Public hearing 12: The experiences of people with disability, in the context of the Australian Government’s approach to the COVID-19 vaccine rollout, Sydney - Day 1
CHAIR: Good morning, everybody. I would like to welcome everyone to Public Hearing 12 of the Royal Commission Into Violence, Abuse, Neglect and Exploitation of People with a Disability. Today we will have a one day hearing. The purpose of the hearing is to examine the approach of the Australian Government and its agencies to the vaccination of people with disability and disability support workers against COVID 19.
Today I am joined in the Sydney hearing room by Commissioner Barbara Bennett PSM. Commissioner Roslyn Atkinson AO is participating from our Brisbane hearing room, and Commissioner Rhonda Galbally AC will participate from Melbourne. I commence as always with an Acknowledgment of Country.
I wish to acknowledge the Gadigal people of the Eora Nation, the traditional custodians of this land in Sydney and pay my respects to their Elders past, present and emerging. I also acknowledge the Wurundjeri people of the Kulin Nation upon whose lands Commissioner Galbally is situated, and the Turrbal and Jagera nations upon whose lands Commissioner Atkinson and our interpreters are located. I pay our respects to their Elders past, present and emerging. I also pay our respects to all First Nations people viewing this hearing on the livestream.
Before referring specifically to today's hearing, I would like to refer to two matters.
First, as most people following the Royal Commission will be aware, the Australian Government has approved our request for an extension of 17 months to the date by which we must report. This means that the Commission's Final Report is now due on 29 September 2023. That date may seem well into the future but there is a great deal to do within the remaining two years of the life of the Royal Commission. That period of two years allows some three to four months for the printing and production of the Final Report in its various formats.
While the task confronting the Royal Commission is and always has been very large indeed, we are confident that the extension will enable us to complete our investigations of matters within the Terms of Reference to a satisfactory standard. That simply would not have been possible without the extension.
Secondly, as I have already mentioned and you will have gathered, this hearing is being conducted remotely. Two Commissioners and Senior Counsel Assisting the Royal Commission are in Sydney, one Commissioner and interpreters are in Brisbane and one commissioner is in Melbourne. Members of the public, by reason of the restrictions associated with COVID-19, cannot attend the hearing but of course the proceedings can be followed on the webcast.
Our next hearing, Public Hearing 13, is scheduled to commence on 24 May at Homebush in Sydney. That is the same venue in which we held Public Hearing 4 on "Healthcare and services for people with cognitive disability". At the hearing to commence on 24 May, we shall be investigating issues concerning the NDIS and service providers.
We hope that Public Hearing 13 will mark a return to hearings taking place in a single location, with members of the public being able to attend in person if they wish. Whether that proves to be feasible for any particular hearing depends upon whether governments impose further temporary restrictions in response to any outbreak of COVID 19 in the future. In what may be a triumph of hope over experience, we are optimistic that members of the public will be free to observe in person most, if not all, future hearings of the Royal Commission.
OPENING STATEMENT BY CHAIR
Let me turn briefly to this hearing. We have said from early in the life of the Royal Commission that we may conduct hearings with a view to making firm recommendations well before presentation of our Final Report. In other words, the Royal Commission does not have to wait until the Final Report to make recommendations capable of implementation by governments or other entities. That is the approach we adopted for Public Hearing 5, which took place in August 2020, and examined the "Experiences of people with disability during the ongoing COVID 19 pandemic".
We were prompted to hold Public Hearing 5 on that particular issue because, as the Commissioners' report of the hearing explains, we had received a great deal of material, in submissions and in other ways, suggesting that many people with disability with experiencing hardship during the crucial early stages of the COVID 19 pandemic and that the Australian Government's response during that period may not have been adequate.
The Commissioners' Report on Public Hearing 5 was presented to the Governor General on 26 November 2020. The Report contained 22 recommendations. On 27 April 2021 the Australian Government announced that it had accepted, wholly or in principle, 21 of the 22 recommendations.
At the time the report on Public Hearing 5 was presented by the Royal Commission, no vaccine was available in Australia and it was unclear when an effective vaccine would arrive, if at all. The report addressed this situation by recommending that the Australian Government Department of Health should draft guidelines in consultation with the Advisory Committee on the emergency response to Coronavirus for people with disability, and we recommended that the draft guidelines should explicitly address access to a COVID 19 vaccine if and when one became available.
The report also recommended that the Department of Health should itself recommend to state and territory departments of health or similar agencies that they should publish guidelines to the same effect.
As we shall learn today, the origins of the hearing today lie in the publication on 7
January 2021 by the Australian Government Department of Health of "Australia's COVID 19 vaccine national rollout strategy". The publication of this Strategy was consistent with the recommendations we had made in the report of Public Hearing 5. The strategy accorded disability care staff and disability care residents the highest priority for the vaccination; that is, they were included in what was designated as Phase 1A. They were placed at precisely the same level of priority as aged care staff and aged care residents.
On 9 February 2021, the Royal Commission welcomed release of the Strategy and expressed strong support for giving priority to disability care residents who were placed in Category 1A and younger adults were disability who were placed in category 1B.
In early to mid April 2021, sections of the media reported that very few disability care residents or disability care workers had received the first dose of the vaccine. Later that month, April, the Senate Select Committee on COVID 19 heard evidence suggesting that the media reports were substantially correct.
At the Royal Commission's regular quarterly meeting of Disability Representative Organisation which was held on 19 April, a number of representatives expressed serious concern at the apparently slow pace of the vaccine rollout for people with disability and disability care workers. They also recorded concern about the lack of accessible information available to people with disability concerning the vaccine rollout, particularly people with disability in residential care. We heard from the organisations that the delay in vaccinating people with disability and the lack of information was having a significant adverse impact on people with disability.
In the light of the concerns expressed by the Disability Representative Organisations and the information reported in the media and elsewhere, the decision was made to hold this hearing. The decision does not necessarily mean that the Commissioners sitting at this hearing will produce a report on Public Hearing 12 making firm recommendations in a manner similar to that that was adopted for Public Hearing 5 on COVID 19. The form and content of any report by Commissioners will depend upon the evidence presented today and the Commissioners' assessment of submissions made by Senior Counsel Assisting and any submissions made by parties given leave to appear.
The decision to hold a hearing also does not detract from the Commissioners' appreciation of the complex situations and difficult decisions faced by governments in this country attempting to protect Australians from the extraordinary dangers posed by a global pandemic. Nevertheless, there are issues that arise out of the vaccine rollout of great importance to people with disability and these issues warrant investigation at a hearing.
I shall now take appearances.
MS EASTMAN: If the Commissioner pleases, my name is Kate Eastman and
I appear as Senior Counsel Assisting the Royal Commission. I wish to make a short opening statement Commissioners, but you may wish to take other appearances first.
CHAIR: Perhaps we will start with appearances for the Commonwealth.
MS DOWNES: Kylie Downes with Benjamin Dighton, instructed by Gilbert + Tobin, Commissioner.
CHAIR: Thank you very much, Ms Downes.
The State of NSW? Is there an appearance for the State of NSW?
Ms Furness, are you attempting to speak but are on mute? Can you say something that we can hear?
I shall assume that Ms Furness is attempting to announce her appearance on behalf of the State of New South Wales and that she is instructed by the Crown Solicitor's Office.
MS FURNESS: I am, thank you, Chair. The Royal Commission had me on mute, which is why I wasn't heard. I was certainly unmuted at this end.
Gail Furness. I appear for the State of New South Wales, instructed by the Crown Solicitor's Office.
CHAIR: I'm sure it wasn't Ms Eastman that was putting you on mute, she pleads innocence!
MR CHESTERMAN: Scott Chesterman, appearing for the State of Victoria.
CHAIR: Thank you very much, Mr Chesterman. I take it there are no other appearances?
In that case, Ms Eastman.
OPENING STATEMENT BY MS EASTMAN
MS EASTMAN: Thank you, Commissioners. In the preparation of this hearing I have been assisted by Ms Aditi Rao of Counsel and we are instructed by the Office of the Solicitor Assisting the Royal Commission.
We acknowledge and pay our respects to the traditional custodians on the lands on which we are meeting today. We pay our respects to First Nations Elders past, present and emerging, as well as to all First Nations people following this Public Hearing.
Commissioners, on 7 January 2021 the Australian Government released its COVID 19 vaccine rollout strategy. It described five phases reflecting the Government's priorities. I will put those on the screen now.
You will see that the vaccine rollout strategy identified those phases and within each phase identified who would be covered by the phase. You will see, with respect to Phase 1A, that among those included in Phase 1A were Aged Care and Disability Care staff, representing 318,000 people; and Aged Care and Disability Care residents, numbering 190,000 people.
Within these categories, the numbers of people who are classified as disability care residents is not separately identified.
Today we will ask the Commonwealth Government how people described as Disability Care residents were identified for Phase 1A and the number of people with disability in this category.
On 22 February this year the Australian Government rollout commenced with Phase 1A. There were consultations, meetings and webinars about the Phase 1A rollout. The service providers who provide residential care for people with disability with disability were preparing for the rollout at their various sites.
By 3 March 2021, the Department of Health announced in two different places that either 94 or 97 people with disability in residential care over eight sites had received one dose of the Pfizer vaccine. This appeared to be part of a trial rollout.
By 11 March this year the Commonwealth Department of Health confirmed it was hoping that people in Phases 1A and 1B would be fully immunised by the middle of this year. However, by April 2021 media reports reported growing anxiety and there were claims made that only one third of people in aged and disability care had been immunised. You will hear today from people with disability, Inclusion Australia, the National Disability Services, about their concern around this time.
By 20 April the community learnt that Phase 1A and 1B had been merged. The community also learnt that Phase 1A, people in aged care and disability care, had been changed to the extent that people in aged care had been prioritised over people in disability residential care.
Today we will ask Ms Edwards, the Associate Secretary for the Department of Health, when and why Phase 1A and phase 1B merged. We will ask Ms Edwards why people in disability residential care were de prioritised. The effect of de prioritising people in disability residential care is evident by the Australian Government's data.
By 21 April this year, 746 people with disability in disability residential care facilities had received one or two doses. Within this cohort, 117 people had received
two doses of the vaccine; 629 people had received one dose of the vaccine.
With respect to disability care workers, the support workers, the Australian Government data recorded that 894 workers had received one or two doses. The breakdown reveals that only 75 workers had received two doses of the vaccine and 819 people had received one dose.
Moving forward, by 6 May, over 2.5 million people had been vaccinated in Australia and this included 254,632 people who had received vaccine doses in aged or disability residential facilities.
We asked the Commonwealth for a breakdown of this data to identify those in aged care and more specifically those in residential facilities. The most recent data about people with disability and support workers working in disability residential care was received by the Royal Commission on 11 May. The data was for the period up to and including 6 May.
The data told us this: 834 people with disability in residential care had been vaccinated, that is, an additional 200 people since 21 April. 707 people had received one dose, and 127 people had received two doses.
The breakdown included a breakdown on a state by state or territory by territory basis. In South Australia, six people with disability in residential care have been vaccinated. Of those six people, only two have had two doses. In Tasmania, eight people in residential care have been vaccinated. Of those eight people, two have had two doses.
For the support workers, the data tells us that 1,098 support workers have been vaccinated. 90 of this group have had two doses with an increased overall of 15 people since 21 April. Again, looking at the state by state and territory by territory data, in South Australia, four support workers working in residential disability care have been vaccinated, and only two have had two doses. In Tasmania, seven support workers working in disability residential care have been vaccinated and only four of those seven have had two doses.
The Commonwealth Department of Health advises that these numbers do not include people with disability or support workers who have made their own arrangements. However, there is no data available to the Royal Commission that captures this group and the number of people with disability who have made their own arrangements.
Commissioners, based on the data alone, it may be open to you to find that the Australian Government's rollout of vaccines to people with disability in residential care and these are people who represent some of our most vulnerable members of the population has been an abject failure.
However, we accept that you will need to hear from the Australian Government as to its explanation as to why such a small number of people with disability and their
support workers in residential care have been vaccinated, before you can make a finding of that kind.
We will explore why the rollout of Phase 1A has reached so few people over the past three months. You are likely to hear from the Australian Government that they relied on expert health advice in relation to identifying the priority groups for the rollout, particularly for Phases 1A and 1B. If that is so, then there are early signs that people with disability in residential care may be left behind, and that people with disability generally may have been overlooked.
A key body in relation to the Australian Government's strategy in relation to the rollout is an organisation called the Australian Technical Advisory Group on Immunisation, ATAGI. ATAGI's role includes advising the Minister for Health on medical vaccinations available in Australia. Last year, on 13 November 2020, ATAGI published its preliminary advice. This is a publicly available document. I want to put up a few extracts of that advice on the screen.
The document identifies the specific aims of the COVID-19 vaccination program. You will see, Commissioners, at the second dot point, the vaccination program should seek to achieve the following aims, including:
..... ensure equity of vaccine access and uptake, especially for groups likely to experience a disproportionate burden of disease.
The advice then identifies the possible priority population groups. There are three groups mentioned in the advice: older people, Aboriginal and Torres Strait Islander people, and then a third group which are described as people with pre existing underlying select medical conditions.
Commissioners, you will see in this extract of the advice, if we can zoom in on the paragraph which says "People with pre existing underlying select medical conditions", you will see how that paragraph is described. While there is a reference to a number of medical conditions, you will see there is no reference in that group to people with disability. Indeed, the only mention of disability in the entirety of this advice is where disability appears twice and that is in relation to the description of people with disability who work in disability care.
Commissioners, you are aware that the risk of COVID 19 for people with disability was recognised in Australia very early. You heard this evidence in August 2020 during the Royal Commission's Public Hearing 5. I may ask rhetorically: have the approximately 1.8 per cent of the population with intellectual disability been overlooked?
Commissioners, you have heard evidence that people with intellectual disability have a higher mortality rate compared to the rest of the general population, with death rates reported to be two to four times higher and life expectancy two decades shorter than the general population.
Today we will ask the Australian Government how it proposes to complete the rollout of Phase 1A and Phase 1B with respect to people with disability, including people with intellectual disability.
I will now turn to how we propose to conduct the hearing today.
Commissioners, many people have contacted the Royal Commission recently about the vaccine rollout for people with disability. It is not possible for you to hear from everyone today. Over the past week, we have prerecorded evidence from 11 people and we will start the hearing today by playing you extracts of the pre recorded evidence. The entire recording of that evidence for each of the witnesses will be tendered into evidence in due course and made available on the Royal Commission's website.
Commissioners, we will not be asking you to make any particular factual findings about the experience of these witnesses.
We will also tender into evidence statements from witnesses who you will not hear from in person today. This includes Julia Squires, the CEO of Ability Options, and Mr Kevin Stone, an advocate with VALID. They will not give evidence during the hearing but I will cover the matters identified in their statements during the course of the hearing.
After morning tea you will hear from three witnesses: Catherine McAlpine, the CEO of Inclusion Australia; David Moody, the CEO of National Disability Services; Professor Anne Kavanagh, the Chair of Disability and Health and Head of the Disability Health Unit in the Centre for Health Equity in the Melbourne School of Population and Global Health at the University of Melbourne.
After lunch, you will hear from Ms Edwards, the Associate Secretary of the Commonwealth Department of Health.
Commissioners, we have prepared a working chronology for you and the parties with Leave to Appear have copies of the chronology. It is intended to be an aide memoire for the key dates but to also identify publicly available material. It is likely at the conclusion of this hearing and after all relevant material has been received that we will ask you to receive that chronology as part of the record of this hearing.
Commissioners, we propose to defer the tender of any statements or material until the end of the day, and that may be subject to the Commission's further directions.
Finally, some of the evidence that you will hear today may be distressing and the Royal Commission encourages those watching to be mindful that topics might be upsetting and we encourage those people who feel any distress to seek support.
The Blue Knot Foundation provides a specialist counselling support and referral
service for people with disability, their families and carers. Their contact details are available on the Royal Commission website. I note that there are provisions in the Royal Commissions Act which have the clear object of protecting witnesses who give evidence before the Royal Commission. In particular, I want to draw attention to section 6M. It says:
Any person who uses, causes, or inflicts, any violence, punishment, damage, loss or disadvantage to any person on account of:
(a) the person having appeared as a witness before the Royal Commission;or
(b) given evidence before the Royal Commission; or
(c) producing documents to the Royal Commission…;
commits an indictable offence.
The maximum penalty for committing such an offence is imprisonment.
Thank you, Commissioners.
CHAIR: Thank you, Ms Eastman.
MS EASTMAN: Commissioners, we will turn to the evidence from our witnesses with lived experience. We have short extracts of their recorded evidence. I will start with the evidence of Mr Clifford Stephens and Mr Christian Stephens. The Royal Commission will first hear from them. Mr Christian Stephens lives in a four unit supported residence in Victoria. In the extended version, Mr Clifford Stephens – which takes about 15 minutes in total , will speak about his experiences in seeking information about the vaccine rollout and trying to arrange for his son who, is in the Phase 1A category, to be vaccinated. I will ask for those pre recorded extracts to be shown now.
[VIDEO RECORDING PLAYED]
MS EASTMAN: I want to ask you some questions about the COVID-19 vaccinations. Both of you have decided to take a COVID-19 vaccination?
MR STEPHENS: Yes, I don't have any issues with it and I have talked to Christian about it and you have agreed to do it, Christian, haven't you? Yes. Christian is under 50 so he needs the Pfizer, so that might take a little bit longer.
MS EASTMAN: I want to ask you, when you decided that you wanted to have the COVID-19 vaccination, how did you go about finding out about the process for obtaining the vaccination? Were you given any information?
MR STEPHENS: No, there hasn't really been any information at all. We can look on the internet, Christian has access to the internet, and of course I do, so --- you hear what's going on in the world on the news broadcasts and we knew that one way or
the other, Christian was 1A priority. But there's been no information about it. It's all very well to say you have priority but there's been no information about how you physically actually get the vaccinations.
MS EASTMAN: What's been the source of your information? Have you gone to speak to a general practitioner, have you had information from the service provider, have you looked at government information, how have you gone about getting relevant information?
MR STEPHENS: We approached Christian's GP, but he couldn't help because they haven't registered to do it. And we asked them if there was anybody they could recommend and they said “Yes, there was another clinic nearby”. So I've contacted them and made sure that they have the disability access, so we will probably go there. Basically, we have been sort of left on our own. There's been no information except for the 1A priority from the Federal Government, there's been absolutely nothing from the State Government, and there's nothing from the service provider. So we have basically said, well, we had better get on with it and did do it ourselves. So fortunately, Christian has a family who can support him with that and we can get on the internet and there is an internet site that you can go to and it establishes your priority and then it gives you a whole lot of sites where you can get the vaccination. So you can even book online. So that's basically what we've done. So we're basically on our own.
MS EASTMAN: Has it been difficult to find information about how to access the vaccines?
MR STEPHENS: Well, it has been difficult in the sense that there's been no information. If you sort of consider that Christian is supposed to be priority 1A, indeed I'm priority because of my age, I'm 1B as well, but there hasn't been any information about what to do. There is a website that, as I said, you can go to and answer a whole lot of questions and then they say, "Yes, you're category 1A and these are the sites that you might like to book into." And basically that's what we've done.
But with all of the discussion about aged care and disability and the priority category that they are in, we were sort of expecting that somebody like the State Government or the service provider would give us some information. I mean, we didn't know whether we had to do it ourselves, we didn't know whether somebody was going to knock on Christian's door and say, you know, "We're here to give you your vaccination." There was just absolutely no information whatsoever. So we were just left with fending for ourselves.
As I said before, we can fend for ourselves, but what concerns me is there's people who can't, there's people with disability that don't have family support and sometimes they can't even give consent. So, really the people with disability have been left to their own devices and very often they don't have any devices.
MS EASTMAN: Christian and Cliff, can I ask you, what would you like to see happen now in relation to the rollout of the vaccine for the community generally but for yourselves specifically?
MR STEPHENS: Well, we've taken the sort of action to get ourselves organised, so that we can continue with that. But it certainly would be helpful down the track to know what's happening with the support staff, whether they have been vaccinated and what precautions are being taken.
But it really seems to me that we have been let down by the Federal Government and the State Government and probably the service provider hasn't been able to give us more information because they need to get that information from the Federal or the State Government. They are not good at communicating at any time and even just the absence of information or confirming that they don't know, would have been helpful, but it's really difficult.
MS EASTMAN: Commissioners, the next recording is from a witness Faith. Faith is a disability support worker and she works part time for an NDIS provider but she also operates as a sole operator and support worker. She has a family member with a disability and her family member contracted COVID 19 last year, during a long lockdown. The extended version of the recording, which will be available, takes about 10 minutes. It discusses Faith's feels about being vaccinated herself as a support worker. I'll ask for the extracts that we wish to show the Commissioners today to be played now.
MS EASTMAN: First of all, can I ask you about your role as a disability support worker and provider? What's been your experience in relation to the vaccine rollout?
MS FAITH: So I work part time for an NDIS provider, and I received correspondence from them saying that it was our turn as staff to have the vaccine, and that we would receive documentation in the mail. So I didn't end up --- I didn't receive --- that was at the end of March and I haven't yet received any documentation
offering the vaccine. In saying that, I also work as a sole operator and I did wonder how Department of Health would reach me and all the thousands of other sole operators operating providing support to people with disability. So yeah, as a sole operator I haven't had any contact or offering of the vaccine.
MS EASTMAN: So as a sole operator, who has been your source of information? Has there been a particular body that you've sought information from or who you expect to receive information from?
MS FAITH: I mean, I often refer to the NDIS for updates and often it's more about safe distancing restrictions and that side of things. Other than that, Department of Health or, really, the only source of information I received is the news, which I'm not a fan of.
MS EASTMAN: (Inaudible).
MS FAITH: Yeah, and so that's really the only information I'm receiving.
MS EASTMAN: And you have a family member who has a disability, and your family member also has to make a decision around the vaccine and your family member has asked you to read a statement that the family member has prepared. The family member wants to share that story with the Royal Commission. Could I ask you to tell us what the family member has said?
MS FAITH: Yes, I've got the letter here. My family member writes:
In July 2020, I got COVID 19. It was a really scary time for me and my family. I was terrified of how sick I could become. I was mostly anxious of who I may have passed COVID-19 on to. A family member spoke on my behalf at the Disability Royal Commission earlier this year, relating to an issue about me getting COVID 19. The Disability Royal Commission created a platform for my story to be heard. This resulted in a positive outcome, making change for me and others with disabilities.
Without the Disability Royal Commission, I don't know how I would have coped with my daily living. I haven't had the COVID-19 vaccine, I haven't been contacted to get the COVID-19 vaccine. I haven't received any information about the COVID-19 vaccine. I have seen on the news that if you have a disability, you were in category 1a. I don't know if that means it's for all people with disabilities or just for people living in residential care.
I'm not able to make a decision to receive the COVID-19 vaccine or not. I feel scared to receive it. I don't know if it will affect me differently because I've had COVID 19. If it was the Pfizer vaccine, I may consider it, but if it was the AstraZeneca vaccine, definitely not, because it's causing people to get really sick and get blood clots.
I wish there was more information so I could make a decision about having the vaccine.
MS EASTMAN: Thank you very much for sharing your recent experience and also for speaking for your family member. The Royal Commission is grateful for your evidence. Thank you.
MS FAITH: Thank you for having me, Kate.
MS EASTMAN: Commissioners, the next witnesses are four young people who gave evidence together. You will hear an extract from the pre recorded evidence from a group of self advocates with intellectual disability, Ms Suzannah MacNamara, Mr Greg Tucker, Mr Uli Kaplan and Mr Reed read. They are all members of VALID. Commissioners, you will recall that Kevin Stone gave evidence at Public Hearing 3, as did a number of the members of VALID on that occasion. VALID is an organisation that supports and reference people with disability, particularly intellectual disability and it is based in Victoria.
When you see the pre record, you will see Ms MacNamara sits on the far left of the table and lives in a group home. Mr Tucker, who sits next to Ms MacNamara, lives with his parents and he told us he has a job working, packing in an assembly industry. Mr Kaplan, who appears third from the right, told us he's 25 years old and he lives in a two bedroom unit in residential care. Mr Kaplan has been involved in making a documentary recently about his journey with disability and chronic illness and his path to becoming a disability advocate. He is associated with VALID. I think you will get a flavour of how strong Mr Kaplan's advocacy is when you hear from him shortly. Finally, on the far right is Mr Anthony Reid. Mr Reid told us he lives in a group home with three other people who are older than him and he does some work for self advocacy for VALID and I think in another area as well.
The full pre recording of this evidence goes for just over 30 minutes, but the extract that we will play for you now begins with a discussion between the self advocates about what each of them knew around the COVID 19 vaccination and its relevance to them. I will play that extract now.
MS EASTMAN: What do you know about the COVID 19 vaccinations?
MR TUCKER: Yeah. What I heard last week is it was all over the news. Like, that this new virus has just come out and it then started in Asia I won't say the country, out of respect in Asia, and it spreads out throughout the world and earlier on they started talking about developing a vaccine and it's like they were aiming to have it developed within 18 months, or as soon as possible. It's to combat this latest virus that we are all going through right now and, yeah, that's it, really.
MS EASTMAN: Suzie, do you want to say anything?
MS MacNAMARA: I heard about the vaccine as well. I heard it on the TV and they are trying to get everyone in Australia to have the vaccine if they want to have it, so we don't get sick.
MS EASTMAN: Has anyone --- have you had the vaccine yet?
MR KAPLAN: No, not yet.
MR REID: You could say with me, Kate, I've been told from my carers at my place and the service provider that's looking after the group home, we've all been told my housemates and carers, and me, we've been told that we're going to be given it on May the 16th, which was announced.
MS EASTMAN: Okay.
MR KAPLAN: I got a notification recently that, actually, late Sunday night, that one of the health services that is partnered with the service provider will be doing it on the 14th. Starting on 14 May or 16 May 2021. But, yeah, in my opinion it's just taking way too long.
On top of having a disability, I have a lung condition and I have multiple medical conditions on top of that. So…and just to add to my answer before, I saw on social media as well. But, yeah, it's yeah, I don't, yeah.
MS EASTMAN: Do you all want the vaccine?
MR REID: Yes, I do.
MR TUCKER: Yes, I do.
MR KAPLAN: Yes, I do, but it makes me nervous.
MS EASTMAN: Why does it make you nervous?
MR KAPLAN: Because there's a lot of, there's lot of information coming thick and fast very quickly, overwhelming. Some of it is misinformation. Some of it I don't need, like the police to come out. Like, the people that I should be getting information from is health professionals, not newspapers, not social media, not news companies. I understand they have a job and, you know, God bless them, they keep us up to date, but it's just like is the vaccine ready? Like, you don't make drugs that quickly normally. Like, is it safe? Obviously it should be safe because it wouldn't be on the market, but it's still overwhelming and nervous nerve wracking but, yes, I could take it.
MS EASTMAN: So you have heard it from the doctors and the health people that it's safe?
MR KAPLAN: Yeah.
MS EASTMAN: Does everybody agree with that?
MR TUCKER: Yeah.
MR REID: You could say that. There was one thing about the vaccine, Kate, that I would like to add to that.
MS EASTMAN: Yes.
MR REID: And that was that even I am getting it shortly, well, basically there's a lot of people with a disability that's a fair way, through all the group homes, that might be on different medications which I'm thinking the vaccine might somehow try and interact with the medications they're on.
MR KAPLAN: Yeah.
MR REID: Which could make things a little bit worse for us.
MS EASTMAN: So do you want to have information about what might happen if you're on or taking other medication? Do you want to know what's going to happen?
MR REID: That could be a handy one of information to have coming out for people with a disability. I'm on medication, it would be nice to know that sort of thing, yes, Kate.
MR KAPLAN: And I think on that point is there's AstraZeneca, there's Pfizer, from what I know. I'm happy to take either vaccine but, like, now, since the media reports have come out, I'm concerned about blood clots, which everyone is, but with my lung condition and my immune system I'm already, you know, open to, you know,
getting sick. So I'm just like, well, I consented, I wrote you know, I signed a consent form for my service provider to work with a health provider to give me AstraZeneca but now that might not be a safe option. So do I do I still get that?
Like, I consented to AstraZeneca. Can I obviously I can say, no, I don't want it, but that's a bit pointless. Like, which one do I get now? I spoke to my treating health professionals at a specialist hospital in Melbourne and they just said, "Well, the government advice", and I'm like, well, no one really knows what the answer is because it's developing, which is understandable, I'm not expecting everyone to have all the answers, but, like, these are the concerns. And it's just like they may, they may give you information that's very broad and they're trying to keep you up to date, I'm not saying they're not, but it's just like, well, I asked my service provider for about three or four weeks, "What's going on with the roll out?", and they're just like, "We don't know. We don't know. We're waiting for the government", and I'm, "Well, I want my vaccine", like, so, yeah, it's a complicated topic, Kate.
MS EASTMAN: Suzie, do you think you've got all of the information you need?
MS MacNAMARA: Yeah. I'm not sure that I want to take it because I'm really scared of taking it as well.
MS EASTMAN: Why are you scared?
MS MacNAMARA: Because I'm a bit nervous that I might, could die at a young age and I don't know if I would actually take it or not, so I'm really scared of having it.
MS EASTMAN: Has anyone offered to help you so that maybe you're not so scared when you decide to take the vaccine?
MS MacNAMARA: Well, I asked through my key worker at my group home, and she told me, "Well, it's your choice. If you don't want to have it, you don't have to take it", but we had the other two girls in my group home that actually took it and they seemed to be okay. I don't know if I'll take it 'cause I'm too nervous and scared.
MS EASTMAN: So you are still deciding?
MS MacNAMARA: I'm still deciding, yeah.
MS EASTMAN: You live with your mum and dad?
MR TUCKER: Yeah.
MS EASTMAN: At home, what information do you need to decide to take the vaccine?
MR TUCKER: Well, I don't really need that much information. When when I can get the vaccine, I will do it, for sure. But as Suzie mentioned, I am also a bit
nervous, too, with those cases, with the blood clots. But they also keep saying that the chances of getting a blood clot is one out of every 400,000 which is a very good odds. So overall once I can, yeah, I'll be getting the vaccine.
MS EASTMAN: Is there anything else that you want to tell the Royal Commission about the vaccine or what you think could be done to make it better for other people
to get information? Anything else you want to tell us?
MR KAPLAN: No, go, I'm thinking of the words.
MR TUCKER: The only thing I can say is why is it taking so long.
MR REID: Yeah.
MR TUCKER: I mean, we are a much smaller country than, say, the United States and they already have, like, 200 million people vaccinated already and we only have 2 million people vaccinated here. So, yeah, I mean, I just want to know, like, because the last thing I heard was Australians probably won't be fully vaccinated until the middle of next year.
MR KAPLAN: If not late next year.
MR TUCKER: Yeah. Yeah.
MS EASTMAN: How do you feel about that?
MR TUCKER: Yeah.
MS EASTMAN: Is that too long or is that okay?
MR KAPLAN: Do you want my honest opinion?
MS EASTMAN: Yes.
MR KAPLAN: Throw politics out the window. Stop saying that you're going to be, we're the best country and we're doing better than this, we're doing better than that. Just give us the vaccine. Like, I'm sitting here nervous not having it. I spent three and a half months locked in my unit for my own safety because I had four cases next door in my house.
So, throw politics aside. You're saying that we're rolling out. It's gone from the end of the year to the end of next year. I'm not going to crucify anyone for that. Just do your job. Like, I want the vaccine and if I have to tell the Royal Commission anything, or government anything, don't underestimate our intelligence because we're quite switched on in our own way. Just get the vaccine to us. Like, that's it. If you want us to take it, give us the right information. If that's not working, just roll the vaccine out. But I think make sure that the information can be, say, justified; you
can explain why we need to do something. Stop arguing with each other, stop fighting, work together and get the vaccine out because normal people have the right to have the vaccine; we have the right to have the vaccine, but you need to understand that when you're talking to us about this, this is stressful, extraordinarily stressful. From people being scared with needles, to people feeling overwhelmed with information, to people watching news outlets. Just give us the vaccine. Stop saying you're going to do it and just work towards it and do it.
MS EASTMAN: On behalf of the Royal Commission, I thank everyone who has given us their time over the past week to pre record their evidence. You have seen just a small part of the entirety of the pre recorded evidence and we will make those available on the Royal Commission's website at the earliest opportunity.
Commissioners, at this point, can I propose that we adjourn for about 20 minutes and then we will resume with Ms McAlpine.
CHAIR: Thank you, Ms Eastman, we will resume at 11.20.
ADJOURNED [11.01 AM]
RESUMED [11.20 AM]
CHAIR: Yes, Ms Eastman.
MS EASTMAN: Thank you, Commissioners. Can I just note with respect to the this morning's experiences that the issue was entirely on our side, and I apologise if that has caused any embarrassment to those representing the State of NSW. Sometimes the technology gets away with us, Commissioners.
Our first witness for this session is Catherine McAlpine, who will be known to you. She gave evidence at Public Hearing 9.
CHAIR: Yes, thank you. We will wait for Ms McAlpine to come up on the screen.
Thank you, Ms McAlpine, we had to wait a moment until you appeared on the screen. Would you be good enough to follow the instructions for taking the affirmation, please.
MS CATHERINE MCALPINE, AFFIRMED
CHAIR: Thank you, Ms McAlpine, just to explain where everybody is today, Commissioner Galbally is in Melbourne, Commissioner Atkinson is in Brisbane, Commissioner Bennett is with me in Sydney, as is Ms Eastman, who you know, will ask you some questions.
EXAMINATION IN CHIEF BY MS EASTMAN
MS EASTMAN: You are Catherine McAlpine?
MS McALPINE: Yes, I am.
MS EASTMAN: You have provided your address to the Royal Commission and you are the Chief Executive Officer of Inclusion Australia?
MS McALPINE: I am.
MS EASTMAN: You made a statement in relation to this Public Hearing, dated 14 May?
MS McALPINE: I have.
MS EASTMAN: Do you have a copy of the statement with you?
MS McALPINE: I do.
MS EASTMAN: The contents of the statement are true?
MS McALPINE: Yes.
MS EASTMAN: The Commissioners have had the chance to read your statement and I want to turn to some issues of immediate concern in relation the vaccine rollout. In paragraph 14, in your statement, Inclusion Australia is concerned about two particular aspects of the Australian Government's implementation of the vaccine rollout. The first is the lack of delivery of COVID-19 19 vaccination to "disability care residents", and the second is the lack of appropriate and accessible information about the vaccine rollout and the COVID-19 19 vaccine itself.
They are the two principal issues?
MS McALPINE: That's correct.
MS EASTMAN: I think you have said there are a range of other issues but those are the two most important issues that you want to address today.
MS McALPINE: Yes.
MS EASTMAN: First of all, you were aware, when the vaccine rollout was announced, that there would be phases of the rollout, including Phase 1A and 1B, and with respect to Phase 1A the language used in the rollout documents just described "disability care residents". What was your understanding about what that actually meant and who might be included?
MS McALPINE: It was our understanding that, that meant people mainly in group homes and that was any place that people with two or more people with disability lived together.
MS EASTMAN: Did the people in group homes have to have any particular type of disability?
MS McALPINE: No, not for 1A. It was the residential nature of their living circumstances that made them eligible for 1A.
MS EASTMAN: What was your expectation of the Phase 1A rollout in relation to people who lived in group homes? What did you expect when you first heard about the rollout?
MS McALPINE: We were really pleased because we know that people with intellectual disability in group homes are second only to people in residential aged care who are at risk, and we expected that they would roll out together, that people in group homes would receive the vaccine before other people in the population, because they were a priority group.
MS EASTMAN: Reflecting on the past few months, it's your view, expressed in the statement, that people with disability living in group homes have not experienced prioritisation in the rollout and you have set out in paragraph 16 what your understanding is. Can I work through each of those with you?
MS McALPINE: Yes, sure.
MS EASTMAN: These views are expressed based on members of Inclusion Australia, members of the advocacy group VALID, members of the group Parent 2 Parent, and members of the group Speak Out Tasmania; is that correct?
MS McALPINE: That's correct.
MS EASTMAN: Based on your feedback from all of those groups and members, it's your understanding that people in most group homes have received no notification at all about when they may receive the vaccine or which vaccination they will receive?
MS McALPINE: That is correct.
MS EASTMAN: Most people with intellectual disability have not received a COVID 19 vaccination, including people who are over the age of 50. Do you mean by that not just people in a group home but people with an intellectual disability generally?
MS McALPINE: Yes, it's true in both cases. It's true that most people in group homes have not received a vaccination and it's true that most people with intellectual disability have not received a vaccination, but noting that many of them fall into category 1B rather than 1A.
MS EASTMAN: Thirdly, that most people have not been advised when they will receive the COVID 19 vaccination.
MS McALPINE: That's right. So the advocacy organisations that are our members have been sort of overrun with people calling or contacting them trying to find out when they might get the vaccination, or concerned that they haven't heard anything.
MS EASTMAN: You became aware, from both media reports, of some evidence given at a Senate Committee, that there had been a de prioritisation of people in disability residential care with respect to the Phase 1A, and that occurred around 20 April 2021; is that right?
MS McALPINE: That's correct. There are other advocates too who have described that as gobsmacking, and I would agree, that we had been having regular meetings with the Health Department and we understood that people in group homes were equally a priority as people in residence aged care and we were not aware that such little progress had been made and we were not aware that in fact there had been an internal decision to prioritise people in residential aged care over people with disability. We were also concerned because by then we were hearing at a state level that people in Phase 1B were starting to be vaccinated and there was reference to that being more "efficient" and that was a problem for us because we know logistically getting to group homes is difficult, but we weren't aware that they just popped that in the you know, it seemed to us, they put that in the "too hard" basket.
MS EASTMAN: Can you tell the Royal Commission, based on what you are hearing from your members and others, what has been the impact on people living in residential care to know that they were de prioritised?
MS McALPINE: There's been a mixture of effects for people living in residential group homes. They are very concerned, you heard from the self advocates this morning, they are concerned about dying from COVID-19, they are concerned that they are not a priority for the government. It was an ongoing issue during the early phase of the COVID-19 pandemic that we didn't hear the Prime Minister talking about people with disability as a priority. And so it just still makes people feel forgotten and not important. The other thing that's happening are people are now picking up on the vaccination hesitancy and are becoming scared of the vaccination
itself, and that is adding to the stress levels and the misinformation that's flowing around group homes.
MS EASTMAN: That takes us to the second priority area for you, and that is the lack of information about the vaccine rollout. It's the case, isn't it, that it's your view that a significant barrier to achieving higher vaccination rates among people with intellectual disability, including those who live in group homes, will be overcoming fears and misunderstanding about receiving the COVID 19 vaccination, in particular the AstraZeneca vaccination? Can I ask why you have focused on AstraZeneca and whether that had anything to do with the understanding that those in Phase 1A would all receive the Pfizer vaccination? What can you tell the Royal Commission about that?
MS McALPINE: When we were first told that both people in Residential Aged Care and people in disability care would receive, would be 1A, we were told that all of those people would receive the Pfizer vaccination, and we had been operating on that assumption until 20 April, when we heard the stuff from the Senate Estimates, where they were unclear whether or not they would continue with that plan. So the Residential Aged Care have all received Pfizer, even though they are over 70, but for disability care they describe the logistics of going into group homes and giving some people the Pfizer and some people the AstraZeneca, as complex, so that led us to understand, did that mean the people in disability care would be given the AstraZeneca vaccine.
MS EASTMAN: Have you raised those concerns with the Commonwealth Department of Health, and if so, when?
MS McALPINE: No. So we became aware of that quite late in the piece and I was unable to attend the last meeting, the last roundtable meeting, so that particular issue of why people with intellectual disability, or disability in group homes, which is mainly people with intellectual disability, why there was a different approach taken to them than to people in Residential Aged Care.
MS EASTMAN: You may have heard the evidence from the people who live in group homes and who are self advocates for VALID and others who have given some evidence this morning about where they get their information and the type of information that they want. It's your view that the rollout has not been accompanied by adequate or appropriate information from the Australian Government, advising people with intellectual disability about COVID 19 or the vaccine rollout. You have expressed that in the statement.
But you're aware, aren't you, that the Commonwealth Department of Health has published on its website quite a lot of brochures and information, and you're aware, aren't you, that the Commonwealth Government has produced Easy Read about the vaccination, about AstraZeneca and about Pfizer? Why do you have this concern that the information hasn't been adequate or appropriate, based on what you know about the information that is available? What can you tell the Royal Commission
MS McALPINE: There are three issues with the information that's given. Firstly, a lot of information is very timely, so right at that moment when there were concerns about the AstraZeneca vaccine, there was no information in Easy Read at all, because it takes about two weeks to produce an Easy Read document. So what we found very difficult is that there was no plain language messaging at all that was publicly available, that could be shared with people with intellectual disability, who were highly anxious at that point. Secondly…
MS EASTMAN: Pausing there, I'm going to ask you a quick question. You and I have used the expression "Easy Read" but not everybody may be familiar or have heard of Easy Read. Can you tell us what Easy Read means?
MS McALPINE: Easy Read materials are materials that are designed to make information as accessible as possible. They are particularly designed for people with intellectual disability, so they are very plain language, one idea per sentence, and they are augmented by pictures. So Easy Read has some images that support the text and it is particularly helpful for people with any sort of cognitive disability.
MS EASTMAN: Does that mean that any person could look at information and perhaps try to put it in very plain English and perhaps accompany it with graphics and that's what Easy Read is? Is that how it works?
MS McALPINE: If only it were that simple. Some people do do that and think they have done Easy Read, but in fact it's more complex than that because you have to be very careful about the ideas, you have to be very careful about using facts. And you need to test it with people with intellectual disability to make sure that it's understandable.
MS EASTMAN: Who are the best people to speak to in relation to the preparation of Easy Read documents?
MS McALPINE: People with intellectual disability. There's people that have some expertise in writing and editing work into plain language and into Easy Read text. But it always needs to be tested with people with intellectual disability because even though you might meet the technical elements of Easy Read, so you might have the right white space and the right font size and you might have short sentences, if those sentences don't make sense in context then it's not still not acceptable.
The other point I should make is that Easy Read is designed to be read with support. Some people with a mild intellectual disability might be able to access it themselves, but most people with intellectual disability will need support to read Easy Read. So it's not enough to just put something on a website, which my second point was going to be, it's hard to find on the website, which also goes to accessibility, but it's not enough just to have it on the website, you need to understand how it's used for it to be fit for purpose.
MS EASTMAN: Last week you pre recorded some evidence with Tara Elliffe, who is a young woman who lives with Down syndrome.
The Royal Commission has heard evidence from Ms Elliffe in Public Hearing 4 and she is a user of Easy Read documents. The two of you worked through the Easy Read explanation of the AstraZeneca vaccine. We got to about page 9 in 20 or so minutes and stopped at page 9, I think, with many pages to go. The Royal Commission will receive that pre recorded evidence as part of the record of this hearing so I'm not going to play it now, but from your perspective, having done that exercise with Ms Elliffe, who uses Easy Read, what are the observations you made from that process?
MS McALPINE: The observations that I made from that process were that, first of all, there was information in the Easy Read documents that really Tara didn't need, and there was information in that document that was very complex and the messages that were trying to be portrayed were not received by her, that the information was too complex. I'm going to use the term "convoluted." The information wasn't straightforward, and she was not able to understand it without some considerable support and explanation and relating it back to her own personal experience, that I was able to do when I worked through the information with her.
MS EASTMAN: I want to move now to the final part of your statement, which is the way forward.
Commissioners, you will find this part of Ms McAlpine's evidence starts at paragraph 27 of the statement.
Ms McAlpine, you have set out in these parts of your statement what you think could be done now to support people with intellectual disability in the vaccine rollout, both in terms of information being prioritised and also improving communications, so can I walk through what the issues are in terms of the way forward.
Paragraph 27, you refer to some research in relation to very high risk factors for people with intellectual disability, and you say in your view it is imperative the Australian Government prioritise people with intellectual disability in the vaccine rollout and provide these people with urgent access to COVID-19 19 vaccinations.
I'm asking you this question --- you may not know the answer, but aren't all people with intellectual disability covered in Phase 1A or Phase 1B?
MS McALPINE: No, they are not. The Phase 1B only prioritises people with particular underlying health conditions, so if you have got a heart condition or some other conditions, then you will be included. Now, many people with intellectual disability are thereby covered by those conditions but they have not included all people with disability with intellectual disability, at the moment they are saying people with severe intellectual disability but with no definition around that. But
because people with intellectual disability are more at risk of COVID-19, because possibly they have an underlying condition, but also they need more support to adhere to the recommendations along personal hygiene and social distancing, and also because they are more likely to be in contact with other people, they are at more risk of catching it. So for a variety of reasons they are at risk, and this research from the US shows that the possibility of dying from COVID-19, that the risk for people with intellectual disability is second only to advanced age.
MS EASTMAN: On improving communication, what do you suggest the Commonwealth Government could consider to improve communication for people with intellectual disability or cognitive disability more broadly?
MS McALPINE: We suggest that they be very careful about the way that they commission and use Easy Read materials and that they adhere to some of the suggestions that we have made in the statement. The information to people should be provided via the obvious formal supports. So doctors and pharmacies, group home providers and support workers should all receive good quality, plain information that they can share with people with intellectual disability that they support.
We would like to see a little bit more directed information towards people with disability in a way that makes sense to them, for instance, TV ads, short online videos and animation. And brochures in Easy Read that can be re read and re read. The provision of clear targeted information for families and other supporters which could be shared by peer support and advocacy networks, as well as by social media and mainstream mechanisms. And where the nature of time critical information excludes the option of fully developed Easy Read resources, that essential messages are provided in very plain English and shared widely. So, for example, after the problem emerged with the AstraZeneca vaccine, it would have been very helpful to make clear statements, such as "A problem with the AstraZeneca vaccine has been found. The government is thinking about changing the vaccine rollout plan. No one in group homes will receive the AstraZeneca vaccine until the new decisions have been made. The government will announce the new plan on [such and such a date] after the National Cabinet meeting."
A sort of message like that could have been broadcast on TV, or radio, on social media, through disability networks, so that it reached everyone who needed to hear that in a time sensitive way.
MS EASTMAN: Ms McAlpine, thank you for a very comprehensive statement that you provided to the Royal Commission. You have also included a copy of the research article, "The Devastating Impact of COVID 19 on Individuals with Intellectual Disabilities in the United States", that was published on 5 March this year. Thank you for providing us with that document as well. I will check if the Royal Commissioners have any questions for you before we conclude.
CHAIR: Yes, thank you, Ms McAlpine. I'll ask first if Commissioner Galbally has
any questions to put to you.
QUESTIONS BY THE COMMISSION
COMMISSIONER GALBALLY: Thank you. I have a couple of questions. One is the issue of group homes in terms of people's proximity to each other, the difficulty in social isolation, but is it also going off to day programs and sheltered workshops that would make them a very high priority? You know, a gathering, a large gatherings of people with disabilities?
MS McALPINE: Absolutely. We have concentrated in this way on group homes because that's where people live and sleep, but for people with intellectual disability who are much more likely to be in congregate settings, Australian Disability Enterprises, day programs and other settings, are also risky environments for them.
COMMISSIONER GALBALLY: The ADEs and day programs were kept open through a lot of the COVID-19, the height of the COVID-19 break out too, as far as I recall. So that's also really important.
The second question to you is, you say they are difficult places to access to vaccines. In what way are they difficult? And more difficult than Residential Aged Care, for example?
MS McALPINE: Yes. It's been explained to us that it's particularly to do with the Pfizer vaccine cold chain requirements. So because maybe somewhere between 2 and 6 people might live in a group home, they need to be able to keep the vaccines cold for the day, going from group home to group home, whereas in residential aged care you might have 100 people in one site. So it's been explained to us that the logistics are more complicated. But I have to be frank and say, for us, we feel like it's the social model of disability in real life, in terms of it's not the impairment that is stopping people getting the vaccine, it's the fact that government is choosing not to use the resources at its disposal to go and visit the approximately 6,000 sites they need to visit to give people the vaccination.
COMMISSIONER GALBALLY: So the de prioritisation, in your view, you are indicating you see that as quite discriminatory?
MS McALPINE: Yes, I do. I'm indicating that particularly once we found that there had been a pivot away from disability and the fact that 1B had started for a great variety of Australian citizens, that there had been a deliberate choice to not put the resources, the necessary resources, into ensuring that people with disability in group homes received the vaccination, according to the priority that the government itself had set.
COMMISSIONER GALBALLY: Thank you.
CHAIR: Thank you. Commissioner Atkinson.
COMMISSIONER ATKINSON: No questions, thank you.
CHAIR: Thank you. Commissioner Bennett.
Ms McAlpine, you referred in your evidence to going through the Easy Read material prepared by the Australian Government that is on the website, and you have explained the deficiencies as you see it. Are you aware of the consultations, if any, that took place before that Easy Read material was placed on the site, particularly with people with intellectual disability or advocacy organisations?
MS McALPINE: I'm not aware of any consultation that has happened with us. I do believe that most of the providers of the Easy Read do have some people with intellectual disability that check the materials. But it would certainly be our recommendation that we get consulted when the materials are being designed, not just to look at them after they have already been produced, because the only time I ever get asked about them is when they want to put them on the website tomorrow and they ask me to look at it and that's really problematic because it shouldn't be me that is looking at it, it should be people with intellectual disability, and there should be enough time for that to happen.
CHAIR: Yes, thank you. I will ask if there are any questions from any parties given leave to appear. I'll start with the Commonwealth, Ms Downes.
MS EASTMAN: There are problems at our end, so I would ask those assisting us to be proactive in unmuting counsel for the parties.
MS DOWNES: No questions, thank you, Chair.
CHAIR: Thank you, Ms Downes. Ms Furness?
MS FURNESS: No questions, thank you, Chair.
CHAIR: Thank you. And Mr Chesterman?
MR CHESTERMAN: No questions, thank you, Chair.
CHAIR: Thank you very much, Ms McAlpine, for coming and giving your evidence today. As previously, the Royal Commission very much appreciates your assistance. Thank you.
MS McALPINE: Thank you, sir.
THE WITNESS WITHDREW
MS EASTMAN: Commissioners, the next witness is David Moody. He is the CEO of National Disability Services. Commissioners, he has provided a statement to the Royal Commission dated 11 May 2021. He is coming on the screen in a moment.
CHAIR: We will wait for Mr Moody to come on screen.
Good morning, Mr Moody, thank you very much for coming to the Royal Commission. Could I ask you please to follow the instructions and take the affirmation in accordance with those instructions. Thank you.
MR DAVID MOODY, AFFIRMED
CHAIR: Thank you, Mr Moody. Let me explain where everybody is, just to make you are aware of it. Commissioner Galbally on the screen is in Melbourne, Commissioner Atkinson is in Brisbane, Commissioner Bennett is with me in the Sydney hearing room, and Ms Eastman, who is the Senior Counsel Assisting the Royal Commission, is also in the Sydney hearing room, and now Ms Eastman will ask you some questions.
MR MOODY: Thank you.
EXAMINATION IN CHIEF BY MS EASTMAN
MS EASTMAN: Good morning. You are David Moody?
MR MOODY: Yes.
MS EASTMAN: You have provided your address to the Royal Commission?
MR MOODY: Yes.
MS EASTMAN: You are the Chief Executive Officer of National Disability Services?
MR MOODY: Yes.
MS EASTMAN: We might refer to it in its shorthand "NDS" when you give your evidence this morning. You have held the role of Chief Executive Officer initially in an acting capacity but then on an ongoing basis since February 2019?
MR MOODY: That's correct, yes.
MS EASTMAN: You have set out in your statement to the Royal Commission a little bit about your background prior to assuming the role of CEO of NDS?
MR MOODY: I have.
MS EASTMAN: Do you have a copy of that statement with you?
MR MOODY: I do.
MS EASTMAN: Are the contents of that statement true?
MR MOODY: They are.
MS EASTMAN: I want to start by asking you about NDS and what its role is. It is the peak body for non government Disability Services Organisations, and you have told the Royal Commission that it represents over 1,150 non government service providers and your members are in every State and Territory of Australia.
Can I ask you to briefly tell the Royal Commission about the non government disability service organisations and the nature of the services provided?
MR MOODY: Certainly. Our members, 1,150 odd, provide a range of services for and with people with disability. Services include the provision of residential services for people with disability, they include community participation services, therapeutic services, services to support people with disability to find and keep a job, and a range of other (increasingly these days) bespoke services, depending upon the choices being made by the person with disability under the National Disability Insurance Scheme.
The National Disability Services as a peak body provides a range of advocacy services for and on behalf of our members, we also provide a huge range of information and support to our members to support them to understand and grow their organisations to meet the expectations of people with disability, who may be their clients.
We also provide a range of sector transformation services and supports for our members to support them in their increasing focus on ensuring that the services they are providing are the services that people with disability wish to purchase under their plans and to ensure those services are to a high quality and as far as is possible innovative in their approach.
MS EASTMAN: Mr Moody, I'm having some difficulty hearing you so I have asked the people assisting us with the Royal Commission to perhaps increase your volume a little.
Could I also ask you, and it's a reminder to myself, that we can slow down a little bit,
so our Auslan interpreters can follow us as well.
MR MOODY: Very fair point and I do apologise.
MS EASTMAN: Thank you. I want to ask you about the vaccine rollout and the Phase 1A and 1B. Can I start with the Phase 1A. When the announcement was made that there would be Phase 1A and in that Phase there would be people with disability in disability care and support workers, did you understand what that actually meant and who would be covered in Phase 1A?
MR MOODY: We did, and we did because the Federal Government, in making the announcement about this part of the sector would get priority access to the vaccines, was pretty specific. We understood that people with disability, living in residential disability accommodation, would be given priority access to the vaccine, subject to them choosing to have the vaccine, and we understood that the workers supporting them in residential disability accommodation would also have that priority access under Phase 1A. That was our understanding and nothing we saw or read publicly dissuaded us from that view.
MS EASTMAN: How many sites, if I can use that expression, for particular residents would that cover, what was your understanding?
MR MOODY: It was my understanding that would cover around 23,000 residents at least, and about 6,000 sites.
MS EASTMAN: When you say about 23,000 residents, how would you identify those residents? Is it anybody with any type of disability but they have to live in residential care or was there some other way of identifying those people?
MR MOODY: The mechanism, as I understand it, was whether or not the person was living in residential disability accommodation, and that was, if you like, the point of the exercise, to focus on people who were living in disability accommodation, irrespective of the nature of their disability.
MS EASTMAN: Does that mean that the person has to be an NDIS participant?
MR MOODY: No. Our understanding was it meant beyond merely NDIS participants, albeit that the vast majority of people living in residential disability accommodation would have been NDIS participants.
MS EASTMAN: Did you understand that in terms of residential accommodation that there was a number of residents in any particular facility that would be captured by 1A?
MR MOODY: Well, we assumed, certainly I assumed, that the residents who would be captured by 1A would be all of residents in residential disability accommodation, whether that be residential beneficial accommodation numbering five bedrooms, four
bedrooms or three bedrooms, as the case may be.
MS EASTMAN: But there are people who live by themselves who are NDIS participants, and when they live by themselves their residents are supported with support workers who may come in and out. Did you understand that there was any distinction between people who lived by themselves and people who lived with two or more people where there may have been more shared accommodation?
MR MOODY: I only came to the understanding, I confess, that there was that distinction being made in the rollout of Phase 1A, when I heard the same media reports that I think everybody else heard at the time. Before that I had assumed that if you were in residential disability accommodation or being supported in accommodation, that you would at least have a fair crack at being part of Phase 1A.
MS EASTMAN: There wasn't a qualifier that it had to be shared disability residential accommodation, Phase 1A just described disability residential care; is that right?
MR MOODY: As I can recall, yes.
MS EASTMAN: Concerning residential support workers, you have done a workforce census to try to capture the number of support workers working in residential care for any people with disability and the census that you undertook last year identified 51,000 workers; is that right?
MR MOODY: Yes, spread across 284 organisations. I say that simply because we don't suggest for a minute that that's the sum total of organisations providing services under the NDIS that are employing workers.
MS EASTMAN: I want to turn to the vaccine rollout, and you have set this out in your statement in some detail at paragraph 23 and following. It is the case, isn't it, that during February this year, NDS was one of the stakeholders consulted by the government about a strategic plan for the vaccine rollout?
MR MOODY: Yes.
MS EASTMAN: You had the opportunity to provide feedback on the plan?
MR MOODY: We did.
MS EASTMAN: You gave a number of suggestions to government about what would be necessary if the rollout of the vaccinations for Phase 1A had to be on the 6,000 or so sites; is that right?
MR MOODY: We did, yes.
MS EASTMAN: In mid February you issued a policy position statement, and that
was made publicly, where you called on the Australian Government to do certain things. You have set that out at paragraph 26 of your statement.
MR MOODY: Yes.
MS EASTMAN: One of the issues was that you wanted there to be mandatory vaccination of all disability support workers who were working directly with people with disability, regardless of the setting or the circumstances of the work; is that right?
MR MOODY: Subject only to that mandatory approach being taken to the vehicle of public health orders, made by state governments, and I want to emphasise that.
MS EASTMAN: So there could be exceptions but you wanted to have some clarity about when it would be mandatory for workers to be vaccinated or not, or what the exceptions would be; is that right?
MR MOODY: That is correct.
MS EASTMAN: You also wanted support for the rollout to the sector with comprehensive and accessible community education programs?
MR MOODY: Yes.
MS EASTMAN: That were targeted appropriately to provide information for the providers, the support workers, people with disability, carers and family members, but also to the suppliers and contractors, and that was to be developed in consultation with NDS and other industry partners and peak bodies. Can I just ask you about suppliers and contractors. Does that mean the private organisations that would be involved in doing the rollout at the particular sites or does it mean something else?
MR MOODY: It actually tends to refer to those who may be providing other services on sites, for people with disability to access. They may not be disability service providers but they may be providing other services for the purpose of ensuring that people with disability are appropriately supported.
MS EASTMAN: Part of this was so that if there were going to be particular contractors or suppliers to come to sites to administer vaccinations to people living in residential care, and this includes, doesn't it, Mr Moody, people who are vulnerable, people with intellectual disability who may have behaviours of concern, who may have deep fears about health procedures, who may be non verbal; that the contractors needed to know the cohort of people to whom the vaccines might be administered?
MR MOODY: Correct, absolutely. That would have been imperative.
MS EASTMAN: It was your expectation, was it not, that a contractor couldn't just turn up without any comprehensive education or training to be able to administer
vaccinations in a group home setting? Is that right?
MR MOODY: Certainly our expectation is that when vaccines were to be administered to people with disability who chose to have them, there would at least be sufficient expertise and understanding of the needs and preferences of the person with disability and how they wished to be supported, present during the vaccination. We tried as far as possible, to be pragmatic in our approach to these issues. Given at that time the necessity of rolling out the vaccine into the sector as a priority and speedily, we were open to the reality that those doing the vaccinations may not have been experts in the provision of disability services or understanding people with disability and their needs. But insofar as there were other people present at the site or where the vaccines were being administered that were experts and told to hold themselves out as such in supporting people with disability, we were comfortable with that approach. If…
MS EASTMAN: Sorry, go ahead.
MR MOODY: We were comfortable with that approach insofar as it was actually implemented.
MS EASTMAN: When you say to the extent it was implemented, it hasn't been implemented in that form, has it?
MR MOODY: Our view is that the Phase 1A rollout has been unsuccessful, to say the least, to date, insofar as it was supposed to have been concluded by the end of March and it wasn't.
MS EASTMAN: You have some views as to why that's the case; is that right?
MR MOODY: We have several views. As an organisation, amongst them being the lack of vaccine access for people with disability and the workers who support them, the challenges in terms of logistics around getting the vaccine out to the 6,000 or so residential disability accommodation services who are the subject of Phase 1A, and essentially those would be two of the more significant reasons. Certainly from our point of view I would say that we were absolutely delighted as a sector to be referred to as having priority access to the vaccine in the first place alongside health and aged care, and perhaps for that reason alone we were even more disappointed than you might have expected us to be by the fact that priority access has not been delivered at this point.
MS EASTMAN: The government might say to you, "But hasn't NDS been involved in consultations with the government, providing advice to government, participated in webinars, in seminars, you have received a lot of material from the government about education plans and the like?" But you still say something has gone wrong. Is that right?
MR MOODY: That's correct. --- If that question was to be asked by government,
I would respond by saying, yes, we were consulted initially in regards to the strategy plan, but I think everyone entering into those discussions was working on the assumption that there would be sufficient vaccines for people within --- to be covered by Phase 1A to get those vaccines and that in fact --- we certainly didn't get into the detail nor were we asked about the detail in terms of the logistics of the rollout, other than to confirm that our members were on notice to expect that a vaccinator would be coming to our premises and the circumstances in which that would occur. So we always entered into those discussions on the basis there was going to be enough vaccines to meet the expectations of those in Phase 1A.
MS EASTMAN: We have seen in some publicly available material that one of the webinars in early March, around 3 or 4 March 2021, that representatives of the government said that there would be a Disability Residential Care COVID-19 Vaccine Implementation Plan put up on the website in the coming week or so. Have you seen a specific implementation plan?
MR MOODY: If one has been produced, I can't recall having seen it.
MS EASTMAN: I want to bring you to about 20 April 2021. On that date you became aware that the government had pivoted to focus on aged care, and that people in disability residential care had been de prioritised. You also became aware around that time that Phase 1A and Phase 1B would merge. Did you have any prior notice that a decision had been made in relation to the Phase 1A to make a distinction between aged care and disability residential care?
MR MOODY: No, we didn't.
MS EASTMAN: What was your reaction to finding out that information?
MR MOODY: I was pretty furious on behalf of those people who had particular expectations around Phase 1A, people with disability and the workers who supported them ---
MS EASTMAN: Had you had any correspondence at all from the government about it?
MR MOODY: Before the announcement?
MS EASTMAN: Yes.
MR MOODY: No.
MS EASTMAN: Have you had any correspondence since the announcement from the government about the decision or any implications of that decision to your members?
MR MOODY: Not that I can recall, no.
MS EASTMAN: Those representing the Australian Government have asked us to tender into evidence a letter addressed to you from the Minister, the Hon. Linda Reynolds. We will do so, but before the tender, I need to ask you, have you received a letter from Senator Reynolds?
MR MOODY: Yes, I have.
MS EASTMAN: When did you receive a letter from Senator Reynolds?
MR MOODY: Friday of last week.
MS EASTMAN: About what time on Friday of last week? Do you remember? Was it sent by email?
MR MOODY: It was sent by email. I would have to refer to my records but I believe it would have been in early afternoon.
MS EASTMAN: I assume you have read that letter carefully?
MR MOODY: I have.
MS EASTMAN: Was there anything new in this letter in terms of what the government's proposed program would be?
MR MOODY: Yes. Certainly based upon my recollection of discussions and documents that I have read in the past, amongst the new elements were --- I'm assuming that all Commissioners have a copy of the letter in front of them --- but the Department of Health and providers will be engaging with disability residential accommodation providers in the following ways: three weeks before the scheduled vaccination day to inform the provider of the date and confirm the number of residents, and one week before the visit the vaccine provider will contact the provider to confirm the final number of people to be vaccinated, to inform those ordering.
I draw that out simply because those time frames are new, and also because, at first blush, they appear to be more reasonable in terms of the amount of time being allowed for things to be got in place for the vaccination process.
CHAIR: Mr Moody, I wonder if you would be good enough to remember, as best you can, to speak slowly, because it is difficult for the Auslan interpreters to operate with someone speaking very quickly. I know that is something that regularly happens and it does take a degree of determination to do it, but if you wouldn't mind trying as best you can.
MR MOODY: I will, Commissioner. I should know better. I do apologise.
CHAIR: That's alright.
MS EASTMAN: Commissioners, I will tender the letter. We received it late last night from those representing the Commonwealth. I will ensure that, Commissioners, you have a copy of that letter and we will tender it. I wanted to first check with Mr Moody whether he had received the letter.
CHAIR: Thank you.
MS EASTMAN: Mr Moody, I want to conclude by taking you to that part of your statement that talks about what needs to happen now.
You have set this out at paragraphs 39 and following. You prepared this statement on 12 May, so a little bit ahead of the Senator's letter to you from Friday. In looking at what you consider needs to happen now, and what you have been told by Senator Reynolds on Friday last week, what can you tell the Royal Commission about what needs to happen to ensure that people in disability residential care can be vaccinated or at least have the choice if they wish to be vaccinated?
MR MOODY: I want to preface my remarks by saying that we want to acknowledge the incredible pressure that the Australian Government public servants have been under to roll out the vaccine in the first place. So the observations I make are intended to be a constructive critique of what's next, rather than an express criticism of the work done to date.
We do think that the public education campaign needs to be ramped up dramatically through social media and a range of other platforms. We do think that people with disability, families and their supporters, need to be the beneficiary of that campaign and certainly the focus of that campaign. We also think that the disability support workforce, that there needs to be dramatic increase in promoting the virtues of having the vaccine, in terms of providing higher quality and safe disability services for the workforce.
As recently as last week I suggested to the Department of Health that, amongst other things the government might avail itself of, an offer that was made by the ACTU very early in the piece to identify workers as disability --- as vaccine champions, to actually…
MS EASTMAN: Just pause there. Disability vaccine champions, what does that mean?
MR MOODY: That means workers who are prepared to actually be part of a public campaign and say things like, "I have had the vaccine, why haven't you?", et cetera. I'm not suggesting that would be the tag line but certainly we think that there is a very strong case to dramatically increase the vaccine education in a range of different languages, including a range of languages for Aboriginal and Torres Strait Islander communities. We think there is a very strong case for demonstrating, particularly
saying to people with disability, but also families and their supporters, why having the vaccine is so important in terms of the education piece, reminding or telling people about the research that has been done over a number of years to demonstrate, certainly over the last two years, to demonstrate the heightened level of risk associated with getting the COVID 19 for many people with disability, particularly where they have a co morbidity that may include a respiratory condition.
Certainly we have been concerned for some time that reports, initially from our members, and subsequently confirmed by academic surveys, that anything up to 30, perhaps 50 per cent of disability support workers, if offered the opportunity to voluntarily have the vaccine, would decline to do so, for a range of…
MS EASTMAN: Pausing there, you have seen the research published by Professor Anne Kavanagh in relation to a survey of disability support workers?
MR MOODY: I have, yes.
MS EASTMAN: I think Professor Kavanagh will shortly give some evidence, following you, about those issues. But did that research concern you in terms of disability support workers having the right information to be able to make decisions around vaccination?
MR MOODY: Yes, it did, very much. Perhaps sadly it also confirmed the anecdotal feedback we were getting from our members around Australia about the advice they were getting from their workforces as to the level of support for having the vaccine voluntarily. Certainly that continues to be a concern for us, and perhaps that goes back to an earlier question you asked as to how we came to have a national policy around the mandate of the vaccine for disability support workers in limited circumstances, face to face.
MS EASTMAN: Mr Moody, it's been drawn to my attention that there are some technical issues. I don't know whether we require a short adjournment before we complete your evidence, to address those issues or whether, Commissioners, we can press through and have an adjournment after Mr Moody's evidence is complete.
CHAIR: The note I have just received suggest we can proceed to the end of Mr Moody's evidence and then we will adjourn for a brief period.
MS EASTMAN: Mindful of those concerns, Mr Moody, thank you very much for your evidence. The Commissioners may have some questions for you.
CHAIR: Thank you, Mr Moody. I will first ask Commissioner Galbally if she has any questions.
QUESTIONS BY THE COMMISSION
COMMISSIONER GALBALLY: Mr Moody, the de prioritisation and the merging of 1A and 1B, were you very surprised? It seemed to come out of the blue.
MR MOODY: I was completely surprised. I…
COMMISSIONER GALBALLY: Have you got any views about why that happened?
MR MOODY: Only those that I would have gained from the evidence given in the Senate estimate, Commissioner. I think it appears that the Australian Government made a decision to pivot to "the aged care sector" because of the potential shortage of the vaccine.
COMMISSIONER GALBALLY: So an element of people with disabilities may be being de prioritised too, just in their importance.
MR MOODY: I don't think it would be unreasonable to assume that, no. Yes, I think --- yes.
COMMISSIONER GALBALLY: Back to the mandating issue, how would that work with NDS's policy? You would say that if a support worker refused to have the vaccine and they are in face to face work, that that would preclude them from that work? Is that how your view about mandating would work?
MR MOODY: Unless they were able to avail themselves of a formal exemption, as laid out in any public health order that mandated the vaccine.
COMMISSIONER GALBALLY: Right, yes.
MR MOODY: Also, I need to be clear on this, I appreciate there are a range of industrial relations associated with that scenario, and certainly we would be advising our members to consider redeployment in those circumstances, and a range of other legal options to address that issue.
COMMISSIONER GALBALLY: Thank you.
CHAIR: Thank you. Commissioner Atkinson.
COMMISSIONER ATKINSON: No further questions, thank you.
CHAIR: Thank you. Commissioner Bennett.
COMMISSIONER BENNETT: Just a quick question. On paragraph 31 of your evidence, one of the points you had made about the need for time was for proper consent, and you said that might be third parties. Are you saying that in some circumstances, such as guardianship arrangements, another party has the control over
health decisions of people in disability residential homes, so that's the proposition I'm asking about. The question actually is: how responsive have the various public guardianships been in turning around the documentation needed for consent?
MR MOODY: Thank you, Commissioner, for the question. In the first instance, yes, that's exactly what I'm saying. Whether or not the person with disability is differing of living in residential disability accommodation or isn't, there are many people with disability who in fact have guardianship or nominee arrangements, and the issue of informed consent for what is an invasive procedure, an injection, has certainly been an ongoing one for the sector during the vaccine rollout. So it is of a concern and the time --- in terms of any planning or internal rollout of the vaccine, time needs to be given to ensuring that there is time for that consent to be obtained. That's certainly something which our members have been very strong in reporting back to us.
In terms of the second part of your question, forgive me, I'm trying to recall what it is.
COMMISSIONER BENNETT: Responsiveness, particularly of Public Guardian or trustees in turning those documents, the required consent, as quickly as possible. Have you found that they are doing it, prioritising it? Or has there been, in your view, a longer delay than is needed to get those consents, where it's not family members, guardianship or trustees?
MR MOODY: I do apologise, I am not able to say, I don't have that information available. I'm saying that more time is required than 48 hours for a Public Guardian or [inaudible] to obtain or act in terms of that consent piece. But I don't have information available. If I could take that question on notice, with the Commission's consent, as to the responsiveness as or otherwise of public guardians and nominees.
COMMISSIONER BENNETT: Yes, I would be interested to know, thank you.
CHAIR: Mr Moody, I would like your help, if I could, to get a little bit more precise information, to the extent you have it, about the numbers of people that would have been covered by Phase 1A, that is to say the number of people with disability covered by Phase 1A.
At paragraph 10 of your statement, you say that the NDIA records that over 23,000 NDIS participants were receiving Supported Independent Living support late in 2020. Is that your estimate of the number of people with disability who would have been covered by Phase 1A, or is that part of a large cohort? To the extent that you can. I only want information that you think you can make reasonable estimate. To the extent that you can, what would be the total number?
MR MOODY: Yes, the best I can do, Commissioner, is to say that I thought the 23,000 number was pretty light, actually, we essentially did our best to provide quantifiable data in light of the agencies' data in that regard. But I would not be
surprised if it was more than that number, is the best I can do.
CHAIR: Your view is that that is a minimum number?
MR MOODY: Yes.
CHAIR: Thank you. In paragraph 11 you refer to your workforce census in 2020, and you say that 284 organisations recorded over 51,000 workers. These, I take it, are workers in disability care?
MR MOODY: Yes, disability support workers, therapists and the like, yes.
CHAIR: You have also said in your statement that your membership consists of 1,150 non government service providers. That's in paragraph 5.
MR MOODY: Yes.
CHAIR: Do we take it that only about 25 per cent of your membership responded to the survey?
MR MOODY: You would have to, Commissioner, yes. I should say --- the workforce census has been running as a longitudinal study for seven or eight years now, and one of the virtues of it is it allows individual organisations to undertake the census, it can be quite a laborious process, I'm advised to benchmark themselves against the sector in terms of how they are doing on a number of indicia.
CHAIR: I understand that. What I'm interested in is how far we can go in estimating the number of disability care workers who do require vaccination, assuming they are prepared to be vaccinated. Does that 51,000 figure represent a quarter of the workforce or some larger percentage or don't we know?
MR MOODY: To be quite honest, to the best of my knowledge, we don't actually know the number of workers in the sector. It's been an issue for the sector, in fact in the time I have been in the sector since 2015, I have no doubt before that as well. On some estimates there are anything between 90,000 and 120,000 workers in the sector now. It is actually a statistic which we would be fascinated to get to the bottom of, to be quite honest.
CHAIR: I'm sure we would all like to know. But I'm not assuming, I should make it clear, that the fact that only 25 per cent of the members responded, that doesn't necessarily mean that 51,000 workers is only 25 per cent of the total workforce. It would depend upon the proportion of large employers who responded to the survey. But assuming those numbers in your statement to be correct, taking figures that Ms Eastman referred to in her opening, and assuming those figures are to be correct, by 6 May, 834 people with disability in residential care had been vaccinated. I'm assuming that's correct. We will see whether the evidence bears it out. But if it is correct that people with disability in residential care amounted to 23,000, that would
be around about 4 per cent had been vaccinated? That's your understanding?
MR MOODY: It is, Commissioner, yes.
CHAIR: Similarly, if we take the figure of 1,098 workers in disability residential care as having been vaccinated, that's the figure that Senior Counsel gave, that would represent about 2 per cent of the 51,000 figure, but of course a much smaller percentage if the 51,000 figure really needs to be much larger.
MR MOODY: It would appear so, Commissioner, yes.
CHAIR: Thank you very much. I'll now ask Ms Downes, representing the Commonwealth, if she has any questions.
CROSS EXAMINATION BY MS DOWNES
MS DOWNES: Yes. Mr Moody, in relation to the letter that you received on Friday, did it have any attachments to it?
MR MOODY: It did, yes, it did.
MS DOWNES: Can you recall how many there were?
MR MOODY: There were three.
MS DOWNES: All right. Was one of them headed "COVID-19 Vaccine National Rollout Strategy 1A Residential Disability Care Cohort"?
MR MOODY: Yes, it was.
MS DOWNES: Terrific. Was another one, "How people with disability in a group residential setting can get a COVID-19 19 vaccination"?
MR MOODY: Yes.
MS DOWNES: Was another one, "How disability support workers can get a COVID-19 19 vaccination"?
MR MOODY: Yes.
MS DOWNES: Terrific.
Chair, we provided those to Counsel Assisting and we understand that they will be tendered as well.
CHAIR: Yes, thank you. I'm sure they will if Counsel Assisting has indicated they will. Do those documents to which you have just referred, Ms Downes, have a date?
MS DOWNES: They don't have a date but they do have --- no, they don't, I'm sorry.
CHAIR: I have noticed a certain tendency of correspondence from the Commonwealth or at least Ministers not to have dates. Perhaps that's a practice that operates within that sphere.
MS EASTMAN: Chair, the documents were received last night. The copy I had only had the letter, and I wasn't aware, until it has just been pointed out by my learned friend's junior counsel, that there are attachments. I have said to him that I'm happy to tender the attachments but I need to identify those attachments. I'm grateful to Ms Downes for identifying those documents. Thank you.
CHAIR: Anything else, Ms Downes?
MS DOWNES: No. Thank you, Chair.
CHAIR: Ms Furness, do you have any questions?
MS FURNESS: I don't, thank you very much.
CHAIR: Mr Chesterman?
MR CHESTERMAN: No questions from me, thank you, Chair.
CHAIR: In that case, Mr Moody, thank you very much for your statement and for giving evidence today. We appreciate your attendance and the assistance you have provided to the Royal Commission. We will now adjourn for five minutes to enable the experts to cure any technical difficulties we seem to be having.
MS EASTMAN: Thank you, Commissioners. Thank you, Mr Moody.
THE WITNESS WITHDREW
ADJOURNED [12.29 PM]
RESUMED [12.39 PM]
CHAIR: Let's proceed.
MS EASTMAN: Thank you, Commissioners, and thank you for those following the
broadcast, we apologise for the technical delays. It means we are running a little bit behind time and I may need to encroach beyond 1.00 pm where we proposed to have an adjournment. Our next witness is Professor Anne Kavanagh.
CHAIR: Professor Kavanagh, thank you very much for coming. Sorry to have kept you waiting slightly. If you would be good enough to follow my associate's instructions as to taking the affirmation, please.
PROFESSOR ANNE KAVANAGH, AFFIRMED
CHAIR: Thank you, Professor Kavanagh. Just to make sure you are aware of where everybody is, we have Commissioner Galbally in Melbourne, Commissioner Atkinson in our Brisbane hearing room, Commissioner Bennett is with me in our Sydney hearing room, as is Ms Eastman, Senior Counsel Assisting, and Ms Eastman will now ask you some questions.
EXAMINATION IN CHIEF BY MS EASTMAN
MS EASTMAN: Thank you, Commissioners.
You are Professor Anne Kavanagh?
PROFESSOR KAVANAGH: Yes.
MS EASTMAN: You have given evidence on a number of occasions to the Royal Commission?
PROFESSOR KAVANAGH: Yes.
MS EASTMAN: Commissioners, with your leave, could I dispense with the formal introductions of Anne Kavanagh and remind the Commissioners of Professor Kavanagh's fairly extensive CV and her experience, which is part of the Royal Commission records.
CHAIR: Yes. Certainly.
MS EASTMAN: Professor Kavanagh, I want to go directly to the Phase 1A vaccination program
PROFESSOR KAVANAGH: Yes.
MS EASTMAN: --- you were part of an advisory committee set up to implement a disability management plan for people with disability and COVID-19 19. In the
participation of that advisory committee did you have any consultations about the implementation of the Phase 1A vaccination plan?
PROFESSOR KAVANAGH: We were very much part of lobbying for Phase 1A and people with disabilities in disability residential settings being --- and the support workers there. Being in Phase 1A, and also in relation to Phase 1B. In terms of the implementation of the strategy, we have had a variety of conversations about challenges with the implementation of the rollout of the vaccines, particularly in disability residential settings. My understanding is that the implementation is actually contracted out to another agency but we have also had conversations about communications and also conversation --- conversations about some of the challenges and some of the problems with implementation of those 1a in particular.
MS EASTMAN: What challenges can you recall raising through the Advisory Committee?
PROFESSOR KAVANAGH: I guess the main issue is that it's just been incredibly slow. And in part I think that's due to, as we found in the original --- in the COVID-19 second wave, particularly in Victoria, the lack of understanding of those settings in terms of having a proper plan for rollout of the vaccination in those settings.
MS EASTMAN: Have you seen a specific implementation plan for the rollout of Phase 1A for people with disability who fit that description residential care, whatever that means?
PROFESSOR KAVANAGH: That is a very broad term. We can come to that later. But we --- no, we have had lots of conversations about it, though. Not that I can recall, though.
MS EASTMAN: I wanted to ask you about some research that you have done between March and April this year. That research focuses on disability support workers on the extent to which disability support workers are prepared to be vaccinated and what your findings are, so can I ask you about that report which you have made public at the end of April; is that right?
PROFESSOR KAVANAGH: I think it was a bit later than that. It might have been the end of April, sorry, I apologise, I don't remember the exact date.
MS EASTMAN: The nature of the research is that there was a survey conducted of 368 disability support workers across Australia.
PROFESSOR KAVANAGH: Yes.
MS EASTMAN: You asked them about their experiences during the COVID-19 19 pandemic. You wanted to get their perspective on the COVID-19 19 vaccine and where they obtained their information.
PROFESSOR KAVANAGH: Yes.
MS EASTMAN: The results of the survey you have published in a report. We might turn to the results and recommendations part of the report where, very conveniently, you have summarised the findings in some graphs. Figure 1 is where disability support workers get COVID 19 vaccine information. You can see that's on the screen and we have highlighted that.
The Commissioners can see there that the sources of information range, 72 per cent from government websites, 62 per cent from employers, 62 per cent from official news media, and then a fairly significant drop to 28 per cent search engines, 26 per cent social media, 14 per cent colleagues and 4 per cent clients. Do you mean by "clients" that these are the people to whom disability services are provided?
PROFESSOR KAVANAGH: Yes.
MS EASTMAN: What did these results tell you, if anything, about the sources and the importance of the sources of information for disability support workers?
PROFESSOR KAVANAGH: This question was just where they got their information, not so much what they trusted most. But clearly obviously, government employees and news media are all critical sources of information for support workers.
MS EASTMAN: Having identified the sources of information, you also surveyed them about the trust in the sources for information on the COVID 19 vaccine, and that is set out in the graph at figure 2, can we put that up on the screen, please. If we reconcile the sources of information with the trusted sources of information, 78 per cent say their own doctor, 75 per cent say chief medical officer, 64 per cent the Federal Government, 65 per cent State Government --- I assume that's state governments generally; is that right?
PROFESSOR KAVANAGH: Yes.
MS EASTMAN: Then a drop, 32 per cent pharmaceutical companies, 19 per cent family and friends and 7 per cent social media. What did this tell you about reconciling the sources of information and the trust in the sources of information?
PROFESSOR KAVANAGH: The first thing I need to say is if I was designing this survey again, I would do something different because I don't align, the questions are slightly different. So we didn't ask the people in the first question about their own doctor and the chief medical officer, so that's --- in terms of getting access to the information, so I just point that out at this point. But I guess the most important thing is that we need to recognise the role of independent medical professionals or health professionals in terms of sources of advice. There were a number of comments throughout the survey about wanting information from independent health professionals rather than government or politicians per se.
MS EASTMAN: When you did the survey, is it the case that the survey participants would all have been in the Phase 1A group?
PROFESSOR KAVANAGH: No. About half of the participants were working in residential settings and about half were not working in residential settings in the previous month. So half would have been in Phase 1A and half in Phase 1B.
MS EASTMAN: One of the issues the Royal Commission has just heard David Moody talk about is mandatory vaccination for support workers. One of the questions you asked in the survey was whether the participants were willing to get a COVID 19 vaccine when it became available, and you have summarised the results in figure 3. We will put that up. Half said as soon as possible. But then what can you tell us about the balance? I will describe this for people who may not be able to see the document. 17 per cent will not get a vaccine; 13 per cent undecided; 11 per cent only if required; and 9 per cent of the participants said they will wait a while. What did this tell you, and as an epidemiologist, does that raise any concerns for you?
PROFESSOR KAVANAGH: Yes. We know that we need more than 50 per cent of support workers getting vaccination to be able to both provide protection for them but also to provide protection for the people with disabilities that they are supporting. So that level of people being prepared to get the vaccine is concerning in this group, but perhaps understandable in the context of some of the concerns being raised in the media and so forth.
I think also of concern is the 17 per cent who at the moment say they will not get the vaccine. I think what's really important about that group --- we have called them "vaccine refusers" in our survey --- is that very, very few of those people actually are refusers of vaccines in general. Less than 1 per cent of the whole sample are anti vaccine, completely against vaccines. So this group is what I would call COVID-19 specific vaccine refusers.
MS EASTMAN: You asked them a subsidiary question, which is, "What are the reasons if you decide that you will not get the vaccine?" So covering that 17 per cent, and it seems also perhaps some of those who are undecided, what were the primary reasons that participants decided that they will not get a vaccine or delay having a vaccine? What did your research find?
PROFESSOR KAVANAGH: We divided them into vaccine refusers and what we have called vaccine delayers, which are the other three groups, so there are slight differences in those results. But basically the major reason was concerns about safety and worry about side effects. Among the refusers, over half reported that they didn't trust government. So that was --- that's among the vaccine refusers, there's very high levels of distrust in government.
MS EASTMAN: In terms of looking at the risks for the cohort of people with
disability who live in --- I use that expression --- residential care, what does it mean if 50 per cent of disability support workers, and accepting as you say that the survey participants were not all working in residential care, but looking at these numbers, what concerns does that raise about managing the risk to people with disability in residential care?
PROFESSOR KAVANAGH: One thing I point out, before answering that question, is that we actually did do the analysis according to whether they were working in those settings. So there pretty much was not much difference between the two groups, so rather than present them separately, we presented them this way.
I guess, you know, we learnt from the Victorian situation and the second wave that outbreaks in these settings can take off. And so with only 50 per cent vaccinated --- this is presumably, presuming they do get access to the vaccine fairly soon --- that you really are at risk of outbreaks occurring in those settings, with --- if workers aren't getting vaccinated at higher levels.
MS EASTMAN: Based on the research that you have done, you have identified some recommendations or you have described in the report ways forward. Can I ask you about what recommendations you would make to achieve higher levels of vaccination or at least preparedness of support workers to be vaccinated? What are your views about the way forward?
PROFESSOR KAVANAGH: I think part of the issue is that I think there's quite a poor understanding about the vaccine. If I take you to the questions we asked about people's understanding about the vaccines, where we asked them questions about "How would you stop COVID 19", whether or not they thought that they would be less likely to get COVID-19, which only 54 per cent thought that was the case and only 54 per cent thought that the people they support would be less likely to get COVID-19. So that shows some pretty poor understandings about the efficacy of the vaccine. So that's one question, and very high concerns about safety.
What that says to me is we need to have a fairly targeted strategy with that group of people and sort of co design, both with the workers, services, people with disabilities, how we achieve better vaccination. I think the concern for me is that it demonstrates this implementation of a lack of understanding of those settings, and a lack of understanding of the day to day issues, and of the workforce in general, and some of the issues facing that workforce. So I feel very strongly that we need to understand some of the reasons for that hesitancy.
I also wanted to emphasise that support workers are often one of the major sources of information for people with disabilities, particularly those living in those kinds of residential settings. They are people that people with disabilities in those settings might actually go to for advice. So I think it's really important that this workforce understands much more of the importance of vaccination.
I do also point out the fact that this workforce felt left behind in the pandemic, as
I presented at the hearing in August, and so that also has undermined their trust of government in this context. Like you have heard others say, concern that the vaccine has been rolled out quickly and all of those kinds of things, they don't feel --- many of them don't feel --- are worried about safety.
I really think it's about a much --- what concerns me is the vaccinators don't fully understand the contexts in which we are rolling out vaccines to these disability residential settings, what the concerns of workers are, how people with disabilities in those settings are getting information, how you might best tailor responses, just like we found in the August hearing.
MS EASTMAN: I think you are currently doing some research to ask similar questions of people with disability and their attitudes to the vaccine, but that research has not been completed; is that right?
PROFESSOR KAVANAGH: Yes, that's nested in another study so it's a fairly small number of questions, it's not as extensive as these questions but it will look at vaccine hesitancy and hopefully we will be able to look at that in the next few weeks.
MS EASTMAN: Do you know, apart from yourself, whether anyone else is under taking research or a survey of that kind?
PROFESSOR KAVANAGH: No.
MS EASTMAN: Are you aware as to whether or not the Australian Government, for example, is undertaking research of that kind at the present time?
PROFESSOR KAVANAGH: No. I'm not.
MS EASTMAN: Would research of that kind help inform any future planning in relation to the rollout of the vaccine for people who might generally be within the Phase 1A and Phase 1B groups?
PROFESSOR KAVANAGH: Yes, of course it would be useful. Yes. I guess one of the challenges with any of these surveys, as I think David pointed out in his evidence, for the support workers, for instance, we don't actually have a register of who the support workers are in Australia, so it's actually very hard to recruit. And I guess it's similar in relation to disability and this raises the question of poor data more generally around who we are talking about, but there certainly would be room to do much more work to understand what's happening in those contexts.
MS EASTMAN: Part of the observations made by members of the Advisory Committee, when the rollout was first announced, was to ask in the context of the Advisory Committee who is Phase 1A and who is Phase 1B. Did you get any clear understanding from government as to precisely who were in the Phase 1A category and who were in the Phase 1B category?
PROFESSOR KAVANAGH: Well, I always thought the Phase 1A category was fairly straightforward. With the exception of to the extent to which we --- where other kinds of settings, like supported --- what we call SRSs in Victoria but might be called boarding houses or something elsewhere, where they fitted into the vaccine rollout in 1A. And so that's more complicated because they are very different than a traditional, say, group home, that we are talking about with the disability residential, which is seen to be covered in that disability residential setting, and even more complicated in terms of how you would do in reach in those situations.
In terms of Phase 1B, it took a fair bit of clarification to understand who's in that, and basically it includes people with disabilities who would --- who have a range of underlying medical conditions, which are already named by the government as putting people at risk if they contracted Phase 1 --- sorry, contracted COVID 19. So that's a bit ambiguous and I think it has been a bit ambiguous all along and is sort of evolving. But, yes, I think it's been difficult for people to know whether they fit in the Phase 1B group.
Support workers clearly fit in Phase 1B, that's support workers who aren't working in those residential settings clearly fit in Phase 1B.
MS EASTMAN: Professor Kavanagh, thank you, it's been brief evidence today but the Commissioners will have a copy of your report and I thank you for your evidence this afternoon. I will check if the Commissioners have any questions.
CHAIR: Thank you. Again, I'll ask Commissioner Galbally, do you have any questions?
QUESTIONS BY THE COMMISSION
COMMISSIONER GALBALLY: I would just like to ask you, Professor Kavanagh, about mandating, because you were against that, as I understand, that you don't think that would work. Is that because of the numbers of support workers available or do you have other reasons?
PROFESSOR KAVANAGH: I wouldn't say --- I changed my mind about that sometimes. I have to --- in terms of the survey that we did, we did find that if it was mandated, 20 per cent of workers said they would actually leave the workforce, if it was mandated. And another proportion said they --- that they would consider it, I can't remember the exact proportion. But having said that, 11 per cent said they would only get vaccinated if it was compulsory. I wouldn't say not making it compulsory in the future, I would like to have another go at rolling this out properly because there's still real implementation issues here, and there is still potential to make sure that the messaging is much better and that the workers --- we understand those workforce --- the actual working conditions and so forth, before we push it out.
I would like to see messages more targeted towards workers in relation to the public good of getting a vaccination. I think that we have concentrated too much on the individual risks rather than, as a support workforce, what their duty of care, if you like, is to the people that they are supporting. I think that message is very important to get across. Because I think that could --- because workers are working in those contexts because that's the kind of work they want to do so I think if we could start to appeal to the community benefit and the people they support, I think that's absolutely critical and that message hasn't got out.
Having said that, if the vaccination levels remain low, I think then we have to move to thinking about another strategy.
COMMISSIONER GALBALLY: My second question is about the matter that you raised about people in boarding houses, hostels and SRSs. Did your research pick those support workers up? Because there are support workers going into those places with NDIS participants.
PROFESSOR KAVANAGH: Yes. Not particularly in this research but we have in the past. We didn't particularly in this research partly because we were trying to match what the 1A and 1B workforce was. It's actually quite hard to identify that group, which comes back to the question that we need to know more about what this workforce actually so, but we didn't ask that question specifically.
COMMISSIONER GALBALLY: But people with psychosocial disability in those places might wonder whether they are being included in 1A or 1B or anywhere, really, they might be the forgotten group.
PROFESSOR KAVANAGH: Yes, they should be in 1A. I share your concerns that they are being missed out.
COMMISSIONER GALBALLY: Thank you.
CHAIR: Thank you. Commissioner Atkinson?
COMMISSIONER ATKINSON: No further questions. Thank you.
CHAIR: Commissioner Bennett?
COMMISSIONER BENNETT: No questions, thank you.
CHAIR: I think we heard this morning from Mr Moody that the disability care workforce might be 100,000 or thereabouts. But I notice that in this study the participants numbered 368. Is this a survey that enables statistically valid conclusions to be drawn?
PROFESSOR KAVANAGH: It's really difficult. I would love to have a register where I could recruit people. We are very much reliant on services sending this out,
social media and unions. It's the best we can do under the current circumstances. Having said that, I think it also matches up with some of what we are hearing anecdotally around the workforce. So I think --- my answer is yes and no, it's the best we can do under the circumstances. It's not a perfect study by any stretch of the imagination.
CHAIR: The way in which the participants were recruited, I think you say at page 5 of the report that they were recruited through social media, disability services and unions. Could you tell us very briefly how that worked?
PROFESSOR KAVANAGH: We obviously promoted it on Facebook pages and so forth for disability support workers. We promoted --- David Moody promoted it through NDS and some of the disability services there, and also some of the unions, and I can't remember which unions off the top of my head. But they would then reach out to their members to share the link for the survey.
CHAIR: Thank you, and I judge from figures 1 and 2, which add up to more than 100 per cent, that the respondents were telling you that they had multiple sources of information or degree of trust related to the various sources of information to which they might have had access?
PROFESSOR KAVANAGH: Yes. Yes.
CHAIR: And we don't know, I take it, from what you said earlier, how many would have actually got information from their own doctor, because that's ---
PROFESSOR KAVANAGH: Yes, we didn't ---
CHAIR: That's in figure 2 but not in figure 1.
PROFESSOR KAVANAGH: Yes.
CHAIR: I follow that. You say at page 11, in "The Way Forward":
Without high levels of vaccination in Australia, we will not achieve herd immunity and the community including people with disability are at risk when Australia opens its borders and/or residents return.
Can you expand on that a little and explain the concern that you have at a more general community level?
PROFESSOR KAVANAGH: Okay. Obviously, if we don't achieve herd immunity, that means that once the virus enters Australia and we open up, so there's more social mixing and so forth, we are actually pretty much living a COVID-19 free lifestyle in Australia at the moment in many ways, so if that were to continue and people from overseas were to come in from high risk countries, obviously the virus would start to circulate more, and if we don't have high levels of vaccinations, vaccination allows
you to get acquired immunity to the virus, but you need high levels of acquired immunity, which is herd immunity, to be able to prevent the virus circulating and infecting people and getting serious COVID-19, so we would see outbreaks. Again, as we have seen, people living in these kind of congregate environments, whether they be SRSs or group homes, or as was mentioned earlier, some of the day programs or ADEs, these are exactly the places where we will see outbreaks. So I guess that's my concern. We need to have a high level of this workforce vaccinated to protect the people with disabilities they support, as well as themselves.
CHAIR: This was a study of disability care workers. You were asked by Ms Eastman about studies of this kind. Have there been studies of the attitudes of the broader workforce to being vaccinated with similar sorts of questions?
PROFESSOR KAVANAGH: My understanding is there is some of the more general healthcare workforce. I haven't actually looked at them specifically. There has been population wide surveys and the one that most recently from ANU showed about 43 per cent would immediately get the vaccine. So in fact this workforce is a tiny bit better than the general population, but not much and probably almost not statistically significant. So we have an extremely high level of vaccine hesitancy in Australia at the moment which is of concern.
I should point out that this survey was mostly done before the government's announcement of the AstraZeneca vaccine, of restricting the AstraZeneca vaccine to people over 50, but obviously it was at a time when we were starting to hear about some of the adverse effects of AstraZeneca vaccine. So more generally in the population we are seeing increasing levels of vaccine hesitancy with the adverse effects to AstraZeneca. But about half this workforce are under 50, so should theoretically be eligible for Pfizer vaccination.
CHAIR: The final thing I noticed was the comment by a survey participant:
I will not get the vaccine because COVID-19 is only a serious risk to people of expiring age anyway.
There are some people on the Commission that apparently are of expiring age, which is good to know!
All right, Ms Downes, do you have any questions?
MS DOWNES: No, thank you, Chair.
CHAIR: Ms Furness?
MS FURNESS: No, thank you.
CHAIR: Mr Chesterman?
MR CHESTERMAN: No, thank you, Chair.
CHAIR: Professor Kavanagh, as always, thank you very much for your work, thank you very much for your contribution to the Commission and thank you very much for appearing today and helping us. Thank you.
PROFESSOR KAVANAGH: Thank you. Cheers.
THE WITNESS WITHDREW
CHAIR: Yes, Ms Eastman, do we adjourn now and if so, until when?
MS EASTMAN: Not yet. Commissioners, there are two further pre recorded videos we wanted to share with the Royal Commission. One is quite long and I might defer that to after lunch. I would like you to hear, before we move for lunch, the evidence of Pia Sappl. She has cystic fibrosis, she is a single parent of three children under the age of eight, she is the founder and coordinator of a community group called Adelaide Australian CF Hub, which is an online community group for adults with cystic fibrosis in Australia. What you will see is a short extract of evidence that was recorded over about 9 minutes last week. This extract begins with Ms Sappl speaking about the impact of COVID 19 on the cystic fibrosis community and when she understands she will be eligible to have the vaccine.
MS EASTMAN: When the government announced that there would be a vaccine rollout and there were various phases in the rollout, what did you understand to be your place in the queue in relation to the vaccine rollout?
MS SAPPL: I think it's also important to say that like with the pandemic, that's had a
10 really massive impact on our community so, a lot of people, they self isolated
because they were extremely concerned about if they got COVID-19, how that would impact their health. A lot of people have lost work because they were in exposed occupations and there's been a lot of, yeah, like increased mental health issues for our community because of the anxiety and triggering trauma and stuff. So people are really, really keen to be vaccinated, there's a very strong desire for that. In terms of ---
MS EASTMAN: So --- sorry, any information about the rollout and as I said, where you might fit into the queue, so to speak?
MS SAPPL: Yes. So I did a quick survey of our community group and I've been looking at what people have been saying. Really, there's a lack of information, we
feel confused, a lot of people are turning to social media for information. So particularly so most of our community, I think almost 100 per cent of the people with CF are linked in with our CF clinics through the hospital system and so a lot of us have been going to our clinics to try to ask for information and they basically don't have any, they are just referring us back to the website or to our GP, so people
MS EASTMAN: So is there nothing that's assisted to know whether people with CF are in the rollout as 1A or 1B?
MS SAPPL: Some people, if they are really proactive and they have been doing their own research, they are aware of where they fit in the roll out. But yes, nothing has very little information has been filtered directly to us.
MS EASTMAN: In terms of the context of you saying d "we haven't had much information" and you are looking at different sources, so against that background, what do you feel about the COVID 19 vaccinations that you are trying to get access to vaccinations? So has that lack of information or the information that you have got from social media affected your feeling about being vaccinated and when you want that to be done?
MS SAPPL: People with CF, So people with CF, they definitely want to be vaccinated, the overwhelming majority are really keen, they are even keen, even with the risk of blood clots with the AstraZeneca vaccine, they are even keen to take that one if they are under 40. That's how not desperate but that's how willing they are to be vaccinated. People who've had it, they've just said they feel so much relief now that they have had it. Maybe they feel like they can re engage in the community a bit more and do things like that. So, yes, people are totally for having it. The problem is the access.
MS EASTMAN: Have you had access to the vaccine yourself yet?
MS SAPPL: No, I haven't.
MS EASTMAN: Have you decided what you want to do in terms of getting access to the vaccine?
MS SAPPL: I would like to be vaccinated and I'm trying to figure out at the moment how to do that.
MS EASTMAN: Thank you, Commissioners. If we could adjourn now. I'm just conscious that it's about 1.20, so if we could resume in an hour, at 2.20.
CHAIR: Why don't we resume at 2.15, if that's convenient.
MS EASTMAN: That's convenient.
Caroline Edwards is the next witness. Just in terms of not inconveniencing her too much, what I propose to do when we resume after lunch is to do two things: first of all, I will play the extract of evidence from Isobel, and then I want to take the Commissioners to some evidence of Julia Squires who is not giving evidence in person but there are some matters that I would like to address the Commission on because they will be relevant to some of the questions for Ms Edwards. It may mean that perhaps during the course of Ms Edwards' evidence, that we have a short break mid afternoon and we will probably still be on track to conclude by 4.30, Commissioners, thanks.
CHAIR: Thank you very much. We will adjourn until 2.15 pm.
ADJOURNED [1.18 PM]
RESUMED [2.17 PM]
CHAIR: Yes, Ms Eastman.
MS EASTMAN: Thank you, Commissioners. Last week we took some evidence from Isobel. Isobel is a disability support worker, and she has worked in disability residential settings for over eight and a half years. She currently works in a group home where four residents live. The extended version of Isobel's pre recorded evidence goes for about 16 minutes and she provides a lot of detail in relation to her experience with the rollout, finding relevant information and her eligibility about the vaccine. So I will just play part of Isobel's evidence. Thank you.
CHAIR: There's no sound.
MS EASTMAN: Commissioners, perhaps while that's being sorted out, I might deal with some other matters.
Commissioners, you have in the material a statement from Julia Squires. She is the CEO of Ability Options, which is a large non government organisation that provides disability and employment services in NSW, including residential services and, as she said, sometimes the shorthand expression used is "group homes". Her evidence addresses the experience of Ability Options in relation to the COVID 19 vaccine rollout. She speaks in her evidence about Ability Option' understanding of who is captured by the Phase 1A cohort. She will tell you that the initial consultation in relation to the vaccine was positive and Ability Options was contacted by the Department of Social Services on 18 February 2021 and Ability Options had been identified to participate as a trial provider.
Two of the group homes were identified for the first vaccine rollout.
She says a date of 26 February was identified, and Ability Options then provided some feedback on the form, such as consents, fact sheets, logistical information and templates. There was then communication with the Commonwealth Department of Health and Ability Options was asked whether they would participate in a media event.
On Sunday 21 February, which is the day before the general rollout occurred, one of Ability Options's workers received her vaccine alongside the Prime Minister as part of a media event. She says vaccinations at two group homes for 10 residents were confirmed for Friday, 26 February. What she will say in her statement is that she will tell you that that date was cancelled and a new date of 8 March was provided.
She says on 8 March vaccinations took place uneventfully, however, two employees on site were offered and accepted the vaccine. She says luckily they had suitably qualified managers on site to support the team and she was able to support the roster while the employees had their vaccinations.
I won't detail the entirety of her evidence, Commissioners, you have a copy of her statement. But she does give firsthand experience of a service provider participating in that initial trial and rollout, and some of the challenges, if I can use that expression, that Ability Options confronted in relation to the rollout.
She says at paragraph 30 that the rollout has not been fast or smooth, and of the 700 people with disability and support workers that have been identified by 12 May, only 13 had received the Pfizer vaccine, and 3 employees and 10 people with disability.
This led her to write to the Hon. Greg Hunt MP and also to Senator Linda Reynolds, the Minister for the National Disability Insurance Scheme. She wanted clarification from the Ministers in relation to the employees concerned and what was going to happen in relation to the rollout. You have a copy of her letter as an attachment to her statement.
Included in her letter she provided an extract of an email of one of the support workers who had emailed the CEO to express her concern about how confusing and uncertain the rollout had been for the support worker. She says that as at 12 May no advice had been received from the taskforce regarding an incorrect delivery to one of the facilities, Casuarina Grove. Casuarina Grove is one of the largest residences operated by Ability Options with over 50 participants on the central coast of NSW. She said, on 30 April, two couriers arrived at Casuarina Grove with the Pfizer vaccinations and there was no forewarning. The couriers had said that this had happened for the past three days. Anyway, they took the vaccinations with them as they cannot leave the vaccinations at the particular residence, and there was then this confusion.
Ms Squires received a letter from Senator Reynolds on 5 May. We will include this as part of evidence. Ms Squires says, while the letter is dated 5 May, she did not receive that letter until after she had finalised her statement. I hope that has given a little bit of time to ---
CHAIR: No it hasn't, apparently. We need to have a short adjournment in order to allow the problems to be rectified. We will take a short adjournment for that purpose.
MS EASTMAN: Thank you, Commissioners.
ADJOURNED [2.25 PM]
RESUMED [2.27 PM]
CHAIR: Yes, Ms Eastman. I understand the difficulty has been resolved.
MS EASTMAN: You will hear from Isobel.
[VIDEO RECORDING PLAYED]
MS EASTMAN: When you heard that the vaccines would come in, what were you told about any vaccination for support workers like yourself but also for the participants or the residents in the group home where you work?
ISOBEL: Well, it was a relief to hear that we were going to be prioritised. We were categorised as essential workers, so building on that, it looked like it was a sure thing, we were going to get the vaccine, alongside nurses and other important frontline or essential services people. So we had high hopes. We were getting frequent messages through our workplace and also through my union but it was, "This is --- you are 1A, you are 1A" --- but there was no --- "and this is what's happening next." It seemed like absolutely no one knew what was going on. Myself, I started to get proactive, I contacted my federal member, I spoke to his people. That federal member is in opposition, so they couldn't tell me a lot, but they could tell me that they couldn't see that anything had been planned. I spoke to HealthDirect obviously. They knew nothing. I even tried calling Health Australia. They knew nothing. Everyone knew nothing and, unhelpfully, all along I was being told, "Yes, you're eligible, yep."
MS EASTMAN: Did anyone at any time say, "Look, the expectation might be that in six weeks' time someone is going to come to where you work and you're going to be vaccinated and the participants and residents in the group home are going to be
vaccinated"? Did you get information of that kind?
ISOBEL: No, not really. I did ask my manager, whenever I would see her, roughly every fortnight, "Do we know anything yet?" She said, "We don't know anything. We don't know anything. We're not being told anything. We knew bee were a priority or we were told we were a priority but that's where the messaging ended.
MS EASTMAN: Did I take it from what you just said that you were very keen to be vaccinated?
MS EASTMAN: Have you been vaccinated yet?
ISOBEL: Two hours ago.
MS EASTMAN: In the lead up to now being vaccinated a couple of hours ago, and you have made all these calls and inquiries, what steps did you take next?
ISOBEL: A friend of mine winged it on the eligibility checker again, because I had been playing with that for, you know, months now and I had sort of given up, and she also works in disability, and she said, "I got a booking," so I got on to it straightaway and we went in together this morning, and this morning into this afternoon because it's quite a long experience --- and I used one of the COVID-19 vaccination centres in Sydney.
MS EASTMAN: Thank you, Commissioners, that's a short extract of a much longer pre record and that will be available on the Royal Commission's website at an appropriate time.
Can I then move to Caroline Edwards.
CHAIR: Thank you.
Ms Edwards, thank you very much for coming to the Royal Commission, at least notionally, to give evidence. I shall ask for the affirmation to be administered, if you would be good enough to follow the instructions from my associate. Thank you.
MS CAROLINE EDWARDS, AFFIRMED
CHAIR: Thank you, Ms Edwards. Just to explain where everybody is, in case you
are not aware, Commissioner Galbally, whom you presumably see on the screen, is in Melbourne; Commissioner Atkinson is in our hearing room in Brisbane; Commissioner Bennett is with me in our hearing room in Sydney, as is Ms Eastman, Senior Counsel Assisting the Royal Commission.
Ms Eastman will now ask you some questions.
EXAMINATION IN CHIEF BY MS EASTMAN
MS EASTMAN: Commissioners, before I start, we haven't received a statement from Ms Edwards and with the time available to prepare this hearing, Ms Edwards has very kindly agreed to give evidence without the preparation of a statement or without a large bundle of documents to review.
So if, at any stage, Ms Edwards, any of my questions require you to look at any particular document or you need a note of something, please let me know.
Commissioners, I have endeavoured to prepare these questions without the need to resort to a lot of documents. But if we do then I will put them up on the screen and, Ms Edwards, please let me know if you need time or any assistance with the documents.
MS EDWARDS: Thank you.
MS EASTMAN: Ms Edwards, you are the Associate Secretary of the Commonwealth Department of Health?
MS EDWARDS: Yes.
MS EASTMAN: You commenced that role on 12 August 2020?
MS EDWARDS MS EASTMAN: Correct.
MS EASTMAN: You previously served as the Deputy Secretary of the Commonwealth Department of Health between 2017 and 2019?
MS EDWARDS: Yes.
MS EASTMAN: In that role, you had responsibility for primary care, mental health, health economics and research, Aboriginal and Torres Strait Islander health, and the whole of the portfolio strategic policy and long term health reform?
MS EDWARDS: That's right.
MS EASTMAN: You returned to the Associate Secretary role, and in that role you
have responsibility for the whole of portfolio, strategic policy and relation, health economics, medical research, sport, a strategic and corporate operations of the Department; is that right?
MS EDWARDS: Yes, except the sport function is now transferred to a different deputy because of workload issues.
MS EASTMAN: I don't know if that's a relief or not.
MS EDWARDS: In addition, counsel, there was an additional period I actually returned to the Department of Health on 24 February last year, and was there for an details period as Acting Secretary.
MS EASTMAN: Have you had any specific responsibilities, both in terms of the Department of Health's management during the COVID 19 pandemic and then more specifically the vaccination rollout?
MS EDWARDS: Yes, I have. During the period as acting secretary I was the senior officer responsible for the health response to the pandemic and had engagement with vaccine work at that time. Then from 10 August when I commenced the role of Associate Secretary, since that time I have been the senior officer, subject to the direction of the Secretary, for the vaccine rollout.
MS EASTMAN: You are aware, aren't you, that in April 2020 the Department of Health released the management and operational plan for COVID-19 for people with disability, sometimes called the MOP; is that right?
MS EDWARDS: Yes, although I'm not aware of it being called the MOP.
MS EASTMAN: I'm working, during the previous hearing, that seemed to be the shorthand expression used by some people from the Commonwealth.
MS EDWARDS: It may well be.
MS EASTMAN: I'll call it the plan, if that's convenient. You're aware, aren't you, the plan was developed to provide a targeted response for people with disability during the COVID 19 pandemic?
MS EDWARDS: Yes.
MS EASTMAN: You are away, aren't you, that the plan sought to uphold the government's commitments under the United Nations Convention on the Rights of Persons with Disabilities, the CRPD? You are aware of that?
MS EDWARDS: I'm aware it was to ensure that we catered appropriately for people with disability in the context of the pandemic, and I've probably been aware that it made reference to the international obligations.
MS EASTMAN: You are aware, aren't you, that the plan focused on a broad clinical public health and communications actions that would be of benefit to all Australians, including people with disability, as well as targeted action specific to people with disability?
MS EDWARDS: That sounds correct, from my understanding of the plan. I haven't got it in front of me and I haven't reviewed it in that detail very recently, but it sounds exactly right.
MS EASTMAN: I think we are aware that the latest version of the plan was released on or about 9 October last year. Are you aware of that?
MS EDWARDS: That sounds correct. I wasn't aware of the date, off the top of my head.
MS EASTMAN: Given your responsibilities in the Department of Health, what if any specific responsibilities do you have in relation to that plan?
MS EDWARDS: I have responsibilities to ensure that all work we do within my responsibility and as a member of the Executive, the Department has regard to the commitments made in that plan, and many others and generally all patients in Australia, including those from particular groups and including people with disability have the benefit of appropriate consideration in all the work we do.
MS EASTMAN: In your work with the Department of Health, have you had any specific responsibility for the health of people with disability generally?
MS EDWARDS: Yes. In all of the work I've done in the Department of Health, people with disability have been an important patient group. In addition, as the Deputy Secretary prior to November 2019, I was in charge of the primary care group. That was the group that engaged with organisations representing people with intellectual disability and was involved in the commencement of the work to ensure specific assistance for that group. That work now reports to a different Deputy Secretary but I'm still aware of it. And in my current role, responsible for firstly the vaccine rollout, I have a branch which is solely dedicated to the rollout of the vaccine for people with disability and also for a team which has --- in relation to hospital funding, in which the issue of interface with disability is often raised and an important element.
MS EASTMAN: Are you a decision maker within the Department in relation to any decisions that may touch on the health of people with disability?
MS EDWARDS: Yes.
MS EASTMAN: You are aware, aren't you, that accompanying the plan, the Department of Health also established an Advisory Committee on the health
emergency response to coronavirus/COVID 19 for people with disability? Are you aware of the Advisory Committee?
MS EDWARDS: Yes, I am.
MS EASTMAN: What, if any, is your role or responsibility in relation to that committee?
MS EDWARDS: I'm not directly involved in convening or preparing work for that committee, but I'm aware that it's an important input to the work we do, and as a member of the Executive Committee of the Department, and lead on vaccines, have regard to the information that is both put into the committee and the advice received from it.
MS EASTMAN: How do you have regard to the information from the Advisory Committee?
MS EDWARDS: In relation to vaccines in particular, the advice and views expressed in the committee are fed through to my disability vaccine team and the policy team in relation to vaccines, and informs the work we do there in relation to people with disability.
MS EASTMAN: I want to turn to the initial planning for the vaccine rollout. In August last year the Australian Government released the COVID 19 Vaccine and Treatment Strategy. Are you aware of that?
MS EDWARDS: Yes. I ---
MS EASTMAN: Did you have any involvement in the preparation of that strategy?
MS EDWARDS: Limited involvement, given I took up the new role on 10 August and was not in the Department for the month preceding, I was on leave. But I'm aware of it and have been involved with it to some degree before its release and extensively afterwards.
MS EASTMAN: Is it the case that one of the key bodies relevant to the development of the strategy is the Australian Technical Advisory Group on Immunisation, known as ATAGI?
MS EDWARDS: Yes.
MS EASTMAN: ATAGI's role, among other things, to is individual the Minister for Health on the medical administration of vaccines available in Australia?
MS EDWARDS: Yes.
MS EASTMAN: And it was required to provide the technical scientific expertise on
the development of the Australian strategy for the rollout of the COVID 19 immunisation program; is that right?
MS EDWARDS: I'm not sure the manner in which it was required but it certainly is the source of the core medical and scientific advice on vaccines that is taken into account --- or relied upon.
MS EASTMAN: Is ATAGI independent of the Department of Health?
MS EDWARDS: Yes.
MS EASTMAN: In terms of the membership of ATAGI, are the members of ATAGI appointed by the Minister for Health? Do you know that?
MS EDWARDS: I believe so, but I'm not absolutely certain. I have not been involved in the appointment of any member of ATAGI to date.
MS EASTMAN: ATAGI was tasked in identifying priority groups for a vaccine rollout in Australia. That's right, isn't it?
MS EDWARDS: Yes.
MS EASTMAN: Are you aware of preliminary advice published by ATAGI on or around 13 November last year?
MS EDWARDS: I'm aware of a range of advice provided by ATAGI, but I don't know the date or which was the initial advice.
MS EASTMAN: I might bring that document up on the screen.
MS EDWARDS: It would be helpful.
MS EASTMAN: Commissioners, this is the document that I referred to in opening this morning.
Ms Edwards, that is the front cover of the document. I want to draw your attention to some parts of the document. If I can paraphrase, the document sets out the aims of a vaccination program for Australia, and it also seeks to identify possible priority population groups. These are groups who have increased risk of developing severe disease or dying from COVID 19.
The ATAGI advice then identifies three particular groups, which span over two pages. We will start with the page where you see, there is a heading "Possible priority population groups", in the second column at the bottom of the page. The first there is the older population. You will see that ATAGI identifies increasing age as the clearest risk factor associated with the high risk of COVID 19 morbidity and mortality. Other factors --- I'm dropping down:
Other factors associated with older age such as residents in aged care facility may also increase risk, noting the occurrence of multiple serious outbreaks in these settings.
So that's the first cohort, older people.
MS EDWARDS: Yes.
MS EASTMAN: The second cohort, which is over the page, is "People with preexisting underlying select medical conditions". Are you familiar with this part of the ATAGI advice or is this the first time you are seeing this?
MS EDWARDS: No, I'm familiar with it.
MS EASTMAN: So this is identifying people with certain underlying pre existing medical conditions, and the ATAGI group identify the medical conditions to include but not limited to immunocompromised, multiple comorbidities, chronic lung disease, diabetes, cardiovascular disease and severe obesity. You will see a reference is made to the Department of Health's list of at risk population groups for COVID 19. Do you see that?
MS EDWARDS: Yes.
MS EASTMAN: Do you accept that in terms of the description of this cohort, there is no reference to people with disability, is there?
MS EDWARDS: There's no express reference to people with disability, no.
MS EASTMAN: Excepting that the medical conditions identified may also be described as a disability. You would agree with that?
MS EDWARDS: Yes.
MS EASTMAN: There is no reference to people with intellectual disability or more broadly cognitive disability, you would agree with that?
MS EDWARDS: Not referred to, no.
MS EASTMAN: The third category is Aboriginal and Torres Strait Islander people. You are familiar with this passage as to the risk assessment for First Nations people?
MS EDWARDS: Yes.
MS EASTMAN: I have looked at the advice and I can see two mentions of "disability" in the advice, and the two references are in the following column on that page, to disability support workers. I don't know if you are more familiar with this
document than me, but would you agree that this document, being advice from ATAGI, does not address risk factors for people with disability?
MS EDWARDS: I agree it doesn't refer to them.
MS EASTMAN: Is it the case that the Department of Health views advice from ATAGI to be the best scientific evidence available to assist the Department of Health in identifying risk groups?
MS EDWARDS: It's definitely the group to which we --- on whose advice we rely in relation to the scientific and medical advice on vaccination.
MS EASTMAN: Is it the case that the Department of Health hasn't sought to question ATAGI's advice at all? It accepts that advice as reliable?
MS EDWARDS: We do accept the advice as reliable. We do refer issues and questions to ATAGI for consideration.
MS EASTMAN: Does it concern you that, going back to November last year and identifying priority groups, that ATAGI appears to have overlooked people with disability and specifically people with intellectual disability?
MS EDWARDS: I couldn't comment on whether they have overlooked those groups. My reading of that advice and later advice from ATAGI is that they have considered all of the evidence and listed the groups which are most at risk of severe disease and death from COVID-19, and that that does not include --- has not been expressed to include people with intellectual disability, necessarily, unless they have other conditions that are listed.
MS EASTMAN: I think --- I'll be fair to you, I'm going to be fair to myself --- the Department has provided us with some documents including minutes of ATAGI meetings, and we have reviewed all of those minutes and we cannot see any specific consideration by ATAGI of people with intellectual disability or more broadly cognitive disability, including autism. Do you know --- I'll start: have you yourself read all of the minutes of the ATAGI meetings?
MS EDWARDS: No.
MS EASTMAN: Then I can't really ask you the question are you aware --- although you may be --- whether ATAGI has specifically sought --- I withdraw that --- that ATAGI has specifically considered risk factors for people with intellectual disability? Are you aware of that?
MS EDWARDS: I'm not aware of whether they have considered it so described. My understanding of the ATAGI advice is that they have considered at least some forms of intellectual disability and I point to the fact that Down syndrome, which is accompanied by intellectual disability, is included in one of the at risk groups, so
I had understood they had regard to intellectual disability and have acted on that basis. But I have not read all the minutes and could not comment.
MS EASTMAN: You are aware, are you not, that the Advisory Committee, which I asked you about earlier, had a meeting on 1 December 2020? Are you aware that at that meeting, the committee discussed the inclusion of people with disability in the priority groups for the vaccine? Are you aware of that?
MS EDWARDS: I'm not specifically aware of that conversation, no.
MS EASTMAN: Do you know whether any steps were taken to take the concerns of the Advisory Committee to ATAGI and ask ATAGI to re examine its preliminary advice to include people with disability as a priority group?
MS EDWARDS: I'm not aware.
MS EASTMAN: I now want to turn to the rollout of the plan. On 7 January this year the Australian Government released its COVID 19 vaccination rollout strategy, and that describes five phases. I have got that initial document and I will put that up on the screen, but you may have a copy with you.
MS EDWARDS: I do.
MS EASTMAN: There are two pages I need to take you to. The first page sets out the phases and identifies Phase 1A through to Phase 3, and identifies the number of doses that might be relevant to the particular phase. Then in Phase 1A you will see in the box there, included in the Phase 1A category are described as "Aged care and Disability Care staff" and then "Aged Care and Disability Care residents". Do you see that?
MS EDWARDS: Yes, I do.
MS EASTMAN: There are some numbers indicated there. Do we take it that the numbers of the 318,000 and the 190,000 are an assessment of the number of people in that cohort?
MS EDWARDS: They are the assessment of the number of people in that cohort at the time this document was prepared. We have had some refined numbers in relation to aged care and disability care staff since that time.
MS EASTMAN: In terms of the preparation of this document, do you know the source for the 318,000 and the 190,000 estimates?
MS EDWARDS: They are numbers provided by our Department.
MS EASTMAN: Where did the numbers come from?
MS EDWARDS: I believe that the 190,000 estimate for Aged Care and Disability Care residents was on the basis of our understanding of the Aged Care Sector, and then an estimate of the number of people likely to be in residential care for disability, and that the numbers in relation to Aged Care and Disability Care staff are the sum of our estimates of the staff in each of the Aged Care residential staff, Aged Care home staff and Disability Care staff.
MS EASTMAN: You say these are based on information prepared by the Department of Health or just available to the Department of Health?
MS EDWARDS: Probably both things. Some of this data would be held by our aged care teams, and others we would have sourced from the Department of Social Services.
MS EASTMAN: The language used here, "Aged Care and Disability Care", if I can focus on "Disability Care", where does that language come from, "Disability Care"?
MS EDWARDS: It's an extrapolation, I think, to include with Aged Care staff those who would provide similar services for people with disability, so as to include both sectors.
MS EDWARDS: Do you know if anyone checked whether the description "Disability Care Staff" and "Disability Care Residents" had any particular meaning, what was the source of these expressions, do you know?
MS EDWARDS: I know that we were talking to the Department of Social Services throughout this period, but I would think that these terms were not checked to be terms of art for people with disability, but included in order to ensure we included disability sector in this work.
MS EASTMAN: You would be aware, wouldn't you, that the expression "care" perhaps has a connotation of being paternalistic, using medicalised models and reflecting perhaps an institutional model of people with disability? Do you accept that?
MS EDWARDS: I can see that's a characterisation of it.
MS EASTMAN: You would be aware, wouldn't you, that preferable terms would be "people with disability living in residential settings", "disability residential settings" and "disability support workers"?
MS EDWARDS: I accept that.
MS EASTMAN: I have taken you to the ATAGI advice a few moments ago. There is nothing about disability care residents in that advice. There was a reference to disability care staff in the ATAGI advice. Can you tell the Royal Commission, how is it that disability care residents --- and I'm using the language in the document
there, how did they get included?
MS EDWARDS: My understanding is that the advice you took me to from ATAGI was not the core advice from which we built the phases. It was later advice, which I don't have in front of me, which identified three core priority groups described for priority in vaccinations, those being people at most risk of severe disease or death from COVID-19; those in circumstances where there would be more likely to be spread of COVID-19, including spread to people at more risk of severe disease and death from COVID-19; and critical workers.
Those three groups were understood by us, and I believe by the Government in finalising the document, to cover people in Aged Care who are at risk, especially because of age, but also because of the nature of the places in which they live, and also extended to apply to people with disability who might live in similar types of facilities, because the potential for spread might be great and also critical workers, healthcare workers and so on.
MS EASTMAN: Who gave that advice?
MS EDWARDS: Sorry, which advice?
MS EASTMAN: I asked you about the ATAGI advice and you said there was later advice. Who gave that advice?
MS EDWARDS: ATAGI.
MS EASTMAN: When was that advice given?
MS EDWARDS: I haven't got the materials in front of me, but the material I've got is I thought it was later than November. I could be mistaken about that, but the summary advice we have used throughout identified those three groups as the priority ones, and it was on the basis of those three groups that we prepared material with potential phases, which was considered by government and ultimately adopted.
MS EASTMAN: I assume that well before 7 January, that the document that I took you to with the phases --- I'll come back to the second page of that in a moment --- that document was in preparation long before 7 January; is that right?
MS EDWARDS: Which document, sorry?
MS EASTMAN: I'll put it back up. The one that describes the phases.
MS EDWARDS: Yes, the one with the Chevron, yes. A version of it was in preparation some time before 7 January.
MS EASTMAN: Can you say when perhaps those first drafts were developed? Because that may assist us in trying to identify where between 13 November and 7
January, the advice that you have described can be found.
MS EDWARDS: I can --- this thinking was going on for some months before 7 January. I can tell you that it was finalised on 7 January. And I'm sure that we could provide very quickly after the hearing the detail of the advice which I'm understanding was putting the three groups --- perhaps we can give it later today if that's convenient.
MS EASTMAN: We may take that as a question on notice, and it may be that the solicitors assisting you can identify, in the production of documents that we have asked for, where that document is. I may have overlooked that but I haven't seen an advice in those terms.
MS EDWARDS: Thank you, Counsel, or I may have understood those three groups as an extrapolation from the document you have taken me to. But I'm telling you my understanding of the core advice and I'm sure the people listening will be able to assist in clarifying.
MS EASTMAN: Can we going back to the document on the second page, which gives us a photographic breakdown of the Phase 1A group. This is the second page of the 7 January strategy, and that describes the first priority populations. You will see there is a graphic with a house, which says "Residential Disability and Aged Care Facilities", and underneath that that is a shaded box, if we can move into that, which describes "Aged Care and Disability Care Residents". So you have got the residents and the support workers. Are you familiar with this document?
MS EDWARDS: Yes.
MS EASTMAN: And how the factors 1 to 4 for the residents and 1 to 5 for the workers was developed?
MS EDWARDS: Yes.
MS EASTMAN: Was it the intention that the rollout of the vaccine for this cohort, that the vaccines would be administered at the particular residence site, so they didn't have to go anywhere, the vaccinators would come to they, so to speak?
MS EDWARDS: It was certainly anticipated that an in reach, as we call it, to aged care facilities, would be commissioned and conducted by the Federal Government. Our intention with this document and the plan was to ensure that a similar service was provided to disability facilities, which might be akin to an aged care residence. And --- I'll leave it there.
MS EASTMAN: When you say akin, there was an assumption, wasn't there, that aged care and disability care were broadly the same; is that right?
MS EDWARDS: There was an assumption that there might be Disability
Residences very much like Aged Care Residences in which we knew there was severe risk of spread of COVID-19, and we wanted to make sure that in that event, they were also included.
MS EASTMAN: Were assumptions made about the nature of those facilities, for example, the number of people who may live in both aged or disability facilities generally?
MS EDWARDS: It's true to say that as the Department of Health we were not as well informed about the nature of disability care as we were in relation to aged care, which is within our portfolio, and so the decisions and inclusions were made to ensure that if there were similar facilities, they would be included as we continued to work with colleagues with other agencies to get the data we needed about the real situations.
MS EASTMAN: Why wasn't there consultation, for example, with the NDIA, to identify, first of all, where people in disability residential settings lived and the nature of those settings, for example, the number of people who might live in what commonly be called a group home?
MS EDWARDS: There was engagement with both the Department of Social Services and the National Disability Insurance Agency but it is true to say we hadn't yet had the data exchanged to have a true picture of what was going on, and the plan was put in place that the time to ensure that if there were similar disability residences with similar risk factors, that they were included and we have learnt a lot since then.
MS EASTMAN: You would accept, wouldn't you, that there are significant differences between the nature of Aged Care Residential Facilities and the nature of where people with disability live?
MS EDWARDS: Yes, I do accept that.
MS EASTMAN: Looking at some of the documents that the Department has provided to us, and I asked you at the beginning about the 190,000, and I think you said it was an estimate. There's a document the Department has provided to us that says that of the 190,000 Aged and Disability Care Residents, 183,989 are Aged Care Residents. That would leave 6,011 Residents in Disability Care. That's a document that the Department has provided to us. Do you accept that there may have been a significant error in identifying the number of people who live in disability residential settings?
MS EDWARDS: There was an underestimate, yes.
MS EASTMAN: The 6,011 might actually be the number of disability residential settings, not the number of people who lived in the settings.
MS EDWARDS: I accept the maths works like that. I don't think that was the basis
of the underestimate.
MS EASTMAN: If the Department of Health thought there were 6,011 people who lived in disability residential settings, you would agree that is a gross underestimate of the number of people with disability who live in supported accommodation?
MS EDWARDS: 6,000 is a lot less than the approximately 26,000 that we now understand to live in this supported accommodation of two or more people. But I'm not sure the 190,000 was correct for Aged Care Residents and then the balance was deemed to be disability. I think we estimated both groups and as a totality underestimated the total.
MS EASTMAN: If the estimates were wrong at the outset, wasn't that inevitably going to have a consequence down the track in terms of meeting the target of completing a Phase 1 rollout within a particular period of time?
MS EDWARDS: The numbers estimated in that document on 7 January were an underestimate, and we were always aware that we would have to seek a lot more granularity of information in order to ensure the design of the rollout was appropriate.
MS EASTMAN: I put to you that that error could have been readily and very easily addressed if there had been relevant consultation with, among other people, the Advisory Committee within the Department of Health and other stakeholders such as the NDS, the National Disability Services, which are the organisation that operate Disability Residential Facilities. It would have been a very simple thing, wouldn't it, to have undertaken consultation?
MS EDWARDS: I think consultation is an extremely good idea in all circumstances, I'm not sure it would have been simple. It's been quite a task for us to work out exactly where and who are and to come up with an estimate of 26,000 people.
MS EASTMAN: Do you accept that there was a failure on the Department of Health in making the estimates of people with disability living within residential settings for the purpose of identifying Phase 1A?
MS EDWARDS: I accept there was an underestimate of the number of people in Aged Care residences and Disability Care residence, however described, and that was an estimate made incorrectly by the Department of Health.
MS EASTMAN: Do you accept that the underestimate is in fact a failure?
MS EDWARDS: A failure to estimate it correctly, yes.
MS EASTMAN: It is the case, isn't it, that all people who qualified for Phase 1A were to receive the Pfizer vaccine?
MS EDWARDS: No, that's not correct.
MS EASTMAN: If the disability service providers, received alerts from the government that said people in Phase 1A were to receive the Pfizer vaccination, would that information be incorrect?
MS EDWARDS: No. It's a more complex situation. So the Pfizer vaccine was approved in advance of the AstraZeneca vaccine, and so initial efforts to roll out 1A commenced with Pfizer in mind. In addition, prior to the approval of the AstraZeneca vaccine, it was unclear to us on what basis it would be approved, for which group, in what circumstances and so on. For example, we weren't sure what age group would be approved, and so in particular, the elderly age group proceeded with Pfizer because of its early authorisation for that group. We always sent ---
MS EASTMAN: And ---
MS EDWARDS: Sorry ---
MS EASTMAN: Go ahead.
MS EDWARDS: The nature of the vaccine was not linked to any particular phase, other than by timing and appropriateness.
MS EASTMAN: Do you feel that the message for the community has been clear with respect to people in Phase 1A receiving the Pfizer vaccination, and that the AstraZeneca vaccination was for other groups? Do you think that messaging has been clear in the community?
MS EDWARDS: I think there is a lot of misunderstanding about the vaccines that are available and the groups who are scheduled to get each.
It's a complex evolving situation, and one which I accept we need to continue to communicate very carefully about.
MS EASTMAN: Was it the government's intention that everyone in Phase 1, that their vaccinations would be completed before starting to roll out Phase 1B, Phase 2 and onwards?
MS EDWARDS: No.
MS EASTMAN: The purpose of the phases was to complete the most vulnerable members of the community before moving on to others; is that right?
MS EDWARDS: No. That was never the intention.
MS EASTMAN: Can I ask you about the initial rollout of the Pfizer vaccine. I think we know that with respect to the Pfizer vaccine there are issues about cold storage
and then cold chain logistics. What investigations did the Department make before 7 January as to the impact of cold chain logistics in relation to the rollout in disability residential settings?
MS EDWARDS: There's a few questions there, counsel, and to go first, about cold, both vaccines approved in Australia have cold chain requirements. They are much more difficult in relation to the Pfizer vaccine, the deep freeze, the thawing, and also the storage solution, all manner of the administration of Pfizer is more complex than AstraZeneca. But the AstraZeneca also has some important stringent cold chain requirements. That was the first part of the question. The second part, sorry?
MS EASTMAN: Any investigations that were undertaken about the logistics with respect to rolling out the vaccines in disability residential settings.
MS EDWARDS: A lot of work was done about the logistics of rolling out the Pfizer vaccine at all, including working closely with Pfizer and our providers who do distribution logistics. We did work on how that would work in all sorts of circumstances. It's true to say that we are learning --- we were learning as we went along in relation to providing Pfizer to large facilities, small facilities, public hospitals, other hospitals, state clinics. Whether we specifically thought about what we now know to be the more common type of disability residence, that is a small --- a location with two to five residents, say, I don't know. But I imagine --- I expect it would have been within the contemplation.
MS EASTMAN: I want to ask you about whether you are aware that on 18 January there was an Advisory Committee meeting --- and this is the Advisory Committee that I have referred to earlier.
MS EDWARDS: Yes.
MS EASTMAN: Some of the concerns raised by the committee on that occasion was the need for clarity in explaining the priority groups, and a concern about what evidence would be required to prove eligibility for Phase 1. Were you aware of those concerns being raised?
MS EDWARDS: I'm not aware of the extent to which they were raised at that meeting, but I am aware that the issue of how you establish you are in any of the groups across any of the phases was a continuing issue in many forums for a long time.
MS EASTMAN: In terms of communication, that issue was raised at the meeting about the need to have effective communication with people with disability and their supporters, particularly about people who may not be NDIS participants or non registered disability support workers or informal carers. Did that matter come to your attention?
MS EDWARDS: Not in relation to that Advisory Group meeting. But the issue of
communication, how we communicated complex changing messages to the whole of the community, including those with whom communication might be more difficult, has been a constant theme and concern of the Department.
MS EASTMAN: I want to ask you about the advice coming from the Advisory Committee, because I need to understand, and you know this, we don't, how does the advice from the Advisory Committee make its way through various channels in the Department of Health to decision makers like you or Professor Murphy or even up to the Minister? So a few questions in one. If I was a member of the Advisory Committee, I'm giving my time to the Commonwealth to give advice, can I expect that my advice in the Advisory Committee will actually make its way to somebody who will make a decision?
MS EDWARDS: Yes.
MS EASTMAN: How does that happen and how is the advice acted on?
MS EDWARDS: Many of the important decisions in this regard aren't made by Professor Murphy or myself but are made with the people entrusted with those decision making. So for example, our Communications team, both generally across the Department and specifically in relation to vaccines, makes the decisions in relation to communication materials for most purposes. So general messages and directions would be set from the Executive, from myself, Professor Murphy and other members of the Executive, for example, that communication is a key element of the vaccine rollout, that communication should be accessible in a number of languages, in a way that is appropriate for First Nations people, in a way that is accessible to people with disability and their providers. But the actual mechanics of each piece of advice and how it is operationalised would be unlikely to cross my desk specifically.
MS EASTMAN: In terms of the Phase 1A, what consideration was given to being able to obtain informed consent to residents in disability residential settings?
MS EDWARDS: Consent has been a core issue across the whole of the program from very early on, and one which we have engaged in particular with medical --- the medical and health sector about. In relation to disability, the issue of ensuring that we could go through the process, which could be difficult and lengthy, of ensuring informed consent from people with disability or their carers in appropriate circumstances, was considered from early on, and I believe we were engaging with providers about that issue from --- I think from late last year, but at least from January, in order to commence the process of having those discussions in order to seek consent for a vaccine.
MS EASTMAN: On 2 February this year there was a Roundtable with State and Territory representatives and key stakeholders on COVID 19 Vaccination Program for People with Disability. Were you involved in that Roundtable?
MS EDWARDS: No.
MS EASTMAN: Are you aware of the matters discussed at the Roundtable and any outcomes of that Roundtable?
MS EDWARDS: What date was it, I'm sorry?
MS EASTMAN: 2 February.
MS EDWARDS: No.
MS EASTMAN: I next want to move to what we understand to be the trial phase.
It is the case, isn't it, that the Department of Health determined that there would be a trial for a rollout of vaccine in disability residential settings and the Department identified a number of service providers to participate in the trial rollout; is that right?
MS EDWARDS: I would characterise it differently. I know it's been described as a trial. What I understand to have happened is that we had some initial delivery of vaccine in reach to disability sites. That initial rollout was very modest in nature, and because of the small number of sites and because we knew that it would be complex and that we had a lot of learning to do to make sure it was effective, we used those initial sites and a core learning and we actually engaged those providers to provide the vaccines but also to provide feedback and understanding and some planning, working with the providers with which they were engaged on how we could develop the further rollout for later in the year. So ---
MS EASTMAN: I want to break that down into a few areas. First of all, are we right in understanding that the number of residential settings identified was about eight?
MS EDWARDS: The numbers I have are a few more than that, in the initial weeks. But it was very modest, less than 20.
MS EASTMAN: Where were those sites located --- (overspeaking) --- 24 ---
MS EDWARDS: In the first week, one in each jurisdiction, as I understand it, although two of those couldn't proceed for logistical issues that week and were rescheduled. And then some further sites in various states around the country, I think in WA, Queensland, NSW. So small numbers in various sites around the country is my understanding.
MS EASTMAN: How many people with disability who were residents of the facilities were earmarked for this initial --- I've called it trial but you say initial rollout.
MS EDWARDS: Well, I don't know the exact number across those sites. But they would have been small numbers in each site because of the nature of the site.
MS EASTMAN: But you don't know the precise number?
MS EDWARDS: No.
MS EASTMAN: What about workers in those sites, the disability support workers? How many support workers were included in that initial trial or rollout?
MS EDWARDS: I don't know the answer to that because at the time of the initial rollout, we were engaging with our medical advisers about the propriety or not of vaccinating residents and staff at the same time. We had some strong advice in relation to aged care facilities that that shouldn't occur because of the risk of having residents who were ill with side effects the following day, and also that a large number of staff might also be off ill, hence having a problem with care. I don't know, but my expectation would be we would have been similarly cautious in relation to these initial sites.
MS EASTMAN: Who was responsible for doing the rollout? Was that a commercial provider, was it the members of the defence force or local GPs?
MS EDWARDS: It was commercial providers, those we had engaged to do this type of work initially and then later supplemented with a medical team from the Australian Defence Force.
MS EASTMAN: Were the commercial providers Aspen and Healthcare Australia?
MS EDWARDS: Yes.
MS EASTMAN: Any others?
MS EDWARDS: There was an additional provider whose name is escaping me.
MS EASTMAN: Is it Sonic?
MS EDWARDS: Sonic came later. There were three to start with, and then we added Sonic as a fourth.
MS EASTMAN: That's all right if you can't remember. If I ask you this: of those commercial providers, do you know whether they had any experience in engaging with or working in disability residential settings?
MS EDWARDS: I don't know but they were very experienced health providers.
MS EASTMAN: In terms of procurement practices, if you had tendering or procurement guidelines, did those guidelines include any guidelines about standards
that you required of people going into disability residential settings? Do you know that?
MS EDWARDS: I would have to refer to the expression, to the approach to market. But it was always envisaged that they would be engaged to do work in aged care and in disability care, so my expectation would be the approach to market would require that. But I don't remember the detail.
MS EASTMAN: You are aware of the Royal Commission's Public Hearing 4 held in Homebush last year, and I don't know if you have read the Royal Commissioners' hearing report following that hearing?
MS EDWARDS: I don't know which hearing that was, sorry.
MS EASTMAN: That was on healthcare for people with intellectual disability. I don't think you were part of that hearing. Three of your colleagues were. You may have been out of the Department at the time.
MS EDWARDS: I'm aware of colleagues appearing in the Royal Commission in relation to healthcare, so I'm aware of that. I didn't know it was Hearing 4.
MS EASTMAN: What the Royal Commission learnt from that hearing is that for people with intellectual disability --- and if you assume that a very significant number of people in residential facilities in group homes are people with intellectual disability, having a needle can be a really big deal. We heard evidence of people having to be sedated, restrained, and to really require a lot of care in the administration of needles. So I'm asking: when it comes to whether these commercial providers had the requisite skills to be able to vaccinate in those settings, what can you tell the Royal Commission about the Commonwealth Department of Health's requirements that these commercial providers could actually do the job? What can you tell us about that?
MS EDWARDS: Well, I can tell you that was always envisaged that we would have very important and difficult, both logistical and clinical tasks to do in reach vaccination, both for elderly people in Aged Care and for people with disability, and that we required our providers to have extensive experience in providing healthcare in that sort of regard. I don't remember the detail of the approach to market so I would have to refer to that to look at the detail, but our expectation that it would be both important and difficult in disability settings was part of our motivation to make sure we used those initial sites for learning, to ensure that the broader rollout did accord for best practice for people with disability.
I am aware of the issues that people with intellectual disability may have in relation to healthcare, they are not alone. People with dementia, for example, and other people in the community also have great concerns. We need to be cognisant of all of those, but it is absolutely important to us to design a program which caters is for people with intellectual disability and people with disability of all sorts.
MS EASTMAN: By 4 March the Department held some webinars, and the webinars were variously for relevant stakeholders, so service providers, in some cases GPs and in some cases carers.
At a webinar on 4 March, the participants were told that either there were 94 or 97 --- there are two different documents with different records --- but 94 people with disability across eight sites had received the first dose. Eight sites is significantly less than the 24 sites that you have identified that may have been part of the initial rollout. Would you agree with that?
MS EDWARDS: The initial rollout that I'm thinking about, to be clear, was the first week, which would have been about five sites, a second week with three sites, which perhaps accords with the eight you are discussing, and then two further weeks of about 15 sites. So I accept that at that date it may well have been eight sites. But I'm not sure exactly how the dates align.
MS EASTMAN: At this webinar, the attendees were told by Ms Carrick that the final implementation plan for people with disability in disability residential care was going up "on the website next week". We cannot find a final implementation plan that went up on the website the week after 4 March or if at all. Is there a final implementation plan with respect to vaccination rollout for people with disability in residential disability settings?
MS EDWARDS: Not finalised, no.
MS EASTMAN: Why would Ms Carrick --- I know you can't give evidence about what was in her mind --- say on 4 March to the participants that it was coming next week and it's never been finalised? That might suggest to me, Ms Edwards, that something went wrong in the intervening period between 4 March and the following week. Would I be right in making that assumption?
MS EDWARDS: Lots of things have gone wrong, but no, nothing to do with the plan. Ms Carrick would have been expecting it to go up, as we often do. It's not that it's never been finalised, it's yet to be finalised, and it requires update, the draft is still in train.
MS EASTMAN: You are three months into the rollout of Phase 1.
MS EDWARDS: That's right.
MS EASTMAN: When can people in the sector expect a final implementation plan to be made public? They have been waiting for three months.
MS EDWARDS: So the --- I'm aware that the documents we're talking about, I understand that there has been an assessment that some of them are Cabinet in confidence, so I am just cautiously proceeding because I don't want to
inadvertently go somewhere I shouldn't. My lawyers may be able to help. But the original draft of the plan was shared with the sector on 20 January. There was feedback received. Further drafts have been in train. It is a complex logistical and difficult area. It's also required, since 8 April, considerable change as a result of the new ATAGI advice about the age differentiation application of AstraZeneca, and that work is underway. Exactly when it will be finalised is not fully a decision of the Department, and so I couldn't give an exact date.
MS EASTMAN: To the extent you can comment on any draft plan, is one of the reasons that the draft plan hasn't been finalised is that in this initial trial or rollout, the Department identified a large number of issues about the logistics of rolling out the vaccines to disability residential settings?
MS EDWARDS: I suspect I can't comment on the reasons why the document may or may not have progressed, but --- (overspeaking) ---
MS EASTMAN: I'm not asking but the document but why the plan ---
MS EDWARDS: (overspeaking) it is definitely the case that we have identified a large number of logistical issues for the rollout of vaccines to people with disability, to people in Aged Care facilities, to all sorts of people, and it has been a continually changing environment including, because of the development of our understanding of the vaccine and its appropriateness for different groups, the changing arrangements in relation to cold chain and so on, our learning about logistics and how it works, our learning about the nature of vaccine hesitancy, and many other items.
So it has been a very changeable environment and that would be contributing to our policy on all manner of the rollout, including in relation to people with disability.
MS EASTMAN: What were the large number of specific issues concerning disability residential settings?
MS EDWARDS: So, as you know, and we have heard --- I've heard from witnesses, I have been watching during the day, unlike aged care, most people who live in supported accommodation, most people with disability, do so in small residences with, say, two to five people. They have carers who come in of all different types for different things. It's very much, as I'm learning about it, a function of the individual nature of the National Disability Insurance Scheme, so as opposed to the aged care facility, which the Department is more familiar to, it's a much more individualised, and data in relation to who might share an accommodation with someone else is much more difficult to obtain.
And also, the logistics of using Pfizer into a small residence, and in addition to the cold issues with Pfizer, it also comes in a set number of doses, so we have multidose vials, for example, which is not the usual way any other vaccine in Australia has been done. So that means the number of people to be vaccinated need to be very
carefully assessed and so on. So working out how all of those things happen.
In addition, you mentioned earlier, had everyone got Pfizer? No. We were actually looking at using AstraZeneca for these facilities because it is much easier to transport and manage doses and so on. And so until 8 April, that was looking to be our preferred mode of in reach into disability facilities. But, of course, because people with disability in residential care are both over 50 and under 50, that made it a much more complex process, we could no longer offer the AstraZeneca to people under 50.
So those are among the major issues. And in addition, obviously the issues that many people with disability have in terms of the environment in which they are comfortable to have a vaccine, the person from whom they are happy to have it received, what the support arrangements, have obviously become clearer to us, and very important, and so working through those to make sure it's an appropriate mechanism which encourages the maximum uptake.
Those are among the major issues.
MS EASTMAN: Is there any reason why those large issues were not shared with the sector, with the service providers, with unions, who represent disability support workers, by the peak advocacy groups? Why didn't you share those concerns or issues with them?
MS EDWARDS: I accept that our communication, I've heard today, need to improve, we always need to improve it, I accept that people have felt underinformed but I can assure you that our efforts to share those things have been ongoing, we have been trying to do it, we will try and do it more, and we will continue to try and communicate. So it's an ongoing process that we need to improve. But we have been trying to share those things.
MS EASTMAN: I'm conscious of the time and I want to get to some quite specific issues. The Commissioners may have some questions, but we will come to those later, if that's all right.
Can I ask you now about the merging of Phase 1A and Phase 1B. The record suggests that the decision was made around 19 March. Does that accord with your recollection?
MS EDWARDS: I'm not familiar with the concept of merging the phases. It's not a concept --- I'm aware of Phase 1A and Phase 1B running concurrently, as is always the design, and there being some uncertainty in some groups as to which healthcare workers, for example, are in 1A and which were in 1B, and also that some of our reporting hasn't been able to distinguish between 1A and 1B. But I'm not aware, and I don't think there has been any decision to merge the phases. They have always been separate, they continue to be separate, but our delivery of them is concurrent or at the same time. With that caveat, I'm happy to talk about the relationship between the two phases.
MS EASTMAN: There is some material within some of the ATAGI minutes which suggests the importance of keeping to the plan. Is that the plan --- am I wrong in understanding that the plan was to try to accomplish Phase 1A before then starting the rollout? But you are saying that the phases are to be concurrent?
MS EDWARDS: If you refer back to the document on 7 January, which is repeated very often, it's clear that the phases run over one another. In fact, if you look at Phase 1A from 7 January and many, many times since then, it goes out, and then the words "ongoing" appear, because we knew that the people in 1A might always need to receive the vaccine using that particular focus. For example, people who enter aged care, people who enter disability residential during the year, or people who become employed in those sectors and so on, people who become healthcare workers. So it's always been the view that we started there, but that all of the phases would run concurrently and the diagram, in fact only Phase 3 in this diagram doesn't overlap.
So we knew this was the most important group but also hard to reach and difficult to design the program for, so once supply increased of vaccine in Australia, Phase 1B began but in no way to reduce the focus on Phase 1A, both things happening at the same time. And ---
CHAIR: Can I ask a question?
MS EDWARDS: Yes, Commissioner.
CHAIR: Is it your understanding and evidence that it was always intended from 7 January 2021, when the strategy was released, that 1A and 1B would operate concurrently?
MS EDWARDS: Yes.
CHAIR: Would you mind going to the third page of that document. It has the number 0003.
MS EDWARDS: You might have to put it up on the screen, sir.
CHAIR: That's fine, let's put it up on the screen, the number is DRC.9999.0036.0001, and page 0003.
MS EDWARDS: I have got that document.
CHAIR: Thank you very much. You will see that that document is headed, under the national rollout strategy, it says:
First priority populations
The Australian COVID 19 vaccination program will commence with priority populations including aged care and disability care residents and workers, frontline healthcare workers and quarantine and border workers.
MS EDWARDS: Yes.
CHAIR: Do you accept that that is a description of category 1A?
MS EDWARDS: Yes.
CHAIR: How is this document consistent with 1A and 1B rolling out concurrently, when the document says priority will be given to 1A?
MS EDWARDS: Because 1A commenced first, but it's never been the instance that it would complete before we commenced the second, so there would be ---
CHAIR: Where is this dealt with in the document?
MS EDWARDS: On page --- the first slide of that document, so the page prior to this one, you can see Phase 1A commences, which it did on 22 February and it continues, and it's ongoing to make sure we continue to focus on that population. For example, there might be a number of people, we heard earlier today, that are hesitant about taking the vaccine, and we have to do some real work to persuade them that it is appropriate, to give them the information they need. We certainly don't want to prevent them from taking up the vaccine later in the year if that's when we can provide them with the information they need. We commenced 1A, then we commenced 1B on 22 March, they are both running forward, you still give enormous priority to Phase 1A and making sure ---
CHAIR: Where does it say 22 March?
MS EDWARDS: It doesn't. This is the 7 January document. But as it turned out, Phase 1B started on 22 March, a date that ---
CHAIR: I understand that. But I wonder if you wouldn't mind just attending to my question.
MS EDWARDS: Apologies.
CHAIR: My question was: how would anybody reading this document know that 1A and 1B were intended to be concurrent, in the light of the way the material is presented?
MS EDWARDS: Because the chevrons overlap one another in the document.
CHAIR: Chevrons overlap one another?
DWARDS: Apparently that's what that's called, that arrow, that says "Phase 1A up to 1.4 million doses", it goes out and says "Ongoing", and it overlaps Phase 1B, which starts at a later moment but continues on, and the word "Ongoing" is there specifically to be clear that it doesn't finish, we keep going with that group, because they are so important, throughout.
CHAIR: You are saying that any person unfamiliar with bureaucratic jargon would understand that this was a document that contemplated that there would be overlap, indeed concurrent, operations as between 1A and 1B?
MS EDWARDS: I'm just saying, Commissioner, what was intended and what we had intended to convey with this document.
CHAIR: Would you agree with me that it doesn't in fact convey that to a reasonable reader unfamiliar with the way in which the Department of Health might choose to use chevrons?
MS EDWARDS: I would point out this is not a Department of Health document in the end, it's a government document. But I certainly accept, if some people have understood it differently, there has certainly been a lot of questions about, "Are we going to complete one before the other?", but my evidence is that was never the intention because we needed to continue focusing on this group for as long as needed and ---
CHAIR: I understand your evidence as to the intention. I'm just asking how people in the wider community, including people with disability, could know that was your intention? And I think that's the burden of Ms Eastman's questions.
I'll invite Ms Eastman to resume her questions.
MS EASTMAN: Thank you. As you said, Phase 1B rollout started on 22 March this year. Phase 1A was the 600,000 or so but Phase 1B is over 6 million people and an estimate of 14.8 million doses. So there's a very significant difference, isn't there, between the Phase 1A cohort and the Phase 1B cohort?
MS EDWARDS: Yes.
MS EASTMAN: With respect to Phase 1B, for people with disability, the eligibility checker says you have to have a severe disability, is that right, to be in Phase 1B?
MS EDWARDS: The eligibility checker takes you to the --- well, it takes you to whether you are in residential care as one element and then it takes you to some specific items which would be chronic disease, and those are the things that would make you eligible in 1B. So I'm not sure if I have understood your question.
MS EASTMAN: That's all right. I will make it more direct. Why wasn't the eligibility for Phase 1B extended to everyone with intellectual disability?
MS EDWARDS: Because the advice, the medical advice and the ATAGI advice, did not include that group as a priority group required to be in advance of when they would otherwise be eligible due to age or other circumstance.
MS EASTMAN: Do you know what specific medical advice or scientific advice ATAGI took into account to make a distinction between severe intellectual disability and intellectual disability?
MS EDWARDS: I'm not sure where severe intellectual disability comes from. My understanding is the criteria don't use that term but I may be misunderstanding. In terms of ATAGI, I'm not across the medical information, I'm not a clinician, but I understand them to be a pre eminent group that takes into account all the relevant evidence.
MS EASTMAN: You would have expected them to take into account, for example, the research that's been undertaken in Australia and overseas pointing to people with intellectual disability having significant decreased life expectancy compared to the general population? You would have expected ATAGI to have taken that into account?
MS EDWARDS: In relation to --- from COVID-19 or generally?
MS EASTMAN: Generally.
MS EDWARDS: I would expect ATAGI to take into account all the evidence of what are the pre existing conditions or situations of a person and the likelihood that the evidence shows COVID-19 would have on impacting them, and I understand them to have done that and to have identified the circumstances in which COVID-19 is likely to increase the risk of severe disease and death. But I can't go to the clinical material.
MS EASTMAN: I accept what you've said earlier. But if you accept this proposition, if the Royal Commission has been told that eligibility in Phase 1A is on the basis of severe intellectual disability, do you accept that a distinction between severe and general intellectual disability is not an appropriate way to identify a person with intellectual disability who should be vaccinated in Phase 1B?
MS EDWARDS: Did you say 1B? You said 1A earlier in the question?
MS EASTMAN: 1B.
MS EDWARDS: My understanding is that the conditions which put a person into 1b, regardless of age, are set out clearly in the advice we have received, and included in the eligibility checker. And the eligibility checker in that section includes some conditions which include intellectual disability. But I'm not aware, and it may be just I'm not aware, of any distinction between levels of intellectual disability. It's a very
complex issue obviously. So you go back to the eligibility checker and what's there. As I mentioned earlier, Down syndrome is included.
MS EASTMAN: Do you count that as severe intellectual disability or not severe?
MS EDWARDS: I don't comment. If someone is Down syndrome, they are included within the eligibility checker and hence in 1B, and there are other conditions also. But that is really a matter that our medical advice has dictated and we have included and I couldn't add any more on that issue.
MS EASTMAN: Can I leave this topic by asking you this: could the Department of Health assist the Royal Commission as to whether or not the eligibility tracker or checker makes a distinction between severe intellectual disability and intellectual disability and, if so, the basis upon which that distinction is made? Could I ask you to take that on notice?
MS EDWARDS: Absolutely. I would be happy to.
MS EASTMAN: With respect to category 1B, the Royal Commission has heard evidence from people who don't live in disability residential settings --- they may live by themselves, they may live in their own homes --- and some people are unable to leave their homes. The Royal Commission heard this was an issue in relation to attending for COVID-19 testing during its previous hearing.
What is the situation for people with disability who cannot leave their own homes, in terms of having access to vaccination as part of 1B? What happens to that group?
MS EDWARDS: That group is not part of 1A, it's specifically excluded. And they may or may not be included in 1B. If they are included in 1B, by nature of the disability that they have and they cannot leave their home, then there are mechanisms currently for GPs to make home visits and so on. That has been made much more difficult by the ATAGI advice of 8 April. So our original expectation, which was the primary care sector, GPs, would do a lot of heavy lifting, for all Australians, including those with disability, has been complicated by age. And the situation of people who cannot leave their home because of disability or for other reasons will be a matter which we will need to develop policy options for. At the moment it's difficult --- if the person is under 50, it's difficult for them to receive Pfizer in those circumstances.
MS EASTMAN: The day after the Phase 1B rollout commenced there was a webinar for carers and Ms Carrick from the vaccine task force told the participants of that webinar that AstraZeneca is the appropriate vaccine for disability residential settings. Do you know anything about any decision with respect to how AstraZeneca was identified as the appropriate vaccine for disability residential settings?
MS EDWARDS: Yes. I think I mentioned earlier that we started with Pfizer because it was approved earlier. But because of the greatly increased logistical
ability to transport AstraZeneca, that we were moving to use it, particularly for locations where there's a small number of residents, because of the way Pfizer works, the tray, the way it's frozen and so on, the need to dilute it and for it to be used quickly after that dilution, as opposed to AstraZeneca, which is much more like the vaccines we are familiar with in Australia. So there was a view that we should use AstraZeneca to increase the speed and logistical ease of that work. That of course had to be completely revisited upon receiving the ATAGI advice of 8 April.
MS EASTMAN: As at 23 March, was the Department aware that perhaps of the majority of people living in disability residential settings were people under the age of 50?
MS EDWARDS: I don't ---
MS EASTMAN: Not in aged care but in disability?
MS EDWARDS: I know. I don't think I was aware or we really prosecuted the issue about age until we knew there was a meaningful distinction between the preferred vaccines due to age. We certainly knew quickly after 8 April about the relative split across all of our groups and my understanding is that people in those circumstances of two or more people with disability in a residential setting is about evenly split; perhaps slightly more people under 50 is my understanding, and that is also the case in relation to aged care workers and many disability workers. But I don't think I would have had any reason to ask that question prior to 8 April.
MS EASTMAN: On 8 April, ATAGI recommends that Pfizer is the preferred COVID 19 vaccine for adults under the age of 50 and that resulted then in some changes in terms of the distribution of Pfizer and AstraZeneca to the population based on age; is that right?
MS EDWARDS: It led to a fundamental rethinking, known as recalibration, of the program as a whole, including --- well, for all elements of it.
MS EASTMAN: What was the specific consideration for people living in disability residential settings in relation to AstraZeneca?
MS EDWARDS: The discussion that was had --- and I led the discussion with states and territories --- we provided advice, that was then considered by National Cabinet, which obviously I can't go to because of the Cabinet in confidence element. But the discussion across all of the health departments was the extent to which the age differentiation should be taken very strictly, so effectively to what extent will we only offer AstraZeneca to people over 50 and to what extent would some people over 50 be offered Pfizer for any reason?
The decision of National Cabinet of 22 April, which is public, was that Pfizer would only be offered to people under 50, except in very limited circumstances and one of those circumstances was in respect of people living in disability residences, which
was a pleasing outcome for us and our design because it meant we could do a single vaccine in reach program for people where there are people both above and below 50 in a particular setting, which is clearly a much easier logistical exercise. So the exception was a pleasing outcome from National Cabinet for this program.
MS EASTMAN: Just dealing with National Cabinet, I think the Prime Minister said in a public statement that you were one of the Department of Health officials to provide advice to National Cabinet. I'm not going to ask you what advice you provided to government but you were part of the Department of Health team to advise National Cabinet; is that right?
MS EDWARDS: That's what the Prime Minister's statement said, yes.
MS EASTMAN: Overnight, the lawyers representing the Commonwealth have provided the Royal Commission with some documents, they are eight pages, and the reference number --- I don't need it to go up point but I will put it in the transcript so it can be readily located --- is CTD.0800.0001.0005, and that continues for the following eight pages. That is material that was provided to National Cabinet for briefing National Cabinet; is that right?
MS EDWARDS: I have I'm sorry, I don't know at all what that document is.
MS EASTMAN: I might in due course ask my learned friend Ms Downes to explain those documents. We are happy to tender them but we have very little understanding based on the documents themselves as to whether they were part of the 19 April briefing. Can I just defer that so I can get through the questions?
CHAIR: Yes. I think you said, on your understanding the eight pages of material were supplied to Cabinet.
MS EDWARDS: There was an eight page slide deck that was presented by the Prime Minister following the National Cabinet on 22 April. But the number I have noted down doesn't match that. But it is headed "COVIDCOVID-19 19 Vaccination Program National Cabinet Update, 22 April 2021".
MS EASTMAN: Yes.
MS EDWARDS: Yes. That's not --- well, I can't talk to what went into briefing National Cabinet, as it is Cabinet in confidence, but this is the presentation given following National Cabinet, by the Prime Minister, I believe, and Professor Murphy, to record the outcome.
MS EASTMAN: We are happy to tender the documents but it wasn't clear to us whether these were documents provided to National Cabinet for their update or something else. You say these documents were prepared after National Cabinet to inform the public of what National Cabinet decided?
MS EDWARDS: I'm not sure what I can say here. This was presented outside --- after National Cabinet, but I'm not sure whether I can even go to the fact of what did or didn't get considered, given that would be Cabinet in confidence, what went in, as opposed to what was presented afterwards. I would need advice about that. But it does reflect the National Cabinet decision.
MS EASTMAN: We might come back to it. Looking at this document at page 0011, it still has 190,000 of Aged Care and Disability Care Residents. So the language continues to be used but also the numbers continue to be used. Have you got that?
MS EDWARDS: Yes, I do.
MS EASTMAN: By 22 April, the actual numbers of people with disability in disability residential settings had not been updated; isn't that right?
MS EDWARDS: The numbers had not changed, no, in the document.
MS EASTMAN: When have the numbers changed then?
MS EDWARDS: I think the intention here was to show only the changes as a result of the recalibration from the original document. We know that the numbers are --- so the number of aged care and disability care staff we now understand to be 250,000, not 318,000, and, as we discussed before, the number of Aged Care and Disability Care Residents is understated.
MS EASTMAN: When did those numbers change?
MS EDWARDS: Our understanding of the numbers changed?
MS EASTMAN: Yes, when?
MS EDWARDS: But the document here is to show the changes between the original document of 7 January and what has happened as a result of the recalibration, so the numbers don't change.
MS EASTMAN: Wouldn't the recalibration have included that you were aware of more than, say, 6,000 people living in Ddisability residential settings?
MS EDWARDS: That the total of that number is more than 190,000, as we discussed before?
MS EASTMAN: Yes.
MS EDWARDS: I hear the point. This is a decision of National Cabinet document. I don't think I can comment further on what the motivation might have been.
MS EASTMAN: Walking back, you provide advice to National Cabinet on or around 19 April. On the same day, the Prime Minister announced that over 1.5 million Australians had been vaccinated. The following day, the Health Minister, the Hon. Greg Hunt, announced that there had been 1.7 million doses administered, of which 115,000 were to Aged Care and Disability Care residents. Does that accord with your recollection of the number of people vaccinated in aged cared and disability care?
MS EDWARDS: Because I see these numbers every day, I'm not sure at what point --- there would have been a point at which they were the correct numbers. I accept what you say but I don't have a separate recollection of what numbers on what days.
MS EASTMAN: It's the case, isn't it, that whenever the government has announced the number of vaccinations for people in Phase 1A who are described as Aged or Disability Care Residents, that those numbers have always been combined; there hasn't been a separate identification of Aged Care residents and people who are residents in disability residential settings? You would agree with that?
MS EDWARDS: Not in every instance but whenever the general update is given, yes.
MS EASTMAN: At some point on or prior to 20 April a decision was made to prioritise Aged Care Residents over Disability Care esidents in relation to Phase 1A. Who made that decision?
MS EDWARDS: I don't accept that that was the decision.
MS EASTMAN: Was there a decision to prioritise Aged over Disability Care residents?
MS EDWARDS: No, there was a decision to focus the resources of the Commonwealth in reach providers to Aged Care residents first.
MS EASTMAN: That sounds like --- if you are focusing on aged care, that sounds very much like prioritising Aged Care over Disability Care residents.
MS EDWARDS: There was a decision that the in reach resources should focus on aged care first, yes.
MS EASTMAN: Who made that decision?
MS EDWARDS: As the owner of the program in the Department of Health, I --- that decision can be attributed to me. But I would say that it was made in very close consultation with the Chief Medical Officer and on the basis of scientific advice and clearly in consultation with our Ministers.
MS EASTMAN: What was the scientific advice that you relied on?
MS EDWARDS: The fact that the single highest criteria of risk for severe disease or death from COVID 19 is age and that two of the three groups in which --- the ATAGI advice that I referred to before, that we had a discussion about, identified the two top groups as those most at risk of severe disease or death, which is elderly people. We know that the median age of death in Australia from COVID-19 has been 86 and also that people who live in facilities which are mostly likely for a spread of COVID-19 to happen should be in the top group. And aged care residential facilities are very much, both from the theoretical medical advice and our experience here in Australia and world wide, as the places and the people most at risk of severe disease and death from COVID 19.
MS EASTMAN: Was that advice provided to you in writing?
MS EDWARDS: That advice was provided to me in very many forms, both in the ---
MS EASTMAN: I just asked you if it was provided in writing?
MS EDWARDS: I have had it in writing and had it orally and had it in very many forms.
MS EASTMAN: Who gave you the written advice?
MS EDWARDS: So there are numerous documents. There is not an instance of me asking for that advice and it being provided to me in writing in response to that question. There is a large number of documents which document both the experience in Australia and overseas for people who are elderly and in aged care facilities and the advice of the AHPPC, the advice of ATAGI and the advice we have had in numerous meetings and the oral direct advice from the Chief Medical Officer.
MS EASTMAN: Did you seek any advice from any person with relevant expertise in the health of people with disability, and specifically intellectual disability, before making your decision?
MS EDWARDS: No.
MS EASTMAN: Did you review the scientific literature that had been released since November 2020, up to when you made your decision, to assist you in informing making the decision that you made?
MS EDWARDS: No, but I relied on the advice of the Chief Medical Officer and other people of scientific who have reviewed that material, for which they have got expertise to do, which I do not.
MS EASTMAN: Who were those people? Can you tell me who they were and when they reviewed that advice?
MS EDWARDS: I can't ---
CHAIR: Reviewed the research.
MS EASTMAN: Sorry, reviewed the research. Who were they?
MS EDWARDS: I can't tell you. The Chief Medical Officer is the core person and my understanding is these issues have been discussed at the AHPPC. Again, I received that advice from the Chief Medical Officer and the ATAGI advice which we have already referred to and including the advice which you put up, Counsel, about the highest risk factor, which is age.
MS EASTMAN: Did you seek any advice? The afternoon sun is coming in. I am conscious of the time. I am speeding. I have about another 10 minutes to go.
CHAIR: That's quite all right.
MS EDWARDS: I am here at your convenience.
MS EASTMAN: Just in terms of this decision that you made, did you consult the Advisory Committee that we have talked about earlier?
MS EDWARDS: On the decision to focus our resources on Aged Care Facilities?
MS EASTMAN: Yes.
MS EDWARDS: No.
MS EASTMAN: You didn't seek any advice from the Advisory Committee?
MS EDWARDS: No.
MS EASTMAN: Did you seek any advice about what the impact of refocussing the priorities would be for people with disability living in disability residential settings?
MS EDWARDS: The issue and it was clear that we would have to do two things: one, that the in reach service to people with disability would be delayed; and, secondly, that we needed to ensure that we obtained additional channels for vaccinations for those people.
MS EASTMAN: I asked you about the impact of the decision on the people themselves. Was there any consideration of the impact and did you receive any specific advice as to what the impact might be?
MS EDWARDS: No.
MS EASTMAN: Did you consult with the NDIA or the Quality and Safeguards Commission before making that decision?
MS EDWARDS: I speak to the NDIA and the Department of Social Services frequently. I may have discussed it. I do not speak to the Quality and Safety Commission as a --- in the ordinary course.
MS EASTMAN: Did you make the decision because it was all just too difficult to roll out the vaccine to disability residential settings? Is that the real reason you made the decision?
MS EDWARDS: No. The real reason is that 685 people died in residential aged care in Australia and that it was clearly the greatest risk group and it was one that I felt obliged to make sure we safeguarded in the first instance we could, with the resources we had available; at the same time, acknowledging that that would have an impact on other people and continuing to work on how we would do the vaccination program for others.
CHAIR: Can I just ask about your understanding, please. You have said that age is the greatest risk factor.
MS EDWARDS: Yes.
CHAIR: Is it your understanding that all aged people in aged residential care are necessarily more at risk of contracting COVID 19 and the serious consequences following from that than any people with disability in residential disability care?
MS EDWARDS: It's my understanding that the combination of age, which is by far the single most at risk factor, combined with the nature of aged care facilities --- which tend to be larger, with more people coming and going, more numbers of residents --- puts them at by far the greatest risk of severe disease and death. And that is borne out both by the experience here in Australia and all over the world.
CHAIR: You can't seriously suggest that there are not people with disability in residential disability accommodation who are seriously at risk of contracting COVID 19? In other words, there are people with disability very much at risk of contracting COVID 19, at least as much at risk as elderly people in aged care homes, aren't there?
MS EDWARDS: Yes, and there are people with disability who live in residential aged care facilities who are at extreme risk who have been offered the vaccine as a result of this approach.
CHAIR: Have they? How?
MS EDWARDS: Yes, anybody who lives in a residential aged care facility, regardless of age, has been offered the vaccine. So those people with disability who
live in a residential aged care facilities ---
CHAIR: I'm sorry? In residential aged care?
MS EDWARDS: Yes.
CHAIR: No, I'm not talking about Aged Care, I'm talking about accommodation for people with disability. My question, I suppose, to rephrase it, to put it slightly differently: have you made any attempt to ascertain who is particularly at risk, being a person with disability, in accommodation specifically for people with disability?
MS EDWARDS: No, we haven't made any inquiries in relation to any individual. We have made decisions, pragmatic decisions, based on the mechanism to address those at greatest risk.
CHAIR: So it's John Stuart Mill in action.
MS EASTMAN: Ms Edwards, can I ask you, do you recall when you made that decision?
MS EDWARDS: I recall in the first week of March, when it was clear that the in reach rollout was slower and more difficult that than we had anticipated and we had a particular issue with one provider, which caused the suspension of delivery by that provider, that we had a real issue with our capacity to move ahead with the program as we had hoped and we needed to refocus the program to ensure that we could provide vaccinations to the most at risk group as quickly as possible. So --- (overspeaking) ---
MS EASTMAN: So you made the decision some time in that first week of March?
MS EDWARDS: I believe so. It was an iterative process of having a look at what was happening and what we needed to do. It could have been the second week of March by the time we moved all the resources across but it was in that timeframe.
MS EASTMAN: The first week of March, you recall, was when there were webinars telling everybody how the Phase 1A rollout would occur and telling people that the final implementation plan would go up on the Department's website the following week. Is that about the period of time you made this decision?
MS EDWARDS: Yes.
MS EASTMAN: Why did you not tell anyone that you had made that decision publicly? I assume it was known within the Department; is that right?
MS EDWARDS: Well, the decision was to focus the resources on aged care.
MS EASTMAN: Why didn't you tell anyone publicly that?
MS EDWARDS: I don't make public statements, I'm a public servant. We talk to people about it. And I accept the communication could have been better about these issue.
MS EASTMAN: Why wasn't it raised with the Advisory Committee? Do you accept that they were left in the dark, attending meetings, thinking that Phase 1A was rolling out for not only aged care but also for people living in disability residential settings? Why wasn't the Advisory Committee informed about this?
MS EDWARDS: I can't --- I can't answer that. In retrospect, we probably should have talked to the Advisory Committee about it.
MS EASTMAN: You didn't inform --- you heard today David Moody from NDS. You didn't inform the peak service providers?
MS EDWARDS: We provided a lot of information to service providers, weekly updates, and not this --- we've never said, characterised the decision in the way you have because we haven't characterised it in that way and we've continued to make efforts to ensure that we can roll out. At the same time as this period was the period in which we were doing the initial rollout, as we discussed before, so there were vaccinations happening on a very small scale in disability and we were planning with the sector what to do next. We were also working to make sure that access could be had through GPs when that rolled out on 22 March, which is an important element, and looking at other mechanisms to ensure the vaccination of people with disability.
MS EASTMAN: Can I ask you then, what on earth was the point of these communication strategies, preparing Easy Read material, preparing documents requiring service providers to gear up and get ready when behind the scenes, since the first week of March, you had prioritised aged care over disability? What was the point?
MS DOWNES: I object to the question. It is unfair and there are about six questions in it.
CHAIR: I would have thought it was perfectly clear.
Do you understand the question?
MS EDWARDS: I did not make a decision to deprioritise disability. I made a decision to focus on those Australians that I considered to be at risk of severe disease and death and to be the people who were most likely to suffer, and that the evidence in Australia shows that in the entirety of the Australian pandemic, nine people who are NDIA participants have died of COVID-19; very tragic in every instance. But I compare that to 685 Australians who died in aged care. I made a decision to prioritise those groups and I stand by it.
MS EASTMAN: Are you aware of the Disability Discrimination Act?
MS EDWARDS: Yes.
MS EASTMAN: Are you aware there is a provision in the Act which says it is unlawful to discriminate on the grounds of disability with respect to the administration of a Commonwealth law or a Commonwealth program? Are you aware of that.
MS EDWARDS: Yes.
MS EASTMAN: Did you take any advice before you made your decision in March this year as to whether or not your decision may give rise to a breach of the Disability Discrimination Act?
MS DOWNES: I object to the question.
MS DOWNES: The witness is going to be talking about whether or not she has committed a breach of an Act.
MS EASTMAN: With respect, I have asked whether she got advice.
CHAIR: There is an objection. I rather thought the question was, did the witness seek advice on something. That's not a question about whether she was in breach of the Act.
MS EASTMAN: Commissioner, all I want to know is whether she sought advice.
MS EDWARDS: No, I did not.
CHAIR: Okay. There you are.
MS EASTMAN: The Royal Commission has asked the Department to provide its most recent data in relation to the number of people with disability and disability support workers. The Royal Commission has received on 11 May some data provided by the Department on 6 May. I have just put up the graph of the data provided.
MS EDWARDS: Yes, I see that.
MS EASTMAN: Are you aware of that and did you have any role in preparing this document?
MS EDWARDS: I cleared the final document.
MS EASTMAN: Looking at that data, it's divided into dose 1 and dose 2?
MS EDWARDS: Yes.
MS EASTMAN: The second column, under dose 2, these are people who have received both doses, and I assume Pfizer rather than AstraZeneca; would that be right?
MS EDWARDS: I think we have just got round to the second doses of AstraZeneca for a few people because of the start date. But it would be primarily Pfizer, yes.
MS EASTMAN: Looking at the numbers of the first dose, that's a larger collection of people, 127 to 707.
MS EDWARDS: Where is the 127?
MS EASTMAN: 127 is two doses for people who are residents
MS EDWARDS: Yes, I see.
MS EASTMAN: --- and one dose is the 707.
MS EDWARDS: Understood.
MS EASTMAN: And for support workers, two doses 90 and one dose just over 1,000.
MS EDWARDS: Yes.
MS EASTMAN: You have provided us a breakdown by state and territories.
MS EDWARDS: Yes.
MS EASTMAN: This morning in my opening I made reference to the numbers in South Australia and Tasmania.
MS EDWARDS: Yes.
MS EASTMAN: Do those numbers cause you any concern?
MS EDWARDS: Well, they are very low.
MS EASTMAN: Do they cause you any concern?
MS EDWARDS: They tell me that we need to ramp up our rollout of in reach disability, people with disability residential care as quickly as we can, which we intend to do.
MS EASTMAN: If we look at those numbers against the background of the total number of Australians who have been vaccinated by 6 May, which I think is in the order of 2.7 million, would you agree, based on these statistics alone, that the Commonwealth's rollout for people in Phase 1A, being people with disability in residential disability settings, is an abject failure?
MS EDWARDS: I agree it is much lower than we would like to do. But I would like to make two other points about these figures.
MS EASTMAN: I've asked you whether you agree it is an abject failure?
MS EDWARDS: I think it reflects us needing to have an agile program and we have much more work to do in this element.
MS EASTMAN: Do you accept that it's an abject failure?
MS EDWARDS: No.
MS EASTMAN: With respect to support workers, what do you say about the support workers? The numbers indicate more support workers being vaccinated than residents with disability. This is a significantly lower amount than support workers in aged care residential facilities, would you agree?
MS EDWARDS: I haven't got the numbers in aged care in front of me but I'm happy to accept that's the case.
But I do have a point to a make about this data, two points. Could I please make those?
MS EASTMAN: One thing I want to raise with you before you make the points is that the Department has said this data does not include people with disability or support workers who have made their own arrangements to secure a vaccine; is that right?
MS EDWARDS: Yes, and that's one of the points I wanted to make.
MS EASTMAN: What has the Department done to collect data that captures people who have made their own arrangements? What have you done to address that?
MS EDWARDS: That is a difficult issue to collect and it is one we are very occupied with. So what we've done is we've gone out to talk to the top supported living accommodation providers to ask for weekly reports from them about the number of their staff who have been vaccinated. Because if you go to a GP or a state hub or one of the other mechanisms, it's not recorded by your occupation. We are doing that in order to have a good picture of who else may have been vaccinated, in addition to those that are vaccinated through our in reach program. This data only
represents what has been done in our in reach program.
MS EASTMAN: Do you accept that there has been a failure on the part of the Commonwealth in terms of the rollout to disability support workers?
MS EDWARDS: I accept that it's been very slow and we have a lot of work to do.
MS EASTMAN: What you do you propose to do in terms of, as you say, a lot of work to do? What can the disability sector expect from the Commonwealth from here on in?
MS EDWARDS: As I mentioned before, one of the major issues that happened at the beginning was to do with our desire to focus on those most at risk of severe disease and death, and then the decision of 8 April required a major re look at what we were going to do with disability. We have done that work, and the material you were talking about with Mr Moody today attaches our plan of what to do going forward. At this point in time there are three major channels available for the vaccination of people with disability in residential care and support workers. They are the in reach program, which is still modest but ramping up and will ramp up significantly over future weeks; there is the GP process for those over 50 to have AstraZeneca, and communications have gone out to the GP sector frequently to impress how important it is that disability workers and people with disability who are able to attend can be vaccinated; also, the state Pfizer hubs, which are our core mechanism to distribute Pfizer outside our in reach program, every state and territory has agreed to prioritise people with disability and aged care and disability workers and are now accepting appointments from those people.
In addition, we are working with states and territories to ensure that the facilities they have for vaccinations deal as well as it possibly can with the issues we were talking about earlier, about how we ensure there are quiet spaces, for example, for people with autism or who may have a fear of appearing in a large facility, and working closely with states and territories to make sure that's the case. In addition, we are engaging with THNs to enable GPs who are willing and able to go into those residential aged care facilities where only residents over 50 live, to provide AstraZeneca vaccine. And in addition, we are looking at a whole range of bespoke models, in collaboration with providers, to try and increase the availability of vaccinations for both workers and for residents who are able to leave their home or who wish to do it in that way. All of that work is under way.
MS EASTMAN: Why wasn't that work done prior to 7 January this year?
MS EDWARDS: Because, as I mentioned before, at 7 January we were in a very rudimentary state of knowing the situation. We did not have any approved vaccines, we did not know who they would be approved for, we did not know the conditions under which they could be provided, and many other aspects. So we have been working --- in fact, in December last year we didn't know there would be any vaccines at all approved. This has been a very difficult important program, very
changeable. Very variable, very subject to medical advice and to logistical difficulties and many other things.
We have not vaccinated people with disability as quickly as we would have liked. It is an issue. We do need to focus on it. But I can ensure you of our enthusiasm and our great commitment to doing it.
MS EASTMAN: How can the sector trust the Department of Health to do what you have described, in circumstances where you made a decision in the first week of March and no one was informed about that decision until you were asked questions in a Senate Committee? How can people trust the Department of Health?
MS EDWARDS: We will continue to engage as much as we can with the sector, with people with disability and with everyone who will talk to us about it, in an effort to increase vaccine uptake and to roll out this program. And we would encourage people with disability or their providers or their families to contact us with suggestions about how we might do it better and we are really open to any sort of ideas in that way.
MS EASTMAN: Thank you, Ms Edwards. Those are my questions, Commissioner.
CHAIR: Thank you. Commissioner Galbally, do you have any questions?
COMMISSIONER GALBALLY: Within the logistics of focusing on disability, just to ask about people with psychosocial disability, in boarding houses, hostels and SRSs, to make sure they are on the list. And also, looking at the spread, the risk of spread in congregate care, to raise the issue of day programs and sheltered workshops. It's sort of a question that I don't think they are on the list and it would be really good to get them on the list.
MS EDWARDS: Thank you, Commissioner. None of those groups appear in the overarching assessment of the phases, I accept that, but all of those people are included within Phase 1B and all of them are able to make appointments and go to a GP or to a state hub. In addition, we are aware that for some of those people they may not have the wherewithal or the ability to present and so we are working with the states and territories on mechanisms to have --- to provide vaccinations to those people. It's a work in progress, it's a very important group, but we are working with states and territories about how to do that and how to find those hard to reach groups and it will be something we need to work on more.
COMMISSIONER GALBALLY: It may require an in reach program.
MS EDWARDS: It may.
CHAIR: Thank you. Commissioner Atkinson?
COMMISSIONER ATKINSON: I have no further questions.
CHAIR: Commissioner Bennett?
COMMISSIONER BENNETT: I have no further questions.
CHAIR: May I ask when you became familiar, if you have become familiar, with the Royal Commission's report on Public Hearing number 5?
MS EDWARDS: I became aware of it when it was released.
CHAIR: Did you read it?
MS EDWARDS: Yes.
CHAIR: Did you notice that there were recommendations concerning consultations with people with disability?
MS EDWARDS: Yes.
CHAIR: Have you had consultations with people with disability in relation to the rollout?
MS EDWARDS: The Advisory Committee we talked about before is the primary mechanism for us to consult with people with disability and their representatives in relation to the pandemic generally and including in relation to the vaccine.
CHAIR: But the Advisory Committee didn't know what was going on, did they?
MS EDWARDS: We didn't talk to them about how we were focusing on protecting people in aged care, no.
CHAIR: It is fair to say, isn't it, that as far as you, a decision maker, was concerned, you did not consult with people with disability?
MS EDWARDS: Did not consult with people with disability in relation to the decision to allocate aged care facilities to our providers, no, I didn't, because that wasn't about that.
CHAIR: Or at all?
MS EDWARDS: I don't accept that.
CHAIR: When did you consult with people with disability?
MS EDWARDS: Me personally, Commissioner?
MS EDWARDS: No, I didn't --- I'm not involved in those consultations. I'm not involved in almost everything that happens across the Department, there's so much activity. But I'm aware of it and have instructed that we consult with people with disability in relation to the work we do.
CHAIR: You may have given instructions but so far the only reference you have made to an organisation or a subdepartment or committee is the committee that was set up in April 2020. Is there any other mechanism that you can point to that constituted consultations with or receiving advice from people with disability or their representative organisation?
MS EDWARDS: Yes. For example, the disability provider alerts that have been issued every week, sometimes twice a week, for this year are a mechanism that goes to every NDIS provider plus every unregistered provider that we are aware of. They happen at least weekly. We provide various ---
CHAIR: I'm sorry, just pausing there, providers are not people with disability, are they?
MS EDWARDS: No, but I think your question was, did you provide it to people with disability or their representatives?
CHAIR: I wasn't thinking of service providers as their representatives. By that I meant Disability Representative Organisations that represent people with disability. I'm sorry if I didn't make it clear.
MS EDWARDS: We did provide material to representative groups and we work with the NDIA and the Department of Social Services, who also provide various information and engage with them and the webinars and so on that the counsel was referring to earlier are another key mechanism for us to do that.
CHAIR: Thank you very much. I shall ask Ms Downes if she has any questions.
MS DOWNES: Thank you, Chair. Counsel Assisting was going to tender three attachments to Mr Moody's letter and one of those was something that was referred to in the evidence of Ms Edwards, so I wondered if that could happen now, then I can ask a question about it.
CHAIR: Yes, go ahead.
MS DOWNES: I wondered if the tender could happen now.
MS EASTMAN: I mentioned earlier this morning that we are going to defer the tender of all material until the evidence had been completed today, and I think you were going to shortly make some directions about the tenders.
CHAIR: There's no reason Ms Downes can't ask questions?
MS EASTMAN: No, not at all. I do propose to tender all of that material but I want to try and deal with the tenders in an orderly way in consultation.
CHAIR: Ms Downes, it's perfectly okay for you to ask the question. We will assume the tender will take place in due course.
MS DOWNES: Thank you, Chair. Could the document CTD.9800.0001.0013 be brought up. Ms Edwards, can you see that?
MS EDWARDS: Yes, I can and I have it in front of me. Thank you.
MS DOWNES: You referred earlier to attachments to a letter that was sent to Mr Moody. Is this one of those attachments as far as you are aware?
MS EDWARDS: Yes.
MS DOWNES: You were asked a question about what the Commonwealth is doing in relation to the national rollout strategy for people with disability?
MS EDWARDS: Yes.
MS DOWNES: Are you referring to this document in particular or other attachments as well?
MS EDWARDS: So all three attachments are important in this regard but this is a core document, yes.
MS DOWNES: Why is it a core document?
MS EDWARDS: Because it puts on a page all of the channels we are progressing in order to move the rollout for disability --- people with disability or in residential facilities and their carers.
MS DOWNES: If that could be taken down, please. One other question. You were asked about some data and you said you wanted to make two points and I believe you made one of the points. What was the second point you wanted to make about the data?
MS EDWARDS: One point was that it was only in relation to our rollout. The other point was that the reference to two particular states as being particularly low in rollout can be partly explained by the fact that to do a fast logistic rollout, you go by geographical area. If you look for example at the number of vaccinations in the ACT and the Northern Territory, which have been the subject of our initial ramped or increased vaccination program, you will see those numbers are greater. That's not for one moment to say that South Australia and Tasmania are not essential elements but
to go geographically is one of our learnings about the most efficient way to actually move forward. Related to that, the reference to there being more carers than residents being vaccinated is a function of working with providers to let them bring in their carers from places to ensure the most efficient use of the Pfizer doses, which as I mentioned, one has a very difficult cold chain but also are packaged up in a way that you have to have a minimum number of vaccines. So those are the decisions that providers might make about bringing in their carers in order to expedite the rollout. If you have a residence with only two residents but you might end up with a provider presenting eight carers at one time, it means you have a very efficient use of the doses and you are making inroads more quickly than you would only on the staff that would otherwise be in that facility on that day.
MS DOWNES: Chair, a couple of questions were asked of Ms Edwards and she was told she could take the questions on notice. Is it possible for the Commonwealth to provide further information, at least about those issues but also about other issues that have arisen from the material we were given on Friday, would that be a possibility?
CHAIR: Certainly the Commonwealth can provide the information in the form of taking questions on notice. As to whether additional information can be provided or tendered, I think the short answer is it depends upon what you want to tender and whether it is relevant to the issues that we are looking at. But certainly that is a possibility, but it will depend upon the documentation and I suggest that you discuss that with Ms Eastman so that there is a coordinated approach.
MS DOWNES: Thank you, Chair. I have no further questions.
CHAIR: Thank you very much. Ms Furness, I take it you have no questions?
MS FURNESS: I have no questions, thank you.
CHAIR: Mr Chesterman, you are in the same position? Mr Chesterman?
MR CHESTERMAN: That is correct, Chair.
MS EASTMAN: Ms Edwards, in relation to the documents you have been taken to, Mr Moody said he received these as attachments to a letter from Senator Reynolds on Friday afternoon. And the Royal Commission was provided with a copy of that letter and the attachments late last night. With respect to these three attachments, what date were these documents prepared?
MS EDWARDS: The documents --- I do not know the exact date. But the documents were prepared shortly before the letter --- they were in the context of what we knew Minister Reynolds wanted to write but they are versions of documents we have been working on for some time, in terms of refining where we are up to. They are not new documents, they are several weeks older in draft but these finals were perhaps a couple of days before the letter was sent last Friday, perhaps as long
as four days before, I'm not exactly sure.
MS EASTMAN: There are three documents attached to the letter; have these documents been publicly released, are they on the Department's website?
MS EDWARDS: I don't believe so but I'm not certain about that.
MS EASTMAN: And with respect to any or all of these documents what consultation, if any, has there been with the peak disability advocacy groups in relation to the content of these documents.
MS EDWARDS: I think providing it to Mr Moody is part of that process. I think we have discussed certainly the content, whether the documents have been distributed, I don't know.
MS EASTMAN: I was asking you not about Mr Moody, who is the peak for the service providers, but for the peak advocacy groups. Catherine McAlpine, for example, who gave evidence earlier today?
MS EDWARDS: I don't know.
MS EASTMAN: Ms Edwards, thank you very much. I appreciate the difficulties not having questions in advance or prepared a statement, so we very much appreciate your evidence this afternoon, thank you.
CHAIR: Thank you very much, Ms Edwards, for giving evidence and your attendance today, thank you.
THE WITNESS WITHDREW
MS EASTMAN: I haven't got to Mr Kevin Stone's statement but his evidence very much reflects the circumstances where people have had to go it alone and make their own arrangements and I commend that statement to the Royal Commission.
CHAIR: That will be tendered in due course.
MS EASTMAN: It will.
I would like to finish with some evidence from Tara Elliffe and Catherine McAlpine. Tara Elliffe, you may recall, is a young woman who lives with Down syndrome who gave evidence at the Royal Commission's Public Hearing number 4 on access to healthcare for people with intellectual and cognitive disability. Ms Elliffe recently was vaccinated and she wanted to share with the Royal Commission the decision she made to be vaccinated and what advice she would like to give other people with intellectual disability about being vaccinated. The entirety of this evidence will be
available on the Royal Commission's website but I would like to finish with this short extract, then I will invite you to make some directions in relation to the balance of the hearing.
MS EASTMAN: Ms Elliffe, have you been doing some work with Inclusion Australia?
MS ELLIFFE: Yes, I have.
MS EASTMAN: And what work have you been doing?
MS ELLIFFE: Doing co hosting on webinars about COVID 19.
MS EASTMAN: And what's the purpose of having the webinar?
MS ELLIFFE: It teaches everyone to make sure you get a vaccine.
MS EASTMAN: And what can you tell me about the webinar? What happens in the webinar?
MS ELLIFFE: It teaches us a lot of good information.
MS McALPINE: Why is the information important?
MS ELLIFFE: To get vaccined.
MS McALPINE: To make decisions?
MS ELLIFFE: Make the decision.
MS EASTMAN: And what have you found out about the COVID 19 vaccination?
MS ELLIFFE: I have I have a I'm in group 1A, I'm good at it now.
MS EASTMAN: And you've had your vaccination done?
MS ELLIFFE: Yes.
MS EASTMAN: When did you have the vaccination done?
MS ELLIFFE: Last Thursday.
MS EASTMAN: What can you tell us about how you got the vaccination and what
MS ELLIFFE: I just got it from my mother.
MS EASTMAN: And so did your mother organise to have the vaccination?
MS ELLIFFE: Yes.
MS EASTMAN: And what did that involve? Did you have to go somewhere?
MS ELLIFFE: I had to go to RPA to get my vaccine and book in.
MS EASTMAN: And when and RPA is the hospital in Sydney; is that right?
MS ELLIFFE: Hospital.
MS EASTMAN: And so when you went to the hospital in Sydney, what happened? What did you have to do?
MS ELLIFFE: I had to wear a mask the whole time, then I had to get a badge on my wrist, then I went in to get a sticker as well, and then it was then I got my vaccine and it was I was fine.
MS EASTMAN: And did someone explain to you what was going to happen.
MS ELLIFFE: Yes.
MS EASTMAN: Can you remember what they said to you?
MS ELLIFFE: You have to wait for 15 minutes and you'll be all right.
MS EASTMAN: And it didn't hurt, did it?
MS ELLIFFE: No, it didn't hurt a bit.
MS EASTMAN: And then when you finished having the vaccination, did anyone tell you what was going to happen afterwards?
MS ELLIFFE: No.
MS EASTMAN: And do you have to go back and get a second bit of the vaccination?
MS ELLIFFE: Next week.
MS EASTMAN: And will that be going back to RPA and the same way?
MS ELLIFFE: Yes, by my doctor.
MS EASTMAN: And how do you feel now that you've had the vaccination?
MS ELLIFFE: All good.
MS EASTMAN: Do you feel safe?
MS ELLIFFE: Safe and I'm good.
MS EASTMAN: And what would you like to say to other people who might be a bit scared about getting the vaccination? What advice can you give them?
MS ELLIFFE: It's okay to have it. Just do it.
MS EASTMAN: Commissioners, thank you, and thank you to Ms McAlpine and Ms Elliffe for preparing that evidence for you. Her message was strong, "Just do it".
Commissioners, we are in your hands as to whether there is any further material the Royal Commission may need arising out of this hearing. We have suggested some directions, Chair, that will give the parties with leave an opportunity to perhaps liaise with the Royal Commission about the identification of any documents or questions on notice over the course of the next week.
CHAIR: I will read out the proposed directions and then any of the counsel appearing, if they have any difficulties, can let us know.
1. One, by Monday, 24 May 2021, Counsel Assisting the Royal Commission will tender documents into evidence.
2. By Monday, 31 May 2021, any witnesses who took questions on notice during this hearing should provide their answers in writing to the Office of the Solicitor Assisting the Royal Commission. These answers should be targeted and concise.
3. Counsel Assisting the Royal Commission will consider any additional material produced and determine if any additional steps need to be taken. By Thursday, 3 June 2021, Counsel Assisting will tender into evidence whatever additional material she considers appropriate.
4. Counsel Assisting will then prepare written submissions to the Royal Commission. By Monday, 28 June 2021, Counsel Assisting's submissions will be made available on a confidential basis to those parties with leave to appear and to the witnesses who gave written or oral evidence at this hearing.
5. Those parties who wish to make submissions in response to Counsel Assisting's submissions should do so in writing by Monday, 19 July 2021. The submissions in response should be concise and should not include any additional proposed evidence.
6. Following consideration of Counsel Assisting's submissions, along with any submissions received in response, the four Royal Commissioners who have sat on this hearing will prepare what counsel optimistically describes as a short report on the hearing. That report will be made public in due course.
Ms Downes, that is without prejudice to any discussions you wish to have with Ms Eastman about any additional documentation that you wish to put in evidence or otherwise provide for the Commissioners.
MS DOWNES: Thank you, Chair.
CHAIR: Does anybody have any comment on those directions?
MS DOWNES: Those directions suit us, Chair.
CHAIR: Ms Furness, any issue with you?
MS FURNESS: No.
CHAIR: Mr Chesterman, nothing from you?
MR CHESTERMAN: Nothing from us.
CHAIR: In to case, those are the directions that are made and the material in due course would be taken into account by the Commissioners who have sat on this hearing. The only other matter I wish to deal with is to thank all those who have given evidence in one form or another today. It has been a hearing organised at short notice and a great deal has been done in the day. We are particularly grateful of course to people with disability who have made their experiences known to the Royal Commission through the recorded evidence, but also to everybody else who has appeared, either in a pre recorded manner or who has given evidence today. We are grateful to all the witnesses. On behalf of all the Commissioners we are also grateful to those who have helped to arrange for and prepare for this hearing on such short notice. The issues as we have seen today are very important to people with disability and have demonstrated that there is utility in having a hearing on this issue, so thank you again to all those who have contributed.
We will adjourn now and the Commission will in fact resume next Monday, 24 May, at Homebush.
HEARING ADJOURNED AT 4.46 PM UNTIL MONDAY, 24 MAY 2021 AT 10.00 AM