Frydenberg’s directions to ASIC throw the banking royal commission under a bus

Mick Tsikas/AAP

Andrew Schmulow, University of WollongongFor Australia’s habitually-abused financial consumers it’s Back to the Future (minus the DeLorean).

Treasurer Josh Frydenberg appears to have thrown the most important findings of the banking royal commission under a bus, in glorious double-speak.

On Thursday he issued a direction to the Australian Securities and Investments Commission through what is known as a statement of expectations.

It is very different from the previous such statement, issued in 2018.

This one includes an entirely new clause, placed right at the top.

The government expects ASIC to:

identify and pursue opportunities to contribute to the government’s economic goals, including supporting Australia’s economic recovery from the COVID pandemic.

It’s an odd role for a corporate cop, on its face inconsistent with the way ASIC itself describes its function in the “our role” tab on its homepage.

Perhaps not yet updated to take account of the guidelines, ASIC’s description says it is a regulator whose job is to “take whatever action we can, and which is necessary, to enforce and give effect to the law”.

From ‘why not litigate’…

It’s how the royal commission saw ASIC’s role. In his final report, Commissioner Kenneth Hayne was scathing about how ASIC carried out those duties, saying it was too ready to negotiate, and not keen enough to litigate.

Financial services entities are not ASIC’s ‘clients’. ASIC does not perform its functions as a service to those entities. And it is well-established that ‘an unconditional preference for negotiated compliance renders an agency susceptible to capture’.

Negotiation and persuasion, without enforcement, all too readily leads to the perception that compliance is voluntary. It is not.

Hayne said the first question ASIC should ask whenever misconduct was identified was “why not litigate?”.

Frydenberg’s new statement of expectations turns that on its head.

…to ‘why not capitulate’

Rather than “why not litigate,” it reads as “why not capitulate” — justified by the need to identify opportunities to contribute to Australia’s economic recovery.

The statement says the government expects ASIC to “act independently” but also says it should “consult with the government and treasury in exercising its policy-related functions” — a requirement not previously expressed in those terms.

Read more:
Pro tip for Australia’s banks: imagine you are in Canada

It should “minimise regulatory burdens” (including presumably those that require regulated firms to act in the best interest of their customers).

It should ensure any guidance it offers to financial service providers is not “unduly prescriptive”.

The banks have not earned leniency

Granted, these are conditions that could be interpreted positively if ASIC was charged with supervising an industry that had demonstrated its trustworthiness and its commitment to putting its customers first.

Royal Commissioner Kenneth Hayne believed the banks had not earned out trust.

But after the evidence that was ventilated before the Hayne Royal Commission no one – not even the Australian Banking Association makes such a claim.

Indeed, the damage done by more than a decade of financial industry misconduct, fraud, criminality and venality, committed on an industrial scale, is yet to be fully quantified.

Colleagues at the University of Melbourne estimate the full cost at north of A$200 billion, affecting approximately 54% of the population.

Frydenberg’s solution appears to be to put the needs of industry first. Separately, he is trying to scrap responsible lending laws.

From somewhere, to nowhere

What will the upshot be of a newly enfeebled ASIC? In light of the demonstrable failure of banks, super funds and insurers to act with integrity after the royal commission, the upshot will be more of the same.

Indeed, as reported in The Klaxon in November, the almost one million customers in Westpac-BT’s “retirement wrap” umbrella fund had been gouged as much as $8 billion over the past decade, thanks to exorbitant fees.

Between mid-2018 and mid-2020 returns to members were close to zero (0.1%).

According to Australian Prudential Regulation Authority data, had the performance of the Westpac funds been merely average, its customers would have been $5 billion better off.

Read more:
Why bank shares are climbing despite the royal commission

The matter was reported to ASIC on November 23 last year. All ASIC has done since is “review” the situation. In that time fund members might have lost a further $1.5 billion relative to the industry average.

A better way to support a post-COVID economic recovery would be to give customers confidence that the laws meant to protect them were being properly enforced. It isn’t the road the treasurer has taken.The Conversation

Andrew Schmulow, Senior Lecturer, Faculty of Law, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.

4 key takeaways from the aged care royal commission’s final report


Stephen Duckett, Grattan Institute and Anika Stobart, Grattan Institute

The Royal Commission into Aged Care Quality and Safety’s final report into aged care has laid out an extensive plan to overhaul Australia’s aged-care system.

Among the 148 recommendations, the report calls for a new system underpinned by a rights-based Act, funding based on need, and much stronger regulation and transparency.

Over two years, through more than 10,500 submissions and 600 witnesses, the two commissioners heard extensive evidence of a system in crisis. Australians might have expected the commissioners to provide one streamlined blueprint for reform.

But the commissioners diverged on a number of large and some smaller recommendations. This makes the already complex path to reform even more confusing. It reduces the power of the final report. More disappointingly, it gives the government room to pick and choose recommendations as the cabinet likes.

Nonetheless, if the major recommendations are adopted, Australia will get a transformed aged care system over the next five years.

Here are our top four takeaways from this landmark report.

Read more:
Paid on par with cleaners: the broader issue affecting the quality of aged care

1. Australia needs a rights-based aged-care system

In its recommendations, the final report highlights Australia needs a new Aged Care Act to underpin reform. The new Act should set out the rights of older people, including their entitlement to care and support based on their needs and preferences.

This would be a significant shift away from the current ration-based system, and would bring aged care more in line with the principles of Medicare.

Practically, this would mean the number of people in the system would no longer be capped — the long waiting lists for care would disappear over time. The current aged-care programs, such as home-care packages and residential care, would be replaced by a single program.

Under this new program, all older Australians in need of support would be independently assessed, and allocated care according to their personal needs and preferences — whether at home or in residential care.

This is a huge step forward, and, with the right support, would enable older Australians more choice and control over their care.

2. The system needs stronger governance

Ineffective governance and weak regulation of aged care must end. The final report calls for much stronger governance, regulation of the quality of care, prudential regulation, and an independent mechanism to set prices.

These changes would ensure the “quasi-market” aged-care system, as commissioner Tony Pagone described it, was much better regulated, holding providers to a higher standard of care, and better able to address any service gaps in the system. We might see the introduction of home care in locations where home-care services were not previously available, for example.

This change would require all aged-care providers to be accredited against the new standards. We hope that process would weed out some of the poorest performers in the sector. The new system would have offices across the country, to provide on-the-ground support to older Australians and providers.

Unfortunately, the commissioners diverged on the exact mechanisms for these changes. Pagone wants an independent commission to be responsible for aged care, at arms-length from the health department. Meanwhile, commissioner Lynelle Briggs wants governance to remain with a reformed department, but with quality regulation managed by an independent quality commission.

Given the department’s poor track record on managing aged care, we need to see a major change of culture. We urge the government to accept commissioner Pagone’s recommendation.

3. We need to improve workforce conditions and capability

The final report makes numerous important recommendations to enhance the capability and work conditions of formal carers. It calls for better wages and a new national registration scheme for all personal care workers, who would be required to have a minimum Certificate III training.

Residential care facilities would need to ensure minimum staff time with residents. By July 1 2022, this would be at least 200 minutes per resident per day for the average resident, with at least 40 minutes of that time with a registered nurse.

The facilities would be required to report staffing hours provided each day, specifying the breakdown of residents’ time with personal care workers versus nursing staff.

While these measures are good, they are the bare minimum, and would only give facilities a minimum 2 or 3 star rating. But coupled with recommendations for stronger transparency, including the publication of star ratings and quality indicators to compare provider performance, providers might be incentivised to go above this minimum standard.

4. A better system will cost more

The final report makes a series of complex recommendations about fees and funding, with the commissioners diverging in view as to the specific arrangements. But essentially, the proposed new funding model would provide universal funding for care services, such as nursing.

This means there would be no requirement for aged-care recipients to pay a co-contribution, like public patients in public hospitals. Instead, the expectation is people pay for their ordinary costs of living, such as cleaning, subject to a means test and up to a maximum amount in residential care.

A carer holds the hand of an elderly person.
A rights-based system means funding is determined by each individual’s needs.

These changes would coincide with the phase-out of the burdensome refundable accommodation deposits, which some residents currently pay as a lump sum to providers when they enter residential care. This approach is a shift away from the current muddled set of means-tested arrangements, and may help offset some of the additional spending needed to pay for a rights-based system.

Unfortunately, the report does not touch on how much the recommended changes would cost. Australia should be prepared to pay the price of a better aged care system.

Read more:
View from The Hill: royal commission confronts Morrison government with call for aged care tax levy

The government has been underspending on aged care. Most Australians agree the government should provide more funding for aged care. Commissioner Briggs has the more persuasive proposal for funding the new system. She wants the government to introduce legislation by July 1 2022 that establishes an aged-care improvement levy of 1% of taxable personal income.

Commissioner Pagone is weaker on this point. He wants the Productivity Commission to investigate the establishment of an hypothecated aged-care levy (meaning the money raised by the levy can only be spent on aged care).

Either approach will be politically difficult, but Australians should demand their government lock-in a secure funding supply. That will help produce an aged-care system that protects the rights, upholds the dignity, and celebrates the contribution of all older Australians.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute and Anika Stobart, Associate, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Older Australians deserve more than the aged care royal commission’s COVID-19 report delivers


Joseph Ibrahim, Monash University

Amid the ongoing disaster in Victorian aged-care homes, the Royal Commission into Aged Care Quality and Safety yesterday released its special report into the COVID-19 pandemic.

This report finally states who is responsible for aged care — the federal government — finding its actions were “insufficient” to ensure the aged-care sector was prepared for the pandemic.

But the report doesn’t offer us a clear picture of what went wrong and why.

Importantly, its recommendations largely fall short and come too late.

5 main recommendations that don’t go far enough

The report’s first key recommendation addresses the vexed issue of isolating residents from family and friends during lockdowns. The commissioners have asked the government to fund providers to ensure adequate staff are available to facilitate loved ones to visit.

This addresses the universally recognised need for a humane and proportionate response to lockdown, and the need to reduce the mental and physical harms associated with isolation.

But a better approach would be to introduce a mandatory code for visits to aged-care homes during COVID-19, rather than the voluntary code we currently have. We’d also need a way of enforcing this code, including a process to address family concerns immediately.

Read more:
Federal government did not prepare aged care sector adequately for COVID: royal commission

Second, the commission recommends the government create Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to aged-care residents.

While this will assist to some degree, a better recommendation would be instituting structured rehabilitation plans for residents with support from care workers. This would ensure the allied health advice provided through these new Medicare items is followed.

This recommendation also fails to address the fact many allied health staff work across multiple services, which increases the risk of infection spread.

The third recommendation requires establishing a national aged-care plan for COVID-19, including setting up a national aged-care advisory body. This is the most obvious step in any emergency response.

The commission indicates the plan should establish protocols between the federal government and states and territories, which may reduce some confusion around who is responsible for what. The plan should also set up procedures regarding who decides whether residents with COVID-19 are transferred to hospital.

As part of the plan, significant outbreaks in facilities are to be investigated by an independent expert, and any lessons promptly disseminated to the sector.

But the commission doesn’t provide any detail on what constitutes an independent expert, a major oversight. Ideally, the experts shouldn’t be directly involved with government departments, the regulator or affiliated groups involved in the pandemic response.

Read more:
4 steps to avert a full-blown coronavirus disaster in Victoria’s aged care homes

Perhaps most disappointing is the commission did not highlight that multiple outbreaks in aged-care homes reflect systemic issues rather than individual organisational failures. The most useful information is obtained by investigating every aspect of the sector as a whole. This is a missed opportunity and does not serve the best interests of older Australians.

As for the advisory body, the commission was clear the group Prime Minister Scott Morrison established in August was not sufficient — it lacked the right skill mix and was temporary.

But it’s extremely disappointing the commission has not directed that senior nurses, family members and residents (ideally supported by human rights lawyers) be appointed to the group. The people who will be most affected by the decisions should be directly involved in making them.

Read more:
Banning visitors to aged care during coronavirus raises several ethical questions – with no simple answers

The fourth recommendation stipulates all aged-care homes should have one or more trained infection control officers as a condition of accreditation.

The fifth is for governments to deploy accredited infection prevention and control experts into aged-care homes to provide training, and assist with preparing for and managing outbreaks.

These are sound recommendations, but should have been in place more than a decade ago, had we learnt from Hong Kong’s experience with SARS.

The challenges with implementing these recommendations will be having the human resources for such a workforce, including addressing the longstanding issue of health professionals’ willingness to work in regional and remote areas.

Some key omissions

The report’s recommendations are worthwhile, yet all are late in arriving and incomplete. Each recommendation provides a solution to an entirely foreseeable problem.

Notably, there’s an absence of strategies to address the known structural problems in aged care. These are issues the commission itself has previously described, around workforce limitations, widespread neglect of residents, and regulatory failures. They represent barriers to implementing the recommendations.

An elderly woman walks down the corridor of a nursing home using a frame.
Dedicated staff will be deployed to enhance infection control procedures in nursing homes.

The commissioners also fell into the trap of inappropriate comparisons. References to Australia faring better than selected European and North American countries fail to acknowledge our advantages of being an island continent with lower community transmission and an extra three months to prepare. This provides false reassurance to the public.

We should judge our performance on the disparity between what we could have done and what we did do, rather than against countries in different situations.

There’s more to uncover

It’s not surprising the government has accepted all the recommendations, as each of these initiatives should have already been in place well before the second wave hit Victoria.

The commission has recommended the federal government report on the implementation of these recommendations no later than December 1.

Read more:
The budget must address aged care — here are 3 key priorities

Ultimately, this report was not designed, nor did it deliver, an understanding of what went wrong in aged care, and why.

Similarly, the recommendations do not go to the heart of the information gleaned from the appalling and tragic lived experiences of residents, families, aged-care workers and health professionals.

With so many outbreaks, many still ongoing, and tragically, several hundred deaths in aged care already, there remains much we need to uncover.The Conversation

Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Federal government did not prepare aged care sector adequately for COVID: royal commission

Michelle Grattan, University of Canberra

The royal commission into aged care has said government did not prepare the sector well enough for the pandemic.

In a damning report the commission rejected the government’s repeated claim it had a plan for aged care, which is a federal responsibility.

The commission said that now “is not the time for blame” for what happened in aged care, where most of the Australian deaths have occurred – as at September 19, 629 out of 844 total deaths. The latest number of deaths from residential aged care is 665.

But, the commission said, it was clear the measures implemented by the federal government on advice from the Australian Health Protection Principal Committee “were in some respects insufficient to ensure preparedness of the aged care sector”.

It called for immediate action on infection prevention and to ensure residents weren’t cut off from visitors.

In its special report into COVID, the commission said the government should establish a national aged care plan and a permanent aged care advisory body.

Under pressure from evidence to the commission, the government belatedly set up an advisory committee in August but made it clear it was temporary.

As soon as the report was tabled on Thursday, Aged Care minister Richard Colbeck said the government was accepting all its recommendations.

But he continued to insist the government did have a plan for the sector.

“Never before has the aged care sector in Australia faced a challenge like COVID-19,” the report said.

It said the government should fund providers to ensure there were adequate staff available to deal with visits from family and friends.

The understandable restriction of visits “has had tragic, irreparable and lasting effects which must immediately be addressed as much as possible”.

“Maintaining the quality of life of those people living in residential aged care throughout the pandemic is just as important as preparing for and responding to outbreaks,” the report said.

“Funding to support increased visits is needed immediately.”

The commission recommended the Medicare schedule be changed to increase the provision of allied health and mental health services to residents during the pandemic, and the government should “arrange for the deployment of accredited infection prevention and control experts” into facilities.

Announcing $40.6 million as an initial response, Colbeck said the government was already well progressed in delivering some of the recommendations.

The commission said that “confused and inconsistent messaging” from providers, the federal government, state and territory governments had been themes in submissions to it.

“All too often, providers, care recipients and their families, and health workers did not have an answer to the critical question: who is in charge?

“At a time of crisis, such as this pandemic, clear leadership, direction and lines of communication are essential”.

The commission said much had been made during its hearing about whether there was an aged care specific plan for COVID.

“There was not a COVID-19 plan devoted solely to aged care. But there was a national COVID-19 plan that the Australian Government sought to adapt and apply to the aged care sector.”

However “there is a clear need for a defined, consolidated, national aged care COVID-19 plan”.

The commission said the recommended plan should be established through the national cabinet in consultation with the aged care sector.

The plan should establish federal-state protocols, maximise the ability for residents in facilities to have visitors, and establish a mechanism for consultation with the sector about the use of “Hospital in the Home” programs.

It should establish protocols on who would decide about transfers to hospitals of residents with COVID, and ensure significant outbreaks were investigated by an independent expert, with the results disseminated to the sector.

The commission said the government should report to parliament no later than December 1 on the implementation of the recommendations in its report.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Grattan on Friday: Morrison government needs to improve, rather than defend, its poor COVID aged care performance

Michelle Grattan, University of Canberra

The state of aged care preparation in the era of COVID-19 is, it seems, in the eye of the beholder.

Vastly different claims emerged this week, when the royal commission examining the sector turned its attention to the handling of the pandemic.

According to the senior counsel assisting the commission, Peter Rozen, QC, federal authorities had no COVID-19 plan specifically for aged care, always potentially a major risk area. And, Rozen noted, compared with many countries, residents of facilities form a very high proportion of Australia’s deaths.

The government disputes the lack-of-plan allegation and has a different take on the statistics.

Brendan Murphy, secretary of the health department and until recently Australia’s chief medical officer, appearing before the commission, insisted there had been proper planning, and said the death proportion reflected not a failure in aged care but the low number of fatalities in the general community.

If you were taking a bet on who most people would believe, Rozen would be short odds.

Morrison knows the government is highly vulnerable on the issue. Aged care is a federal responsibility. It affects millions of Australians, counting those with relatives in homes. People’s anger buttons are easily triggered when things go wrong.

Some around the government might like to discount Rozen’s attack as being what counsels-assisting do at royal commissions. But his claims were backed by witnesses, from highly regarded geriatrician Joseph Ibrahim of Monash University to union officials with members on the front line.

They also resonated after the numerous first-hand accounts in the media from families as the virus has ripped through well over 100 facilities in Victoria. Currently, there are more than 1,000 cases among residents and over 1,000 among staff, linked to these homes.

Politicians have been congratulated during the pandemic for listening to experts, but according to Ibrahim, there was not enough aged care expertise applied in the preparations to firewall the sector.

It’s hard if not impossible, anyway, to build adequate safeguards when the structure itself is so compromised, due to bad decisions and neglect over many years.

Read more:
Royal Commission into Aged Care reminds Health Department Secretary Brendan Murphy it sets the rules

A sector operating with low paid, often short term, casuals who pick up work across facilities and often have inadequate English (complicating even basic training) was always inviting disaster.

Health Minister Greg Hunt declared recently, after Victoria Premier Dan Andrews said he wouldn’t want his mother to be in some of these places:

The idea that our carers, that our nurses are not providing that care, I think, is a dangerous statement to make. They are wonderful human beings and I won’t hear a word against them.

This misses the point. No one doubts the commitment the majority of the carers have to their work. But the nature of the workforce brings dangers for residents.

Many facilities run on narrow financial margins. The rules allow them to keep their staffing to a minimum, in terms of numbers and skill.

Nor has regulatory oversight been adequate. Often it is families and the media that have exposed neglect and abuses. Morrison announced the royal commission in September 2018 a day before an ABC Four Corners investigation was to air.

The for-profit system emphasises the idea of facilities being “home-like”, which sounds great but can mean inadequate specialised care and challenges for inflection control.

The word “tragic” is thrown around too much by politicians and media. But what’s happened in aged care during COVID-19 has indeed been a tragedy.

It’s just possible if the pandemic had come two years later, after next year’s final report of the royal commission had forced some reform, that fewer lives would have been lost. But even with the system as it is, the evidence indicates better planning could have saved lives.

That’s certainly Ibrahim’s view. In his precis of evidence, he argued “hundreds of residents will die prematurely because people failed to act”.

We had enough knowledge to do better. We failed because when residents are treated as second class citizens there is an absence of accountability and consequences for those responsible for aged care in Australia.

There was “failure to provide the same health response to residential aged care that was delivered to the rest of Australia.”

The government has been playing catch-up on aged care all through the pandemic. It had to put substantial money in to help with staffing; it was slow to acknowledge the importance of masks; it set up a co-ordinated response in Victoria belatedly; National Cabinet only a week ago stepped up preparations in other parts of the country.

Morrison is now confronted at two levels: there must be root and branch reform after the royal commission, and his government is under immediate pressure over this week’s indictment.

The government’s tactic of inserting Murphy into the commission’s witness list was a miscalculation.

It seemed to assume the commission would defer to Murphy when he sought to make a statement to reject Rozen’s claims. But he was refused permission to commence with the statement (which he delivered at the end of the session) and all his appearance did was highlight the government’s sensitivity.

When he summed up the hearings on Thursday, Rozen did not resile from his initial criticisms. He concluded the problems in aged care had been foreseeable; “not all that could be done was done”; and the challenge remained.

Picking up a recommendation from Ibrahim, Rozen urged an “age-care specific national coordinating body to advise government”. It would bring together expertise in aged care, infection control and emergency preparedness.

With such a body, “a national aged care plan for COVID could still be put in place,” Rozen said.

Read more:
Government rejects Royal Commission’s claim of no aged care plan, as commission set to grill regulator

Although the advisory body is not a formal recommendation, commissioner Tony Pagone endorsed it among “practical things that perhaps should not wait.”

The virus doesn’t wait and nor should the measures that need to be implemented to deal with the virus wait either.

The government, which has previously signalled more assistance for aged care in the budget, should stop insisting it has done everything well and act immediately on this and some of the other suggestions made in the COVID-19 hearings.

Morrison said this week in a Facebook message, “I want to assure that where there are shortcomings in these areas they’ll be acknowledged. And the lessons will be learned.”

The government likes to talk about wanting a reform agenda, but this should not be just an economic one. Aged care must be near the top of any serious “reform” to-do list, and vested interests should not be allowed to limit necessary changes.

In his end-of-year ministerial reshuffle, prompted by Mathias Cormann deciding to quit parliament, Morrison should elevate the aged care portfolio from the outer ministry to cabinet.

Having the post in cabinet would send a positive signal but, more importantly, it would encourage a wider range of ministerial eyes on an issue that’s been mishandled for as long as anyone can remember.

Veterans’ affairs is in cabinet, and most families would think aged care is just as worthy of a place.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Royal Commission into Aged Care reminds Health Department Secretary Brendan Murphy it sets the rules

Michelle Grattan, University of Canberra

The Royal Commission into Aged Care put the Secretary of the Federal Health Department, Brendan Murphy, firmly in his place when he tried to make an opening statement to attack claims by the senior counsel assisting the commission, Peter Rozen, QC.

Murphy, who became a nationally known figure when as Chief Medical Officer he appeared regularly at Scott Morrison’s news conferences, had not been due to give evidence at the commission’s sittings on COVID this week.

But after Rozen’s Monday statement the federal government, which is increasingly concerned at the criticism it is receiving over inadequate preparation for the pandemic in aged care facilities, asked to have him added to the panel of Commonwealth witnesses who appeared on Wednesday.

As questioning of the panel was about to start Murphy broke in, saying he wanted to make a statement in response to Rozen inaccurately claiming the Commonwealth had not planned for the outbreak in aged care and as a result there had been a high death rate.

But after a brief adjournment for consultations the commission denied his request, although he was allowed to make the statement at the session’s end. As commissioner Tony Pagone put it with the utmost politeness but equal firmness, “We are really in control of the procedure that we have and we just need to continue with that.”

On Wednesday Victoria announced a record 21 deaths from the previous 24 hours, 16 of them linked to aged care.

In a Facebook message Scott Morrison, expressing condolences, referred particularly to the need to protect the vulnerable elderly.

He also said pointedly: “I want to assure that where there are shortcomings in these areas they’ll be acknowledged. And the lessons will be learned.”

He warned there would be more “difficult news” in the days and weeks ahead.

Earlier on Wednesday professor Joseph Ibrahim, a specialist in geriatric medicine from Monash University, told the commission: “This is the worst disaster that is still unfolding before my eyes and it’s the worst in my entire career”.

He said hundreds of aged care residents would die prematurely because people had failed to act.

“There’s a level of apathy, a lack of urgency. There’s an attitude of futility which leads to an absence of action.

“The reliance or promotion of advance care plans as a way to manage the pandemic and the focus on leaving residents in their setting I think is wrong and inappropriate. When I voiced my concerns, I have had comments saying that everything is under control, that I’m simply overreacting and causing panic,” Ibrahim said.

Early in the crisis Ibrahim made representations to state and federal bodies, and to Morrison, health minister Greg Hunt and aged care minister Richard Colbeck.

The tension was evident when the panel of Commonwealth officials gave evidence.

Michael Lye, the health department’s deputy secretary for ageing and aged care, unsuccessfully tried to divert to Murphy a question about Australia faring badly on aged care deaths compared to other countries. Rozen insisted Lye answer, saying sharply, “No, I don’t want professor Murphy to answer the question, Mr Lye. I’m asking you. You told us you were the senior most official with aged care responsibility within the Commonwealth department of health”.

In one embarrassing moment for the federal officials, Rozen drew attention to Murphy prompting Lye when the latter was struggling under the questioning.

Rozen told both Lye and Murphy, as they periodically veered into wider comments, to just answer his questions.

Quizzed about the apparent lateness of a July 13 decision to make masks compulsory for care providers in Victorian homes, Murphy admitted “in hindsight, you could have implemented that earlier”, agreeing it was “possible” it might have reduced the number of infections entering homes.

In his forcefully-delivered statement at the end of the session, Murphy declared: “We reject categorically that the Australian government failed to adequately plan and prepare” for COVID in aged care.

He also strongly rejected that there was anything pejorative in the fact people from aged care formed a high proportion of “an extraordinary low death rate in Australia”. “I would say the contrary is true.” He said across Australia’s aged care facilities 0.1% of residents had succumbed to COVID compared to 5% in the UK with many more not detected.

The fact that two thirds of Australia’s about 350 deaths were from aged care “is really a reflection of the extraordinarily low community death rate,” Murphy said.

Diana Asmar, Victorian secretary of the Health Workers Union, told the commission: “Our members right now feel like they’re on the bottom of the Titanic ship”. They did not have proper access to personal protective equipment, they were suffering from huge staffing pressures, and they were feeling neglected.

“The lack of communication, the lack of training, the lack of staffing and the lack of protection unfortunately has caused a huge concern in the aged care sector,” she said.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Government rejects Royal Commission’s claim of no aged care plan, as commission set to grill regulator

Michelle Grattan, University of Canberra

The federal government has clashed with the Royal Commission into Aged Care, strongly rejecting the claim by senior counsel assisting the inquiry Peter Rozen that it had no specific COVID-19 plan for the sector.

Aged Care Minister Richard Colbeck told a news conference: “We have had a plan to deal with COVID-19 in residential aged care, going right back to the beginnings of our preparations.

“We’ve been engaged with the sector since late January, and continuously working with the sector to ensure they have all the information they require and the support that they need in the circumstance that they might have an outbreak of COVID-19.”

Acting chief medical officer Paul Kelly said: “We have been planning for our aged population as a vulnerable group since the beginning of our planning in relation to COVID-19”. And there had been “very strong communication with the sector throughout,” he said.

Rozen, in a Monday statement at the opening of this week’s hearings on COVID in the aged care sector, said while much was done to prepare the health sector more generally for the pandemic, “neither the Commonwealth Department of Health nor the aged care regulator developed a COVID-19 plan specifically for the aged care sector”.

The sector had been underprepared, he said.

Asked whether the government’s plan had failed, Colbeck admitted there had been “some circumstances where things haven’t gone as we would like”, saying “the circumstance at St Basil’s [in Melbourne] is one, where we didn’t get it all right”.

On Wednesday the commission will take evidence from Janet Anderson, head of the Commonwealth regulator, the Aged Care Quality and Safety Commission, which Rozen said “did not have an appropriate aged care sector COVID-19 response plan”.

The government has left Anderson out to dry, after it was belatedly discovered her body was told of an outbreak at St Basil’s two days after a staffer was diagnosed, but it failed to pass on the information.

Quizzed about this, Colbeck said under the protocols, “the Commonwealth should have been advised of the outbreak on 9 July by either the Victorian health department or St Basil’s management or both. Instead it was formally informed on July 14.”

But he was also critical of the Quality and Safety Commission which was informed of the outbreak when it was speaking to the home as part of a survey about preparedness and infection control.

“The disappointing thing, from my perspective, is that the information that was gleaned … about a positive outbreak wasn’t passed on to anyone else,” Colbeck said.

“There was an assumption made … that information had already been passed on. It wasn’t.

“The gap in the supply chain, or the information chain, has now been closed. … There should not have been a hole in our systems. That’s been rectified appropriately, as it should have been.”The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Federal departments had no specific COVID plan for aged care: royal commission counsel

Michelle Grattan, University of Canberra

Australia’s aged care sector was “underprepared” to deal with the COVID-19 outbreak and federal authorities had no specific plan for it, according to a stinging indictment from Peter Rozen QC, senior counsel assisting the royal commission into aged care.

In a statement critical of authorities and providers, Rozen said while much was done to prepare the health sector more generally for the pandemic, “neither the Commonwealth Department of Health nor the aged care regulator developed a COVID-19 plan specifically for the aged care sector”.

Rozen was speaking at the start of several days of hearings to look at the sector’s preparations and response to the crisis. The commission will probe the NSW outbreaks in homes but not delve in detail into particular homes in Victoria because the crisis is ongoing there.

Aged care is a Commonwealth responsibility, while the states are responsible for health.

Rozen said on Commonwealth data, more than 1,000 residents had been diagnosed with COVID-19, of whom 168 had died.

The pandemic had “starkly exposed” the flaws in the sector that had been highlighted during the royal commission.

In view of the deficiencies it was “hardly surprising that the aged care sector has struggled to respond to COVID-19”.

He stressed the consequences of the deskilling of the aged care workforce and a shortage of clinical skills in homes.

Rozen quoted health minister Greg Hunt saying on July 29 that “aged care around the country has been immensely prepared”. But, Rozen said, “in a number of important respects, the evidence will demonstrate that the sector has been underprepared”.

“We will be asking if greater attention to preparation may have saved lives and could save lives in the future.”

Rozen said that between June 19 and August 3, a crucial period when new infections in Victoria escalated, there was no updated advice for the aged care sector from the Australian Health Protection Principal Committee – the main source of COVID advice.

“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.”

Rozen was critical of the Commonwealth regulator, the Aged Care Quality and Safety Commission, which oversees the sector.

“The regulator did not have an appropriate aged care sector COVID-19 response plan. Given that it was widely understood that recipients of aged care services were a high risk group, this seems surprising.”

On March 17, the regulator wrote to providers with a survey asking about their preparedness. Overwhelmingly they claimed to be prepared, but evidence would be critical of this survey, Rozen said.

He questioned the late timing of the regulator’s action in relation to the Newmarch House in Sydney and the fact the regulator had not investigated the circumstances of the Dorothy Henderson Lodge and Newmarch House outbreaks.

Read more:
View from The Hill: Aged care crisis reflects poor preparation and a broken system

“We also have concerns about whether the regulator’s powers of investigation are adequate,” Rozen said, adding that comparable regulators in areas such as workplace or airline safety were not as fettered.

There were “notorious problems” in the relationship between the health system run by the states and the Commonwealth aged care sector, Rozen said.

He detailed an argument between federal and NSW authorities about whether residents with COVID should be transferred to hospitals, with the federal authorities wanting transfers and the state official opposing.

“Equal access to the hospital system is the fundamental right of all Australians young or old and regardless of where they live,” Rozen said.

“Many of the residents in aged care homes worked their entire lives to build the world class health system of which Australians are justifiable proud.

“They have the same right to access it in their hour of need as the rest of the community. To put it very directly, older people are no less deserving of care because they are old. Such an approach is ageist”.

Rozen noted the time it took, after experience in Sydney, for the Commonwealth health department to advise providers that 80-100% of their workforce might need to isolate in a major outbreak, and even then it was not highlighted.

“Regulators in other fields such as workplace safety publish page one ‘alerts’ to disseminate promptly via safety information they learn from incident investigations.”

Rozen said masks were not made compulsory for aged care workers until July 13 – two days after the first recorded deaths of an aged care resident in Victoria. On July 13, the number of new Victorian infections was 250.

“Why did authorities wait until after the fir
st death to take what seems the simple and obvious step of making masks compulsory for aged care workers?”

Commonwealth aged care regulator admits it was told of St Basil’s outbreak

The head of the Commonwealth’s Aged Care Quality and Safety Commission, Janet Anderson, has told a Senate inquiry St Basil’s Home for the Aged informed the commission of its COVID outbreak on July 10 – contrary to claims made previously that the Commonwealth was not told until July 14.

In a letter to the Senate committee on COVID-19, Anderson wrote she had become aware that on July 10, during a telephone call responding to the commission’s assessment contact program the St Basil’s representative “provided information that one staff member … was diagnosed with COVID-19 on 8 July 2020 and the Public Health Unit (PHU) had been advised”.

Anderson, the aged care minister, Richard Colbeck, and the secretary of the federal health department Brendan Murphy all told the committee on August 4 the Commonwealth had not been informed about the outbreak until July 14.

That was when the Victorian health and human services department notified it. The time lag has been seen by the Andrews government’s critics as further evidence of its poor administration.

In her letter Anderson said the commission was not the first responder to an outbreak and the phone contact had been part of a commission program to seek assurances from facilities that COVID plans had been developed and were ready to be acted on.

“The regulatory official from the Commission who made the assessment contact referred the service’s responses to the Commission’s COVID-19 Response Team and this information was escalated internally and recorded in the Commission’s daily COVID-19 confirmed case tracker, Anderson wrote.

“The Commission did not escalate the matter externally at the time because the St Basil’s representative had confirmed in the interview that they had advised the PHU [the Victorian Public Health Unit] of the outbreak. The representative also confirmed that they had read the ‘First 24 hours’ document.”

Anderson noted this federal health department document lists four actions to be taken in the first 30 minutes. These steps are: isolate and inform the COVID-19 positive case(s); contact the local Public Health Unit; contact the Commonwealth Health Department; lock down the facility.

Anderson said the commission was later advised about the outbreak by the health department on July 14.

“To manage any risks of provider failure to notify the relevant authorities of a COVID-19 outbreak, the Commission now has arrangements in place to confirm immediately with the Commonwealth Department of Health that they have been directly notified by the affected aged care service of any outbreak at that service that comes to the Commision’s attention by whatever means.”

Asked about the bungle, Scott Morrison was sharp. He said the commission was an independent body that operated formally separate from the government but he was concerned about the breakdown in communication.

He said where there were breakdowns and issues, he wanted to know about them and fix them.

“We will be following [the matter] through with the commissioner. And at the end of the day, they’re an independent statutory office and they know their responsibilities and they need to live up to them.”The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.