Doorstop interview in Melbourne on 29 July 2020
Read the transcript of a doorstop interview in Melbourne with Minister Hunt, Chief Nursing and Midwifery Officer Alison McMillan and Joe Buffone about coronavirus (COVID-19), the aged care response in Victoria and the Aged Care Royal Commission.
The Hon Greg Hunt MP
Minister for Health and Aged Care
And I am joined today here at the site of the Victorian Aged Care Response Centre, a joint partnership with Victoria, by Joe Buffone, who is the Emergency Management Australia Response head and also the head of the Response Centre in partnership with Victoria, and I'm also joined by Professor Alison McMillan, the Chief Nursing and Midwifery Officer of the Commonwealth of Australia.
Today has had more difficult news and there will be more difficult news to come over the days and weeks ahead. This is the sad but inevitable part of a major outbreak, as we’ve seen all around the world.
However, importantly, there has been real progress, real progress in cooperation and protection for and in relation to our beautiful older Australians. And Victoria has reported progress in the numbers today with regards to the number of new infections, but there is a long way to go.
These numbers are still very significant, and therefore they mean that there will be significant consequences 1 or 2 weeks from now. And so I think it is important that we are realistic and honest about those consequences, but we recognise that progress.
I want to give a brief update, and Joe in particular to focus on the work of the Response Centre, and Alison in relation to the nursing response.
The pandemic continues around the world, and therefore we are part of that great challenge and risk and response; 16.6 million cases, very sadly, 658,000 lives lost. In Australia, we are now at 176 lives lost and 15,582 cases on the advice provided to me by the National Incident Centre.
New South Wales remains stable, but with case numbers that are being tracked and traced every day.
Victoria, 295 cases, and very, very sadly, 9 lives lost. Lives lost from infections which have occurred over recent weeks as the numbers have grown. And around the country, 4.1 million tests have now been completed. And that testing is an immensely important part of the Australian response.
With regards to the actions, again, I can update that the ADF has approximately 1,470 members in Victoria engaged across a range of activities. Isolation, checking in terms of different pass points on the road, assisting the police.
I’ve seen them out and about on the streets, assisting in particular, as the Premier set out today, with tracing and tracking, following up contact tracing, doorknocking, assisting the Victorian health authorities and the Victorian Police in that program.
That is improving and strengthening the outcomes as we’ve had to, as a nation and a state, scale up that response to unprecedented levels given the case numbers. And then in particular, what we’re seeing now is that they have also stepped in, in relation to the support for the tracing headquarters, and we’re seeing stronger and better results continuously as a result.
And I also want to praise and thank the Victorian public health unit for their work. It’s been 6 long and diligent months, and there are many more months to go, but they are helping to save lives and protect lives.
The ADF has also stepped in to assist with the aged care centres, in particular, they are currently and they have been supporting work at Epping Gardens. We’ve had a team of nurses there and ADF medical personnel through the evenings. But they are available and are being tasked to assist with other support as may be required over the coming weeks.
That brings me more generally to aged care, and I know the Prime Minister and the Premier have both spoken today, supported by senior medical leadership. With regards to aged care, as of 9:30am this morning, there are 440 aged care residents who have been diagnosed positive. That is about 5% of the cases in Victoria since April and about 7% of the cases in July.
In particular, what we’ve seen is that there are 27 facilities who have positive residents. Those are our facilities where of course we have the highest concern, and this is the work of Joe and Alison and the teams that they are helping to lead.
The Premier mentioned today, transfers of 80 residents to hospital from St Basil's, and 34 from Epping Gardens and 30 from Kirkbrae Presbyterian, for example.
The other actions going forward, which I briefly want to set out, the Response Centre, and Joe will take you through the details of that, but in particular, the identification of risk and transfer, prevention and making sure there are very strong transition plans.
Secondly, the role of the ADF as we’ve seen. Thirdly, AUSMAT, the first arrivals are expected tomorrow and they will come in over the coming week.
And then fourthly, the role of state health and the decision, the difficult decision which was made in March and repeated again this week with regards to hospital placements has meant that there are more places in hospital, but also more nursing staff and medical staff available to attend aged care and other relevant facilities.
And lastly, the PPE and the infection control. Those elements are all in place, and what we’ve seen over the last 48 hours is significant progress.
This is a difficult day. There are more difficult days to come and we need to be honest about that. But we are seeing some early promising signs, too early to conclude that the curve is flattening yet, but early promising signs and we will continue to do everything we can.
I want to finish by thanking our extraordinary nurses, aged care workers, our doctors, our pathologists, and the general population for their commitment to taking difficult actions that will save lives and protect lives. Joe?
Thank you, Minister, and good afternoon. Firstly, just reinforcing that we are dealing with an
unprecedented and extremely complex and difficult situation.
The other thing is I would like to empathise with the families that have residents in aged care facilities, and I want to reinforce and give them confidence that our priority is the care and safety of the residents and safety of the workers in those facilities.
What are we focused on here in the centre? First of all, it’s about joint approach to identification and prioritisation of outbreaks.
So we have now brought together and made sure that those first decisions around disease control are directly linked to operational decisions to maintain the functionality of that facility, but still with the focus on the care and safety of those residents becomes the priority.
That’s a significant thing. The integration of everything, end to end, to make sure that everybody is across the decisions.
The second point I want to make is about rapid response. And that’s about rapidly getting to the worst case situations and supporting those facilities. The key point here is that the operator and owner of that facility has the responsibility to look after the care and safety of those residents, and we are responding and supporting those operators to maintain that facility.
What we’re doing in this multifaceted approach brings together Commonwealth agencies and governments, Victorian agencies and governments, the private sector, the hospital sector, everybody is focused on making a difference in this complex environment.
So what are we doing to bolster this up? The first thing is: we have agreement that the hospital system will outreach into these facilities, into the higher-risk facilities where there are cases, but they are still being managed.
The Minister spoke about AUSMAT, but how are we going to actually use them? They are to bolster our rapid intervention so that when we have these complex outbreaks that escalate quickly, we have the leadership team, the multidisciplinary team to help stabilise the situation, support the owner and operator of the facility, to make sure that our residents, the residents there are looked after.
The other key thing there is that where medical requirements are needed to be provided or where the care cannot be provided for the residents, they will be moved to hospitals, and you’ve seen that happen. So they will be moved to hospitals.
But that needs to be done through a considered approach and making sure that we maintain and understand the risk of taking those actions. Our success will be the unity of effort, and that’s what I am focused on now. I’m focused on unifying all of these aspects of this system to make a difference.
The other key thing is about prevention. We have 776 facilities and they are not all– they all do not have COVID infection, and therefore, we are increasing and enhancing the training and the advice around PPE, around infection control, and making sure that we don't get further outbreaks. That’s the focus.
And we are now looking at training options, advice options and also the outreach model that will actually go in at early stages to provide advice so that situations do not get any worse or, more importantly, that we do not get any more cases.
The workforce. The workforce is our biggest challenge at the moment because as you’re aware, when there are infections and contacts, then our workforce is diminished significantly.
I want to reassure all of the workers out there that we are doing everything to make sure that their safety is looked after, and that is in line with PPE distribution and we’ve made sure that there are no distribution issues and we keep monitoring that.
We will make sure that we will get PPE out to the facilities where they are needed. The other thing is the point that was made around elective surgery.
That will actually assist with the workforce, but we are also reaching out across the state and across the country and looking at options that we might normally not lean on and how we can repurpose some of our medical capability across the country to support this very, very complex and challenging response today.
You’ve heard we have 4 facilities that are in the high-risk category and there have been some challenges with that. There is absolutely no doubt about that.
But we have put response teams in, and this is a joint response between Victorian Government, hospitals, facilities and other providers into those facilities to make sure that we can stabilise, control and, where necessary, decant patients to hospitals, and residents to hospitals.
Those 4– and I’ll let Alison speak about the detail of that, but everybody, I can reassure you, everybody is doing everything possible to try to identify quickly, rapidly respond, control and then a focus on prevention.
This is something that everybody plays a part in. No single person, no single organisation, no single government can deal with this issue. This is an absolute joint response.
And I just want to reiterate: our focus is caring for residents for their safety and the primacy of life, and just remembering that where residents need hospital care, they are provided with that hospital care.
Thank you. Alison, I’ll hand over to you.
Thank you, Joe and Minister. Again, thank you to everyone for being here today. My first message today is to all of those workers in our aged care sector of whom there are many.
This is a very challenging time for all of us, and particularly for you as the focus of your work comes under scrutiny.
We do rely on you to care for those most vulnerable in our community and to support them through this difficult time. So, you do need to look after your own health and well-being too.
And I remind everyone in the sector, direct care workers, nurses, doctors, cleaners, cooks, support workers, ambulance officers and ambulance paramedics that there are support services out there for you during this time and it’s important to look after yourself. So, I encourage you to do that because there is a focus on your work.
I’m very grateful to the amazing work that we have seen particularly in recent days out of the Victorian public and private hospital system who have reached out to these aged care facilities, literally almost wrapped themselves around – in the socially distancing way we can – to support these services, maintain the care of those most vulnerable, the residents in the facilities, and assisting with any transfers to acute hospitals that may be needed during this difficult time.
They have been absolutely fantastic. Stepping out of their normal workplace and going into unusual places and really taking a strong leadership in managing that situation.
And as I speak, colleagues from across the country, nurses are coming to help us with this response, and we look forward to seeing more, but I’m aware, as we have heard, my colleagues with AUSMAT training, nurses from South Australia are on the way to help us manage these outbreaks and to keep our residents safe.
So again, I thank everyone who works in the aged care sector and those that are out there right now supporting them.
If you know someone who works in this sector, who works in the health care system, now is the time to give them a shout out or drop them a text and just remind them of the important work they do and how much we appreciate what they do.
Thank you. Happy to take questions. I think Elias, you’re in the room. So, you get first go.
Why wasn’t aged care prepared for this?
So, I think aged care around the country has been immensely prepared.
We have had, prior to the Victorian outbreak, a less than half a per cent of facilities affected, and what we saw here in Victoria was an outbreak which affects workplaces, which affects– whether it’s offices, meat works, whether it’s school environments, hospitals, I think I’m informed that there are 502 health workers outside of the aged care sector.
So, right across the community where there is a major outbreak, then as we’ve warned one from the outset, any sector can be vulnerable. And this was why we took the actions as early as the first of February of closing the borders with China because we recognise the degree and gravity of a major outbreak.
And so, 150,000 aged care staff have had infection control, we have had PPE available. What we see, though, is of course community transmission leads to the transmission into workplaces or so many other places.
(Inaudible) So can you really say it was well prepared for this?
Well, what we’ve seen is, again, I’ll return to the figures. My advice is that since the 1st of April as a percentage of Victorian cases, aged care representatives represent approximately 5%; since the first of July, aged care represent– residents represent approximately 7%.
But they’re the most vulnerable, which is why we, from the outset, put all our resources there and then facing in 1 state with no criticism, no reflection, but a reality that we set out very early on that it could be anyone at any time, any state at any time.
That’s why we’ve added these additional resources to deal with the fact that so many members of the health and medical workforce have had to either leave, because they have been diagnosed positive or for each one of those you have a ripple effect of multiples of others that have had to be diagnosed and have had to isolate as well.
There’s been a Royal Commission that’s highlighted some of the issues in aged care and then we’ve had Newmarch obviously.
So, couldn’t the Government have – with that precedent – could the Government have done something to prevent these outbreaks and these deaths?
I think what we’ve done is exactly that. There are numerous facilities that without early intervention, could and may well have had cases.
But one of the very important points is that no matter where you are in the world, faced with this pandemic, if there are massive numbers of community cases then it will reach into every area of that community.
And I think that’s a very important point, the best defence for any community is to not have or to stop that community outbreak.
I’ll go over the phone to Dana.
No, with respect, approximately very similar proportions of public and also private and not-for-profit aged cares have had infections in the area.
My advice is that– and I’ll go to the evidence I have, my advice is that it is about 1% less of aged care state homes as a proportion of them that have been infected and so that’s similar. But they are largely in regional areas and not in the hotspot areas.
That’s a historic trend in Victoria to concentrate state homes, largely in regional areas and not in the hotspot areas. More generally the Royal Commission is going on, so I won’t pre-empt that but we’re the ones that called it. We’re the ones that called it.
But it is very important I think to put in place the hospitals agreement with the states, the hospitals agreement with the private sector was precisely because as we said from the outset, that if there is widespread community transmission, that posed an enormous risk to our elderly.
I think this is a very important part of the last 6 months to emphasise and to recall. We warned right from the outset, that a major community transmission outbreak would have the greatest risks to our elderly.
It’s been one of our extraordinary achievements, that outside of Victoria, we have been able to protect and prevent against this. But where there is major infection then that reaches into all different elements and parts of a community.
Thanks Minister, I’ve just got 2 questions that I’m asking on behalf of someone else if that’s okay.
Brendan Murphy today (inaudible) Victoria counterparts a fortnight ago, and then eventually put in a formal request to have it stopped on Sunday.
Was there any frustration on your behalf that this wasn’t suspended sooner, given that we really needed to free up hospital capacity for our aged care residents?
Look, I understand this is a massive decision and we are working in partnership, as Joe has said, with the Victorian Government. This decision was taken in March in order to make that capacity available and it has been taken again.
It’s a decision that follows from the level of community transmission. We’ve provided our request and advice to the Victorian Government and they have responded. I just want to thank them for that.
A difficult decision but already we can see the impact of that. Austin Health is taking the lead as clinical lead in assisting with the support at Epping Gardens for example.
They are able to do that because they have that capacity and that is an example of why this decision was taken. Tamsin, on behalf of someone else?
Thank you. Professor Murphy also said today that some of the lessons learnt at Newmarch House have been applied in-between situations.
He specifically mentioned communications as being one of the biggest issues there but we’ve seen over the past week, that communications has been one of the biggest issues at St Basil’s and to (inaudible) Family members said they didn’t know where their family members were.
There’s been widespread transmission there. Even if that had seemed to be fixed, doesn’t that say that we haven’t necessarily implemented all of those (inaudible)?
I think the challenge with St Basil's of course was there had to be the complete replacement of the workforce and that is an enormous task.
It is hard for the outgoing workers, hard for the incoming nursing and personal care staff and indeed, the entire staff of the entire facility and that was a public health decision, understandable but difficult, transition is a very important part, which is something that Joe and his team are focusing on.
As so, as part of that, we were able to over the weekend to arrange a meeting with all of the families, it was offered to them and a very, very significant number participated. I understand there is another virtual town hall meeting with those families up this evening being co-chaired by Richard Colbeck as Minister.
So moving early to that but there is no doubt that the difficult decision which was taken to replace all staff meant that there were very difficult early days and I recognise that and I do think that is something that we all know for the families has been immensely hard.
Thank you Minister. Should (inaudible)?
Well, we have, firstly there is a general agreement about the readiness and the ability of nursing and other health staff to be able to move. I raised this on Friday of last week with– Thursday of last week with colleagues.
And I think that was an important thing to do. I believe I mentioned it in the press conference of that day. What we have seen is that they are actually moving very quickly. AUSMAT, we have called them in.
Once there were facilities which had significant issues. I think is important to understand that what we saw was a rapid outbreak in 4 key facilities and a response, within an immediate timeframe.
What Allison and her team have been able to do and I have been in contact with the Health Minister and Premier of South Australia, for example, the Prime Minister has been in contact with the Premier, is to arrange for those additional resources to come and we work around the country to mobilise and move people it is a big thing.
We have ADF, nursing staff and we have AUSMAT that are moving.
Sorry, I might just have to turn that up. Hold on once sec, Carrie. Thank you go ahead.
Can you hear me?
Hi there Minister, (inaudible) staff at aged care facilities and I was just wondering some of the providers called for the aged care workforce retention payment that (inaudible) to be extended and I’m just wondering if that’s up for discussion or is that something that he might consider.
And a second point to that question is: is that something that should be offered again to everybody working in aged care facility not just as a direct contact with a resident?
So that was something we initiated and it was a very important part of the protections put in place to ensure support for the aged care workforce. It still has some months to run.
So, if further review is needed, then that will occur. And so it is there with some months to run and as with all of these different elements of government support, as you approach the time, we will view the circumstances against the supports that are necessary to deal with it.
What I am hoping is that we will be in a very strong situation by then that Victoria will have well and truly passed its fundamental need.
And then, Jonathan.
Minister, thanks very much for your time. I just wanted to ask you in relation to– coronavirus has changed (inaudible) go to the GP. What is the (inaudible) of the government to change the rules around electronic prescriptions?
And can you talk to us about the security aspect of the cloud, with information stored there. How can you guarantee the (inaudible)?
Well, we have in fact already brought in place an electronic prescribing system. This is a massive breakthrough.
It is linking with the fact that people are able to have home deliveries will stop as if all of these elements there is a very significant security protocol that has gone over overseen by the digital transformation agencies, also we have national security which looks at all of these things.
And so we have a strong system as we have seen. And the Digital Health Agency plays an important role, as well as the digital transformation agency.
Just on (inaudible) pandemic relief for aged care workers. Is there Government plans to extend that to other areas of the health care sector?
So this was a decision of the Fair Work Commission and the Attorney General will respond to that.
Just finally on aged care. Do you think loved ones should have confidence that their family members will be safe in these facilities (inaudible)?
Sorry just on the phone to a colleague. The nurses that have been recruited to manage Victoria's shortages. Do you know much about that?
I will ask Alison to provide the detail here.
So your question is about the nurses coming from?
Yes, so just how many there will be, where they will come from et cetera?
So initially there are 5 nurse leaders who are coming with the AUSMAT, the Australian Medical Assistance Team.
What we know is really important in the early parts of an outbreak is the nurse leadership about ensuring that all of these measures are put in place, and they are done quickly and effectively. Nurses lead best of all. AUSMAT are on their way.
We know that there are nurses this afternoon flying from South Australia to join us and I am very grateful to the Royal Adelaide Hospital and the other hospitals in South Australia who have provided those.
I am working with my colleagues across the country, the chief nurses and midwifery officers across the country to identify additional workforce. But remember, we are also using that workforce that exists within our public and private hospital systems.
Right now, they are people out there supporting and working with these facilities to make sure that they are putting all of the measures in place. And at times, having to supplement the workforce if for instance the facility manager or the leader of that facility has had to be required to be isolated.
Someone has to move in and I am extremely grateful to a number of colleagues who have taken on those roles for us so we can maintain that the leadership that we know so critically important, and certainly something that we learn from Newmarch is that nursing leadership does bring order to this situation and it is a critical part of our success.
Thank you very much.