Last week, the Royal Commission into Aged Care Quality and Safety (Royal Commission) held its Melbourne Hearing 3 from 14-18 October 2019.

It inquired into the aged care workforce, with a focus on how to enhance capacity and how to make the aged care sector a more attractive and rewarding place to work. Here, we summarise the activities of each day.

Day 1 – Monday 14 October

Melbourne Hearing 3 opened with Senior Counsel Assisting providing an overview of the themes for the week, including workforce issues that examined the link between staffing settings and quality of care outcomes. Professor Kathy Eagar, Director of the Australian Health Services Research Institute, gave evidence in relation to Australia's reputation for having inadequate staffing levels when compared with those of other countries. Professor John Pollaers OAM, Chair of the Aged Care Workforce Strategy Taskforce, then spoke about the implementation of the recommendations made in the report produced by the Aged Care Workforce Strategy Taskforce. The Deputy Chair of the Aged Care Workforce Industry Council, Kevin McCoy, then shared his concerns about the lack of funding for the Council which has been charged with implementing the Taskforce's recommendations. Robert Bonner, Deputy Chair of the Aged Services Industry Reference Committee; Michelle Eastman, Swinburne University, TAFE Directors Australia and member of Aged Services IRC; and Jane Trewin, Executive Director of Educational Delivery at Box Hill Institute Victoria, gave evidence as a panel and discussed the changes that need to be introduced to aged care training programmes in the vocational education space.

Day 2 – Tuesday 15 October

The second day of Melbourne Hearing 3 focused on a case study of Menarock Life Greenway Gardens, specifically, the circumstances that led to the facility's sanctioning in February this year. The facility was sanctioned for failing to meet required staffing levels. The first to speak on the case study were Sandra Nisi and Christine Lynch, the daughters of a former resident, who recounted the experience of their father's time in the facility. The former Director of Nursing, Yvonne Henderson, then detailed her experience at Greenway Gardens where she considered the staffing levels were ''totally inadequate" and noted the issues she faced reporting her concerns to the Department of Health. The former Group Operations Manager at Menarock Life, followed by the Group Operations Manager and Former Chief Group Operations Manager, all reiterated the staffing problems at Greenway Gardens and agreed that the absence of a Registered Nurse on the floor at all times was insufficient. Craig Holland, the Director of Menarock Life then told the Royal Commission that Menarock Group earned a profit of $6.2 million during the time that Greenway Gardens was struggling with poor staffing levels. Ann Wunsch, Executive Director for Quality Assessment and Monitoring Operations at the Aged Care Quality and Safety Commission, detailed the process that took place during Greenway Garden's audit and conceded that the Aged Quality and Safety Commission does not provide guidance to assessors about an acceptable range for staff ratios or Registered Nurse hours.

Day 3 – Wednesday 16 October

The third day of Melbourne Hearing 3 opened with a panel of witnesses who discussed the issues faced by employers and aged care workers in the aged care sector. Lisa Alcock of the Health Workers Union; Clare Tunny of United Voice; Paul Gilbert, of ANMF; Jenna Field from Leading Aged Services Australia; and Darren Mathewson of Aged and Community Services Australia outlined the challenges facing aged care workers including worker safety, assault, worker registration and industrial instruments. Emeritus Professor Eileen Willis from Flinders University and Robert Bonner of ANMF then spoke to a report they had produced for the Commissioners, highlighting the absence of quantifiable minimum legislative standards mandating a minimum number of skilled staff in aged care facilities. Secretary of the Department of Health and Human Services (Vic), Kym Peake, gave evidence regarding the Safe Patient Care (Nurse to Patient and Midwife to Patient Rations) Act 2015 (Vic) and the effect of the legislation in mandating staff ratios based on care settings. A nurse at Sydney West Area Health Service, Amy Lazzaro, then gave evidence regarding the standards of service and common issues relating to staff training and resident care. The final witness for the day, Professor Sara Charlesworth from RMIT University, referred back to the initial panel discussion regarding industrial instruments in the aged care sector and highlighted the working conditions for staff in various aged care contexts.

Day 4 – Thursday 17 October

Dianne Mnich, former Facility Manager of Japara Bayview was the first witness for the day, giving direct evidence of her involvement in managing the misconduct of ‘UA’ - a former staff member of the facility she managed. The second witness, Nicole Farrell, then spoke about the disciplinary process that occurred in relation to UA’s conduct and the barrier imposed by the enterprise agreement that was in place at the time to terminating UA’s employment. Janice Hilter, a home care worker gave direct evidence of her experience working for a large private provider of home care services and spoke of the need for better training and induction processes for workers. Witnesses four, five, six and seven all gave evidence together, with Sandra Hills, CEO of Bents; Jason Howie, CEO of KinCare; Kerri Rivett, CEO of Shepparton; and Richard Hearn, CEO of Resthaven outlining the structure of their respective organisations and shared their thoughts on the issues embedded in the aged care system. The next panel of witnesses comprised Rachel Yates, IRC member and Policy Director of Health and Workforce at Universities Australia; Professor James Vickers, University of Tasmania; and Adjunct Professor Kylie Ward, CEO of Australia College of Nursing, gave an overview of the standard of undergraduate programs for medicine and nurse qualifications with added difficulties in ensuring nursing students received adequate training during clinical placements. The final witness for the day, Dr John Maddison, President of ANZ Society for Geriatric Medicine, provided evidence on the need for more training in geriatric medicine and emphasised the large role it has to play in improving quality and safety in the aged care sector.

Day 5 – Friday 18 October

The first witness for the day was Lavina Luboya, a former assistant nurse, who spoke of her experience with the quality and safety issues at two different aged care facilities. Karen Cusack, Victorian Health Complaints Commissioner; Andrew Brown, Queensland Health Ombudsman; and Shona Reid, Executive Director of Complaints at the Aged Care Quality and Safety Commission then discussed the complaints process within their respective organisations, outlining the jurisdictional issues and referral procedures that each organisation handles. Charles Wann, the First Assistant Secretary of Aged Care Reform and Compliance; and Glenys Beauchamp PSM, Secretary of the Department of Health, together spoke of the Department's leadership in aged care workforce reform and noted the Department's goal to attract and retain one million aged care workers by 2050. Senior Counsel Assisting summarised the evidence in his closing remarks, concluding that without improvement, the aged care sector will continue to lose highly skilled workers.

The Royal Commission hearings will resume in Mudgee on 4 November 2019. It will inquire into arrangements for and issues associated with the provision of aged care services in regional and remote areas, including Multi-Purpose Services. The Hearing will have a particular focus on aged care services in the Mudgee region.