Industry concerns over regulation proposed by Quakers Hill inquest

Aged care industry peak bodies have cautioned against adopting a raft of industry-wide changes recommended by a NSW coronial inquiry report into the Quakers Hill nursing home fire released this week.

Under the recommendations handed down on Monday the Australian Health Professional Regulation Agency (AHPRA) would keep employment records on its registration database, while tighter security of Schedule 8 drugs would be considered for aged care facilities.

Aged & Community Services Australia CEO Adjunct Professor John Kelly said it was not ideal to use extreme cases, such as the deliberate lighting of a fire by drug dependent nurse Roger Dean in 2011, in which 14 residents died, to form policy.

“It is important not to over regulate on the premise that this might achieve the objective of catching a possible Mr Dean ahead of time,” Adjunct Professor Kelly told Australian Ageing Agenda.

“There are already police checks required for employees and providers will have their own policies in regards to reference checks.”

Charles Wurf, chief executive officer of Leading Age Services Australia NSW, said the coroner’s recommendation to expand the AHPRA database to record employment history could breach staff privacy and confidentiality and required careful consideration before being accepted.

“A current employer has a range of obligations to its residents under the Aged Care Act and it has an equally strong set of obligations to its staff under the Fair Work Act and the associated legislation and awards and enterprise agreements,” Mr Wurf told AAA.

“We are very willing to engage constructively around this recommendation but it should be done cautiously and collaboratively and in advance of any regulatory change, there should be an evidence base as to what is best practice.”

Mr Wurf said the change, which the coroner recommended should be considered urgently, would have implications for all health professionals registered through AHPRA not just those that worked in aged care.

Adjunct Professor Kelly said increasing the employment data recorded by AHPRA would also not capture the bulk of unregistered care workers employed in aged care.

In his report, NSW deputy state coroner Hugh Dillon said that requiring AHPRA to keep this information would help overcome the situation when a health professional tried to conceal their employment history from a prospective employer. This recommendation would reduce the capacity of health professionals to manipulate the recruitment process, he said.

The coroner found management at the Quakers Hill Nursing Home owned by Domain Principal Group (now Opal Aged Care) did not undertake any reference checks before hiring Mr Dean and relied on a misleading CV he submitted.

Mr Dillon said because the nursing home was desperate to fill the nursing vacancy, “virtually nothing was done to check Mr Dean’s bona fides.”

“Not to conduct adequate background checks on new employees may constitute a serious failing on the part of a health service organisation to protect the public interest. This is a critical lesson to be drawn from this disaster,” he said.

Call for training on drug dependency 

The coroner also recommended the need for routine in-house training in detecting the signs of drug dependency in professional colleagues and further education on mandatory reporting requirements under AHPRA to report incidents.

Mr Dillon said facilities should have clear operating procedures and protocols in place for the investigation and management of suspected drug intoxication.

The coroner said the management’s failure to remove Mr Dean from the facility and suspend him from duty pending the outcome of police and internal investigations of drug theft from the home “was a lame and risky response”.

“If AHPRA’s system of mandatory reporting and other checks designed to protect patients and staff is or becomes ineffective because it is implemented poorly by practitioners and organisations, more draconian, intrusive and expensive alternatives, such as compulsory drug-testing or giving employers access to employees’ health records, may have to be considered,” he wrote.

Mr Dillon also criticised the situation where a staff member was allowed to have sole access to Schedule 8 drugs at night as “lax management practice” and recommended the NSW Minister for Health consider amending the regulation to improve security of Schedule 8 drugs in nursing homes.

Fire safety audits were also conducted to meet requirements for paperwork rather than with “real fires and real lives in mind”, said Mr Dillon.

However, he acknowledged this was a cultural rather than regulatory issue.

Mr Wurf said there were already tight controls over access to drugs of addiction. However, reviewing they are adhered to by facilities was important.

He said the coroner’s recommendation for all aged care residents to wear an identification wristband failed to recognise that unlike the acute care sector, an aged care facility was a person’s home.

Mr Wurf said enhanced fire safety through the installation of fire sprinklers was the key lesson to emerge from the tragic incident.

The NSW Government legislated to make automatic fire sprinklers mandatory in aged care facilities in 2013.

Adjunct Professor Kelly said ACSA and its members were currently investigating how training and education programs could be enhanced in light of the coroner’s recommendations.

In a statement Opal Aged Care said it was considering the outcomes of the coronial inquiry alongside the company’s own reviews.

“Within eight weeks of the fire, Opal initiated the installation of sprinklers in all our homes, regardless of legislation requiring us to do so,” said Gary Barnier, managing director. “We have reviewed every circumstance leading up to and following this event to inform our policies and procedures now and in the future.”