If history is any guide, the Royal Commission into the aged care sector will focus on systemic issues rather than the role of a few ‘bad apples’, write Ian Holland and Lisa Fenn.
Nearly three decades ago, the Royal Commission into Aboriginal Deaths in Custody delivered its report. Back then some had thought that the Royal Commission would blame a few ‘bad apples’, by finding that brutal or corrupt conduct of individual law enforcement officials had led to deaths.
It did not.
Instead, it found that the causes of Aboriginal deaths were profoundly systemic. It stated that:
“The key is to be found in the hearts and minds of all Australians. It lies in the recognition of the Aboriginal people as a distinct people, the indigenous people of Australia who were cruelly dispossessed of their land and until recent times denied respect as human beings and the opportunity to re-establish themselves on an equal basis.”
Fast forward to August 2014 when a South Australian Royal Commission was triggered by the actions of one ‘bad apple’: child and youth support worker Shannon McCoole, who was arrested in June 2014 on sexual abuse and child pornography charges.
His extreme offences resulted in a sentence of 35 years in prison. The Royal Commission terms of reference asked for a review of state child protection. By the time the Commission reported, it had found issues so profound that Commissioner Nyland labelled it “a system in disarray”, offering 260 recommendations for reform.
McCoole certainly was ‘bad’; so was the system he worked in.
Around the same time, the Royal Commission into Institutional Responses to Child Sexual Abuse was hearing about many cases and some of the alleged abusers were referred for criminal investigation.
Most public attention focused on prominent and high-profile individual clergymen. However in December 2017 when they reported, the Commissioners said:
“It is not a case of a few ‘rotten apples’. Society’s major institutions have seriously failed.”
A Royal Commission into the financial services sector might seem very different in nature but the lessons are the same.
In September 2018, banking Royal Commissioner Kenneth Hayne wrote in his interim report that “the culture and conduct of the banks was driven by, and was reflected in their remuneration practices and policies”.
He was firmly signalling that contrary to what some major industry players had suggested, isolated ‘bad apples’ were not the problem. Rather the systemic culture of the industry was at play.
Now we have a Royal Commission into Quality and Safety of Aged Care. When announcing the Commission, Prime Minister Scott Morrison said “incidences of older people being hurt by failures of care simply cannot be explained or excused. We must be assured about how widespread these cases are…Whether there is a crisis in aged care or not is to be determined.”
It is unlikely to be about a few ‘bad apples’.
The Prime Minister would be aware of the Carnell-Paterson review of aged care quality regulation conducted in 2017, which was triggered by serious failures of care at the Makk and McLeay aged care wards at the Oakden Older Persons Mental Health Service in South Australia.
That review found that one bad service wasn’t the issue. While Oakden was a relatively complex case, the reviewers concluded that “the types of issues found at Oakden have much in common with the types of issues that arise for aged care consumers whenever there are quality-of-care challenges”.
Royal Commissions look wide and deep; the outcomes from an aged care Royal Commission are likely to be similar to others. It is highly unlikely that it will attribute problems to a few ‘bad apples’.
Like many Royal Commissions, what has begun as an inquisitorial process driven by exceptional cases is likely to recommend fundamental and systemic reform.
Government, the aged care industry and the broader community all need to be ready for the conversation about how we improve care – and how we pay for the improvements.
Ian Holland and Lisa Fenn are directors of consultancy firm Hamilton Stone, which provided advisory services to the Aged Care Legislated Review and Carnell-Paterson review of aged care quality regulation.
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