Bupa ignored warnings, cut back South Hobart nursing staff

Aged care provider Bupa cut nursing staff despite being warned doing so would lead to deaths and injuries.

Emily Flanagan, a resident of Bupa South Hobart.

Aged-care provider Bupa continued to reduce nursing staff at its South Hobart home as part of a cost-cutting drive even after a whistleblower doctor warned ­superiors the cuts were leading to “premature deaths and hugely increased morbidity”, the aged-care royal commission has heard.

Elizabeth Monks, a GP employed at Bupa South Hobart, raised numerous concerns with management about “medication mishaps, inadequate wound care and preventable life-threatening falls” because of low staff levels, concerns backed by a series of ­internal audits identifying ongoing deficiencies in clinical care, counsel assisting the commission, Peter Rozen QC, said on Wednesday.

Despite the warnings, the overseas-owned organisation “imple­mented a policy of significant cuts to its nursing staff as part of a Bupa-wide policy of staff cuts to save money because the business was facing financial difficulties,” Mr Rozen said.

He said the across-the-board cost-cutting policy, known as Project James, stripped 26 hours of nursing care a week from Bupa South Hobart as recently as May, 2018: “These cost-cutting strategies were devised and driven by the finance operation at Bupa's head office, in part to respond to funding reforms introduced by the commonwealth. The evidence will be that these strategies were implemented enthusiastically across the Bupa Aged Care business, including at South Hobart.”

Bupa South Hobart was sanctioned in October last year by the Australian Aged Care Quality Agency for failing to meet 32 of 44 accreditation standards, including 13 of 17 standards regarding health and personal care, placing some residents at “an immediate and severe risk to their health, safety and wellbeing”. It was one of 10 Bupa homes sanctioned between July 2018 and March 2019.

Mr Rozen said Dr Monks had on numerous occasions since 2016 warned about substandard clinical care, both in emails and face to face with Bupa Aged Care management, but had felt “ostracised” for speaking out.

The four internal audits conducted at the nursing home between November 2014 and July 2018 revealed consistent deficiencies in staffing, clinical care, medication management, nutrition, skin care, continence care and specialised nursing care, Mr Rozen said.

“Despite the clear pattern of substandard care at South Hobart, at least after October 2016, and the concerns of Dr Monks, no clinical governance audit was instigated by Bupa at South Hobart prior to the accreditation audit in October 2018,” he said.

Mr Rozen said Carolyn Coop­er, Bupa Aged Care chief operating officer from November 2018 to July, had provided a statement to the commission accepting the Project James rostering model reduced the number of registered and enrolled nurses at Bupa South Hobart. Ms Cooper’s statement said “this had an impact on the ability of the care home to provide the quality of care and quality of life to its residents that is rightly expected by the residents, their families and the standards that (Bupa) sets for itself”.

The commission heard of the impact on residents of the clinical care staffing reductions. In her statement to the commission, Diane Daniels described a litany of shortcomings in her 95-year-old mother Emily Flanagan’s care at Bupa South Hobart, where she continues to reside. One issue was the lack of care staff, which she outlined in one harrowing incident, reported to the facility.

“Mum had somehow hit a re­dial button on her phone and called me,” her statement reads.

“I could hear Mum was calling for a nurse and getting agitated. Because it was lunch, I thought someone would come into Mum's room but no one did. Mum began sobbing and saying ‘I wish I was out of it’. This broke my heart.”

Mr Rozen said the commission would hear two consultants brought in by Bupa Aged Care after the sanction by the accreditation agency in October last year were critical of the organisation’s inaction, despite the warnings.

“Had Bupa listened and responded to the complaints of residents and investigated the causes of the complaints then the serious deterioration in service delivery … may not have ­occurred,” their report stated.