Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I present an interim report of the Community Affairs References Committee on aged care assessment and accreditation.

Ordered that the report be printed.

I move:

That the Senate take note of the report.

This particular interim report—I will go into why it is an interim report during my remarks—looks at the effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse and poor practices and ensuring proper clinical and medical care standards are maintained and practised. This inquiry was established to look at the effectiveness of the current frameworks in ensuring that older Australians get quality aged care. In the first instance we had a focus on the shocking revelations of abuse and lack of care that were made about the Oakden facility and specifically the Makk and McLeay wards.

At this point I thank all of the witnesses who gave us evidence, particularly those—by and large they were the relatives of former residents—who shared the most personal experiences of the appalling treatment that many of their relatives received. Many of those witnesses shared evidence that was deeply concerning and troubling both to them and to the members of the committee that heard it. Quite frankly, how long this outrageous situation went on for still boggles my mind. Our report goes through the time line of accreditation and review from when the processes began there in 1998 until it closed. There were many failures on many occasions. Despite this it took a long time before the alarm was raised about the appalling circumstances in Oakden, many of which have been aired in the media.

In February 2016 Mr Bob Spriggs, a resident of Oakden, was admitted to the Royal Adelaide Hospital emergency department with unexplained significant bruising to his hip, a chest infection and severe dehydration. In June 2016 the Spriggs family made a complaint to the Principal Community Visitor in South Australia, who raised concerns with the Northern Adelaide Local Health Network, commonly known as NALHN. After repeated unsuccessful attempts over four months to seek a response from the NALHN and the Office of the Chief Psychiatrist SA regarding the complaint, the Principal Community Visitor noted the inaction in his annual report, which was sent to the South Australian Minister for Mental Health and Substance Abuse on 30 September 2016. The principal visitor wrote to the South Australian minister on 14 October 2016 to formally request a review of the service delivery at Oakden. Then the Northern Adelaide Local Health Network met with the Spriggs family regarding their complaint.

The annual report was tabled in the South Australian parliament on 7 December 2016 and generated media interest with the issues it contained. Subsequently, the chief executive officer of the NALHN agreed to meet with the Spriggs family in December 2016 and, after this meeting, requested the chief psychiatrist undertake a review of Oakden. We know that that ultimately led to Oakden being closed. That's how long it took. We should note that Mr Spriggs's family were not the first family to raise concerns.

I'll cut to the chase here because I know there are a number of other people who want to speak. The report states:

4.70   The evidence presented to this inquiry, which includes the reports of two in-depth inquiries into the services provided at Oakden, shows that Oakden had a toxic culture of wilful negligence, cover-up and avoiding management and regulatory responsibilities, which resulted in a 'care' service which shocked the two external reviews tasked with making an in-depth investigation into Oakden.

4.71   Services at Oakden included appallingly sub-standard clinical and personal care, as well as abusive practices, some of which have now been reported as criminal acts. Evidence of this substandard care was noticeable to anyone who cared to pay attention, but it seems that no-one in a position to effect change wanted to pay the required attention.

I am quoting directly from our report here:

4.72   The committee commends the SA Government for the extensive actions taken to remediate the services at Oakden. However, the committee must also strongly condemn the length of time it took for the relevant SA authorities to take action after receiving serious complaints and clear warnings relating to Oakden. Some of the instances of abuse or neglect occurred well after the date of the Spriggs family complaint, and most likely would not have been possible had appropriate action been taken at the time of the complaint.

4.73   The committee is deeply concerned that the Quality Agency visited Oakden and had no concerns with the service as late as November 2016. This a mere month before the CEO of NALHN formed a serious view about the quality of service at Oakden, a view that was based on complaints made five months earlier. The Committee is not convinced by the Agency's explanation as to how this came about.

4.74   The committee believes that if a situation like that at Oakden can occur for many years under the eyes of the regulators, then there are serious concerns about the quality of oversight for the broader aged care sector, and the quality of care being provided to vulnerable aged Australians.

4.75   The committee cannot be confident that there are not other aged care facilities where abuse and neglect are occurring elsewhere in Australia.

4.76   The committee notes that while the two key inquiries into the standards of care at Oakden have concluded, investigations into individual instances at Oakden are ongoing. These investigations are by the Australian Health Practitioner Regulation Agency into the standards of professional care being given by individual registered health practitioners, by SA Police into assaults on residents under the guise of restrictive practice, and by SA Independent Commission Against Corruption into the appropriate actions of individual local, state and federal management personnel.

…   …   …

4.77   The committee strongly agrees with the views expressed by the majority of submitters that while Oakden is at the extreme end of sub-standard aged care services, it exemplifies broader concerns with the quality and oversight frameworks for the overall aged care sector.

4.78   Of particular concern to the committee is the body of evidence relating to model of care issues, definitions of personal versus medical care, and clinical governance within aged care facilities. The aged care sector appears divided in how it defines the provision of allied health or medical services, and who takes ultimate responsibility for the quality of service provision or the oversight and regulation of that health service.

As you can see, we were very concerned about the evidence that we heard. I'll cut very quickly to our recommendations, but I should preface this by noting that the government commissioned, as part of the response to this, the Carnell-Paterson report, in which they've responded to one of the recommendations, and we received evidence that they'll be responding further, most likely as part of the budget announcements later in the year. There's other ongoing work as well, including the new Single Aged Care Quality Framework, due to be introduced in July 2018, which will play major roles in ongoing examination of the Aged Care Quality Assessment and accreditation framework. Continued inquiry from this committee as part of the ongoing work of this inquiry will be directed at the outcomes of these external bodies.

So our first recommendation is:

The committee recommends the extension of this inquiry into the effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse and poor practices, and ensuring proper clinical and medical care standards are maintained and practised.

The other recommendation is:

The committee recommends that in the current aged care oversight reforms being undertaken, all dementia-related and other mental health services being delivered in an aged care context must be correctly classified as health services not aged care services—

this was another significant issue during the inquiry—

and must therefore be regulated by the appropriate health quality standards and accreditation processes.

We heard a large amount of evidence. My colleagues, I know, will share their thoughts and experiences during the inquiry. We'd like to take this opportunity to very quickly thank our secretariat, who, as usual, did a brilliant job pulling this together. I urge the government to take on board our recommendations.

Helen Polley (Tasmania, Australian Labor Party, Shadow Assistant Minister to the Leader (Tasmania)) Share this | Link to this | Hansard source

I too rise to speak on this report. We are short of time, but I want to concur with Senator Siewert's comments. The inquiry was established, as we've heard, to review the effectiveness of the aged-care framework, to ensure older Australians receive the quality care they deserve and to protect them from the abuse that occurred at the Makk and McLeay wards at the Oakden Older Persons Mental Health Service in South Australia.

The committee was presented with overwhelming, heartbreaking evidence from family members about the abuse, the neglect and the unprofessional care standards that were applied. Among the things that were raised with us during the evidence were residents being left in soiled clothing for long periods of time and not washed, patients not being fed properly, staff force-feeding sleeping patients, patients being restrained for significant portions of the day, unexplained falls and bruises, and patients being overmedicated.

As Senator Siewert said, if we turn to the situation of the Spriggs family, medication mismanagement was common, and many family members reported oversedation and overdoses. In one instance recounted to the committee, an overmedicated patient was unresponsive for 12 hours—12 hours!—before staff called an ambulance. The committee also heard the story of Mr Spriggs, who passed away just six months after being admitted to Oakden. The Spriggs family have detailed a number of the instances of neglect and failure of care which occurred while Mr Spriggs was a resident at Oakden, and Senator Siewert touched on those. They include one very serious instance of medication mismanagement that saw Mr Spriggs admitted to hospital after he received 10 times the correct dose of an antipsychotic drug. The family's evidence was heart-wrenching. They have had to repeat this on a number of occasions, but they were so grateful that they were being heard by the committee, and I think that should be noted.

The evidence presented to the committee shows that the Oakden facility failed to provide an appropriate model of care. I don't think there's any argument about that. The committee heard from a former staff member of Oakden, Ms Sharon Olsson, who detailed many toxic aspects of nursing and management culture in the facility which led to a culture of fear, silence, cover-ups and inadequate care. I want to put on the record that the committee also heard evidence that there were some dedicated staff whom family members said they felt comfortable leaving their loved ones with. Unfortunately they were too few.

I want to turn my attention to the quality agency. The Aged Care Quality Agency appeared as a witness at both the Adelaide hearing and in Canberra last week. One of the most significant concerns the Aged Care Quality Agency centres on is evidence that the recommendations of the auditors were not always taken on board or were overridden by the quality agency in relation to Oakden. In January 2008 the assessment team that had conducted the evaluation recommended that the facility not be accredited, and the quality agency overrode this decision. This was in 2008—10 years earlier. As a member of the committee, I found the lack of acknowledgement and responsibility about renewing the facility's accreditation after repeated noncompliance at audits absolutely appalling.

The CEO of the quality agency, Mr Ryan, expressed that 'there were clearly learnings for us in terms of the way that we undertake our work' but 'responsibility for what occurred at Oakden, under the Aged Care Act, squarely falls with the provider.' Mr Ryan reaffirmed the quality agency's refusal to take responsibility by saying, 'I don't accept that there was chronic failure on our behalf'. I'd hate to be a witness and hear the evidence of when he would accept that they had failed in their responsibilities. I am ashamed, as an Australian, to have sat through those two hearings and to hear this evidence, and to have the head of the agency saying they had some 'learnings'. There are several points at which Oakden could have been closed—as early, as I said, as 2008—rather than continuing to operate for almost another 10 years. The continued blame-shifting from the agency does very little to reassure me of the agency's ability to learn from the past. I know the committee has made remarks about Mr Ryan's evidence in the report, but my disbelief of the attitude from the head of the agency quite frankly leaves me speechless.

In response to the care issues at Oakden coming to light, the Turnbull government announced an independent review on the national aged-care quality regulatory processes, commonly known as the Carnell-Paterson review. The Carnell-Paterson review made 10 recommendations, and the Australian government—the Turnbull government—immediately moved to implement recommendation 8, for unannounced audit visits. One recommendation to fix this issue is simply not good enough. I don't have a lot of confidence, I have to say, in the Turnbull government when it comes to delivering when we're talking about aged care. There are over a dozen important reviews and reports currently gathering dust on the desk of the Minister for Aged Care. There are a number of recent reviews and inquiries, including the Productivity Commission's 2011 report, Caring for older Australians, the Australian Law Reform Commission's 2017 Elder abuse report, and the report of Senate inquiry into the aged-care workforce, whose recommendations remain unimplemented. During the Canberra hearings last Monday night department officials confirmed that the department has no oversight over the agency. I'll repeat that: the federal department responsible for aged care in this country says it has no oversight over the agency, and that the agency is directly accountable to the minister. We still have had no further recommendations from the Carnell-Paterson report adopted.

I, too, would like to put on record my gratitude, and I know my committee members share it. How heartfelt it was for those families to give evidence, relive their tragedies, relive the hurt and abuse, and verbalise once again what happened to their loved ones. To all those who gave submissions, I want to thank you. Your voices have been heard. We are speaking up. I'm sure this won't be the last time that we speak about this issue. The committee heard from family members during the hearing on 21 November 2017 in Adelaide, and that evidence was overwhelmingly what brought us to the final report that we've given in relation to the Oakden situation. No-one should ever have to go through what those families and particularly those residents of Oakden lived through. It does not matter whether you have a mental health issue or you're living with dementia. No Australian, no human being, should be treated like that. Blame-shifting from one government or one agency to another is not good enough. It needs to end, and it needs to end now. This is absolutely crucial as our population ages and we see an increased number of people living with dementia and mental illnesses.

Unfortunately, I say with great regret—and I know I speak for everyone who sat in on any of those hearings—that we cannot change what happened at Oakden. We can't change that. We can't take the pain away from those families. But what we do have a responsibility to do is to ensure that every Australian older person and every Australian who has mental health issues who goes into residential care in this country are treated with respect and dignity and given the best possible care. We are a rich nation, and we should be able to lead the world and provide the world's best care for our most vulnerable people in this community.

I implore the minister and this government to act swiftly. There is no need to wait till the budget. There is no need for us to wait in anticipation that they might finally step up to the plate and do something. That responsibility is upon their shoulders today, and they can do something. They are the government. The families of those poor residents who died and were treated so abysmally need to know that their government has heard and that it is going to act now. (Time expired)

Sue Lines (WA, Deputy-President) Share this | Link to this | Hansard source

Senator Patrick, I just let you know that this debate concludes at 6.25, so you won't get your full 10 minutes.

Rex Patrick (SA, Nick Xenophon Team) Share this | Link to this | Hansard source

That's fine. I also rise to speak on this report of the Senate Community Affairs References Committee. This is a very important report because it deals with one of the most important measures of effective government and, indeed, of any advanced society—namely, how we treat some of the most vulnerable members of our community. The committee has examined the circumstances and the failures that allowed for the long-term abuse and poor care of residents at the Oakden aged mental healthcare facility.

The events that triggered this report were tragic and appalling. They were also avoidable and should never have happened. South Australia's Chief Psychiatrist, Dr Aaron Groves, found that at Oakden there was widespread abuse, overmedication, excessive use of restraint and neglect over a period of more than a decade. As mentioned by Senator Siewert, this investigation was sparked by the alleged overdosing of former resident Mr Bob Spriggs, who was found with bruises thought to have been caused by inappropriate use of restraints. The events at Oakden clearly involve failures in the most basic duty of care to very vulnerable people and their families. 'Shameful' is the description that is most appropriately applied to this state of affairs.

The committee has done well to produce its report in a timely manner—something that stands in contrast to the many delays that have characterised other responses to the situation at Oakden. The secretariat, in particular, have done an excellent job of distilling the evidence received and accurately identifying the issues, and I thank them for that. NXT strongly supports the findings and recommendations of the report.

As the committee identifies, some blame must and should be directed at the Australian Aged Care Quality Agency for their failure to detect and deal with what were systemic and life-threatening problems at Oakden. I share Senator Polley's concerns about Mr Ryan's responses to the committee. Ultimately, however, the primary responsibility for the disgrace that was Oakden lies with the South Australian government. The South Australian government were directly responsible for the causes of the failed operations at Oakden. These include (1) inexcusably, the failure to have an appropriate model of care, which the South Australian Chief Psychiatrist summed up by saying, 'Oakden is not providing the right care at the right time from the right team'; (2) poor infrastructure, as Oakden's facilities were entirely unsuitable for its purpose; (3) major failures in understaffing and inadequate staff training; and (4) profound failures in clinical governance.

Finally, there was undoubtedly a toxic culture. Morale at Oakden was very poor. There was bickering, dissent, and disrespect amongst staff in an atmosphere that could only be described as secretive, inward-looking and poisonous. This was a deeply dysfunctional facility, quite unsuited to the care of frail and vulnerable people. These problems were the results of longstanding neglect by the South Australian government. It is astounding that it was not recognised by South Australian health authorities.

The South Australian government failed to properly fund this facility, because their health budget was heading into crisis, haemorrhaging from the new Royal Adelaide Hospital costs, which eventually blew out to more than $700 million. One can only imagine what a tiny portion of that $700 million could have done to the lives of those that suffered at Oakden.

As stated in the committee's report, family members' accounts of Oakden consistently featured themes of feeling betrayed by the public aged-care system. For too long, their grave concerns about members of their families were ignored and dismissed by an institution, a system, that refused to look at itself. They felt let down by a system that was intended to help vulnerable people. They were let down, and the results were tragic. It was the South Australian government that failed them, and that failure can only be characterised as shameful.

Sue Lines (WA, Deputy-President) Share this | Link to this | Hansard source

Senator, are you seeking—

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I suspect he seeks leave to continue his remarks.

Leave granted; debate adjourned.