This article was first published in the Australian Journal of Dementia Care December 2018/January 2019 (Vol 8 No 6)
By Professor Belinda Goodenough, Executive Director Dementia Training Australia, University of Wollongong
Some AJDC readers may remember Australia’s first television broadcast in 1956. Even fewer might recall that introducing society to television was a cautious decision by the government of the day, influenced by recommendations from the 1953 Royal Commission Into Television.
Royal Commissions have a unique place in the Australian system of government. As the highest form of inquiry, they are typically an expensive last resort to explore matters of public interest – or unravel a scandal. The first was held in 1902 to investigate deaths of military personnel returning from the Boer War on the SS Drayton Grange. The findings about life aboard the ship included serious overcrowding, unsanitary conditions, inadequate facilities, lack of discipline, and a measles epidemic (York 2015).
Since 1902, after more than 130 other Federally-oversighted Royal Commissions, on various topics, a 2019 inquiry into the financial services sector was hailed for tabling a “catalogue of breathtaking behaviour, providing plenty of drama, tears, and public outrage” Australian Financial Review 2019). It called into question industry culture and incentives, including conflicts of interest placing profits above customer service, failures in duty of care, and ineffectual regulators (Commonwealth of Australia 2019a).
These conclusions have a familiar ring. From life on SS Drayton Grange to misconduct in financial services, there are eerie parallels with statements in the Interim Report delivered by the Royal Commission into Aged Care Quality and Safety on 31 October 2019 (Commonwealth of Australia 2019b). Why? In short, this is the stuff of a Royal Commission. The purpose is public transparency: to name, shame, and blame – without fear or favour. Often the government itself becomes a target of critique despite funding the inquiries, and deciding the terms of reference – the government-appointed commissioners are independent and not serving politicians.
Given the limited and oft-used vocabulary available to commissioners for calling out areas needing attention and improvement, how does this latest report into Aged Care Quality and Safety stand out? One word: ‘Neglect’. It’s a succinct title for an interim report unlike any used by a previous Royal Commission for any other topic. In three volumes, it is a hefty account, but also written in language deliberately intended for the non-lawyerly reader. The easy access vocabulary makes the stories even harder to read. The impact is shock – as witnessed by the wide range of public commentary on an aged care industry alleged to have let down the most vulnerable and elderly of Australia’s citizens, including many diagnosed with dementia. It’s a litany of stories about neglect, literally beyond words, collected in a process summarised in one media report as a 10-month “slow drip of horror” (Connolly 2019).
Due to the character of a Royal Commission, the voice for positive stories is understandably less well represented. Examples acknowledged in the Interim Report are proposed as a showcase for innovative and great quality care occurring “despite” rather than “because” of the aged care system (Commonwealth of Australia 2019c). Yet hope remains. Meaningful and sustainable ways to improve care via staff education are being delivered by Dementia Training Australia (DTA), funded by the Department of Health (www.dta.com.au). There is discussion in the Interim Report about the (ab)use of chemical restraint – in particular for people living with dementia in residential aged care. An article in the latest issue of AJDC (December 2019/January 2020, p33) illustrates how a DTA program of staff training in medication management and nonpharmacological strategies can significantly reduce the proportion of residents receiving antipsychotics.
What lies ahead? In the remaining months before the Royal Commission’s final report (with recommendations), one focus for the Commission will be issues surrounding workforce capacity, skills, and training. The Interim Report concludes this workforce to be “under pressure and under-appreciated”. Interesting questions are on the horizon. For example, if training aged care staff in dementia were to be recommended as mandatory, then who pays, who delivers, and who regulates?
There is optimism that this Royal Commission can stimulate real change beyond words. In 2019-20 Australia can watch those words unfold via live broadcast – a privilege made possible in part by the 1953 Royal Commission Into Television.
Vale: Major General the Honourable Richard Tracey AM RFD QC (18/08/1948 – 11/10/2019), Chair of the Royal Commission into Aged Care Quality and Safety.
York B (2015) Royal Commissions: What Are They And How Do They Work? Museum of Australian Democracy At Old Parliament House blog. Available at: http://bit.ly/royalcommissions-backgrounder
Australian Financial Review (2019) Banking Royal Commission Final Report: Key Recommendations. Available at: http://bit.ly/AFR-banking.
Commonwealth of Australia (2019a) Final Report: Royal Commission Into Misconduct in the Banking, Superannuation and Financial Services Industry. Available at: http://bit.ly/banking-finalreport.
Commonwealth of Australia (2019b) Royal Commission into Aged Care Quality and Safety Interim Report: Neglect. Available at: http://bit.ly/RC-neglect.
Connolly A (2019) Aged Care Royal Commission Interim Report Holds First Clue To What Comes After The Horror. ABC News Analysis. Available at: http://bit.ly/RC-ABCnews
Commonwealth of Australia (2019c) Royal Commission into Aged Care Quality and Safety Interim Report: Neglect, Volume 1. Foreword p10. Available at: http://bit.ly/RC-neglect.
Dementia Training Australia https://www.dta.com.au/.