18 September 2019
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Social Policy Section
Commission into Aged Care Quality and Safety (the Aged Care Royal
Commission) was established on 8 October 2018, with the Honourable Richard
Tracey AM RFD QC and Ms Lynelle Briggs AO appointed as Royal Commissioners. An
additional commissioner, the Hon Gaetano (Tony) Pagone QC, was
appointed on 13 September 2019. This quick guide outlines what a Royal
Commission is, the background to the establishment of the Aged Care Royal
Commission, its scope and aims, and how it has and will continue to operate
until the handing down of the final report in November 2020.
About Royal Commissions
A federal Royal Commission is a government inquiry
established by the Governor-General pursuant to the Royal Commissions
Act 1902 (Cth). Section 1A of the Royal Commissions Act
allows the Governor-General, by Letters Patent, to:
... issue such commissions, directed to such person or persons,
as he or she thinks fit, requiring or authorising [those persons] to make
inquiry into and report upon any matter specified in the Letters Patent, and
which relates to or is connected with the peace, order and good government of
the Commonwealth, or any public purpose or any power of the Commonwealth.
The Australian Law Reform Commission in its 2009 report into
Royal Commissions , Making
Inquiries, explained (at pages 53–58) that this type of ‘public
executive inquiry’ is conducted on an ad hoc basis by an entity established by
the executive arm of government to investigate issues and make recommendations
to government. Public inquiries fall into two broad categories:
issues of policy or law reform (policy inquiries) or
investigation of facts or allocation of responsibility with
respect to incidents or problems (investigatory inquiries).
The Royal Commission Act provides for Royal
Commissions to take evidence under oath or affirmation, summon witnesses and/or
produce documents, with penalties for failure to comply. Royal Commissions also
have the powers to authorise search warrants, and jail penalties are applicable
for offences such as the destruction of documents, the giving of false or
misleading evidence, and contempt of court.
The Parliamentary Library maintains a list of Royal
Commissions and Commissions of Inquiry appointed by the Australian
Government from 1902.
Background to the Royal Commission
The establishment of the Aged Care Royal Commission followed
a number of reviews of aged care, as well instances of poor care within the
aged care system being reported in the media. There have been a number of
inquiries into aged care in recent years, with Crikey noting
at least six that occurred in 2017 alone (including inquiries into elder abuse
and disability care).
Significant public attention on the issue of aged care
quality arose from incidents at the Makk and McLeay nursing home at Oakden in
South Australia (which was state-run but also received some Commonwealth
Government aged care funding), which was closed in 2017 following reports of allegations
were being over-medicated, inadequately fed, injured, placed in mechanical
restraints for up to 10 hours a day and isolated in squalid conditions. In
response to concerns which had been raised earlier, the South Australian
government Chief Psychiatrist, Dr Aaron Groves, conducted a review of the
facility. His 2017 Review of Oakden
Older Persons Mental Health Service found an absence of a satisfactory
model of care, noting:
The Review finds that the Oakden facility is more like a
mental institution from the middle of the last century than a modern Older
Person’s Mental Health Facility. [p. 57]
The allegations arising from Oakden led
to three staff being investigated by police, with eight others being stood
down and 21 staff being reported to the Australian Health Practitioner
Regulation Agency. Beyond this, in April 2017 the South Australian Government
also released its response
to the review undertaken by Dr Groves, accepting all six recommendations.
South Australia’s Independent Commissioner Against Corruption also released a report in
February 2018, outlining a set of 13 recommendations.
The Oakden incident led to the establishment
of the Review
of National Aged Care Quality Regulatory Processes, also referred to as
the Carnell Paterson review. The role of the review was to assess the national regulatory
framework in place, and to make recommendations to strengthen that framework to
prevent further instances such as that of Oakden from occurring. The review
made ten recommendations, including the establishment of the Aged Care Quality
and Safety Commission; to require all residential aged care providers who
receive Australian Government funding to participate in the National Quality
Indicators Program; and to limit restrictive
practices in residential aged care.
The Parliament also inquired into aged care quality, with
both the House of Representatives and the Senate releasing reports which
covered both Oakden, and broader issues with the quality of aged care. The House
of Representatives Standing Committee on Health, Aged Care and Sport tabled its
on the Inquiry into the Quality of Care in Residential Aged Care Facilities in
Australia in October 2018. The report investigated issues relating to
the delivery of care in facilities, and made 14 recommendations aimed at
improving the operation of residential aged care facilities. The Senate
Community Affairs References Committee also conducted an inquiry, releasing the
of the Aged Care Quality Assessment and Accreditation Framework for Protecting Residents
From Abuse and Poor Practices, and Ensuring Proper Clinical and Medical Care Standards
are Maintained and Practised report in April 2019, with the interim
report released in February 2018. The Committee also made 14
The ABC’s Four Corners program’s two-part ‘Who Cares?’, which
aired on 17
September 2018 (the day after Prime Minister Scott Morrison announced the
Aged Care Royal Commission) and 24 September
2018, presented a view into the lives of those living in residential aged
care facilities, highlighting
instances of isolation and neglect.
About the Royal Commission
on 16 September 2018, and established early in the following month, the
Aged Care Royal Commission was due to submit an interim report by 31 October
2019, with the final report to be submitted by 30 April 2020, however, an
extension of six months was
granted by the Government in September 2019, with the final report now due
on 12 November 2020. In a joint announcement with Health Minister Greg Hunt and
Minister for Senior Australians and Aged Care Ken Wyatt, Prime Minister Scott
Morrison explained the decision to establish a Royal Commission, pointing
in particular to:
... a very disturbing trend in what is happening in terms of
non-compliance, abuses, and failures of care that have been occurring across
As well as Royal Commissioners Richard Tracey, Tony Pagone and
Lynelle Briggs, the Commission includes eight Counsel
The Royal Commission is based in Adelaide, with hearings
in Adelaide, Sydney, Broome, Perth, Darwin, Cairns, Mildura, Brisbane, Mudgee,
Hobart and Melbourne; each focusing on a different aspect of aged care.
Hearings and topics announced to date are summarised below:
Table 1: Aged Care Royal Commission Hearings and Topics
of hearings are available on the Royal Commission website.
The Royal Commission has also sought submissions from both aged
care providers and the public. In late November 2018 all approved aged care
asked to provide information on all instances of abuse, mistreatment, or substandard
care in their service since July 2013 (p. 4). Public submissions have also been
invited, with a portal established on the Royal Commission’s website.
In an August 2019 newsletter
the Royal Commission noted that 5,258 submissions had been received to date.
Funding for the Royal Commission was announced in the 2018–19
Mid-Year Economic and Fiscal Outlook (p. 11). The Royal Commission
will receive $104.3 million over four years, starting in 2018–19, administered
by the Attorney-General’s Department. A further $17.2 million was allocated
over two years to the Department of Health, the former Australian Aged Care
Quality Agency, and its replacement, the Australian Aged Care Quality and
Safety Commission, to support activities associated with the Royal Commission.
Scope of the Royal Commission
Patent, signed on 6 December 2018, outline the directive and scope of the
investigation of the Royal Commission. The terms
of reference can be summarised as:
- the quality of aged care services, the prevalence of substandard
care including abuse, the causes of any systemic failures in aged care and
actions that should be taken in response
- the delivery of services to those with disabilities (including
younger residents) and dementia
- the challenges that will arise in the future, given demographic
- how the Government can improve the system
- how to create an aged care system which is consumer-oriented,
allowing for choice and control for residents and users and
how services can be delivered sustainably, with the use of
technology and investing in the workforce.
As noted in the Letters Patent, the scope of the Royal
Commission includes all types of Commonwealth Government-funded aged care
services, all aspects of quality and safety of aged care services, the aged
care workforce, the diversity of users, the intersection between aged care
services and other services accessed by users, examples of good practice, and
previous aged care reports and inquiries.
The Royal Commission is operating not only to investigate
the system, but also to make recommendations for change and reform. As
Commissioner Briggs notes
in the preliminary hearing:
The Letters Patent direct us to make recommendations about
any policy, legislative, administrative or structural reforms that we consider
necessary. A policy and research program has been developed to assist us to
make recommendations that would provide a sustainable aged care system of high
quality that is safe and meets the expectations of the Australian community. [p.
The Royal Commission has published
seven background papers into areas relevant to the Commission’s work, including
legislative framework of aged care quality and safety regulation, the
use of restrictive practices in residential care, and pressures
on the aged care system in the medium-term and long-term.
coverage of the Royal Commission into Aged Care Quality and Safety is being
compiled by the Parliamentary Library as the Commission progresses.
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