Office of Aged Care Quality and Compliance (OACQC):  Complaints Investigation Scheme Review

The Australian Government has engaged Associate Professor Merrilyn Walton to conduct a review of the operation of the Aged Care Complaints Investigation Scheme. The Consultation Paper provides background information on the Aged Care Complaints Investigation Scheme to inform input from interested organisations and individuals.

Merrilyn Walton is the Associate Professor of Medical Education at the University of Sydney and was formerly the Director of the NSW Health Complaints Unit and Commissioner for the NSW Health Care Complaints Commission.

The CIS is two years old and it is now appropriate to consider and evaluate its effectiveness to ensure that it continues to meet the needs and expectations of service recipients, service providers and other interested parties. The review of the complaints scheme coincides with the Government’s review of the aged care accreditation process.

A Consultation Paper has been developed which provides background information on the Aged Care Complaints Investigation Scheme to inform input from interested organisations and individuals.

In order to ensure comments are able to be considered, submissions should be made by no later than close of business on 28 August 2009.

*** UPDATE *** 16 April 2010 ***

Aged care complaints system found wanting

Source: ABC Radio - National Interest (audio available)
Date: 16 April 2010

Peter Meares: Merrilyn Walton, welcome to the National Interest

Merrilyn Walton: Thanks Peter

Peter Meares: What were your conclusions about the current complaints investigation scheme for aged care – how well is it working?

Merrilyn Walton: Well the report goes into a lot of detail, but ultimately, I found the scheme is not designed to achieve what residents and the aged care sector really would expect from a complaints system. As you probably be aware, the complaints system is part of the Department of Health and Ageing so it’s subsumed in quite a fragmented way within a large complex beurocracy, and that makes it very difficult for both providers of aged care services and consumers and residents to understand the complaints system and ultimately access it and trust it.

Peter Meares: I think the question of trust is the really big one there, because essentially what you’ve got is the Department of Health and Ageing which funds and regulates aged care, also investigating complaints about aged care – so in a sense - the department is investigating itself.

Merrilyn Walton: That’s true and it’s very difficult for the department because it has so many conflicting interests, and for example, whilst they’re responsibility for the quality of aged care services, a complainant really wants more transparency and exposure of poor quality services so the immediate conflict for the department or an officer that are working in the department, is how do they manage this tightrope - meeting their obligations as a department employee … their role as an independent complaints investigator or person managing complaints. I think it’s too big an ask of anyone in the department to do that.

Peter Meares: My reading of your report – it’s very interesting reading, but it does present a pretty bleak view of the current system and I’m going to try and summarise some of the key problems. You say essentially that it’s a system that’s not meeting anyone’s expectations. It’s not trusted by those who complain nor by those who are complained against. Both sides perceived bias in the system. The appeal mechanisms are restrictive and inadequate. And the scheme is run by staff who are overworked, inadequately trained and don’t have enough access to expert clinical advice. Is that a fair summary?

Merrilyn Walton: That’s a very fair summary. Coming from a complaint background like I did as you mentioned before I went into academia, as the Health Care Complaints Commissioner of New South Wales, I’ve spent nearly 20 years – and – you know – in the 21st century, we have very well developed complaint mechanisms in place. We know what makes for an effect complaints system, and when I was asked to review this particular system, it struck me really early on, about the design - was just not setup to comply with any best practice, complaint handling mechanisms.

Peter Meares: In fact you say it’s quite a rudimentary system

Merrilyn Walton: That’s right, and we have… most people that are going to go into aged care sector, us baby boomers, I suppose… and there’s lots of us and we’re used to articulating our rights and we’re very aware of effective complaints mechanisms. So if we don’t establish soon a proper structure that meets the needs of the providers, that they trusted – even if the outcome might not be what they like…

Peter Meares: ...that is people that run nursing homes…

Merrilyn Walton: Exactly right. And complainants and families and resident can make a complaint without fear of their suffering some detriment, the, you know, the system will collapse and more importantly we’re going to miss some potential catastrophes because the system at the moment is so over-burdened because they have a very low threshold for investigations and …

Peter Meares: What do you mean by that – a low threshold for investigations?

Merrilyn Walton: When… say I make a complaint, and I’ve made a complaint, or a family member has made a complaint about um, wrong medication to me as a resident, my family member, and the person next door has had a complaint about the quality of the food. Now whilst that may well be an important issue the quality of the food – because that can lead to malnutrion and dehydration, they will be treated probably pretty similarly - go into the system and both be investigated, where we need a much better triage system to identify those complaints which can be resolved with the human touch what I call, the speaking to each other, trying to resolve it – like you would try and resolve family member problem in your own home. Compared to a problem that has significant clinical or health issues attached to it that needs investigation

Peter Meares: So what you’re saying is that the current system is not separating the wheat from the chaff – as it were, not saying that this is urgent serious - someone’s life could be at stake, or you know, this matter could be of concern, but perhaps we can resolve it by getting the DON at the aged care facility to talk to the family.

Merrilyn Walton: That’s right. It’s like they need to … and one of the recommendations I made is to use a risk assessment framework where they triage the complaint so instead of at the moment when I did the review, over 60% of the complaints were categorised for investigation, and the problem with that was they’re not really investigations as I would categorise an investigation. The matters that get investigated should be, you know, a lot lower than that – 25-30%

Peter Meares: they should be the really serious ones

Merrilyn Walton: That’s right – that can be dealt with timely – that can be um, probably investigated – including looking at forensic evidence and indeed what came out from the consumer’s who made complaints was that the evidence that they provided as family members and carers wasn’t given the same weight or attention as the evidence of the provider’s – and that lead to your statement that, well, no-one seems happy. The consumers think that the system’s on the providers side – and the provider’s think it’s on the consumers side. Now that’s probably quite a good place if you’re independent - but not if there’s not a lot of transparency around the processes.

Peter Meares: And indeed many residents or their families who you quote say they offered the complaints investigators evidence, photographs, documents, whatever, but they weren’t taken up. They weren’t interviewed even, about their complaints – and it just seemed to them, that the officers went straight to the nursing homes and looked in the booked and if the books said things were ok, well then… they were ok?

Merrilyn Walton: Mmm…. And I don’t think that these were people with um, bad intentions – I think that they just were not appreciating the role of the investigation. A proper investigation is not just looking at the documents, because one can have beautiful protocols in place – but as the protocol being implemented is the real question, so you to talk to people to be able to determine the situation rather than just do a document investigation and I think because of the workload, the confusion about what matters get investigated – I think many of them worried that this might be more serious than it appears…

Peter Meares:…so that they feel they have to investigate every single thing….. This is the National Interest on Radio National and I’m speaking to Professor Merrilyn Walton who’s conducted an independent review of the Aged Care Complaints Investigation Scheme. That review has just been released by the federal government.

Peter Meares: Merrilyn Walton, you also say that the complaints scheme is very poor at communicating it’s findings. People make a complaint and then they feel they are never told what the outcome is – or if they get told they don’t understand it.

Merrilyn Walton: That’s true, and these are basic communication strategies in any complaints system that the relevant parties all know what is being complained about and how it is going to be handled. And they all know the findings and outcomes of any complaint mechanism whether it’s conciliation or mediation, or indeed investigation, and that lack of communication just leads people to think well, what’s the point of complaining, or they certainly may feel that their complaints been ignored, where it might not have been ignored.

Peter Meares: You make many recommendations for reform – but one of them is absolutely fundamental – and your fundamental recommendation is that there needs to be an independent aged care commissioner and complaints system setup outside the department – so separate from government as an independent statutory authority.

Merrilyn Walton: I do . And I think without that, we will have continual problems. There was a senate inquiry into the complaints system in 2005 and many of the submissions did raise the independence of a complaint body, and that inquiry did not recommend independence – it was, sort of, fell short of that. But I think now we’re 5 years on, and we have a coalescence really, of concern from all the stakeholders about the location of the scheme…

Peter Meares: ….by location you mean where it sits within the beurocracy – whether it is part of the department or not

Merrilyn Walton: Yes, yes…it’s not geography – it’s where it sits as a separate statutory body. It’s really important to… that the experience and knowledge that accumulates over time with complaint bodies, is maintained and kept, and not diluted. It’s important that everyone trusts this independent body, and then the other issues I have around the need for a separate statutory body, obviously the conflicting interest that we talked about earlier on, but it’s also around the ability to collect data, to be able to collect trend data, so we can look at where the problems are in the system, to be able to be really consistent about training and education of staff and accountability of that staff. And they have one hat – and that’s to manage complaints effectively. If it’s remains within the department, they have other hats that they wear.

Peter Meares: And that can then confuse the roles.

Merrilyn Walton: That’s right…

Peter Meares: On the issue of data, what about the transparency of that data? Because I know some advocates for the frail elderly would like to see a My Nursing Home site like the My Schools website – where you could see how many complaints have been made against this particular aged care provider – you know, how many of them were upheld, and what were they for?

Merrilyn Walton: Well, I think that’s just basic data in any modern contemporary democracy….

Peter Meares: So, it should be available…

Merrilyn Walton: …Is to report this… yes… definitely… um…. Now we need to really separate complaints about named individuals that are unfounded…. I think there is a…. you don’t put those into the public arena…. But I think complaints about institutions the types of complaints, and also the outcomes of those complaints, I think, is should be in the public arena. That helps…. That does two things, I think… It drives improvement…. One of the resident aged care facilities I did visit, was terrific on this. They had information about complaints, they encouraged the residents to make complaints – the complaints were dealt with in a type of peer of review improvement model, and so I as a family member, would feel very comfortable about raising complaints in that place and would recommend it to other people. So more information is better, in terms of the reputation and I suppose the opportunity for improvement.

Peter Meares: You’re review was delivered to government back in October – it’s just been released.. and there is a promise of an extra $25 m. dollars to strengthen the complaints system – but as far as I can tell, the government has not promised to implement your key recommendation – the idea of setting up an independent statutory authority complaints scheme separate from the department?

Merrilyn Walton: Yes – that’s right, I mean at this stage, umm… the way I did the report was there was sort of, concern about some immediate changes we needed to make – or they needed to make as soon as possible. So I understand those changes are happening as we speak internally, but the major recommendation about a separate commission is a structural change. I have been advised that there’s going to be a reference to the Productivity Commission who is going to review all the structures because even in my own experience of observer over the last 10 years there has been a very reluctance of government’s – state and national – and indeed other countries to look at independent statutory instruments, and I’m hoping the Productivity Commission will see the necessity to have the separate complaints commission, for really important reasons of trust and independence, so at this stage I think it’s a story still unfolding.

Peter Meares: Well at this stage, it means we’re going to have another review which will probably be another year before we get an independent commissioner if we get one.

Merrilyn Walton: I hope they don’t do another review – I hope they take the report onboard and look at the umm – the criteria, umm which a commission should be established rather than go through it all again. I think the complaints investigative scheme has been reviewed now, three times in very short span – and I think it’s time for action now rather than more reviews.

Peter Meares: Merrily Walton, thank you.

Merrilyn Walton: Thank you.

Peter Meares: Merrilyn Walton, former New South Wales Health Care Complaints Commissioner, now Professor in the Medical school in the University of Sydney. She carried out that independent review of the Aged Care Complaints Investigation Scheme. I know that quality of aged care is an issue of great concern to our audience, so we look forward to your comments.