speak to other leaders, they look at our laws and they say, "We want more of what they are having", when it comes to protecting their countries. They want the integration that we have between our agencies. They want the legal frameworks that we've had that the courage to establish, and defend, and defend in response to criticism of those laws. So, I can assure Australians - our Government will never be lacking on the watch when it comes to protecting Australia's legitimate interests in this area.

JOURNALIST: The Chief of the Defence Force has also described this as a kind of grey zone warfare, which is another term that we hear about. Do we have the spending of our defence and intelligence money right? We're spending a lot on big kit. Perhaps is there more to be done on the home front, do you think, in terms of resources that could be devoted to these organisations, which are pursuing this kind of interference?

PRIME MINISTER: When I refer to the investment we have made in agencies and resources, I'm not excluding the work of our ADF and the ASD and other important agencies. They are very much part of our planning, our preparations. They have been integral to the work that we have already done. You mentioned the previous Director-General of ASIO. He was monumentally involved in setting up the very systems to ensure Australia is protected against whatever threats may come at us right now. And so I'm not surprised he would make those remarks, because they were the same remarks he would make when he would be advising and recommending action which we adopted.

JOURNALIST: You have spoken about the broad threats that Australia faces. Could you, perhaps, comment on the specifics of this allegation that China tried to infiltrate the political party that you lead in order to corrupt, in a way, Australia's democracy?

PRIME MINISTER: I find the allegations deeply disturbing and troubling. And I refer you to the Director-General's statement, which said that these matters were already under investigation, and those investigations are continuing. I would caution anyone leaping to any conclusions about these matters. And that's why we have these agencies. I'm not. But I do find the allegations troubling and disturbing.

JOURNALIST: Prime Minister will you grant the alleged spy asylum if the agencies find that it’s warranted, regardless of any threats of retribution from our biggest trading partner?

PRIME MINISTER: Well, I think we have to separate the issues here. Asylum claims are assessed on their merits, through an independent process which is run through the Department of Home Affairs by the relevant officials. And that is the same case for this person, or anyone else who might make such a claim. That claim would be assessed about what they would be - a reasonable fear of persecution in their home country. If they were to make judgements along these lines, that would necessarily mean that any allegations they've made, were true or untrue, it would just simply go to the specific circumstances of that individual. Now, I expect the department to make their decisions in the ordinary course of events, and they will do that. And we will honour our obligations, as we always do, under the Refugee Convention.

JOURNALIST: Was this matter raised when you spoke to Donald Trump this morning?

PRIME MINISTER: I don't go into my private conversations with the President. What I can say though- but I thank you for the question about speaking to President Trump this morning. It was a great opportunity to say thank you to the President for the amazing work done to get Tim Weeks out and to get him on his way home. We appreciate the tremendous work they’ve done in relation to that case. We work with them on many such cases. He was also very interested to know how we were going in relation to the terrible bushfires in Australia. He was very aware of that, and had been very impressed by the firefighting efforts of Australians, and I also thanked him for the participation of our friends from the United States - as we do from all of the other countries - who are participating and helping us. So that was another good opportunity. We talked broadly about strategic issues in the region, like we always do, because we both have a keen interest in those. And - so that was pretty much a good summary -

JOURNALIST: So he didn’t raise it and neither did you?

PRIME MINISTER: I think I’ve answered the question, and in a way I was happy to do it.

JOURNALIST: Have you spoken to Tim Weeks since his release?

PRIME MINISTER: I haven't spoken to Tim as yet, but I have spoken to his family. They were very grateful. Very, very grateful.

JOURNALIST: Prime Minister can you guarantee the safety of Mr Wang and his family while his asylum claim is processed?

PRIME MINISTER: Well he's in Australia. He's in Australia. And we have the rule of law in Australia. And as a result then you can expect the same protections to apply to anyone who is living in our country, whether on a visa or any other arrangement. I've made it pretty clear that the Director-General of ASIO has issued a statement on this matter about how it's being handled, and that's exactly how it should be handled. So, I can assure Australians that under our Government, the resources have never been stronger, the laws have never been tougher, and the Government has never been more determined to keep Australians free and safe from foreign interference. Thank you very much.