Lack of clarity among gov agencies revealed in Newmarch House review

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An independent review of the Newmarch House outbreak has revealed a lack of clarity among government agencies, which created confusion for the Anglicare Board and managers.

The review, conducted by infectious disease physician Professor Lyn Gilbert, suggests this was a key factor in the COVID-19 outbreak that cost 19 residents their lives.

She opened her report with this statement:

These quotes from people we interviewed, encapsulate the challenge and the context in which Newmarch House was operating: “I couldn’t believe this was happening in my country”
[Staff Member, Aspen Medical]

“… although we were preparing; I thought we were prepared. Nothing prepared us for what was to come.”
[Medical Specialist, Nepean Hospital]

“So to be honest with you and I feel terrible to say it but nothing worked well from the outbreak … that’s not to say, I have absolute gratitude for all of those workers who had the courage to turn up when they did.”
[Family Member, Newmarch House]

Seven key areas

The Professor explored seven key areas that made up events that unfolded at Newmarch House. They were:

  1. Emergency response
  2. Leadership and management
  3. Communication
  4. Staffing
  5. Infection prevention and control
  6. Medical and clinical care
  7. Family experience

Under ‘Emergency response’ Professor Gilbert said:

“(There was) a lack of clarity in the relationships and hierarchy among government health agencies, including Nepean Blue Mountains Local Health District, NSW Health, the Commonwealth Department of Health and the Aged Care Quality and Safety Commission,” it said.

“This created confusion for the Anglicare Board and managers.”

Under ‘leadership and management’ she said:

“Leadership and management at Newmarch House, and in the broader Anglicare organisation, was generally invisible to external parties interacting with them.”

Loss of so many staff could not have been anticipated and problems with PPE

The review argues staffing issues at the site, which were caused by infections and staff having to be quarantined due to close contact, could not have been anticipated.

“Staffing during the COVID-19 outbreak was severely depleted as a result of many staff being isolated due to COVID-19 infection or quarantined because of close contact. The requirements for staff replacements could not have been reasonably anticipated; they greatly exceeded the organisation’s planned surge capacity,” the report stated.

The report also says in some cases loss of staff was exacerbated due to poor quality or incorrect use of personal protective equipment (PPE).

“Hospital in Home” approach compromised

The report said while it had merits in theory the “Hospital in the Home” approach was, “compromised by inadequate training and support”.

“Many residents and their families felt that if often failed to fulfil its promise to provide care equivalent to that of inpatient hospital care.”

“The continued presence of residents with COVID-19 in the home, many of whom required a disproportionate share of limited nursing resources, were an ongoing potential source of infection, especially in the face of faulty (infection control) procedures,” it said.

The Professor then identified 20 key learnings.

The 35 page report can be found HERE.

NSW Health response

NSW Health responded to the review where it challenged several of the review’s assertion.

NSW Health said the organisation’s response was prompt and that it had stepped in to provide PPE throughout the course of the outbreak, and that hospital care was always available and is always available to residents who required more complex support.

“NSW Health considers decision on the best care settings should always be made by the treating clinicians with residents and their families, rather than generic guidelines,” they added.