Consumers Frozen Out by OPA, Victoria ...
A Sad Case of Victoria’s Community Visitors Program Lagging Behind that of the United Kingdom, by LISA Inc.
Despite the claim that much of what we do in Victoria is bigger and better than elsewhere in Australia or even the world, no such claim can be made for what is known as Victoria’s Community Visitor Program.
Who are the Community Visitors?
Victoria’s Community Visitor Program (CVs or the program) as associated with visiting residential services for people with an intellectual disability was established just on three decades ago under the then Intellectually Disabled Persons’ Services Act 1986, and has continued ever since. The program provides for appointed volunteers ‘to visit any premise where a disability service provider is providing residential services and to inquire into’ a range of activities. The program functions under the auspice of the Public Advocate.
The program has long been promoted as an effective element in safeguarding the rights of people with a disability who live in supported accommodation. The program’s activities are reported to Parliament via a Community Visitors Annual Report.
Despite the positive promotion of the program’s activities and outcomes by the Office of the Public Advocate, there are families and advocates who question the program’s value. This questioning is not so much related to any statutory restrictions that may be imposed, but more because of the way the program operates under the ‘rules’ imposed by the Public Advocate.
The questioning has become even more pronounced since Victoria’s Ombudsman undertook her investigation into abuse and reporting in the disability sector and a Parliamentary Inquiry has been undertaking a similar review.
A matter of comparison and contrast
How then might the program as it operates in Victoria compare and contrast to a similar program elsewhere?
Recent correspondence sent by the Care Quality Commission in the United Kingdom to the family of a person with an intellectual disability who resides in a residential facility, provides an eye-opening and indeed concerning contrast.
This family says they have obtained many copies of the reports community visitors present to service providers following their inspection visit, and few bear any relation to the services families are observing during their frequent visits.
The relative non-engagement of families and guardians
A significant concern reported by some critics relates to how information is gathered and the inspection methodology used when CVs undertake their visits. This is particularly significant in the context of how feedback is sought and obtained from key stakeholders, particularly those who act on behalf of people with communication difficulties.
These are residents or clients who, by virtue of their cognitive and expressive communication limitations, are unable to evaluate the complex support services they are receiving or are intended to receive. Therefore, consumer service evaluation is not included in the report community visitors present to the service provider. How can this be considered social justice?
In Victoria, although the Disability Act 2006, the Act under which the Community Visitors now operate, gives them the authority to inquire into ‘any complaint … made by a resident’, as per S. 30 (h), the way in which this can be achieved with those residents who do not have the cognitive or language skills to express their concerns, even if by way of facilitated communication techniques, has not been satisfactorily answered by the Public Advocate.
Essentially, the Public Advocate has primarily relied upon promoting that CVs do receive training in communication techniques and rely on observation and staff input. By contrast, what happens under the UK approach is that the views of families and friends, among others, are actively sought and indeed encouraged.
A refusal to facilitate
A core criticism of the advice provided by Victoria’s OPA, as noted above, is the refusal of the Public Advocate to facilitate what families and legally appointed guardians might call reasonable access to CVs. Certainly, it has been stated that if a family member is present in the home of their family member with the disability at the time the CVs make their visit, the CVs can be approached and issues of concern discussed with them. However, the problem with this is that families are never advised when the CVs will be visiting. Thus, the likelihood of the family being present at the same time the CVs are visiting is at best a long-shot. What’s more, the OPA refuses to provide such information. The OPA also refuses to allow CVs to undertake what might called ‘announced visits’, even though there is no statutory impediment to this occurring. This would allow families who may want to meet with CVS at the time they visit to do so.
Information gathering and facilitating residents making complaints
Associated with the above, when OPA has been challenged about how CVs gather information that encourages those residents, who by virtue of cognitive and communications limitations, are unable to initiate or express a complaint, the tired old rhetoric has been one of they have been trained in communication skills, they talk to staff, they access records and they ‘observe’. This approach is of course flawed in several ways.
Firstly, whatever communication skills training is provided to CVs, it is at best a day here or day there. They are not communication specialists. Secondly, by suggesting that CVs ‘observe’ and somehow what at best may be but a few minutes of observation, even if the residents are present, can hardly be suggested as being an analytical assessment. Thirdly, by relying on the caregivers for information, as in staff, this not only provides for a biased input but also ignores the requirements of the Act to inquire into a resident’s complaint.
By contrast, the UK approach is one that states, ‘People who use services are at the heart of what we do. We want them to give us their views, ideas and experiences of the care they receive easily in a way that meets their individual needs.’ Further, the UK program notes that, ‘In gathering evidence during an inspection our team will communicate with and seek views from people who use the service, their families, friends, carers or advocates. The team will speak to people individually and in groups and also use information gathered from complaints and concerns in the process of building up a rounded view of the care provided.’
The significant contrast is that while the UK approach actively seeks the view of families and friends, Victoria’s approach does not. Essentially, families are frozen out.
Overcoming communication barriers
In order to address communication barriers where the resident does not have the cognitive or communication skills, the UK approach is one where a methodology called a Short Observational Framework for Inspection (SOFI) is used. Inspectors apply this tool to capture the experiences of people who use services and who may not be able to express concerns or complaints. Also, where there are language barriers interpreters are used. While it is true OPA in conjunction with La Trobe University has produced a guide for CV’s entitled – Guide to Visiting and Good Group Homes, the guide goes beyond advising CVs - What to look for and extends into What to ask staff. Whatever value this guide brings to inquiry and assessment process, the fact remains families are shutout in that they do not have the same opportunity as do staff to be asked and answer questions.
Also by contrast, Victoria’s amateur volunteer CV program, does not use ‘Experts by Experience as part of the inspection team.’ The UK experts have special skills in communicating with and focusing on the things that matter most to people who are in care. The experts have personal experience of care, either because they use (or have used) services themselves or because they care (or have cared) for someone using services. Experts by Experience are involved in the majority of inspections. In addition, visiting team may also include inspectors or specialists with specific skills, such as for those with expertise in intellectual disability and learning disability.
Feedback and Contributions
Victoria’s CVs do not seek input from families and do not provide feedback on their findings to families. Essential, families are left in the dark and have no opportunity to put forward a view about the service quality provided to their sons and daughters. Because, as noted above, families are not engaged in the assessment process.
By contrast, the UK model not only actively encourages families to be engaged during the assessment process, but the approach also requires that at the end of an inspection, inspectors hold a feedback meeting with the service provider to give initial feedback about the visit and findings. This may also include the Expert by Experience. After this, the inspector will gather all the evidence together and produce a draft report. Part of the pre-publication process involves the provider being given a four-week period of time to consider the draft report and comment on its factual accuracy. Such comments are taken into account before a report of the visit is published. The real key however, is the following.
The UK Quality Care Commission promotes itself as ‘a transparent organisation’. They back this claim up by publishing on their website inspection reports on all the services regulated by them www.cqc.org.uk <http://www.cqc.org.uk/> . They note that, ‘The reports reflect, among other evidence, the views of people using services, families, carers and staff with whom we engaged during the inspection or from whom we have otherwise received feedback.’
Victoria’s CV program provides for no such transparency. In fact the contents of reports are kept secret.
A concluding comment
Victoria’s Community Visitor program is far from satisfactory. Given it has been so loudly hailed as a positive element in Victoria’s safeguarding platform, and given that it has now been operating for nigh on thirty years, the following simple questions must be asked:
- Given that it is recorded in the Community Visitors 2015 Annual Report that there are ‘concerns of a systemic problem’ concerning abuse, and further, given the previous year’s annual report recording that, “abuse and neglect has been a continuing theme in Community Visitors annual reports in recent years.’ - What real value has been had from the Community Visitors, visiting and reporting program?
- Why, has Victoria’s Ombudsman in her the Foreword (p.5) to her Phase 2 Report as associated with Reporting and investigation of allegations of abuse in the disability sector, stated in relation to the safeguarding of people with disability that, ‘all too often the official response lacks care and compassion for the rights of the individual.’ Noting that Community Visitors are part of the safeguarding system.
A volunteer Community Visitors program overseen by what might be described as an over-protective ‘parent’ as in the Public Advocate can no longer be allowed to continue. A truly professional inspectoral approach is long overdue and must be established as quickly as possible as a replacement for the current CV program. The time for amateurs, no matter how well meaning, is long past. People with a disability deserve better. They must be given the same rights to protection as the entitlement given to workers, as provided for by Workplace Inspectors under Occupational Health and Safety legislation.