The aged care regulator has been accused of “unacceptable ignorance” about the standard of work being performed by consultants that are paid tens of millions of dollars to inspect nursing homes across the country.
The Aged Care Quality and Safety Commission (ACQSC) has revealed one-third of all safety and quality audits conducted by consultants over a 12-month period – affecting about 350 homes – were initially rejected because they were not up to standard.
Guardian Australia has reported that four firms were paid more than $40m to conduct the work despite having declared 528 real, potential or perceived conflicts of interest. The commission spent $1.6m supporting 99 consultants and created a quality assurance team.
Greens senator Janet Rice has criticised the commissioner, Janet Anderson, for telling her in a Senate estimates hearing in late October that only “a small proportion” of audits by consultants were initially rejected due to substandard work.
“Anderson’s response to me that the problem only lay with a small proportion of the audits indicates an unacceptable ignorance of the problems that so often occur when sensitive and complex tasks are outsources to for-profit providers,” Rice said.
“This admission, as well as hundreds of reported conflicts of interest, is an illustration of what can go wrong when for-profit consultants are brought in to do a job that should be handled by government.”
Anderson did not respond directly to Rice’s criticism, but said every audit was subject to “rigorous quality assurance” and that the volume of work being conducted by consultants has decreased in recent months. All audits were eventually accepted once more work was done.
“An audit report could be up to 100 pages or more in length, depending on the size and complexity of the service being audited and the observations made by the quality assessor team,” Anderson said.
“When we refer to reports requiring additional work, it can include things like adding extra detail or clarification to an observation, changes to formatting or correcting typographical errors.”
The four firms – RSM, HDAA, SAI Global and KPMG – have conducted more than two-thirds of all audits since 2021. They were hired to help address a backlog of inspections that were not possible during the pandemic, when lockdowns prevented site visits. All firms have been contacted for a response to criticism of their work.
The ACT independent senator David Pocock said he was concerned by the initial rejection rate given some of Australia’s most vulnerable people lived in aged care homes.
“There is a place for contracted work, but to find out that two-thirds of the aged care Commission’s site audits were outsourced, and one-third of these not completed to standard, is deeply troubling,” Pocock said.
“The commission is the regulator. Site audits are their core business and it should be a capability that they have in-house.”
The former senior public servant David Tune, who conducted an independent review of the commission’s capability, has described aged care audits as “a core function of the commission” and warned the level of outsourcing presented “a significant risk”.
The Community and Public Sector Union’s national deputy secretary, Beth Vincent-Pietsch, has also renewed her criticism of the outsourcing.
“If the Albanese Labor government is serious about improving the quality of aged care facilities across this country, then they need the work of the aged care regulator to be done by experienced, frank and fearless public servants,” Vincent-Pietsch said.
But Charles Maskell-Knight, a former senior health department official and a senior adviser to the royal commission, defended the use of consultants in some circumstances.
“If there is a choice between not doing audits at all due to staff shortages, or doing them using third parties, it is clearly in the interests of people receiving aged care that the audits are carried out, even if it is by consultants,” Maskell-Knight said.
“I am sure that the ACQSC will be making every effort to ensure it has the staff in-house to carry out its core functions and avoid the need to outsource the work, given the inherent risks of conflicts of interest and under performance.”
