NEIL MITCHELL:
On the line is Australia's Chief Nursing and Midwifery Officer for the Federal Government, until recently Clinical Lead for the fairly new Victorian Aged Care Response Centre which had the job of taking out COVID outbreaks in aged care, Professor Allison McMillan, good morning.
ALISON MCMILLAN:
Good morning, Neil.
NEIL MITCHELL:
Those figures - 372 new cases, 14 deaths - do we still have reason for cautious optimism?
ALISON MCMILLAN:
Yes, Neil, I think that we do. We know that these numbers do bump around a little, up and down, but the trend is still down. But that doesn't mean that anyone can be complacent about all of the things that we need to do to keep this number on the downward trend.
NEIL MITCHELL:
You spend a lot of time within the nursing home, in the aged care facilities which has just been so tragic what has happened there. What went wrong?
ALISON MCMILLAN:
I think, Neil, is that what we saw is that what we've seen across the world is once you get significant community transmission in any population it's very difficult to avoid getting that into an aged care facility such as these, and sadly that's what we've seen. We saw that in other countries, and now where we saw some in Victoria, particularly in Melbourne, now outbreaks in a number of aged care facilities across Victoria.
NEIL MITCHELL:
I think the St Basil's 184 cases which reported it took the regulator four days to tell the Federal Government about St Basil's. I had the first case July 10, the Government wasn't told of July 14. How could that happen?
ALISON MCMILLAN:
Well, I think that's now - from my understanding is Professor Murphy has asked that the outbreak at that facility be investigated and the investigation's- be underway. So, I think that those dates and that information will come to light through that investigation. That's my understanding, is that there was some delay in notification.
NEIL MITCHELL:
When did you go into St Basil's yourself?
ALISON MCMILLAN:
I first went in, Minister Colbeck, asked me to go the morning- I can't remember the exact date to be honest, Neil - but the day when it was apparent that the entire workforce needed to be isolated because there either were positive or close contacts. A lot of work had been done that evening and overnight to secure additional staff. I went along with a senior colleague from the Department of Health and Human Services to see whether or not those staff actually turned up that morning, and pleasingly, they did. And staff, when we got there, were being organised into groups and teams and all of them were having their PPE checks as they went in.
NEIL MITCHELL:
What did you find in there when you went in? I mean, as a highly qualified medical professional, as a person, what was it like?
ALISON MCMILLAN:
What I found was that the team that were handing over were the regular staff who were all close contacts, and they had been there much of the night and that morning trying to organise as much as they could. They were incredibly dedicated people who had invested a lot of their time and work life in that facility, and were finding it extremely difficult to have to leave those that they cared for behind.
Today- I've kept in contact with many of those afterwards, and also there were staff who had voluntarily come from other local residential facilities to help organise the staffing and the patients. So, what I saw was lots of people committed to coming to help that facility do the very best they could in what was an extraordinary difficult situation.
NEIL MITCHELL:
So, the residents weren't left alone? I mean, we've read stories of residents being left alone in their own waste, not fed, that sort of thing.
ALISON MCMILLAN:
I have heard concerning allegations of some neglect, Neil, and any neglect is very disappointing-
NEIL MITCHELL:
[Interrupts] But, did you see any yourself?
ALISON MCMILLAN:
I didn't. No, I didn't, Neil, but obviously, that is an enormous facility - it's over- a very large footprint and were, at that time, more than 120 residents. So, I didn't see every resident-
NEIL MITCHELL:
[Interrupts] Were you given reports of that?
ALISON MCMILLAN:
No, I wasn't. I've heard it subsequently through different reports.
NEIL MITCHELL:
But, do you believe it to be true?
ALISON MCMILLAN:
Well I think the investigation will find that information out. We certainly saw and brought in significant additional registered nurses into that facility to help work, to supervise the care of those individuals. And there was a geriatric in reach team coming every day from Northern Health which was also providing medical advice to that facility. So, there was an enormous amount of investment and services wrapped into that facility to try and manage the situation.
NEIL MITCHELL:
The State Government points out that there are a comparatively small number of cases in state run facilities where they've got responsibility. Why is the federal so much worse?
ALISON MCMILLAN:
I can't answer that readily, Neil. I think that's something that will come out as we see the difference. Certainly, that's what I understand has been reported. There are other low numbers of Victorian Government facilities as opposed to private facilities. Many of these facilities are privately owned and operated, and quite small.
NEIL MITCHELL:
Have you- I see. Is there adequate cooperation between state and federal demand? Because there's some tension at a political level obviously.
ALISON MCMILLAN:
I can't tell you how privileged I was, Neil, to work with such an enormous group of dedicated people in that Response Centre. Some of them, obviously, I had worked for both before when I worked at DHHS. But, you know, if you think that there was the DHHS, Commonwealth, Emergency Management Victoria, Emergency Management Australia, Defence Force health service staff, clinicians, a huge number of people who were working with one goal in mind and that was to care for the health and welfare of those most vulnerable and it was a privilege to work with those people.
NEIL MITCHELL:
Are you aware of cases of COVID positive patients, perhaps with dementia or some other issues being refused beds in the hospitals?
ALISON MCMILLAN:
I haven't heard refused beds. I know- and there's no stepping away from the issue that a wandering demented patient, resident in an aged care facility is incredibly difficult to manage and that the DHHS did set up additional facilities to specially train staff in a particularly designed facility to manage a wandering demented resident. But there are a significant number at the moment and I know that they are working hard to move those residents into some where they are safe and they will allow to keep others safe as well. [Indistinct]…
NEIL MITCHELL:
Will that be an acute hospital or not?
ALISON MCMILLAN:
I think it was a part of an acute hospital system but not an acute hospital bed in the way you would think of it. It's a designed facility where groups of patients can be kept, secured for their own well-being.
NEIL MITCHELL:
So I've had a couple of, or several doctors - three now say to me that they were trying to have the homes were trying to have patients submitted and two specifically to the Royal Melbourne. Beds were available, they were told they were okay to go in and then changed their mind. Said no, no, take them back to your place and sedate them and provide palliative care. In other words, bomb them out of their mind and leave them there to die. And one of the doctors said to me look, they've got a much better chance of survival in the hospital than the nursing home. Are you aware of that happening?
ALISON MCMILLAN:
Not to that level of case. There have been some, obviously some discussions between hospitals and the facilities about the appropriate transfer. Where there's a clinical- appropriate clinical need, [indistinct] an individual, the resident should be transferred to an acute facility. That is the Commonwealth position and has always been that where it's deemed clinically appropriate, they should be moved.
NEIL MITCHELL:
Well it's claimed that was overruled by DHHS, but you aren't aware of that?
ALISON MCMILLAN:
No.
NEIL MITCHELL:
Are you were aware of the problem at the Royal Melbourne? They've had to close, well effectively close almost part of the campus because of an outbreak.
ALISON MCMILLAN:
No, I'm not, Neil. That's more of a, obviously a local state based thing. I'm sure that Royal Melbourne will be able to give you that answer.
NEIL MITCHELL:
We're trying. Clinic- any problems with clinical waste disposal I've been sent photographs of piles of hazardous stuff in net bags marked hazardous, spilling out of bins and lying around at aged care centres. Are you aware of that?
ALISON MCMILLAN:
There were- yes, and there continues to be a lot of work done in managing waste, Neil. When you start using high volumes of personal protective equipment as is required in an outbreak, it does generate an enormous amount of waste and that means that some waste needs to be removed more frequently in order so it doesn't collect. And I know my colleagues in the response centre are working with a range of companies to ensure that waste is collected on a regular basis so it doesn't accumulate.
NEIL MITCHELL:
The figures we've done and we've done the maths ourselves - [indistinct] it's reliable - 57 per cent of the deaths of the deaths of people in aged care facilities. Is that within the figures that we see internationally or is this a particularly bad result?
ALISON MCMILLAN:
The figures I have at the moment, Neil, are that let's first look at Australia wide. So our figures in relation to the entire population, we have a mortality rate of about 1.5 per cent. We saw 5 per cent in the US and 15 per cent in the UK, so we are seeing very pleasingly a low mortality rate in Australia. Our aged care deaths, what the figures are, how there's a 0.1 per cent mortality or simply one in thousand people in an aged care facility who have passed away as a result of COVID. So it's a very low percentage in comparison to the United Kingdom which was with 5 per cent. So they're demonstrating to you while every day is very sad, and I don't forget that, our figures are well below that of- in international comparison.
NEIL MITCHELL:
Well yeah, but the national figures aren't a fair comparison, because they've been comparatively- apart from New South Wales, comparatively few deaths in aged care around the rest of the country. You don't have the Vic- well 57 per cent of our cases in Victoria- well 57 per cent of our deaths, rather, are aged care.
ALISON MCMILLAN:
And that's because our aged care facilities do house and accommodate the most vulnerable. And from the very beginning, Neil, you will remember that it was our arguments about why all of the things we were asking to do and all of the restrictions were to protect those most vulnerable, because we knew they were the people who are likely to succumb to this based on previous experience.
NEIL MITCHELL:
And it hasn't happened in other states, why? Because they haven't had an outbreak like this.
ALISON MCMILLAN:
They haven't had the community transmission, Neil. So it is that community- sadly, the community transmission, once it reaches a certain point, it's very difficult to prevent it from getting in.
NEIL MITCHELL:
Did Victoria learn anything, or the Federal Government learn anything from what happened in Sydney?
ALISON MCMILLAN:
Oh very much so ...
NEIL MITCHELL:
And was that applied in Victoria?
ALISON MCMILLAN:
I think it was applied across the country. We've done enormous amounts of work to learn from what we've seen in Sydney, to increase and reinforce the messaging with the providers about what they need to do about their plans, the PPE, further investment in workforce. We certainly are have engaged very early on in the time additional companies to help us with first response and workforce, so that whenever there's an outbreak, there's an immediate response by us to support those facilities, to make sure that they have got the systems in place to cohorts, which is the most important thing.
NEIL MITCHELL:
I've seen the approach from Qantas to staff who have been stood down, suggesting work- and in fact looking for people to work in residential aged care as assistance. Is there a shortage of staff?
ALISON MCMILLAN:
There's certainly a need for more staff. Obviously, a large number of the positives and cases and the close contacts are staff of residential aged care, so there's a need to supplement those staff. But certainly that was one of the ideas we had in the response centre. We know that airline staff - Qantas - for which we're very familiar are used to working with people. There are significant numbers not currently working, so there's a program up and running, a pilot program to train them to do some assistant work in aged care so that you can supplement the staff.
NEIL MITCHELL:
How many more ...
ALISON MCMILLAN:
We also need more staff, Neil, also because just putting on and removing the PPE delays- creates a great deal more workload, and that's something we learnt from Newmarch. And so you need more staff generally than you would on a normal basis.
NEIL MITCHELL:
So how many more staff are you looking for?
ALISON MCMILLAN:
As many as we can find.
NEIL MITCHELL:
Really?
ALISON MCMILLAN:
So this pilot program is up and running I think in the next few days. But anyone who has particularly an interest in working in aged care, we encourage you, or experience in working in aged care, we encourage you to go to the DHHS portal where they are looking to recruit people to work in hospitals and in aged care.
NEIL MITCHELL:
So what's the pilot program you're referring to?
ALISON MCMILLAN:
It's a program where you take- obviously you first need to check the staff who have been nominated and have volunteered through Qantas. They will go through a training program and then they will go and work as support staff in residential aged care. That will be evaluated to see how effective the training was. Tweak it obviously, [indistinct] this is the first time this has ever been done and you want to make sure that both the individuals who do the training feel safe and confident. If it's successful, then it will be expanded to more staff.
NEIL MITCHELL:
So previously, what was a residential aged care assistant? Were they more fully trained than this?
ALISON MCMILLAN:
There's a range of training. It is generally a- a Certificate 3 training, Neil. But always remember that there is always a registered nurse to supervise care in aged care. But s residents- a patient care assistant, patient care attendant is generally trained to a Certificate 3 level in a TAFE.
NEIL MITCHELL:
Yeah but these people won't be, clearly.
ALISON MCMILLAN:
No, no.
NEIL MITCHELL:
How much training will they get?
ALISON MCMILLAN:
The details of training I'm not familiar with, Neil, but it has been designed by those who have experience in knowing the sort of skills you might need. They won't do personal care, as I understand it, but they can assist with feeding, moving, just general assistance in the facilities with residents.
NEIL MITCHELL:
I get regular contact from retired nursing- nurses wanting to help in contact tracing or in aged care facilities. What about that? What about looking- because these are extremely skilled people who might have perhaps been in the workforce for 5, 10 years. What about that?
ALISON MCMILLAN:
So again, Neil, DHHS does have a portal where people expressing an interest in working and returning to work in health or feel that they could contribute can register their interest. I'm sorry, I don't have the details at hand, but that does exist, looking for people who are looking to in what is a challenging but very rewarding environment.
NEIL MITCHELL:
Look, thank you so much for your time. I know you're busy. Final question, have you ever heard the term patient zero? I know they're referring to something out of hotel quarantine here as patient zero. Is this such a phrase used around the business?
ALISON MCMILLAN:
Index is perhaps the more common term, but it can be interpreted in a number of ways. It is often the primary identification of where an outbreak may occur. I think everyone needs to be very careful. This is not the time to be blaming any individual for anything. People are often inadvertently infected through that- not of their own volition. So I don't think we should be looking to hound down or identify any individual who may have been the index or the zero case, whatever that is. I think that's not- there's no benefit in that, Neil.
NEIL MITCHELL:
Thank you so much for your time. Take care.
ALISON MCMILLAN:
Thank you, Neil.
NEIL MITCHELL:
The Chief Nursing and Midwifery Officer for Australia, the Federal Government. She's sort of the equivalent of the Chief Health Officer in nursing and midwifery, Professor Alison McMillan.
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