The team behind Wilson & Webster Consultancy Services – the independent conflict and complaints resolution consultancy who were commissioned by Bupa to report on eight of its sanctioned faculties between September 2018 to March 2019 – say they found systemic issues at its South Hobart facility – but were requested to change this in their final report in March 2019.
In a 45-minute session, Dr Penny Webster (pictured above) – who previously worked for the Professional Standards division of the Police Registration and Services board and gave evidence alongside her business partner Bethia Wilson AM (pictured below) – said she had used the word “systemic” because she kept seeing the same problems over and over again at the facility.
“A lot of the problems were based on, or sorry, arose out of the same kinds of issues, which was a lack of accountability, lack of people management skills, lack of placing the resident as central to the decision-making,” she stated. “So – and that focus on finances. To me that indicated that there was a systemic problem, that was sitting underneath some of the smaller things that we saw.”
“Were you given any reasons for removing the words ‘systemic problems’? Ms Bergin asked.
“No,” said Dr Webster, with Ms Wilson adding: “Bupa just didn’t seem to like it.”
The pair revealed they had originally been approached by Bupa in September 2018 after its Traralgon facility in Victoria was sanctioned and requested to hold a consumer engagement meeting there.
“We were told about the sanctions, what they meant, Bupa were unhappy about the sanctions, they complained their facilities had been reviewed previously and were found to be fine,” Ms Wilson – a barrister and solicitor who was Health Commissioner of Victoria from 1997 to 2012 – said. “So, they were saying, well, why have we got sanctions now and people were saying to you, well, why weren’t they sanctioned a long time ago.”
The pair attended Bupa South Hobart in November 2018 for two-and-a-half hours for a consumer engagement meeting but say they encountered hostility from staff who were reluctant to help set up for the meeting with a Bupa staff member trying to take the names of the residents and family members attending.
They say residents told them they were concerned about a lack of complaints handling, poor communication, staff being overworked and unqualified, and poor medication and continence management – and that Bupa wasn’t fit to run the facility.
“Bupa has written values but from what we saw those values were not being lived at the facilities,” Ms Wilson concluded.
Dr Webster gave the example of the Acting Chief Financial Officer telling a family member at the meeting at their Seaforth facility that raising carers wages from the minimum wage would be a race to the bottom.
“That is, of course, completely contrary to the years and years of empirical research on people management that says that if you pay people better, if you give them better working conditions, if you take your needs and interests of your workers, your staff into account, when you design your working life, then you get better workers, you get better service delivery and you get better performance,” she said, terming it “upside down knowledge” of people management.
“If that was followed through, that would be a way of reducing service, of getting the least experienced, the least committed workers, and therefore, the worst care and you would, in fact, create a downward spiral in your organisation of performance and delivery of service,” she added.
The team added there was little feedback from Bupa on their recommendations for the sanctioned facilities and they came to the conclusion that they hadn’t been taken up when some were re-sanctioned.
Dr Webster said this was disappointing in the case of the South Hobart facility as many of the recommendations they made didn’t have a cost, such as setting up a whiteboard at the front of the facility to communicate the staff who were on that day and regular meetings with residents to obtain feedback.
“There was a lot in those recommendations that the general manager at South Hobart could have implemented straightaway, particularly around communication and food, that would have really uplifted the place very quickly,” Dr Webster argued.
“But we were told and we did convey back to Bupa that if the staffing issues were attended to, then a whole lot of the other problems would be fixed up as well,” Ms Wilson added.
The final report was also not circulated to families, according to the pair.
“Was this an indicator of a reluctance to be transparent by Bupa?” Ms Bergin asked.
“Yes, I believe it was,” said Ms Wilson.
“Why is that?” Ms Bergin followed up.
“I think perhaps they didn’t want to look bad,” Ms Wilson replied. “They’re running a business, of course, in my opinion not particularly well but I can really only guess.”
The pair say providers failing sanctions should be open and transparent and listen to complaints, adding they believe Bupa “missed a great opportunity”.
“I’ve been a complaints commissioner for many years and I believe that a little complaint is a wonderful thing in terms of quality improvement, consumer complaints are a window of opportunity to improve your practices,” Ms Wilson said.
The Counsel Assisting also tested a couple of propositions with the two, including:
A register of complaints available to the public:
Ms Wilson said providers should always have this kind of register listing the complaint, what action was taken and a six-month review of whether those improvements were maintained.
The Commonwealth to have more oversight of the funding paid to provider to monitor whether it is spent on care delivery:
“If I was paying for something, I would want to know what I’m getting for my money,” Dr Webster. “So if I’m the government, I would want to know what I'm getting for my money on an annual basis, I would want to see the books, I would want to see line by line how many staff, what residents, the care needs of those residents, what money is going to the cost of the facility, just like any other transaction. I think it should be completely open.”
She added this should not be any different for For Profit or Not For Profit providers.
Commissioner Tony Pagone wanted more detail about how the pair saw the role of the Commonwealth in ensuring providers meet standards.
“I think that the regulators in these – in the cases that we’ve seen were a bit slow to act,” Ms Wilson stated. “It wasn’t until the Royal Commission was announced that the sanctions began to be placed on the facilities that we visited, and that all happened very, very quickly once it started. So, I guess I’m going back to that question of why weren’t they sanctioned earlier rather than why have we been sanctioned now.”
They agreed there should be more scrutiny of the regulator – but like the panel of administrators and advisers on Thursday, the Commissioner wanted a clear “blueprint” in his words.
“If you do have any further thoughts about the detail about how one might go forward, we would be delighted to hear from you,” he said.
Yet again, a sign the Commissioners want ‘new thinking’ – and how it can actually be implemented.