Pre-Budget Submission 2019

CPSA welcomes the opportunity to make a submission to the 2019 Budget and would like to highlight the following federal budget priorities it has identified in the areas of aged care, social services and health.

Aged care – Home Care Packages

CPSA acknowledges that the Home Care Package (HCP) program has recently seen a significant expansion. The HCP program supplies almost 92,000 packages at the time of writing and a further 10,000 high-level packages were announced for immediate release in December 2018.

However, even with the significant boosts to the program, including the 10,000 high-level packages, the demand for HCPs continues to outstrip supply dramatically, with a total of almost 117,000 people waiting for program entry or for a package at the level at which they have been assessed.

The expansion of the HCP program is being managed in a way inconsistent with the Department of Health’s planning approach for residential aged care places, where the supply has always been tight but without the quite extreme supply and access problems evident in the HCP program.

Since February 2017, when Customer Directed Care (CDC) was introduced and HCPs were no longer caught by the definition of an ‘operational place’, the Department of Health no longer reports on the provision ratio of HCPs. Prior to the introduction of CDC, the Department of Health reported the provision ratio for residential and home care places and used an overall provision ratio of 125 places per 1,000 people over 70 to be achieved by 2022, 45 of those being for HCPs. The Department continues to report the provision ratio for residential places, but not the provision ratio for HCPs and it is not clear if the target of 45 HCPs per 1,000 people over 70 is still operational.

At the same time, the Home Care Packages quarterly data reports reveal the inadequacy of supply arrangements, with two-thirds of people who had an HCP being allocated an HCP at a lower level than for which they had been assessed. The same quarterly report shows that almost 90,000 of those waiting on an HCP also have approval to go into residential aged care, which would be overwhelmed if those so assessed wanted to exercise those approvals. There clearly is an overall shortage of supply of aged care places, residential or at-home.

There is a lack of transparency regarding what aged care supply planning the Department of Health is carrying out. There have been some large, ad hoc increases in the number of HCPs without an explanation of whether the Department is working towards the elimination of the HCP waiting list or what its objective might be. Over the past two years, there has also been a move away from allocations of residential aged care places. In the 2016-2017 year there was no Aged Care Approvals Round (ACAR), while for 2017-2018 the ACAR had a focus on residential aged care in rural and regional areas, where a supply shortage exists.

However, what the increases in HCPs and the reduced ACAR activity suggest is that the Government recognises that HCPs rather than residential aged care places are the future of aged care.

To ensure adequate supply of aged care places in residential aged care and in the HCP program, the Government needs to present an aged care supply plan, identifying targets and committing the funding to achieve those targets.

Social services – Newstart

Newstart as a security net payment is itself in need of a security net. Partnered people have a total weekly income of $564.20, or 18 per cent below the poverty line of $691.58. Single people are in an even worse position with a weekly income of $344.70, or 33 per cent below the poverty line of $516.99.[1]

Newstart plus Energy Supplement is 40 per cent less than the Age Pension plus the Pension and Energy Supplements and stands at $550.20 per fortnight for singles (Age Pension rate $916.30) and $993.40 for partnered people (Age Pension rate $1,381.40). Over-60s who are single and have been unemployed continuously for nine months receive an additional $44.90 a fortnight.

Newstart is increasingly becoming an ageing issue. The largest age cohort of Newstart recipients are the over-55s (of working age) with just over 185,000 on this payment, making up 22.4 per cent of all recipients. The proportion of the over-55s population (of working age) on Newstart is also the largest: 12.6 per cent of over-55s rely on Newstart for income support. For those aged 65 the situation is even grimmer: 17.3 per cent of all over-65s (of working age) rely on Newstart for income support.

Sources: for population data, 3101.0 – Australian Demographic Statistics, June 2018,

Australian Bureau of Statistics; for Newstart and Youth Allowance data, DSS Demographics

March 2018, Department of Social Services.

The already high proportion of over-55s on Newstart is set to increase due to two factors. First, the number of people over-55 in proportion to the overall Australian population is increasing, which means more will spend time on Newstart before they reach pension age. Second, the Age Pension eligibility age was 65.5 at the time to which these data relate, but will go up to 67 by 1 July 2023. This means a longer wait for over-55s on Newstart until they reach pension age. Combined with an increase in the number of new entrants, existing Newstart recipients staying on this payment longer will significantly increase the overall number of Newstart recipients.

CPSA submits that there is no need in a wealthy country like Australia for anyone genuinely unable to find employment to be condemned to such extreme financial hardship and the social disadvantage accompanying it. The Newstart Allowance should be raised to a level where the long-term unemployed no longer live below the poverty line.

Social services – Social housing

CPSA calls for an adequate investment by the Australian Government in social housing construction. As the respected Australian Housing and Urban Research Institute (AHURI) has reported, Australia needs to triple its social housing stock over the next 20 years to cover both the existing backlog and newly emerging need.[4]

The current backlog and newly emerging need for social housing dwellings will lead to a total shortfall of 727,000 dwellings by 2036 if nothing is done. The effect on the rate of homelessness would be surpassed only by the devastating effect on human lives, young and old.

The current construction rate of around 3,000 dwellings a year cannot keep pace with rising need or even make inroads into the backlog and fixing the problem of both the backlog and newly emerging need calls for a major program of social housing construction. Simply preventing the existing problem from getting worse calls for nearly 15,000 extra dwellings a year to be built. To eliminate the backlog would require an annual program averaging 36,000 units.

The required increase in social housing construction sounds significant, but it is a rate Australia managed in the past. Direct government investment in social housing is ultimately far more efficient and effective than subsidising private sector investors in the long term.

CPSA submits that the Australian Government should include a Minister for Housing and should develop and fund an adequate social housing construction plan to be executed by the states and territories.

Health – Dental care

Dental care is one of the greatest areas of health inequality within Australia. The majority of the health related calls CPSA receives from members and constituents are concerning access to affordable dental care. Public dental systems are massively oversubscribed and underfunded. As a result, in NSW alone, over 74,000 adults are awaiting treatment on the public dental list and over 19,000 are waiting to be assessed.[5] The system is essentially only able to provide treatment to those on the top of the priority list. Those who are categorised as lower priorities will only receive treatment once their condition has deteriorated to the point that they become a higher priority or if they can scrounge enough money to pay for treatment through the private dental system.

Delayed treatment due to public waiting lists and high out-of-pocket costs for private dental treatment is not only detrimental to the individuals who suffer immense pain and diminished quality of life, but also has flow-on cost effects for the broader healthcare system. Untreated dental issues are one of the leading causes of potentially avoidable hospital admissions in NSW. It is much more expensive to provide emergency dental treatment to those with serious, long term issues than it would be to provide treatment at first presentation so that the patient’s condition doesn’t deteriorate to the point of needing emergency care.

Dental health care can no longer be considered separate and secondary to general health care. The two tiered dental system in which pensioners and low income Australian’s either go without or receive inferior dental treatment needs to be addressed. CPSA urges that that the Australian Government increases funding to state and territory governments for public dental care to ensure that all citizens, regardless of income, have access to timely dental care.

[1]  Poverty Lines: Australia, June quarter 2018, Melbourne Institute.

[2] The age group 16 – 20, which receives Youth Allowance, has been included as receiving Newstart.

[3] The data used in this submission relate to the period during which the Age Pension age was 65.5.

[4] Social housing as infrastructure: an investment pathway, AHURI, November 2018.

[5] NSW Health (2018) ‘NSW public dental services – waitlists and activity’ , Table 2: Number of NSW residents waiting for dental assessment and treatment as at 30 September 2018, Accessed at: https://www.health.nsw.gov.au/oralhealth/pages/public-dental-care-waiting.aspx