Senior Counsel Assisting Peter Rozen QC (pictured above) has closed the Hobart hearings into the leadership and governance of aged care providers, suggesting board members should have a formal duty to ensure their organisation provide safe and quality care – and make sure they are receiving information about issues in their facilities.
In 20 minutes, Mr Rozen said the evidence presented this week through the case studies on Southern Cross Care Tasmania and Bupa’s South Hobart facility highlighted common issues caused by governance issues – namely, deficiencies in care caused by insufficient care time, deficient organisational culture, insufficient attention to quality and safe clinical care, poor communications from facilities and a lack of responsiveness to complaints.
Following the pattern recently established at the Mudgee hearings, the Senior Counsel was less fiery than in previous closing addresses – instead the focus was pinpointing the problem but also some possible solutions through four main themes:
Is providing quality and safe care sufficiently paramount?
The Senior Counsel emphasised that quality and safety of care should be the core business of aged care providers – and while providers are legally obligated to stay financially viable, he said it must be remembered that “financial viability is a means to an end in aged care; it is not an end in itself”.
Running through the evidence from the week, Mr Rozen argued it was clear financial consideration were prioritised at both Southern Cross Care (Tas) and Bupa South Hobart at the expense of care.
Turning to solutions, he noted witnesses had stressed the importance of organisational support for the education of staff and the need for leadership to support facility managers.
“It may be appropriate for board members and other officers of aged care providers to owe a strategy of duty when exercising powers and discharging duties to take reasonable steps to ensure that the provider delivers quality and safe care,” he added. “It may also be appropriate for such officers to be under a corresponding duty to inform themselves of quality of care issues.”
In particular, Mr Rozen noted former SCC (Tas) Chairman Ray Groom’s call for national training for facility managers.
“For our part, we consider the training of managers along with other employees must remain the responsibility of aged care providers themselves,” he stated.
Whether enhanced organisational governance including clinical governance is required?
The Senior Counsel point to the role of good governance as a central theme from the hearings, reflecting on Ms Maxwell’s point that this requires transparency, accountability, stewardship, integrity and risk management.
Mr Rozen also stressed the need for the sector to learn from others such as banking and finance, noting the banking Royal Commission recommended financial service provider develop an ethical framework based on a number of key principles: “obey the law, do not mislead or deceive, be fair, provide services that are fit for purpose, deliver services with reasonable care and skill, and when acting for another, act in the best interests of that other”.
Mr Rozen also highlighted the issue of workforce ‘churn’ in aged care (my term, not his).
“One strong theme in the various case studies the Royal Commission examined in 2019 has been that providers that in trouble have high levels of staff disaffection and turnover at all levels,” he stated, noting this was the case at both Glenara Lakes and Bupa South Hobart.
Solutions-wise, the Counsel said clinical governance is about a whole organisation working together and with accountability to provide care.
“The results of monitoring must consistently be taken into account and acted upon,” he said.
“Clear and accessible policies must be available to staff and they must be reviewed regularly and kept up to date. A structured process for making and responding to complaints is essential.”
How can organisational culture be improved?
The Senior Counsel said it was clear there was a lack of oversight at the facilities in the case studies.
“Ms Cooper this morning told us that there was a need for people at every layer of an aged care business to visit aged care facilities,” he said. “In her view, if you’re in the office and you’re not in a care home regularly then you’re not doing your job well enough. She said that sitting down with care and other staff and engaging with them, as well as the residents and their family is extremely important.”
Mr Rozen also said management need to set an example of positive culture by communicating with staff and residents.
“Ms Maxwell gave evidence about boards of aged care providers,” he added. “She emphasised the need for the skills of governing boards and observed that board education is necessary but is not being undertaken routinely. She raised concerns about how boards identify risks and make objective decisions.”
How can a funding environment be created that does not draw resources away from direct care?
The Senior Counsel said it can’t be ignored that the changes at Bupa and SCC (Ta) were both driven by legitimate funding concerns.
“This is a vital issue that will be explored in more detail in the Royal Commission’s work next year,” he flagged.
Mr Rozen repeated that witnesses had raised conflicting ideas for alternative funding models, and whether to replace ACFI or improve it.
In closing, the Senior Counsel says it is clear that either way, something has to give.
“We must have an aged care system in which organisations have the governance, leadership culture and skills to ensure that high-quality and safe care becomes not just a stated vision but the daily practice of all involved in caring for older Australians, a system in which the decision-makers and approved providers consider not only whether they can make decisions such as cutting staff but whether they should make such decisions,” he said. “This is what our elderly citizens deserve.”
A short statement, but a powerful one – and it’s not over yet. Mr Rozen promised the Commission will return to the issue of organisational governance in the New Year.
Watch this space then.
