The New South Wales government has launched a broadside at the federal Coalition, echoing criticisms made at the Royal Commission into Aged Care Quality and Safety that the Commonwealth lacked any operational plan to manage the threat of Covid-19 in aged care.
In its formal response to an independent review of the April coronavirus outbreak at Sydney’s Newmarch House nursing home, NSW Health says an “apparent lack of preparedness” of residential aged-care facilities – for which the federal government has responsibility – had forced the NSW government to take steps to oversee ground-level planning.
Its criticism supports other evidence that jurisdictional confusion impeded the official response as Covid-19 spread through the vulnerable aged-care sector.
It also reinforces suggestions the federal government failed to consider the real-world implications of – and gaps in – its guidelines issued to aged-care providers and did not follow through with grassroots checking or adequate support for some time.
“The reality was that neither the Commonwealth nor Anglicare Executive had an operational plan for how the residents should be managed,” the NSW Health statement says.
The Newmarch crisis, which came in the wake of another Sydney outbreak at Dorothy Henderson Lodge, caused the death of 19 residents between April and June, with 71 residents and staff infected. Subsequent outbreaks in aged-care facilities in Victoria have seen the number of nursing homes recording infections in Australia exceed 120. As of late this week, more than 350 of the almost 600 people who had died from the virus in Australia were in aged care.
NSW Health’s reproach echoes a similar blast two weeks ago from counsel assisting the aged-care royal commission, Peter Rozen, QC, at the opening of hearings scrutinising management of the Covid-19 pandemic.
Rozen said while much was done to protect the health sector generally, “neither the Commonwealth Department of Health nor the aged-care regulator” had developed a Covid-19 plan specifically for aged-care residents and he questioned “whether everything that could have been done to protect them was done”.
The comments were rejected by former Commonwealth chief medical officer Dr Brendan Murphy, who is now secretary of the federal Department of Health.
“Since the release of fact sheets on 31 January 2020 to the aged-care sector, that impact has been at the core of our planning and preparations,” he said.
Murphy said aged-care outbreaks were “inevitable” once Victoria’s quarantine problems – coupled with the “unexpected overwhelming” of its health system – led to community transmission. He said a second wave that size was “not anticipated”.
Murphy outlined the government’s steps, beginning in January with an emergency response document for aged care, establishing a taskforce and response team and drafting the national guidelines.
In its response to the Newmarch review, though, NSW Health says it had to take “assertive action” during the outbreak to clarify responsibilities between state, federal and local agencies.
“The apparent lack of preparedness of residential aged care facilities, highlighted by events at Newmarch House and subsequently in Victoria, has prompted NSW Health to step in and ensure that aged care facilities can demonstrate they have progressed comprehensive planning for outbreaks, as required by the Commonwealth,” its statement says.
The NSW assessment was published quietly on Monday alongside the findings of independent reviewers Professor Lyn Gilbert and Adjunct Professor Alan Lilly.
Their review describes “chaos and lack of control” at Newmarch, with staff ill-prepared and overwhelmed, management failing to communicate and no ongoing expert leadership on or supervision of infection prevention and control. General practitioners were also reluctant to visit the home for fear of being infected.
While the NSW Liberal premier, Gladys Berejiklian, and her Health minister, Brad Hazzard, avoided criticising the federal government explicitly this week, Hazzard urged journalists repeatedly to “read the NSW Health response”.
He emphasised that although “regulation and supervision” of aged-care providers was a federal responsibility since the Newmarch outbreak, NSW had taken the unusual step of contacting the state’s 800 facilities to ensure “connectedness”. It also developed a protocol to ensure “clarity around leadership”.
“NSW Health stepped up and, in effect, filled in where there was a failure – or a shortcoming – by the management at Anglicare and certainly there would appear to have been, at that time, very difficult challenges for the federal government in responding and supporting,” he said.
Evidence to both the independent review and the royal commission queried the decision to keep infected residents at Newmarch rather than transferring them to hospital.
Both NSW Health and its minister denied they stopped patients being moved to hospital. Hazzard said seven residents had been transferred.
Following the subsequent Victorian outbreak, the federal government has emphasised that ill residents should be moved to hospital.
NSW Health also noted that Anglicare had been unable to source enough personal protective equipment from the Commonwealth’s national stockpile and that NSW had provided “significant quantities”.
The federal review found that staff at Newmarch weren’t using protective equipment properly and were sometimes wearing it when they shouldn’t, including in high-traffic public areas, which risked spreading infection.
On March 13 – the same day the federal aged-care guidelines were drafted – Brendan Murphy wrote to providers to update them on the pandemic, detail a $2.4 billion support package and offer advice on personal protection.
“Generally there is no need for aged care workers (or the public) to wear masks,” Murphy wrote. “Health and personal care workers are advised to wear masks only when dealing with symptomatic patients or consumers.”
The updated advice is that masks are appropriate and, in some circumstances, essential.
As parliament resumed this week, Health Minister Greg Hunt said the federal regulator, the Aged Care Quality and Safety Commission (ACQSC), had contacted all aged-care facilities in Australia “through the course of the pandemic” to check on their preparedness.
But in a letter to aged-care providers dated July 31, the regulator’s commissioner, Janet Anderson, said the ACQSC would “shortly commence” unannounced checks on facilities to check infection control procedures and the proper use of personal protective equipment.
Facing a barrage of opposition questions on aged care, Prime Minister Scott Morrison countered that 97 per cent of Australia’s 2706 aged-care facilities had experienced no outbreaks – a much better record than in other countries, including Britain. Nevertheless, he acknowledged serious outbreaks in 16 facilities and said the outcomes in four had been “severe and completely unacceptable” and offered his apologies.
“It was not good enough … We openly acknowledge the honest truth that on some days the virus does and will get the better of us, and we fall short,” Morrison said.
In the face of opposition calls for his resignation, Aged Care Minister Richard Colbeck also apologised for being unable to recall how many aged-care residents had died from coronavirus during questioning by a senate committee last week.
The royal commission heard that Australia’s aged-care deaths as a proportion of all deaths from Covid-19 was among the highest in the world. Greg Hunt rejected this and instead quoted deaths as a percentage of all aged-care residents.
On Thursday, Labor leader Anthony Albanese dedicated his National Press Club address to the aged-care situation.
“None of what is going wrong just crept up on us. This government was warned by experts,” he said.
Some on the Coalition backbench have also criticised their own government’s handling of aged care.
NSW Liberal senator Concetta Fierravanti-Wells made a personal submission to the aged-care royal commission proposing changes that she said the Coalition had promised in 2013 but had failed to make.
Victorian Liberal MP Russell Broadbent aired concerns he first raised three years ago that bureaucrats were shutting out small providers, especially in regional areas, in favour of funding big corporates, with no transparency in the process.
“This area of government is corrupt,” Broadbent told The Saturday Paper. “The system has been corrupted … It doesn’t work if the minister doesn’t have accountability.”
Broadbent says the minister should be directly responsible for funding decisions, not the department.
Scott Morrison said his response to Broadbent’s concerns was to establish the royal commission.
The prime minister has promised additional funding for aged-care places in the October budget. Research released by the aged-care royal commission this week found that achieving the best levels of care in Australia’s aged-care sector would require an annual funding boost of $3.2 billion.
This article was first published in the print edition of The Saturday Paper on August 29, 2020 as "NSW Health rebukes feds on aged care".
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