Communique from the Co-Chairs of the Governance Advisory Panel - 15 November 2022

The Child Safe Governance Review Governance Advisory Panel (the Panel) met for the eighth time on Tuesday, 15 November 2022 on location in Launceston with some participants joining online.

The meeting agenda focussed on:

• a discussion with the Secretary, Department of Health
• a report from the Chair of the Lived Experience: Expert Reference Group
• an update on the implementation of the Child Safe Organisation Framework, including accountability for child safety at a statewide and local level
• an update on the implementation of mandatory child safety training and
• a discussion on the child safety related recommendations of the Panel.

Discussion with Secretary, Department of Health

Kathrine Morgan-Wicks, Secretary of the Department of Health, joined the Panel and thanked members for the contribution they have made throughout this process. The Secretary also made a point of thanking the group for the interim recommendations that were made in September and provided a brief update on the implementation of those recommendations.

The Secretary noted that the work of the Panel is a key priority for the Government, and she is looking forward to receiving the final report of the Panel.

The Secretary responded to questions from Panel members on a number of topics, including engagement with the community, the role of the child safety liaison officer at the LGH, the relationship between the Department of Health and the child safety service, resourcing and availability of staff to undertake required training, as well as the presence the Department has on the internet and how the Department can improve the way it advertises job vacancies.

A number of external Panel members made note of how impressed they have been with the commitment and willingness they have seen from staff at the LGH to move forward and be involved in the renewal and recovery of the hospital and its relationship with the community.

The Co-Chairs and a number of Panel members thanked the Secretary for the immediate response to the interim recommendations. The Co-Chairs noted that they have been impressed with the Secretary’s leadership and commitment to tackling the issues at the LGH and in Human Resources that became apparent during the Commission of Inquiry process.

Report from the Chair of the Lived Experience: Expert Reference Group

Dr Maria Harries spoke about her continued work with those who expressed interest in the Lived Experience: Expert Reference Group to enable input from the lived experience of victim-survivors to the Panel.

Maria has had ongoing communications with members of the Lived Experience: Expert Reference Group and met with a number of participants in Launceston prior to the Governance Advisory Panel meeting.

Maria summarised for the Panel some of the themes she has been hearing from victim‑survivors, including:

• Most were pleased with the recent apology from the Premier and others to victim‑survivors. Some were worried about the implications of the apologies being seen as a solution. The apology was generally seen to be heartfelt and authentic, but it is vitally important that real action is now demonstrated.
• Powerful statements from two victim-survivors of their sense of hope following their experience of what felt like “a sea change” of attitudes.
• Generally, victim-survivors see themselves as patients (or family members of patients) rather than as “consumers or customers”.  The language that is used is important - patients are vulnerable and there is a duty to ensure their safety.
• Participants appreciate the interim recommendations made by the Governance Advisory Panel, noting that recommendations had mainly been focussed on the management of the LGH.  They are looking forward to seeing and commenting on the final report and recommendations – particularly around the complaints management system.
• Some of the participants are keen to meet with the Co-Chairs of the Panel, while a number have indicated they are happy to continue engaging with Maria directly.
• The participants noted with interest the decision to rename Ward 4K and there are mixed views about this decision. Feedback is largely that victim-survivors aren’t focused on a name change but on a change of practice and culture. There is a sense from some that if such a change works for the staff and helps patients in the future then that is a goal worth pursuing.
• All victim-survivors are focused on the need for there to be a trustworthy, independent access point for patient complaints - such as a patient advocate. There is also a need for people who have been traumatised to have someone they know they can access to ensure their safety from repeated traumatic triggering. Trauma informed care must be the standard level of care and every patient should be approached with the understanding they may well have experienced previous traumas.

Implementation of the Child Safe Organisation Framework, including Accountability at the Statewide and Local Level

Dale Webster, Acting Deputy Secretary Hospitals and Primary Health, and Frances Hall, Project Manager Child Safe Organisation Project, presented to the Panel on progress of implementing the Child Safe Organisation Framework, including accountability for child safety locally and across the organisation.

Some of the key observations made to the Panel on progress and the principles behind the framework were:

• The Child Safe Organisations Framework must be embedded in the Department of Health and the Tasmanian Health Service so that it endures beyond the tenure of individual people.
• Staff within the Department of Health and the Tasmanian Health Service do know about child safety, their awareness is high, but trained competence in child safety is low.
• The Framework has been developed using the 10 principles from the final report of the 2017 Royal Commission into institutional Responses to Child Sexual Abuse.
• The Framework will be continually under review; it must be dynamic to adapt to the environment and ongoing engagement with children.
• The Department of Health and the Tasmanian Health Service needs to create a culture that encourages reporting of child safety concerns and where children are believed. If in five years’ time people are still fearful of reporting, then the framework could be seen to have failed.
• Child Safety Training is the key to ensuring child safety and any blockers to staff accessing child safety training must be removed.
• All staff within the Department of Health and the Tasmanian Health Service will be accountable for child safety and all staff will have child safety as a component of their Performance Development Agreement.
• A baseline understanding on where the organisation is now will be important in assessing progress going forward.

Dale and Frances also provided an overview of the governance and processes for the new child safety module in the Safety Reporting and Learning System.

Panel members raised a number of basic scenarios to interrogate how the system will work, including whether staff members will receive feedback on complaints they have entered. It was confirmed that the system has already been ‘stress-tested’ using a number of scenarios.

The child safety module of the Safety Reporting and Learning System is expected to be rolled-out by mid-December 2022.

Fundamental to ensuring child safety in the future is that there is considered to be no “wrong door” for making a complaint or registering a concern. Whether someone wants to raise a concern about child safety or make a complaint, they can use the Online Complaint Form, the Reporting Concerns of Inappropriate Behaviour Form, the Safety Reporting and Learning System, send an email or fill in a paper form.  Effectively, all roads will lead to the Child Safety and Wellbeing Service.

Dale and Frances also provided the Panel with an insight into how the state-wide Child Safety and Wellbeing Service (CSWS) will work as a central oversight function.  The Panel recommended that Child Safeguarding Officers from the CSWS be located within the LGH and that they have a direct day-to-day reporting line to the Chief Executive Hospitals North, as well as a professional reporting line to the State-wide Service.

A one-page flow chart on Reporting Child Safety Concerns has been developed by the Child Safe Organisations Project Team and the project team is now working through the best way to disseminate it throughout the Tasmanian Health Service to ensure it is available to all staff.

The Governance Advisory Panel then discussed the Tasmanian Health Service Chaperoning Policy.  Tony Lawler noted that the Policy is currently under review.  It was noted by the Panel that the Chaperoning Policy, as it currently stands, is for use during intimate examinations only.

The Panel recommended that the Chaperoning Policy be broadened to include an offer of a Chaperone for all episodes of care with vulnerable or at-risk patients.  The Panel also recommended that the patient information pamphlets be updated to include an offer of a Chaperone for vulnerable or at-risk patients during an episode of care.

Will Gordon advised that due to staff resourcing and with the layout of Ward 4K, it may be difficult to ensure that there is a Chaperone available at all times during a patient’s episode of care.

The Co-Chairs flagged an issue with the Panel on a matter that has been brought to their attention in relation to digital medical records.  The Panel were advised that victims of sexual assault and/or family violence have a completely separate medical record to their digital medical record (which is supposed to record all of their health data).

It is understood that the practice of keeping completely separate records was intended to preserve the privacy of patients.  However, in effect, it often means that continued abuse is not picked up by staff providing care or a victim of sexual assault or family violence has to continually re-tell their story (and thereby re-live their trauma) to staff providing care.

The Panel recommends that all sexual assault records (including child sexual assault) and family violence records are digitised as soon as possible and that they are kept in a single digital medical record for patients.  The Panel also recommends that the sexual assault records and family violence records are locked down to enable access only to certain (nominated) clinicians.

Mandatory Training in Child Safety at the LGH

Dale Webster and Frances Hall provided the Panel with an update on the implementation of the child safety mandatory training program at the statewide and LGH level. To date, 141 staff at the LGH have now undertaken their child safety training.  Staff that have already undertaken their training at the LGH include staff on Ward 4K and the LGH Executive.  Training is now being rolled out to staff in the Emergency Department and Paediatric Outpatients.

A number of staff members on the Panel who have already undertaken the mandatory child safety training provided feedback to Dale and Frances on how the training could be improved. The project team will be taking on all feedback during the implementation phase which will be used to strengthen the training program going forward.

Child safety training will also be available to all staff who work for the Department of Health / Tasmanian Health Service via the Tasmanian Health Education Online website.

The Panel recommended that all Department of Health / Tasmanian Health Staff be required to undertake the mandatory child safety training by the end of September 2023.

The Panel noted that clinical staff are required to undertake a significant number of mandatory training courses on commencement and that training must be undertaken again at regular intervals (some every year, others every two years).  The Panel noted that there is a lack of available time for frontline staff to undertake mandatory training within work hours. The Panel recommended that a review of current mandatory training requirements should be undertaken to ensure that mandatory training is targeted to specific roles and service areas.

The Panel recommends that mandatory training for child safety should be undertaken during paid working hours and there be no expectation that it be undertaken in an employee’s own time.

Compliance with the mandatory training will be monitored, audited and reported on. Areas where there is minimal compliance after a reasonable amount of time will be queried and directions issued if required.

Further communication from the Secretary to all staff will go out soon to detail the rollout of the training and confirm that training will be undertaken on paid time. It will also be made clear that the expectation is that all staff members must have undertaken the training by the end of September 2023.

Discussion on Child Safety Recommendations of the GAP

The co-Chairs presented to the panel the collective child safety related recommendations that the Panel has come up with to date. There was a brief discussion amongst the Panel on the collated recommendations, noting that some refinement will be undertaken in the production of the final consolidated report.

Next Meeting

The next meeting of the Governance Advisory Panel is scheduled for 29 November 2022 and will be held via Microsoft Teams.

This meeting will be focussed on discussing and finalising the full suite of recommendations. This will be the final meeting of the Panel and the next step will be providing a final report of to the Secretary for consideration and implementation.

View the Interim Recommendations of the Child Safe Governance Review – Governance Advisory Panel

Find out more about the Child Safe Governance Review