Aged Care Reform welcome the ICAC report and its recommendations, however once again all of the reports findings are non-binding. SA is now in caretaker mode due to the upcoming election, and the caretaker government have promised to implement all recommendations – if re-elected. SA Labor have also said that they are “deeply sorry”. Saying sorry after the fact is only one small part of the reparations owed to former residents and their families.
We have had an absolute plethora of reports in recent times that have delved into the various failing systems that oversee aged care services before and after Oakden, and it is our view that the time for action is now – in fact it is well past due.
The complex, cascading structural issues that occurred in the Oakden facility may never be totally recreated anywhere else, but it it is imperative that hard lessons are learned without continued resistance from those within the system, and appropriate actions are taken immediately towards reparation and positive change. Oakden fell into a “grey area” where it was predominately a mental health facility, it was being overseen by the states public health service provider, and receiving State and Commonwealth funding for aged care services. No wonder no one was rushing forwards to take sole responsibility for it failing so spectacularly.
It is however good to see that most of the senior persons involved with the delivery of care at Oakden have now accepted some or full responsibility for the various failings outlined in the report, but it would also be remiss to not point out that there are many, many people not individually identified who also have some measure of responsibility to take. The “Oakden Culture” has become a recognised term relating to secrecy and inaction in public discourse – this is unacceptable moving forward. Whether the fault lies at the top or bottom, there were multiple people involved in direct care, or indirect oversight who simply should have taken action sooner.
As private citizens, it is difficult, or almost impossible to profess to have formed widely learned opinions on such reports, which though usually made available, are not always entirely accessible to the public in terms of the length, full access to all hearings and evidence, and some of the legal language used in setting out the various recommendations. The ICAC Commissioner, Mr Bruce Lander attempted to hold public evidence hearings, and was blocked by legislation from doing so. He also sought Cabinet documents, and was denied access to these by recently introduced legislation. By denying the Commissioner the full range of information, the public were also robbed of the full story. This is unacceptable.
Being an aged care reform campaign, a number of the recommendations do not apply to services governed by the Aged Care Act. Therefore we can really only focus on addressing this particular reports terms of reference that relate to investigating the overall adequacy of the complaints system, which is one of our reform targets. Putting it mildly, we would rephrase that to inadequacy of the complaints system. There was also mention in the report of inadequate staff ratios, skill mix, poor practice (which points to poor staff education), poor oversight and a lack of resources. All these issues are present in the aged care system also – Oakden is NOT unique, and the public has a right to be assured that the neglect and abuse suffered by consumers is not continuing elsewhere undetected. The promised audit of all state-managed services has been put aside – this is unacceptable.
One of our campaigns reform suggestions is a dedicated, transparent and accessible complaints system for consumer families and other concerned persons who suspect abuse is occurring. We are also advocating for mandated reporting of abuse of vulnerable people, or reasonable suspicion of abuse for all healthcare professionals who are engaged in their care. We feel that this could reasonably be implemented in the wake of Oakden, where many people within the complex management structure of health care service delivery are professing a commitment to adopting an open and honest healthcare system that applies open disclosure procedure and self reflective practice routinely. No system can ever claim to be perfect, but best practice should always include consumer and community engagement in the delivery of care.
Effective open disclosure practices should result in a mistake or failing being identified, reported, acknowledged, transparent and timely actions are undertaken, and then assessed at some future point as to their effect. Any persons involved in incidents, or the reporting of them should be informed and engaged with the process at all stages. Reflective practice examines what went wrong and why, and comes up with suggested ways to prevent it from happening again. These are foundational principles of a modern healthcare system, no matter the discipline.
As members of the community who have had recent dealings with some of the families who spoke out about the treatment and care provided to their loved ones in the Oakden Older Persons Mental Health Service – or apparent lack thereof – we have been saddened and angered by the revelations that have been exposed by the various reports. The only possible response at this point in time is a professed desire and determination to ensure that the failings that have been exposed in the delivery of care within Oakden never happen again in South Australia, or indeed in any state.
A commitment must be made to better engage the community at large in the process of rebuilding the complaints system in an open and transparent manner. It is clear that complaints were being made frequently from within and outside Oakden by consumers, families and staff, as well as concerned persons. What is not entirely clear is how those complaints were ever dealt with. There is little to no indication that all those people who should have been aware, and concerned about the issues being continuously raised had any real commitment to action. It is possible (though not excusable) that many were completely unaware of any issues, and simply trusted the system to inform them instead of actively seeking information and data that might have alerted them earlier. This is unacceptable.
Oakden was defined as a mental health service, and therefore is subject to different legislation and funding than aged care services in this state, however the consumers of this particular service were also elderly South Australians who deserved to be treated with dignity and respect by the system designed to deliver their care. This clearly did not happen, and there must be open and honest dealings with those left behind to pick up the pieces going forward. The public is understandably outraged and concerned, but it is the experience of consumers and families that must always be returned to first and foremost when reflecting on what went wrong, and how to fix it. We all have loved ones who could potentially be at risk from systemic failures as shockingly lax as those uncovered at Oakden.
There are many barriers to a robust complaints system, but the first must be the ability for all to participate in improving, and the desire to do so with a view to improving conditions for all. It is apparent from “reading between the lines” that staff at Oakden were reluctant or slow to take up training related to the introduction of the SLS which points perhaps to their disillusionment with the complaints system. Who could blame them?
Consumers may not always have the cognitive ability to voice their concerns, but those who do are often disempowered to do so to the fullest extent. Dependent upon others to care for them, it must be terrifying to consider speaking out and then not being listened to. What retribution might be visited upon you if you are considered to be a “troublemaker”?
In Appendix 12 of the report, there are numerous documented visits from the Community Visitors Scheme which mention consumers complaints made to the visitors (intended to be first and foremost advocates for the consumers from our understanding), but no resultant evidence that complaints were followed up.
Families certainly spoke out. There are numerous recorded interactions in the Complaints register, and SLS data. However, once again, no actions are recorded with any great transparency or determinable impact, and it is apparent that poor practices continued with little intervention from anyone in management. This resulted directly or indirectly in the abuse, neglect and even death of consumers.
Staff complained, and there is testimony that senior persons were engaged to address some of their concerns, but ultimately were foiled and defeated by the poorly designed and confusing management system. There are a number of people who resigned their posts in frustration, citing stress and bullying among their reasons for “giving up” on reform.
Pleas for more clinical staff and indeed better continuity of staff, and access to allied health, updated equipment and concerns about care practices are documented. Whose job was it to respond and explain why these requests were ignored or turned down?
The Community Visitors Scheme appear to have identified issues on a number of occasions, but overall feedback was positive – reading between the lines it becomes apparent that there were regular (volunteer) visitors who knew the staff well and praised the facility up till around 2016 despite documented issues including that the CVS commenced visits shortly after sanctions were placed upon the facility.
The CVS had the power to perform unannounced visits, but did not. There is also an SLS report of an advocate being denied access to a consumer, and mention that advocates were accompanied by staff when seeking to speak with a consumer – highly concerning.
Management from the lower tiers all the way up to the Minister’s office obviously face barriers to fully accepting the need to robustly investigate complaints such as the fear of sanctions and subsequent loss of funding, and the inability to stretch tight budgets to meet constant demands for more staff and more resources. The community rightfully expects that good managers should be actively committed to recognising and responding to issues swiftly, and not be afraid to have those difficult conversations with those above them in a proactive manner. We must move away from the practice of being reactive – and therefore defensive. Prevention should be the underpinning principle.
The various agencies who should have been overseeing the system clearly had some sort of communication breakdown, or merely a total lack of motivation to take action. Maybe this is demonstrable justification for the community calls for replacement of these agencies all together.
Lastly, the barrier to involving governments and parliaments fully in making proposed changes to any publicly funded system always comes back to funding, or lack thereof. We believe that this is a convenient excuse to deflect from any real conversation about the deeply concerning issues highlighted when examining the system that was supposed to be providing good and safe health care to elderly South Australians. More resources including staff, transparent oversight systems, and flexible models of care that are based on best practice are all highly achievable goals.
It is the role of our elected representatives to address these issues urgently, and we would like to see less time and effort spent on generating more reports, and more time allocated to taking up the recommendations of the existing, excellent reports already available – including this one. The community and the workforce are willing and ready to assist with providing ideas and feedback. Take action now, and put the Oakden Culture to rest forever.
Aged Care Reform Team