Last week two Royal Commissions with overlapping themes delivered their findings. The Federal Government Royal Commission into Aged Care for the ageing was appropriately painstaking and complex. Its findings were also complex, with the two Commissioners differing on central points. Many of the eventual recommendations were also opposed in submissions by Government Departments and the Minister. The findings were received cautiously by the Prime Minister. The Royal Commission into Victoria’s Mental Health System was shorter and less detailed but no less ambitious. It was accepted enthusiastically in its entirety by the Victorian Premier.
As with all such inquiries the test of their effectiveness depends on how governments act. Past experience offers little confidence. Almost every inquiry has revealed appalling stories of neglect and mistreatment, of underfunding and of demoralised staff. Subsequent inquiries usually show that little has changed. The reason is that people are readily shocked, but their interest is neither sustained enough nor strong enough to accept the fiscal pain necessary for change to take place. Governments therefore talk the talk but rarely walk the walk, fearing that higher taxes will see them being forced to walk the plank at the next election.
This suggests that the precondition of any lasting reform is that the public, including politicians and civil servants, understand both the human reality of mental illness and ageing and what matters in responding to them. Without that understanding any reform is likely to be short-lived and partial.
The Royal Commission into Aged Care emphasised that reform should centre on the human rights of the patient. This is grounded in respect for the human dignity of each human person, regardless of their mental state or capability. A person in advanced dementia is as entitled to appropriate care as is a person in good health. Respect for human dignity entails considering all the relationships salient to a person’s wellbeing and ensuring that they too are built upon respect. They extend beyond keeping persons alive and sheltered to being adequately fed, clothed, clean and provided with medical care. They must also begin with and be supported by good personal relationships with people who have time to care, are sufficiently empathetic and have sufficient knowledge of their condition and needs.
Respect is built on personal relationships and not on services alone. These relationships must be nurtured not only between the people cared for and their direct carers, but also between members of staff,