Royal commission hears of ‘notorious problems’ with relationship between state health and federal aged care sectors

By Shannon Jenkins

Tuesday August 11, 2020

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Australia has “no hope” of fighting the COVID-19 aged care crisis if the state and federal governments do not work together, the aged care royal commission has heard.

Counsel assisting the aged care royal commission Peter Rozen QC on Monday raised concerns over the potential link between cross-jurisdictional collaboration and the impact of COVID-19 on Australia’s aged care facilities.

“There are notorious problems associated with the relationship between the health system which is run by the states and the Commonwealth-run aged care sector,” he said.

“These so-called interface issues were always going to be brought into stark relief by an outbreak of COVID-19 in the residential aged care sector.”

He referred to a statement from Anglicare boss Grant Millard, who said that when Anglicare was responding to the Newmarch House outbreak, the roles and responsibilities of various assisting authorities were unclear.

“Over the course of the outbreak, there has been a frustrating level of dysfunction in the collaboration between Newmarch House, Anglicare Management and the numerous government departments, agencies and hospital employees at both federal and state level with an interest in management of the outbreak,” the statement said.

“Anglicare has looked to these authorities for their expert advice in dealing with the outbreak but this advice has often been conflicting. Further, there is a lack of clarity regarding which of these authorities has responsibility for decisions and how this authority intersects with Anglicare’s responsibilities under the Aged Care Act to manage the home.”

Rozen noted that evidence from the Department of Health’s deputy secretary for ageing and aged care, Michael Lye, had said there was no lack of clarity about roles and responsibilities.

The royal commission intends to examine the “difference of opinion” as well as what measures have been taken since the Newmarch outbreak to ensure there is no confusion between organisations.

COVID-19 has “starkly exposed all of the flaws of the aged care sector” which have been previously highlighted, such as the deskilling of the aged care workforce, Rozen argued.

“Those flaws have been revealed by evidence led in the royal commission and were outlined in the interim report in October 2019. It is hardly surprising that the aged care sector has struggled to respond to COVID-19,” he said.

“While there was a great deal done to prepare the Australian health sector more generally for the pandemic, the evidence will reveal that neither the Commonwealth Department of Health nor the aged care regulator [the Aged Care Quality and Safety Commission] developed COVID-19 plan specifically for the aged care sector.”

Rozen also raised concerns over whether ACQSC’s investigative powers are strong enough, noting that its authorised officers can only enter the premises of a provider with the provider’s consent, but consent can be refused or withdrawn “without the need for a reason”. Any questions officers ask are also not required to be answered.

“Comparable regulators in fields such as workplace or airline safety have no such limitations on their powers and it’s not as if these statute provisions have sat on the statute books for decades, waiting to be modernised,” he added.

“The Act establishing this regulator was passed on the eve of this royal commission. The limits on the regulator’s powers reflect contemporary government policy.”

Read more: Opinion: aged care crisis shows a disaster waiting in workplace ‘flexibility’

On providers losing their workforces during outbreaks, Rozen noted that the Department of Health didn’t advise providers that 80-100% of their workforce may need to isolate during a major outbreak until June 2020, preventing them from amending their preparedness plans accordingly.

However, Lye stated that a key part of Health’s response to the COVID-19 pandemic has been sourcing additional staff for providers when facing an outbreak.

On whether aged care staff who worked at multiple facilities may have spread the virus between facilities, a statement from Lye said:

“Health and aged care workers were able to continue to go to work at other services if they have had casual contact with COVID-19 cases and are well and/or have directly cared for confirmed cases while using PPE properly provided they monitor themselves for symptoms and self-isolate if they become unwell.”

Rozen said the commission would look at whether the department’s advice adequately considered workers who may have contracted the virus but were asymptomatic.

“In light of recent developments in Melbourne, this appears to be an important question,” he said.

Outbreaks in aged care were linked to 14 of the 19 deaths announced on Monday in Victoria — the state’s deadliest day of the pandemic, which was repeated on Tuesday. On Monday, there were 1765 active cases relating to aged care facilities.

Rozen noted that when Victoria’s case numbers began to escalate in mid-June, the Australian Health Protection Principal Committee did not update its guidance on aged care, and on June 19 issued a statement on loosening restrictions for visitors to aged care homes “based on the low levels of local transmission”.

“However, there was no updated advice for the aged care sector from the committee between June 19 and August 3, a crucial period of six weeks during which the number of new daily infections in Victoria grew from 25 to 413,” he said.

“There was no advice about how the sector should respond to the risk posed by aged care workers who may be COVID-19 positive yet asymptomatic, particularly those who work in multiple facilities.”

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