Showing posts with label aged care. Show all posts
Showing posts with label aged care. Show all posts

Wednesday, 6 November 2019

Many of the cases of deficiencies or outright failings in aged care were known to both the providers concerned and the regulators before coming to public attention. Why has so little been done to address these deficiencies?

Opening page of the Royal Commission interim report on Aged Care in Australia......

Royal Commission into Aged Care Quality and Safety, Interim Report, Volume 1, p.1: 

It’s not easy growing old. We avoid thinking and talking about it. As we age, we progressively shift our focus from work to the other things that give us purpose and joy: our children and grandchildren, our friends, our holidays, our homes and gardens, our local communities, our efforts as volunteers, our passions and hobbies. The Australian community generally accepts that older people have earned the chance to enjoy their later years, after many decades of contribution and hard work. Yet the language of public discourse is not respectful towards older people. Rather, it is about burden, encumbrance, obligation and whether taxpayers can afford to pay for the dependence of older people. 

As a nation, Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities. Sadly, this failure to properly value and engage with older people as equal partners in our future has extended to our apparent indifference towards aged care services. Left out of sight and out of mind, these important services are floundering. They are fragmented, unsupported and underfunded. With some admirable exceptions, they are poorly managed. All too often, they are unsafe and seemingly uncaring. This must change. 

Australia prides itself on being a clever, innovative and caring country. Why, then, has the Royal Commission found these qualities so signally lacking in our aged care system? We have uncovered an aged care system that is characterised by an absence of innovation and by rigid conformity. The system lacks transparency in communication, reporting and accountability. It is not built around the people it is supposed to help and support, but around funding mechanisms, processes and procedures. This, too, must change. 

Our public hearings, roundtable discussions with experts, and community forums have revealed behaviour by aged care service providers that, when brought to public attention, has attracted criticism and, in some cases, condemnation. Many of the cases of deficiencies or outright failings in aged care were known to both the providers concerned and the regulators before coming to public attention. Why has so little been done to address these deficiencies? We are left to conclude that a sector-wide focus on the need to increase funding, a culture of apathy about care essentials, and a lack of curiosity about the potential of aged care to provide restorative and loving care—all of which is underpinned by an ageist mindset— has enabled the aged care system to hide from the spotlight. This must also change. [my yellow highlighting]

Left isolated and powerless in this hidden-from-view system are older people and their families. ‘This is not a life.’ ‘This is not my home.’ ‘Don’t let this happen to anyone else.’ ‘Left in her own faeces, and still no one came.’ ‘Mum doesn’t feel safe.’ 

This cruel and harmful system must be changed. We owe it to our parents, our grandparents, our partners, our friends. We owe it to strangers. We owe it to future generations. Older people deserve so much more. 

We have found that the aged care system fails to meet the needs of our older, often very vulnerable, citizens. It does not deliver uniformly safe and quality care for older people. It is unkind and uncaring towards them. In too many instances, it simply neglects them.

Thursday, 24 October 2019

The hidden costs for rural & regional older Australians when accessing Home Care packages

There are a number of people in the Clarence Valley who are hesitant to apply for Home Care packages - often because the houshold budget maths just don't add up when it comes to what is now essentially privatised and very expensive assistance for older people in their own home.

Here is yet another example......

The Daily Examiner, 21 October 2019, p.3:

Clarence Community Transport CEO Warwick Foster said there were misconceptions surrounding how government funding works with Commonwealth Home Support, NDIS and Home Care Package clients.
“People don’t have the correct information about how the system actually works, and that’s understandable because it’s a confusing system,” he said.
Mr Foster said Clarence Community Transport was primarily a home support program, designed to provide subsidised transport to eligible clients.
“When it comes to clients who transition to a Home Care Package, regardless of the level, then they technically become ineligible to access Commonwealth Home Support Programme services,” he said.
“I think where the problem comes in is that there’s not enough education for the clients about what it means when they accept a Home Care Package.
“Unfortunately clients who had been using community transport to get to appointments go from paying one fee then having to pay another fee because we’re no longer able to provide subsidised transport. That’s why it’s such a shock.
“Three days a week we transport clients to Brisbane and the Gold Coast, and to get them up and back for a subsidised client is $80, but that fee goes up to $780 once someone accesses a Home Care Package.
“We get notified by the government, who tell us when a client is in receipt of a Home Care Package, that they’re no longer eligible for CHSP services.”.....
“We’re a not-for-profit but that doesn’t mean we’re here to provide free transport.
“We are required under our contracts to recoup some costs of the transport service from our clients.”

Monday, 26 August 2019

Morrison Government's understanding of human rights and aged care appears flawed

"Restrictive practices can elicit concern for a number of reasons. Fundamentally, they impact on the liberty and dignity of the care recipient. In circumstances where they are not absolutely necessary, their use is likely to sit uncomfortably for many. Their use without lawful consent may infringe the resident’s legal rights and constitute a civil or criminal offence, such as assault or false imprisonment, although there are very few cases in Australia where a criminal or civil complaint has been pursued to challenge the use of a restraint in an aged care setting. Physical and chemical restraint can have significant adverse effects on a resident, both physically and psychologically. There are also fundamental questions about their effectiveness."  [Royal Commission into Aged Care Quality and Safety, Background Paper 4, May 2019]

9 News, 20 August 2019: 

The Commonwealth government recently introduced changes aimed at limiting the use of restraints in residential facilities. 

But experts believe the regulations have created many more problems than they solved. 

They are urging the Commonwealth to scrap the regulations and start again from scratch. 

Queensland's public guardian Natalie Siegel-Brown said the changes placed her agency and the community in a "really compromising" position. 

"Unfortunately in their current form, the principles actually regress the recognition of human rights of people living in aged care, particularly with respect to chemical restraints," she told the committee in Sydney on Tuesday. 

"But the entire suite itself lacks any monitoring, enforcement or oversight in any event, and this can lead to greater problems." 

Colleen Pearce, from the Victorian Office of the Public Advocate, said aspects of the regulations were flawed and ambiguous. 

"We consider the principles are inconsistent with people's human rights (and) would preferably be contained in legislation," 

Dr Pearce told the committee. "(The principles) introduce, in the case of physical restraints, a new flawed and ambiguous substitute decision-making regime, provide virtually no regulation of chemical restraint usage, and lack the safeguards of other restrictive practices regulatory schemes." 

Joseph Ibrahim, the head of the Health Law and Ageing Research Unit at Melbourne's Monash University, described the regulations as stupid. 

"There is no monitoring mechanism, there are no sanctions associated, there is no way of implementing or making sure the law comes into effect," Professor Ibrahim said. 

A group of advocates believe the government should be prohibiting the misuse of restraints and over-medication, rather than regulating them. 

They argue medication should only be used for therapeutic practices and be administered with a patient's free and informed consent. 

The group includes Aged and Disability Advocacy Australia (ADA) and Human Rights Watch, both of which addressed the hearing on Tuesday. 

"Older people in nursing homes are at serious risk of harm if this new aged care regulation is allowed to stand as is," ADA chief executive Geoff Rowe said. 

"Australia's parliament should act urgently to ensure that everyone, including older people, is free from the threat of chemical restraint.".....

The Canberra Times, 21 August 2019:

New rules on the use of restraints in aged care could lead to more elderly residents being sedated, a parliamentary inquiry has heard. 

The regulation is also unenforceable, and does nothing to relief the staffing pressures that have led to the use of restraints, expert witnesses have said..... 

Professor Joe Ibrahim from Monash University's Health Law and Ageing Research Unit said the regulation also did not recognise the pressures within aged care that forced staff to use restraints. 

"Staff restrain residents to get through their day because they don't have enough hands to get through what's needed or they don't have the skills, knowledge, ability to assess why a person has responsive behaviours or unmet needs to address that," Professor Ibrahim said. 

"A law that isn't monitored, has no sanctions, no way of checking, it will drive practice underground." 

Queensland Nurses and Midwives Union professional officer Jamie Shepherd said he knew of a case where one registered nurse had to administer medication to 166 residents on night shift, and management resisted rostering on an enrolled nurse to help until the RN threatened to call an ambulance each night to assist. 

Australian Nursing and Midwifery Federation federal professional officer Julie Reeves said through a recent member survey, she learnt of an aged care home where there were just six staff rostered on overnight to look after 420 residents. 

"We cannot always effectively manage challenging behaviour issues for dementia residents while at the same time caring for others who have very complex health issues. 

We receive little to no support from management when things don't go as planned," she quoted the member as saying. 

Australian Human Rights Commission president, Emeritus Professor Rosalind Croucher said while parts of the regulation had merit, it should not be allowed to proceed unless there was a mechanism for independent oversight. "If it's a choice of it or nothing, nothing might be better than it as it is," Professor Croucher said....

Physical restraining devices currently allowed in Commonwealth-funded aged care facilities are:

Bed rails
Chairs with locked tables
Seat belts other than those used during active transport
Safety vests
[my yellow highlighting]

Chemical restraint is any medication or chemical substance used for the purpose of affecting a person's behaviour, other than medication prescribed for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition. 

Use of chemical restraint is specifically excluded from assessment in the National Aged Care Mandatory Quality Indicator Program. [See p.15]


 Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019

Monday, 22 July 2019

What many frail aged Australians can expect if they enter a nursing home - maggots, rotten food and a starvation diet

ABC News, 16 July 2019:

PHOTO: Pictures supplied to ABC investigations as part of a crowdsourcing project on food in aged care. (Supplied)

..Cutting corners

Earlier, a roundtable of three chefs with almost 100 years of experience in a range of aged care services and kitchens between them suggested an answer to why food standards were so poor.

The commission heard the quality of aged care menus — described by one panellist as "the one thing [residents] get to look forward to" — came down to what the facility paid per resident.

For $16 a day, the residents of the unnamed facility Lindy Twyford manages were served salt-and-pepper squid, fillet mignon, and occasional portions of frozen but high-quality produce.

At the other end of the spectrum, a home spending $7 would rely on secondary cuts of meat and mass-ordered vegetables, some of which would be thrown out at the expense of serving sizes.
"You're having to cut corners, you're having to use frozen foods, you're having to use processed foods just to feed residents," chef Nicholas Hall said.
Mr Hall said food costs at some facilities he formerly worked at were inflated by an ordering system beyond supermarket prices, in one instance by as much as 100 per cent.

Chef Timothy Deverell raised concerns about the lack of training to create texture-modified foods, menus that had no input from residents until they complained, and food served on open-air trolleys that was often cold by the time it reached some residents.

Some homes would place food orders using a "restrictive" system in which a drop-down box offered just a handful of options, Mr Hall said.
Facilities would opt for finger food platters because they were "low-risk", cheap, and didn't require a chef.

Some meals would be repeated up to three or four times a week as providers made a bid to reduce costs.
"They're racing to the bottom to see who can feed for the lowest amount of cost," Mr Hall said

Maggots, rotten food

The commission was also told of one "upmarket residential aged care facility" which had a maggot-infested rubbish store between service trolleys and a nearby fridge containing enough rotten food to fill a trailer.

"[I've seen] reusing food that's already been out, served to residents and come back to the kitchen," Mr Deverell said.

"They use that for texture-modified diets."

Mr Hall said food safety audits were too infrequent and services were given advance notice, meaning extra cleaners could be hired to bring facilities up to scratch.

He said nutritionists failed to properly engage with residents and their needs…..

Tuesday, 4 June 2019

The National Disability Insurance Scheme continues a bumbling problem-filled roll out during which its clients suffer

Newcastle Herald Sun, 31 May 2019:

AT least 3000 NDIS recipients from regional NSW and Victoria will have to find new care providers after mutual company Australian Unity decided to cut back on disability services to concentrate on aged care in Sydney.

Australian Unity confirmed the decision after concerns were raised with the Newcastle Herald by the Public Service Association.

It did not dispute an assertion by PSA regional organiser Paul James that the decision was a consequence of the financial pressures facing NDIS providers.

The decision comes just three years after Australian Unity bought the NSW Government's Home Care agency in February 2016, picking up 4000 former government employees and 50,000 aged care and disability clients.

Australian Unity said it would "work closely" with the National Disability Insurance Agency (NDIA) to ensure NDIS participants found "another service provider of their choice".

It said 57,000 clients on aged care packages would not be affected. 
It did not expect the NDIS decision to cause job losses but Mr James questioned how this could be.

"Even if they say the majority of their clients are unaffected, there's still 3000 people in regional areas who will have to find new providers," Mr James said.

"The NDIS was originally supposed to be helping people with disabilities into work, but instead it's become an opportunity for the states to ditch their responsibilities for disability services."

Australian Unity said the decision to "scale down" its NDIS services came after a review of its "Home and Disability Services" business - as it renamed the former Home Care agency.

According to the Dept. of Human Services (recently renamed Services Australia) In NSW as of 31 March 2019:

101,963 people have a NDIS service;
4,219 initial plans have been approved; and
34,397 people will be receiving services for the first time.

While according to the National Disability Insurance Scheme (NDIS), 12 April 2019:

There are now 250,000 participants nationwide;
Almost one in three of these participants are receiving disability supports and services for the first time; and
Costs to NDIS clients for individual service delivery have risen between 10.9 per cent and 20.4 per cent from 1 July.

This price rise will include a minimum rise of almost $11 per hour for therapists, and up to a 15.4% price increase to the base limit for attendant care and community participation and appears to be driven by the demands of service providers.

The number of NDIS participants is set to rise to 460,000 at full roll-out in 2020.

Due to the demand for home care packages, for most people, the expected wait time for approved packages is:

The expected wait time for the level of interim package you agree to receive (while waiting for your approved level to be assigned) is:
In May 2018 the Commonwealth Ombudsman investigated the National Disability Insurance Agency (NDIA) handling the annual reviews of those already receiving service under a NDIS plan after around one-third of all complaints he received about the scheme related to review issues.

The conclusions drawn was that the NDIS scheme was administratively under-resourced for the rollout task, however there were a number of areas where NDIA could improve its administration of participant-initiated reviews. Otherwise the review process would remain unwieldy, unapproachable and the driver of substantial complaint volumes.

If you are in New South Wales and have a complaint about a support or service you have received under the NDIS, you can contact the NDIS Quality and Safeguards Commission.

Monday, 8 April 2019

The Morrison Government's Budget 2019-20 appears to be fooling very few

By 26 August 2018 North Coast Voices was posting this……

On this list are individuals who have:
* not yet been approved for home care;
* been previously assessed and approved, but who have not yet been assigned a home care package; or
* are receiving care at an interim level awaiting assignment of a home care package at their approved level.

Waiting time is calculated from the date of a home care package approval and this is not a an ideal situation, given package approval times range from est. 27 to 98 days and the time taken to approve high level home care packages is now [more] than twelve months - with actual delivery dates occurring at least 12 months later on average….

By June 2017 New South Wales had the largest number of persons on the home care waiting list at 30,685.

Given the high number of residents over 60 years of age in regional areas like the Northern Rivers, this waiting list gives pause for thought.

This was the Morrison Government announcement of 17 December 2018 reported online…….

Community Care Review magazine, 17 December 2018:

The federal government has announced $553 million in aged care spending including the release of 10,000 home care packages and increased residential supplements for the homeless and people in regional areas.

The splash-out is a centerpiece of the federal government’s Mid Year Economic and Fiscal Outlook, which forecasts a return to budget surplus and a raft of new aged care spending initiatives.

The new high-care home care packages will be available within weeks, Prime Minister Scott Morrison said. Funding will be split across 5,000 level 3 and 5,000 level 4 care packages, providing up to $50,000 per person in services each year.

This is the Morrison Government pretending that the 10,000 aged care packages it announced last year are a new round of age care packages in Budget 2019-20……

Budget Papers 2019-20:

To support older Australians who choose to remain in their own homes for longer, the Government is providing $282.4 million for 10,000 home care packages….

However, not everyone was fooled……

The Conversation, 2 April 2019:

In aged care, the government will fund 10,000 home care packages, which have been previously announced, at a cost of $282 million over five years, and will allocate $84 million for carer respite. But long wait times for home care packages remain.

Tuesday, 12 February 2019

The lies Liberals tell on the subject of aged care

The Australian, 7 February 2019:

Aged Care Minister Ken Wyatt was handed a departmental briefing report showing the “winners and losers” from the Coalition’s $2 billion savings drive in the aged-care sector shortly after Scott Morrison announced a royal commission and denied funding cuts.

Documents obtained by The Australian under Freedom of Information laws show the proportion of “losers” almost tripled to 53 per cent following the budget savings revealed in late 2015.

In the three-year period to 2018, aged-care services that had been classified as “winners” almost halved to 47 per cent, according to the brief sent to Mr Wyatt.
A series of “hot issue briefs, question time briefs and general briefs” sent to Mr Wyatt last year acknowledged the budget hit to the Aged Care Funding Instrument — which is the basic taxpayer care subsidy paid to all nursing homes — together with “increasing cost pressures will be putting pressure on the sector”.

Mr Wyatt was also made aware of reports of “cut backs to staffing”. At a press conference announcing the royal commission into aged care in September, the Prime Minister was questioned about two cuts to the ACFI in the 2015 mid-year economic update and the 2016 budget but denied any had been made.

“No, no, the Labor Party said that. I don’t accept that,” he said. Two days later, a question time brief prepared for Mr Wyatt offered advice on what to say if asked about funding cuts to ACFI.

The ministerial brief also contains a breakdown of funding changes by domain, revealing that average annual taxpayer subsidies per resident increased by just $400 between 2016-17 and 2017-18 despite the growing frailty and complexity of Australians as they enter residential aged care older than ever before.

For the first time, funding for the two areas that provide extra boosts for nursing home residents with significant behavioural problems and complex healthcare requirements went backwards by $300 a person.

The peak body for aged-care providers, ahead of the April 2 budget, has urged the Coalition to include an additional payment of almost $700 million each year.

“This estimate reflects a range of factors, including the value of foregone indexation (through ACFI),” Leading Age Services Australia (LASA) says in its pre-budget submission, seen by The Australian. “This is approximately a 5.2 per cent increase in residential care funding in 2019-20, noting that this is difficult to calculate as forward estimates for residential and home care are no longer separately reported.” LASA said it considered the money to be a “down payment” and a notably larger funding boost might be needed following the findings of the royal ­commission.” The commission, which is due to release its interim report in Oct­ober and the final version by the end of April 2020, has already highlighted the widespread industry practice of “doping” nursing home residents, which doctors, nurses and consumer groups attribute to overworked staff. [my yellow highlighting]

Friday, 1 February 2019

Scott Morrison and his cronies want to buy your vote ahead of the May 2019 Australian federal election

Despite there being a growing urgency to invest in the full range of climate change mitigation measures, in the face of evidence that it is going to take billions of dollars to step back from the developing environmental, social and economic disaster developing in the Murray-Darling Basin, regardless of constant cost cutting in the welfare sector leading to a fall in services for older Australians and those with disabilities, while all the while failing to confront a growing public debt which now stands at est. 679.5 billion, the Morrison Lib-Nats Coalition Government intends to try and buy votes ahead of the May 2019 federal election.

Brisbane Times, 28 January 2019:

The Morrison government is now more focused on protecting its electoral chances than the nation's finances with claims it is going on a pre-poll spending spree based on a short-term boost in tax collections.

Deloitte Access Economics said in a quarterly report out on Tuesday that Scott Morrison is looking to buy back disappointed voters, with the government sitting on $9.2 billion worth of tax cuts and handouts that were included in the December mid-year budget update but not announced.

Deloitte Access partner Chris Richardson said the government had promised $16 billion in extra spending and tax cuts in the past six months, the biggest short-term spend by a government since Kevin Rudd in 2009 in the depths of the global financial crisis.

He said with the budget in a reasonable condition on the back of strong global growth and a surge in company tax profits, the Morrison government had made a decision to woo back voters with taxpayers' cash.

"Of late, the government has been busily taking decisions that add to spending and cut taxes, thereby worsening the bottom line rather than repairing it," he said.
"After all, they've got the dollars to do it, they're behind in the polls and the election is just around the corner.

"That powerful combination of motive and opportunity means that the government's focus has shifted to shoring up its electoral standing rather than shoring up the nation's finances.", 24 January 2019;

Pensioners and some families could receive one-off cash payments from the Morrison government in a pre-election sweetener.

Senior advisers are looking at two one-off payments that could be included in the April 2 budget, the Australian Financial Review reported on Thursday.

If the government decides to go ahead with the plan, the payments could be distributed before the federal election, which is due by mid-May.

The first option is a one off handout to age pensioners and the second is a cash injection for families.

It’s believed the single payments would be aimed at luring those who won’t directly benefit from the Coalition’s $144 billion personal income tax cuts being phased in over the next six years.

Monday, 21 January 2019

Australian Royal Commission into Aged Care Quality and Safety now underway

Commencing in 2016-17 when Australian Prime Minister and Liberal MP for Cook Scott Morrison was then just the Federal Treasurer he cut $472.4 million from Aged Care funding over four years, then followed that up with a $1.2 billion cut over the same time span.

When deteriorating conditions in nursing homes around the country began to be reported in the media and the Oakden scandal came to light in 2017, concerned citizens began to call for a royal commission.

The Liberal Minister for Aged Care and Liberal MP for Hasluck Ken Wyatt was of the opinion that such an inquiry would be “a waste of time and money”.

Once Scott Morrison realised that ABC Four Corners was about to air an exposé on aged care provision he quickly changed his mind and announced the Royal Commission into Aged Care Quality and Safety on 16 September 2018.

The Royal Commission into Aged Care Quality and Safety was established on 8 October 2018 by the Governor-General of the Commonwealth of Australia, His Excellency General the Honourable Sir Peter Cosgrove AK MC (Retd).

The Honourable Richard Tracey AM RFD QC and Ms Lynelle Briggs AO have been appointed as Royal Commissioners…

The Commissioners are required to provide an interim report by 31 October 2019, and a final report by 30 April 2020…
The Commissioners were appointed to be a Commission of inquiry, and required and authorised to inquire into the following matters:
a.    the quality of aged care services provided to Australians, the extent to which those services meet the needs of the people accessing them, the extent of substandard care being provided, including mistreatment and all forms of abuse, the causes of any systemic failures, and any actions that should be taken in response;
b.    how best to deliver aged care services to:
                i.        people with disabilities residing in aged care facilities, including younger people; and
               ii.        the increasing number of Australians living with dementia, having regard to the importance of dementia care for the future of aged care services;
c.    the future challenges and opportunities for delivering accessible, affordable and high quality aged care services in Australia, including:
                i.        in the context of changing demographics and preferences, in particular people's desire to remain living at home as they age; and
               ii.        in remote, rural and regional Australia;
d.    what the Australian Government, aged care industry, Australian families and the wider community can do to strengthen the system of aged care services to ensure that the services provided are of high quality and safe;
e.    how to ensure that aged care services are person‑centred, including through allowing people to exercise greater choice, control and independence in relation to their care, and improving engagement with families and carers on care‑related matters;
f.     how best to deliver aged care services in a sustainable way, including through innovative models of care, increased use of technology, and investment in the aged care workforce and capital infrastructure;
g.    any matter reasonably incidental to a matter referred to in paragraphs (a) to (f) or that [the Commissioners] believe is reasonably relevant to the inquiry.

A preliminary hearing was held in Adelaide on 18 January 2019.

At this hearing the Commissioner Tracy stated in part:

The terms direct our attention to the interface between health, aged care and disability services in urban, regional and rural areas. These issues necessarily arise because of Australia’s changing demography. We are also required to look at young people with disabilities residing in aged care facilities and do our best to deliver aged care services to the increasing number of Australians living with dementia. Part of our task is to examine substandard care and the causes of any systemic failures that have, in the past, affected the quality or safety of aged care services. We will consider any actions which should be taken in response to such shortcomings in order to avoid any repetition. This will necessarily involve us in looking at past 25 events. There have been a number of inquiries which have considered matters that, in certain respects, fall within our terms of reference. We are not required by the Letters Patent to inquire into matters which we are satisfied that have been, is being or will be 30 sufficiently and appropriately dealt with by another inquiry or investigation or a criminal or civil proceeding. As a general rule, we do not intend to re-examine matters which have been specifically examined in previous inquiries. We do, however, expect to examine the changes and developments which have followed previous inquiries, as well as the extent to which there has been implementation of recommendations from those inquiries. Where we have different views, they will be made known.

According to ABC News on 18 January 2018: Out of almost 2,000 Australian aged care providers invited to shed light on the sector ahead of the royal commission, only 83 have been forthcoming with information, the Adelaide inquiry was told.

The Guardian on 18 January reported: Counsel assisting Peter Gray said the commission had received more than 300 public submissions since Christmas Eve and 81% concerned provision of care in residential facilities, with staff ratios and substandard care the most common themes. The federal health department has also passed on 5,000 submissions it received before the commission’s terms of reference were set.

Interested members of the public can still make submissions as the Royal 
Commission will continue to accept submissions until at least the end of June 2019.

Details on how to make a submission can be found here.