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Fair Work Act 2009                                                    






s.158 - Application to vary or revoke a modern award


AM2020/99 – Aged Care Award 2010 – Application by Ellis & Castieau and Others


AM2021/63 – Nurses Award 2020 – Application by  Australian Nursing and Midwifery Federation-Victorian Branch


AM2021/65 – Social, Community, Home Care and Disability Services Industry Award 2010 – Application by Health Services Union




9.30 AM, TUESDAY, 3 MAY 2022


Continued from 02/05/2022



JUSTICE ROSS:  Good morning.  I think we've got Mr Eddington first, is that right, Mr Gibian?


MR GIBIAN:  Yes, your Honour, it is.


JUSTICE ROSS:  Just before we go to him, we've received an application for an order to appear directed at a Marie Phillips, I think.  What's that about?


MR GIBIAN:  It's just one of the witnesses on our side giving evidence in relation to home care.  She just - for personal reasons - required an order in order to be able to appear and attend.


JUSTICE ROSS:  All right, we'll send that through to Commissioner O'Neill and she'll deal with it.  It's one of the employee lay witnesses, I assume?


MR GIBIAN:  It is, Your Honour, yes.


JUSTICE ROSS:  All right, okay, thank you.  We'll call Mr Eddington.


THE ASSOCIATE:  Mr Eddington, can you see and hear me?




THE ASSOCIATE:  Can you please state your full name and work address?


JUSTICE ROSS:  Are you able to turn up your microphone, Mr Eddington?  We're having trouble hearing you.


MR EDDINGTON:  Is that any better?


JUSTICE ROSS:  Not much.  Look, in the HSU room, can you turn off your microphone?  While we're waiting for Mr Eddington, the parties will shortly receive an email from my chambers, just outlining a suggestion for discussion at the mention at 1 o'clock.  Of course it could be that I'm the only one having trouble hearing Mr Eddington.


MR GIBIAN:  No, I had the same problem, your Honour.




MR EDDINGTON:  Hello, I'm back.


JUSTICE ROSS:  Yes, that is better, thank you.


MR EDDINGTON:  Sorry about that.


JUSTICE ROSS:  No, not at all.


THE ASSOCIATE:  Mr Eddington, could you please restate your full name and work address?


MR EDDINGTON:  James Eddington, 11 Claire Street, Newtown, Tasmania.

<JAMES EDDINGTON, AFFIRMED                                                  [9.04 AM]

EXAMINATION-IN-CHIEF BY MR GIBIAN                                    [9.04 AM]


JUSTICE ROSS:  Thank you, Mr Eddington.  Mr Gibian.


MR GIBIAN:  Thank you, your Honour.  Mr Eddington, can you hear me?‑‑‑Yes.


Can you just repeat your full name for the record?‑‑‑James Eddington.


You're a legal and industrial officer for the Health and Community Services Union, Tasmanian branch?‑‑‑That's correct.


You've made a statement for the purposes of these proceedings in relation to home care work, which is dated 5 October 2021 and runs to some 70 paragraphs over 13 pages?‑‑‑That's correct.


You have a copy of that with you?‑‑‑Yes, I do.

***        JAMES EDDINGTON                                                                                                                      XN MR GIBIAN


Just for the benefit of the Bench, I understand a communication was sent yesterday evening in relation to - or yesterday - in relation to one of the annexures.  It's annexure JE4, which is referred to at paragraph 69 of the statement and in the court book is a document commencing at page 7747.  That document, I understand, is the wrong document and it should be the document that we sent through yesterday, which is a position description for a support worker A2 integrated - - -


JUSTICE ROSS:  All right, look, we'll take the same course that we'll take in respect of any of the amendments or corrections that have been made.  If you refile the relevant statement in full and incorporate all the changes, don't put them in tracked, just put them in clean and then we'll insert them in the court book.  If you can also provide them in PDF and Word, my associate is going to do an audit of which documents we currently have outstanding from each of you in word form and she'll send that to you tomorrow.  But if you could ask your instructors to attend to that just to make sure that all the documents that you've filed are in PDF and Word.  With that change, Mr Gibian - are there any other changes in the document?


MR GIBIAN:  I was just going to note that the other annexures to Mr Eddington's statement are correct but something between filing and then their insertion into the court book appears to have resulted in them being not correctly identified by way of the annexure number and that's a matter that we can deal with in the same way that your Honour the President has mentioned.  Mr Eddington, have you had an opportunity to review your statement?‑‑‑Yes, yes.


Is it true and correct to the best of your knowledge and recollection?‑‑‑Yes.


Then that is the witness statement of this witness upon which we seek to rely and have part of the evidence.  The statement itself is document 130 in the court book, commencing at page 7717 and we will undertake to replace - or replace the whole statement, which won't change, but the annexures correctly marked and with the correct documents.  Mr Eddington, Mr Ward, I think, will now ask you some questions, who hopefully you should be able to see on the screen.


JUSTICE ROSS:  All right.  Thank you, Mr Ward.

CROSS-EXAMINATION BY MR WARD                                           [9.08 AM]


MR WARD:  Mr Eddington, can you hear me?‑‑‑I can, yes.

***        JAMES EDDINGTON                                                                                                                    XXN MR WARD


Thank you.  Mr Eddington, my name is Nigel Ward.  I appear in these proceedings for the principal employer interests.  I'm just going to take you through a number of matters in your statement.  Can I just start with a general question:  I take it that you're primarily responsible - you all right?‑‑‑I'm trying to - my phone is quite precariously placed.


I was just more worried that you fell?‑‑‑No, unlike the clients that many of our home carers look after that's not the case.


Good comeback - in your role as legal industrial officer, are you the principal person involved in bargaining for the union in Tasmania?‑‑‑I wouldn't say the principal person.  We have, probably like a lot of unions, a system of lead organisers who will probably lead a lot of the bargains.  I'll be the person that looks at the enterprise agreements of those bargains being made, sees that the terms are going to be acceptable, sees that wording's going to be acceptable, looks after and oversees the whole process relating to approvals through the Fair Work Commission.  So, that's really my role.  I will - - -


You're the legal support rather than necessarily the person at the table?‑‑‑I will quite frequently be the person at the table but I'm not saying that on all occasions I am that person or that I am the principal person as you put it.


When I look at the statement, particularly paragraphs 13 and 21, am I right in saying that you have enterprise agreements with most of the operators in Tasmania?‑‑‑Yes, most of the larger ones we do have enterprise agreements with.  Some of those ones on that list that I've provided at paragraph 13 we don't.  Independent Health, for example,  certainly - based in the south here is one of the largest home care operators and we don't have an enterprise agreement with them.


I think your evidence is that most of your enterprise agreements have rates of pay close to the award.  Is that correct?‑‑‑Yes, that's right, or fractionally above.


I think in paragraph 31 you say that based on your analysis the average rate above the award is 2.9 per cent.  Is that correct?‑‑‑That's right, yes.

***        JAMES EDDINGTON                                                                                                                    XXN MR WARD


But you do say there's some outliers.  Can you tell us what the outliers are?‑‑‑Well, there are some outliers.  There's certain organisations that have got a percentage that is in excess of that.  Certainly they're organisations that we understand have got - and I'm not saying this is true for other employers but certainly they do have a great deal of concern about the wages that they're paying their staff.  They're usually locally based organisations in small communities, such I think in the list there I have May Shaw, for example, which is a major care operator in Swansea on the east coast of Tasmania.  So, they're not sort of owner/operated on the mainland, so they have a very strong connection with their local community.  In some of those cases I think the wages are higher than the award and probably higher than the two per cent example.


You don't know how much higher by?‑‑‑Well, I think in the table below that in some cases it can be quite significantly higher by up to, I think, about eight per cent higher.  But that's very, very rare.  But I have included that in the schedule to the - to the statement.


There's some evidence that's already been put on by the HSU that employers often say they'd like to give more money in bargaining but they can't afford to because of the funding.  Is that something you hear a lot in Tasmania?‑‑‑Yes, no doubt.  I mean that's something that is consistent.


Do you think that's a tactical ruse or do you believe them?‑‑‑Well, I think there's a probably a little bit of both but no, I think that there is issues with funding, but there is also, you know, there may be some capacity for some of these organisations to pay more than what they allege they can in bargaining.


Can I just take you to paragraph 36?‑‑‑Yes.


You talk in paragraph 36 about the SCHADS equal remuneration order.  Are you talking about it there because the Tasmanian union wants to get rates of pay to equal that order?‑‑‑Well, I'm raising that just simply, I think, because the equal remuneration order was granted in 2011 and it has seen, I guess, a lot of inequality in terms of the industry.  In that once that order was granted in relation to disability services, obviously there were increases within the vicinity of around 20 per cent made to disability support services.  So, from that time we had members and employees in an industry that were covered by the same award and one classification stream received through the equal remuneration order a significant increase in pay, albeit it was done on a transitional basis, and other workers in the same industry under a different classification stream were not included as part of that decision and therefore their wages remained quite depressed.


As the legal officer, you would appreciate that this isn't an equal remuneration case and that your union could have run one of those if it wanted to?‑‑‑No, I appreciate that.  I do understand that.  I understand that this is a work value case but the work value case I think has strong and overdue merit.


I wouldn't expect you to say anything else, sir.  Can I just take you to paragraph 51?‑‑‑Yes.

***        JAMES EDDINGTON                                                                                                                    XXN MR WARD


You talk in paragraph 51 about a member of yours travelling various different distances and that the members are not paid travel time and they're not paid a travel allowance.  I'll just deal with those matters in two parts.  I understand the award requires an 80 cents per kilometre payment to be paid when people use their cars.  Is that your understanding?‑‑‑Yes, that's right, but only - the condition, and this is the difficult condition is that it has to be in the course of their duties and quite frequently this is the problem.  That if there is a break between engagements of a significant period of time it's deemed that they're no longer travelling in the course of their duties between those engagements.


I'm not going to have an argument with you about how the award works.  Are you aware of the amendments to the award that come into operation on 1 July?‑‑‑Yes, yes.  I'm aware that the - - -


Am I right - am I right in saying that some consent agreement's been reached to vary the award in relation to minimum engagements in lieu of actually paying people for travel time?  Is that your understanding?‑‑‑I don't know if it's specifically in lieu of travel time but I understand that there has been some consent agreement reached to increase minimum engagement.


But you've not personally been involved in that consent arrangement?‑‑‑No, the national union's been handling that.  I haven't.


I won't ask you that, it'd be unfair.


JUSTICE ROSS:  I'm not sure what consent arrangements you're referring to, Mr Ward.


MR WARD:  Your Honour, it's my understanding that there's been a major case involving the SCHADS Award over the last - - -


JUSTICE ROSS:  Yes, I know.  I was presiding on it.


MR WARD:  I know but my understanding is there's been some arrangement made on broken shifts to make sure that people get paid a minimum for sort of chunks of work during the day.  If I'm wrong - - -


JUSTICE ROSS:  No, it's not - that was the decision but I'm not sure, are you talking about another consent arrangement that they're going to file after the decision or - - -

***        JAMES EDDINGTON                                                                                                                    XXN MR WARD


MR WARD:  Your Honour, my understanding was that it was consented to.  If I'm wrong on that I apologise.


JUSTICE ROSS:  No, I don't think it was consent.  In any event my main question is are you talking about the variations the Commission has made, or are you talking about some further agreement that's been reached after the Commission's decision?


MR WARD:  I'm talking about the changes the Commission's made - - -


JUSTICE ROSS:  Okay, no problem.  No, that's fine.  All right, thanks.


MR WARD:  Could I take you to paragraph 56?‑‑‑Yes.


Now, you might help me with this.  In terms of assistance with medication as I understand the evidence that's put on assisting people in their home with medication seems to be a little different to assisting people in residential aged care.  Is that your understanding?‑‑‑Other than - they're obviously - it may well be that the person or the client has medications that they're prescribed to take and that the home carer might be there to ensure that that's done correctly and safely.


There's a phrase that's in most of the home care evidence about the home care worker prompting them to take the medications.  Is that your understanding that they prompt them?‑‑‑Yes, I think that's correct.


Can I take you to 62 - when you talk about some clients may have medical conditions is that they have clinical medical conditions?‑‑‑In some cases, yes.


And your members aren't trained to deal with clinical medical conditions, are they?‑‑‑They're expected to identify and report on them.


They would actually diagnose a clinical condition, would they?‑‑‑Yes.  Well, they would use their knowledge and skills in the industry to identify whether it's their belief that somebody has a medical condition and report on it.  Certainly they're not - it would be negligent upon them if they indicate or it was reasonably clear to them that there was a medical condition of concern and they did nothing about it.

***        JAMES EDDINGTON                                                                                                                    XXN MR WARD


Are you saying they could clinically diagnose somebody has dementia?‑‑‑They would use their qualification, skills and experience to make an assessment, and it may well be that they will look - as I say they're the first responder in respect to these people because they've been caring for them potentially for some period of time, so they can notice nuances and changes in their behaviour.  So technically they're not nurses, they're not going to be making a clinical assessment of the calibre of what a nurse or a doctor would do, but they will on a preliminary basis I think identify whether somebody may need further medical assessment and clinical assessment.


So in accordance with their Certificate III training they will make observations in relation to the client.  Those observations will be recorded or charted, and if a clinical diagnosis is required a registered nurse or a doctor will make that?‑‑‑Indeed, but they're the ones that have to do that first identification.


They're the ones making the observations, aren't they?‑‑‑Well, they're making an observation, but it's an observation that requires a degree of skill.


Yes.  Those are the skills that they obtain when they do their Certificate III training?‑‑‑Yes.


You've just - and I don't want to ask you a question you can't answer, so bear with me - you talk about your members in paragraph 63(b) involved in minor wounds.  What do you mean by minor wounds?‑‑‑Well, quite frequently frail elderly clients will have skin tears and minor wounds.  So they may treat in terms of just applying a bandage.


Do you have any understanding of when your members should not attend to the resident - sorry, the client, if it's more than minor, it requires clinical work?‑‑‑Well, I know that this can be a point of contention as to where that line is drawn.  That may be a better question to ask the members themselves, because I know different employers have different policies and expectations as to what's expected.


But you would expect your members to work within their competency, wouldn't you?‑‑‑Yes.  Yes.  No, that's true.


In paragraph 64 you say this:


Particular skill is needed to provide care and support service to clients with dementia.  As such clients may need to be encouraged to participate in care tasks.

***        JAMES EDDINGTON                                                                                                                    XXN MR WARD


And then you go on.  You would agree with me that caring for people with dementia is part of the Certificate III program?‑‑‑Look, I'm not familiar specifically with the course content of the Certificate III program, but I do know that many of our members care for people with dementia and that they do require a Certificate III in order to do their work.


Can I just ask you this for the last question.  A lot of your evidence is about bargaining, and you've already told me that employers often would say to you they can't afford to pay higher rates because they're not funded for it, and your evidence also is to the effect that a lot of employers try and not bargain with you.  If the award rates of pay go up and it's not funded do you expect more bargaining or less bargaining?‑‑‑I would expect that we will continue to try and bargain.  Certainly whether there's more or less it will probably become difficult.


In other words if they can't afford it today they will have less room to afford it tomorrow?‑‑‑Well, it doesn't mean we won't stop bargaining, and I don't think the employers - anyone that we've got an enterprise agreement with will very likely continue.  The ones that we don't have enterprise agreements with regardless of this outcome are probably going to be difficult to commence bargaining, because there is some culture where they're resistant to bargaining.


You're not sure if bargaining will go up or down in terms of the amount of bargaining in Tasmania?‑‑‑I couldn't say it precisely, no.


That's fine.  No further questions.


JUSTICE ROSS:  Any re-examination, Mr Gibian?

RE-EXAMINATION BY MR GIBIAN                                                 [9.28 AM]


MR GIBIAN:  There's just one matter, Mr Eddington.  You were asked some questions by reference to paragraph 56 of your statement, and specifically the reference to the personal care tasks undertaken by home care workers, including providing some assistance with medications?‑‑‑Yes.

***        JAMES EDDINGTON                                                                                                                   RXN MR GIBIAN


And you were asked whether that could include prompting clients to take medication, and I think we agreed with that proposition.  Is there any other assistance in your general knowledge that home care workers would commonly provide in relation to medication?‑‑‑Again, look, I think this is a better question to ask the members themselves.  All I can say is I am aware that, and certainly I've spoken to some members who's - and part of the problem that we had with minimum engagements is that there were members that were being - having some engagements that were as short as 15 minutes, and the whole purpose of (audio malfunction) was that they would go to somebody's house just simply to assist in the provision of medication.  Exactly what that entailed, I must admit I'm not sure, but I'm aware because I've spoken to them.  That's what they indicated that they were doing.


Thank you, Mr Eddington.  That's the re-examination.


JUSTICE ROSS:  Thank you for your evidence, Mr Eddington.  You're excused?‑‑‑Thank you.

<THE WITNESS WITHDREW                                                            [9.30 AM]


JUSTICE ROSS:  The next witness, Professor Kurrle.


MR GIBIAN:  Kurrle, yes.


JUSTICE ROSS:  Kurrle?  Okay.


MR GIBIAN:  I understand he's logging in right at this minute.


JUSTICE ROSS:  Thank you.  There she is.


THE ASSOCIATE:  Ms Kurrle, can you see and hear me?


DR S KURRLE:  I can, good morning.


THE ASSOCIATE:  Good morning.  Can you please state your full name and work address?


DR KURRLE:  Susan Elizabeth Kurrle, Hornsby Kur-ring-gai Hospital, Hornsby, New South Wales, 2077.

<SUSAN ELIZABETH KURRLE, AFFIRMED                                  [9.30 AM]

EXAMINATION-IN-CHIEF BY MR GIBIAN                                    [9.30 AM]


JUSTICE ROSS:  Thank you, Dr Kurrle.  Mr Gibian.

***        SUSAN ELIZABETH KURRLE                                                                                                        XN MR GIBIAN


MR GIBIAN:  Yes, thank you, Dr Kurrle.  Can you hear me?‑‑‑I can hear you, good morning.


Can you just repeat your full name for the record?‑‑‑Susan Elizabeth Kurrle.


I'm just having a problem with my system, momentarily.  Can I just have a moment, your Honour?




MR GIBIAN:  Apologies.  Dr Kurrle, you're the senior staff specialist dietician for the Hornsby Ku-ring-gai and (indistinct) Health Services in New South Wales?‑‑‑Yes, I am.


And also the clinical director of the rehabilitation aged care network from the Northern Sydney local health district?‑‑‑That's correct.


I think you were also - for a period between 2019 and 2021 - medical adviser to the royal commission?‑‑‑Yes, I was.


You made a statement for the purpose of these proceedings dated 25 April 2021 and annexing a report of the same date?‑‑‑Yes.


You have a copy of that with you?‑‑‑I do.


Have you had an opportunity to review that, the contents of that statement and the attached report?‑‑‑I have.


Is it true and correct to the best of your knowledge and recollection and does it represent your opinion?‑‑‑Yes, it does, although it's slightly outdated, being almost a year old.


That's the statement of Dr Kurrle on which we wish to rely.  It's document 118, commencing at page 3743 of the digital court book.  Dr Kurrle, Mr Ward, who you should be able to see in one of the boxes in the screen in front of you, will now ask you some questions.

***        SUSAN ELIZABETH KURRLE                                                                                                        XN MR GIBIAN


JUSTICE ROSS:  Just before we go to Mr Ward, Dr Kurrle, when you say it's slightly outdated, which aspects of the report - I also note someone has got their microphone on - thank you.  Yes, Dr Kurrle?‑‑‑Just that I talked about new quality indicators coming in in the future.  They came in in July 2021 so it's just small - very small changes like that but it's certainly nothing material.


All right, thank you.  Mr Ward.

CROSS-EXAMINATION BY MR WARD                                           [9.34 AM]


MR WARD:  Dr Kurrle, can you hear me?‑‑‑I can hear you, Mr Ward.


Thank you very much.  Just for the record, my name is Nigel Ward and I appear in these proceedings for the principal employer interests.  I'm not sure how to ask this question:  I was struggling, when I read your statement, to understand how you've actually worked in the aged-care sector.  I understand you've been heavily involved in it but have you actually practised in the aged-care sector?‑‑‑Yes, I'm sorry I didn't make that clear.


It's probably me?‑‑‑No, I started my training in geriatric medicine exactly 40 years ago and I have been working in and out of residential aged-care facilities and old people's homes and also working within the hospital-based aged-care service so literally across those three areas and have been doing it in this space for 40 years.


As the doctor involved are you normally working specifically for one provider or do you play more of a kind of floating role across different providers?‑‑‑No, I work as a consultant, working out of our aged-care service, both here at Hornsby Kur-ring-gai Hospital and in Southern New South Wales.  So referrals are made almost always by a general practitioner for a request for me to review a resident in aged care or it may have been someone I've looked after in hospital or it's someone I've seen in my clinic.


So if I could just make sure I understand that:  there would be at a particular facility there'll be a general practitioner who is assigned to that facility, working for that facility.  Let's say they've got a resident with some challenging vascular dementia.  That person might then be referred on to you for a specialist consultation?‑‑‑Yes, that's correct, although I would note that there's often many GPs in the facility so I would get referrals from a number of GPs to the same facility but for different residents.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


And your specialty is dementia or is it much broader than that?‑‑‑It's probably broader than that - I'm a geriatrician so I'm trained in diseases of older people.  Dementia would probably be what I do most of because there is a lot of it around but frailty, falls, are also areas I'm often asked to review a patient who is falling often.  As well as that we do look at complex medical issues so there might be someone with heart failure who is following - who has a dementia, what can we be doing about the treatment because the treatment for one thing will often have a side effect that causes another.  So, look, I could go on all morning and I won't.


Don't (indistinct)?‑‑‑Yes, we're generalists in a broad way with older people but for me, I've done a lot of work, a lot of research in dementia so I guess that's what I do most of.


I understand.  If you look at the layers in aged care, we sort of have the registered nurse, possibly the clinical care manager, the GP and then we have you as the sort of consulting expert at the top?‑‑‑I would prefer to see myself on the same level as the general practitioner, working with them.  We started that in 2005 here, a geriatric outreach service that was initiated by GPs to enable them to look after their residents better.  That's been the basis for the geriatric outreach services across Australia and that working together, that partnership.  We put the care manager in there as well and the family along with the patient.


Yes?‑‑‑We try and see it very much as a level rather than, as you said, different layers.  We all have an important part to play.


I want to be fair to you so can I just ask you an opening question to see what level of knowledge you have about something:  do you have - what level of knowledge do you have about the content of the Certificate III in Individual Support that personal care workers get?‑‑‑I have no specialised knowledge in that area at all.  However, I have often been asked to give guest lectures to Hornsby TAFE, when they ran a Certificate III course in Aged Care, so I have a general idea of what was in the course say 10 years ago.  I would also note my youngest son, who is a nurse, started by doing his Certificate III in Aged Care when he was working in residential care.  And so I was very aware then of the content.  What I am aware of is that it varies quite significantly across the different educational providers.  I only know that because of talking to staff who are doing it and some will do a lot in one area and not in another.  So the variability I'm aware of.  Other than that I have no specialised knowledge whatsoever, and not over the last two to three years at all.


Doctor, if I pose a question to you about that that's outside of your knowledge just say so straight away, please.  Can I take you to your statement.  Can I ask you to go to page 3?‑‑‑Yes.


Do you have it in front of you?‑‑‑I do.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


If you look at the second paragraph you say:


Duties traditionally performed by nurses are now being performed by personal care workers.


And then you give four examples;


Medication administration, wound dressing, assistance with feeding and performing vital observations.


Can you tell me what year that change started to happen?‑‑‑Now you're really pushing me.  Thinking back to when I first started working in aged care, and most of the residents still drove their own cars and administered their own medication and fed themselves, but were living in residential care.  That's how it was in up to the late 80s, which is why the whole reform system and aged care assessment teams came in.  Over the last, I'd say 30 years, that I have been in and out of aged care facilities, almost weekly the dependency of the residents has changed dramatically.  So, certainly when I'm thinking back to, say, the early 1990s where the registered nurses were a large proportion or appeared to be a much larger proportion of the workforce, they would be doing the wound dressing, they had to under the regulations then do medication administration.  They would do vital observations, particularly pulse and blood pressure and respiratory rate.  That then moved on to enrolled nurses, and I couldn't give you the dates but I certainly observed this, and then to personal care assistants as they were upskilled.  So - and I think I noted that registered nurses used to be one in five of the workforce.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


Back in?‑‑‑That was - that was pre-1997, because I think that's when it - that's when it all changed with the new Aged Care Act, and the stopping of the requirement to actually have a certain number of each sort of staff in the facility.  I only saw this though from the view of a clinician going in.  However, I was on the board of HammondCare, which is a not for profit organisation, for 14 years and so I was very aware of the drive to reduce registered nursing because of the costs and replace with enrolled nursing or personal care assistants.  So, sitting at a board level I saw that happen, perhaps not so much in HammondCare as other organisations but it was definitely push across aged care to reduce the amount of nursing.  I would also note that Minister Bishop, that's Minister Bronwyn Bishop not Julie Bishop, when she was minister for aged care basically said that they are no longer nursing homes, they are aged care homes.  So, there was a bumper sticker that, you know, said stop taking the nursing out of nursing homes.  But it's exactly what happened and there are still residential care facilities that have very little registered nursing and these are people when we talk about medication administration, we're talking about people taking eight or 10 medications.  We're talking about drugs like Warfarin, which is a blood thinner.  It is really important, I think, that people understand a little bit about what they're - what they're giving when they're doing medication administration.  Wound dressing - - -


Can I - sorry, can I - bear with me, I asked a simple question.  This might go a little smoother if you answer my questions.  I understand you're passionate about this issue, okay.  So, you're telling me that back in the 1990s, personal care workers were not doing the things in that statement?‑‑‑I can't say that they weren't doing it but mostly it was done by the registered nurses or enrolled nurses.


And you give that evidence based on being there at the time and observing that?‑‑‑Absolutely, yes.


That's fine.  I just want to go through.  Would you agree with me that those skills; medication administration, wound dressing, assistance with feeding and performance of vital observation, would you agree with me that those skills are now part of their Certificate III Training and Competency?‑‑‑Yes, they are.  They're taught how to give medications from Webster-paks, from blister packs, not straight from the medication bottles.  There's a few modifications there.  But I would agree that the training that they have and then the on - the in work, the placement training should enable them to be able to do those things.  They were not doing them 15 years ago to that same extent.


I understand that's your evidence.  When you say medication administration, that's Schedule 4 medications, not Schedule 8 medications?‑‑‑That's correct.


I think you've already described - there's a lot of evidence about medications, about how people take the Webster-paks out or the blister packs.  They have to count the pills, they have to check them off against the colour chart that actually shows the shape and colour of the pill.  That's your understanding of what they're doing?‑‑‑That's my understanding, yes.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


When you say they do wound dressing, I assume you're not suggesting there they do clinical work?‑‑‑I would say it probably is clinical work.  I'm not talking about changing a Band-Aid.  I'm talking about someone who has a skin tear on their leg and requires a non-adhesive dressing to be placed.  Now, initially that would be reviewed, if there is a registered nurse in the facility, by the registered nurse and they could suggest the treatment.  But often it is the personal care worker who will then actually apply, if you like, the dressing and maybe put the bandage on.  And when the person is showered they would be taking the bandage off and then putting it back on again.  So, the really significant wound dressings, hopefully, hopefully are done by a registered nurse and that's certainly my understanding in most of the facilities that I have worked in.  But I am very aware that dressings are done afterhours when there is no registered nurse on.  For instance a dressing will come off in the shower or a resident will pull their dressing off.  There is no registered nurse to put it back on.  It's the personal care workers that then are required to do that.  And I have certainly observed that.


Well, let me just put that to you again.  I think you agreed with me that when they do wound dressing as a personal care worker, they're doing it within their Certificate III competency.  You've agreed with me on that haven't you?‑‑‑Yes.


And you'd also agree with me that they don't do work that requires a registered nurse?‑‑‑I can't say that for sure because I know that when a registered nurse is not on the grounds of a - you know, of a facility it is then the personal care worker who's required to do that.  We see that often when we're called, as we are in the evening - - -


So, your evidence is that the personal care worker will often do work that actually requires a registered nurse?‑‑‑In some situations, yes.  It's usually an emergency situation where the person has - - -


You've observed that?‑‑‑The resident has fallen.


You've observed - - -?‑‑‑I haven't observed - I haven't observed the resident falling.  I've observed the resident when they've come into hospital with a bandage around their leg brought in my ambulance and clearly it wasn't done by a registered nurse.


How do you know who did that?‑‑‑Because we have the yellow sheet which is the form that comes in, plus we have the ambulance report that notes what the situation was.  Sometimes the ambulance, depending on the skill of the - of the ambulance attendants will do a - will put a dressing on as well, particularly if it's bleeding profusely and we certainly had one of those very recently.  It was a medical emergency.  There wasn't a registered nurse on the - in the facility at the time.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


You talk about vital observations.  Do I take it - I'm just going to give you a list just to see if we have some accord on that.  I understand that they record fluid intake for some residents.  Is that your understanding?‑‑‑Vital observations - I should have said observation of vital signs probably would have been clearer, so I apologise for that.  Read that as performing observations of vital signs.  Vital signs normally would be seen as pulse, blood pressure, and respiratory rate and pulse oximetry.  It's a really good suggestion of yours that fluid - whether someone is dehydrated or not is part of that.  The problem is it is extremely hard to assess if someone's dehydrated unless you are doing their urine output along with their fluid intake, and that's something which certainly happens if someone clearly is losing weight and you are then asked to look at input and output.  But that I would not include as a vital sign.  So I apologise for that - - -


Would blood pressure be a vital sign?‑‑‑Yes, absolutely.


I assume that they would be trained in their Certificate III with their theory and also their practical in how to actually check for blood pressure; they would be trained in that, wouldn't they?‑‑‑Yes, if they've got a Certificate III, yes.


Yes.  If they haven't I'm not sure why they're doing it.  They would then record that on their progress chart for the resident?‑‑‑Yes.


And I'm assuming that they might be trained to understand if they're observing something critical?‑‑‑A lot of charts have upper and lower limits, and there will be - you will have the white - it's usually white, yellow and red, and if an observation is within the white area that's seen as normal.  If it's in yellow it's - you're watching it.  If it's in red you would call a registered nurse or GP.  So they're taught that.  But I just would take you back to a comment you make, they don't all have Certificate IIIs, and that's a real issue, and particularly for the first six to 12 months that they're working in aged care they're learning on the job.  So when you say they would be able to do that because they've got their Cert III that is certainly something that hopefully will happen in the future, but is not necessarily happening now.  I work with a number of very good personal carers who are doing their Cert III at the current time.


The union evidence in this case I think is that about 80 per cent of people have a Cert III and that employers now require it.  Is that your understanding?‑‑‑I believe so, yes, and it fits with obviously the Aged Care Royal Commission, their findings - their recommendations, sorry.


Can I take you to page 5?‑‑‑Yes.


You were asked some questions here by the union about general and administration services and food services streams, and in the second paragraph say:


I do not have the specialised knowledge to comment in detail on the general and administrative service stream, but note that there are high levels of documentation required in residential care.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


Is that high levels of documentation completed by the general and administrative services stream, or are you talking about something else?‑‑‑I am not sure how much is completed by the general and administrative services stream and how much is completed by the clinical staff.  So I'm sorry I can't - I can't say that.  I do know though that when I worked in several nursing homes that have electronic systems it's the general and administrative staff who organise my log-in, my (indistinct) authentication and assist me to make sure that I'm putting things in the right place within the electronic clinical records.  So certainly we call on the administrative staff for assistance there.  So they obviously have to have knowledge of that.


When you talk about high levels of documentation what documentation are you talking about?‑‑‑I'm talking particularly about the clinical documentation, the fact that you need to record observations about the resident every day, who you've spoken to about their care.  Now, that is done as I understand by clinical staff on (indistinct).  The high levels of documentation are what then needs to be sent up to the Aged Care Quality and Safety Commission into their quality indicators, the mandatory quality indicators.  My understanding is that a lot of that is done by general and administrative staff, but as I said I don't have any specialised knowledge on that, I just know what I've observed when I'm actually in the facility seeing it.


When you talk about high levels of documentation you were talking there about the care plan, the progress notes, various things that have to be charted, you're talking about those things?‑‑‑Yes, particularly with the new requirements for behaviour support plans, and the evidence around what care is being provided before you can say what's considered restricted practices.


Okay.  In the paragraph below that you go on to say:


In terms of the food services stream I note the importance of tasty and nutritious food for older people generally and the requirement that food is presented attractively and in a form that the older resident is able to manage.


Who do you understand authorises the menu for a residential aged care facility?‑‑‑It should be an accredited practicing dietician.  In a number of facilities or organisations they actually have an executive chef who works with an accredited practicing dietician to design the menu based on available - you know, current available food.  For instance when asparagus is in season they will have, you know, quite a few meals that include that.  I think the issue of food is huge and is ignored, and I don't know, Mr Ward, if you've ever gone into an aged care facility and seen what some people are - - -

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


I have lived in one, Doctor?‑‑‑Okay.  That is really good to know, because I think there are a few people that have no idea what is presented to residents, and the evidence is very clear.  I mean it's as simple as having a tablecloth on a table means people eat more, and there is evidence of that.  So presentation of food is really important and understanding that is really important, and certainly the Royal Commission - you know, there was - and the government, they agreed that an extra $10 a day would probably be appropriate.  Food is one of the few pleasures that older people have left, and their meal times are really, really important.  We've discovered that with the use of - when you do the cottage model of care where meals are cooked in the facility, as they would be in a person's home, and people don't lose weight as fast, we understand that happens.  So, yes, I just make that point.  I don't have any comments to make, because I have no specialised knowledge of what happens behind the scenes in the facility kitchens.  Because I have seen what happens in the cottage model of care, in a number of places the meal is actually cooked in front of the residents and the families and given to them - - -


We have some evidence on that in this case.  So your knowledge is that the dietician authorises the menu and that there normally will be some level of engagement, if there's a head chef, between the dietician and the head chef.  I think your answer was 'Yes' to that.  You talk in your statement in a form that the older resident was able to manage.  I take it when you're talking about that you're talking about the International Dysphagia Diet Standardisation Initiative Scheme, that's what you're talking about?‑‑‑Yes, dysphagia is very common, the difficulty swallowing - - -


Bear with me, if we just - respectfully, if we just keep the answers a little shorter, otherwise we're going to be here all day.  If you could bear with me.  I don't want to stop you talking but that's what you were talking about when you were referring to older people able to manage the food was it?‑‑‑It is making sure that the food is in a form that if a person has swallowing difficulties it is puree, it is - or it might be soft, there are plenty of people that can eat a normal diet but it needs to be presented to them in a bowl or on a plate with a spoon or a fork that they can use.  That they can - and it may be specialised cutlery.  It's important that is done if a food services person is the person providing that to the resident.


Is it your understanding - we've had some evidence on this from a cook.  Is it your understanding that the care plan will include in it the resident's status in relation to the IDDSI scale?‑‑‑I have no idea what the IDDSI scale is.


That's the International Dysphagia Diet Standardisation Initiative scale; regular, easy to chew, soft bite size, minced and moist, pureed, liquidised.  Are you familiar with that?‑‑‑No, not as it is.  Not at the IDDSI but definitely - - -

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


I won't ask anymore questions if you're not familiar with it?‑‑‑No.


Can I take you to page 8.  You talk in page 8 in the second sentence.  You say:


These commonly include diabetes -


This is co-morbidities -


which require regular monitoring of blood sugar levels through testing.


My understanding is that personal care workers do test the blood sugar.  That's your understanding is it?‑‑‑Yes, depending on whether it's a finger prick test.  There are a number that are accredited - are competent to do that because they have done that in their training.  But they also have what's called Libre which is a device that people wear, usually on their upper arm, but diabetics wear and you simply place an electronic device close to it.  Care staff are learning to use that because it doesn't require a finger prick.  So, there is training going on in that area as well.


That's a non-invasive device, is it?‑‑‑It is, it is.  The device itself actually has some little needles in it but it's only the one time when it's put on, so it's much more comfortable for people than having a finger prick.


You then go on to talk about attention to diet.  We've got some evidence that personal care workers, in fact a number of people will observe whether or not somebody is actually eating or not eating or whether or not they're eating half their meal or whatever.  When you talk about attention to diet, is that what you're referring to?‑‑‑Certainly there's that but there's also making sure they're not eating someone else's meal which will often - - -


Right?‑‑‑Which will often happen. There's also the issue of family bringing them chocolates or Tim Tams or other food that may be is not part of the diabetic diet and it'll be up to the personal care worker probably to deal with that as diplomatically as possible.


As a personal care worker if I've got a certain resident allocated to me, obviously I'd be in their room and I'd be able to make that observation if I see some Tim Tams?‑‑‑Yes.


Yes, okay?‑‑‑For some reason it's often Tim Tams.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


It would be in my room.  You then talk about insulin injections.  We seem to have some evidence that nurses do that and then other evidence that personal care workers do that.  Is it your understanding that personal care workers are competent to provide insulin?‑‑‑I have usually seen the situation where it is the nurse that will draw up the insulin, depending on the blood sugar level, and sometimes the resident will actually give it to themselves.  Sometimes the personal care worker will do it, sometimes the registered nurse will do it.  But usually - particularly where it's variable because it depends on the level of blood sugar, there will be registered nurse supervision.


Thank you.  And you later on - you talk about chronic heart failure patients need to be weighed daily.  I think on one of the inspections we saw like a weigh chair that you sit the resident in.  Is that your understanding of how people are normally weighed?‑‑‑It varies.  The chair is certainly one way to do it.  The good old fashioned scales are another way to do it.


So, if I was ambulant I might use the scale?‑‑‑If you were ambulant you would use the scale if you can step that short step up and they usually have a rail each side to stabilise.  That's a little more accurate, yes.


If you could turn to page 9. In the second paragraph it starts with:


This approach has been encouraged.


I might - if you haven't read this for a while you might just read this.  You seem to discuss in this paragraph infections that require regular antibiotic administration through intravenous cannula.  I don't want to sound facetious.  Obviously the doctor, the GP would prescribe the antibiotics?‑‑‑The GP or the outreach team or the acute post, acute care team or the hospital in the home team, whatever it's called in that particular jurisdiction.  The first dose and usually the cannula - the cannula can be inserted by a registered nurse who has that competence.  The first dose of antibiotic is traditionally given by the - with at least one nurse watching because of the issue with the possibility of allergy but, yes.


Okay.  And am I - we haven't seen antibiotics mentioned before.  Are antibiotics Schedule 4 medications?‑‑‑Yes, they are.


Can I ask you to go to page 10.  In your second paragraph on page 10:

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


It is clear that personal care workers need specialised skills and knowledge to be able to deliver this level of care which will benefit their older residents.


I don't think there's any issue in this case that they have specialised skills and knowledge.  Are you suggesting there that they need skills and knowledge outside of the Certificate III?  Are you suggesting there that there might be circumstances where they need a Certificate IV?‑‑‑There's certainly an issue - and this - that paragraph relate to particularly the concept of geriatric outreach services where a specialist goes into the facility and provides care that would otherwise be provided in an acute hospital setting.  That's where there's been very big changes over the last 15 years, and a lot of care is now provided in residential care and that's my - that was certainly the answer to Question - - -


Bear with me, bear with me.  You might not be able to answer this question but I'm just trying to understand.  Are you suggesting in that circumstance that the competence and knowledge I obtain from doing my Cert III is insufficient to work in that circumstance?‑‑‑No, I'm not suggesting that.  I am suggesting that they need to have the skills which may not come straight from the Cert III.  They need to have the observational skills and that's particularly experience to be able to look after people who 10 years ago would have been sent to hospital for a couple of days for the start of their - you know, their treatment, and then perhaps sent back.


From your observations, how many years experience might I need to be competent to do that in that acute situation?‑‑‑My answer to that is it could be any amount of time.  You get someone who is a born carer and loves what they do.  They'll be able - they'll learn these things, they'll be motivated to do their competencies because that's the key.  It's not just your Cert III.  It's all the - learning the other things to do.  If they're in an organisation that encourages them to do that extra education then they will be able to do that.  There are other situations I've seen where care workers would not have been able to do a lot of these things.  They wouldn't understand if someone was breathing faster that perhaps there was a lung problem.  It can be so simple or so complicated.


You just used the phrase there 'a born carer', what are the attributes of a born carer?‑‑‑That's terrible and I shouldn't have used that word, should I.  Yes, but I did.  And there are people who are nurturing and who, you know, engender confidence in the person they're caring for, and that's at all levels, and they take to this and they love their work and they're motivated to do it.  They're not just coming for their eight hour shift.  That's a very different person to the one that's there to sign on and sign off, and I know who I would want looking after me if I was dying in a residential aged care facility, and it wouldn't be the latter, it would be the former.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


Thank you.  Thanks for that.  You then further on in the page in (indistinct) you start talking about the home model, and it's got different names, depending on who we talk to, homemaker model, house model.  I take it you've physically been in a position where you can observe that model in practice?‑‑‑Yes.  We did the research in Australia that showed the benefits of the cottage model of care, and that was published in - over 2018/2019, but my mother was in a cottage model of care for six years in three different versions thereof.  So I observed it twice a week, three times a week, and all different times, and I've observed it where she was and she was in three different levels of care, but I've also observed it - since she died I've been back, I go back to the various facilities to see my patients who are residents there, and I've watched how that - you know, how well it works.


If you look at the second paragraph you say:


This model of care requires personal care workers to be very flexible.  They will be both providing personal care and assistance to the older residents, and also providing housekeeping services, particularly cooking and meal provision as meals are prepared within each home.


Can I just focus on that word 'housekeeping services'.  What do you mean by - obviously there's been some other evidence about this - what do you mean by housekeeping services?‑‑‑So particularly cooking and meal provision.  So the care workers will also have a menu and have the food.  They will take their residents down to the supply room to collect whatever provisions they need for that day, so it's almost like going to the supermarket.  Those care workers will then sometimes supervise residents in say chopping the beans or peeling potatoes or pumpkin.  So they're really modelling that home - that home model of care doing what the resident, and obviously it's usually women, what they would be doing at home.  So there's particularly around that preparation - - -


I am not trying to cut you off, but I just want to ask a question about it if I can.  The evidence we've got to date is, and I will try and paraphrase this as fairly as possible, the evidence we've got to date seems to be that these operators still maintain a central kitchen, and the central kitchen is still providing food to the cottage, and that the person in charge in the cottage - one of them said yesterday, I think they said they make toasted sandwiches.  Last week one of them said that they might make scrambled eggs and things like that for the residents.  Are you saying you've seen a model where the central kitchen has been done away with?‑‑‑Absolutely.  If you go out to Hammondville - - -


Where at Hammondville?‑‑‑At Hammondville, at Horsley Park down in Wollongong, at Miranda, at Wahroonga, in a four level residential care facility each unit has its own kitchen.  There is a supermarket in the basement that the residents with the carers will go to, to get what's on the menu for that day.  But food is prepared from scratch, and I have observed that probably three times a week for the last six years, and - - -

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


Is it your evidence that you've observed the home model where the personal care worker prepares all the breakfasts, all the lunches, all the dinners, as well as caring?‑‑‑Yes, which is why they have a higher number of carers in those - in those facilities.  Let me give you an example, a specific example.  So in Collingridge which is that unit in HammondCare Wahroonga there are 12 residents each with their own rooms with a central kitchen, and there are four care staff during the day.  Four care staff for 12 residents.  Three in the afternoon, late afternoon, evening, and two overnight.  So they have an extra number of care staff because those care staff do other activities as well, which is what I've mentioned here.  When I talk about housekeeping if someone spilt something on the floor they will go and clean it up, as you would if you were the daughter of a lady at home and you would clean - you would clean that up.  If there was a mess made in the bathroom you would go and clean it up.  That's what I mean by housekeeping.  You make the beds, you change the linen, you do the laundry.  Each apartment, certainly in the three facilities I've been in, have had their own laundry, you know, within the actual apartment, and the residents hang their own washing out.


Can I just then clarify, because we don't have any evidence from anybody else on this - - -


MR GIBIAN:  I do object to that.  That is not an accurate reflection to say that we don't have any other evidence of that nature, we do.  I just note that for the record.


JUSTICE ROSS:  No, we don't need to debate whether there is or there isn't.  Just ask the question, Mr Ward.


MR WARD:  I will just put the question - so you're saying that there is a home model where there's no centralised kitchen.  I take it you're saying there's no centralised cleaning facility?‑‑‑There will be cleaners that will come out, if you like rather like forensic cleaners, who come out if there's a particularly bad stain to be cleaned, but the staff do the cleaning.  There is absolutely definitely no centralised kitchen, and I'm sorry, but you need - - -


I believe you, Doctor, I'm just trying to clarify what your evidence is.  No centralised kitchen?‑‑‑No.


There's no routine centralised cleaning.  You're saying that if there's an emergency they might come out?‑‑‑I can't comment on that for sure, but there are cleaners who are available if there's things that need to be done perhaps beyond what the personal care staff are able to do with a vacuum cleaner and a mop.  Yes.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


And you say that there's no centralised laundry in those facilities, they do all the laundry in the home?‑‑‑The centralised laundry is for sheets and towels, but all the residents' laundry is done in a standard washing machine and drier set up in a standard laundry in the facility.  And then there will be a washing line outside, and look I can send you photos of all this if you'd like it because - - -


I am not doubting you, Doctor, I just want to clarify?‑‑‑Yes, and it is the two home model - home style model of care where people are doing in the facility what they would have done at home, and it really normalises things when it's like that, rather than an institution.


And I think it's your evidence that they put extra staff on to accommodate for that, is that right?‑‑‑I don't know if they put extra staff on, I know there are staff that - in this particular case because it's a high care apartment, as I said there are four staff for 12 residents, and I paid for mum exactly the same, the $52 a day care fee as would be paid by anybody.  There wasn't extra services.


Can I ask you to go to page 11 and under (a) you were asked if you've got any other information to consider and you discuss palliative care.  Do you see that?‑‑‑Yes.


You say it requires a degree of skill and knowledge.  Can I put this to you in case you don't know.  There is an elective in the Cert III for palliative care.  Were you aware of that?‑‑‑But it's not always done.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


No, hence I used the word 'elective', it may be done, it may not be done.  If somebody is looking after somebody, if they're palliating that person, if that person's at the end of that life, do you believe that it's necessary for them to have done extra study in palliative care, to actually deal with that properly?‑‑‑I don't know about the extra study but they do need to have extra experience in understanding what happens as a person is dying.  What we would always ask for if the care staff, and I'm thinking particularly the registered nurse, is not experienced in this area then you would call in one of the palliative care teams that is in the area.  Now, I work both in urban and rural settings and we have access to palliative care.  It's not wonderful but it certainly is available in rural settings.  And they would assist the care staff in - you know, in knowing how to manage the symptoms because, you know, everybody's different and they could be dying of, say, chronic heart failure where basically their lungs fill up with fluid and they suffocate.  Now, clearly for that you need a different level of symptom management that is to manage the distress from shortness of breath and also manage the family and their distress.  It's different to someone who, say, becomes unconscious and then dies five days later because they're not receiving any food or fluid because, you know, they're at the end of the life.  So, it's very, very different and that huge difference is why I drew attention to it because most people in nursing homes die in nursing homes and my observation is it's not always done well and the Royal Commission, you can read it in their reports, they received a number of pretty horrifying reports about that.  So, that's why I drew attention to it.  Some organisations do it extremely well.  Some ask for help or get it in.  For instance, where I work here at Hornsby we have a nurse practitioner in palliative care who works with our geriatric outreach team and most of her work is in residential aged care facilities, and she has upskilled staff there.  But it needs that level.  It's very hard to teach dying in a Cert III or a Cert IV, or even if you like in a PhD.  You need to have that experience on the ground and you know that's really important when - - -


And in terms of - in terms of getting that experience, am I right in saying that you would believe some people would pick that up quicker than others and some people would take a long time to gain the experience?‑‑‑That's one way of putting it yes, yes.  We're all different, yes.


We're all different?‑‑‑Yes.


I've got two more questions if I can.  I just want to just jump back to the home model.  You talked ab out preparing meals.  I'd be right in saying that all meals in the home model are still reviewed by dieticians and nutritionists?‑‑‑They're designed - the menu's designed by the executive chef, with - - -


Just hang on, bear with me.  Sorry, bear with me.  So, I thought we agreed there wasn't a central kitchen in the home model?‑‑‑Absolutely.  The menu, I said, the menu is designed by the executive chef with input from the accredited practicing dietician and that menu then goes out to all the - to the facilities and those care workers will then do that cooking.  So, for instance, for breakfast - if my mother wanted poached eggs and bacon at 10 am, she could have that because the staff would do that.  Lunch was usually a - it could be a slow roast, it could be a baked - it was often a baked lunch.  All the deserts were cooked there from scratch and it - but it was all designed by the executive chef with the input of a dietician.  Then it's up to the care workers to work out okay, so this particular resident needs to have their pureed, this particular resident needs to have some protein supplement added and they do all that in the kitchen.


Bear with me if you can.  Your experience is with a facility that doesn't have a central kitchen but employs an executive chef who obviously doesn't cook but prepares menus.  Is that right?‑‑‑That is my understanding.

***        SUSAN ELIZABETH KURRLE                                                                                                       XXN MR WARD


That's okay.  And in terms of understanding whether or not the resident in that facility you're thinking about requires a particular texture of foods with minced and moist or easy to chew, I take it that would be in their care plan?‑‑‑It's in their care plan.  It's listed on the fridge and the care staff know what that means.  So of some, as you say, it'll be chopped up.  For some it'll be minced.  For some it'll be pureed.


Can I take you to the - - -?‑‑‑For some it will be as it comes.


As it comes, yes.  Can I take you to page 12.  I'm just trying to understand why you added this in there.  You've talked about recommendation 77.  As I understand recommendation 77, recommends that the Certificate III qualification in effect be mandatory.  Are you identifying that because you simply support that as a proposition?‑‑‑Yes.  Yes.


You think that would be - that would be a good thing?‑‑‑I think care workers having appropriate education is definitely a fair thing.


And - no, I won't, I'll withdraw that.  No further questions.  Thank you, doctor, thank you.


JUSTICE ROSS:  Any re-examination?

RE-EXAMINATION BY MR GIBIAN                                               [10.26 AM]


MR GIBIAN:  Yes, just a few matters.  Dr Kurrle, can you hear me again?‑‑‑I can.


Excellent.  Just at the start of the cross-examination you were asked about the Certificate III course and you said you don't have a specialised knowledge of it but you indicated that you had in the past at least given guest lectures, I think, at Hornsby TAFE.  What was the subject matter of those - - -?‑‑‑Yes.


What was the subject matters that you were asked to address in guest lectures?‑‑‑One on dementia, one on frailty, one on falls.  I think that was - those sorts of areas.  And I did them on several occasions.


You were then asked some questions about the evidence you've given in your report concerning personal care workers taking on tasks that in the past were performed by registered nurses?‑‑‑Yes.

***        SUSAN ELIZABETH KURRLE                                                                                                     RXN MR GIBIAN


And you were asked whether your experience and understanding was that personal care workers would, on occasion at least, undertake tasks that were required - that required a registered nurse.  And I think you gave an example of an emergency where there had been a fall or a skin tear which required wound dressing.  In relation to that evidence, is it the case that there's some regulatory requirement for wound dressing to be done by a registered nurse or were you referring to a view that, particularly if it were more serious, that it would ideally or more appropriately be done by a registered nurse?‑‑‑The latter, yes.  I'm not aware of any regulation that says, you know, at what level a registered nurse is required for wound dressings.


I understand.  You were asked some questions about administrative work by reference to page 5 of your report, the second last paragraph on that page, where you referred to the high levels of documentation?‑‑‑Yes.


I just wanted to ask you about - in the final sentence of that paragraph, that's the second last paragraph on page 5, you indicate:


An ability to process and upload the new mandatory quality indicators will be necessary.


I just want to ask you is that a reference to the National Aged Care Mandatory Quality Indicator Program that started in 2019?‑‑‑It is, yes.


Then you were asked some questions by reference to page 9 of your report, in particular in relation to the first full paragraph that appears on that page and the reference to the administration of antibiotics, including by an intravenous cannula.  Do you recall that?‑‑‑Yes.


And in answer to those questions you indicated that where there's antibiotics that have been prescribed ordinarily or perhaps at least ideally the first dose would be given in the presence of a registered nurse because of potential allergic concern?‑‑‑Yes.


What would happen thereafter for the remainder of the dose in your general experience, that is who would be involved or responsible?‑‑‑It would still be the registered nurse giving the - giving the antibiotics, but the first dose is traditionally given by the treating team.  So they would put the cannula in, secure it, give the first dose, and be there to observe, the general rule is 10, 15 minutes just to make sure there isn't an immediate allergic reaction.  Obviously staff would have checked for allergies, and that sort of - hopefully that would be covered.  But it is something that does need to be taken very carefully.

***        SUSAN ELIZABETH KURRLE                                                                                                     RXN MR GIBIAN


That evidence in the first full paragraph on page 9 of your report is given in - or those statements are given in the context of what you refer to in the preceding paragraph that appears at the bottom of page 8 and goes over to page 9, namely that there's been a push to manage medically unwell residents in the aged care facility, rather than have them be admitted into hospital?‑‑‑That's correct.


Are you able to give examples of other types of circumstances in which residents in the past might have been admitted to hospital, but are now able to be managed in an aged care facility through Outreach - - -


JUSTICE ROSS:  Are you suggesting this was the subject of cross-examination or are you now straying into further examination-in-chief?


MR GIBIAN:  Dr Kurrle was asked some questions about observational skills and gave some evidence about observational skills that were required of personal care workers in the context of dealing with residents who were being treated in the aged care facility rather than being admitted into hospital, and I just wanted - - -


JUSTICE ROSS:  Yes, but you're now asking about examples of where they've been treated in the aged care facility and not in the hospital.


MR GIBIAN:  Yes, for the purpose of explaining the types of - or if Dr Kurrle is able to give - to explain in the types of conditions or illnesses that are being treated where those observational skills that she was asked about and gave evidence about are required - - -


JUSTICE ROSS:  I am not sure it arises from cross-examination.  So either ask her directly about the observations, but don't stray into the other topic.

***        SUSAN ELIZABETH KURRLE                                                                                                     RXN MR GIBIAN


MR GIBIAN:  You were asked about, and you gave evidence about observational skills that personal care workers are required to utilise, and you specifically referred to them having to gain experience in making those forms of observations of residents who were being cared for by an Outreach team in a residential facility.  What types of conditions did you have in mind that those residents might be experiencing in the context of which those observations skills are required to be utilised?‑‑‑The most common would be pneumonia, which often will require intravenous antibiotics, but may just require oral antibiotics.  Also falls and fractures where we have an X-ray machine, a mobile X-ray machine comes to the facility, does the X-ray.  Our specialist reviews the X-ray.  The physiotherapist may well review the patient - the physiotherapist in the Outreach team may well review the patient.  A third case would be behavioural and psychological symptoms of dementia where often the ambulance would be called because the person's behaviour cannot be managed any longer.  That is now usually managed in the residential aged care facility by the - by the staff within (indistinct) from the geriatric Outreach service.  A fourth example would be if someone suddenly becomes acutely unwell, develops what we call a delirium.  Again that would be - it would be a visit from the geriatric Outreach service and treatment would be put into place, but that person would not need transport to hospital, so would not come into hospital, because as we know hospitals are dangerous and unfriendly places for older people.


I think just two more matters.  You were asked some questions about end of life care and palliative care, and you referred to there being available access to palliative care teams that were able to provide some external assistance?‑‑‑Yes.


Who is - what types of staff I should say really are involved in those palliative teams?‑‑‑So these are state run - state funded services, and it would be a registered nurse or a clinical nurse consultant, or a nurse practitioner that would be involved.  They would be supervised by a palliative care physician if that palliative care physician is available.  So in Northern Sydney that's the model.  In Southern New South Wales there is a nurse practitioner, but any other links with a palliative care physician would be by Telehealth.  But it's all done into the facility.  So the person, the resident stays in their home, they're not transported elsewhere.


And what is the level of assistance that the palliative care team is able to provide in a particular facility, that is are they there for a period of time or is it just a visit to make sure things are set up appropriately and appropriate care can be provided?‑‑‑It's usually a visit to make sure things are set up, but it will be provision of syringe driver which is how one gives medication subcutaneously, and it would be advice, but it will be up to the care staff in the facility to actually provide most of the hands-on care.  They're the people sitting with the dying patient.


Thank you, Dr Kurrle.  That's the re-examination.


JUSTICE ROSS:  Thank you for your evidence, Dr Kurrle, you're excused?‑‑‑Thank you very much, your Honour.

<THE WITNESS WITHDREW                                                          [10.36 AM]


JUSTICE ROSS:  Is the next witness Julianne Bryce?


MR GIBIAN:  Yes, your Honour, that's right.

***        SUSAN ELIZABETH KURRLE                                                                                                     RXN MR GIBIAN


THE ASSOCIATE:  Ms Bryce, can you see and hear me?


MS BRYCE:  Yes, I can.


THE ASSOCIATE:  Can you please state your full name and work address.


MS BRYCE:  Julianne Margaret Bryce, and it's Level 1, 365 Queen Street, Melbourne.

<JULIANNE MARGARET BRYCE, AFFIRMED                           [10.37 AM]

EXAMINATION-IN-CHIEF BY MR HARTLEY                             [10.37 AM]


JUSTICE ROSS:  Do we have the ANMF?


MR HARTLEY:  Yes, we do, your Honour.  It's Jim Hartley speaking.  Ms Bryce, you might not be able to see me because I'm a little distance from the camera, but I hope you can hear me?‑‑‑Yes, I can.


Great.  Could you just state your name once more?‑‑‑Julianne Margaret Bryce.


And you're the Senior Federal Professional Officer at the ANMF?‑‑‑Yes, I am.


You've made a statement in this proceeding dated 29 October 2021?‑‑‑Correct, yes.


And that's a statement over eight pages and 53 paragraphs?‑‑‑That's right.


Have you had an opportunity of reading that statement recently?‑‑‑Yes, I have.


And is the statement true and correct to the best of your knowledge and recollection?‑‑‑Yes, it is.


Thanks, Ms Bryce.  Mr Ward I think will now ask you some questions.



***        JULIANNE MARGARET BRYCE                                                                                                XN MR HARTLEY

***        JULIANNE MARGARET BRYCE                                                                                                   XXN MR WARD

CROSS-EXAMINATION BY MR WARD                                           [3.38 AM]


MR WARD:  Thank you, your Honour.  Ms Bryce, can you hear me?‑‑‑Yes, I can.


Just for the record my name's Nigel Ward, Ms Bryce.  I appear in these proceedings for the employer interests.  Do you have your statement in front of you?‑‑‑Yes.


Can I ask you to go to paragraph 7.  I'm just trying to understand what your role is.  Are you the sort of guru on standards and clinical care?  Am I being unfair to you if I say that's what your role is?‑‑‑Well, my role is to advise the Federation on behalf of our members about professional issues relating to nursing and midwifery.


And that's about the professional standards themselves?‑‑‑Yes, certainly professional standards for nurses and midwives.


Okay, that's fine.  I think you said in your statement you haven't actually worked in aged care, is that correct?‑‑‑I have as a very junior nurse.  I've also obviously cared for a lot of patients over the years that are aged in the acute care sector.


Yes, okay.  Can I ask you to go to paragraph 20?  I apologise if this sounds like a silly question but you identify in paragraph 20 a variety of professional practice framework?‑‑‑Yes.


I'm right in saying that applies to nurses no matter where they work?‑‑‑Correct.


Yes, yes - can I ask you to go to paragraph 21, 22 and 23?  Are you able to explain what it is - what is the difference in what an enrolled nurse studies versus what a registered nurse studies?‑‑‑Yes, an enrolled nurse does an 18-month qualification through the VET sector - through the vocational education and training sector.  A registered nurse does a three-year degree through the university sector.

***        JULIANNE MARGARET BRYCE                                                                                                   XXN MR WARD


In terms of what they're actually learning, what is the qualitative difference between the two?‑‑‑So the learning about the differences between their roles and so the role of an enrolled nurse is to work in a team with the registered nurse under their direction and supervision to provide care for the people that they're allocated to look after.  So registered nurses are doing critical thinking and they are doing the higher-level skills as far as the decision making goes and they are learning about their role as it relates to that, as well as the art and science of nursing.  So are enrolled nurses but their role is responsible and accountable to the registered nurse in everything that they do.


In terms of the registration process, are there things that only a registered nurse is allowed to do?‑‑‑Yes.


Can you tell us what those would be?‑‑‑It's about assessment, setting a plan of care; as far as implementation there is a range of nursing activities that would only be considered to be the responsibility of a registered nurse, the very technical, procedural skills.


Can you give us some examples?‑‑‑For acute care it might be caring for a chest tube or removing cardiac sutures.  There's more complex care that requires the registered nurse to do.


Do you have an example for aged care?‑‑‑Aged care, it's the overall assessment of the resident.  So their role is about ensuring that they're providing holistic care, setting the plan of care for the resident and providing that care and that assessment that they need to do is constant.  So every single aspect of care that's required, they need to be able - if they're going to delegate that care to an enrolled nurse - they need to understand that that's appropriate, to be able to do that.  They're responsible and accountable for the provision of that care.


I think at paragraph 42 to 43 you discuss this notion of delegation.  Can you help me clarify that?  Does that mean that a registered nurse - put Schedule 8 drugs aside for a minute, which I understand only a registered nurse can play with - that's probably a bad phrase; can be involved in administering - can a registered nurse delegate any activity to people below them or are there some things they can't delegate?‑‑‑Yes, there are definitely things that they can't delegate as far as the care that they're required to provide themselves.  They have to ensure that what they're doing is legal, it's safe to be done and that the person that they're delegating to is competent to do that, they have the education and that they're safe and competent to do that care.  So that's all part of the delegation framework but that legal aspect to it as well and authorisation - they have to be authorised to do it, so there are some things that although it might be legal, you might be educated to do it, you might not be authorised according to the policy of the organisation as well.


Thank you for that.  In a practical setting, if I could just sort of take your mind to a residential aged-care facility, is what you're saying to me that the activities that the person care worker - they're operating under the RN's delegation at all times?‑‑‑Absolutely, absolutely - they are providing aspects of nursing care only under the delegation and supervision of the registered nurse.

***        JULIANNE MARGARET BRYCE                                                                                                   XXN MR WARD


Bear with me - if you can't answer this, let me know - is it sufficient, by way of example, for the RN to know that I've got a Certificate III as a personal care worker or would the RN need to go further to be confident that I'm competent?‑‑‑Absolutely they would need to go further to know that you are competent and safe and authorised to be able to provide care.


And they would do that through observation themselves?‑‑‑Absolutely, yes - that's the way they need to do it.


And the same would apply for an enrolled nurse?‑‑‑Yes, although with enrolled nurses, we do know that - with a diploma of nursing that they've had an 18-month program, that there is a nationally-consistent, agreed, accredited framework that the Australian Nursing and Midwifery Accreditation Council has set and in conjunction - approved by the board, the Nursing and Midwifery Board of Australia.  So we know that with enrolled nurses so you have that known element that you don't have with a care worker.


But I'd just like to use an example of an issue and see if you can help me with it.  There is a variety of evidence in this case about what's described as wound care and phrases like minor wound care are used.  Can all wound care be delegated to a personal care worker?‑‑‑No.


Could you explain how the line would be drawn by a registered nurse?‑‑‑Well, a registered nurse would have to assess it in every situation before they could delegate that care, every time.  So as far as the wound goes, they would need to be able to see it and assess it to determine whether it's appropriate for them to do the dressing, for them to delegate the dressing, either to an enrolled nurse or to a care worker, depending on people's qualifications and their safety and competence to be able to do that.


So in each of those occasions there would be a competency assessment by the RN in the particular context?‑‑‑Yes.


Yes, okay - so it's not the case that particular classes of wounds are the domain of one group and a particular class of wounds are the domain of the other:  it's an assessment by the registered nurse in the context of the wound?‑‑‑Yes.


Those are the questions, Ms Bryce, thank you.


JUSTICE ROSS:  Any re-examination, Mr Hartley?

***        JULIANNE MARGARET BRYCE                                                                                                   XXN MR WARD


MR HARTLEY:  No re-examination, your Honour.


JUSTICE ROSS:  Thank you.  Thank you, Ms Bryce, you're excused?‑‑‑Thank you.

<THE WITNESS WITHDREW                                                          [10.48 AM]


JUSTICE ROSS:  It might be a convenient time to take a 10-minute break until 11?  Does that suit everyone's convenience?


MR HARTLEY:  It does, your Honour.


JUSTICE ROSS:  All right, we'll resume at 11 with Ms Chrisfield, I think.  Thank you.

SHORT ADJOURNMENT                                                                   [10.48 AM]

RESUMED                                                                                             [10.59 AM]


JUSTICE ROSS:  Thank you.  Can we swear in Ms Chrisfield.


THE ASSOCIATE:  Ms Chrisfield, can you see and hear me?




THE ASSOCIATE:  Can you please state your full name and work address?


MS CHRISFIELD:  Katherine Anne Chrisfield, 535 Elizabeth Street, Melbourne.

<KATHERINE ANNE CHRISFIELD, AFFIRMED                         [10.59 AM]

EXAMINATION-IN-CHIEF BY MR HARTLEY                             [10.59 AM]


JUSTICE ROSS:  Mr Hartley.


MR HARTLEY:  Thank you, Your Honour.  Ms Chrisfield, can you hear me?‑‑‑Yes, I can.

***        KATHERINE ANNE CHRISFIELD                                                                                              XN MR HARTLEY


Great, thank you.  Could you just restate your name please?‑‑‑Katherine Chrisfield.


And you are the OHS Team Manager and the ANMF?‑‑‑Yes, that's right.


That was the role previously known as the OHS Unit Coordinator?‑‑‑That's correct.


Now, have you made a statement in this proceeding dated 29 October 2021?‑‑‑Yes, I have.


For the benefit of the Full Bench that's at tab 134 of the digital hearing book, commencing on page 9246.  Ms Chrisfield, do you have a copy of that statement to hand?‑‑‑Yes, I do.


Could you look at paragraph 1 of that statement?‑‑‑Yes.


Where it says occupational health and safety unit coordinator, should that now be occupational health and safety team manager?‑‑‑Yes.


In paragraph 4, second line, I beg your pardon.  In paragraph 4, first line, after the words ANMF Vic Branch, it says in this role.  Would you there insert the parentheses previously known as occupational health and safety unit coordinator?‑‑‑Yes.


Could you look at paragraph 19 please?‑‑‑Yes.


Now, in paragraph 19 you refer in the first line, first few words, 'just this year'.  Should that now read 'last year'?‑‑‑Yes.


And in paragraph 56?‑‑‑Yes.


In the third line where you refer to about midway through, 'almost all of the last 18 months'.  Should that now read 'the last two years'?‑‑‑Yes.


With those corrections, is your statement true and correct to the best of your knowledge and recollection?‑‑‑Yes, it is.

***        KATHERINE ANNE CHRISFIELD                                                                                              XN MR HARTLEY


Thank you, Ms Chrisfield.  Mr Ward will now ask you some questions.


JUSTICE ROSS:  Mr Hartley, if you could just attend to re‑filing a document with those amendments.


MR HARTLEY:  Yes, your Honour.


JUSTICE ROSS:  Thank you.  Mr Ward.

CROSS-EXAMINATION BY MR WARD                                         [11.02 AM]


MR WARD:  Thank you, your Honour.  Ms Chrisfield, can you hear and see me?‑‑‑Yes, I can.


Thank you.  I appear in these proceedings for the employer interest, just so you know where I'm coming from?‑‑‑(Indistinct).


That's okay.  You're the person who gives advice to organisers (indistinct) health and safety.  Is that a reasonable description?‑‑‑Yes.  I manage a team and all of us in the team do it but yes, I also do it.


I don't want to say this in an offensive way but as I read your statement, you generally seem to think that working in an aged care facility is quite dangerous.  Is that a reasonable description?‑‑‑Yes, it is.


Yes, okay.  I'm just going to take you through that if I can.  You seem to have some criticism of modern purpose‑built facilities.  I think you say that while they look quite good, they're actually more difficult to work in than old facilities.  Is that a reasonable description?‑‑‑I don't think they're more difficult than old facilities but I also don't think that they take 100 per cent into account the safety needs of the staff.


I'll come to that slowly if I can.  In terms of modern purpose-built facilities, and I'm thinking about ones we saw on the inspections just by way of visual reference in my mind.  My understanding is that modern facilities have purpose designed beds that can move up and down, the bedhead can come up, the legs can come up.  Is that your understanding in modern facilities?‑‑‑Yes.

***        KATHERINE ANNE CHRISFIELD                                                                                                 XXN MR WARD


And my understanding is that the rooms in modern facilities are made of a size that allows wheelchairs to be easily move around in the room.  Is that your understanding?‑‑‑Yes.


In terms of bathrooms, my understanding is, is that the showering areas are purpose designed so that people can actually be comfortably sat on a chair or a wheelchair actually in the shower.  Is that your understanding?‑‑‑That differs depending on the facility and how they've been designed.


In a more modern facility, is it your understanding that that's what happens, or not?‑‑‑Not always.


Not always.  So, you have some experience where the bathrooms not purpose designed for taking wheelchairs and the like?‑‑‑Yes, that's correct.


My understanding is that that's - those modern designs are in part for the resident but also to make it easier for the care worker to move around.  Is that your understanding?‑‑‑Yes.


Yes, okay.  Am I right that your primary criticism of the modern design is the distance between rooms?‑‑‑That's one of the - yes, that's one of the big issues.


Typically, what's the distance between a room in a modern facility that causes you concern?‑‑‑It's not in terms of the amount of distance.  It's the - it's the overall distance that it requires the workers to walk, so meaning that there is a lot of time spent walking as opposed to being able to spend that time undertaking the care that they need.


Are you drawing a distinction there to a time when residents were put in rooms where there was three, four, five, six, seven, eight residents in a room?‑‑‑Yes, there's a significant difference in the amount of time spent walking, absolutely.


How long has it been since residents were in sort of general wards like that?‑‑‑I couldn't tell you.  It's been a long time certainly.


That's okay, that's okay.  Now, you make some observations about lifting equipment.  I think you say it can be dangerous if it's not properly maintained.  Would you agree with me that most residential aged care facilities have procedures for when two people are required to do a lift?‑‑‑They have procedures, yes, yes, I would agree with that.

***        KATHERINE ANNE CHRISFIELD                                                                                                 XXN MR WARD


Am I right that these days if you're going to lift the resident the - and bear with me with this, I'll do this slowly.  You probably have more knowledge than I do.  My understanding is that the first point of call in lifting a resident, if they're quite capable themselves, might be just to literally steady them.  Is that your understanding?‑‑‑If they're able to assist that is possible.


Yes.  I then understand the normal approach to lifting a resident after that is to put one of these lifting belts around them, so you're not actually holding onto the resident, you're holding onto the belt.  Is that correct?‑‑‑It depends on the type of lifting that you're doing and the type of transfer.  If you're lifting them, for example, from a bed to a chair and they're unable to assist then you would need to put a sling under them to attach to the machine.


When I use the word belt, that's not the right word.  It should be sling is it?‑‑‑There are - there are different types of machines.  Some have a belt like operation but usually it is a sling, yes.


Whether or not I need to use a lifting device, is that - is that something that will be in the care plan or am I making that decision on the run?‑‑‑Theoretically, it should be in the care plan but it depends on how recently the care plan's been updated and reviewed and the resident's condition at that time.


Is it your understanding that most residential aged care facilities have rules around the amount of weight one person can actually lift?‑‑‑It changes from facility to facility and I hesitate with that because there's been a move away from determining weight limits because it's very dependent on the individual and their capabilities, so we don't - - -


I see.  So, it might - the weight itself might not be determinative.  It might be more about how much the resident themselves might be able to assist or not assist?‑‑‑Yes. Yes.


I understand.  Thank you for that.  I think we have some evidence which identifies a number of devices.  One of them is a standing lifter.  Can you describe what that is?‑‑‑A standing lifter is - I can't describe it in a lot of detail, but it's a machine that you bring up to the side of the bed or the chair and the resident will grab onto it and it will - it has a bit of a swing or a belt that can go around the back and can help them up, but there are many different types of machines though - - -


Is that - - -?‑‑‑(Indistinct) specific one.

***        KATHERINE ANNE CHRISFIELD                                                                                                 XXN MR WARD


I take it there's lots of different brands and designs.  Okay, yes.  I think there's some evidence of what's called a swing and hoist lifter.  Is that different to a standing lifter?‑‑‑Yes.  So the standing lifter helps someone come to a standing position.  The sling lifter literally lifts them up.


There's one called a forearm support frame?‑‑‑I'm not sure what that one - - -


That's all right, that's fine.  And I think we've seen a number of weight chairs where people actually weighed in the chair.  Yes, okay.  I take it that if I'm properly trained in the equipment working using that equipment shouldn't in itself be dangerous?‑‑‑If you're properly trained - you have adequate staff as well, because - - -


Yes, I agree with that?‑‑‑Required more - yes.  But then, yes, it should be safe.


Now, it's uncontroversial in this case that residents will occasionally display signs of aggression.  I'm not trying to suggest they don't when I ask this question, bear with me.  You would agree with me that personal care workers, enrolled nurses, registered nurses are trained in de-escalation strategies for dealing with that?‑‑‑No, actually we find that it's quite uncommon that in aged care they're given that specific training.


Okay.  You're not familiar with a Certificate III in individual support?‑‑‑I'm not specifically familiar with it, no.


So you wouldn't know whether or not there's de-escalation involved in a Certificate III?‑‑‑No.


Are you telling me that when a nurse does their university degree and they do aged care as a unit, are you telling me that that doesn't involve dealing with aggression and de-escalation strategies?‑‑‑I'm not familiar with the nursing - - -


So it's that you don't know the answer rather than I'm wrong?‑‑‑I know that there's very rarely that training provided by the aged care facility.  I don't know about their previous qualification.


Okay, that's fine.  Would I be right in saying that aged care facilities don't require their employees to place themselves to remain in a position of harm?‑‑‑That would be their policy.

***        KATHERINE ANNE CHRISFIELD                                                                                                 XXN MR WARD


And they would have procedures for when the employee should remove themselves from the situation?‑‑‑They should.


They should.  Thank you.  My understanding is that most operators work with some sort of alarm system if somebody needs help.  That might not be present everywhere, but do you understand some of them have that approach?‑‑‑Some of them do have both individual duress alarms for the staff and also the nurse call buttons in the resident room, but - yes, (indistinct).


I think your evidence - your concern in the evidence is that somebody might not always be available to help them; that's right, isn't it?‑‑‑Yes.


In relation to home care am I right - I think there is some evidence of this - am I right in saying that before I start sending people, and this might be the very first visit, I'm not entirely sure, but there's normally a risk assessment done at the home?‑‑‑That would be dependent upon the provider.  That's what should occur, yes.


So you have knowledge of some providers who don't do any risk assessment?‑‑‑Who either do - sometimes there's a risk assessment done over a telephone, so not at the premises, so they can't actually see the location, or sometimes they're not done because there's an urgency to get someone in to see the person.


And in the latter case is it that they would do the risk assessment as soon as they could?‑‑‑That's what should occur.


That's good.  But you would agree with me that there are people who undertake risk assessments before - - -?‑‑‑Yes.


You would, yes?‑‑‑Yes.


Okay.  And my understanding is that those risk assessments in home care examine the physical environment of the home and whether or not it's fit for the person to provide care.  Is that broadly your understanding?‑‑‑It's very dependent upon the risk assessment done by the provider, because there's no standard risk assessment form, so those risk assessments cover - I can't say what each - - -


So from your experience as a professional safety person you might be happy with some and less happy with others?‑‑‑Yes.

***        KATHERINE ANNE CHRISFIELD                                                                                                 XXN MR WARD


Yes, okay.  Am I right that if I'm doing home care work, a bit like residential aged care, there will be a protocol about de-escalation if I'm confronted by aggression or something like that?‑‑‑I would expect that that would be in place.


Would you also expect there would be a protocol about when I leave the home environment if I'm in an unsafe situation?‑‑‑I'm sorry, I don't quite understand, in terms of the protocol for calling for help or reporting - - -


Sorry, I apologise, that wasn't very fair of me, I will go through.  So let's say I'm in a home environment and I'm the carer and I am confronted by the person I'm caring for and they're demonstrating some aggression.  I assume the first thing that I would call somebody about that or do I just apply de-escalation strategy?‑‑‑It's going to very much depend on the circumstance and the nature of the risk that you're exposed to at that time.  Some of those would require you to remove yourself immediately from the circumstance.  Others you might be able to attempt de-escalation.


I take it in your knowledge most of the home care providers have rules about when you have to ring for assistance or to get further advice?‑‑‑I'm not familiar with the home care providers - - -


Okay?‑‑‑In terms of their protocols.


Bear with me, I don't quite know how the Victorian safety system works, so if I use language which sounds certainly like New South Wales bear with me if you can.  Have you ever had cause to call Safe Work Victoria in because of a safety incident in an aged care facility?‑‑‑Yes.


And how often would you do that?‑‑‑Amongst myself and my team that would occur at least once a month.


And what's typically what you're calling them in for?‑‑‑It can vary quite significantly.  A number of the - I would say probably the majority of the calls are either around occupational violence and aggression risks that are not being managed, or patient handling, resident handling, concerns for staffing levels and the safety of the staff in terms of working alone, or access to assistance in an emergency.


So I take it if it's a staffing level issue you're suggesting that the staffing levels have reached a point where the person is unsafe?‑‑‑Yes, that's right.

***        KATHERINE ANNE CHRISFIELD                                                                                                 XXN MR WARD


Do those normally result in improvement notices being issued?‑‑‑Quite frequently.


Quite frequently.  On a monthly - - -?‑‑‑Pardon?


On a monthly basis?‑‑‑I would say perhaps one out of two.


And what about prohibition notices?‑‑‑Rarely.


And I take it that if an improvement notice is issued the facility will comply with it?‑‑‑As far as we're aware, yes, absolutely.


Okay.  Just a moment if I can.  Thank you very much, Ms Chrisfield, that's all.


JUSTICE ROSS:  Any re-examination, Mr Hartley?


MR HARTLEY:  Thank you, your Honour.

RE-EXAMINATION BY MR HARTLEY                                          [11.19 AM]


Ms Chrisfield, there are two matters that I want to raise with you in re-examination.  Just toward the end of Mr Ward's questioning you were asked some questions about whether risk assessments are done for home care premises.  Do you remember those questions?‑‑‑Yes.


And you identified some circumstances in which a risk assessment might not be done before the first visit.  Do you remember those answers that you gave?‑‑‑Yes.


You were then asked whether risk assessments are then done as soon as possible thereafter.  Your answer was, according to my note, that they should be.  Do you remember giving that evidence?‑‑‑Yes.


Are you able to assist the Commission in regard to whether you know how often they are in fact done thereafter, or do you not know?‑‑‑I couldn't help, I don't know.

***        KATHERINE ANNE CHRISFIELD                                                                                            RXN MR HARTLEY


Yes, thank you.  Earlier in the questioning you were asked whether there were procedures for lifting people in aged-care facilities and you said that there were such procedures.  Do you know whether those procedures are or are able to be followed at all times or not?  Can you assist the Commission in that regard?‑‑‑Yes, from our experience they're not able to be followed at all times. There are a number of reasons for that.  Some of those are because there might not be adequate staff to assist in following those procedures.  Those procedures, if you're using a lifting machine, for example, will require two staff members to assist.  There won't always be two staff members to assist.  Therefore, the staff member will be required to either not attend to that particular resident or use the lifting equipment, for example, on their own, which is against policy.  So they have to make a decision as to whether they comply with the policy or they assist the resident, and that's a difficult one for our members to make.


Relatedly, you were asked in effect to make some assumptions.  Assuming that there are lifting machines available, assuming they're maintained, assuming there's adequate staffing, are they safe and your answer was yes.  We've dealt now with adequate staffing.  Are you able to give evidence about whether in your experience lifting machines are generally adequately maintained or not?‑‑‑I would say that that is very hit and miss.  Some are but there is quite a number that aren't.  It requires a significant maintenance regime to ensure that the lifting machines are maintained appropriately, both in terms of servicing but also they require replacement every 10 years or so, depending on the machine, and that therefore requires quite a lot of capital input and that doesn't always occur as it should.


Thank you.  I don't have any more re-examination, thank you, Ms Chrisfield?‑‑‑Thank you.


JUSTICE ROSS:  Thank you, Mr Hartley.  Thank you for your evidence, Ms Chrisfield, you're excused?‑‑‑Thank you.

<THE WITNESS WITHDREW                                                          [11.22 AM]


JUSTICE ROSS:  The next witness is Mr Venosta?


MR HARTLEY:  That's so.


THE ASSOCIATE:  Mr Venosta, can you see and hear me?


MR A VENOSTA:  Yes, I can, thank you.

***        KATHERINE ANNE CHRISFIELD                                                                                            RXN MR HARTLEY


THE ASSOCIATE:  Can you please state your full name and work address?


MR VENOSTA:  Andrew Peter Venosta - now you've got me.  It's the ANMF Vic branch, Elizabeth Street, Melbourne.

<ANDREW PETER VENOSTA, AFFIRMED                                  [11.22 AM]

EXAMINATION-IN-CHIEF BY MR HARTLEY                             [11.22 AM]


JUSTICE ROSS:  Mr Hartley.


MR HARTLEY:  Thank you, your Honour.  Mr Venosta, it's Jim Hartley speaking.  Can you hear me?‑‑‑I can.


Thank you.  Could you just restate your name, please?‑‑‑Andrew Peter Venosta.


Thank you, sir - and you're an industrial organiser with the ANMF?‑‑‑That is correct, yes.


Did you make a statement in this proceeding dated 29 October 2021?‑‑‑Yes, I did.


For the Full Bench's benefit, that's at tab 214 of the digital hearing book, commencing on page 11588.  Mr Venosta, do you have a copy of that statement with you?‑‑‑Yes, I do.


Have you had an opportunity of reading it recently?‑‑‑Yes, I have.


Could you look at paragraph 4 in your statement, please?‑‑‑Yes.


Where you say, 'Aireys Inlet', should that now read, 'Moonee Ponds'?‑‑‑That's correct.


Can you look at paragraph 9(d)?‑‑‑Yes.


The very last word appearing as, '1988', should that read, '1998'?‑‑‑Correct.


With those corrections, is your statement true and correct to the best of your knowledge and recollection?‑‑‑There is one more correction I'd like to note, if I may.

***        ANDREW PETER VENOSTA                                                                                                     XN MR HARTLEY


Of course?‑‑‑Page 17, paragraph 110.


Yes, what's the correction?‑‑‑So when I was at Lyonsville, the enrolled nurses.


Thank you, Mr Venosta.  With that further correction - sorry, go on?‑‑‑No, and just in the very next sentence:  'Assistance with meals undertaken by P and (indistinct)' also managed residents' laundry needs so the PCWs also assisted with ADLs, hygiene, tidying, which is the way I've written that.  Just wanted to correct that, the way it reads.


Yes, I see - so you want to add after the phrase, 'residents' laundry needs', you'd like to insert, 'and also with ADLs, hygiene and room tidying'?‑‑‑Correct, thank you.


Yes, and with those corrections the statement is true and correct to the best of your knowledge and recollection?‑‑‑Yes, it is.


Thank you, Mr Venosta.  Mr Ward will now ask you some questions?‑‑‑Thank you.



CROSS-EXAMINATION BY MR WARD                                         [11.25 AM]


MR WARD:  Thank you, your Honour.  Am I pronouncing it right, Mr Venosta?‑‑‑That's correct, thank you.


(Indistinct) Mr Venosta.  My name is Nigel Ward, Mr Venosta.  I appear in this matter for the employer interests?‑‑‑Sure.


Do you have your statement in front of you?‑‑‑Yes, I do.


Can I ask you to start at para 13?‑‑‑Yes.


You say there you were the low-care manager.  Does that mean you were the manager of the facility?‑‑‑That's right - so it's a 138-bed facility that cared for, 'low-care residents' at that time.

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


Can I ask you to go to paragraph 18?‑‑‑Yes.


I think you're describing in paragraph 18 the facility you're the low-care manager of.  Is that correct?‑‑‑That is correct.


You say:  'The facility was (indistinct) environment for residents (indistinct) functioning because beds were not height-adjusted and were usually located against the wall.  Staff could not operate either side of the bed to assist residents with transferring in and out of bed.  The size of the room meant that moving the bed still had to provide adequate' - then you read on?‑‑‑That's correct.


Is that typical of what you would have seen in an old-style aged-care facility?‑‑‑Yes, that is correct.  I think that building is circa 1950s, 1960s.


Later on in your statement you talk about purpose-built?‑‑‑Yes.


Purpose-built modern facilities - bear with me, I'm going to struggle to remember exactly where you say it.  I'll come to it in a moment.  But in terms of the purpose-built facility, I take it if you look at paragraph 18, in terms of beds, does it have beds that sort of move up and down and the head comes up?  Does it have adjustable beds in a purpose-built modern facility?‑‑‑Certainly the facilities I managed, yes.


Yes, they did, okay.  Just stay with the facilities you manage, if we could.  In terms of the actual size of the rooms, are they now designed so that the person caring can actually navigate around the bed quite easily?  Are they designed that way?‑‑‑That's correct.


Am I right in saying that the bathroom is also designed with that in mind?‑‑‑That's right.

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


What are some of the things that fit into the design of the new modern bathroom that makes caring for the resident easier?‑‑‑Door is to comply with disability access:  so pushing wheelchairs and commode chairs through the doorways, we have adequate width.  You'd have - toilets could be placed in a corner on an angle so staff could access either side of the toilet rather than having one side of the toilet against the wall.  That could vary between facilities but we certainly have that.  You can have overhead tracking devices built into the ceiling framework, which means you have manual handling hoist systems where you can manage to transfer the resident from the bed to a chair directly into the toilet or shower using the overhead lift hoist system, and just generally more space - - -


Can I ask you to go to paragraph 22?‑‑‑Yes.


You say there 'The documentation' - you're now referring back to when you were the low care maintenance manager, are you, in paragraph 22?‑‑‑Correct.


So back then everything was paperwork, was it?‑‑‑It was.  The whole documentation system was paper-based.


Paper-based?‑‑‑Big, big files.


I think later on in your evidence you talk about the fact that most things have now moved to being electronic?‑‑‑That's a general trend, that's correct.


And from your experience was it easier with paper or is it easier now it's electronic?‑‑‑From my experience I'd say it was a lot easier to have the electronic system.


Can I take you to paragraph 24.  This is about the role of the RN:


Each RN is now effectively a care coordinator for each of the three units.  Key aspects of the role include - - -


And (a), (b), (c) and (d).  In terms of resident assessment is this how resident assessment worked when you were there, that the registered nurse would meet possibly with a potential resident's doctor, they would meet the resident, they would meet with the family, and they would use that to create an assessment of that resident and then build the care plan for that resident.  Is that what the role of the registered nurse would be in that initial assessment?‑‑‑That is correct, but I would also suggest that there's a little bit more detail than just that as you'd have care staff contributing to the documentation process in the form of charts.  So it might be continence charting, (indistinct) charting - yes, behaviour charting, all those aspects - - -


I will come to that.  I am not suggesting that doesn't happen.  At the point of the actual admission of the resident it's the registered nurse that plays that key role in engaging with the doctors, engaging with the resident, engaging with the family?‑‑‑Yes, absolutely.  Absolutely.

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


And then in (d) you've got participation and quality assurance activities.  Who did the registered nurse participate in those activities with?‑‑‑Under the guidance of either a - usually, depending on the structure, there might be a care coordinator - - -


I am sorry, Mr Venosta, I've lost you.  I don't know if it's me or you.


THE WITNESS:  Perhaps some guidance - - -


MR WARD:  Sorry, Mr Venosta, can I ask you to say that again.  I didn't hear your answer, I'm sorry, sir.


JUSTICE ROSS:  Your phone dropped out.


THE WITNESS:  Did it?  Sorry about that.  So with the - sorry, I might get you to repeat the question, Mr Ward, just - - -


MR WARD:  No, that's fine.  If you go to (d) I think you were describing here the role of the RN in - bear with me - - -?‑‑‑Yes, sorry.


- - - in (indistinct) care, and I asked when you say participating and quality assurance, who else do they do that with?‑‑‑So there'd be the - in that scenario it was me as the manager of the facility.  We also had a quality coordinator who supported those processes.


Can I then take you to 27, you seem to have been promoted by this time?‑‑‑Yes.


And you're now the chief executive officer.  Does that mean you ran the show at Lyonsville?‑‑‑Yes, that's correct.


At 29 you say:


Some of the achievements in my time at Lyonsville were implementation of a new policy and procedure framework to ensure compliance with regulator requirements and the accreditation standards.

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


Who actually designed and wrote the policy and procedure framework?‑‑‑We actually purchased the template framework which we then used and moulded to fit our facility.


You bought something from a consultancy to start with.  Is that a reasonable way of describing it?‑‑‑That's correct, yes, and we would then tailor it and mould it.


That's okay.  When you say we tailored it and moulded it who in the facility was involved in that exercise?‑‑‑So myself, the care coordinator.  Registered nurses would be consulted as required.  So you're talking about the development here.  We'd also have external consultancy assisting us just to guide us along with our process as well.


Can I ask you to go to 59, Mr Venosta, if you could.  Please feel comfortable taking time to read 59 if you need to.  You're talking in 59 about the work of personal care workers.  You then say at the end of 59:


As with all aspects of the work to be performed this again needs to be supported with more training of upskill PCWs for such purposes.


When you say more training are you suggesting that a Certificate III in individual support aging is insufficient to be a fully functioning personal care worker?‑‑‑I guess what I'm commenting on my experience is that there need to be ongoing regular training to reinforce these processes.  So I'm not - you know, I've not been involved in the training at the TAFE sector, and very familiar with what those course curriculums are, other than some basic awareness of what the modules might be.  My experience is that we would need to continually reinforce those expectations around how we - and this is I think regarding the model of care, consumer (indistinct) care, et cetera, about how, you know, you facilitate residents' choices and the expectations around that (indistinct).


That would be back when you were the employer, that would be in-house training programs you're talking about?‑‑‑Correct.


Can I ask you to go to 67?‑‑‑Yes.


You're talking in 67 about a variety of things, including physical and violent aggression.  You then say at the end of 67:

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


Training is now provided in-house to identify, manage and de-escalate these incidents.


Is the training there the training, the modules that are in the Certificate III, or are you again there talking about your personal experience about in-house?‑‑‑Yes, I'm talking about my personal experience in providing additional in-house training and particularly with extreme behaviours.  That would often involve getting an external consultant in to deliver that training.


Is this when you were the CEO?‑‑‑Yes, as well.


Okay.  That training you'd get the consultant in for that would have been face to face training?‑‑‑Sorry, face to face did you say?


Yes, I did?‑‑‑That would be correct.


Bear with me, Mr Venosta, you're breaking up a little bit at my end.  I will try that again.  What was the duration of that training?‑‑‑It would be a minimum of - certainly a minimum of one hour.  Depending on the complexity of the issue that we were looking to address it could be anything up to two hours, possibly longer.  But it would be tailored – and often we would have regular annual mandatory training, which would be one hour, specifically, with a whole host of other training needs throughout a scheduled day, if you like.  That might be on hour in the whole day, training.  But we would often deal with resident behavioural incidents, which may or may not involve consequences of harm to other residents or staff.  That could occur at times; it may not.  So, depending on what those incidents were, we would get external consultants in; initially do the debrief as to what occurred, and then look at the corrective actions, if you like, and the training around how that could be dealt with differently in the future.  So we would do that as a process.


If I can just see if I've understood that.  You might have quite a serious incident.  You would investigate it, review your policies and procedures, and if you believed you needed to update those, you would.  And then you'd induct and train people into those policies and procedures?‑‑‑That's right.


Yes.  In paragraph 60A, you say this:


At VMCH (indistinct), PCWs would be rostered in this unit.



***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


My understanding is, you're talking here about a dementia unit; is that right?‑‑‑That's right.  It's dementia-specific, secure environment.




Based on their ability and willingness to work in this environment.  Staff who did not have the right attributes would be rostered in general care areas.


What do you mean by staff who didn't have the right attributes?‑‑‑There'd be various staff who just did not want to work in the environment, because of the confronting nature of the work.  That would be one aspect of that.  You would have staff happy to work in there, but didn't necessarily have the patience to work with those residents and provide the appropriate level of support.  I think another issue is, aged care is a very culturally diverse workforce.  So, depending on cultural background, some people would perhaps find it more difficult in working in that environment as well.  It's a broad sort of issue, without a specific criteria.  But on our observations, based on feedback with the staff, how they were feeling about working in that environment – we had staff who were happy to be there all the time, because they loved working in that space.


Can I take you to paragraph 80.  You're talking here about the accreditation standards, and perhaps you could (indistinct).  I've lost track.  By the time you get to talk about this, where are you working at that stage?‑‑‑Specifically, paragraph 80 is referring to the previous standards, which were replaced with the new standards, I think from memory, in – to start 2018.  So this is the old four standards – A, B, C, D in paragraph 80 – and that was in place right from my first commencement in the aged care sector, way back from my time in (indistinct) care and rehab service and Jewish Care.  So that's basically the four key standards which I've itemised there in paragraph 80.  And then you had the 44 what they called expected outcomes that hang off those four standards.


Thank you, Mr Venosta.  When you talked earlier about buying a system from the consultant and then tailoring it, is this the policy and procedures that you were talking about?‑‑‑Sorry, I'm not sure what you're actually asking there in relation to accreditation.

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


Earlier on you talked about a quality system – I think you said you bought something from a consultant, as a sort of off-the-shelf, and then you worked with your team to tailor it.  When you were talking about that, is that talking about a system to give effect to the aged care accreditation standards?‑‑‑I guess there's a bit of a chicken-and-egg element as to which comes first; driving the policies and procedures and the outcomes.  But obviously policies and procedures have to guide staff on their practice, and at the same time, as a provider, we have to ensure our compliance with the standards.


No, that's all right.  So you might have had a quality system first, and then you tailored it to the accreditation standards?‑‑‑That's right, possibly, yes.


Can I take you to 85?‑‑‑Sorry, what was that?


Paragraph 85, Mr Venosta.  You're talking here about the Aged Care Standards and Accreditation Agency.  And again, this is related to the old standards, is it?‑‑‑Yes.  Just around – my best recollection, around 2017 or 2018, they were just changing the system.  And my facility at that time, which was Star of the Sea, was fortunate, because we went through the last accreditation round before the system changed.  So basically that meant we had a fixed date, we knew when it was happening, and we prepared on that basis.  But thereafter, they had introduced the notion of the three-month window, and the agency would come in within that three-month window.


You talk here about unannounced visits by the agency.  Do you see that?‑‑‑Yes.  Sorry, yes.


That's all right.  When the agency came unannounced, who actually turned up?‑‑‑Sorry.  Inevitably you would have two auditors from the standards agency, quality assessors.


Quality assessors.  And would you meet with them, or who from your organisation would meet with them?‑‑‑The first – the process is fairly well structured, as it was managed by the standards agency.  So the assessors would come in and announce themselves.  They would go straight to the person – the most senior person in the facility on site at the time, meet and greet, show them their credentials and their authority to be on site.  Then they would ask for – it had a specific name, but basically a meeting, which would be a team meeting and briefing, where you had the opportunity to bring in key staff, and they then talked about what the purpose of the visit might be.  And sometimes - - -


So - - - ?‑‑‑Sorry, go on.

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


Sorry, Mr Venosta, you carry on?‑‑‑And they might have a particular focus.  They might be wanting to look at (indistinct) management and fire and emergency procedures.  Depended upon I think what was being driven in the industry at the time, the agency would sort of review various outcomes based on trends they were seeing across the sector, as I recall.


So when you were at these facilities that you were managing and running, how many times did the agency turn up?‑‑‑Minimum once a year, on that schedule, yes.


And I take it when you said they would meet firstly with the most senior person, if you were there, that would be you?‑‑‑That's correct.


And you said that you would bring in relevant members of your team?‑‑‑That's correct.


When you say 'your team' – I'm not being disrespectful, but when you say 'your team', who would you have brought in?‑‑‑So that would be my care manager, clinical care manager, or whatever titled; clinical care coordinator.  The lifestyle coordinator.  Depending on the size of the facility and the roles, you would look at maybe your – one or two of your registered nurses who happened to be on duty on the day.  Possibly a maintenance officer, your chef.  So the key staff in what you'd consider I guess to be your key department areas.


And you said that sometimes they had a particular area of focus?‑‑‑Yes.


And if they were to look at a particular area of focus, would they walk through the facility unaccompanied, or would they be accompanied?‑‑‑So the practice was, straight after the meeting they would then do a tour of the facility, which was guided.


And who would guide them?‑‑‑Usually me, the most senior person.  And that's really just an opportunity to show them really the floor plan and the layout of the facility and, obviously, for the assessors, that's their opportunity where first impressions are very important in their work.


Let's say that they were looking at your incontinence procedures.  If I've said that very badly, let me know.  What sort of information would they ask for?‑‑‑They'd want to look at care plans, assessments, charts; they'd do a random sample of residents, so they'd then track that assessment/care plan process with that resident.  They'd look at progress notes.


Sorry, Mr Venosta - you dropped out?‑‑‑Believe it or not - I'm pleased to say mine didn't.  But that would be an indicator and they would also have direct discussions with residents about how they felt and perceived their continence management, i.e. are they happy?

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


Yes?‑‑‑They'd talk to staff:  'Do you have enough supplies in the form of continence aids', et cetera - 'Do you have the right training?  Do you actually know what you're doing?  How do you know what you're doing', all those conversations.  So they'd link it all the way through to the policy and procedure as well.


Okay.  So when it gets to that level, would you have put a registered nurse in charge of dealing with it at that stage or would you still be involved?‑‑‑No, you don't, no - you don't have control because the control - they go and talk to who they want to talk to, basically.  So they ask for a file, we just give them the file.  It's there for them to peruse, for example.


They're then free to talk to whoever they want to talk to?‑‑‑That's pretty much how it worked, yes.


At that stage they're not being supervised by you or anybody else?‑‑‑That's correct.


Okay.  Can I ask you to go to paragraph 92?  You talk about aged-care funding instruments.  You talk about the ACFI care assessment.  Who is responsible, who is accountable for doing the ACFI care assessment?‑‑‑Well, ultimately the facility manager is responsible to the organisation for ensuring the ACFI assessments are up to date, correct and managed according to schedule and that they're accurate so the funding is maximised.  But then there is a whole system and process that has to follow on underneath that.  The care coordinator would probably be the lead role, managing and supporting the care and medicine staff, in particular the RNs.  Depending on the size of the facility, larger organisations with multiple facilities, for example - so this would be Villa Maria Catholic Homes - they actually had roving ACFI coordinators who would roam around the facilities.  So they would keep you on your toes with your schedules.  They would come in, check the schedule, make sure the packs are out, come and talk to me if we're not up to speed, et cetera, and what that looks like and what we need to do.  A smaller facility like Lyonsville - actually that was asked yesterday, sorry, but a small facility like Arcadia where we only had three facilities in the organisation, we didn't actually have roving coordinators.  So that would be very dependant on myself working and putting quite a bit of responsibility down onto the care manager and the nurses to monitor those ACFI packs, making sure they're out, timely, according to schedule, appropriately completed, no gaps, et cetera.

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


Thank you very much.  In 98 you talk about maintaining care plans.  Can I just see if my understanding is correct (indistinct) from you:  my understanding is the registered nurse is the creator of the care plan.  Is that your understanding?‑‑‑Well, the registered nurse signs off on the care plan ultimately, with the ultimate responsibility, and that's in accordance with their scope of practice.  It may well be that personal carers have contributed to that because they've provided all the charting and documentation to inform the registered nurse and I think over the years it was even more common that the ENs would contribute to the assessment process although under the scope of practice it would still have to go to an RN for a review and a sign-off.


Can I just go through that slowly, if we can?  My understanding is that at the point of admission the registered nurse is normally the person who creates the first version of the care plan.  Is that your understanding?‑‑‑Yes, there is an interim care plan, that's right.


That's right?‑‑‑On the day of admission there would be what we call an interim care plan which is based on the registered nurse's interview of the resident initially and then you have a period of - and this is also ties in with - when the current system actually I think it was a four-week period to develop the full assessment suite to then complete the full actual assessment and then you'd have the full care plan developed at that point.


My understanding is this, that personal care worker obviously is doing their progress notes of the residents they look after, they're doing charting.  I understand that the RN has access to that material.  The RN might talk to the EN or talk to the personal care worker, listen to their observations about what they're seeing with the resident and if there is a change to the care plan it's the registered nurse who makes the decision to change it?‑‑‑That would be correct, based on the relevant information.


Yes, okay.  Can I ask you to go to paragraph 129 and, Mr Venosta, if you don't know the answer to this question just let me know.  You talk in 129 about the inclusion of medication training into the diploma of nursing, which as I understand it, is what the enrolled nurse does.  That's correct, isn't it?‑‑‑That is correct, yes.


Do you know why the medication training was rolled into the diploma?‑‑‑I couldn't specifically answer that, no, other than that - to provide additional workforce support and capacity but I can't specifically say why it was at the time.  Probably also had to broaden the scope of practice of the enrolled nurse.


Just give me a moment.  Thank you, Mr Venosta, for your evidence - no further questions.


JUSTICE ROSS:  Any re-examination, Mr Hartley?

***        ANDREW PETER VENOSTA                                                                                                        XXN MR WARD


MR HARTLEY:  There is no re-examination, your Honour.


JUSTICE ROSS:  Thank you for your evidence, Mr Venosta.  You are excused?‑‑‑Thank you very much for your time.

<THE WITNESS WITHDREW                                                          [11.57 AM]


JUSTICE ROSS:  Do we have Mr Gilbert next, is that right?


MR HARTLEY:  That's correct, your Honour.




THE ASSOCIATE:  Mr Gilbert, can you see and hear me?


MR R GILBERT:  I can, thank you very much.


THE ASSOCIATE:  Can you please state your full name and work address?


MR GILBERT:  Robert Francis Gilbert, 535 Elizabeth Street, Melbourne.

<PAUL FRANCIS GILBERT, AFFIRMED                                      [11.58 AM]

EXAMINATION-IN-CHIEF BY MR MCKENNA                           [11.58 AM]


JUSTICE ROSS:  Thank you, Mr Gilbert.  Mr Hartley.


MR HARTLEY:  Yes, Mr McKenna with this witness, your Honour.


JUSTICE ROSS:  All right, Mr McKenna.


MR McKENNA:  Thank you, your Honour.  Mr Gilbert, can I confirm that you can see and hear me?‑‑‑I can, yes.  Well, I can't see you yet.

***        PAUL FRANCIS GILBERT                                                                                                        XN MR MCKENNA


Do you want an opportunity to try and find the - Mr Hartley, Mr White and I are in - we're small figures in the one screen?‑‑‑Yes, yes, I can see you but your lips weren't moving.


Hopefully they are now.  Could you please repeat your full name?‑‑‑Paul Francis Gilbert.


Your professional address?‑‑‑535 Elizabeth Street, Melbourne.


You are an assistant secretary of the Victorian branch of the ANMF?‑‑‑Correct.


Have you prepared a witness statement for the purpose of these proceedings?‑‑‑I have.


And is that a statement dated 29 October 2021?‑‑‑It's at 9293 in the digital book if that helps.  I don't remember the exact date, but I - - -


Do you have it with you?‑‑‑Yes, it's on the screen, yes, but I just wasn't at the first page, so - - -


And that's a statement of 78 paragraphs running over 22 pages?‑‑‑That would be correct.


And on the last page hopefully you will see the date 29 October 2021?‑‑‑That's why it's been taking me a while because I was looking at the start.  Look, there we go, it is dated 29 October 2021.


Terrific.  And have you had a chance to read that recently?‑‑‑I have.


I understand there are a number of changes that you wish to make to it, the first of those on page 12 to paragraph 42.  Can I take you to that, please?‑‑‑Yes.  Sorry, paragraph 42 I do make a statement about - a conflicting statement about the number of standalone facilities.


So paragraph 42 in the second sentence currently reads:


The number of standalone facilities has collapsed from over 200 in the early 2000s to the current number of approximately 10 or 15.


Would you omit the words 'of approximately 10 or 15'?‑‑‑That would be beaut, yes.

***        PAUL FRANCIS GILBERT                                                                                                        XN MR MCKENNA


And also in that paragraph in the third last line reading from the fourth last line:


In most cases this was due to absorption of exiting standalone facilities.


I understand you change that to 'existing'?‑‑‑Yes, please.


And then moving to paragraph 67, which commences on page 17, we have there - if you forgive me, I will catch up - you have there a number of dot points under the chapeaux at paragraph 67 in response to the question, 'What would have prevented some hospital transfers', and I understand that that paragraph would end at the second to last dot point.  So the second to last dot point being, '43 per cent of respondents reported GP availability', and you put a stop there and delete the 'and'?‑‑‑Yes.


And then the following dot point would form standalone paragraph providing - and you insert the words 'of respondents'.  So it would read, '87.5 per cent of respondents (indistinct) that mandated minimum ratios' - and so on?‑‑‑Correct.


And then I think finally paragraph 70 commencing on page 18, and over the page on page 19 there is part of that paragraph which isn't numbered, perhaps might be, but at the end of that on the fifth line on page 19 it ends in the word 'years'.  It says, 'But the dramatic changes I have observed in the last 15 or more years.'  I understand you'd add to that, 'have meant that the system is far worse than it was.'  Is that correct?‑‑‑That's correct.


Are there any other changes, corrections or clarifications you would make to the statement?‑‑‑No, thank you.


Subject to those changes that I've identified are the contents of your witness statement true and correct?‑‑‑Yes.


And within your statement you also refer to a number of other documents identified as 'ANMF' and then a number, those documents being contained in the ANMF tender bundle.  Have you had a chance to review the documents that you refer to in your statement?‑‑‑I have.


And are the documents in the tender bundle true copies of the documents that you refer to in your statement?‑‑‑Yes, they are.

***        PAUL FRANCIS GILBERT                                                                                                        XN MR MCKENNA


If the Full Bench pleases that document subject to those amendments is relied upon, and if it's convenient to the Full Bench we will file an updated or amended version.


JUSTICE ROSS:  Thank you.


MR McKENNA:  So, Mr Gilbert, you hopefully will see Mr Ward in one of the squares on your screen and he now has some questions for you.  Thank you.



CROSS-EXAMINATION BY MR WARD                                         [12.04 PM]


MR WARD:  Mr Gilbert, can you see and hear me okay?‑‑‑I can, yes.


My name is Nigel Ward, Mr Gilbert, and I appear in these proceedings for the employer interests.  You're the last witness before lunch, so I will go quickly with you if that's okay, sir.  You're the assistant secretary in the Victorian branch is my understanding; that's correct?‑‑‑That's correct.


It's not clear to me - have you been a union official since 2009?‑‑‑An elected official since 2009 and a union employee prior to that.


So when is the last time you weren't a union official either employed or elected?‑‑‑About the year 2000.


Okay.  So I think you say that you started your career as an enrolled nurse in Bendigo in the mid 1980s?‑‑‑Yes.


So from the mid 1980s to 2000 you were acting as an enrolled nurse, is that right?‑‑‑That's right.


Were you working in the aged care sector at that time?‑‑‑I worked a year at the aged - the Bendigo Home and Hospital for the Aged as it then was, and then I went to Queensland for a couple of years and then I came back to the same facility, the Bendigo Home and Hospital for the Aged and worked there until 2000.

***        PAUL FRANCIS GILBERT                                                                                                             XXN MR WARD


So you were working in the aged care sector from the mid 80s to 2000?‑‑‑That's right.


Okay.  Thank you.  Bear with me, I'm going to jump around a little bit if I can.  Could I ask you to go to paragraph 59?‑‑‑Yes.


I think at paragraph 59 and paragraph 60 you're talking about some ANMF Victoria Enterprise Agreement.  Do you see that?‑‑‑Yes.


Are you talking there about enterprise agreements in aged care, or are you talking about enterprise agreements somewhere else?‑‑‑In 59 I'm talking about both, because it was - it talks about the structure that was developed for the public sector enrolled nurse that was then flowed onto most private hospitals and private aged care, or a proportion of private aged care as well.


And you talk in 59 about medication modules and achieving a 4 per cent medication allowance for endorsed ENs into the agreement.  Do you see that?‑‑‑Yes.


Just for my benefit what was an endorsed EN back then?‑‑‑That was an enrolled nurse who had completed education to the satisfaction of the Nursing and Midwifery Board of Australia to enable them to administer medication.


And later on you talk about the fact that that I think it becomes consumed in the Diploma of Nursing.  Do you see that in 60; that's my understanding of what you're saying there, is it, 'The diploma (audio malfunction) included medication modules.'  Do you see that?‑‑‑Yes.  We had people who did it as an add on to their existing qualification, and then you had new people coming through for whom it was embedded in their education.


Do you know why it became embedded in their education?‑‑‑Because it needed to be.  I have spoken about that in other parts of my witness statement about the issues around administration of medications in private aged care and the need for a skilled workforce to do that.


Do you have any understanding as to why the ANMF agreed to a 4 per cent allowance?‑‑‑It was a case of all we could achieve in the circumstances.  There was no science to it, it was - - -


Okay.  It was the haggled number rather than a scientific number?‑‑‑Correct.

***        PAUL FRANCIS GILBERT                                                                                                             XXN MR WARD


Can I ask you to go to page 8, and in particular starting at paragraph - - -?‑‑‑Can you tell me the paragraph.


No, I was going to do that, sir.  Sorry, my apologies, paragraph 26.  Do you see that paragraph?‑‑‑I do, yes.


Obviously it's your understanding that registered nurses now undertake a university degree?‑‑‑Correct.


Is it your understanding that what they actually do in aged care reflects the competencies they learn from that university degree?‑‑‑Yes, it does by much.


I'm right, aren't I, in saying that nurses have ultimate authority over clinical care of the people underneath them?‑‑‑They have responsibility for the clinical care of those they delegate it too, yes.


Yes, yes.  And it's your understanding that the registered nurse is accountable for the care plans of residents in aged care?‑‑‑That's my understanding of how it works, yes.


The enrolled nurse - you see in 27 you talk about the enrolled nurse.  Again, I assume you'd agree with me that they're exercising competencies that arise from their diploma program?‑‑‑That's right, yes.


And you talk there about the fact that there's been a tendency for them to become team leaders?‑‑‑Yes.


You see that.  I take it that that is a supervisory role of personal care workers sitting between the personal care worker and the registered nurse?‑‑‑That's right.


But again, the enrolled nurse is still working under the general delegation of the registered nurse in that role, aren't they?‑‑‑Yes, they have to be by law.


Yes, okay.  You talk in paragraph 27 about undertaking complex wound care.  Could you just describe for me what you meant by complex wound care?‑‑‑It's probably easier to describe what's not but a complex wound is one who - their  wound's something bigger than a skin tear, so it's gone through various layers of skin into potentially muscle and bone.

***        PAUL FRANCIS GILBERT                                                                                                             XXN MR WARD


Bear with me, I'm not medically trained in any sense of the imagination.  Would that suggest that the wound requires sutures or - - -?‑‑‑No, it usually requires a packed dressing of some description.  So you've got to be; (a) capable of understanding the process of doing a dressing; (b) you can do with an aseptic technique and so forth.


You would - it's your understanding that that's the domain of the enrolled nurse?‑‑‑Not the sole domain of the enrolled nurse.  It's the domain - - -


Could be registered nurse as well?‑‑‑Yes, registered nurse, enrolled, yes, that's right.


And then when you talk about personal care workers, you talk about them performing basic wound dressing?‑‑‑Yes.


I assume that's - you're saying that in distinction to complex wound care?‑‑‑I am.


Could you describe for me what you meant by basic wound dressing?‑‑‑It'd be something like a film dressing over a skin tear, for example.


For somebody who's really not medically inclined, could you develop that a little bit so I can understand that?‑‑‑Well, one of the most common injuries suffered by people, elderly people is what's called a skin tear.  So, it's where you and I - used to me - might bump into something and go ouch, an elderly bumps into something and their skin actually breaks open and that means you've got a very - it's superficial but a lot of blood and you've got skin that's peeled away from the body a bit.  So the dressing aims to put that skin back in place and create a sealed space in which it can hopefully recover.


That would be an example, in your evidence, of basic wound dressing?‑‑‑That's correct.


Okay, that's fine, that's fine.  And I assume that you would agree with me that if a personal care worker has a Certificate III, they will be exercising the competencies arising from that Certificate III in their job?‑‑‑I'm afraid they're probably exercising more than the competencies for the Certificate III, and that also depends on where they did their Certificate III.

***        PAUL FRANCIS GILBERT                                                                                                             XXN MR WARD


Is that because Certificate IIIs are better than others?‑‑‑I think that's been fairly consistent evidence from us and the findings of the Productivity Commission to the same effect, but it doesn't have the rigor, if you like, of the nursing qualification where the nursing qualification has to be approved by the Nursing Board, the Certificate III qualification is a - is a competency based qualification that isn't delivered in the same form by all providers.


Just bear with me a minute if you could.  I just want to understand what you've just told me.  So, you have a view that some registered training organisations are better than others, do you?‑‑‑Yes.


Assuming - I don't know what you think of as a good one or a bad one but let's assume you're thinking of a good one and they're discharging the requirements for a Certificate III in Individual Support, reference number CHC33015.  I don't expect you to know the number but that's it.  You would be - if it's a good one, you'd be confident about the competencies that that employee would have?‑‑‑To the extent the competencies were included in the training, that's right.


And your concern is that - to put it bluntly - you think there's some shonks out there?‑‑‑Yes, but I think there are - I wouldn't go as far as to say shonks, there is just a hierarchy and someone's always at the bottom.  There's - look, it's well known in the industry that there are good and bad deliverers of Certificate III, I don't think that's controversial.


Your observation is that that arises because they don't have the same rigors of registration that nurses do?‑‑‑That's how you get a differentiation between what should otherwise be the same course.


So, you can - I can rely on the education the nurses get to be the registered nurse or the enrolled nurse.  I can rely on the level of competency that they hold but you're saying that the personal care worker, the level of competency they might hold might different depending on who was their RTO?‑‑‑Yes.


Thank you very much, Mr Gilbert?‑‑‑Thank you.


No further questions.


JUSTICE ROSS:  Mr Gilbert, I just have a question for you.  I wanted you to explain paragraph 62 to me.  Can I take you to that?‑‑‑Yes.

***        PAUL FRANCIS GILBERT                                                                                                             XXN MR WARD


I'm just trying to understand the table.  So, this is headed 'The average number of residents each registered nurse is responsible for', and you've got on the left, 'zero to 50, 50 to 100'.  Can you explain - just go to one of the boxes and interpret it for me and explain what it's saying?‑‑‑Well, in the first line you've got 47 per cent of registered nurses having responsibility for zero to 50 residents on a morning shift.


And - - -?‑‑‑And if you go down one from that 41 per cent have responsibility for over 50 but 50 to 100, that should be 51 to 100, so it's just that's the - what it's breaking down to is the number of residents that one registered nurse is responsible for in respect to a given shift.


And if you look at the number of residents naught to 50, the percentage drops from morning to afternoon to night?‑‑‑Yes.  Meaning that there's less registered nurses on some shifts than others.


I see?‑‑‑It's also a bit problematic because in some of these facilities there is no RN at night, so when you look at the data it spins back an odd number in some cases.


Well, there's also a difference in the 100 to 150 residents there.  The percentage seems higher for the night than the morning?‑‑‑Yes, so it's more common at night to be responsible for a higher number of residents than it is in a morning shift.


I see, yes.  Because there are fewer - - -?‑‑‑There might be two registered nurses on a morning shift and they're splitting the number between them.


I see.  No, I follow.  Right, thank you.  Anything arising from that?  No.  Any re-examination?


MR McKENNA:  Thank you, your Honour.  No re-examination.  Might Mr Gilbert be excused?


JUSTICE ROSS:  Certainly.  Thank you for your evidence, Mr Gilbert.  You're excused?‑‑‑Thank you.

<THE WITNESS WITHDREW                                                           [12.19 PM]


JUSTICE ROSS:  I think we now have - I thought you were a bit optimistic, Mr Ward, with the no more before the lunch break because I think we've got Melissa Coad, don't we?


MR WARD:  She's not required, your Honour.

***        PAUL FRANCIS GILBERT                                                                                                             XXN MR WARD




MR WARD:  Apologies - I had asked for that to be communicated first thing this morning.


JUSTICE ROSS:  No, no, that's fine.  No, never apologise for not requiring a witness, Mr Ward.  So I think that concludes the evidence insofar as the Full Bench is concerned and then I think you're before Commissioner O'Neill later today and you're before me at 1 o'clock for the mention and as I've indicated, I think you've probably  already received the short email with some suggestions that might inform our discussion at the mention.  Thank you very much, we'll adjourn.

LUNCHEON ADJOURNMENT                                                          [12.20 PM]

RESUMED                                                                                                [2.00 PM]


COMMISSIONER O'NEILL:  Good afternoon.  Just a couple of matters before the first witness is called.  In relation to the hearing plan, I understand there's a plan for tomorrow that's been provided earlier today.  I am just inquiring as to the plan for the remainder of the evidence, through to the end of next week, if there's any difficulty in providing a plan by the close of business tomorrow.  I am not so troubled by the identification of the individual lay witnesses, if that is troublesome, but at least in relation to the days on which the Full Bench is required to sit as the Bench.


MR GIBIAN:  Thank you, Commissioner.  Look, there's no difficulty with that.  I think the broad scheme was chartered in the earlier document, and we've been filling in the names of the individual witnesses at least a couple of days beforehand, which we'll continue to do, but we can certainly repeat the sort of broad scheme.


COMMISSIONER O'NEILL:  I think that would help, for a couple of reasons.  One is a number of the experts from the original plan that was filed have already given evidence, so there's been some reasonable changes, but I also noted in one of the emails – I think it was on Friday – indicated that the Bench would only be required on 9 May for Dr Eagar's evidence, and I wanted to disabuse them of that, which I'm assuming that's not the case.  So the earlier that advice is provided, I think that would help.


MR GIBIAN:  Of course, Commissioner.


COMMISSIONER O'NEILL:  The second thing was in relation to the application for an order for Maria Phillips to appear.  I just wanted to check, she was originally down to give evidence tomorrow afternoon I think in the original – or the plan as of yesterday that's been moved.  I just wondered, Mr Ward, if you're able to confirm that she will still be required for cross‑examination.


MR WARD:  Yes, she will, Commissioner.


COMMISSIONER O'NEILL:  All right.  I take it you have no issue in the order being made.


MR WARD:  No.  It's a matter for the Commission.


COMMISSIONER O'NEILL:  It is.  The draft order that was provided with the application was for that order to apply from today.  If there's any greater clarity around when she will be giving evidence, that might just assist; if you could perhaps provide that to my Chambers later this afternoon.


MR WARD:  Of course.


COMMISSIONER O'NEILL:  And I'll make the order accordingly.


MR WARD:  Thank you, Commissioner.


COMMISSIONER O'NEILL:  All right.  Is Ms Cowan - - -?


MR GIBIAN:  Yes, just in terms of this afternoon briefly before we go to Ms Cowan, we had originally intended to have Anita Field as the third witness.  She's had a personal family issue come up, which means she's not available this afternoon, so we'll have to rearrange her for another time, which means there's four witnesses that are left to be dealt with that we'd arranged for this afternoon.  The first of those is Ms Cowan.


COMMISSIONER O'NEILL:  I think you're there, Ms Cowan.  Can you hear me all right?  You're on mute.


MS COWAN:  Okay, I'm not on mute anymore.


COMMISSIONER O'NEILL:  All right.  My associate's going to just have you take the affirmation.




THE ASSOCIATE:  Ms Cowan, can you please state your full name and work address?


MS COWAN:  Lynn Marie(?) Cowan, Bolton Clarke in Rockhampton.

<LYNN COWAN, AFFIRMED                                                              [2.04 PM]

EXAMINATION-IN-CHIEF BY MR GIBIAN                                    [2.04 PM]




MR GIBIAN:  Thank you, Ms Cowan.  Can you hear me?‑‑‑Yes, I can.


I don't think I've spoken to you.  I'm Mark Gibian.  I'm appearing for the HSU.  Can you just repeat your full name for the record?‑‑‑Lynn Marie Cowan.


And you're a personal care worker with Bolton Clarke Residential Aged Care?‑‑‑Yes, I am.


You've made two statements for the purpose of these proceedings.  Do you have those both with you?‑‑‑I do.


The first of those is dated 31 March 2021?‑‑‑Yes.


And runs to some 138 paragraphs over 14 pages?‑‑‑It does, yes.


Do you have that one?‑‑‑Yes, I do.


Have you had an opportunity to read it through?‑‑‑I've read most of it through, yes.


Is it true and correct to the best of your knowledge and recollection?‑‑‑Yes, it is.

***        LYNN COWAN                                                                                                                                XN MR GIBIAN


That's the first statement, Commissioner, that we seek to rely upon from Ms Cowan.  It's document 183 in the digital court book commencing at page 10692.  You should I think also, Ms Cowan, have a reply statement, a document headed, 'Reply witness statement of Lynn Cowan.'  It's dated 19 April 2022?‑‑‑Yes, I do.


And it runs to some 62 paragraphs.  I don't they're numbered pages?‑‑‑Paragraphs.


Have you also had an opportunity to read that document?‑‑‑Yes, I have.


Is it true and correct to the best of your knowledge and recollection?‑‑‑Correct.  Yes, it is.


That's the second statement of Ms Cowan we seek to rely upon, Commissioner.  It's at document – and has to be included in the evidence – at document 184 in the digital court book commencing at page 10829.  Ms Cowan, I'm not sure how well you can see on the screen in front of you, but one of the squares should have Mr Ward in it.  He wants to ask you some questions?‑‑‑Yes.  Thank you.

CROSS-EXAMINATION BY MR WARD                                           [2.07 PM]


MR WARD:  Ms Cowan, can you hear and see me?‑‑‑Yes, I can.


Can I just ask, are you safe in that car giving evidence?  Are you okay?‑‑‑Yes, my husband's driving.


Okay.  No, that's okay?‑‑‑Sorry.


I was worried you might be driving?‑‑‑No, no, no.  No, my husband's driving.  I'm in the passenger seat.


I am content.  That's fine.  Do you have your first statement in front of you?‑‑‑Yes, I do.


Can I just ask you to go to paragraph 3 for a moment?  You see paragraph 3?‑‑‑Hello?


Sorry, Ms Cowan, we lost you for a moment there.  I think you might have broken up.  You certainly did for me?‑‑‑Is that the education qualifications?

***        LYNN COWAN                                                                                                                               XXN MR WARD


Yes.  Have you got that in front of you?‑‑‑Yes, I do.


Can you tell me what year did you get your Certificate III in Aged Care?‑‑‑It would have been around 2016 I think.


And your Certificate IV in Aged Care?‑‑‑2017 or '18.  Sorry.


That's okay.  Certificate IV in Dementia Care?‑‑‑I think.  Might have been (audio malfunction) I can't remember offhand.  That was done around 2016.


Sorry, you broke up there.  Is that the certificate for aged care or the certificate for dementia care?‑‑‑Certificate for dementia care, 2016.


Thank you.  Then you say you have a certificate in food handling.  Can you tell me what that certificate is?‑‑‑(No audible reply)


Are you there, Ms Cowan?


COMMISSIONER O'NEILL:  Ms Cowan, you appear to have frozen.


MR GIBIAN:  Can I suggest we ask Ms Cowan if she can pull over and maybe that might be at least - her husband can pull over, sorry, and that might at least reduce the prospects of interruptions.


COMMISSIONER O'NEILL:  Ms Cowan, did you hear that all right?‑‑‑Sorry about that.  Yes, I did.  We are pulling up soon.  We've just got to make a safer area.


All right.  We'll just give you a moment?‑‑‑Probably in the next couple of minutes.  Sorry about the hold‑up.


That's all right?‑‑‑We're on the highway.  We're just waiting to get into a service station that is just up the road.


All right?‑‑‑I was hoping to be pulled up well before now actually, but we've had a bit of traffic.

***        LYNN COWAN                                                                                                                               XXN MR WARD


Just while you're doing that, Ms Cowan, is your surname spelt with an 'A' or an 'E'?‑‑‑An 'A'.


An 'A'?‑‑‑I did try and get them to rectify that one, but obviously they haven't.  They have done it on one.  They have got 'Witness statement of Lynn Cowan' - 'a‑n'.


Yes?‑‑‑And then the have put 'e‑n' on a lot of other places in it.


Yes, including your reply statement, so I just wanted to be sure?‑‑‑Yes.  No, it's 'a‑n'.  We're just about ready to pull up soon, sorry.


MR GIBIAN:  Commissioner, just while we're waiting, I think in terms of the scheme of evidence, as I understood what the Full Bench intended is that they would be available to hear the expert evidence - of which there is some - on Monday, the 9th.  As I understood it, also the employer's witness evidence which is proposed for the 11th and the 12th.


COMMISSIONER O'NEILL:  Are there any remaining union officials?  I thought, unless I've missed something, there is still Mr Bonner and Ms Svenson.


MR GIBIAN:  I think Ms Svenson is not required for cross‑examination.  Mr Bonner, I think is a Nurses Federation witness who had COVID, as I think I recall the indication.  He has been rearranged to the 9th so he can be dealt with after Ms Eagar who is an expert that we're calling at that time, so it can be continuous.


COMMISSIONER O'NEILL:  So the 9th, the 11th and the 12th we'll cover it from the Full Bench.


MR GIBIAN:  It's really only contemplated the morning - and maybe not even all of the morning - of the 9th.


COMMISSIONER O'NEILL:  All right.  That's helpful, thank you.


How are you going, Ms Cowan?  Have you pulled over?‑‑‑Yes, just about.  I'll sat the tables around the corner.

***        LYNN COWAN                                                                                                                               XXN MR WARD


You can stay in the car, that's perfectly fine.  It's just without moving you're less likely to come in and out of bad reception?‑‑‑That's all right.  I'll go around to the table.  Okay.


All right.  Mr Ward?


MR WARD:  Thank you, Commissioner.


THE WITNESS:  I apologise for that.


MR WARD:  No, no, Ms Cowan, don't you do that.  That's fine.  That's entirely fine.  I was taking you to paragraph 3(1)(d)?‑‑‑Yes.


And it says there you have a certificate in food handling?‑‑‑Yes.


Can you explain to me what that certificate involves?‑‑‑That was done through the Barrier Reef TAFE in Cannonvale in the Whitsundays.  It just showed you a basic thing on how to handle food, what contaminates food can have, all the outside stuff that food can get contaminated with and periods of time in which food is - the heating temperatures, their cooling temperatures, what times you've got between both.  Yes, just basic food handling pretty much.


Do you have a copy of that certificate?‑‑‑Not on me at the moment, no.


In your possession do you have a copy?‑‑‑I do at home, yes.


I call for that, Commissioner.


COMMISSIONER O'NEILL:  Right, well, we'll adopt the same approach.  Mr Gibian can arrange that.


MR WARD:  Don't worry about what I've said, Ms Cowan.  Mr Gibian is going to ask you to provide a copy of that to him, okay?‑‑‑Yes, no worries.


That's fine, that's fine.  How long was that food handling course?  Was it several days or how long did it go for?‑‑‑I think it was just a couple of days.  It was only just a basic food handling one for work.

***        LYNN COWAN                                                                                                                               XXN MR WARD


If you go down the list, you've got in paragraph 3(1)(h) - - -?‑‑‑Yes.


- - - a certificate to recognise healthy body systems?‑‑‑Yes.


What is that certificate, Ms Cowan?‑‑‑That was just an online one we do at work - through work.


Right?‑‑‑Yes, just the company provides online training.


How long was that online course for?‑‑‑Probably only about half an hour.


What was it teaching you about?‑‑‑Offhand I can't remember at the moment.


That's fine, that's fine?‑‑‑It was as while ago.


That's all right.  When did you do that?‑‑‑I'm not sure about that one either, I'm sorry.


No, that's all right.  Please don't answer a question if you're not comfortable, that's fine?‑‑‑Yes.


Then at the bottom you have got an assist with client medication certificate?‑‑‑Yes.


Was that a company course or was that an external course?‑‑‑That was an external course through Blue Stone Medical.


How long did that course take to do?‑‑‑Three days.


What was the content of that course?  What was it about?‑‑‑Just basically assisting clients with medication prompting; doing creams, applying creams; with their eye drops, doing eye drops; ear drops.  Just more or less along those sort of lines.


You used a phrase then, you said 'medication prompting'?‑‑‑Yes.

***        LYNN COWAN                                                                                                                               XXN MR WARD


Can you explain to me what medical prompting is?‑‑‑It's not actually physically giving them their medication.  It is just prompting the clients, to remind them to take their medication, and just view that they have taken them.


The application of the creams, I take it they - are they creams related to bruising of skin and things like that?‑‑‑


Yes, bruising of skin, moisturising creams, those sort of things, yes.


The eye drops; what sort of eye drops were you being trained in?‑‑‑Medicated eye drops and just your normal eye drops for dry eyes, and, you know, irritated eyes and stuff.


I take it that once you had completed that course you were qualified then to prompt medications, apply creams and do eye drops.  Is that what it was for?‑‑‑Yes.


Yes, okay.  Do you have a copy of that certificate?‑‑‑I do in my possession, but not here.  At home.


That's fine.  Commissioner, I call for that, as well.


Now, can I take you to the bottom of the first page of your statement?‑‑‑Yes.


You talk there about employment with Whitsunday Leisure Activity Centre.  Just bear with me, Ms Cowan, I just need to understand what that is and I'm struggling a little bit.  As you seem to describe it, it's an activity centre that older people, people with a disability can come and do activities.  Is that right?‑‑‑It's a - like a respite centre from family and that where they can - we pick them up in the mornings and bring them to the centre.  We offer them morning tea and then we do craft, we do singalongs, we play games, we play - you know, do other things with them, as in encouragement to get outside, do gardening, make craft stuff and then we offer them lunch.  Then after lunch, we have a bit of quiet time where they can read or watch a bit of television, and then in the afternoon we offer them afternoon tea and then we take them home.


Right.  When you say you take them home?‑‑‑Yes.


That could be back to a residential aged care facility?‑‑‑Not normally.  It's normally to their home residence where family are.  The family - sorry.

***        LYNN COWAN                                                                                                                               XXN MR WARD


No, that's all right.  Keep going, I don't want to interrupt you, that's fine?‑‑‑Yes.  Their family, it's respite for their family.  They may go to work or something like that, so we pick them up in the morning and bring them to the centre and take care of them while their family or their caregivers are at work or doing other things and then we drop them home of an afternoon.  And normally the family is always there to greet us sort of thing when we drop them home.


I don't - I'm not familiar with these types of centres so just bear with me if I say something that sounds a little silly?‑‑‑Yes.


Is there a registered nurse on duty at this centre?‑‑‑Not normally, no.


What do you mean by not normally?‑‑‑Well, if we need someone we call up an ambulance or something like that, we don't have a registered nurse on premises.  I don't know whether things have changed because I haven't been with that company now for 10 years.


No, that's fine.  Just think about when you were there, that's all I'm asking you to do?‑‑‑Yes.


Who's in charge of the centre?‑‑‑In charge of the centre was Ms Deighton.


What was the title of that person?‑‑‑She was the CEO.


Do you know if that person was a registered nurse?‑‑‑No, I don't think she was.


So, am I right - and I think you'll understand what I'm about to say because you're qualified?‑‑‑Yes.


Am I right in saying that you were not aware of the care plans of those people when they attended the centre?‑‑‑No.


So, you were not giving them care under their care plan if they had one, you were just giving them time out and activities, socialisation and things like that?‑‑‑Yes.


No, that's fine, that's fine.  And I understand that you were the cook there?‑‑‑Yes, I was.

***        LYNN COWAN                                                                                                                               XXN MR WARD


At that time had you had any training in cooking?‑‑‑No.  No, just basic cooking.


Am I right in saying that - did you work with a nutritionalist to prepare what you were going to cook?‑‑‑Not really.  We just sort of cooked basic meals and just took notice of what people were allergic to, their basic needs for like diabetics, low fat.


How did you know they had an allergy?  How would you have found that out?‑‑‑By talking to the client when they came in.


By themselves, you talked to the clients?‑‑‑Yes.  Yes.


I take it the clients - put the people with a disability aside for a minute.  I take it the older clients were low acuity, they were low needs?‑‑‑Yes.


When you were working there, were there any care workers actually working there with you?‑‑‑Yes, there was.


Were those care workers Certificate III care workers?‑‑‑Yes.


But those care workers themselves, they wouldn't have been aware of what the care plans for those people were?‑‑‑I'm not sure.  I can't speak for them.


No, okay?‑‑‑Yes, I don't.


But as the cook, you were just - you were just cooking what you thought were healthy food for them, subject to any allergies they told you about?‑‑‑Yes.


If you look at your statement?‑‑‑Yes.


You then say:


In or about May 2014 -


This is paragraph 15, sorry, Ms Cowan.

***        LYNN COWAN                                                                                                                               XXN MR WARD


In or about May 2014, whilst working at the centre I obtained my Certificate III in Aged Care.




I take it - did you do that because you wanted to move into aged care?‑‑‑Yes.  Yes.


You say:


Once I obtained my Certificate III in Aged Care, my manager started asking me to help with providing personal care.


Is that at the leisure centre?‑‑‑Yes, it was.


So, as I asked you before were there people there who were care workers with Certificate IIIs, you started take that role on at the leisure centre, did you?‑‑‑Yes, I did.


Were you still cooking at the same time or were you - did you move out of cooking into being a care worker?‑‑‑No, I did both.


You did both?‑‑‑Yes, we cooked up until one o'clock, prepared all the meals and that and then after that - and also if one of the staff members were aware or went on holidays we would get another cook in and I would go out on the floor and be just care provider.


I think your evidence is also that you were a bus driver as well?‑‑‑Yes, we did a lot of things.  We went and picked up the clients of a morning and dropped them off of an afternoon.  That was part of our work.


You ran a shuttle service to the client's home and then to the leisure centre and back?‑‑‑Yes.

***        LYNN COWAN                                                                                                                               XXN MR WARD


Am I right in saying that occasionally you'd take the clients on trips in the bus?‑‑‑Yes, we'd have an outing say once a month, where we'd go on a barbeque to somewhere or we'd you know take them just on a sightseeing trip, or visit a - you know, prominent place in the community where we could go and we could find out things about it.  Just to break up being in the centre all the time.


And then I think your evidence is that, around paragraph 21, around September 2017 you moved to work with Integrated Living.  Is that correct?‑‑‑Yes, I did.


Am I right in saying that Integrated Living is an in-home care provider?‑‑‑Yes.


Geographically, what area are they providing in-home care?‑‑‑How do you mean by geographically?


Well, which part of Australia are they providing care in?‑‑‑As far as I know most of Australia but I was working in Rockhampton at that stage.


This is in the Rockhampton area still?‑‑‑Yes.


Yes, okay.  And when you were taken on by Integrating Living, who was your boss?‑‑‑I think it was a lady in Townsville.  I can't remember her name offhand.


Do you know what her title was?‑‑‑Not - no, not really.  Sorry.


That's all right.  That's okay.  But she was in Townsville?‑‑‑Yes.  She was based in Townsville.


By this time you've got your Certificate III?‑‑‑Yes.


And am I right that you've got your Certificate IV in Dementia Care?‑‑‑Yes.


And you've got your Certificate IV in Aged Care?‑‑‑Not through Integrated Living, I got that later on.


All right?‑‑‑Then I went to work for Seventh Day Adventist.


But you've got your Cert III in Aged Care and Cert IV in Dementia Care at this time?‑‑‑Yes.

***        LYNN COWAN                                                                                                                               XXN MR WARD


And am I right that you only worked for them for a short period of time?‑‑‑Yes.


I think you say in paragraph 26 you received shifts for a period of three months?‑‑‑Yes.


When you say you received shifts, does that – you weren't working on a regular basis?‑‑‑No, I was only casual at that stage.


When you went into people's homes when you worked for Integrated, you were doing personal care, personal support activities?‑‑‑Yes.


And I take it that that might have included caring for the individual, showering, toileting; it might also have included cooking for them, doing shopping, things of that nature?‑‑‑Yes.


And that qualification you had, the medication, about prompting medications, were you prompting medications then?‑‑‑No.


That's later, is it?‑‑‑Yes.


You then move to Adventist Retirement Plus?‑‑‑Yes.


Am I right that that's a residential facility?‑‑‑It is.  It's a residential facility, yes.


Sorry, am I right – how long did you stay there for?‑‑‑Approximately five years.


Five years, all right?‑‑‑Five years – no, two years, sorry.


Two years?‑‑‑My apologies.  Two years.


That's all right.  Were you working with high-acuity residents or low-acuity residents?  What were you working with?‑‑‑Just general residents in their own units, and, you know, quite all right to move around themselves.  There was no really high-care people in that part, because they were all up in the main building.


And who did you report to when you were in that job?‑‑‑Jo.

***        LYNN COWAN                                                                                                                               XXN MR WARD


Can you - - - ?‑‑‑Joanne Adine.


Was Jo a registered nurse?‑‑‑Not that I can remember.  I'm not sure.


Did you have a registered nurse in that facility?‑‑‑Yes, we did.


But you're not sure if you worked for the registered nurser or somebody else?‑‑‑We worked for the Seventh Day Adventist village, and Jo I think was just our manager.  And we had – it's like a nursing home as well as, so we had access to the nurse that was there on call all the time.


And when you were working at that nursing home, when you were working at Adventist Retirement Plus, you were performing work that was within your competency; that's your Certificate III and your Certificate IV in Dementia Care?‑‑‑Yes.


You then leave that, and you go to Bolton Clarke, working as a casual again?‑‑‑Yes.


How do I best describe what Bolton Clarke is?‑‑‑Bolton Clarke has both nursing home facilities, but we work within the community as well.  We don't have much to do with the actual nursing home itself.  We just work with Bolton Clarke residents who have their package with us, and work with them in their own homes.


So they have the residential facility, but you weren't working in that; you were doing home care?‑‑‑Yes.


Were the people you were providing home care to, were they high-acuity, low-acuity?  What were they?‑‑‑Most of them were low.  We did have a couple of high-care ones.  But most of them were fairly independent.


Can I just take you through the process in terms of care.  Did you have a group of regulars you visited, or could it be anybody you might visit in a given day?‑‑‑You had a couple of regulars, but most times it was, whoever you got on your roster is who you attended for the day.


And am I right in saying that you might shower a client, you might prepare food for a client, you might do a health check-in with a client?‑‑‑Yes.

***        LYNN COWAN                                                                                                                               XXN MR WARD


And is it at this stage that you're using that prompting medication skill?‑‑‑Yes.


And the skill to apply to creams and eye drops and the like?‑‑‑Yes.


When you arrive – tell me if I'm right or wrong with this, if you would, Ms Cowan – when you arrived for the first time at a client's premises, did you have to do a risk assessment of the premises?‑‑‑Yes.


And I take it that was a document you would fill out, identifying whether or not the kitchen is safe, the bathroom is safe for what you need to provide care for?  Is that a reasonable way of describing it?‑‑‑Yes.  I don't remember doing any documented – as in, written document.  We'd go back to our facilitator and say, 'Look, we found out that the mat in the bathroom is not secure and could be a trip hazard.  The chairs or clutter in the lounge room may become a hazard.'  And then they would send an occupational therapist down to do a proper assessment of it.


And that occupational therapist would sort that out for you for when you returned later?‑‑‑Yes.


And I take it that after you've been to a client, would you write up progress notes on the client at the end of the visit?‑‑‑Yes.


Could you just – let's say that you had showered a client.  What would the progress note say?‑‑‑Just, 'Attended client for personal care.  Found everything was all right.  The client was happy.  Dressed the client and left, with everything being all right.'  I'm not sure.


That's fine.  And if the client was – let's say the client had some bruising on their arm.  You would've been trained to observe for that, wouldn't you?‑‑‑Yes.  You take note of what the client's skin is like when you're showering them.  If you think that it (indistinct), you take a photo, with their permission, to send back to the facilitator, who passes it on to the nurse.  And the nurse will then sort of say, 'Well, look, we may need to attend that', so the nurse will come and visit.


And the nurse will make that decision about whether or not that then becomes a clinical issue which the nurse needs to look at?‑‑‑Yes.

***        LYNN COWAN                                                                                                                               XXN MR WARD


If you were with a client, and they were demonstrating some serious medical condition – let's say they were struggling to breathe – what was the procedure you had to follow?‑‑‑We'd ring Triple 0 straight up and be on the phone to them, and take notes from what they tell us to do.  Because obviously you can only make one phone call, so your one phone call – some clients have got a thing around their neck that can be activated, which takes them to the ambulance or to a service that they need.  So if we need to, we can press that and talk to a machine at the residence.  And then we can also get on to our phones and also ring our boss up and say, 'Look, we've had a problem.  This has happened.  I've activated the thing around the lady's neck, or the gentleman's neck, and we have an ambulance on its way and explain to them what's going on, you know, and what's happened with them.


When you say you rang your boss, would that boss have been a registered nurse or would it have been somebody else?‑‑‑No, somebody else, I think - she's not - our boss is not a registered nurse but we do have registered nurses on at the office.


So if your boss was concerned, they could have spoken to a registered nurse and put a registered nurse to talk to you?‑‑‑Yes.


Now, have you ever found yourself in a home with a client who is acting aggressively towards you?‑‑‑Once, yes.


Once - does Bolton Clarke have a procedure you have to follow when that's happening?‑‑‑Yes, we have to just - normally the client's family are around and we sort of - if we feel in danger of ourselves we put ourselves outside.  We don't go into the client's home if we feel we're going to be in danger.  But nine times out of 10 it's probably just a medical thing or an upset thing with them.  If the client's family are there, we talk to them before we proceed but if they're on their own then we ring up and say, 'Look, this client is acting a bit agitated and I don't really want to do inside just in case.  What would you like me to proceed and do?'


What would the normal answer be, Ms Cowan?‑‑‑It would be more or less, they'd say, 'Do you fear that this client is aggressive, that it's going to harm you or anything like that?'  And you sort of make a judgment yourself in a way, to say, 'Well, look, he's probably just agitated because he doesn't know me', or there is something else that's worrying him or her and try and make a judgment yourself before proceeding.


If you said, 'I am fearful of being harmed', I take it you wouldn't be required to go into the client?‑‑‑No, they would say, 'Don't proceed'.


Now, you talk a little bit in your statement about care plans?‑‑‑Yes.

***        LYNN COWAN                                                                                                                               XXN MR WARD


Am I right - tell me if I am right with this - that my understanding is that the care plan will initially be written by a registered nurse.  Is that your understanding?‑‑‑That's my understanding, yes.


Am I right that as you write progress notes, as you observe changes in a client, those can be communicated either in writing or possibly directly by you talking to a registered nurse and you might make observations about what you've seen and how that relates to the care plan?‑‑‑Yes.


Am I right that ultimately if the care plan is to be changed it will be the registered nurse who makes the decision to change the care plan?‑‑‑Yes.


Yes, thank you for that.  Just a moment, if I can, Ms Cowan - just a moment.  Can I - sorry, I'll just (indistinct)?‑‑‑No, you're right.


Thank you.  Ms Cowan, can I ask you to go to paragraph 83 of your first statement?‑‑‑Yes.


You say:  'Most mornings I will engage in conversation with the client, (indistinct) any complaints that seem to be new or serious'.  You're not talking about complaints about the care you're providing, are you?‑‑‑No, no, just physical complaints with themselves:  'I didn't sleep well last night, I woke up' - - -


Sore elbow, something like that?‑‑‑Yes, yes.


Okay, I didn't know who you - - -?‑‑‑Sorry.


No, no, it was me (indistinct) how you were using it, that's fine?‑‑‑Yes.

***        LYNN COWAN                                                                                                                               XXN MR WARD


When you got your Certificate IV in dementia care, if you're not - if you don't understand how I'm asking this question just let me know - is there anything specific that you were trained in the Certificate IV that you've used since you've been working in this home care operator?‑‑‑Yes, it's a different sort of outlook on people with dementia because they aren't fully aware of what they're doing, sort of thing.  It's a regression of - what I think is a regression of their memories and that and they may not remember you if you came yesterday or there's something that may trigger a happy memory or a sad memory from something that's done.  Their short-term memory is not as good as their long-term memory.  With one gentlemen that I had we - he loved music so we played music and that sort of made him a lot more pleasant, in a way.  I think I put him in my notes as being a bit abusive to start with but then when I spoke to his family and said that he likes 60s music and stuff like that so we started playing that and he was started to become quite pleasant, in a way.


Can I ask this - tell me if you agree or disagree with me - having the competency from your Certificate III sound very important.  Is the competency from the Certificate IV in dementia - would you call it necessary or helpful?‑‑‑Helpful.


Can I ask you to go to paragraph 99?‑‑‑Yes.


You say:  'I have to be particularly careful when I administer medication'.  You've talked to me a lot so far about prompting medication?‑‑‑Yes.


Are you suggesting something different between prompting and administering?‑‑‑Yes, and no - we don't actually administer medication but if you sort of put the medication in front of the person, and, you know, it doesn't really sort of get messed up because you're at one person's home and it's only their medication that's there.  So you go through your sort of right person, administering the right medication, the right way and sort of look at that as your basis.  But if you're just at a person's home there is only their medication there so you're not sort of having to juggle five different people's medication and wondering, 'Did I give them their medication or did I give them someone else's?'


So - go on, sorry.  I interrupted you, sorry?‑‑‑No, you're right.


So when you're doing that, am I right in saying that - do you check to make sure it's their medication?‑‑‑Yes.


We've heard some evidence in residential aged care that people check the shape and the colour of the tablet against a picture chart.  Do you do that in home care?‑‑‑They usually have Webster-paks and it's already set up into how much medication they take for the morning, afternoon, evening.  So most times I check their medication to see that there is all the medication being pushed out of the Webster-paks.


Yes?‑‑‑So there is nothing left behind - and they have a listing on the back of the medication, on the Webster-paks, what medication they are and the pill is a white, oval pill or a pink, oblong pill - like that.


Right?‑‑‑So you check to see what medication it is.

***        LYNN COWAN                                                                                                                               XXN MR WARD


You said you don't actually give them the medication.  I take it you take it out of the Webster-pak and put it in front of them or put it in a cup.  Is that what you do?‑‑‑Yes, yes.


I take it you observe to make sure they take it?‑‑‑Yes.


Would I be right in saying that they have sufficient acuity to actually take it themselves?‑‑‑Most of them do, yes.  Most of them are able to take their own medication.  We don't have to actually, you know, physically give it to them.  We just put it in front of them and they take it themselves.


And if somebody didn't have the capacity to do that what would happen?‑‑‑Well, we'd talk that over with our supervisor and the nurse because we aren't actually able to give them their medication.


I understand.  So it might be a family member or somebody like that gives it?‑‑‑Yes.  If there's a family member about then they can do that.


Otherwise you might record in your notes that they haven't taken the medication?‑‑‑Yes.  We always make sure if they have not taken their medication or (indistinct) medication was taken, if it's not taken, the client has refused to take medication or was unable to take medication - - -


Okay.  You understand the difference - I'm not being rude to you - you understand the difference between Schedule 8 and Schedule 4 drugs?‑‑‑No.


I won't go any further if you don't.  That's fine.  Can I take you to paragraph 109, you discuss there about redressing a wound?‑‑‑Yes.


I take it that you were comfortable that was within your competence to do that?‑‑‑Yes, it was.


And if you were doing that and you had any concerns about that who would you contact?‑‑‑We'd contact the office who would put us through to the nurse.


I take it the nurse would - tell me if I'm wrong - the nurse would talk to you about what's going on, and the nurse would make a decision as to whether or not you were competent to proceed or whether or not they had to come themselves?‑‑‑Yes, that's true.

***        LYNN COWAN                                                                                                                               XXN MR WARD


When you go to your home visits do any of your clients require equipment to help position them or move them, such things as standing lifters or sling and hoist lifters, are any of your clients in a state where they require those types of devices to be used?‑‑‑We only have one.


And do you look after that person yourself?‑‑‑Not very often, no.


But you have on occasions?‑‑‑I have on occasions, yes.


What is the piece of equipment that - - -?‑‑‑It's a hoist.


Is that hoist used to get them out of bed?  When and how is it used, Ms Cowan?‑‑‑Getting out of - get the client out of bed, put him onto a chair to take to the shower, and then back to his bed.  You take the chair back to the bed, put the hoist on, put the sling on and put him back to bed.


How were you trained in using that?‑‑‑We did a manual training thing with that to show us what to do, and also the client's wife was there and she also was there to assist.


With the lifting process?‑‑‑Yes.


Just a moment.  Ms Cowan, thank you very much for your evidence.  Commissioner, I have no further questions.


COMMISSIONER O'NEILL:  All right.  Thank you.  Mr Hartley, nothing from you?  All right.  Mr Gibian, anything in re-examination?


MR GIBIAN:  No, thank you, Commissioner, there's no re-examination.  Thank you, Ms Cowan.


COMMISSIONER O'NEILL:  Thank you for your evidence this afternoon, Ms Cowan.  You're excused and free to hit the road again?‑‑‑Thank you very much.

<THE WITNESS WITHDREW                                                             [2.53 PM]


COMMISSIONER O'NEILL:  All right.  Is Ms Curry ready?

***        LYNN COWAN                                                                                                                               XXN MR WARD


MR GIBIAN:  Ms Curry is next.


MR WARD:  Can I just indicate that I'm not doing Ms Curry, Ms Rafter is doing Ms Curry.  I will just swap with her if I can.


COMMISSIONER O'NEILL:  All right.  Do we have Ms Curry?


MR GIBIAN:  I understand she's - yes.


COMMISSIONER O'NEILL:  Thank you.  All right.  Good afternoon, Ms Curry, can you hear me all right?


MS CURRY:  Yes, I can hear you, can you hear me?


COMMISSIONER O'NEILL:  Very clearly.  My associate is just going to have you take the affirmation.


MS CURRY:  Sure.


THE ASSOCIATE:  Ms Curry, can you please state your full name and work address.


MS CURRY:  It is Alison Lee Curry, and I work at Warrigal Mt Terry.  I believe it's 95 Daintree Avenue, Albion Park.

<ALISON LEE CURRY, AFFIRMED                                                  [2.54 PM]

EXAMINATION-IN-CHIEF BY MR GIBIAN                                    [2.54 PM]




MR GIBIAN:  Thank you, Commissioner.  Thank you, Ms Curry.  Can you hear me?‑‑‑Yes, I can.


Excellent.  Can I just ask you to repeat your name for the record?‑‑‑Alison Lee Curry.

***        ALISON LEE CURRY                                                                                                                      XN MR GIBIAN


And you're employed at Warrigal Mt Terry as you just said?‑‑‑Yes.


I think you also now work at TAFE you've indicated in your second statement?‑‑‑Yes, I do.


And you've made two statements for the purposes of these proceedings, the first of those dated 30 March 2021.  Do you have a copy of that with you?‑‑‑Yes, I do.


And have you had an opportunity to read that through?‑‑‑Yes, I have.


And is it true and correct to the best of your knowledge and recollection?‑‑‑Yes, it is.


That's the first statement of Ms Curry we wish to be part of the evidence.  It's document 154 in the digital court book commencing at page 10,199.  I think you should also have, Ms Curry, a statement headed 'Reply witness statement of Alison Curry'?‑‑‑Yes, I do.


It's dated the 20th I think of April 2022?‑‑‑Yes, I do.


Have you also had an opportunity to read that statement through?‑‑‑Yes, I have.


And is it true and correct to the best of your knowledge and recollection?‑‑‑Yes, it is.


That's the second statement of Ms Curry we wish to have as part of the evidence.  It's document 155 in the court book at page 10,216.  I just had one matter of clarification, Ms Curry.  Can I just ask you to turn to your first statement and the first page of your first statement.  You've listed from paragraph 6 a number of different qualifications.  At paragraph 9 you've referred to having obtained administer and monitor medication certification and a copy of the certificate is attached I think at AC4.  Do you see that?‑‑‑Yes.


Was that a certificate you obtained by completing a unit outside of your Certificate III and Certificate IV?‑‑‑Yes, it was.  It was a standalone medication course.

***        ALISON LEE CURRY                                                                                                                      XN MR GIBIAN


And can you just briefly tell us what was involved in obtaining that separate qualification?‑‑‑I was - had to attend TAFE for ten weeks, and we went through all the knowledge, what is required to know for the performance criteria of the unit.  The unit I studied was administer and monitor medications, which is HLTHPS007, and I had to complete a knowledge assessment, a skills assessment and then a work placement assessment, and then afterwards I was assessed at my workplace after TAFE had assessed me.


COMMISSIONER O'NEILL:  Ms Curry, I didn't quite hear your answer to how many weeks the course was?‑‑‑It was around ten weeks.


Thank you?‑‑‑Short courses are usually ten weeks.


MR GIBIAN:  Sorry, just two questions arising out of that.  firstly, in terms of the ten weeks how much attendance time was there each week?‑‑‑There was two days a week, and then there was self-directed learning after that, which equivalents to about five hours outside of TAFE class hours.


And you referred to both a knowledge assessment, which I take it was a written test of some type?‑‑‑Yes.


And a skills assessment?‑‑‑Yes.


What was involved in the skills assessment?‑‑‑The skills assessment is a simulation of what would have happened.  So I would be presented with a workplace environment with either dummies or a student that was going to - I was going to administer the medications to.  We would have placebo drugs like M&Ms for tablets and I would administer them and it would be the whole demonstration on what you would do with a client.


And - I'm sorry?‑‑‑Sorry.  I would have to do different types of medications too.  So, I would have to use oral tablets, puffers, patches, insulin, I would do topical medication, eyedrops, eardrops.  I would have to demonstrate everything that I would require for a normal day to day medication round.  And the knowledge assessment was a - just a general knowledge assessment and a maths test, and I had to get 100 per cent correct on the maths test.

***        ALISON LEE CURRY                                                                                                                      XN MR GIBIAN


Just finally, did I correctly understand that there was a separate workplace assessment that your employer undertook, in addition to the skills assessment that was undertaken through TAFE?‑‑‑Yes, so the workplace assessment I would go to my place of employment and my TAFE assessor met me there and they assessed me.  And then after I was competent and received the certificate then Warragul, my place of employment, then assessed me on top of that.


Thank you, Ms Curry.  Ms Rafter, I think, is in one of the screens, although it says Mr Ward underneath.  Ms Rafter now is going to ask you some questions?‑‑‑Sure.

CROSS-EXAMINATION BY MS RAFTER                                        [3.01 PM]


MS RAFTER:  Hi, Ms Curry, my name's Alana Rafter, I'm appearing for the employer interest in these proceedings.  I just want to ask you some questions to first make sure I have your chronology with respect to aged care all right.  So, you entered the aged care industry in around 2003?‑‑‑Yes.


And that's when you obtained your Certificate III?‑‑‑Yes.


Is that also the same time you commenced at Christadelphian was, I believe, 2016.


And then shortly after 2016, is that when you - Christadelphian was then taken over by Warrigal.  Is that right?‑‑‑I believe in 2019 (indistinct).


2019, no, I'm not trying to (indistinct) or anything.  We're just obviously trying to get it set in my head.  And you say you have about six years' experience in the aged care care industry.  So I'm just trying to - you got your certificate at 2003 but you also do some - - -?‑‑‑Yes.


Could you just explain the six year or seven year?‑‑‑Yes.  What happened was I got my certificate in 2003.  I started working for Warrigal at their Coniston in 2003, at their Coniston facility.  And then I come across another job, I left the industry and then I worked at my other job for about 20 years.  And then I left my job, had a family and then changed careers and then got back into the aged care industry in 2016, and I've been there ever since.


Thank you for that clarification.  It's very, very helpful.  Now, with your qualifications you have got and Mr Gibian has taken you through a lot of them.  So, you have your Certificate III, you have a Certificate IV in Training and Assessment?‑‑‑Yes.


The Administer and Monitor Medication certification.  That's a standalone one as you confirmed?‑‑‑Yes.

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


Is the Provide Support to People Living With Dementia certification also a standalone certification?‑‑‑Yes.  Yes.


But it can be done as part of the certificate?‑‑‑Certificate III and Certificate IV, yes.


No worries.  But you don't - as I understand it, you don't have a Certificate IV in Aging Support.  Is that right?‑‑‑Yes, I do.  I have a Certificate IV in Aging Support and I have the disability skillset which gives me an equivalent in Certificate III in Disabilities.


Looking at your annexures AC5, that's only the Certificate IV provides support for people living with dementia.  I don't believe you've attached your Certificate IV in aging support?‑‑‑No, I haven't because I just acquired that in February and this statement went out before I attained it.


Well, I note we would call for that Certificate IV in Aging Support, Commissioner?‑‑‑Yes.




MS RAFTER:  You don't need to worry about that at the moment, Ms Curry.  That will be a separate matter?‑‑‑Yes.


So, now I'm just going to take you through some parts of your statement and ask you questions.  So, I know you have it in front of you.  I'll direct you where I want to take you?‑‑‑Beautiful.


So, if you could go to paragraph 19 of your first statement I should say?‑‑‑Yes, my duties.


Yes, that's right.  Under that heading.  You state that you would see the roster upon arrival and that's where you would find out what ward you were on?‑‑‑Yes.

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


Am I correct in understanding that that is the first time you would see the roster?‑‑‑You would be - there is a little app that we have and we would pick up a shift.  So we are aware that we are working on a shift.  Sometimes it says the area that we are located at, but the RNs on duty or management can change the roster and who is allocated in their sections at any time.  So, usually I will get on and I will check the roster because that's where I'm going.  It won't necessarily be where I'm at on the app that I have on my phone.


Is the original roster the one that's programmed into this app, is that set by the RN?‑‑‑No, we have a rostering team that is not on-site.  So, sometimes that can be tricky because that's where the changes are made to meet whatever issues are needed on the floor.  So, it's up to the RN's discretion on who goes where and who's needed where, in what ward.


Thanks for that clarification.  That's very helpful?‑‑‑Yes.


I'll now take you to paragraph 25?‑‑‑Yes.


Now, I'm just wanting to check, you might not be meaning - do you mean it literally when you say you're running in-between rooms to answer buzzers?‑‑‑Running in-between rooms.  We could be brisk walking not actually running but if there is an emergency, I will run down the hallway to get to that room.  But in 24, did you say, or - - -


Twenty-five, I'm directing you to?‑‑‑Twenty-five.  Yes, we will be brisk walking I would say.


Thanks for (indistinct) - - -?‑‑‑Brisk walking (indistinct) answering buzzers because we will be going from one end of the corridor and if someone's buzzing they could be needing to want to go to the toilet now, and if we can get their quick enough we will not be running but brisk walking.


Thank you?‑‑‑But if there - if there was an alarm that went off, I would run to that room.


So, it'd be an absolute state of emergency to be running?‑‑‑Yes.


It wouldn't be the norm to be - I'm just checking.  I'd like to take you to paragraph 32 and you may or may not be able to answer this question, so it's fine.  I understand that the Mount Terry facility has around 155 beds.  I was curious if you can give an answer as to how many residents of those 155 beds would have catheters?‑‑‑I would say - let me just think about this, because I'm thinking of who's on what ward.

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


Now, if it's an - I don't want to be unfair to you, so I'm not - I'll give you a moment?‑‑‑Eight that I know of.  Eight that I know of, yes.


Thank you.  Thank you for that.  Now, at 33, paragraph 33, where you refer to dressing checks on wounds and redressing wounds, would it be - is your evidence that you would redress any wound regardless of complexity?‑‑‑Complex wounds are the RN's duty to do, but most of the wounds are skin tears and pressure areas where the medication officer or the Cert IV on duty will do, and these are not the complex care wounds.  But we will be assisting with complex care wounds with the RN.


At paragraph 34 where you talk about checking on the mental health of residents, you're not trained to make a mental health diagnosis, are you?‑‑‑No.


So with your evidence there, you're talking about how you're making observations of the residents, you'll be talking with the residents and seeing if there's any change potentially in their demeanour?‑‑‑Yes.


And if there was, you might note it in progress notes?‑‑‑Yes.  We will check them, their mental health, as in how they're feeling that day, if they're feeling down, if they're expressing any suicidal thoughts, if they're crying, if we've walked in on them, and you know, we're noticing anything that is affecting their mental health we will report and monitor that, and we will make referrals on their behalf to the mental health nurse that we have.


When you say 'report', are you reporting to the RN, or is that the mental health nurse you've just mentioned?‑‑‑I report to the RN, and either me, as the team leader, or the RN will alert the mental health nurse to come in and do a review.


I'll now take you to paragraph 46 on the next page, if I may?‑‑‑Mm‑hm.


Here your statement says that if a doctor were to come in and make any changes to a resident's medication, you would communicate with the pharmacy.  I just want to unpack that a bit?‑‑‑Yes.


Would it be normal for you to be directly liaising with the doctor?‑‑‑Yes.


And would you also be liaising with the registered nurse?‑‑‑Yes.

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


Is the reason why you're liaising with the doctor because you've been delegated that responsibility by the registered nurse?‑‑‑Yes.


I want to take you – you talked about medication.  Bear with me whilst I find the spot I want to take you to.  If I could take you to paragraph 80 of your statement.  That's on page 9?‑‑‑Yes.


This is your evidence as to the administration of insulin?‑‑‑Yes.


My understanding of this process is that it involves a prick test?‑‑‑Yes.


And that's the blood glucose level check, I take it?‑‑‑Yes, the BGL check, yes.


The RN will then draw the dose for the insulin?‑‑‑Yes.


The RN would then administer the dose?‑‑‑After I've checked the dose, we both will – I would do the BGL check, then I will inform the registered nurse of the BGL level.  We will both check the diabetes management plan, then we will both check the order for the insulin, then we will both check the dose, and then the RN will draw up the insulin.  I will check the amount that she's drawn up is correct, and then the RN will administer the insulin, which will be a needle sub‑cut into the stomach, and then discard the needle, and then I would document everything on what had happened there.


It's very precise.  Thank you very much.  It's very helpful to get a clear image of the exact process, so thank you for that.  I then want to turn your eyes to another type of medication round.  That's the Schedule 8 medication.  I believe you talk about that at 96 of your first statement?‑‑‑Yes.

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


Would it be fair to say it's a similar process, in that the - that would occur; that the RN would exclusively administer this medication?‑‑‑So we would go together to the locked cupboard.  We would go to the primary med charts for everyone who would be getting the s8 medication.  We will both be checking the primary med chart against the MedMobile, against what is unpacked out of the cupboard.  We will load it into the trolley together.  We would go to the resident's room.  We would check again and count – a registered nurse would count.  I would be standing next to her witnessing her counting the medication.  The RN dispenses it into a cup, and then I walk with her to the resident and witness her or him giving the medication.  We both witness the client taking the medication.  We then both sign that we have given the medication, I as a witness, and the RN as the primary signer, and then we will go back together to the medication cupboard and lock the remaining medications away.


Thank you for that once again.  It's very helpful to get a clear understanding of that step‑by‑step process.  And then the other form of medication round that I would just like to walk through the steps, by step‑by‑steps again, is what you earlier referred to as the 'normal medication round', so the Schedule 4 medication round.  Could you walk me through that process of how you approach that?‑‑‑So what paragraph was that, sorry?


I'm taking you to – apologies – to paragraph 84.  It is after the insulin round, you do the first medication round?‑‑‑Yes.  So, I would then get my trolley, pack it with everything that I need, and then start from one corridor, one room, and I would go from room‑to‑room, if the person was in there.  If that person wasn't in there, I would have to go to either a dining room or a lounge room of wherever that person is in the facility, and I would follow all my steps from 85 basically over to 100.


So you will in this process, as you have the medical competency, you'll be doing the checks, and you'll also be the one administering the medication for this medication round?‑‑‑Yes.  I do this solely by myself.  I am not supervised.  I have a Dect phone on me, so if I have any questions I can then call the RN wherever she or he is in the facility and then get clarification then, but I do everything myself.


I'm just going to turn to your second statement now and ask you some questions there?‑‑‑Sure.


Bear with me whilst I find the relevant paragraphs I'd like to take you to.  I'd like to first take you to 32 of your second statement, and that's under the heading, 'Changes in technology'?‑‑‑Yes.


As I understand it from your evidence, the MedMobile you would accept is a very useful tool for medication management?‑‑‑Yes, it is useful, but it does add an extra step to the duty of what I have to check in the medication round.


I note at paragraph 35 that you say that there's only one iPad per section for the MedMobile?‑‑‑Yes, and that's kept on the medication trolley.


You say that it adds an extra step.  Would it be fair to say that it would be more helpful if there were more iPads with the MedMobile app; access to more iPads?‑‑‑Well, no, because you only need one MedMobile iPad, because there's only one medication officer on that ward.

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


Thank you for that clarification?‑‑‑Actually we would like two for the RN to have at all times, because then whenever I call her she can – instead of coming to me, she can just look up whatever I need to (indistinct) check, I suppose.


So when you're doing your Schedule 4 medication round, and you have the iPad with the MedMobile app on it, you have access to it and can see all the relevant information?‑‑‑Yes.


But when there's a problem, and you need to contact the RN, using the phone – my apologies, I forgot the reference used there to – you described the phone as?‑‑‑A deck phone.  Just little portable deck phone.


Thank you for that.  And so when you call, and there's an issue that requires the nurse check, essentially do you require the RN to come to you (indistinct)?‑‑‑Yes.  Or I would go into the office, lock my trolley away, and track her down if it was an emergency, or him down.


Now, turning to the mechanical aids.  At Warrigal Mt Terry, am I correct in understanding your evidence that you have access – that they have access to sling lifters?‑‑‑Yes.


(Indistinct) steadies?‑‑‑Yes.


And stand-up aids?‑‑‑Yes.


And from your time at Warrigal Mt Terry, have there always been access to those types of mechanical aides?‑‑‑Yes, ever since 2003.  We've had exactly the same ones.


But back when you first started at - - - ?‑‑‑They have not changed.


And my understanding – I want to take you to paragraph 43.  So I accept they haven't changed.  You're saying the same, on our evidence?‑‑‑Yes.


At paragraph 42 you give an example that the sling lifter, whilst they are there to be used, there are times where you might not have immediate access to it; is that correct?‑‑‑That is correct.  If someone else is using them for another resident, and we only have one, we have to wait.

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


Could you shed light on how long you might be waiting for?‑‑‑Say, 20 to 40 minutes.  While – that time, we have to do time management and prioritise other tasks.  We're not just standing waiting for 40 minutes.


I was not suggesting you would be doing that.  I'm just trying to see the time.  So if you needed it, and it was in use, you'd just effectively have to change some things around and then come back to it, to use it?‑‑‑Yes.


So it is there for your use, but you might have to wait on some occasions?‑‑‑Yes, exactly.  So it could be 20 minutes for someone to get someone on the toilet, or they could be assisting someone within a shower or a bed bath, which may take up to 40 minutes if they're complex.


Thank you for that.  Now, I want to take you to contact with family members, at paragraph 47?‑‑‑Forty-seven, yes.


Now, I want to put an example to you, to see if I have an understanding.  So if you're giving care to a resident, and that family is there, you may engage in conversation?‑‑‑Yes.


And if the family member raises an issue, for example, with the linen, that maybe there's not enough, or it's dirty, they may request for more; for something to be done.  In that instance, would you typically respond to that issue?‑‑‑Yes.


And would that mean you would contact another team and the laundry, or would you be doing things yourself?‑‑‑I would be doing (indistinct) myself.  So if they were referring to me, and about their linen or their clothing, I would then go to the linen store or go to the laundry and investigate things myself.  And I would try and resolve that matter before I went to the RN.


Thank you for that.  And would you typically write – document that on the care plan or a progress note somewhere?‑‑‑Yes.  There's a communication form that Warrigal has, and I will fill it out, that I spoke to family member so-and-so about their mother or their father; their concern was this; this is what I'd done; I've handed it over to the RN; I've left a note or informed the laundry staff.  And I would pretty much resolve most of that issue myself, before going to the RN.  If it was a complex care matter, I would go - - -

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


(Indistinct) pause there for a second whilst I just – I want to deal with things very discretely, and in their little pockets.  So it would be fair to say, it would be a completely different scenario, and the response would be completely different, say, if the family member put a formal written complaint – and bear with me; this is a hypothetical – a formal complaint against you personally, about something you were doing.  In that instance, you would not be the first person to respond to that type of complaint, would you?‑‑‑No.  I believe if someone put a complaint in against me, I will then be brought into management for a fact-finding meeting.


I might pause there.  So you wouldn't be dealing with that; it would go to – so it would go to potentially the clinical care manager?‑‑‑Yes, or whoever got that complaint.  So if it was another care service employee that a family member were complaining about me to, then that care service employee may then go to the RN.  The RN may inform the manager.  The manager will then conduct a fact-finding meeting me, to find out what happened or tell me the nature of the complaint and so forth, and then try and resolve it that way.


Thank you for that.  I'll now take you to – I will take you back to paragraph 57, under the heading Medication?‑‑‑In my first - - -


Apologies for that.  That was my not being very clear?‑‑‑Yes.


Now, I note you disagree with – 58, on the next page, out of fairness, I'm reading from right now.  I note you disagree with parts of Ms Brown's statement?‑‑‑M'mm.


And would this be – is this disagreement based on the fact that – I withdraw that.  By your disagreement, you're not seeking to say Ms Brown's evidence is wrong, right?  But based on your experience, you've seen a different practice, or differences?‑‑‑Yes.  It's not wrong, but there is times where we would do a lot extra.


And that's based on your experience at Warrigal Mt Terry?‑‑‑Yes.


Thank you.  I would now like to take you to paragraph 69, under the heading Residential expectations?‑‑‑Yes.


Now, your evidence with respect to showering, and how – I want to focus on that example briefly, if I may.  So, with the focus on person-centred care, you're still required to incorporate showering and assist residents with showering.  But as I understand it, you now have to factor in their preferences more, which will be included on their care plan?‑‑‑Yes, correct.

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


Thank you.  I'd now like to take you to paragraph 75, under the heading Serious incident response scheme?‑‑‑Yes.


Now, it's my understanding of the process is that if an incident occurs, the person that sees it will be then responsible for all the related documentation; they will be filling out all the paperwork, documenting what they see.  And then, once that's done, then they'll talk to the RN, show them the documentation, and the RN will sign off.  Is that correct?‑‑‑The RN will be informed before the documentation starts.  But whoever witnessed the incident will do the initial start of the form.  And then there is a little saved button where we can save it.  And then the RN will go in and access that form, and then fill out their little bit at the end.


So would it be correct that if an incident happens, that the first point of call would be to tell the RN first.  Is that the process?‑‑‑Yes, because, in the middle of the incident, we will be buzzing the buzzer for assistance.  And usually, when the alert buzzer goes off, everyone comes running, and the RN is supposed to attend that room straight away.  If someone else gets there first then they will go and get the RN, and the RN will be present with us dealing with whatever situation we're dealing with at the time.


And this document and the form that's being filled out are you referring to a form for the SIRS report or an incident reporting form?‑‑‑Incident reporting form, injury reporting form, wound, skin injury reporting form, a wound chart if something was to happen, behaviour charts, progress notes.  We can start the SIRS form for the RN, but the RN finishes off the SIRS assessment form.


Thanks for that, once again very helpful.  I will now take you to paragraph 79 of your statement, and it's under the heading 'Daily work of Warrigal AIN'?‑‑‑Yes.


And similar to the question I asked before, when you say you do not agree with the statement of Ms Bradshaw my understanding is you're not necessarily saying that her evidence with respect to the Warrigal Stirling Residential Aged Care is wrong, but rather your experience and observations at Warrigal Mt Terry differ in some respects?‑‑‑Yes, they're not wrong, but I believe that a lot of steps were left out in the job description that she has put forth, and I think she believed - I believe she stated in her statement that she asked a manager about the duties instead of actually asking an AIN or a care service employee about the actual duties that they do perform.  So it's - I think a broad overview is missing out of the duties that we were - that was described in her statement.


And that's once again based on your experience at Mt Terry, but - - -?‑‑‑Yes, that was (indistinct) Stirling.


And you haven't been to Stirling?‑‑‑No, I haven't been to Stirling.

***        ALISON LEE CURRY                                                                                                                 XXN MS RAFTER


Thank you for that.  Just bear with me one moment.  No further questions.


COMMISSIONER O'NEILL:  All right.  Mr Hartley, a head shake?


MR HARTLEY:  Nothing from us, thank you, Commissioner.


COMMISSIONER O'NEILL:  All right.  Mr Gibian, any re-examination?

RE-EXAMINATION BY MR GIBIAN                                                 [3.31 PM]


MR GIBIAN:  There were just two matters.  Ms Curry, can you hear me again?‑‑‑Yes, I can.


Firstly just with your first statement I think you clarified on the first page of your first statement at paragraph 10 that you obtained or attained the certification in provide support to people living with dementia?‑‑‑Yes.


You indicated in the statement that that was part or is part of the Certificate IV course, but did I understand correctly that you had done that component separate to the Certificate IV that you subsequently undertook?‑‑‑Yes, I did do that independently as a standalone course, but then when I'd done the Certificate IV, when I completed that in February, I got a credit transfer, because I already completed that unit.


I understand.  And when you did it as a standalone unit can you again just describe what that involved in terms of the amount of course time and the like?‑‑‑It was a short course run over three weeks.  It was - this was when we were all employed and we were doing self-directed learning at our own facilities and outside of - outside of classroom setting about five hours a week, and we also had three assessments to complete in that role.


And briefly what were the nature of those assessments?‑‑‑It was a written assessment, skill assessment and work placement assessment.


And the second question I had was you were asked some questions about - it was by reference to paragraph 34 of your first statement about observing the demeanour of residents, and you mentioned that the facility has a mental health nurse?‑‑‑Yes.

***        ALISON LEE CURRY                                                                                                                   RXN MR GIBIAN


Is there one mental health nurse for the facility, or more than one?‑‑‑She presides over all Warrigal facilities.  So when - she's not actually on site most of the time, we have to email a referral to her, and then she either comes on site or does a Telehealth kind of Teams or Skype communication with - - -


Yes, thank you.  All right.  So that is there is one mental health nurse as you understand it across all of - who has responsibility across all of Warrigal's facilities?‑‑‑Yes, that's the only one I've met.


Yes.  Thank you, Ms Curry.  That's the re-examination.


COMMISSIONER O'NEILL:  Thank you, Ms Curry, for your evidence.  You're now excused, you're free to go?‑‑‑Thank you everyone, bye bye.

<THE WITNESS WITHDREW                                                             [3.34 PM]


COMMISSIONER O'NEILL:  All right, is Ms Digney up next?


MS DOUST:  Yes, Commissioner, I will be taking those witnesses.  It's Ms Doust.




MS DOUST:  I think Ms Digney is just about to log in.


COMMISSIONER O'NEILL:  All right.  We can't see you, Ms Doust, or at least I can't.


MS DOUST:  I'm just next to Mr Gibian.


MR GIBIAN:  She's sitting next to me.


COMMISSIONER O'NEILL:  There you are.  All right.  Ms Digney, is it, can you hear me all right?  You're on mute, so you will just need to change that.  Are you able to do that?  Is there someone that can help Ms Digney?  All right, Ms Digney, you can hear me all right?



***        ALISON LEE CURRY                                                                                                                   RXN MR GIBIAN


COMMISSIONER O'NEILL:  All right.  Now, my associate is just going to have you take the affirmation.


THE ASSOCIATE:  Ms Digney, can you please state your full name and work address.


MS DIGNEY:  Susan Grace Digney.  My work address is Muswellbrook in New South Wales.  I'm not 100 per cent sure of the address.

<SUSAN GRACE DIGNEY, AFFIRMED                                            [3.36 PM]

EXAMINATION-IN-CHIEF BY MS DOUST                                      [3.36 PM]


COMMISSIONER O'NEILL:  All right, Ms Doust?


MS DOUST:  Yes.  Thank you, Commissioner.  Ms Digney, can you hear me okay, it's Ms Doust speaking?‑‑‑Yes, I can hear you fine.


Thank you.  Ms Digney, is your name Susan Digney?‑‑‑Yes, Susan Grace Digney.


And are you a support worker employed by Integrated Living Australia?‑‑‑Yes.


Have you prepared a statement for the purpose of the proceeding before the Commission which is dated 27 October 2021?‑‑‑Yes.


And do you have a copy of that statement with you?‑‑‑Yes.


I will just take you to a couple of matters in that statement that I understand need corrections.  Can I ask you just to look at paragraph 2, please?‑‑‑On the first page 'Employment history'?




You see there you refer to Integrated Living Australia being based at Muswellbrook?‑‑‑Yes.  Our CSO office is in Newcastle though, so we don't have an office in Launceston.  We did have one, but now we don't.

***        SUSAN GRACE DIGNEY                                                                                                               XN MS DOUST


In fact you work for them in Tasmania, is that right?‑‑‑Correct.


Can I just ask you to look at paragraph 5, please?‑‑‑Yes.


You see there you refer to the Tenison Hostel for retired sisters for St Josephs - should that be the Tenison Hostel for retired sisters of St Josephs?‑‑‑Yes.


And going to paragraph 6, you've referred to having worked for Community Care Tasmania on Mondays and Tuesdays.  Should that just be Mondays?‑‑‑That is correct.


Finally, if I can ask you to go to paragraph 32, where you refer to a client collapsing on the floor of a newsagency?‑‑‑Yes.


You refer to performing CPR?‑‑‑Yes.


Is it the case that the client came to before you placed them into the recovery position?‑‑‑Yes, so I didn't have to commence CPR.


I see, thank you?‑‑‑And then the ambulance attended.


All right.  Now, subject to those changes, is the statement then true and correct to the best of your belief and knowledge?‑‑‑Yes.


Thank you.  We read that statement, Commissioner.


COMMISSIONER O'NEILL:  All right - if you take the same approach, just file a corrected version for the hearing book, please.


MS DOUST:  Yes.  That's document 197 at page 11011, Commissioner.


COMMISSIONER O'NEILL:  All right, Mr Ward.


MR WARD:  Thank you, Commissioner.

CROSS-EXAMINATION BY MR WARD                                           [3.40 PM]

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


MR WARD:  Ms Digney, can you see and hear me?‑‑‑Yes, I can see you, I can hear you.


Thank you very much.  Ms Digney, my name is Nigel Ward.  I appear in these proceedings for the principle employer interests.  I'm just going to ask you some questions, if I can?‑‑‑(Indistinct reply)


Can I just start with - who do you report in to in the role of support worker?‑‑‑We report to a team leader.  Like, we're put in teams, we have a team leader now.  That wasn't the case years ago.  I've been in the - with the company for - I think it's 18 years or so so I report to a team leader now, yes.


Is the team leader a care worker or a registered nurse?‑‑‑The team leader to my knowledge used to be a support worker, a domestic assistant, and she went into the role of a team leader.  I'm not sure what training she's had.  That's out of my scope of practice, I don't know.


Okay, so the current team leader used to be a support worker.  Is that right?‑‑‑Correct.


Do you know what qualifications they hold?‑‑‑Out of my scope of practice - I don't know what the company employs or what you've got to have.  I know they do advertise positions to say, 'No necessary experience required'.  They will train them up.  So I don't know what they do with - inside that.


Ms Digney, I was just asking you a very particular question.  The person you report to, your team leader, you do not know what qualifications they hold?‑‑‑No.


That's okay.  You yourself hold a Certificate III, is that correct?‑‑‑That's correct.


Your statement says you obtained that in 2008?‑‑‑Correct.


And where did you - did you do a practical component for that?‑‑‑I did that within another agency, which was connected to Anglicare - a family (indistinct) I think they got offered a couple of positions to join into that training.


So when you did your practical, did you do it in a residential aged care facility or home care?‑‑‑Residential.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


Residential?‑‑‑That's the line that I work in.


Okay, and you say in paragraph 11 of your statement you're contemplating getting a Certificate IV.  Do you see that?‑‑‑Yes.


You say that this is to take up a coordinator position?‑‑‑Yes.


Is a coordinator position the same as a team leader or is it a different position?‑‑‑That's a different position.


What is the position of a coordinator?‑‑‑A coordinator gets given a certain amount of clients.  They work within the clients, not within the employers with the workers.  The team leader works in with us.  The coordinators work with the clients - go and assess, same as like a case manager.


Okay, case manager - I take it your employer requires you to have a Certificate IV for that?‑‑‑I am not sure about my employer.  Other employer places do advertise that but like I said, my employer sometimes advertises, 'no experience necessary, training will be provided'.


That's okay - your statement says this:  'I'm currently thinking about doing some further training to get a Certificate in Case Work Management and I'm also considering doing a Certificate IV in Aging so that I can take up a coordinator position'.  I read by that that you needed it.  You're telling me you don't need it to be a case manager or coordinator?‑‑‑You do with most companies.


What about your company?‑‑‑Like I said, they advertise.  They send inhouse advertisements about jobs.  Sometimes it says no experience necessary, they will train within.


So have they advertised the coordinator job?  Have you applied for it?‑‑‑I'm not 100 per cent sure within this company.  I'm not sure.


Can I take you to paragraph 10?  Do you have that in front of you?‑‑‑Yes, I certainly do.


Thank you.  You say:  'We regularly do update training like MedeHealth and hygiene training'.  You see that statement there?‑‑‑Yes.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


Can you explain to me what MedeHealth is?‑‑‑Well, we do our training on a - through a training platform.  MedeHealth is sort of tied in the same with hygiene training.  Yes.


But is MedeHealth the name of the platform or is it a form of training?‑‑‑MedeHealth is a form of training.


What is that training about?‑‑‑Probably ties in with the hygiene training.


Right?‑‑‑So it's all sort of tied in to - yes, medical side, yes.


Is it an online program?‑‑‑What is an online program?


Do you do it on a computer or in iPad or do you do it in a classroom?‑‑‑No, we do it through a platform.


Platform, so on a computer?‑‑‑Yes.  We used to do it face to face but now everything is on - yes, more computer.


How long is the course, how long does it run for?‑‑‑They're all different.  We get assigned a MedeHealth training, which could be 30 minutes allocated to us.  So we go on and we do that training, that 30-minute whatever it is.  Sometimes it takes a bit longer but we're paid for the 30 minutes.  We get monthly MedeHealth trainings, yes, to do now, we do.  A lot more - there's a lot more trainings now than what there was years ago.  You used to have to have your first aid, your manual handling.  Now you've got all these other - - -


So you do - - -?‑‑‑You do food handling now and a lot of other things.  They're more thorough about food handling, things like that so that's all added to it over the years.  Like I said when I started you used to only have to have your first aid and your manual handling every two years.  Now, every month you're doing a training.


What training did you do this month?‑‑‑Infection control, I think it was.


Is that a half-hour program?‑‑‑Yes.


That's run by your employer, is it?‑‑‑Yes, through a platform.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


Okay, and when did you last do your hygiene training?‑‑‑We do that every 12 months.


Every 12 months - and you do your manual handling every 12 months?‑‑‑Yes, now on the platform - before COVID we did our manual handling at a team meeting which was out at Deviot, at a church hall, and that's where we used to do our team meetings, but now it's all online.


When you do your manual handling training, is that training about how to lift clients?‑‑‑Yes, and how to bend and how to twist, and not only lift, bend, twist, it's how to – yes, it involves a lot.  But I really think that it's more beneficial if an instructor's watching you bend and lift, because over the years I've been to many trainings that have been, you know – you go into a classroom, they watch you.  I think manual handling should not be done online, especially if you're a new worker.  I think it should be done with the instructor watching, because you can't see online – like, you can think, yes, you bend this way, you bend that way, but you've got to watch someone literally to see if they're doing it right or not; an instructor.


You would prefer it to be face-to-face?‑‑‑I think so.  Like, I've been to many trainings and that, but I think if you're a new worker in the industry it should be face‑to‑face so that that instructor can watch how the person bends down and picks something up or, you know – because you can do it a certain way that could, you know, harm you, and harm the client.


Can I take you to paragraph 13 of your statement?‑‑‑13, yes.


You say:


When I was first employed with FBC as a support worker I used to do a lot of personal care work, such as assisting a client to shower or dress, very basic domestic work such as making the bed, maybe put a load of washing on the line.  Since the takeover I perform more domestic assistance work.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


Can you explain to me what you mean by 'domestic assistance work'?‑‑‑Well, you can go into a client's place – I think you can go into a client's place and do domestic.  Domestic on a lot of their, you know, work schedules and that is vacuuming floors.  So you get given an hour to vacuum a full house of floors, mop, clean the toilet, clean the shower, make a bed – so you get allocated an hour.  You also get allocated an hour to do a unit.  So some of those allocations aren't long enough and you're under the pump.  You're running around, you're just under the pump to get everything done in an hour.


So domestic assistance work would include vacuuming?‑‑‑Yes.  I just said that.


I understand.  I just want to make sure I understand - - -?‑‑‑Yes.  Can you hear me?  Sorry.  Can you hear me?


I can hear you fine?‑‑‑Okay.


I can hear you fine?‑‑‑Excellent.


Vacuuming, I didn't pick up what you said after that.  What other activities does it include?‑‑‑Mopping.


Mopping?‑‑‑Yes.  Cleaning the toilet, the shower, making the bed.


Okay?‑‑‑Dusting could be.


And you now do more of that than you used to?‑‑‑Yes, and sometimes that's connected to a personal care shift, so you might have half an hour personal care, and an hour domestic.


When you go to a client for the first time, when you do that, I think your statement says that you have to do a risk assessment of the house.  Is that right?‑‑‑Sometimes.  Sometimes you might be allocated a client that the case manager hasn't been to.  So you might be allocated a client, and they'll send you as part of your shift that you've got an OH&S assessment, which - - -


Okay.  So - - -?‑‑‑Which they say takes 10 minutes, but I've disputed that.  It takes longer than 10 minutes.  You cannot do it and mark everything off in 10 minutes.  There's no way known that you can plug all appliances in in 10 minutes, and check to say that they're all working right.


Ms Digney, I think what you've just told me is that the case manager usually does that assessment, is that correct?‑‑‑Yes.  They usually go in – well, for years they'd always go in first up, assess the property and different things, and put down hazards and that, yes.  Now you could be called upon to do that.  You could be the first one going in there to visit that client.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


And you're asked to do the risk assessment if you're the first one in, are you?‑‑‑Yes.  Sometimes, yes.  Not all the time.


The case manager – who is your case manager?‑‑‑Excuse me, I don't have a case manager.  I have a team leader.  The case managers are allocated to clients.  So clients have case managers.


Okay.  Do you know what qualifications the case managers have?‑‑‑Excuse me, I would not know.


That's fine?‑‑‑You probably know that information more than me.


I'm interested in your evidence, not what I know?‑‑‑Okay.


When you finished at a client's, let's say that you've gone to a client and you've vacuumed or you've mopped, am I right that you will write something – you'll write some progress notes before you leave?‑‑‑Probably not just for mopping and whatnot.  When I leave, if I've showered a client and that, yes, I took progress notes, but sometimes you could be there to do a domestic shift and someone – like, I did a domestic shift and the lady said I'm not feeling real good, I feel a little faint, so I sent a note.  In the 10 minutes I had to go from one shift to the other, I managed to stop alongside the road and write a note.


I'll ask the question again.  When you finish a shift, when you've been with a client, do you normally write a progress note about what you've done while you were there?‑‑‑Some clients used to have books in their houses where we write, where we wrote a progress thing.  In the notes we now have, our agency likes us to put in notes that are, you know, not just oh I mopped and I did this.


Does that operate on your phone?‑‑‑Yes, NTA app, which freezes all the time, it's stupid - - -


I understand you don't like the app, I understand that?‑‑‑It takes up time.  It freezes.


I understand that.  But you're required to write a progress note on the app, is that right?‑‑‑Yes.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


Have you ever found yourself in a situation where you were unsafe with a client?‑‑‑Yes.


You have?‑‑‑Yes.  Definitely have.


What is your employer's procedure if you find yourself in that situation?  What are you required to do?‑‑‑You're required to leave the premises if you're inside the premises, and call your customer service officer straightaway, and they usually let you know, but that is not – they're not – the phones, sometimes you could be waiting five, 10, 15 minutes for them to answer a phone.


Is the customer service officer somebody different to your team leader?‑‑‑Yes.


I take it the customer service officer is in a central location?‑‑‑They're all situated in Newcastle at the service centre.


Again, they're different to the team leader, different to the case manager, and different to the coordinator?‑‑‑Could you repeat that, please?


The customer service officer, they're different people to your team leader, you agree with that?‑‑‑Yes.  You get in touch with them for any emergencies – if you arrive at the client's house and they're not home, which happens quite a fair bit, and you think, oh gee, I hope they're not on the floor, fell over, you ring the CSO.  They say we'll put you on hold and we'll ring their next of kin.  They try and find the next of kin and work out where on earth the client is, and the whole time you've got to be sitting there at the client's home, and wishing that they're not, you know, on the floor or anything.


I take it that in your time working with this company, have you ever spoken to a registered nurse?  Does the company employ any registered nurses?‑‑‑They do more so now than years ago.


What does the registered nurse do?  What's their job?‑‑‑I'm not 100 per cent sure.  They go around and they do dressings, give injections.  I've been at clients when the nurses have arrived.  So, after I've showered a client, the nurse might arrive to do a dressing.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


So, if there is help required with clinical care the nurse would come and do that?‑‑‑Well, you would report things to the CSO or your team leader.  I always cc my team leader in anything that I send to the customer service, I cc my team leader so that she is kept in the loop.  Because you only need one person that's not kept in the loop and that's where things go wrong.


So, I'll just ask the question again.  So, if you - if you're with a resident who requires clinical assistance, the registered nurse comes and does that?‑‑‑Not straight away.


No, but - it might not come straight away but if the client requires clinical care, that's what the registered nurse does?‑‑‑We ring the CSO, they see what sort of care is in the package of the client, as far as I know.


Yes?‑‑‑And if they've got the funding to have a nurse from Integrated come to them.


Now, if you found yourself at a resident's house and the resident was seriously unwell.  Let's say that they were having breathing difficulties.  What is the procedure you're require to follow?‑‑‑Call Triple 0.


You would stay with them until an ambulance arrived?‑‑‑I certainly would.


Yes.  And having called Triple 0 and organised the ambulance, do you then call your team leader or the customer service officer?‑‑‑Customer service officer.


Is that in case they need to get a registered nurse or somebody else to talk to you?‑‑‑No, that's in case they need to get in touch - well, they would, need to get in touch with the client's family and let them know.


Okay, thank you.  Thank you for that?‑‑‑And they do all that.


They do all that.  You don't do that, they do that?‑‑‑No, they do that.  We ring them, they run round.  They may call you back to say to say can you, you know, write down what happened and go through it again.  Maybe not.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


Now, am I right that before you go to a client, you will have - you will have read the care plan of the client?‑‑‑I laugh because some clients don't have care plans.  They're not updated.  Some of them are years old.  I have said - spoken about that.  I did go to a client once and they said his keys underneath a rock in his garden.  Well, he must have had about a thousand rocks.  I thought I'll be here all day looking under these rocks, so I had to ring it in and he said - he said, 'That was ages ago'.  He said, 'That was ages ago', he said, 'I had that', so obviously that care plan wasn't updated was it?


So, your evidence is that your employer doesn't have care plans for everybody?‑‑‑They're working on that, updated care plans, they're working on them.


I'm asking a different question?‑‑‑Yes.


Is your evidence that they don't have care plans for all their clients?‑‑‑Not new ones, maybe not.  They go and assess them and we could be sent in before they have all the care plans up to scratch.  It's up to us to let them know if the care plan's not up to date and if there's not one in the house, so I was told some time ago.  It's up to us to let them know.


Let me see if I can ask that a different way to help.  Does the case manager meet with the client to do an assessment to write the care plan?‑‑‑Yes, they're supposed to, yes.  The initial first visit, they're meant to but sometimes - - -


When you say they're supposed to, you're saying they don't always do it?‑‑‑Well, sometimes I've been called into a client over time that has been just put on the books and no care plan.  So, I go in, I usually ring and say well, what's, you know, what's needed to be done, and go in.  So, you're going in sort of blind.


Who do you ring - when you say I ring, who do you ring?‑‑‑If they've got a case manager, I normally ring the case manager to find out.  This is what we're told to do now.  This changes all the time.  So, you - - -


You just said - - -?‑‑‑Yes, this changes all the time.  Sometimes they send things out and they say this happened, you ring your team leader or you ring the CSO or the case manager.  But now for case managed clients you ring the - yes, if you're wanting to know anything to do about the client within their care plans.  You know, if they've got one.


So, your evidence is that not every client has a care plan but that the case manager is meant to do the initial assessment and care plan of the resident - with the client.  Is that right?‑‑‑Yes.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


And once a care plan has been prepared by the case manager, I take it that they will review your - - -?‑‑‑They're not all case managed either.  The clients aren't all case managed.  They're case managed with certain case managers.  Some are CSO clients, so customer service centre clients, so the CSO officer, some of them you ring into there, but on our phone app it will say case manager such and such or case managed by the CSO.


So, you do not write, you do not do the initial assessment and you do not write and authorise the care plan?‑‑‑We go in and we do an OH&S assessment.  Like I said to you before.


We've talked about that already haven't we?‑‑‑Yes.  Yes.


Yes.  So, I'm going to ask the question again, I don't know if you answered it.  You do not do the initial assessment and write the care plan for the client?‑‑‑Not in my position, no.


No.  And if a care plan needs changing, who has the authority in your visit to change it?‑‑‑You can ring up and say look, such and such needs a bit longer for a shower.  Over the years her health has gone down, so she takes - a 30 minute shower might take 15 minutes to get her to the bathroom.  So you let them know, the case manager, and they assess the situation.


You don't - I think you've already told me you don't know if the case manager is a registered nurse?‑‑‑I don't think they are registered nurses.


Are you saying you know they're not or are you saying you don't think so?‑‑‑I'm saying I'm not sure what the company - whether the company employs them as a registered nurse or what.  I'm not 100 per cent.


You don't know the answer?‑‑‑Not 100 per cent sure.


Well, do you know the answer or not?‑‑‑Going by their job, like, when they send out that they're employing, you know, there's job positions available, that's not in the position to be a registered nurse.


Do you - how many case managers do you have involvement with?‑‑‑Sorry?


How many case managers do you have involvement with?‑‑‑Well, probably all of them, I suppose.  I haven't spoken to - - -

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


How many is that?‑‑‑I haven't spoken to all of them because I haven't had issues with that client.


Well, how many have you spoken to?‑‑‑We're going back 18 years.  I'd need to think about it.  You know, you're asking me 18 years, like.


I'll ask it again.  You don't know what qualifications the case managers have.  Is that right?‑‑‑What qualifications my agency requires.


No, I'm asking you.  You don't know what qualifications the case managers have.  That's correct, isn't it?‑‑‑Yes, I would say so.


Thank you.  Now, do you get involved when you're with a client with medication?‑‑‑Only up until recently.  We did a Medi-health training to hand out medication.


How long was that training?‑‑‑An hour, believe me, an hour, which I don't think was - is enough.


And you say 'hand out medication'.  Can you explain to me what you mean by 'hand out'?‑‑‑Well, in the training, they distinctively - in the hour's training that we did, it was online and it's only for certain medications.  It was an hour training like for eardrops, eyedrops, nasal spray, S8 patches which I always thought it was only for nurses to do but apparently our agency requires that now, for us to do.


I didn't hear what you said.  Can you repeat that again?‑‑‑I said with S8 patches I thought they were only meant to be applied within a registered nurse.


So, you're saying that you administer Schedule 8 drugs, do you?‑‑‑I have not, and I am thinking about saying to the company that I don't wish to, but that's part of the training that we've just done.


But you yourself have not administered Schedule 8 drugs?‑‑‑Not at this point.


The answer's no?‑‑‑No.


Do you administer Schedule 4 drugs?‑‑‑No.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


Do you give anybody any pills of any kind?‑‑‑Only if they're in their dorset.  As part of the training we've just done, only if they're in their dorset.  We had a meeting, a team meeting, and a worker said:  so that means I can give anyone any medication; and I piped up and said no, within the training that we did it only states that we can give it in a dorset that's been done by the chemist.  If little Molly comes up with a box and says you've got to give me that, you say no to it, because it's not part of the training that we did.


Bear with me, the phrase 'dorset' is something I'm not familiar with.  Is that a Webster‑pak or a blister pack?‑‑‑Yes, within the chemist, that the chemist does.  So it's all sealed off and you have a little pill bob you put in the back, twist it, the pills drop in it.


Am I right in saying that you prompt the client to take the medication; you don't actually feed it to them yourself?‑‑‑Within the training that we have done, we're able to hand it to them.


Hand it to them, and then they - - -?‑‑‑And get it out of the thing.  But before the training that we did – I think it was about a month ago – we did an hour's online training, and then we did 30 minutes within a Team's meeting with a registered nurse.


Okay - - -?‑‑‑We tried (indistinct).  I don't think that's enough training for workers.


When you say you hand it to them, does that mean that you place it in front of them or put it in the cup?‑‑‑Put it in their hand.


And are you required to record that they've had their medication on your app?‑‑‑No, no, no.  I've only (indistinct) about a month ago, so it's all new to me.  We get a sheet, a medication sheet where we've got to mark how it's administered and all that.  So there's a lot – they did say that they were going to send a sheet out to everyone that did the training, like, two sheets to have a look at, but I'm yet to see them in the mail.


So if you put a pill in somebody's hand, you have to write down on a paper sheet that you've done that?‑‑‑Yes.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


And you don't do that in your progress notes on the app?‑‑‑In the progress notes?  No, I don't think – it's not necessary to put it in the progress notes, unless you go, I suppose, by what they explain, and you have a look and there might have been a medical incident where the worker before hasn't signed off or something like that, or if you know there's a medical incident – a medication incident, sorry.


When you fill that piece of paper out after you've put the tablet in their hand, who do you send that piece of paper to?‑‑‑That stays at the client's house, so I was informed in my training I did a month ago, and when that paperwork finishes I think you take a photo of it, scan it on my tiny scanner on my phone and send it off.


When you send it off, you send it off to the customer service officer, the team leader or the case manager?‑‑‑I think within the training it said the CSO.


Thank you.  Just a moment, if I can.  No further questions.  Thank you very much.


COMMISSIONER O'NEILL:  Mr Hartley, is that a headshake?


MR HARTLEY:  It is a headshake.


COMMISSIONER O'NEILL:  Any re-examination, Ms Doust?


MS DOUST:  No, thank you, Commissioner.


JUSTICE ROSS:  All right.  Thank you, Ms Digney, for your evidence this afternoon.  You're now excused?‑‑‑Okey doke.  I'll try and log off this.

<THE WITNESS WITHDREW                                                             [4.13 PM]


COMMISSIONER O'NEILL:  All right.  Well, we are essentially at 4.15.  Mr Ward, how long would you be with Ms Sedgeman?  I - - -


MR WARD:  Sorry, Commissioner.


COMMISSIONER O'NEILL:  No, you go.  Do you have an indication?  I have some limitations this afternoon, so anything after 4.45 becomes very problematic for me.


MR WARD:  Then, Commissioner, I think it would be appropriate to adjourn.


COMMISSIONER O'NEILL:  All right.  We are adjourned until 9.30 tomorrow, unless there's anything any party raises.  No.

***        SUSAN GRACE DIGNEY                                                                                                              XXN MR WARD


MR GIBIAN:  Thank you, Commissioner.


COMMISSIONER O'NEILL:  All right.  The Commission is adjourned.

ADJOURNED UNTIL WEDNESDAY, 04 MAY 2022                        [4.14 PM]



JAMES EDDINGTON, AFFIRMED................................................................. PN3490

EXAMINATION-IN-CHIEF BY MR GIBIAN................................................ PN3490

CROSS-EXAMINATION BY MR WARD....................................................... PN3502

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THE WITNESS WITHDREW........................................................................... PN3557

SUSAN ELIZABETH KURRLE, AFFIRMED................................................ PN3566

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RE-EXAMINATION BY MR GIBIAN............................................................. PN3685

THE WITNESS WITHDREW........................................................................... PN3710

JULIANNE MARGARET BRYCE, AFFIRMED............................................ PN3716

EXAMINATION-IN-CHIEF BY MR HARTLEY........................................... PN3716

CROSS-EXAMINATION BY MR WARD....................................................... PN3726

THE WITNESS WITHDREW........................................................................... PN3752

KATHERINE ANNE CHRISFIELD, AFFIRMED......................................... PN3760

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RE-EXAMINATION BY MR HARTLEY........................................................ PN3840

THE WITNESS WITHDREW........................................................................... PN3848

ANDREW PETER VENOSTA, AFFIRMED................................................... PN3854

EXAMINATION-IN-CHIEF BY MR HARTLEY........................................... PN3854

CROSS-EXAMINATION BY MR WARD....................................................... PN3873

THE WITNESS WITHDREW........................................................................... PN3967

PAUL FRANCIS GILBERT, AFFIRMED....................................................... PN3974

EXAMINATION-IN-CHIEF BY MR MCKENNA.......................................... PN3974

CROSS-EXAMINATION BY MR WARD....................................................... PN4006

THE WITNESS WITHDREW........................................................................... PN4061

LYNN COWAN, AFFIRMED............................................................................ PN4086

EXAMINATION-IN-CHIEF BY MR GIBIAN................................................ PN4086

CROSS-EXAMINATION BY MR WARD....................................................... PN4101

THE WITNESS WITHDREW........................................................................... PN4304

ALISON LEE CURRY, AFFIRMED................................................................ PN4315

EXAMINATION-IN-CHIEF BY MR GIBIAN................................................ PN4315

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THE WITNESS WITHDREW........................................................................... PN4444

SUSAN GRACE DIGNEY, AFFIRMED.......................................................... PN4456

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THE WITNESS WITHDREW........................................................................... PN4610