Two hearings stood out at the Aged Care Royal Commission last week for their bruising assessments of reform in the sector.
The first was from Professor Ron Paterson, an international expert on patients’ rights and health care regulation, and co-author, with Kate Carnell, of the Carnell-Paterson Review.
Professor Paterson said regulators rely too heavily on processes and procedures and lack the curiosity needed to properly monitor poorly performing operators.
The second indictment came from Counsel Assisting the Royal Commission, Peter Gray, who said the government has been “tardy” in implementing change.
Progress on Carnel-Paterson reformed “disappointing”
Ms Carnell and Professor Paterson were appointed in 2017 to examine how aged care regulators allowed Oakden nursing home to continue operating, receiving 100 per cent scores during audits, despite what we now know were appalling failings in its care.
The resulting report – Carnell-Paterson Review – made ten recommendations, and the highly anticipated report was handed down to the then Aged Care Minister Ken Wyatt in October that year.
Last week Professor Paterson told the royal commission he was “disappointed” by the progress of reform.
“I’m disappointed… 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.”
Consultation dominated by providers
Professor Paterson said reform has been stymied by ongoing industry consultation.
He said while there is a place for industry consultation, in Australia “there also has to be an end to consultation”.
“At some point, you have to get on and do it and it does seem like there has been an awful lot of consultation and it does seem as if the consultation is dominated by the provider groups,” Professor Paterson said.
Regulators reluctant to escalate problems
He said regulators do not have enough options when it comes to remedying poorly performing operators.
He said the binary system means regulators are too often caught trying to manage facilities back into compliance, because it has limited options for escalating the matter.
Such a system “holds grave dangers”, Professor Paterson said because people aren’t able to see “red flags”. He said the Earle Haven closure was a key example.
Professor Paterson said he did not believe aged care quality and safety could be left solely to market forces. He said listening to what residents want is vital to aged care, and operators and staff should have easy access to the latest research and information about best practice. He recommended aged care advocates be publicly funded, as they are overseas.
He recommended that consumer reports be conducted for 20 per cent of residents and for results to be made public. He said progress in this area was “disappointing”, and lagging behind what other countries are doing.
He said complaints are the “canary in the coalmine” in aged care, and information about complaints should be visible to regulators. A culture of “curiosity and agility” among regulators is essential to address problems sufficiently.
Providers that do not cooperate with complaints inquiries should be publicly named, Professor Paterson said.
“I think there has been a mechanistic approach to the role (of regulation). It feels as if people have been going through the motions and not looking at what’s right there in front of their noses.”
Culture of secrecy “odd”
He said the fact that information about aged care providers remains secret is not helpful.
“These are publicly-funded providers and they are providers who are caring for the most vulnerable members of our community. Why would the default position be secrecy of information about the providers? That strikes me as odd,” he said.
Defects in the system are “old news”
In summing up the wee’s hearings, Mr Gray said the royal commission has exposed serious “defects in the regulation of quality and safety of aged care”, but that the defects are “old news”.
“Government has been tardy in implementing previously recommended forms. There’s been no sense of urgency,” he said.
“Critical urgent reform tasks have been outsourced to consultants and appear to be mired in protracted and multi-staged industry consultation processes.”
He said the Department of Health relies too heavily on policies and procedures, and a spirit of inquisitiveness and curiosity is lacking.
He said even though the functions of the Aged Care Quality and Safety Commission are housed under one roof, there appears to have been little in the way of “cultural change”.
He said the hearings about Earle Haven showed communication disconnects within the Commission, within the Department, and between the two bodies, and that the Commission merely gives “lip service” to complaints without giving them due concern.