Royal Commission into Aged Care Quality and Safety

Royal Commission into Aged Care Quality and Safety
Name	Royal Commission into Aged Care Quality and Safety
Established	2018
Commissioners	The Hon. Patricia Bergin, The Hon. Richard Tracey, The Hon. Tony Pagone
Jurisdiction	Australia
Report	Final report (2021)

Royal Commission into Aged Care Quality and Safety

The Royal Commission into Aged Care Quality and Safety was a major Australian public inquiry initiated in 2018 to examine standards, delivery and funding of aged care services in Australia. It investigated care in residential facilities, home care programs and aged care regulation, producing a comprehensive final report in 2021 that influenced policy responses by the Commonwealth of Australia and prompted debate involving institutions such as Department of Health (Australia), Aged Care Quality and Safety Commission and national stakeholders including Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry-era public scrutiny.

Background and establishment

The inquiry was announced amid high-profile media investigations such as those by the Australian Broadcasting Corporation and the Four Corners episode that amplified concerns raised by advocates including Dementia Australia, Australian Nursing and Midwifery Federation and community groups tied to figures like Carmel Tebbutt and Dr Bernadette McSherry. It reflected prior inquiries including the Aged Care Reform Implementation Council reports and parliamentary scrutiny from committees like the House of Representatives Standing Committee on Health, Aged Care and Sport and the Senate Community Affairs References Committee following coronial findings and cases involving providers such as Bupa and events comparable to international scandals like the Francis Report in the United Kingdom. The Governor‑General appointed commissioners under provisions of the Royal Commissions Act 1902 (Cth), selecting legal figures with judicial backgrounds from courts including the Supreme Court of New South Wales.

Terms of reference and scope

The Commission's terms of reference required examination of the quality of aged care services provided in residential and home care, matters affecting care for people with dementia and the governance, funding and regulatory frameworks overseen by the Department of Health (Australia), Aged Care Quality and Safety Commission and the Commonwealth Ombudsman (Australia). It assessed workforce issues involving occupations represented by bodies such as the Australian Nursing and Midwifery Federation, Australian Medical Association, and unions like the Australian Council of Trade Unions. The scope included consideration of international standards exemplified by agencies such as the World Health Organization and comparative systems in countries like the United Kingdom, Canada, United States, and New Zealand, as well as legal frameworks such as the Aged Care Act 1997 and human rights instruments including the Convention on the Rights of Persons with Disabilities.

Hearings, evidence and key findings

Public and private hearings drew testimony from thousands of witnesses including residents, families, frontline staff, executives from providers such as Japara Healthcare, RSL Care, and Valentine Care, clinicians from institutions like Royal Melbourne Hospital and St Vincent's Hospital, Sydney, academics affiliated with Australian National University and University of Sydney, and regulators including the Aged Care Quality and Safety Commission. Evidence encompassed case studies, coronial reports, workforce data from the Australian Bureau of Statistics, and submissions from advocacy groups such as Ageing on the Edge and COTA Australia. Key findings documented systemic failures: inadequate clinical care, chronic underfunding traceable to budgetary decisions by administrations including those led by Malcolm Turnbull and Scott Morrison, insufficient staffing levels noted by experts associated with Monash University and Flinders University, and regulatory shortcomings paralleling critiques found in reports like the Royal Commission into Institutional Responses to Child Sexual Abuse. The Commission identified recurrent issues including substandard medication management, infection control deficits highlighted during the COVID‑19 pandemic in Australia, and governance lapses in some large providers.

Recommendations and government response

The final report made numerous recommendations addressing funding, regulation, workforce, clinical standards and governance, urging reforms such as a new Aged Care Act, increased funding comparable to models in the Netherlands and Denmark, establishment of single‑line responsibility for clinical oversight, and enhanced rights for consumers aligned with documents like the Charter of Aged Care Rights. The Morrison government and subsequent Albanese ministry responded with staged policy packages including funding boosts, workforce training initiatives in partnership with institutions like TAFE NSW and regulatory changes implemented by the Aged Care Quality and Safety Commission. Major legislative developments referenced in implementation debates included amendments to the Aged Care Act 1997 and budget allocations debated in sessions of the Parliament of Australia.

Implementation, reform and impact

Implementation involved coordinated action across federal agencies, peak bodies like Leading Age Services Australia and Aged and Community Services Australia, and state health authorities including New South Wales Ministry of Health and Victorian Department of Health. Reforms addressed home care package waitlists, introduced minimum staffing ratios trialed in some states, and funded clinical nursing positions in residential aged care informed by research from Griffith University and Deakin University. The pandemic accelerated infection control reforms inspired by guidance from Australian Health Protection Principal Committee and the Royal Australian College of General Practitioners. Impacts included heightened public scrutiny, shifts in accreditation processes by the Aged Care Quality and Safety Commission, and influences on provider consolidation similar to corporate trends tracked by the Australian Securities Exchange.

Criticisms and controversies

Critics argued the Commission's remit and resources produced extensive recommendations that were costly and challenging to implement, provoking debate among stakeholders such as Business Council of Australia, unions like the Australian Services Union, and advocacy organisations including ACOSS. Some provider groups disputed staffing ratio proposals, citing constraints highlighted in submissions from entities like Calvary Health Care and Anglicare Australia, while legal commentators from institutions such as University of Queensland critiqued aspects of proposed reforms to liability and consent law. Political controversy arose over timing and funding commitments across administrations including responses from figures like Peter Dutton and Anthony Albanese, and analysts compared the inquiry's outcomes with outcomes from other major inquiries such as the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.

Category:Royal commissions in Australia