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The $3 Billion Senior Squeeze

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I recently asked questions about the government’s decision to cut the private health insurance rebate for seniors. Senator Green and government officials said that the rebate will now be based solely on income rather than age, aligning support across all cohorts. The government expects to save $3 billion from this measure, which it says will be reinvested into aged care and public hospitals.

It’s estimated that 3.1 million people will be affected, experiencing an average rebate reduction (and effectively a premium increase) of $250. Additionally, it’s predicted that approximately 44,000 people may drop out of private health insurance entirely.

I expressed my concern that forcing seniors into the public system would worsen existing hospital shortages. Amazingly, I was told that the impact on the public system would be minimal (less than 1%) and spread out. It was also highlighted that $24.4 billion was being invested into the public health system, adding that workforce and bed management are ultimately the responsibilities of state and territory governments.

I accused the government of punishing seniors to fund wasteful spending and a “socialist agenda.”

Senator Green rejected this statement, framing the move as a necessary offset to fund record investments in aged care.

Transcript

Senator ROBERTS: I want to talk about the private health insurance rebate being cut. It was announced in the recent budget that the rebate for premiums paid by seniors towards private health insurance would cease; why? Is this a socialist agenda, Minister?

Senator Green: No, it’s not. We did go through this quite lengthily this morning. I don’t plan to add too much to what the minister had to say in response to questions from Senator Ruston, other than to reiterate that, under the proposed changes, all Australians will now receive the same private healthcare support based on their income and not on their age. What we’ve set out is that, through this budget and as a consequence of this decision, we will be investing over $3 billion in delivering more aged care beds, more packages and better care for older Australians.

Senator ROBERTS: I’d like to get on to some specifics after this next question. Why does the government wish to punish seniors, most of whom have chosen to opt out of the public health system and pay premiums to receive private health treatment, by now wanting to make them pay even more than they currently pay?

Senator Green: I reject that assertion in your question. We are investing a record amount of funding into improving the healthcare system, particularly for aged care and older Australians, and that’s why we’ve made this decision. Of course, as you will stand up in the Senate many times over the next couple of months and decry the spending from our government, we know that it’s important to offset decisions that we have to make. That is why we have said that this decision will benefit older Australians through the aged care system.

Senator ROBERTS: How can you deny that older Australians on private health cover will not be paying more?

Senator Green: We’ve gone through this at length this morning. If you have a question about the impact or the policy decision, I will direct that to the officials. But I can say to you that, through this budget, we are making record investments in healthcare and aged care

Senator ROBERTS: And older Australians will be paying more, which is a point that I’ll get to in a minute, and this is during a cost-of-living crisis. Currently, how many seniors, effectively, will be forced to pay more for private health cover or enter the public system? Do you have any modelling?

Mr Hawkins: As we discussed this morning, 3.1 million people will be affected by the change in the rebate. We also put on record—we talked about this at length this morning—that our modelling would suggest that potentially about 44,000 might drop out of having cover and, therefore, would then no longer engage with the PHI system.

Senator ROBERTS: That’s what I was after. What would be the effect of the extra load being placed on the public health system? Hospitals are already short of beds now.

Mr Hawkins: As I’ve said, our modelling would indicate that it’s a less than one per cent impact on the public health system and, again, as we went through in quite a lot of detail this morning, that would be spread across the system, with not everyone needing to use the system at any one time. Also, we might find that people decide to opt out of PHI but then self-fund any care that they need.

Senator ROBERTS: We’re already critically short of beds in many hospitals due to mass immigration. Post COVID injections, cancer detection has increased dramatically. Cancer deaths have decreased, because of treatment. But the available beds have decreased. This is going to add more strain to the public health system.

Ms Street: An additional $24.4 billion has also been invested into the public health system, bringing it up to $220 billion over the five years. So, yes, there might be some ‘additional’ but, as we’ve said, it would be less than one per cent. We think that estimation is at the higher end, because we do think, potentially, people will self select into private, or they may be people who are less likely to use the services anyway, so a number of factors contribute to that number. So we think this investment and this measure will have a minimal impact on that element.

Senator ROBERTS: What would be the total value of the extra premiums raised by those who choose to stay in the private health system?

Mr Hawkins: We’ve calculated that there will be an average impact of $250 on those who will have their rebate reduced. Everyone was to have access to the rebate, but it’s the size of the rebate that is reducing, and our average calculation is about $250.

Senator ROBERTS: How much does the government plan to save by refusing to rebate premiums for older Australians, or by cutting them back?

Mr Hawkins: By cutting the rebate, we are looking at $3 billion.

Senator ROBERTS: Has the government modelled the extra cost to the public system by absorbing older Australians, who are more likely to require major healthcare in their elder years?

Mr Hawkins: No, we do not have that specific level of modelling. But as I’ve said, we have looked at and modelled what we think the impact would be, and that’s under one per cent.

Senator ROBERTS: What about the chronic shortage of beds, doctors, nurses, specialists and allied health professionals in public hospitals?

Senator Green: That’s veering a little bit into outcome 1, Public hospitals. But I’ve got Caitlin O’Brien from our public hospital team here, if you want to talk about the investment that the government is putting in through the NHRA agreement that we’ve put in place. Do you want to cover that?

Ms O’Brien: As Ms Street has said, an additional $219.6 billion over five years has been invested into the state- and territory-run public hospital system. Your questions in relation to workforce capacity and beds are best directed to state and territory governments who, under the National Health Reform Agreement agreed on 30 January, are very clearly listed as the stewards of their system.

Senator ROBERTS: Would you not have assessed that, though, before making the changes?

Ms Street: As we’ve indicated, we think the ‘additional’ is less than one per cent, and we think that estimation is at the higher end. So, in terms of the fiscal impact, it will depend on the services that people need and the conditions that they’re seeking treatment for.

Senator Green: The officials have made this point but, again, we’re investing almost $25 billion into the hospital system over the next five years.

Senator ROBERTS: Minister Clare O’Neill said, reportedly, that the budget is deliberately hitting older people. It’s a tax grab because you’re paying for so much waste in government.

Senator Green: I don’t think that’s what Minister O’Neill would have said. I think you might be verballing her.

Senator ROBERTS: I’m just going on reports. It is a fact that the budget is also hitting young people. What I’m getting at is that this is a cover for the massive waste within your government spending, and now you’re going to ask older people to share in that.

Senator Green: No. We are making record investments in once-in-a-generation reforms in aged care and healthcare. That includes investing almost $25 billion into public hospitals, funding the states and territories to do the very important work that they do in making sure that the public hospital system is free.

Senator ROBERTS: It’s a fact, Minister, that older people will be paying more.

Senator Green: We’ve changed the rebate so that now it’s means tested, so it’s based on income now. We can take you through how that might impact certain cohorts, but we have changed the rebate so that now it is means tested on income.

Senator RUSTON: On a point of clarification, Minister, you just said that you’ve changed the rebate so that it’s means tested on income. Are you suggesting that it’s currently not means tested on income?

Senator Green: No, that’s not what I said.

Senator RUSTON: You just did say that.

Senator Green: I’m not going to go back over the evidence that Senator Gallagher gave to you this morning. What I’m saying to Senator Roberts is that there is a means test for the rebate that is based on income.

Senator RUSTON: Now?

Senator Green: How semantic do you want to get?

Senator RUSTON: You just said that it is now going to be means tested. It has always been means tested.

ACTING CHAIR: I think, as the secretary has said, it is ‘solely’.

Mr Comley: ‘Solely means tested’. In fact, it hasn’t always been means tested.

Senator RUSTON: It was means tested prior to this change.

Mr Comley: I think it was, but it was not means tested on introduction in 2000.

Senator RUSTON: It has been means tested up until now.

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The Price of Compassion?

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A $68.5 million budget measure (allocated over three years) intends to provide HIV treatment to people who are not eligible for Medicare.

Why are Australian taxpayers funding treatment for non-citizens when we are in the middle of a cost-of-living crisis?

Officials declined to comment on this, stating the policy and funding mechanism were developed strictly by the Department of Health.

I then shifted the discussion to the Significant Cost Threshold (SCT) for visa health requirements, which was raised from $51,000 to $86,000 in July 2024.

How this works is that if a medical officer of the Commonwealth estimates that an applicant’s health condition (such as HIV, a physical disability, or other chronic illnesses) will cost the Australian healthcare system more than $86,000, they fail the health requirement, and the visa is refused (unless a specific waiver is applied).

I asked whether this framework allows Australian citizens a “perfect way” to bring in family members with known health conditions to receive immediate taxpayer-funded care, provided the projected costs fall just under the $86,000 limit.

The Department repeatedly stated they could not answer the “family member” line of questioning.

They reiterated that immigration rules and the $86,000 threshold are applied uniformly to all applicants, independent of separate Department of Health funding measures.

Data on exactly how many people reside in Australia under the updated threshold was taken on notice.

Transcript

Senator ROBERTS: I’ll get back to the topic I started on this morning. It’s an immigration issue, not a health issue.  

Ms Foster: We’ll just get our chief medical officer up to the table.  

Mr Willard: I can speak broadly about the criteria. There’s a health criteria that applies to all visas. It looks at questions of health protection for Australians. It looks at costs to the health service, and it looks at the access to health treatment for Australians. It’s applied across all our visa types. It’s applied on a risk management basis. It looks at where somebody is coming from, and the sorts of health risks that might be presented. It looks at what the person might be doing in Australia, whether they’re going to go to a medical facility, whether they’re staying for a short time or whether they’re looking for a permanent visa. All of these factors are taken into consideration when the health criteria are assessed. Dr Grant Pegg, our chief medical officer, oversees the system that undertakes medicals. I think there are very large numbers of medicals undertaken each year.  

Senator ROBERTS: Can you tell me what the three basic criteria are again?  

Mr Willard: It’s health protection for Australians. It’s cost to the health system, and it’s access to Australian health services.  

Senator ROBERTS: This is primarily with No. 2—cost. The 2026-27 federal budget included $68.5 million, or $69 million, over three years to provide HIV treatment and pre-exposure prophylaxis, which is medication that stops transmission to people in Australia who are not eligible for Medicare. They’re not eligible for Medicare, but we are paying for their treatment anyway so they don’t infect Australians with their HIV. Is that the logic behind this allocation? I know it wasn’t allocated by you.  

Mr Willard: Because it is a measure from the department of health, I really can’t talk to the logic behind the measure.  

Senator ROBERTS: Why should Australians allow entry of people with HIV and then pay for their treatment, especially when Australia is under pressure economically and individual Australians are under pressure cost-of-living-wise?  

Ms Foster: Mr Willard is unable to comment, because the measure was developed by the department of health.  

CHAIR: Senator Roberts, I think that the right place for this is at the community affairs estimates committee next week.  

Senator ROBERTS: But I want to know. Many Australians are calling for noncitizens who have HIV or AIDS to be deported instead of paying for their medical care. We’re letting people in here with a known liability of cost to Australians. What is your response to that criticism of this budget allocation—the criticism, not the budget allocation itself? People are concerned that we’re letting in people who have a disease, and now we’re paying for their treatment.  

CHAIR: Senator Roberts, I think that is asking the officials at the table for their opinion on a matter that is not within the purview of the questions allowed to be asked at Senate estimates, particularly as it relates to the budget.  

Senator ROBERTS: Okay. I’ll move on to the next one. Australia raised the significant cost threshold for visa health requirements in July 2024, from $51,000 to $86,000. For those following this thread, I’ll give a quick explanation. The significant cost threshold determines whether a health condition, such as HIV/AIDS or physical disability, is likely to impose significant costs on Australia’s health and community services. Exceeding it typically means failing the health requirements for a visa, although health waivers are available for some visa subclasses, including partner and humanitarian. A person who comes in under your new, higher cap can access medical care and medications for free or for a small co-payment depending upon the state in which they live. How many people are here under this arrangement across all health conditions?  

Mr Pegg: I don’t have the data in that detail, so I’d have to take that on notice.  

Senator ROBERTS: If you could. Thank you. This is my last question on this topic, Chair.  Isn’t this a perfect way of getting a family member into Australia and having their care paid for straightaway? The other part of the question is that the numbers are increasing, which means the Australian taxpayer is paying more.  

Mr Pegg: Perhaps, if I can just offer, that’s the purpose of the operation of the significant cost threshold—to try and avoid significant cost to the Australian healthcare system. That’s why it exists.  

Senator ROBERTS: Could you explain that more?  

Mr Pegg: When someone is identified as having a health condition through the immigration medical examination as part of their visa process, they’re then costed by a medical officer of the Commonwealth who looks at that, on a hypothetical basis for someone with the same condition—the nature of condition and severity— to determine what their costs might be to the Australian healthcare system. That could be lab tests, X-rays, visits to the doctor—those sorts of things. There’s a comprehensive process that is undertaken to do that. When that’s undertaken, a figure is determined, and then, if that figure exceeds the number that you talked about, $86,000, that is considered to be ‘not meeting the health requirement’.  

Senator ROBERTS: The first part of my question was: isn’t this a perfect way of getting a family member into Australia and having their care paid for straightaway?  

Ms Sharp: Are you talking about a situation where the health requirement is waived? I guess what we’re saying is that the general rule is that if you fail the health requirement—as in your healthcare costs are coming in above $86,000—you will not be granted the visa; you won’t come to Australia.  

Senator ROBERTS: That’s initial assessment. Forget about the—well, the payment matters, but I’m not interested in the total amount. What I want to know is: isn’t this a perfect way of getting a family member into the country and having their health care paid for straightaway? That’s basically what it is. The government’s allocated $69 million over three years to provide treatment and pre-exposure prophylactics just for people with HIV. They’re coming in here with a known condition, and we pay for the treatment.  

CHAIR: Was there a question, Senator Roberts?  

Senator ROBERTS: Isn’t this a perfect way of getting a family member into Australia and having their health care paid for?  

CHAIR: This is a question that the officials at the table have responded to. It sounds like—  

Senator ROBERTS: Yes or no?  

CHAIR: you’re not using the same words to describe the same thing. I think the officials at the table have spoken about what their role is. I think you’re talking about it in a different way, but it’s not necessarily what the officials are—  

Senator ROBERTS: It’s about immigration, though.  

CHAIR: I think they’ve responded to your question, which is that there’s a program that exists to essentially weed out, for want of a better term, people who have costs higher than the amount the official said.  

Senator ROBERTS: No. If they’re projected to have a significant cost threshold higher than $86,000, then I understand, but, if it’s less than $86,000, isn’t this a perfect way of getting a family member into Australia and having their care paid for straightaway?  

Ms Foster: Senator, I don’t understand the link between the answers we’ve been giving and the family member issue. 

Senator ROBERTS: Yes or no?  

Ms Foster: That’s why we’re struggling to answer you.  

Senator ROBERTS: Yes or no?  

Ms Foster: We don’t understand the relation of the question to the information we’ve given, and, in a sense, it’s asking us for an opinion: ‘Is this a perfect way to do something?’ That’s not our role. Our role is to provide you with information about how the program operates.  

Senator ROBERTS: Okay, I’ll make it easier. Is it a way of getting a family member into Australia and having their care paid for straightaway?  

Ms Sharp: We might finish it where we began which is I think you need to direct this question to the department of health to ask them for the policy reasoning behind the measure—which group of people they were aiming to support.  

Ms Foster: We apply our immigration rules irrespective of whether or not the government has funded a measure such as this through the department.  

Senator ROBERTS: One of your immigration rules covers a significant cost threshold maximising at $86,000. If you assess an application to migrate here and it’s less than $86,000 then they are welcomed in. Is it a way of getting a family member in here?  

Ms Foster: We don’t understand the relationship between what we’ve told you and the question about a family. I can’t say that any more clearly. I’m not trying to be unhelpful. We just don’t understand the question.  

Senator ROBERTS: Could a citizen of Australia use this to bring in someone who is going to cost Australia money and health care immediately?  

Ms Foster: The rule would apply irrespective. We would apply that rule as part of our visa consideration to any visa applicant.  

Senator ROBERTS: I understand that, but this is a way for a citizen of Australia to bring in a family member and have their health care paid for by the taxpayer?  

Ms Foster: I’m sorry, but we have nothing further to add.  

Senator ROBERTS: Thank you. 

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Veterans Face New $5,000 Care Restriction

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These Estimates questions relate to the Department of Veterans’ Affairs’ proposed $5,000 aggregate cap on allied health services.

Our veterans and doctors are worried – and they have every right to be.

The government claims this cap won’t hurt complex-case veterans, yet they admit the system to apply for funding above the cap hasn’t even been designed yet.

Fix the system, don’t punish everyone! If there’s fraud, target the fraudsters. Do not penalise the vast majority of honest, caring doctors and vulnerable veterans.

Those who sacrificed for our country should never face cost-cutting measures disguised as ‘reforms.’ Our veterans deserve certainty, respect, and our support.

Transcript

Senator ROBERTS: Thank you for attending. I want to go over some changes to the annual monetary limit— some details that may not have been covered. I’ll do my best to try and avoid questions that were going to be asked but have since been covered. If I miss out, let me know. I’m also passing on a lot of complaints and questions from veterans as well as doctors. Doctors are appalled and resigned, yet, fundamentally, they all care. You have already confirmed that the cap is an aggregate cap across all allied health services, not per discipline. Is that correct?  

Mr Kefford: No, that’s not correct. It does not include optical, dental or hearing services.  

Senator ROBERTS: Apart from them. Physio, physical treatment, mental health—they’re all aggregate?  

Mr Brown: Open Arms counselling services are also not included.  

Senator ROBERTS: Does the minister accept that an aggregate cap would force complex-case veterans to ration treatment between conditions formally accepted by the Commonwealth?  

Mr Kefford: Again, no. We gave evidence earlier today about the ability, particularly in complex cases, for there to be additional thresholds. The point of having the $5,000 threshold is to ensure that treatment is effective, and there’s an undertaking in the announcement for there to be consultation on the basis on which that additional funding will be provided.  

Senator ROBERTS: Will the TPI gold card holders with multiple accepted conditions be exempt from any aggregate cap, consistent with existing exemptions for physiotherapy and exercise physiology?  

Mr Brown: No. Exceptions to the cap will be considered on a basis of clinical need. Many of the cohort that you’re referring to would potentially meet that requirement, but that will be subject to a consultation process around the design with the veteran community and provider groups.  

Senator ROBERTS: So that’s not designed yet?  

Mr Brown: The process for veteran card holders to go above the $5,000 annual monetary limit where there is a clinical need has not been designed yet. This measure commences on 1 July 2027, and we’ve got that lead-in time to do that consultation work.  

Senator ROBERTS: What objective criteria will DVA use to determine when funding above $5,000 will be approved, and how will veterans be informed of their eligibility?  

Mr Kefford: The focus, as we’ve said, will be on clinical need and effectiveness of the treatment, and the announced consultation process, once it has been concluded and the arrangements have been confirmed, will be communicated to veterans so they can understand the operation of the new arrangements.  

Senator ROBERTS: How will they be communicated?  

Mr Kefford: In our usual mechanisms.  

Senator ROBERTS: Well, that’s what bothers a lot of veterans.  

Mr Kefford: We use our Vetaffairs newspaper, our social media and other presences, as well as the formal publication of the outcomes of the consultation process, as we’ve done for other similar ones.  

Senator ROBERTS: Do you have a collection of microservice organisations, as well as the RSL, that you can send it to?  

Mr Kefford: Indeed. We would normally engage with the ex-service community as well—ex-service organisations.  

Senator ROBERTS: Have you heard of W Edwards Deming?  

Mr Kefford: No, sorry.  

Senator ROBERTS: He was famous, globally, as a management consultant; he died at the age of 95. He said that 95 per cent of problems are not with individuals but with the system. How have you approached the design of the new policy? My point is that you’ve got a problem. There’s some fraud going on—I accept that; wherever there’s money, there are tendencies for some fraud. But the majority of doctors and the majority of veterans are honest and caring people. Has there been any thought to, rather than punishing everyone or limiting everyone, putting a severe punishment on the few miscreants?  

Ms Frame: As we explained earlier this morning, the measure will benefit most veterans in terms of providing them with clearer, up-to-date insights on who they are seeing and where they are up to with their cap. They will have that on MyService, which is a facility they don’t have now. They will have the benefit of more providers. We anticipate there will be more providers availing themselves of the increased rates that are also part of the measure, and we have designed the consideration around $5,000. The policy objective of that threshold of $5,000 is to ensure the maximal effectiveness of the treatment that veterans are receiving. It provides a way by which we can assure the veteran that the providers who are delivering them services are accountable for genuine improvements in their condition and not just delivering services in perpetuity that aren’t subject to any checks and assurances that they are affecting real improvements in veteran wellbeing. 

Mr Brown: I reiterate the evidence I gave earlier today that, of those veteran cardholders who access allied health services with those veteran cards, the average amount of services they provide, based on historical data, is around $3½ thousand per annum, so the $5,000 cap is adequate to facilitate allied health services for the majority of veterans accessing those services through card arrangements.  

Senator ROBERTS: Averages can be really misleading and deceptive. They can hide things. I’m not accusing you of hiding things, but averages—that’s a fact. What percentage of—  

Senator McAllister: He has the median as well. There are a number of statistical indicators. You may enjoy this.  

Senator ROBERTS: They’re partial indicators.  

Mr Brown: We have a number of high-end users that skew that average. The median is $1,900 without those high-end users skewing that average.  

Senator ROBERTS: What percentage of veterans go over $5,000 in a year?  

Mr Brown: It fluctuates, but it’s between eight and 12 per cent, so roughly one in 10 of the eligible population.  

Senator ROBERTS: That’s a sizeable number nonetheless. That skews. It distorts. Have you built systems— or are you still building systems—to take care of that 10 per cent’s needs?  

Mr Brown: That would be the process that we’ll build off the back of the consultation that will occur over the next 12 months to ensure that we’re meeting the clinical needs of those veteran cardholders who require an amount over the $5,000 threshold.  

Senator ROBERTS: What I’ve found in my career is that humans are not afraid of change. People misleadingly say that humans are afraid of change. What they’re afraid of is uncertainty. Is there anything you can do to make things less uncertain for veterans who are worried?  

Ms Frame: I announced in my opening statement this morning that we will be doing this consultation. We have conveyed that. We will be consulting on the mechanism, but we have also put a section on our website in the last week that responds to miscommunications, what is coming to us about the veteran community and where they have fears about how the measure will be affected. As we said, it hasn’t started yet, but we are doing our best to proactively engage with that and put up-to-the-minute information that responds directly to where we see misinformation and misapprehension circulating in the veteran community to address that exact uncertainty and provide as much information as we are able to at this point in time.  

Senator ROBERTS: Are you consulting with any veterans to design the communications before you release the communications? This is not meant disrespectfully. It’s meant with complete respect. Your environment is different from the veterans’ environment. Your language is different. Are you using veterans to guide you in the messaging? That seems to be a big problem.  

Ms Frame: No, not directly with that communication as I understand it at the moment. It is based on direct feedback from veterans, so we’re looking at exactly what they are saying and using their own language and terminology in our responses as much as possible.  

Senator ROBERTS: So veterans will be required to apply for additional funding. What evidence will be required, and how long will approvals take? Is that still being designed?  

Mr Kefford: That’s the nub of the consultation, which will involve a process of both presentations from us and submissions from individuals as well as professional organisations. So that will be worked through, and it will be communicated once it’s been settled.  

Senator ROBERTS: Will there be regular updates and communications?  

Mr Kefford: Indeed.  

Senator ROBERTS: What appeal mechanisms will exist if DVA declines to fund clinically necessary care above the cap? That’s still part of the process being designed, I take it.  

Mr Brown: That will be considered during the design process, but it’s not going to be an administrative decision made under any primary legislation. We’ll consider that issue during consultation, but it’s unlikely—I don’t want to speculate too much—that it will be appealable through our normal administrative decision-making processes. 

Senator ROBERTS: Do you have any ideas on how it will be appealable?  

Mr Brown: No. I don’t want to speculate further about what the process might look like ahead of a consultation period.  

Mr Kefford: Mr Brown’s absolutely correct. I would say two things. First of all, the intention here, as the secretary has outlined, is to ensure that allied health is clinically appropriate and effective. And the purpose of having the process that we’re describing is to ensure that, particularly, those veterans who have more complex needs are properly cared for and receive the support and rehabilitation that they need.  

Senator ROBERTS: What assessment has the government made of the risk that a capped funding model will further reduce provider willingness to treat veterans, given existing concerns about low DVA fee schedules? I’ve had a number of doctors say this is insane.  

Mr Kefford: Part of the measure is, directly to that point, to actually increase allied health fees. One hundred and sixty-seven, is it, Luke?  

Mr Brown: It’s 169—$170 million in round numbers.  

Mr Kefford: And that’s intended to encourage more providers to provide services to veterans. That’s been welcomed by a number of bodies, and we tabled a letter from the physiotherapists association—that’s not the proper title—this morning.  

Mr Brown: For example, as part of that measure, for a face-to-face standard room consultation with a physiotherapist, our fee will increase from $75.10 to $110. Those fee increases apply across the board to allied health providers.  

Senator ROBERTS: How does the government reconcile the introduction of a monetary ceiling with the royal commission’s finding that barriers to healthcare access contribute to veteran suicide risk?  

Mr Kefford: A part of the measure is to, below that threshold, actually remove the requirement for the treatment cycles that currently exist and to provide that flexibility, recognising that the threshold’s been set with regard to what is normal usage, but then to have a process to ensure that necessary treatment is available and that treatment that’s provided is clinically appropriate.  

Senator ROBERTS: Does the government accept that veterans with numerous accepted conditions will exhaust the cap more quickly than those with a single injury, despite both having conditions recognised as service caused?  

Mr Kefford: That would be the logical conclusion, and that’s why we’re having a process of—the $5,000 limit is a threshold at which point there can be further decisions about clinically necessary care that needs to be provided.  

Senator McAllister: I think it’s worth—just in response to your last three or four questions, Senator—putting the whole measure in context. The royal commission did say that the government should take steps to improve access to health care, including by raising the charging or the provisioning for procuring allied health services. This measure does that; it raises the fees. It also seeks to remove some of the administrative hurdles for veterans by removing the treatment cycle, which will remove some of the impediments to people procuring the services that they want for their own needs. And, as Ms Frame said, it also will allow us to invest in some digital systems that will let veterans see what services they’ve already used and what resources might be available to them. So the context for this is actually a broad measure to improve access to allied health across the sector.  

Senator ROBERTS: What safeguards exist to prevent the cap from disproportionately harming veterans with complex, chronic or degenerative conditions?  

Mr Brown: Part of the measure that’s been announced by the government is that, where there’s a clinical need to access allied health services above the $5,000 cap, that will be provided.  

Senator ROBERTS: What transitional provisions will be put in place to ensure veterans do not experience sudden loss of access to essential treatment when the cap begins in July 2027? This is a source of pretty severe mental health pressure. Is there a transitional arrangement?  

Mr Kefford: The detail of, particularly, the mechanism by which veterans will seek additional funding above that first threshold is the nub of the consultation process. I’m sure the concerns that you’re raising will be aired in that context. 

Senator ROBERTS: When will clear, written guidance be issued to veterans and providers explaining how the cap will operate in practice? Do you have a scheduled time or an approximate time?  

Mr Kefford: The undertaking is that the consultations will commence in August. We haven’t set a conclusion or detailed timeline for that yet, but certainly the intention would be to have arrangements clear and able to be communicated well in advance of 1 July.  

Senator ROBERTS: Minister, we understand what you’re trying to do, but I don’t think the message has got out from the department, the DVA, as clearly as possible, because $5,000 is seen by many veterans as pitifully and ridiculously small. It’s an insult. How much of this is a cost-cutting exercise to get your government through the hoops with regard to the waste and hypocrisy that it’s shown—  

Senator McAllister: I indicated to you earlier—  

Senator ROBERTS: across all budget areas.  

Senator McAllister: that our goal is to ensure that veterans have access to the allied health treatment they need in a timely way, and to make sure that the services they’re being provided are clinically effective. One of the consequences of creating a system where very large quantities of services are procured from the private sector by individuals is that we see the emergence of some behaviours in that market that are not in the best interests of veterans. At the worst end of it, it looks like fraud: claiming for services that were never delivered. Stepping a few clicks back from that, sometimes it looks like overservicing: making a set of recommendations for which there is no clinical evidence and from which the individual doesn’t see a material benefit in their own health and wellbeing. We judge that, given what we know about the use of these services by veterans, most veterans are using well under that $5,000 limit. When we see veterans experiencing higher rates, we think it’s appropriate for there to be a threshold to evaluate whether what’s on offer to that person is genuinely going to assist them. We have every intention of ensuring people do get the healthcare services they need, and this reform is about a multipronged approach to make sure that’s true, both for the people whose needs are at lower levels of intensity and for the people whose needs are at the higher level.  

Senator ROBERTS: This government has developed a reputation for wasteful spending and loose spending, and people are concerned about that. It seems to me that there’s a lot of work going on, but the root causes are resignation among the veterans that nothing concrete has been done, and there’s so much fear. I think it’s a matter of not only what you just stipulated as your desire and what your targets are but how it’s being done—the process. Would you agree?  

Senator McAllister: I don’t agree with many of the things you said. Our government in each and every budget have found savings so that we can prioritise the things that we care about and that we know the community cares about. One of those areas of investment has in fact been in DVA, because we came to government knowing that it was significantly underprovisioned and that the lack of staff, in particular, in this organisation had led to unconscionable delays in people being able to access the services that they deserve as veterans. We’ve set about addressing that, and there’s a lot to be proud of in the work that’s been done by the many people who work in this department and the collaborative way that the veterans community has engaged in that work to make sure that we do improve the service level that’s available.  

Senator ROBERTS: Thank you, Minister. 

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Gold Rush on Black Market Tobacco

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How government greed turned citizens into criminals …

As a government, if you wish to stop a destructive public behaviour – you punish it. This can be through fines, incarceration, or economic coercion (taxes).

If you want to turn a public behaviour into a permanent cash-cow that props up the Budget – you tax it carefully.

Somehow, uniparty greed has found a way to implement a ‘worst of both worlds’ policy surrounding tobacco and nicotine products which has turned smoking into a criminal underworld gold mine.

Between 2010 and 2026, tobacco excise has increased in the order of 490% and returned half the revenue in real terms. People didn’t quit. If anything, there is evidence of Australia’s 30-year trend of decreasing smoking being reversed.

After reaching its lowest level with Millennials, smoking has become ‘cool’ again for Gen Z and Gen Alpha. Excessive taxation has destroyed all the good public health work done in this field.

Economically, this is not only a concern for the estimated $11 billion lost excise tax for tobacco.

It also involves the loss of general revenue associated with the full cost of tobacco which previously paid wages, kept stores open, and was re-invested in local communities.

Tens of billions is now being given to the black market where it funds violent crime. This tears apart Australian suburbs and has a follow-on health and economic impact that lowers the quality of life for everyone, not only those directly involved in illegal tobacco. Everything from personal safety to house prices are being affected.

Police have warned that this money, often funneled into crypto, has also been used to expand drug trafficking, firearms offences, worker exploitations, and property damage through activities such as coordinated firebombing.

Worse, if that is possible, the quality and safety of illegal tobacco and vapes is a matter of acute concern. Australians are now exposed to a considerably more dangerous product that was once strictly regulated for safety. And it’s dirt cheap. We are hearing reports of those who gave up smoking previously falling back into the habit because it’s only $10… As for kids, how likely is it that illegal traders are checking them for ID?

Every single feature of the system has been undermined.

It’s clear to me that public health, citizen choice, and the Treasury are in conflict.

And yet they should share the goal of a profitable, legal, regulated industry.

Our current incoherent approach to nicotine products is often referred to as ‘thoroughly broken’ by those trying to petition the government to act.

As Professor Ron Borland said, ‘We are worse off in every conceivable way.’

Tobacco isn’t quite Australia’s re-run of American Prohibition. However, it does share similarities. As with Prohibition, the first question we have to answer is: Should smoking tobacco (and other nicotine products) be legal?

Like alcohol, if the answer is ‘yes’, then any civil penalty or pseudo ban (vaping doctor certificates), should be discontinued.

The second question is: Do we consider smoking tobacco a health risk that costs the state money and which the state actively seeks to discontinue in the long-term?

If ‘yes’ – and this is what we were told for decades through school programs and public advertising campaigns – then the government cannot expect to use taxation on tobacco as a permanent feature in their Budget spreadsheet.

As Clive Bates said, ‘If you push it too hard – the taxes are too regressive, too brutal – then people will defect from the system and they will move to illicit trade and illicit suppliers will come in because there are enormous economic gains to be made.’

The Treasurer must have a replacement plan for tobacco revenue that does not entail continuously raising excise to the point criminals take over distribution.

Experts have suggested alternatives, such as using public information campaigns and alternate products, to wean society off tobacco long-term rather than smacking Australians with tax hikes on an addiction exasperated by economic stress.

To that point, there may never come a time when tobacco and nicotine products exit public use.

As with alcohol, they require a legally and economically stable environment that protects as many people as possible, dissuades new users, and yet does not create opportunities for crime. The most effective measure so far involved banning smoking from bars, clubs, restaurants, and residential balconies which turned it into a social inconvenience rather than a cost burden.

And here sits the heart of the problem.

Tobacco was a huge part of society until earlier suspicions of health risks were confirmed in the 1960s. Community anger and government complicity in a public health catastrophe created a lot of guilt and revenge.

Those days are almost gone. People who choose to smoke today do so knowing the risks and great lengths have been taken to contain those risks to the individual smoker. And so the conversation becomes one about public health costs similar to obesity. How is it fair, it’s said, that the public pay for the self-inflicted health problems of smokers? The numbers strongly suggest that this was never the case. Revenue on tobacco is widely held to cover the health bill. Until now.

The situation today reveals a growing smoking population with a more dangerous product and decreased revenue that doesn’t cover the cost of health, let alone the huge cost of policing the illicit trade. Economic arguments for the current excise level do not hold up to reality.

Scroll through the crime releases…

Permanent surveillance and enforcement on hundreds of tobacco shops. Thousands of online ad takedown orders. Monitoring nation-wide criminal distribution networks. Raiding shipping deliveries. Prosecuting and incarcerating those responsible. Storing and destroying the product. It’s an open-ended revenue drain. And then you have to include illegal vapes, of which the market is in the billions.

If you’re wondering how much policing this costs, the answer is, ‘we don’t know’. No full-cost figure is published. It’s estimated in the hundreds of millions just for policing itself at a state and federal level, while the government admits to investing approximately $350 million specifically for the ‘fight against illicit tobacco and vapes’.

Whatever the number is, it came out of your pocket.

The Australian Federal Police reported that 2.66 billion illegal cigarettes, 510 tonnes of loose-leaf tobacco, and 7.5 million vapes have been seized since 2016. Operation PRINTWALL saw the Australian Border Force intercept 998.5 tonnes of tobacco.

Just this year 20 million illegal vapes worth $1 billion were seized by the Australian Border Force since 2024. The Therapeutic Goods Administration removed another 2.2 million valued at $110.5 million in the same period. They also reported a 300-fold increase in requests to remove online ads for illegal vaping products.

These are not victories so much as temperature readings offering a glimpse at a thriving market.

We must sit down and soberly confront the truth.

Government informs the public that tobacco costs the taxpayer money through the healthcare system, and yet it desperately wants Australians to keep buying tobacco and funding the Treasury. When vapes entered the market, and people began to organically switch products due to health, convenience, and cost – government all-but banned the product. A cynic may say this had little to do with health and a lot to do with an absence of lucrative excise tax. The Treasury saw tobacco revenue evaporating and instead of taking the public health victory – they panicked. This raises serious questions about the government’s motives and ability to solve the current problem.

As Professor Hall with the National Centre for Youth Substance Use Research said: ‘Australia has attempted to regulate vapes by making them prescription-only products, but it’s very hard to get a prescription because doctors won’t prescribe them and most pharmacies won’t stock them.’

What can be done?

Listening at length to experts in the industry, it seems clear that we require a carefully timed approach.

The legal market must be restored before law enforcement can come down on the black market.

To do this in the wrong order risks wasting money and encouraging citizens to protect a criminal underworld to facilitate their smoking habit. This would entrench the behaviour we’re trying to resolve. As one expert said, in some communities, illegal tobacco sellers have reached a ‘Robin Hood’ status actively supported by locals. A path back to legal markets must be seamless as it would in any competitive business environment.

The suggestions that I have heard from a variety of people from within the industry include:

Setting the tobacco excise at a level that keeps cigarettes competitive against black market alternatives.

Removing the ban on vapes and adding the same location restrictions as smoking.

Considering an excise on vapes to recoup some lost revenue.

Ensuring that the tobacco and vape products on offer include a wide variety to ensure maximum customer return from the black market to legal channel.

And then…

Severe and serious penalties for black market traders and the criminal gangs involved.

Mandatory sentencing to simplify the process of cleaning up crime.

Reporting channels to allow people to alert police to continued criminal activity.

And as I have said publicly in front of the Panel of Harm Reduction Experts at the Legal and Constitutional Affairs References Committee, the solution will not be simple.

The cost of living is very high and will naturally lead otherwise law-abiding citizens toward illicit markets – in general. They don’t want to break the law. Any solution must deal with lifestyle measures right across our economy.

People are suffering and nicotine products are part of their lives.

All measures must be enacted with a least-harm approach to Australians who were pushed toward the black market due to government-enforced economic pressures.

And we absolutely must support the legal businesses who wish to help rebuild the market – this will include protecting these shops and owners from crime gangs. For example, insurers say it has become almost impossible to find cover for tobacconists after arson attacks…

Once the legal and government approach is fixed – the criminal infrastructure will have to be dismantled – rapidly – or it will adopt a new product such as alcohol – which is experiencing an almost identical problem.

Make no mistake, excessive alcohol excise has already started to push people toward extremely dangerous black market product. This is even more concerning than illegal tobacco.

No one can solve a public health problem for a product owned and distributed by the criminal underworld.

So please, help us solve it.

Senator Malcolm Roberts, Brisbane

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When Care Turns Into Exploitation

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I spoke with Ms. Liz Hefren-Webb and raised the issue of overcharging by service providers, which is depleting the limited funds available through Aged Care packages.

I highlighted the case of David and Sandra Smith, whose package was debited $3,000 for a small, incomplete gardening job. As a result, they were unable to access certain medical services because they could not afford them. Their complaints to the Commission fell on deaf ears; the Commission provided no explanation for its decision and refused to discuss the matter with the Smiths.

I also raised the case of Mr. Garry Bayliss, who had $14,000 taken from his My Aged Care account simply to replace some timber railings on a fence. Again, the Commission failed to take any action to remedy the situation.

Ms. Hefren-Webb suggested sending the details to the Agency for re-examination. I also raised concerns about the proposed introduction of co-payments into Aged Care packages, which will reduce the actual services provided. Many recipients cannot afford these additional costs, with some services charged at rates of $100 per hour or more. I stated that these shortcomings do not constitute quality care and amount to institutional elder abuse.

– Senate Estimates | December 2025

Transcript

Senator ROBERTS: Thank you for appearing today. Since the introduction of personalised aged-care packages, there has been an abject failure, it seems, of monitoring how funds allocated are actually spent. This is
one of the major failings of the administration of the NDIS that may well bankrupt Australia and be responsible for the death of vulnerable Australians. My question is specifically about the case of David and Sandra Smith. Under their package, they are entitled to some assistance in minor property maintenance. They needed some minor trimming of half a tree and a few branches of another on the property. That was not even completed. They found that $3,000 had been taken out of their package and given to the contractor without discussion between the Smiths and the service administrator of the package. Having raised the issue as a complaint, the Smiths have been ignored. Because of the depleted funds, the Smiths had to cancel some medical appointments they could no longer afford. This issue is gravely affecting their health at an age when they can ill afford such events. The Aged Care Quality and Safety Commission closed off their complaint and refused to even discuss it with the Smiths. They refused to even discuss it, and no explanation was given. To me, this seems like elder abuse by a government agency that is supposed to help older Australians, not abuse them. What is the cover-up, and why was $3,000 paid for next to no work?

Mr Comley: I think the commissioner will provide a response, noting, of course, that it’s difficult for us to talk about individuals in this forum. I will ask Ms Hefren-Webb to comment.

Ms Hefren-Webb: Obviously, I can’t comment on any individual case, and I don’t have any knowledge of the case you’re talking about. We receive around 10,000 complaints a year. Each of them is triaged and assessed, and we do provide a comprehensive response to people. I am not aware that we would ever refuse to provide a response, so I would be very happy to follow up the case you’re talking about.

Senator ROBERTS: So we can put you in touch with them?

Ms Hefren-Webb: That would be great. I’d be very happy to get in touch.

Senator ROBERTS: It does raise issues of accountability, the level of care and the attitude in the department.

Ms Hefren-Webb: It sounds like it’s an issue of pricing that they’re concerned about.

Senator ROBERTS: It might actually be fraud as well.

Ms Hefren-Webb: Potentially. I think the third-most-common complaint we receive around home care is about pricing of services. We do investigate those complaints and we do follow up to see what has driven the
particular pricing. You weren’t here earlier when I said we will compare providers and, if another provider is offering the same service for a lot less, we will ask the provider to explain how they arrived at that price.

Senator ROBERTS: Do you normally get quotes?

Ms Hefren-Webb: We don’t get quotes; we ask the provider how they have come up with their quote.

Senator ROBERTS: So you do not insist on a second quote, but you ask them the source of their quote?

Ms Hefren-Webb: It’s the provider who is managing the package. If there’s a price that the consumer feels is excessive, we will investigate how that’s come about. That’s our role. If we suspect that there is a fraudulent
aspect, we will obviously refer that through to the department, because they’re responsible for fraud and assurance and we’re responsible for compliance with the standards.

Senator ROBERTS: Okay. We will send the contact details.

Ms Hefren-Webb: That would be great.

Senator ROBERTS: Could you check on notice if you have dealt with this or if Aged Care have dealt with this? We would like to know what happened.

Ms Hefren-Webb: Will do.

Senator ROBERTS: This disgrace has badly affected the health of two innocent senior citizens who deserve an answer and money put back into their package. Is that what happens when something is found to be incorrect, wrong or unfair?

Ms Hefren-Webb: I think the department has responsibility for dealing with fraud and how that is dealt with in terms of the individual’s package.

Senator ROBERTS: If there’s something wrong specifically, is the money given back to the aged person?

Ms Snow: I think there would be a range of options. If it’s okay, it might be best to work with the commission really closely to have a look at the case, have a look at what’s been undertaken to date and come back to you.

Senator ROBERTS: Okay. Thank you. I see the caveat, but, if appropriate, can money be put back into their account?

Ms Snow: Yes.

Senator ROBERTS: Thank you. Then there is the case of Mr Gary Bayliss, who had $14,449 taken from his My Aged Care account to replace some worn-out timber rails from a fence. Again the commission failed to take action to remedy the fraud. Now the minister has announced that the concept of co-payments is to be instituted into the aged-care packages. That will mean the cancellation of many services needed by package holders, because they will become unaffordable. Minister, the proposal is that many services will need to be paid for at a rate of least $100 per hour, often at more than twice the market labour rate. An age pensioner cannot afford this. From the absurd to the impossible, this is not care, as I said earlier. It’s abuse. Minister, what can you do to fix this?

Senator McCarthy: Thank you for your questions and the concerns that you’re raising on behalf of your constituents. Clearly, there are many stories there that you’re hearing that really hit at the heart of how people are
feeling in terms of their own care. I will take your questions on notice if that’s okay and get back to you with regard to that particular question.

Senator ROBERTS: Please also take on notice the bigger picture of what can be done.

Senator McCarthy: Sure.

Senator ROBERTS: Commissioner, could you take on the case of Mr Gary Bayliss?

Ms Hefren-Webb: Yes, absolutely.

Senator ROBERTS: Thank you. We’ll be in touch.

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Lyme Disease Denial in Australia

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During this Estimates session, I raised questions regarding the management of Lyme Disease. Unfortunately, my concerns appeared to fall on deaf ears. I was repeatedly told the same narrative—that there is no evidence of Lyme Disease existing in Australia—and it was evident that the so-called “experts” had no interest in exploring this issue further.

There was no substantive response to my request for a comprehensive epidemiological study to be done on tick-borne diseases, nor was there any acknowledgment given of the many individuals living with poorly diagnosed and inadequately treated tick-related illnesses.

The remainder of my questions will be submitted on notice, with the hope of receiving detailed and meaningful responses.

— Senate Estimates | December 2025

Transcript

Senator ROBERTS: I’d like to build on questions from earlier tonight and turn to Lyme disease. For several decades, the risk of harm from tick-borne diseases has been recorded, published, reported and presented to the department of health and the ministers’ offices and advisers at the time. Some of this has even been done through the government’s own infectious disease bulletins. Doctors are verifying Lyme disease—we’ve heard that anecdotally—in Australia. I’m going to talk later about epidemiological studies and records that the department has. In the meantime, could you please specify the dates and events when evidence of the harm of tick-borne diseases has been presented to the department and the actions that have been undertaken to protect Australians historically. You can take it on notice if you like.

Ms Quilty: We’ll take that on notice.

Senator ROBERTS: I acknowledge that in 2016 and 2025 we had very limited Senate inquiries into Lyme disease and tick-borne diseases. The terms of reference were very vague and the recommendations were vague. I’m going to ask about the implementation. But at least the term ‘tick-borne diseases’ was recognised. We still don’t know the full extent and the nature of the entire tick-borne disease problem. Why haven’t these tick-borne disease infections been quantified with a study of the population in the form of a human epidemiological study? There are a lot of people suffering.

Senator Green: We’ve answered quite a lot of these questions before.

Senator ROBERTS: Not these exact—

Senator Green: No, but a study has been done. Anyway, I’ll let the officials answer. We’re just going back over—

Senator ROBERTS: Has an epidemiological study been done?

Senator Green: Not one of those types, but—

Ms Quilty: I’m happy to be corrected, but we’ll take that on notice.

Senator ROBERTS: As far as you know, no studies have been done epidemiologically.

Ms Quilty: Not that I’m aware of.

Senator ROBERTS: Why is the Public Health Laboratory Network’s own diagnosis data being ignored with these diseases when they hold the results of thousands of test results for tickborne disease?

Mr Martin: I’m not aware of the data you refer to being withheld. Some of the tickborne diseases are notifiable, and we do collect information on those. I think one of the challenges is that there are a range of conditions which patients believe may be caused by ticks but, as I’ve mentioned in an earlier answer, there’s not necessarily evidence that the pathogen that would cause that disease is present in Australia. I think that it’s challenging to collect information where we don’t have that causal pathway—

Senator ROBERTS: Have you been given or have you collected samples?

Mr Martin: Samples of?

Senator ROBERTS: Infection.

Mr Martin: There are established diagnostic tests for different tickborne diseases.

Mr Comley: I think the evidence that was tendered earlier was that the bacteria that cause the Lyme disease have not been detected in Australia. It’s not that there aren’t people who contract it overseas and come here. There is also evidence that there are other tickborne diseases that are present in Australia, but not Lyme disease—for the bacteria that’s required to be the cause of the disease.

Senator ROBERTS: I’ll say it again: I don’t understand the exact health system, but why is the Public Health Laboratory Network’s own diagnosis data being ignored with these diseases when they hold the results for thousands of tests for tickborne disease? Why is that being an ignored? What’s been done with it? What’s going to be done with it?

Mr Comley: I think we’re struggling to describe which laboratories you are talking about. Can you provide evidence of that. We’re happy to take on notice whether there is any evidence of that effect in Australia. I think the evidence tendered earlier in this estimate session was that there wasn’t such evidence in Australia, but we’re happy to take that on notice.

Senator ROBERTS: I’m told that there is evidence held by the Public Laboratory Network’s own data.

Mr Comley: We’ll take that on notice, unless the CMO would like to comment.

Prof. Kidd: Senator, there is evidence of tickborne infectious diseases that people have contracted in Australia. There are a number of those infections which are recorded, for which people are tested: some of the Rickettsial infections, Queensland tick typhus, Flinders Island spotted fever, Australian spotted fever, Q fever—due to Coxiella burnetii. There’s data on each of these particular tickborne diseases, which will be in our laboratory systems and which are brought together. The issue about Lyme disease—we’ve talked about that before.

Senator ROBERTS: I am told that hospitals have discharge records, with some stating tickborne illness, Lyme disease, Babesia, rickets, Bartonella et cetera, yet accurate and reliable testing for all these diseases in Australia does not occur. Are you able to provide a quantification of this? This is a public health threat.

Prof. Kidd: I think we’ll need to take that on notice from the PHLN.

Senator ROBERTS: I understand. Why can’t the study of this data for all vector-borne diseases—as part of the responsibility of the Department of Health from the 2016 Senate inquiry—be done to complete an epidemiological study? Can you take that on notice?

Ms Quilty: Yes, we have.

Mr Martin: We can. I think it might take me a moment to find it, but I think the government’s response to the most recent inquiry—

Senator ROBERTS: It’s very vague.

Mr Martin: It does go into the feasibility of—it is not feasible, necessarily, to collect data on everyone who may have been bitten by a tick in Australia. We do have a system around notifiable diseases, where that is nationally collected and reported upon for particular pathogens. I can take it on notice and provide further information on some of those practicalities.

Senator ROBERTS: We’ve got readily available tickborne disease testing panels in Australia for livestock and domestic animals, especially for exports, I’m told. We don’t want to hurt people overseas. Veterinarians know that sometimes it’s necessary for animals that are sick with tickborne disease to be put down. The question raised is: are we doing nothing about humans? Are we going to start putting humans down? That’s pretty far-fetched, of course, but I’m saying that there are lots and lots of people who are sick and crippled a bit and nothing seems to be done.

Senator Green: I understand, but perhaps you could put a question to the officials that they can answer for you.

Senator ROBERTS: On my frustration.

Senator Green: You can express your frustration in the Senate chamber next year.

Senator ROBERTS: I don’t have Lyme disease, but I know people who have, and I know people who’ve got tickborne diseases, and there’s been no epidemiological study done. This has been going on for decades.

Senator Green: I understand. There have been inquiries, responses to those inquiries and the officials have answered your questions.

Senator ROBERTS: I know you, Senator Green. You would not be proud of the studies that have been done in the 2016 Senate inquiry.

Senator Green: I’m very aware of the inquiries. I know that a lot of good senators from this place have been involved in those inquiries and have taken evidence from people who are affected, and the government’s responded to those inquiries.

Senator ROBERTS: I say again: why can’t the study of this data for all vector-borne diseases be part of the responsibility of the department of health and be done to complete an epidemiological study? You’ve taken that on notice.

Senator Green: We’ve taken that on notice.

Senator ROBERTS: Thank you. I’m early this time.

CHAIR: You are early this time. I’m very grateful for that. Senator Liddle.

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NDIS Overlooks Fair Compensation for Family Caregivers

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During this Estimate session in November, I inquired about the potential streamlining of payments to care workers and received responses primarily related to care providers (agencies). It appears that not all care providers are registered, and the registered ones must meet minimum standards. I also asked about the possibility of family or friends providing care being properly compensated for their extensive services. I was informed that these individuals may receive allowances, but that these amounts would be small compared to fair remuneration for their services. The NDIS views these supports as beneficial, yet is not willing to pay unless they are provided on a professional basis by individuals trained to a specific standard.

It seems that the NDIS is not prepared to offer support to family members providing vital care; rather, they will only support workers affiliated with recognised care providers. They seem to overlook the fact that many families make significant sacrifices to care for a disabled relative in a home setting, yet are not entitled to fair remuneration for the many hours of unpaid work they contribute.

Transcript

Senator ROBERTS: Thank you, Chair. What is being done to streamline the payment system for care providers?

Ms C McKenzie: As Ms McKay was talking about before, we have a range of improvements underway through a significant program of work, particularly the crackdown on fraud program of work. That will include
progressive improvements to the provider platform and a range of other payment systems to improve and support the continued improvement of the payment system through to providers.

Senator ROBERTS: Does that mean the IT focus?

Ms C McKenzie: It is predominantly IT focused. Yes, that’s right. So it is upgrading systems that are at the end of their life or are approaching the end of their life. It is also developments in improving both the integrity of the data that we are able to capture and our ability to move more quickly and with more confidence in the payment to providers.

Senator ROBERTS: What is being done to set up a scheme to ensure that family members who provide constant care to a family member are compensated for the time and care put in to deal with high level basic care?
I understand that families like to take care of other family members; I’m not arguing against that. In one case, we had a pensioner on a low income looking after their 60-year-old son who is disabled. They were very concerned about him. There are some extenuating circumstances where families need to be compensated.

Mr McNaughton: There are a couple of components to that question. First of all, obviously through other portfolios, there are income support payments and carers payments and carer allowances in recognition of some of those activities. That is an important part of that. We also recognise that informal care is a really important part of the NDIS. Parents provide informal care for their children with disability. Ageing parents often do the same. There does come a time where that needs to be a paid care role. That is when the NDIS supports having paid, trained carers to come in and support that person with a disability. It is a combination of both. Who do you feel comfortable with providing that level of informal care and support and decision-making and assistance in your daily activities? There is the carer allowance and carer payments through the social security portfolio. The NDIS pays for the funded support workers to provide that trained specialist care for the person with disability as well. It is an ecosystem, a combination of all those things. It really does depend on the individual circumstance of the participant.

Senator ROBERTS: I presume, then, that a very formal assessment is required before moving from one to the other?

Mr McNaughton: Yes. But we know that participants like to have their families and informal supports around them. That is a really important thing. We don’t want to detract from that at all. Some participants also need
additional funded carers. There are regulations for being a qualified carer and a registered provider as part of the NDIS system. Those things need to work hand in glove to provide that support for the person with a disability.

Senator ROBERTS: Are all direct care providers to be registered if they wish to be paid under the NDIS?

Mr McNaughton: They don’t have to be.

Senator ROBERTS: What is registration? What does it involve?

Mr McNaughton: I might defer to the commission, who can talk through registration guidelines. There are differences in terms of pricing within the NDIS and registration criteria. I am not sure if the commission wants to respond about the registration of providers.

Ms Myers: The registration relates to providers. When it comes to workers, there is screening that occurs for workers.

Senator ROBERTS: So you’re looking at their capabilities and their skills?

Ms Myers: Worker screening is about suitability. Worker screening is for people who are in risk assessed roles. Worker screening checks are conducted by the state and territory worker screening units. The NDIS Quality and Safeguards Commission is responsible for maintaining the database. Registered providers can link their workers who have a worker screening check. That is another safeguarding measure so that participants can see which workers have a worker screening check. In fact, we’ve had record numbers of unregistered providers also seeking access to the worker screening database so that they can also link their workers.

Senator ROBERTS: So direct care providers don’t have to be registered, but for some circumstances they must be?

Ms Myers: For some circumstances, they need a worker screening check.

Senator ROBERTS: Are those reforms you both discussed complete?

Ms Glanville: I wonder whether, on the registration topic, Associate Commissioner Wade would like to speak on this, if she is there?

Ms Wade: Yes. Thank you, Commissioner Glanville. Registered providers are an important part of the disability care system. There is also provision for the regulator, which is the NDIS Commission, to regulate both
unregistered and registered providers. Registration status indicates compliance requirements of a provider, but that does not leave providers unregulated if they are not registered. All providers that receive funding from the NDIS are required to comply with a code of conduct. Failure to comply with that code of conduct can see regulatory action brought against the provider by the commission as the regulator.

Senator ROBERTS: Thank you. This is my final question. What monitoring is involved for both registered and unregistered providers?

Ms Myers: The Quality and Safeguards Commission is responsible for the monitoring of both registered and unregistered providers. Much of our work is conducted as a result of either complaints received to the commission or reportable incidents where we need to make further inquiries around the circumstances of particular incidents. Registered providers have obligations that they are required to report certain matters to us, including certain changes of circumstances. The commission utilises that information to determine what regulatory action it might take.

Senator ROBERTS: Are there audits of this? It’s not just self-reporting?

Ms Myers: We do some proactive compliance monitoring work. They also have audit processes tied to their registration. The audit process relates to the standards they must meet in order to maintain their registration.

Senator ROBERTS: Thank you, Chair.

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AFP Questioned on Tainted Blood Complaint

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During this session with the AFP, I inquired whether they had received a complaint about several individuals who had received tainted blood as a result of failures by the Commonwealth Serum Laboratories and the Red Cross to ensure the safety of blood donations used in medical treatments. The question was taken on notice.

Transcript

Thank you all for appearing tonight. I’ll get one question out of the way first. In October this year, several haemophiliacs and parents of haemophiliacs filed criminal complaints with the Australian Federal Police commissioner, Commissioner Kershaw. The complainants have not received any acknowledgement of their submissions. Is the federal government aware of these complaints? When can the complainants expect a response?

Mr McCartney: I’m not across the matter. I’ll take that on notice, and we’ll come back to you.

Senator ROBERTS: We’ve supported these people and we’ll continue to support them. They’ve got a serious case. It’s an injustice that’s very strong and sustained. Their counterparts in Britain have been dealt with properly. These people over here are not being dealt with.

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Government Needs to Focus on Australians

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I informed the Senate that it had lost its way by focussing way too much on international conflicts and spending over a billion dollars on Ukraine while neglecting to fund essential healthcare and hospitals in Queensland and other parts of Australia.

This obsession in providing international aid is misplaced when our own homeless and vulnerable citizens are struggling to access the basic necessities needed for survival.

Australian families are living in tents, children are going hungry and those in power are failing to protect them. Charity should always begin at home.  Politicians must prioritise the needs of Australians before considering assistance to anyone else. We have a national housing crisis and are already in a per capita recession.

It’s time to put Australians first.

Transcript

It’s time for politicians to focus on fixing the problems here in Australia before getting involved in foreign conflict. Last night, yet another motion appeared in the nightly Senate notices from some senators calling for stronger measures to support Ukraine. This Senate only just dealt with a matter relating to Taiwan. The Israel-Palestine war continues to feature in our Senate processes, along with the Uighurs in China and the Rohingya in Bangladesh. Among Greens senators, there seem to be more supporters for terrorist Hamas than for Australia—and that’s my point.

We live in a time when small businesses are closing at record rates—the hopes and dreams of those hard-working Australians broken in a vice of rising costs and falling sales. It’s a disaster arising from deliberate government policy. Supermarkets, traditionally the least profitable of businesses because of the social contract to not rip people off on the necessities of life, no longer honour their social contract.

Parents in Queensland are travelling up to 800 kilometres to access specialist maternity care because parliament has found a billion dollars for Ukraine yet cannot find a cent for Yeppoon, Bowen and the 33 other Queensland towns that have lost their maternity wards. Hospitals in many Queensland rural centres are still called hospitals, yet only offer the services of a GP clinic.

Australian families are living in the tent cities appearing right across our beautiful country. I’ve visited many of these in Queensland, and the sense of betrayal is palpable—and people should feel betrayed. The Senate, as the house of review, has betrayed the very people who trusted us with their vote and who trusted us to have their best interests at heart. Although our Senate does have foreign affairs powers, convention dictates the Senate stays out of foreign affairs and concentrates on domestic matters. It’s time to make that convention great again. Let’s spend our time driving the government to do better to look after Australians. Let’s look after all Australians— all who are here—first.

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Australia’s Contaminated Blood Scandal

One of the most troubling scandals in Australia involved government agencies, the Australian Red Cross, blood banks, and CSL, who knowingly transfused contaminated blood to individuals in need of transfusions. This included blood from donors with Hepatitis B, Hepatitis C and HIV, which was then used for transfusions to people, including haemophiliacs, who underwent surgery or other critical procedures.

Many recipients of this tainted blood subsequently contracted these diseases themselves. Despite numerous efforts to seek compensation from the responsible agencies and the Commonwealth, no resolution has been achieved so far.

In contrast, the Canadian government addressed this issue and compensated victims. Furthermore, following a Royal Commission into contaminated blood in the United Kingdom, the full extent of the scandal was acknowledged, and victims were provided with appropriate compensation.

I have actively pursued justice for Australian victims, questioning the Blood Authority at Senate Estimates in February 2023 and again in June 2024 about the possibility of a Royal Commission and compensation. I remain dedicated to ensuring that Australian victims receive the justice and compensation they deserve.

Photograph: Science Photo Library/Tek Image/Getty Images

Senate Estimates: February 2023 | Questions and Answers

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Senate Estimates: June 2024 | Questions and Answers

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