Yes Minister: Another day, another aged care scandal

The Morrison government has redefined Westminster ministerial responsibility. No longer does a minister bear ultimate responsibility for the actions of its ministry or department.

The most recent example is the Aged Care Minister, Richard Colbeck. Minister Colbeck refuses to take responsibility for the 683 residents in aged care homes who have died from Covid.

In a Senate estimates hearing last Tuesday, Minister Colbeck said: “I don’t feel responsible personally for the deaths that have occurred, as tragic as they are, which were caused by Covid-19.”

Given Minister Colbeck has refused numerous invitations to be interviewed on ABC 7:30, we probably shouldn’t be surprised by his lack of interest in ministerial accountability.

Under the Westminster system, a minister is expected to resign if misdeeds are found to have occurred in a ministry. Yet Minister Colbeck has indicated he has no intention of resigning for failing to protect residents in aged care homes during Victoria’s second-wave.

It is also possible for a minister to face criminal charges for malfeasance under their watch. Under Minister Colbeck’s watch, Australia has one of the highest rates in the world of deaths in residential aged care as a proportion of total Covid-19 deaths.

The people who died are partners, siblings, parents, grandparents, aunts, uncles and friends. Minister Colbeck’s lack of empathy for the grieving families may not be malfeasance but it is heartless.

Minister Colbeck had advanced warning of the devastation that community transmission of Covid-19 would wreak. Evidence from around the world showed the virus spread like wildfire in residential aged care settings. It was clear he needed to prepare the aged care sector for community transmission.

Minister Colbeck blames “community transmission” for the deaths in Victorian aged care homes. This is absurd. It was his job to prepare the aged care sector for community transmission of Covid-19. Without community transmission, it would have been business as usual.

To prevent older people in aged care homes from dying from Covid-19, the federal government needed a clear National Plan. And it needed this plan in February, when it was obvious the death toll would be higher for older people who became infected. With proper and timely planning, many deaths in aged care homes could have been prevented.

A special investigation by the Royal Commission into Aged Care Quality and Safety confirmed that Minister Colbeck failed to prepare the aged care sector for the pandemic. You only have to compare the Victorian government’s evidence-based plan to protect Victorians during the second-wave with the federal government’s failure to protect residents in aged care homes.

According to Professor Joseph Ibrahim, the planning should have included a national audit of all residential aged care facilities to judge their level of preparedness. Instead Minister Colbeck relied on an online survey in which 99.5% of providers said they were prepared for an outbreak. Minister Colbeck should have known not to trust the results of a self-reported survey given providers’ appalling track record of self-reporting.

Unfortunately, Minister Colbeck did not insist on a clear national plan. Instead, guidelines were initially released on March 13, a week after the outbreak in BaptistCare’s Dorothy Henderson Lodge in NSW, the first Covid-19 outbreak in aged care. This suggests these guidelines were written on the run. They were then updated on April 30 (in response to Newmarch House) and then again on July 14 (in response to the unfolding disaster in Victoria).

Prime Minister Scott Morrison came to Minister Colbeck’s defence when he said: “There has (always) been a plan, and it has been updated, so we completely reject the assertion that there was not a plan, because there was a plan.” However, simply updating guidelines does not make them a “plan”.

A national plan should have stated clearly: “All residents who test positive should be immediately transferred to hospital.” Transferring residents to hospital would have ensured they received competent clinical care and would have protected residents who tested negative in the aged care home from acquiring the infection. This strategy was used in Hong Kong where no residents of aged care homes died.

Rather than transfer residents to hospital, some aged care homes “cohorted” residents into distinct sections of the home to keep separate residents who were positive from those who were negative. In some cases, residents were confined to their rooms for more than two months. Taking away an older person’s liberty by confining them to their rooms was profoundly damaging to their mental and physical wellbeing. It was also quite possibly illegal.

A national plan should have ensured all aged care homes had access to personal protective equipment. Yet more than 1500 aged care homes had their requests for masks, gloves and gowns from the national medical stockpile refused. In addition, staff needed to infection control training. A 10-minute video was inadequate training on how to put on PPE and, more importantly, how to take it off.

A national plan should have also included paid pandemic leave to ensure casual staff did not go to work when they had symptoms or were close contacts. It should also have included a strategy to minimise staff working in more than one aged care home. However Minister Colbeck sat on his hands until late July. By then, more than 60 aged care homes had outbreaks in Victoria. In each outbreak, a staff member brought the virus into the aged care home.

To make matters worse, Minister Colbeck refused to name the aged care homes with outbreaks in Victoria. At a Senate inquiry hearing on August 4, 2020, Minister Colbeck explained that providers didn’t want to be publicly named because they were worried about “reputational damage”. It was not Minister Colbeck’s role to protect aged care homes from reputational damage.

On April 13, Minister Colbeck said: “As unlikely as it might be, we have plans in place for worst case scenarios where an outbreak in aged care facilities mean local staff are unable to continue to provide care due to an infection in the service.” These plans included a surge workforce. Yet when the entire staff at St Basil’s Home for the Aged were directed to self-isolate on 22 July, the surge workforce was unable to provide residents with the necessary care.

Minister Colbeck acknowledged that there was no document outlining the surge workforce strategy. He also acknowledged that the change in staffing at St Basil’s Home for the Aged had created confusion, gaps in patient care and strained communication with families. However, he did not take any responsibility for the failures of the surge workforce strategy.

The contracts for the surge workforce went out as a limited tender, an approach the National Audit office says risks departments not achieving value for money. More recently, Minister Colbeck used another limited tender, this time to give two lucrative contracts – worth $415,800 and $503,800 respectively – to a member of the Aged Care Financing Authority. Jobs for the boys?

It is also important to question why Minister Colbeck authorised nearly $1 million to identify aged care providers at risk of collapse and to help stop them from going broke. This is not value for money. A more cost-effective approach would have been for Minister Colbeck to support legislation to make aged care providers disclose how they spend taxpayers’ money. Yet, last year Minister Colbeck voted against a bill that would have improved financial transparency in the aged care sector.

Rather than take responsibility, Minister Colbeck makes announcements and re-announcements. For example, in October, he re-announced funding for a grief and trauma package that was first announced in August.  He said: “The package will provide direct support to aged care residents and their families through improved advocacy assistance, grief and bereavement counselling and for aged care residents, home care recipients and their families.”

However, residents and families would not need grief and bereavement counselling if Minister Colbeck had done his job properly. Also the best mental health support for residents is to see the people they love and who love them. This $12.4 million should have been spent on teaching families infection control. Instead, many families have been locked out of aged care homes.

The horror story in aged care homes in Victoria due to community transmission could have been prevented if Minister Colbeck had tackled the systemic failures in the aged care sector. Instead, he has kicked the can down the road waiting for the royal commissioners’ final report in February 2021.

Sooner or later Minister Colbeck will need to take responsibility for this heart-breaking tragedy – which many of us predicted – that occurred on his watch.

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Dr Sarah Russell is a public health researcher who specialises in qualitative research. She has been the Principal Researcher at Research Matters since 1999. She is also the Director, Aged Care Matters. She believes the aged care system requires greater scrutiny, accountability and transparency.

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