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ROYAL COMMISSION: Lacking regulation and inadequate Government action

The last three days of the Brisbane hearings for the Royal Commission into Aged Care Quality and Safety investigated the efficiency of the Aged Care Quality and Safety Commission and whether it was successful in addressing complaints, the Government’s reaction to regulation change in the aged care sector, and failing quality monitoring by the Commonwealth Department of Health.

Professor Ronald Paterson expressed disappointment in the Government for not implementing any of the recommendations he suggested in his report from two years ago. [Source: Aged Care Royal Commission]
Professor Ronald Paterson expressed disappointment in the Government for not implementing any of the recommendations he suggested in his report from two years ago. [Source: Aged Care Royal Commission]

The Commissioners also heard from a witness on Wednesday, Professor Ronald Paterson, who explained his dismay that the recommendations for his 2017 report about changes to aged care were not adopted properly by the Government.

The closing statement on Friday from Senior Counsel Assisting, Mr Peter Gray, says, “The evidence this week has exposed serious defects in the regulation of quality and safety of aged care at both the operational level and the design level. 

“Equally concerning, these defects are old news. Government has been tardy in implementing previously recommended forms. There’s been no sense of urgency.

“Inside the Department, officials are focused on policies and procedures being in place, standards being met, timing and formal processes. On the evidence this week, a spirit of inquisitiveness and curiosity appears to be sadly lacking.”

The Counsel expressed concern over the failures of the Department and the Quality Commission for not responding to clear and present risks at Earle Haven Retirement Village in Queensland, a big discussion point over the Brisbane hearings.

Executive Director of the Aged Care Quality and Safety Commission Quality Assessment and Monitoring Operations, Ann Dominica Wunsch, took to the stand on Thursday admitting the Commission has a list of service providers who are highlighted as a concern for meeting regulatory requirements, including Earle Haven at number nine on the list in 2017.

Ms Wunsch explained the Homes of Interest list the Commission has supports the oversight of their regulatory program, including home care services, residential aged care, and national Aboriginal flexi-care.

While the list is for the Commission only, Ms Wunsch says 80 percent of the list overlaps with the Health Department’s Service Providers of Concern List.

The Homes of Interest list is a service-by-service list and reflects the regulatory program for each service, while the Service Providers of Concern list is at a provider level and identifies a higher level of risk.

Counsel Assisting, Mr Paul Bolster questioned why the Commission did not direct any queries to the provider or to the new management group, HelpStreet, back in 2018 on what their arrangement or contractual obligations were.

Mr Bolster also inquired into why so many reports from assessing officers raised issue with processes at the facility, but nothing seemed to be done about it by the agency and no further information was sought over whether the issues had been rectified by the provider.

Governments not acting

Ronald Paterson, Professor of Law at the University of Auckland, former New Zealand Health and Disability Commissioner, and author of his own report with Kate Carnell, a veteran public administrator, into the regulatory processes in aged care, explained his frustrations that the government is yet to do anything with the recommendations from 2017 he provided to improve the sector.

Mr Paterson highlighted consumer protection as the most important element of aged care during his statement to the Commission, which was what formed the recommendations of the report to Government.

“In terms of what had been on the agenda here in Australia, it seems like the progress has been slow and then all the more so when you look at the way in which similar initiatives have been progressed internationally. So, yes, it is disappointing,” Mr Paterson says. 

“I think one of the dangers is that people can’t see red flags that are right there before their eyes. That they become desensitised to information and that they become less agile and skilled at putting together the pieces of the puzzle.

“I’m disappointed, however, to learn of the slowness in implementation of the recommendations and I am left with a sense that the 10 recommendations have all been accepted in principle but the devil is in the detail and I can’t help suspecting that some of them are not actually being progressed.”

Mr Paterson was also critical of Australia as a whole, stating the country seemed to be desensitised to what happens in aged care and the report was meant to be a wake-up call.

With Earle Haven’s recent closure, Mr Paterson believes no lessons have been learnt from the Oakden scandal and can understand why there was a need for the Royal Commission.

Some of the recommendations from the report including consumers being able to engage in relevant aspects of the regulatory framework, protection of rights, compulsory reporting of serious incident and limits on restrictive practices use, improvement of monitoring aged care facilities, and moving towards unannounced visits based on risk profiling of nursing homes. 

On Thursday, Assistant Secretary of the Aged Care Quality Regulatory Design and Implementation branch of the Commonwealth Department of Health, Amy Elizabeth Laffan, admitted that the Government seemed to not enforce or take on board any suggestions to improve the aged care sector.

One quarter of complainants not happy

Executive Director of the Complaints Resolution in Performance, Education and Policy under the Commission, Shona Lianne Reid, admitted to Counsel that there was a reasonable portion of people that were not happy with the outcomes of their complaint.  

She says it’s not ideal that more than 25 percent of people surveyed over their satisfaction with the complaints processes were not pleased with how the Quality and Safety Commission handled their complaint.

“Complainants are not always happy with that outcome. Some complainants are seeking more punitive action and our aim is to get the service to improve, fix care and have a much better improved care for care recipients,” says Ms Reid.

“I would prefer all complainants were happy with our service and happy with our outcomes. So we need to constantly be talking about where we can learn, where we can improve to meet their expectations.”

Senior Counsel Assisting, Mr Gray also mentions in his final statement to the Commission that Ms Reid had acknowledged that the complaints area of the Commission were failing to show curiosity and communication in their quality monitoring section.

Mr Gray suggested that this displays the quality monitoring at the Commission was failing to raise alarm based on its own assessment contact.

The next hearing series will take place from the 9-11 and 13 September in Melbourne, Victoria.

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