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Plea to not let regulation get in the way of innovation


Aged care in Australia appears to be heading toward the same risk-averse culture that exists in England, warns a visiting aged care executive.

Ed Russell, who is director of innovation and development at not-for-profit residential aged care provider WCS Care in Warwickshire, England, said care scandals in the UK a couple of years ago have led to a risk-averse culture among both providers and quality inspectors.

“Just hearing the conversations here, it sounds and feels familiar and I am worried about the repercussions,” Mr Russell told Australian Ageing Agenda.

“What really concerns me and it should be on everybody’s radar is doing things for the regulator because they are scary and hold so much power rather than for the people who you are caring for.”

AAA met with Mr Russell in Sydney last month when he was a guest of HammondCare as part of a partnership the two aged care providers have to share learnings.

Ed Russell and Associate Professor Colm Cunningham

The situation in England today is very risk averse and regulatory driven, which is stifling innovation, Mr Russell said.

After facilities were involved in scandals shortly after a positive inspection, regulators became more risk averse because it was riskier to give someone a good or an outstanding rating than a bad one, he said.

The Care Quality Commission, which is the independent regulator of health and social care in England, rates facilities as outstanding, good, requires improvement or inadequate.

“For a regulator to give you a good or outstanding rating it is pretty tough because of their own risk of being caught out that the next day if something not very good happens. So for a care home provider to achieve outstanding it becomes unobtainable and therefore nobody is driven to improve services,” he said.

“The impact on care homes is that care workers feel devalued and under pressure. They are not paid much above the minimum wage. Care home managers caught in the middle are suffering from a punitive management style because everybody is covering themselves down the line. Therefore innovation [and] doing things differently is not out there.”

WCS Care came to recognition when half of its 12 care homes achieved an outstanding rating, said Mr Russell.

“That is not because we did it for the regulator, we did stuff because it was the right thing to do. Generally the two align,” he said.

WCS Care has implemented a range of new technologies and approaches in its facilities aimed at improving residents’ quality of care and life including acoustic night time listening and circadian lighting.

Mr Russell said the people at the top of the UK regulator say they want care providers to be innovative, however that message is slow to get through to inspectors.

He said having case studies that demonstrated the positive impact the service had on resident outcomes were key to the inspection and assessment process.

Mr Russell’s advice to Australian aged care regulators and assessors is to focus on resident outcomes as the most important element.

When the regulation is a lighter touch and focusing on outcomes for people, it’s good for innovation, he said.

Director of HammondCare’s Dementia Centre, Associate Professor Colm Cunningham said it was important that providers were able to safely and freely share both positive and negative learnings.

“If we talk about doing the real stuff – what we did, what we learnt, what we made mistakes about and what we might do differently – we will learn from each other.

“But the point is … if you drive fear, nobody will talk to anybody. Then nobody will learn anything,” Associate Professor Cunningham told AAA.

See the upcoming May-June edition of Australian Ageing Agenda magazine for a report on WCS Care’s use of acoustic night time listening and other innovative technologies.

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7 Responses to Plea to not let regulation get in the way of innovation

  1. Geoff Coleman April 26, 2019 at 10:09 am #

    This is very true, and already occurring in Australia, I do hope that someone listens and takes this UK advice very seriously. I was in Aged Care Management for many years and recently got out and returned to Hospitals. A lot of the reason I got out was due to the issues identified in this article. It is unfair for our elderly to lose their rights to risk and independence just because they enter a nursing home, you can write it in a Charter of Rights and in the new Standards as much as you like, but if the Provider you work for and Assessors are highly risk averse and scared then you may as well put the documents in the bin.

  2. Associate Professor Maree Bernoth April 26, 2019 at 11:26 am #

    My comment is related to Associate Professor Cunningham’s comment – “But the point is … if you drive fear, nobody will talk to anybody. Then nobody will learn anything,”

    Nobody talking is exactly what has happened in the past and continues – no-body talked to anybody and you certainly can’t talk about abuse and neglect. It is precisely because of the silence that has been imposed by organisations, managers, politician, accreditors and the intimidating responses to complaints that abuse and neglect has flourished. This is an industry that imposed silence, has allowed issues to fester until now when we have a Royal Commission, where people have a venue to talk about what has happened in the past.
    The aged care industry has not been open and willing to share experiences nor take a quality improvement approach to complaints so it is the industry that has built the culture that now exists and may eventuate in the future. It is not acknowledging fear, not talking about the sources of fear that leads to an exaggerated response and potentiates ignorance, abuse and neglect. Talk up everyone and the aged care industry, with the culture of intimidation leading to silence must take responsibility for what has happened and the implications for the future of aged care.

  3. Michael April 26, 2019 at 11:36 am #

    The problem surely is that without close regulation too many in the system seize the opportunity to exploit the vulnerable. Both these models have adverse consequences for care. We need something that changes the way those people think and behave. It needs the flexibility and adaptability that regulators lack.

    If we go back to the 1980s we see that the philosophy of the new free market system rejected society as a controlling force. In doing so it removed the most powerful way of controlling bad behaviour. We used to have some responsibility for each other. No one talks about that today. Look around you to see the many failures that have occurred since then.

    Why don’t we try being innovative ourselves and take responsibility ourselves for what happens in our communities. If we are responsible then the providers become our agents and we have a right to be involved and see that they do what we want.

    We need empowered community visitors who can access documents and talk to staff then keep us informed. The visitors will have oversight and join with groups in the community. They will be involved and work with the provider to monitor care, sort out problems and in innovating for better care. The most powerful front line regulator is the person you see and talk to regularly.

    It is governments role to support community and not take over its core function of controlling and guiding its members. Formal regulation is a backup for when this is not enough. Systems work best when regulation is simply built into it and is part of daily life.

  4. Margaret Goodson April 26, 2019 at 12:03 pm #

    “After facilities were involved in scandals shortly after a positive inspection, regulators became more risk averse because…” should not be an issue at all as any inspection finds its results ‘on the day of the inspection’ so whatever negative or substandard happens after that day is obviously not a deficit of the inspectors evaluation.

  5. Jason Burton April 26, 2019 at 3:54 pm #

    Surely that is the risk averse culture of the organisation, not the regulators? We have found focussing on meeting our clients needs, achieving wellbeing and making sure services are genuinely consumer directed and delivered by a skilled, competent and emotionally intelligent workforce ticks all the regulators boxes whilst achieving the main goal of improving the lives of our elders. If some organisations are scared I’d suggest it is a reflection on the organisation rather than the system!

  6. Marcus April 28, 2019 at 12:46 pm #

    Not really true. Inspectors have very little training (2 weeks) and have no idea what they’re doing. They have a surface look, tick a few boxes, talk to a few selected people, have long lunches and then rubber stamp the provider for another 3 years.
    The inspectors boss (of AACQA) is an ex-CEO of LASA. it’s called the revolving door, no transparency, no accountability and aged care will deteriorate and providers will profit at the expense of resident care until we have a government that properly funds aged care and properly legislates staffing levels. The RC better come up with ratios otherwise it will have been a waist of time and money

  7. Mary Martin April 30, 2019 at 6:40 pm #

    It was with the aim of empowering consumers that the NSW Aged Care Round table, consisting of clinical and patient advocacy groups developed the series of ’10 Questions to Ask…’leaflets around various needs, Mental health, staffing, Palliative care etc. they are free to download and will hopefully contribute towards more empowered consumers.
    http://www.10questions.org.au

    Without mandated staffing in RACFs and nurse to patient ratios nothing will change. There is real fear from many staff about speaking out – and real intimidation and harassment on many occasions.

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