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Senate Select Committee on COVID-19
26/05/2020
Australian Government’s response to the COVID-19 pandemic

ANDERSON, Ms Janet, Commissioner, Aged Care Quality and Safety Commission

BOLGER, Mrs Christina Mary, Executive Director, Regulatory Policy & Performance, Aged Care Quality and Safety Commission

EDWARDS, Ms Caroline, Acting Secretary, Department of Health

LAFFAN, Ms Amy, First Assistant Secretary, Aged Care Reform and Compliance Division, Department of Health

LYE, Mr Michael, Deputy Secretary, Ageing and Aged Care, Department of Health

MURPHY, Professor Brendan, Chief Medical Officer, Department of Health

RISHNIW, Ms Tania, Acting Deputy Secretary, Health System Policy and Primary Care Group, Department of Health

RODDAM, Mr Mark, First Assistant Secretary, Mental Health Division, Department of Health

WUNSCH, Ms Ann Domenica, Executive Director, COVID 19 Taskforce, Aged Care Quality and Safety Commission

Evidence from Ms Bo lger and Ms Wunsch was taken via teleconference—

Committee met at 13:01

CHAIR ( Senator Gallagher ): I declare open this hearing of the COVID-19 Select Committee. Today the committee will hear evidence from the Department of Health, the Aged Care Quality and Safety Commission and the Chief Medical Officer, from 2.30 pm, as set out in the circulated program. Information on procedural rules governing public hearings and claims of public interest immunity has been provided to departments and agencies and is available from the secretariat. The committee will have a 10-minute break at around 2.25 pm to assist the arrival of the Chief Medical Officer. I understand we have opening statements from the Department of Health, the Aged Care Quality and Safety Commission and the Chief Medical Officer. With the agreement of the committee, those will now be approved for publication. In addition to that, there are a number of answers to questions on notice from the Department of Health which were circulated last night and this morning. If the committee agrees to publish those now, without any dissent, we will proceed on those lines because I think some senators may want to ask questions based on those answers.

The committee acknowledges that the aged-care sector has been particularly affected by COVID-19 and, most significantly, in relation to the number of Australians who have passed away who have been residents of aged-care facilities. We would like to acknowledge that and of course send our condolences to all of their loved ones and families and the staff who work in those facilities who will have been deeply distressed by these deaths. We would like to acknowledge the efforts of the aged-care sector and, in particular, the staff who have worked hard to support residents today. Ms Edwards, would you like to make your opening statement?

Ms Edwards : Yes. Thank you very much. I have a short opening statement and then I have one correction to a question on notice that I'd like to table.

Thank you for the invitation to provide further information about the Department of Health's involvement in responding to the COVID-19 pandemic. I'd like to start by briefly updating the committee on the issues that I expect to be the subject of questions today, namely arrangements to protect and assist residents in aged-care facilities and recent mental health initiatives put in place in response to the pandemic. In addition, as you've mentioned, Chair, Professor Murphy has prepared a short statement on the current epidemiology of COVID in Australia for when he arrives.

First, to aged care: older Australians, particularly those in residential aged-care homes, are among our most vulnerable community members and are more at risk of severe disease from COVID-19 infection than other Australians. In fact, to date, the median age of deaths in Australia from COVID-19 has been 80 years. A key consideration in developing and implementing the national response to COVID-19 has been how to best shield older Australians from infection. Australia's whole-of-population measures and border controls have been critical in mitigating the spread of COVID-19 and, combined with targeted measures to reduce the risk of exposure in the over-60 age group, particularly in residential aged care, have limited the impact to this highly vulnerable cohort in comparison with other countries. For example: in Norway, 60 per cent of deaths have occurred in aged-care facilities; in Canada, 62 per cent; Ireland, 60 per cent; Spain, 67 per cent; France, 51 per cent; and Belgium, 53 per cent. In Australia, our current data equates to 29 per cent of deaths. Of course, every one of these cases is a tragedy and our condolences go to their families.

Specific measures to protect and assist people living in residential aged care include infection control guidance and freely available training for the aged-care workforce; visitation restrictions combined with guidance to enable residents to remain safely connected to their family and community; rapid provision of PPE, clinical expertise and additional skilled workforce; inreach pathology testing; and access to telehealth to ensure residents continue to safely receive needed health care. The Australian government has committed more than $850 million in specific funding to support our older Australians during the pandemic, including $101.2 million for infection control training and education of the aged-care workforce and the provision of additional workers, including nurses; $444.6 million to support aged-care workforce continuity, including a retention bonus; $10 million for the Community Visitors Scheme; $59.3 million for the delivery of meals and groceries to older people who are self-isolating; $205 million to supplement residential aged care; and $47.8 million for the extension of the Business Improvement Fund. Officers with me today will be able to discuss these measures in detail with the committee.

Now I'd like to turn to mental health. It is clear that the pandemic is taking a toll on many people's mental health. We have a compounding situation where fears about the virus are heightened by the need for social distancing and physical isolation and magnified further when people lose their jobs, see their incomes fall or worry about the longer-term impact of the crisis on our economy. We know that it is critically important that we take extra care of people's mental health at this time. Since 30 January, the Australian government has invested approximately $500 million in preventative mental health and suicide prevention. In addition, a significant proportion of the $669 million telehealth package has enabled GPs, psychologists, psychiatrists and other mental health professionals to provide services remotely.

The preventative mental health package in response to COVID-19 was announced by the Prime Minister on 29 March. At a cost of $74 million, it has funded the establishment of a 24/7 phone counselling service, led by Beyond Blue and staffed by accredited mental health professionals. It has also provided additional funds for other critical phone and online support services such as Lifeline and Kids Helpline. It's also funding the development of mental health resources for expecting and new parents and for First Nations people, among others. This package has also funded a dedicated mental health and wellbeing program for frontline health workers, led by the Black Dog Institute, provided online and by phone so that our busy frontline workers have access to support when and where they need it. The government has also committed to a public education campaign cutting across traditional advertising and social media to raise awareness about mental health and the importance of seeking help. More recently, on 15 May, the national cabinet endorsed the National Mental Health and Wellbeing Pandemic Response Plan. The plan provides for coordinated action by all Australian governments based around key principles, priorities and actions. The Australian government is contributing $48.1 million towards initiatives consistent with these principles, priorities and actions. It focuses on improving access to services and pathways of care, and strengthening the mental health system, including the mental health workforce and governance arrangements. Again, the relevant officers are in attendance today to assist with the committee's questions.

CHAIR: You had a correction you'd like to make?

Ms Edwards : I do. There was an error in relation to written question on notice, IQ20-000013: a figure had been put in the wrong column. I table a replacement.

CHAIR: With the agreement of the committee, I'll approve that for publication? Thank you. Ms Anderson, would you like to make your opening statement?

Ms Anderson : Thank you for the opportunity to appear before the committee today. The principal role of the Aged Care Quality and Safety Commission, as the national regulator of Commonwealth funded aged-care services, is to protect and enhance the safety, health, wellbeing and quality of life of older Australians receiving aged-care services. During the pandemic we have continued to place the safety and wellbeing of aged-care consumers at the centre of our approach and all our decision-making. Our workers regulator has complemented the activities of other agencies in the pandemic response, and we have moved quickly to ensure that our regulatory approach is fit for purpose in these challenging times. Crucially, we continue to use the full range of our regulatory powers to ensure that providers are meeting their obligations with respect to the Aged Care Quality Standards and mitigating the risk of transmission of the virus consistent with the advice of health authorities. Our monitoring compliance activities are ongoing. We continue to conduct site visits based on identified risks and are undertaking telephone contacts and online surveys of all providers to gain intelligence and monitor risk across the sector. Through our complaints function we are providing assistance to consumers and their families, and engaging with providers on the complainant's behalf to resolve issues and concerns. Sector communication remains a high priority, and we are providing clear and targeted advice, guidance and resources to aged-care providers and consumers to support them at this time. We're also collaborating with industry bodies to address key issues impacting aged-care services. A strong focus of our efforts has been on working in close partnership to support the Commonwealth Department of Health and state based public health units in responding to a suspected or confirmed outbreak of COVID-19 in an aged-care service.

The pandemic is ongoing, and the Aged Care Quality and Safety Commission remains vigilant and focused on undertaking our role. We are also learning and innovating as a regulator during these unprecedented times.

Senator KENEALLY: Thank you to all of the witnesses who are appearing before us today. I'd like to back in the statements from our chair, Senator Gallagher, regarding condolences to family and friends of those who have died and our appreciation to all those who have cared for people in our aged-care facilities during this coronavirus health crisis. My first set of questions goes, in particular, to the Aged Care Quality and Safety Commission, but perhaps Health will also need to provide some answers. I'd like to go specifically to the Newmarch facility. My understanding is that the outbreak at Newmarch is the nation's second-worst after the Ruby Princess fiasco. On 22 April, the Minister for Aged Care said:

The Department of Health, the Aged Care Quality and Safety Commission, the NSW Ministry of Health and Anglicare are working in lockstep to coordinate and deliver an effective response which prioritises the health and wellbeing of every resident at Newmarch.

We've also understood that the Older Persons Advocacy Network was on site. Of these five authorities or organisations, who was actually in charge? Who had the responsibility for final decision-making at that facility in managing the COVID outbreak?

Ms Anderson : The Aged Care Act is very clear about the responsibilities of approved providers in relation to the delivery of care and services to aged-care consumers. There is no footnote in the act which says 'except in a pandemic'. An approved provider must continue to have governance arrangements in place which ensure that they are in overall charge. However, in an outbreak where the principal response is a public health response, there is a very important role to be played by public health experts, and this was exactly what happened in the Newmarch outbreak as, indeed, in every outbreak. As you know, the public health services are funded and operated by state governments. They are the first responders in the main. They are the ones who have the necessary expertise in public health measures—in infectious disease, in the main. Therefore, they have very strong sway in relation to all the clinical decisions which are being made at Newmarch and at other outbreak sites. They are one of many, and they are pre-eminent in relation to many of the clinical decisions, but the approved provider retains overall legal responsibility and the obligations which pertain to their role under the act.

Senator KENEALLY: That's an interesting answer, because, on 16 May, the CEO of Anglicare said in the Nine newspapers, 'Right at the outset there was frustration about who we needed to take directions from.' Why was there confusion on his part about who they needed to take directions from? Were there too many cooks in the kitchen there at Newmarch? I'm trying to understand why he felt confused.

Ms Anderson : The commission has taken three regulatory actions—escalating measures—in relation to Newmarch House and Anglican Community Services, which is the approved provider entity. They were taken in a very measured, considered, evidence based way on the basis of our assessment as to the way in which the approved provider was managing the situation. It was not a compellingly good example of outbreak management. My commission, looking at all the evidence we had available to us daily as it emerged, concluded that they needed significant help in their management of that outbreak. I won't second-guess what Mr Millard said. I am also aware of his comments. I can only speak for the actions and the understanding that my commission has in this regard.

Senator KENEALLY: Around 23 April, the commission directed Anglicare to bring a management team into Newmarch House. How did that management team fit into the decision-making? Were they responsible for the decision-making?

Ms Anderson : It was a trio of individuals who were brought in from Dorothy Henderson Lodge—BaptistCare. They had already experienced the outbreak at Dorothy Henderson Lodge and came with that level of expertise into the service. We had a facility manager, somebody who was coordinating the interagency action more generally and also a clinical lead.

Senator KENEALLY: Who were they then accountable to—to you as the regulator?

Ms Anderson : No. They were incorporated within the management structure of Newmarch House and, let's call them, Anglicare Sydney.

Senator KENEALLY: So they were still accountable to Anglicare?

Ms Anderson : That's correct.

Senator KENEALLY: Did they take over decision-making from Anglicare or did the decision-making authority still rest with the CEO of Anglicare?

Ms Anderson : They were managing services on the ground. They were managing Newmarch House. Anglican Community Services, the approved provider, has 22 residential aged-care services in New South Wales. There is a corporate entity, and there are numbers of corporate operators as it were—chief operating officers, HR folk and so on—who continued to work alongside the management on the ground to work things out at Newmarch House.

Senator KENEALLY: In your earlier statement. I think you said something like, 'It wasn't particularly good management of the outbreak at Newmarch House.' I'm trying to understand why the outcomes were so different at Newmarch than they were at Dorothy Henderson or, indeed, at the facility in Bankstown. Can you give us a sense? Do you have any insight as to why the outcomes were so different at Newmarch compared to the other facilities that had COVID-19?

Ms Anderson : It's a multifactorial answer; bear with me and I'll step through it. If Professor Murphy were here he'd be providing you with what I'm about to say, and he'd do it more elegantly, but I'll have a stab. The origin story of the Newmarch outbreak is fundamentally different from any other in Australia. The extent of the initial exposure of staff and residents set the scene for what followed. There was a trajectory that was established in those opening days. I'm going to quote some numbers to you, Senator, because I think it tells the story very prominently.

Day 1 was Easter Sunday, Sunday 12 April, and there was a finding of one positive consumer and one positive staff member. By day 7, the following Saturday, 25 residents were found to be positive and 14 staff were found to be positive. So in the space of six days we moved from one and one to 25 and 14. That was set before day 1. That was set by virtue of the degree of exposure of those residents and those staff to an individual who unwittingly was infectious and working at the service.

Any outbreak—and there have been nearly 30 or more of them across Australia—knocks aside business as usual. There is nothing routine or ordinary about dealing with an outbreak because you have to put the residents into self-isolation as best you can. You need to take staff off the roster if they have been exposed, so they go into self-isolation at home. You have to bring in replacement staff, who have to be trained in the use of personal protective equipment. You have to make sure that you have supplies of that equipment. You have to get infection control advice and so on. So you run out a sequence of steps, which we are now very well versed in, and nothing is predictable. Nothing is what we expected to do today because it is entirely focused on managing an outbreak.

We found over the course of time that Anglicare Sydney was not as well placed as we wanted them to be and needed them to be to make right, well-informed decisions and then see them through to immediate implementation. The gaps were getting too large. We weren't getting the responsiveness that we expected from an aged-care service managing an outbreak.

Senator KENEALLY: I don't know how much time I have left, Chair, on this block—

CHAIR: About eight minutes.

Senator KENEALLY: Okay, then I will go to that. Some of the issues the CEO has raised publicly have been around access to PPE. He says that he pushed on the Commonwealth's door and wasn't able to get access to PPE. We're trying, as a committee, to understand: is their inability to access PPE something that sits with them or something that sits with the Commonwealth?

Ms Anderson : I might start and then hand over to Mr Lye and Ms Laffan. As we've talked about before in this committee, the Commonwealth does keep a strategic supply of PPE in the National Medical Stockpile. One of the groups to which we have made access available is aged-care facilities in the case of an outbreak, and that was the case in relation to Newmarch House. Mr Lye might be able to tell you exactly how PPE was dealt with in this instance.

Mr Lye : I'll get Ms Laffan to run through the supply of PPE over the time line at Newmarch, and you'll see that PPE has been provided at a regular interval from the national stockpile. I would make a comment that we had some degree of difficulty with the organisation in terms of responding to requests to identify their needs in terms of PPE, to manage those stocks, to understand that they had received stocks, to know what they had on hand, and also to plan for requests for PPE. So we had an issue that relates in some ways to what Ms Anderson is saying in terms of the organisation's ability to both ask for and receive PPE, and that could account for the CEO's concern that they didn't have it. I think that we, the department, would say that the organisation may not have been sure about what they did actually have. I'll get Ms Laffan to run through the supplies that have been provided at regular interval upon request from Anglicare. On maybe four or five occasions the person from the Department of Health who is responsible for organising provision of PPE asked the service to document what they needed, and on several occasions throughout the time line of the Newmarch outbreak it was two or three days before the requirement was specified by the organisation.

Senator KENEALLY: Because we have limited time, it would be great if you could table that information. I think it would be very useful to the committee and to the public oversight role that we play. In the limited time that we have, I'd like to ask a broader question. Is that process of the time lag that you just described something that was unique to Newmarch House? It doesn't seem like we had similar problems—other aged-care facilities, such as Dorothy Henderson, haven't reported similar challenges. It was a fairly stark statement from the CEO of Anglicare. He said, 'When you actually started knocking on the door, pushing and shoving on the door, there ain't nothing inside.' He's talking about trying to get Commonwealth PPE. I'm trying to understand whether what you've just described is something fairly particular to Newmarch House or whether other aged-care facilities responded in a similar way to Newmarch when you made those types of requests or offers of assistance.

Mr Lye : The overall context is that, in the initial outbreak, there were limited supplies of PPE in some circumstances, so organisations who did not have an outbreak have been coming to us to access the national stockpile. That has been managed to say that if you don't need PPE, we don't dispense it. Certainly that's the overall environment. But when there is an outbreak, we will move heaven and earth to get PPE to people. I think we have succeeded in doing that in all locations. There were some restrictions around, for example, gowns in New South Wales at various times. But we have worked with the New South Wales government to make sure that those supplies were met in cases where there were outbreaks. So where we've had a request of the stockpile and somebody in the food chain has said, 'Look, we're very short on this particular item,' we have worked to make sure those things are made available.

I think one of the things that has happened in Newmarch—I think it's entirely reasonable that the CEO might say that there was an issue there, but I think the actual problem we've identified is that there was a difficulty for the organisation on the ground in being able to tell us what stock they had and what stock they needed, and what stock they needed in terms of forward days. That's something we have worked with them on, and I think we now have a procedure in place to make sure that they can say to us, 'This is what we will need over the next seven to 14 days.'

Ms Edwards : Senator, we'll table, as you've asked, what has been provided; you'll have the whole list. But it is important to note that we have complied with every request, notwithstanding some of the times where it was not so clear what was being requested. We've complied with every request and done it very quickly. We'll table the full details.

CHAIR: In relation to Newmarch?

Ms Edwards : In relation to Newmarch and in relation to all facilities in which there has been an outbreak and a need for PPE.

Senator KENEALLY: Thank you very much; I appreciate that, Ms Edwards. I will come back to this issue of Newmarch later on, because I did want to get to the hospital at home and the decision not to transfer people to hospital. But if I could just go back to the aged-care commission, could you briefly outline—and feel free to take it on notice if we don't have enough time—what factors prompted you to issue the regulations and to require them to put in place a management team? What really motivated you to take those decisions?

Ms Anderson : We weren't confident that the facility was being managed in a way which was fully across the emerging complexities and managing those adequately. That's it in a nutshell. There are many dimensions to that, but effectively we were concerned for the wellbeing of the residents, which has been our primary focus all along. There were ill-informed decisions or decisions which weren't well enough informed and they weren't looking as far ahead as we needed them to in terms of the fundamentals: Did they have sufficient staff? Did the staff have the right skill set? Were they managing their stock control adequately, as Mr Lye referred to? Were they on top of things sufficiently that we as a regulator could be assured that the safety and wellbeing of the residents was well in hand? And we did not have that assurance.

Senator KENEALLY: Thank you.

CHAIR: It would help the committee if we could be given on notice the number of requests to the stockpile, the number that have been declined and the criteria in making decisions.

Ms Edwards : We'll divide that into the categories of all the requests where there has been an outbreak—all of which are agreed to—and the number of requests from aged-care facilities in which there has been no outbreak, which we consider very separate.

CHAIR: Yes, absolutely. We are trying to understand the issue around access to PPE in general, not just access to PPE where there's an outbreak. I think that's the point.

Ms Edwards : Can I just make one very brief comment to follow up what Ms Anderson said. She has obviously outlined her actions as a regulator, entirely as she has to do, and made some comments about the operator of this particular facility, but I want to note that we are all aware of what a difficult situation it was for everyone, including the proprietor of this facility, the operators, the staff and so on. So, while it was necessary to take very important action under the regulator, we do appreciate that Newmarch was in a very difficult position and we certainly think that everyone was trying their hardest to do the right thing by the residents there. We wouldn't want any suggestion that we think otherwise.

CHAIR: Thank you, Ms Edwards.

Senator PATERSON: Just on Newmarch before I move to some other matters, I think you've taken on notice to provide in response to Senator Keneally the PPE that was provided to Newmarch and requested. I'm interested also in Commonwealth staff that were provided to Newmarch to assist. I don't know if you also took that on notice at the same time.

Mr Lye : Senator, we can probably provide some aggregate numbers of Commonwealth staff provided to Newmarch. Is that what you're interested in?

Senator PATERSON: Yes. I'm interested in a couple of things. How many staff has the Commonwealth provided? What type of staff has the Commonwealth provided? What are the professional qualifications and occupations of the people provided? What were the various points at which they were provided and what were they in response to? So I'd like just a bit of a breakdown on that aspect.

Ms Edwards : We can certainly take that on notice, but I'll just give you an indication. There have been large numbers of Commonwealth staff. An average of 27 Commonwealth funded staff worked per day during the major part of the outbreak. That gives you the sense that there was a major influx of staff funded by the Commonwealth as part of our major response.

Senator PATERSON: Thank you. I look forward to the full detail on notice. Just briefly from your memory or from anything you have at hand now, how early in the outbreak were Commonwealth staff on the ground?

Ms Laffan : Staff funded through the Mable platform commenced on 16 April and Aspen staff commenced on 20 April, noting that arrangements were made for them earlier and offers were made earlier.

Senator PATERSON: You say 'offers were made earlier'. Was the offer of assistance not immediately taken up by Newmarch House?

Ms Laffan : With respect to Aspen, that's correct.

Senator PATERSON: How long was the delay between the offer being made and the assistance being taken up?

Ms Laffan : Aspen was first offered to Newmarch House on 14 April and, as I said before, were first deployed on 20 April.

Senator PATERSON: Did Newmarch House give a reason why they didn't want to accept that offer of assistance from the Commonwealth?

Mr Lye : I'll talk about our experience through the outbreak. All aged-care facilities are required to have an emergency management plan. Typically those organisations look at two things. They say, 'If we lost 25 per cent of our staff, what arrangements would we make?' They plan for that outcome. I don't think Newmarch is any different to any other organisation. They're backed by the Anglicare network, so they have an ability to reach out to other services to assist. We have often encountered in this outbreak—Ms Anderson and I have talked to CEOs where we have an outbreak—that they don't quite understand the impact on their workforce of an outbreak. They think that they're going to be alright. We have learnt to now counsel them aggressively at the start and say, 'You will have, as well as your ICE staff, staff who have to isolate'—and in Newmarch's case it was particularly severe—people who will be scared.' Families will say to them, 'Don't go to work, Mum and Dad, because of the risk of the illness.' People have a legitimate fear about the illness. I think Newmarch was no different to other organisations who've said, 'We think we'll be okay,' and then they haven't been. With our learnings from Dorothy Henderson, we were much more assertive with Newmarch about putting in place contingencies because we could see the seriousness of a staff member, through no fault of their own, working in that organisation asymptomatic. The illness had spread before we became aware of it, so we had a very serious situation on our hands.

Senator PATERSON: Right, but obviously it did become clear after a number of days to Newmarch House that they wouldn't have the capacity within their own network to supply those nurses and other professionals on their own and that they needed Commonwealth assistance.

Mr Lye : That's correct.

Senator PATERSON: I look forward to the further detail on notice. I want to move to another topic that has often been raised with me by constituents, particularly early on but still from time to time—access to aged-care facilities for family visitation. I know an industry code was issued to govern this. Could the department give an update on how that's tracking?

Mr Lye : We might also ask the commissioner to reflect on that, because part of how it's going would be reflected in the number of complaints the commission receives in relation to visitation. The code was obviously developed by the industry and noted by national cabinet. It has been in place for approximately two or three weeks now. Very shortly it's due for a review by the sector. There are positive signs from that. The issue which was subject to a lot of concern from family members probably has settled somewhat since the code was developed. That said, we still have cases where people are concerned about not gaining entry and not having access to loved ones in aged-care facilities. I might ask the commissioner, if that's alright, if she has a reflection.

Ms Anderson : The commission has been re-exercised by this matter. I've issued advice to providers specifically which has exhorted them to pay close attention to the Aged Care Quality Standards as they implement the restrictions to ensure that they are doing it with care and compassion. The code has certainly assisted, but, as Mr Lye foreshadowed, we have received a very significant increase in the total number of complaints. The vast majority of that increase is attributable to the visitor restrictions. That's probably unsurprising, because families are used to accessing their loved one in care without restriction, so any imposition or constraint on that is going to come as a bit of a shock and an unwelcome event. Largely the complaints that we've received have been able to be addressed by providers, but we're also somewhat confounded because each state and territory has its own public health order or emergency management order, which is subordinate legislation which has implemented the national cabinet decision. So we have eight different versions of visitor restrictions around the country and then we have the provider's interpretation of that public health order in their jurisdiction. That's why the visitor access code is vital, because it provides for a uniform and consistent interpretation of what is going to work for a provider, a family member and a resident in terms of enabling access. Of course, physical access must always be complemented by other means of connecting a family with their loved one. All the technology based solutions that you can imagine, and some more, are now being implemented by aged-care providers across the country.

Senator PATERSON: Yes. The government have a special program to facilitate that, don't they?

Mr Lye : That's correct. It's specifically targeted at homecare and Commonwealth home support clients—My Aged Care clients—who might be isolating, and it enables providers to use funds flexibly to purchase technology to assist those people to maintain contact with friends, family and others. In addition, there's a call-back service. A small number of people have refused service because they're concerned about people coming into their home, so we have offered, through the consumer peaks, an ability for someone to call and check in with an older Australian who might be isolating.

Senator PATERSON: You mentioned a significant increase in the number of complaints. Can you quantify that in numbers?

Ms Anderson : Yes, I can. The rise has been essentially from the beginning of March, and I can provide some figures, if you would like, on notice.

Senator PATERSON: That would be good.

Ms Anderson : In March, the COVID-19-specific complaints and inquiries numbered 371. In April, they numbered 760. So you almost had a doubling. The May numbers have eased back again. The peak was probably in the last week of April and the early weeks of May, but that was where there was an intensity of feeling from both providers and family members about ensuring that they could access their loved one in care.

Senator PATERSON: So, post the code's introduction, there has been a decline in the number of complaints?

Ms Anderson : It is difficult to assess particular trends, but we were seeing—even as it was being consulted on before it had been officially finalised—some easing of some of those tensions, as providers understood that it was necessary to explain what they were doing to understand individual circumstances and to come to an agreement with specific families about how they could best keep in touch with their relative in care. So, again and again, what we've found in our complaints resolution work is that the answer lies in the individual case—making it work for an individual and their family in their particular context. It's only when you try to generalise and have a sweeping rule, which grabs everyone in, that you start to get into difficulty.

Senator PATERSON: Does your data give you sufficient visibility to identify whether there were particular providers or categories of providers that were subject to more complaints and that had more issues?

Ms Anderson : We haven't done that analysis. I could have a look and see whether that level of drill down is possible.

Senator PATERSON: Yes, thank you. On notice, that would be helpful. In perusing this matter, I completely understand the anxiety of providers to protect their residents from a deadly virus. Touch wood—although we have had deaths here in Australia, the number hasn't been as bad in aged-care homes as in some other countries. But equally important to balance against that is the mental health of residents, and I'm particularly concerned about the stories I've heard about patients with dementia and the way in which their condition can decline if they don't have regular access to family and loved ones.

Ms Anderson : If I may, we saw this as an emerging area of contention, and we knew that everyone was doing their level best. It wasn't that providers were being perverse or that families were being contrary; it was just one of those really difficult situations. We actually convened two round tables—one with providers and the other with consumer peak bodies, specifically. We call them problem-solving round tables, because this is what we took to that group: 'Here's the dilemma. We know that we must keep residents safe, on the one hand, but we also must ensure their emotional wellbeing on the other. How are we going to sort this out? What are the ideas that we see in the industry already? What are the new ideas that people can bring to the table?' It was very informative of the further advice that the commission was then able to issue to the sector at large.

Senator PATERSON: Just finally from me—because I suspect we're getting towards the end of my time—we flagged that there's going to be a review of this code. Is one of the rationales or purposes for that to ensure that, as state governments relax their own restrictions more broadly, aged-care homes can return to a less restricted environment as well?

Mr Lye : I think to look and see what's working and what isn't is one of the considerations for the industry. The other issue that the sector is confronting at the moment, which is complicated, is that we have really pushed around vaccinations for influenza. Influenza killed 820-odd over-65s in 2019. So it's actually a very substantial risk to residents of aged-care facilities. So governments have collectively asked facilities to tighten the reins on vaccinations, and that is having an impact. That will also feed into complaints, because they are refusing people or asking people to produce evidence of a vaccination. So that's another thing that the code is able to capture, because it's an issue of concern for providers trying to navigate that discussion with people coming into facilities.

Senator SIEWERT: Going back to the code, what process is there for enforcement of the code? At the moment, it's an industry code that's been agreed to. What if someone wants to enforce the code?

Ms Anderson : As you point out, it's an industry-led code. The use of the word 'enforcement', therefore, is slightly misplaced, because the commission can have regard to a provider's attention to the code—if that isn't too many subordinate clauses in a sentence!—in our regulatory work. So as we look at a service and assess their performance against the standards, because we have an industry supported code, which is therefore demonstrative of what the industry considers to be good practice in relation to visitor access, we can have regard to the code and the providers' adherence to the code in our assessment of their performance against the standards.

Senator SIEWERT: So the only way for a relative or a resident to get it enforced is effectively to complain to the commission, isn't it? That's going to take a long time.

Ms Anderson : I disagree. I believe that the code performs the important role of empowering consumers and their family members to have conversations with providers. Surely, a family member can say: 'But this is an industry-led code that has been developed for the sector. What say you in relation to your operation against this code?'

Senator SIEWERT: But, in effect, if the provider is not coming to the party, all they can do is complain to you and go through that process. Is that correct?

Ms Anderson : I'm slightly uneasy about saying that it's all they can do. It's a legitimate function that we perform, and we're very happy to take complaints.

Senator SIEWERT: I'm not trying to downplay what you're doing at all. But I, like Senator Paterson, have had a lot of people raise their concerns with me about not being able to see their loved ones.

Ms Anderson : Yes, I understand.

Senator SIEWERT: Can I go to the matter of an update on the stats in terms of the number of facilities that had a COVID outbreak, the number of residents that were affected and the number of facilities that currently have an outbreak?

Ms Laffan : Are you focused on residential aged-care services or home care?

Senator SIEWERT: Residential—I wanted to come to home care in a minute. If you've got them all together, that's fine.

Ms Laffan : I've got the data cut multiple ways. In terms of residential aged-care services, there has been a total of 31 services with cases or outbreaks, of which six are currently active.

Senator SIEWERT: How many residents had COVID?

Ms Laffan : There have been, across Australia, 67 residential aged-care recipients, of which 28 have recovered and, sadly, 27 have passed away.

Senator SIEWERT: Are you—

CHAIR: Sorry, Rachel. When was that data from?

Ms Laffan : That data was hot off the press before I left the office.

CHAIR: It just updates the question on notice from yesterday that was provided. Sorry, Rachel, go.

Senator SIEWERT: That's why I wanted the most up-to-date data; thank you. Would you then be able to take on notice, against the numbers, the stats for each of the states?

Ms Laffan : Certainly.

Senator SIEWERT: Thank you. Going back to asking about the number of complaints, we looked at the number of complaints and the increases across March and April. How many of those were not related to COVID?

Ms Anderson : The total number of complaints and inquiries—no, I'm not going to be able to give you the same numbers. I have in front of me the number of complaints as a total for March and April, but then I have complaints and inquiries bundled. I'm sorry, Senator; can I take that on notice? I'd be very happy to provide that to you.

Senator SIEWERT: Yes, okay. I'm trying to look at COVID-19 activities: what is some of the ongoing work of providers and what are some of the issues? If you could take that on notice, that would be appreciated. I want to go to the survey. You made the announcement at the end of April, I think, that you were undertaking an online survey around the preparedness for COVID-19 based on the CDNA and the AHPPC guidelines. Can you outline what you found there and the take-out message from there—what level of preparedness there was?

Ms Anderson : We undertook a self-assessment online survey for both residential care and in-home care. We have very significant numbers, which I will bring to hand shortly. In relation to residential aged care, we had 2,638 responses. The majority were answering in the high 90th percentiles for many of the questions we asked. I'll just run through a couple of them to give you an impression but then talk to you about the ones where they dipped below where we thought was a useful place to be. Under the heading of things like planning actions is the question: does the service have an infection control respiratory outbreak plan? And 99.3 per cent said yes. But then, when we went down to the question of whether all service staff are aware of the plan, including their roles and responsibilities, 91.1 per cent said yes. It's still above 90 per cent, but we're an exacting regulator, and we obviously want that to be just as high as the usance of the plan. So that was an alert that perhaps a plan existed but hadn't been refreshed recently and so on. We used that as a bit of an indicator to identify services that perhaps hadn't done as much recent work on a plan as we wanted.

Senator SIEWERT: When the outbreaks occurred, did that turn out to be the reality? Were the providers actually prepared? It's one thing to say, 'Yes, we are,' and then another thing to actually have it happen. Was that reflected in reality?

Ms Anderson : That's an insightful comment. I suspect that what is happening, as Mr Lye said earlier, is that providers are routinely underestimating the enormity of the impact that an outbreak has on their services. We saw it in the bushfire response as well, I might say, where we asked, 'Do you have an emergency response plan?' The answer would be yes. We asked, 'Have you looked at it recently?' 'Yes, we got it out the other day, and it looks good to go.' And then a service threatened by fire suddenly realises that the scenario planning they'd done hadn't appreciated evacuating 14 bedbound residents 20 kilometres down the road in quite the way that it needs to be done. It's a salutary lesson for us as a regulator, but I think it's equally important for providers to understand this. That has been and will continue to be a part of our messaging back to providers. There is no room for complacency here. A tick-a-box approach, to the extent that there are any providers adopting that—and I'm not saying that that is routinely the case at all—and to the extent that this is given inadequate attention, will show up in their capacity to respond quickly to the emerging complexities of an outbreak situation.

Senator SIEWERT: I do want to get some mental health questions in. Commissioner, could you take on notice the rest of the reply in terms of what came out of that survey? I think that will give us an indicator of where people thought they were and where they actually were.

Ms Anderson : I'd be happy to.

Senator SIEWERT: I'd like to deal with a couple of questions around mental health, starting with people in aged care and access to the ongoing provision of mental health services. Have you had any role in looking at that?

Ms Anderson : We continue to be very attentive to the general wellbeing of aged-care residents, and that is part of our routine monitoring. When we've done the risk based site assessments, we'd also have some oversight of that if that was a matter of concern. Also, obviously through complaints, where an individual is concerned about whether somebody's emotional health and wellbeing was sufficiently in the attention of care, we would also inquire in that regard. So it's more a general level of oversight, as we would normally have as a regulator.

Senator SIEWERT: Could you take on notice whether you've had, in the complaints that you've received, complaints around access to mental health services? Ms Edwards, in terms of mental health and the funding that was previously available that we're starting to roll out, can you give us an update on where that is at? Is that continuing to occur, or has that been suspended given the COVID-19 emergency?

Ms Edwards : As I discussed last time, I've brought the experts on mental health, who can tell you everything you need to know.

Senator SIEWERT: Thank you.

Ms Edwards : We've got new protocols on health.

Mr Roddam : Senator, were you referring to where funding is up to in terms of the package announced at the end of March in relation to mental health more generally, or were you referring to aged-care mental health?

Senator SIEWERT: I was particularly interested in aged care. I do want to go to the other packages as well, but in particular aged care in terms of how that is now being made available to residents given the COVID-19 problems.

Mr Roddam : Perhaps I could start with the recent announcements that have been made as part of the mental health packages that relate to older Australians, including those in aged care. On 29 March the $74 million package included $10 million for the Community Visitors Scheme to ensure that people both in residential aged care and in in-home aged care were able to maintain contact through telephone or digital services during the height of the pandemic at that time. Since that time and in the package announced recently, on 15 May, there's been a reprioritisation of funding and also additional funding in relation to the program provided by mental health nurses that the primary health networks provide. Now that face-to-face servicing is becoming more appropriate again, there's some funding provided there. The initial services in aged-care facilities through the PHNs, the residential aged-care facilities program, is ongoing and has been ongoing during that time, as well as the existing mental health nurses program through the primary health networks.

Senator SIEWERT: Do you have data on the take-up of that through the COVID-19 pandemic?

Mr Roddam : I'll see what I can provide on notice; we don't have it with us.

Senator SIEWERT: Yes, take that on notice. I'm specifically interested in this issue around the impact on understanding people taking their own lives—suicide. The issue has been raised—and it's an issue that I've been working on for quite a period of time—to get an understanding of the numbers in real time. The new pandemic response talks about getting numbers in real time. I'm wondering what you're doing to address that, given we've been after that for a long time. What data is available at the moment about this issue and whether or not the current pandemic has had an impact? They're interlinked, obviously.

Mr Roddam : Prior to the pandemic there was a project already underway, a $15 million project, with the Institute of Health and Welfare to get that. It's titled the suicide and self-harm monitoring project. The Institute of Health and Welfare is working with states and territories to get that information in real time. They're making good progress there, and we expect that the first public information on that, in terms of a website, will be ready at the end of July. It may not have everything at that point, but that's the target date at which some information will go live. The Institute of Health and Welfare is continuing to work with states and territories, including with coroners' offices, to get that information. Minister Hunt mentioned at the press conference on 15 May that, of the states that do have registers, in totality there hadn't been any evidence of an increase in suicide, but that is something we continue to monitor closely.

Senator SIEWERT: For the states that do have registers, how convinced are you that in fact they are real-time? And the supplementary to that is: what's happening with the states that don't have them, that are more reflective of real time?

Mr Roddam : I'd need to take the first part on notice. In terms of the second part of the question, the Institute of Health and Welfare, as I said, is continuing to work with those. Perhaps I could provide a comprehensive update on all of that on notice for you.

Senator SIEWERT: That would be appreciated.

CHAIR: Thank you, Senator Siewert. Senator Keneally.

Senator KENEALLY: Could I go back to Newmarch please. I'd like to go to one area that the CEO of Anglicare raised in the media. The reason I want to go to it is that part of our responsibility is to think about what recommendations we might make about future management or how we might understand where things worked well and where they didn't. There is, in particular, the issue of Hospital in the Home in New South Wales. Mr Millard, from Anglicare, said that if he could do it over again he would transfer the patients with COVID to Nepean Hospital. He said in the media that the New South Wales officials wanted to instead treat people in the aged-care facility, because they have the Hospital in the Home approach. I'm trying to understand this. Was the Commonwealth involved in those conversations? Was this management team that was put in place involved in those conversations? How does the recommendation of a state health authority line up against the national guidelines that have been established regarding the treatment of residents in aged-care facilities?

Mr Lye : I think Ms Anderson made the point that, in relation to the outbreak, the New South Wales public health unit and the infectious diseases people, who are part of the hospital network, were responsible for the clinical interactions around that outbreak, notwithstanding that that did not displace the service's responsibility, as a provider, to manage their service. Over the course of the pandemic, we've seen a range of responses undertaken by state health authorities, depending on the situation they've found in front of them, and certainly the decision was for the New South Wales government to establish Hospital in the Home at Newmarch.

The aged-care commissioner, Commonwealth Health, the ministry of health in New South Wales, the service and the people who were managing the Hospital in the Home program for New South Wales Health came together. I think we've had 10 case-management meetings, and the first of those was instituted to make sure that all parties to managing the outbreak had an ability to reach decisions around how that was best done. The first of those meetings looked at issues like cohorting of residents and cohorting offsite options. Hospitalisation of residents has been a regular conversation within that meeting, but I think that we are fully supportive of the approach taken in this instance.

Although we are being repetitious, the situation we found ourselves in because the worker had been onsite asymptomatic for such a long period before being diagnosed meant that we had to assume we had a large number of people who had COVID-19. In fact, that has proved to be the case. The response was how to bring the maximum health resources—and it's called Hospital in the Home for a reason; it's to bring in the resources of a hospital—to the facility for the benefit of those residents, and we support that decision that the New South Wales government took.

Senator KENEALLY: Can I unpack that a little bit as to the differences between Hospital in the Home when you are a person in your own home and Hospital in the Home in an aged-care facility. One of the questions you have to ask, I presume, is: can you manage infection control? If you're a person in your own home, you obviously have the capacity to manage who comes in and limit the number of people who are exposed to the person who is sick. But I presume one of the challenges in an aged-care facility is managing the outbreak of an infection—things like whether or not you can clean down surfaces efficiently, and staff coming in and out of rooms. I'm trying to understand whether those types of considerations were taken into account in determining whether or not Hospital in the Home was an appropriate care model in a residential aged-care facility.

Mr Lye : They were, and you're right that it's an important consideration. The issue of potentially cohorting people offsite was something that the commission and the Department of Health pushed very strongly—at least for it to be considered as an option. It's not so much that people don't have the expertise in aged-care facilities; they have very good expertise. They sometimes understate their ability, because every year they deal with infectious disease outbreaks, including influenza. So they actually have standing capacity to manage that, albeit that people are worried about this; coronavirus is highly infectious and novel.

So, yes, if there isn't an ability, in general terms, to properly separate known positive cases from known negative cases onsite then offsite cohorting is something that can be considered and something that has been done in some outbreak sites. You've seen it used in Rockhampton recently. It is a bit dependent on the situation. In Rockhampton, where the greatest concern was, we had people sharing bedrooms, with two and four bedrooms with shared bathrooms. Creating space to isolate those people made sense, so offsite cohorting was the option taken there. I think Newmarch was slightly different to that, as I said, because of the way in which the outbreak manifested.

Just because there is a Hospital in the Home program doesn't mean that someone requiring the facilities that are available only in a hospital is not taken there. Indeed, we've seen a number of residents go to and from hospital or go to hospital and stay in a hospital setting.

Senator KENEALLY: I understand that point. If I'm understanding you correctly, you're saying that because of the way the infection occurred and manifested itself—that is, before it was even detected it had spread to so many people—there were a number of considerations you had to take into account. At that point in managing the outbreak—and I don't mean to sound crude—it was because the outbreak had already occurred, in effect; people had already been infected by the asymptomatic staff member?

Mr Lye : I think the way we'd characterise the issue is that we had some known positives, some likely positives and some people whom we hoped were negative but whom we couldn't be sure about. That makes the cohorting task very difficult, notwithstanding that that's precisely what happened onsite—a cohorting of residents.

Also, the PPE requirements on staff, to maintain infection control, are onerous. We had some learnings from Dorothy Henderson which we tried to assist with at Newmarch, but they are onerous. The more you can separate people, the better chance you have of reducing spread. To my knowledge, in Newmarch we didn't have secondary spread amongst residents, which made it different from Dorothy Henderson.

Senator KENEALLY: I will go back to something that Ms Anderson remarked about earlier, which was the legal responsibility that sits with the licence holder. I read comments from Mr Millard saying that, if he could do it over again, he would have moved people to Nepean Hospital. At the time, was there anyone blocking him from making that decision to move people to Nepean Hospital?

Ms Anderson : This is the complexity that both Mr Lye and I have been referring to. The clinical response had to be led by the public health unit, but the overarching governance arrangements in relation to the organisation and operation of that aged-care service rested with, and continue to rest with, Anglicare Sydney. In the best of all possible worlds, what would have happened is that there would have been a consideration of all the factors and a judgement would have been made to inform the decisions which were made, including embracing the views of the aged-care provider. Mr Millard, at the time, did not register any objections, and I think all of us have learned an enormous amount on the way through. Here we are, after more than 30 days, and there are tremendous numbers of lessons that we can benefit from and take elsewhere. I agree with Mr Lye. Mr Millard was around every single decision-making table in relation to the clinical judgements which were being made. The public health unit were giving us their best advice, and the Department of Health and the provider were taking that advice.

Mr Lye : I will just add that, because of the complexity of Newmarch and our desire to try and make sure that the best clinical decisions were taken, we weren't second-guessing the people on the ground, but we wanted to provide them, as they were operating in a stressful environment, with the ability to have a forum where we had expertise and they could reflect on decisions that were being taken. So we had Professor Lyn Gilbert from the University of Sydney, who'd done some work looking at the Dorothy Henderson outbreak for Dr Brendan Murphy, and we had one of our own CMOs, Dr Jenny Firman. Those two people provided a bit more distance and a bit more reflection on the issues that we were discussing in that regular case management meeting. People brought different perspectives and different views to that meeting, but I can say to you that we walked away from each meeting with a consensus decision, and I think that the group made the right decision. There were times where I or Ms Anderson would have said, 'Well, why wouldn't we go this way?' and we had people there who, we thought, had a degree of independence and who concurred with the judgement that was being made on the ground. So I think we did our very best to try and make sure that the right decisions were taken.

Senator KENEALLY: In that case management and decision-making process, how were the views of the residents—the people who were either infected or potentially infected with COVID—incorporated into those decisions?

Mr Lye : That perspective really fell to Ms Anderson. I would like to think that I brought that perspective too, but you can be assured that that was the perspective of Ms Anderson, who was coming in as the aged-care commissioner.

Ms Anderson : We had some very robust discussions around that table, but the other thing I would say is that, as a result of work specifically by the department, they brought in OPAN, the Older Persons Advocacy Network, and they very quickly embraced the families and, through the families, also spoke with residents. So we were getting a very strong feed from those quarters as soon as OPAN came into the picture. Indeed, the discussions that Mr Lye was describing included consideration of whether families might seek to take their relative home, whether the families had exercised a full range of choices in relation to what might happen to their relative and so on. This was a very wide-ranging and searching conversation which happened, as Mr Lye said, 10 times in a fairly small space of time. We were determined to bring everything to the table, look at all of the issues and take the best clinical advice available.

Senator KENEALLY: You said, Ms Anderson, that there were lessons learned. Perhaps you haven't had enough time with hindsight to articulate all of those, but, when you look back over the last month or two, are there things that now stand out to you that could have been done differently?

Ms Anderson : The first observation I would make is that the service is still the subject of an outbreak and we haven't yet got to the other side, so your point is well made about it perhaps being too soon to have the benefits of distance. I'd pick up on a comment that Mr Lye made. We are now much more assertive in the opening conversation we have. Mr Lye and I actually talk with every single manager of a service where there is a new outbreak, and we make it our business to have that conversation in the first 24 to 36 hours after the advice has been received about the index case, whether it's a staff member or a resident. We talk very energetically about all of the things that they have done, that they need to do and that we can assist them in doing—particularly what the department can assist them in doing. In particular, in relation to workforce management supply, as Mr Lye said, there is a certain assertiveness to our tone where if they say, 'No, it's all sorted; we're good,' then the next question is, 'And have you got the roster for the next fortnight?' If they say, 'No, but we can see our way through to Thursday,' there's a follow-up line of questions, because we don't take anything for granted.

CHAIR: Senator Keneally, that's your time almost up. Do you have a final question?

Senator KENEALLY: Yes, I do, and I'm happy for this to go on notice. I have two quick ones. You talked about the people at the table. I understood that the various meetings involved the Department of Health, the aged-care commission, the New South Wales Department of Health, OPAN, Anglicare and the new management team. Were there any other organisations or agencies involved in those decisions?

Ms Laffan : The Nepean Blue Mountains local district hospital.

Senator KENEALLY: I'm happy if that goes on notice in case someone else was there. Lastly, in terms of aged-care facilities having a pandemic plan, you said previously that it is the responsibility of the licence holder, but is there an off-the-shelf kind of pandemic plan that they should be reaching for, or is this something where you're discovering that we're having to work through this process that you're now engaging in when an infection breaks out? I'm just trying to understand: if this happens again, what will aged-care facilities reach for first?

Ms Anderson : Aged-care facilities are required to have an emergency response plan, which obviously needs to be fit for purpose depending on the emergency. They are also required to have a specific pandemic response plan. I would also make the observation that infectious disease outbreaks in aged-care facilities are not unknown. In fact, almost every season you will find a cohort of aged-care services with an outbreak of influenza or norovirus gastroenteritis. So responding to an infectious disease outbreak in an aged-care service is not unfamiliar territory. This is novel coronavirus, and there's a heightened level of concern and alertness. We are certainly fully expecting, and through our survey have identified, that services in the main have such a plan and have trained their staff in the deployment of that plan. But I can say that the commission is very alert to the risk that it might be underdone, and we will be doing more work to look at that and to provide further guidance to the sector in order that they can ensure as far as possible that their plans are fit for purpose and have been wind tunnel tested against contingencies that may not at first have been contemplated.

Senator KENEALLY: Thank you.

CHAIR: Thank you, Senator Keneally and Ms Anderson. I will go to Senator Lambie. Senator Lambie, once we finish with your time, we will break for 10 minutes, and I'll come back to Senator Patrick for the remainder of the crossbench time.

Senator LAMBIE: Are surgical masks being used in aged-care facilities to protect the workers from catching or spreading COVID-19? And are they as effective as the P2 masks?

Ms Edwards : We might ask Professor Murphy to add to this answer when he arrives, but I will say that different masks are used for different things, for different clinical needs. In some instances a surgical mask is required and in some instances a P2 mask, also known as an N95. It is more to do with an aerosol type of arrangement, when there is air and liquid flying around. In aged-care facilities they would be required to use PPE, including masks, in accordance with the clinical guidelines. We get involved where there's been a COVID-19 outbreak, and we provide PPE in that instance, in accordance with the clinical guidelines, so that it can be used by all the staff and, where appropriate, residents in the facility. But it's not a case of necessarily using a particular mask in a particular instance in every aged-care facility. There are many, many circumstances in aged care where PPE is not required or recommended. Ms Anderson might want to add to that.

Ms Anderson : I have nothing further, Ms Edwards. I think you've covered the territory.

Senator LAMBIE: I have a question about your COVID-19 clinical guidelines. Now that we know more about COVID-19, have you adjusted those—over the last 10 weeks, give or take—in aged care?

Ms Edwards : Again, I'll defer to Professor Murphy for any detail, when he's here. It has been an issue that's been considered specifically by AHPPC in relation to what the guidelines are for use of PPE in relation to COVID-19, and guidance has been published, effectively. That applies in all circumstances where there are people dealing in a frontline way with people who are or may be infected with COVID-19, and they apply across all the settings, as far as I'm aware. So, aged-care facilities, if they have a COVID-19 situation, would be expected to apply those medically set guidelines in all circumstances. Again, Ms Anderson might want to add to that.

Ms Anderson : No, I don't have any specific comments to make on masks.

Mr Lye : The chief nurse in the department has filmed a video. An issue for us in aged care has been people adequately understanding the PPE requirements. Although we've produced modules of online training, which a large number of people have accessed in the aged-care sector, the feeling was that having someone provide some practical advice around donning and doffing PPE—putting on and taking off PPE, and the right PPE—was required so that people had that practical guidance. The chief nurse has filmed a video that helps people to do that in a practical way.

Senator LAMBIE: Thank you for that. Aged-care homes were locked down in March and April because of cases of COVID-19, and that meant that the federal aged-care assessment officers were not able to access the levels of care that were going on during that period. What actions has the commission taken to ensure that this did not have a negative impact on quality of care for people in aged-care homes? And can they give the Australian people a guarantee that over those two months that quality of care has not dropped?

Ms Anderson : I'll answer that one.

Senator LAMBIE: And also [inaudible].

Ms Edwards : We couldn't hear that last bit, but I think you're asking how the commissioner dealt with ensuring that the standards were being upheld in aged-care facilities during March and April, when we were under a particular COVID situation. Is that correct?

Senator LAMBIE: Yes.

Ms Anderson : We're still there. The visitor restrictions continue to apply. We were talking earlier about the visitor access code that has been promulgated, which is one of the tools now available to the sector to ensure that visitors have access to their loved one in care and can continue to be watchful and support them in their experience as an aged-care consumer. We have undertaken telephone contacts with every single residential aged-care approved provider. We have undertaken telephone contacts with home-care providers. We have also done online surveys, as Senator Siewert was asking about, with both residential aged-care services and home-care services. I don't have the figure in front of me, but we have had over 5,000 contacts with services around the country between those four initiatives, which has given us a very clear understanding of the ways in which providers are understanding their own risks and their own level of preparedness for a COVID-19 outbreak.

We are also continuing to do onsite visits on a risk basis. So, where we have regulatory intelligence that indicates that there is a risk to residents' wellbeing, we will continue to undertake a visit to that site. Currently we provide short notice for those visits, which is less than 24 hours, because the site has to give us advice on their infection standing, and we have to give them assurance that our staff coming in are well versed in infection control practice. So, we're giving short notice of those visits at the moment. We're looking to move back to and recommence unannounced visits sometime in June—literally just around the corner. In the next two or three weeks we will be recommencing unannounced assessment contacts on a risk basis to services where we have advice that there may be a risk to residents.

Of course, we continue to manage complaints, and I talked earlier about the increased number of complaints we've received. We respond to every single one of those, and we deal directly with the provider and ask them very specific questions about how they're managing under the visitor restrictions, what they're doing for residents and what they're doing for a particular resident who may be the subject of a complaint by their family members. So, there has been no absence by the regulator. We remain on duty. We remain very alert and focused on ensuring the wellbeing of residents and all aged-care consumers.

Senator LAMBIE: What does 'regulatory intelligence' actually mean, in your words?

Ms Anderson : It means the information that we gather from a range of different sources about a provider, their understanding of risk and their management of risk. We would hear it from family members. We would hear it from consumers. We might hear it from staff members. We would hear it from the provider themselves. We have had providers disclose to us where they understand that one of their homes is operating at a high risk level. We hear it from public health units, ombudsmen, coroners reports, the Commonwealth department of health and state departments of health. We are agnostic to source. We take our intelligence wherever we can find it. Obviously we scrutinise it in terms of its evidentiary status, and we factor it into our understanding of risk by provider, which then informs the actions we take. We may understand it and decide to keep watch on it, or we may initiate an action very swiftly if we have a heightened level of concern that there is some risk to a consumer.

Ms Edwards : Perhaps I could just quickly mention, before we break, something that I think we may not have covered quite as much as we would have liked. It is in relation to the preferences of residents and families as to the care of elderly people in residential aged care. I just want to emphasise that it's absolutely fundamental to us—key views—and also that many residents will have advanced care directives, and it's fundamental that we respect those. I'm not sure that we quite put that on the record.

CHAIR: No, and I think we had some questions there but ran out of time. Thank you.

Proceedings suspended from 14 : 28 to 14 : 38

CHAIR: As foreshadowed at the beginning of this hearing, Professor Murphy has circulated a copy of an opening statement to committee members. In the interests of time, Professor Murphy, rather than reading the entire opening statement, could you just provide a summary of the key take-outs from it within two minutes. We are travelling a bit behind time, and I would like to get people out of here on time today.

Prof. Murphy : The key elements of my opening statement are that it's quite an interesting time to reflect on where we are at the moment. There have been only eight cases overnight, in the last 24 hours, and all of them have been acquired overseas. There has been one more community case today, in Sydney. But I think essentially we have large parts of the country now where they've had no cases for prolonged periods of time. The majority of our cases are now returning travellers. We really have got a pretty good state of control, with only a handful of people still in intensive care and only 500 people recovering from COVID at the moment.

It is important to reflect on the measures that we have put in place—the border restrictions, the aggressive public health response, the testing and tracing, and obviously the physical distancing. We're now in a significant mode of relaxing the physical-distancing measures across the country, with a fair amount of caution about the potential impact of resurgence of disease, particularly in those eastern seaboard states where there has recently been some community transmission. I know you've been talking a lot about aged care, but it is worth reflecting on the fact that we have had cases detected in over 30 residential aged-care facilities and have only had two outbreaks of material significance.

Probably one final thing I would say is that we have unfortunately had just over 100 deaths in Australia. We often compare ourselves to the United Kingdom—a very similar health system. If we'd had their death rate and we'd had their outcomes, we would have had about 14,000 deaths in Australia so far, not just over 100, so I think we have done well. We are in a very cautious phase now of trying to move to a living-with-COVID economy. I'll stop there, and take the statement otherwise as read, thank you.

CHAIR: Thank you very much, Professor Murphy. I think you'll get unanimous agreement that we are in a much better position, due to the efforts of a whole range of people, including yourself and your team, than the United Kingdom.

Senator PATRICK: Professor Murphy, I'm just wondering, and I ask this question in the context of understanding second waves, are you in regular contact with Chinese authorities, and are you confident the data that we're getting from the Chinese is accurate and helpful?

Prof. Murphy : We are not in direct contact with the Chinese authorities, but they are reporting their data to the World Health Organization, and, to the best of our knowledge, the data is being accurately reported. They've certainly had some further small outbreaks in recent weeks, including some new detections in the city of Wuhan, and they have responded in their very forward-leaning way to lock down various parts of the country. So we are reasonably confident that the data we're getting out of China via the WHO is an accurate reflection, to the best of our knowledge.

Senator PATRICK: On 12 April it was reported in the international press that the Chinese government had imposed a new policy requiring all academic papers on COVID-19 to be 'extra' vetted before being submitted for publication. Have you looked at that from a medical-professional perspective, and does that render those papers somewhat less useful?

Prof. Murphy : I haven't specifically looked at that. Potentially it could, although I would say that we've had some significant publications out of China in relation to the virus that have informed the international public health response quite well, but I wouldn't have any direct knowledge about whether publication was stopped for anything that could have otherwise given different information. But there's certainly been lots of useful information published from China.

Senator PATRICK: In terms of holes in information, is there any information that you think would help us, and indeed our colleagues in countries around the world, that is missing from any data that is coming from the Chinese? Are they being transparent? Are they looking back, looking at how the epidemic unfolded, and providing information along those sorts of lines?

Prof. Murphy : Yes, earlier on particularly we were very reliant on the Chinese published public health epidemiology data because the first 80,000 cases were all from China. That provided us with most of the data on mortality, age range and predictors of severe disease, and that information was extremely useful. I'd have to say that it's been overtaken now by, unfortunately, the US—probably the biggest single source of information—and the UK and Europe are now publishing a lot of information which has really superseded the information from China. So we're relying on data from a large range of countries now and particularly like-minded countries with similar health systems to ours, which probably gives us more relevant data to us than Chinese data.

Senator PATRICK: Switching tack slightly, I've heard reports in the regions that I have visited just recently that some aged-care workers or people who are perhaps not primary healthcare workers in a hospital are being asked to do things like wash PPE. Is that a practice that is acceptable under Australian standards?

Prof. Murphy : No. Disposable PPE should be disposed of, and we would not support anybody being asked to wash or re-use PPE. We certainly are not aware of any critical shortages at the moment of PPE. In fact, we've got an elegant sufficiency of masks at the moment in the country, so I would be disappointed and surprised if that were happening—certainly not something I would support.

Senator PATRICK: Ms Edwards, are you aware of any reports in relation to that?

Prof. Murphy : No, I've not had any reports of that, not in Australia.

Ms Edwards : Nor have I. I think you were asking me as well. No. I've heard it reported here in this committee a couple of times, mentioning these sorts of practices, and I certainly invite any senator to pass on any report so we could follow it up with the relevant state and territory, but I haven't directly—no.

Senator PATRICK: Thank you. I'll maybe stick with you, Ms Edwards: has the federal government been looking at the statistics associated with mental health and suicides, particularly during the lockdown period? Do you have any data on that, and what is your top-level analysis of that data?

Ms Edwards : We have officers who could come to the table to provide a bit more information, but, as we were discussing with Senator Siewert, there's an existing project around real-time data collection, particularly in relation to suicide and suicide attempts. But also there's a big commitment, which was agreed by national cabinet, for data to be at the centre of what we're doing. We do expect people to be under great stress at this time, both because of the impact of isolation, and staying home and disruption to their ordinary lives, and the economic impacts of the COVID-19 pandemic. It's something that we're going to anticipate and are rolling out services. But actually collecting the data is something we'll need to do, but it's too early really for us to have any definitive sort of data about what that increase might have been other than some increased access to services, such as phone lines and so on, which we have been seeing. Ms Rishniw or Mr Roddam might be able to provide more detail.

Ms Rishniw : Yes. As Ms Edwards outlined, we have fairly preliminary data. It tends to be on things like service volume in terms of hotlines and phone lines. The government's original investment of around $74 million around mental health at the start of the pandemic included specific investment: additional investment in things like Beyond Blue and a dedicated COVID-19 hotline for Beyond Blue; and additional investment in Kids Helpline, ReachOut and other services. What we've seen overall is an increase in the use of those phone lines and an increased use and take-up of things like telehealth and MBS services for mental health.

Senator PATRICK: I believe there was a question raised yesterday at a press conference that Minister Hunt was at on comments challenging the basis of Ruth Vine's comments about modelling at the Sydney university's Brain and Mind Centre. Are you familiar with the comments that were made?

Ms Rishniw : I'm familiar overall with the comments that were made but not the specifics. I don't know whether my colleague—

Mr Roddam : Yes. Were there specific elements there.

Senator PATRICK: Why would there be criticism about suggestions that there had been spikes in mental health issues?

Mr Roddam : I think what Dr Vine said was that she hadn't seen the modelling at that time and that it wasn't necessarily helpful to talk about a suspected increase in suicides based on that modelling. That's my recollection of her comments yesterday.

CHAIR: Senator Patrick, a final question, unbelievably!

Senator PATRICK: Finishing on the empirical data that you have, there is some modelling and perhaps some anecdotal evidence that might suggest there are more calls. I'm just wondering how we get to a view that the modelling shouldn't be at least recognised?

Mr Roddam : Definitely, modelling should be done and recognised. As Ms Edwards said, that's why the most recent package, announced on 15 May, included funding to improve data and to procure modelling for that exact purpose: to help us plan for service delivery in the COVID-19 period and beyond.

Senator PATRICK: Thank you, Chair.

CHAIR: Thank you very much, Senator Patrick. Senator Davey, you've been very patient.

Senator DAVEY: Thank you all for coming along today. I just want to pick up on Senator Patrick's line of questioning, specifically on the modelling and the data collection from the mental health services and the funding that we rolled out. Will that data collection also look at the geographic spread of access to services? In regional Australia we've seen drought, bushfires and now the stress of COVID and isolation. I'm just wondering whether we've already seen a trend in the distribution or spread of the people accessing our mental health services?

Mr Roddam : We don't have separate regional data on the telephone and digital services at this time, but what we do have is from the use of the Medicare Benefit Schedule's mental health items. There's been quite a significant shift, as you'd expect, from only a fraction of services prior to this period being delivered via telehealth to now in any given week just under half of those mental health items being delivered through telehealth. The take-up of telehealth has been slightly higher in regional areas than in metropolitan areas, as you'd expect, but not to any huge degree. That's where we do have the regional, metropolitan and rural split to some extent. But, as you'd appreciate, with phone lines and with digital services, it becomes more difficult to gather that data.

Senator DAVEY: Particularly with MBS access to health, we're not looking at the geographic spread, but you've indicated there is a higher uptake. Have there been conversations about continuing to allow access to these services via telehealth post COVID?

Ms Edwards : Senator, are you talking about generally or mental health specifically?

Senator DAVEY: Mental health specifically in this instance.

Ms Edwards : With telehealth, we've had a range of measures over recent years that have provided access, particularly having regard to people in regional areas—specific expansions of access to telehealth for mental health services and so on due to drought. Then, with the COVID pandemic, we've had a very large increase in the number of people who can access telehealth, because, obviously, everybody's a long way from services at the moment, which regional people are used to, because of the isolation and also wanting to protect the vulnerable and so on. That large expansion, which includes mental health services, is limited to six months, but it does feed into what we've already been thinking about, which is how do we make sure primary care is fit for everybody using technology and innovation and so on? That measure is time limited until, I think, September sometime, but we have got some existing telehealth measures. I can assure you that, as we move forward, we'll be looking at which bits of that telehealth learning we want to employ to make sure that people have access to services generally but to mental health services in particular, when and where they need it and in a form which provides the best possible quality care. We're still thinking about that at the moment and we'll have to see, weighing up the right of sort of care, the right sort of place and when telehealth might be an appropriate way of delivering services, which it won't always be. It's a work in progress. That is the short answer. Professor Murphy might want to comment.

Prof. Murphy : I think one of the benefits—if any benefits come out of this terrible pandemic—is that we are learning some new models of not only working and interacting but doing health care. Minister Hunt is on the record saying that he would like to see some elements of the telehealth service delivery model retained. Obviously, we have to be careful. There's a limit to what you can achieve in a telehealth consultation and sometimes you can run the risk of having poor quality care, so we need to balance access against quality of care and making sure that whatever we set in place post-COVID is sustainable. That's a very deep body of work that the department is undertaking: looking at what the world would look like after the very temporary measures that were put in place. The policy was developed pretty quickly to respond to an evolving pandemic. As we look at how telehealth will be sustained in the future, we have to do some very careful planning around it.

Senator DAVEY: Thank you. I want to now turn to something that I'm sure all senators are aware of. We have received several representations around the requirement for all visitors to aged-care facilities to have proof of a flu shot. Can you explain the thinking behind that requirement and how it's rolling out?

Prof. Murphy : The thinking behind that was a strong request from the Australian Health Protection Principal Committee. The thinking behind it was that, coming into winter, we were very keen to make sure that we reduced, as much as possible, flu outbreaks as well as COVID. They can certainly present in a very similar way. We know that flu can devastate residential aged-care facilities. We've certainly had many more deaths from influenza in previous years than we've seen from COVID this year. We want to also reduce the risk of any unwell person going into a facility. It was the strong view of all the state and territory chief health officers that, given that we were seriously limiting the number of visitors and we were very worried about bringing in any infection to aged care, this was a good risk mitigation. And, given that flu vaccination is completely safe and effective, that was a strong recommendation that the first ministers at the national cabinet were prepared to support.

Senator DAVEY: You said we had more cases of influenza deaths last year. Do you have a breakdown of how many were in aged-care facilities so that we can understand the mitigation—

Prof. Murphy : We'd have to take that on notice, unless Mr Lye has it.

Mr Lye : We don't have it for residential aged care, but we do have it for over 65s. The mortality rate in 2019 was 821. It's a large percentage of the total number of influenza deaths. I don't think we've got a breakdown by facility, but we do have it for that older population. It does vary from year to year. The over-65s account for around 95 per cent of the total number of deaths. The high-water mark would be 2017, when we had a really bad outbreak and 1,183 people in Australia died from influenza. Ninety per cent of those are older Australians. As a comparison, in 2010 there were 32 deaths. So the numbers do move around, but it is a significant threat to our aged population.

Prof. Murphy : Certainly in 2017, when we had a very bad influenza season, we had multiple aged-care facilities that had multiple deaths from influenza. I would be very confident in saying that the number of deaths in residential aged-care facilities in 2017 from influenza was far greater than we've seen from COVID this year.

Senator DAVEY: You might not be able to answer this, because this might be feedback that's given direct to aged-care operators, but are the families of residents presenting with grave concerns or are they going along with it and coming along with their certificate of flu vaccination and quite happy? Have you had any indication as to what level of concern there is amongst the families of residents?

Prof. Murphy : I don't know whether Ms Anderson might want to comment.

Mr Lye : I think the vast majority of people accept that the intention of the vaccination program is to protect their loved ones in residential aged care. There are a small group of people who, for ideological reasons, don't accept the science behind vaccinations, and those people have been, in recent times, complaining about the measures. Certainly aged-care providers, who we're currently meeting with every second or third day, are reporting some resistance from some individuals who don't accept that proof of vaccination is required for entry to visit their loved ones.

Ms Anderson : From a regulator's perspective, we're not seeing a large increase in the number of complainants who are concerned about having to produce that evidence at the front door. I suspect those who take exception to it are vocal about it, but it is by no means the majority at all.

Senator DAVEY: Earlier this month, aged-care facilities were given extra funding of $900 per resident in urban facilities and $1,350 per resident in regional facilities. This was obviously to cover the costs of PPE, additional staff where needed and the increased infection control measures. What sort of a time period is this funding designed to cover?

Mr Lye : The idea was that the funding would cover the period for which we expected people to be subject to the extra costs for COVID—so a three- to six-month period. But the determination by the government was not to pay that as an ongoing amount but to pay the full amount upfront—to give services the benefit of that money upfront to assist them with costs.

Senator DAVEY: Will there be a need to review it if, for example, we see a second wave of COVID, if we start to see a reversal in the trend of the flattening curve?

Ms Edwards : I think it's probably fair to say that the whole package of measures, across all of the COVID related measures, are all generally time-limited with about that three- to six-month time frame, and we'll be watching them all, but of course what we're hoping for is that we have suppressed the virus in a very major way so that that time will be sufficient. But we're looking and seeing what happens with all the measures, and it would be no different to those.

Senator DAVEY: I note there have been contingency plans put in place to ensure staff gaps are filled if a facility has a number of staff that have to self-isolate, for example. We've seen it utilised already in some instances. But are these contingency plans going to be effective if there is an incident in a regional facility where there aren't on-the-ground ready-trained staff?

Mr Lye : I think we've had that example already in north-west Tasmania, where we had an outbreak that originated in Burnie, I think it was, and we provided workforce support to three aged-care facilities where there was a staff member who had worked at those sites. So we were able to get assistance to those services as they needed them. Certainly it's more challenging where you've got a regional facility, but we've contemplated that.

Senator DAVEY: Thank you.

Senator WATT: I'm going to move on from aged-care matters for the moment. I want to start with some questions about the reports that appeared in today's papers about counterfeit face masks. I think Senator Patrick was asking a little bit about that, but I think I've got some different questions for you. Who should I be directing these questions to?

Ms Edwards : Probably to me and Professor Murphy between us.

Senator WATT: I assume you've seen the reports that I'm referring to, about counterfeit face masks allegedly being sold to Australian hospitals.

Ms Edwards : Yes. I saw one report, I think, this morning.

Senator WATT: Yes, one report in the Nine/Fairfax papers. It is the department aware of these concerns around the supply of fake masks, particularly to private hospitals?

Ms Edwards : We're aware of it now. We read it in the report this morning. There are a couple of things we've done since then. First, Minister Hunt has asked the TGA to investigate what might have happened. There was a reference to the idea that it might have originated from a change in regulation that we put in place, which we went and checked with. The situation is: we changed the regulation so that certain equipment coming only into the National Medical Stockpile could skip some of the regulatory hoops, on the basis that we did post-market reviews to check that that material is all safe and so on. But it in no way changed the requirements for anyone else using PPE for a therapeutic purpose, as opposed to if you buy at the chemist to wear for some other reason—around your house and so on. If it's used for a therapeutic purpose, which you would expect it would be used for in a hospital, at least mostly, then it needs to go through exactly the same regulatory requirements as always. So the TGA is going to go and investigate what the situation may have been here. But, to be clear, it's not a loophole in any change we've made. If it's the case as reported—and let's investigate—that masks have been sold which do not meet the standard and have not gone through the regulatory processes for therapeutic purposes, then we'll be taking action in relation to that.

Senator WATT: Is the claim that's made in this article—that the TGA dropped its regulations that required all masks to be tested before being registered in Australia—correct?

Ms Edwards : The only change that was made was that there was an exemption from some of the requirements of the TGA for masks bought by the Commonwealth to go into the National Medical Stockpile, on the basis that we have alternative processes which then ensure that they are up to standard, safe and appropriate before they're then dispatched. That was to allow us to take advantage of very fast procurement processes at the time when there was a major global shortage, so we could get things in and check them afterwards—but no change to anyone else's purchases.

Senator WATT: Did the Department of Health make the additional checks on the 100 million masks that had been purchased?

Ms Edwards : All checks and standards are absolutely checked in a post-market way on everything that comes into the National Medical Stockpile, yes.

Senator WATT: How rigorous are these checks?

Ms Edwards : I can take on notice exactly what we do, but they're rigorous. We are absolutely committed to making sure that they're safe and effective, or we wouldn't want anything to be dispatched. But we did want to ensure we could take advantage of what supply lines were available and get things in quickly—so, in effect, risk managing, making sure we were going to have sufficient product in country. We still did checks before we bought things from wherever they came, checking that they provided the appropriate documentation and they were as described and so on, but they were exempted from some of the processes in order to get them into the stockpile. Then we do post-market checks to make sure they're appropriate and fit for purpose before dispatch.

Senator WATT: The claim made in the article is that the masks were initially subject to independent testing but that that requirement was dropped on 22 March, because Australia feared being overwhelmed by COVID-19 and a lack of PPE. So that claim is not correct?

Ms Edwards : Let me just check the date to make sure that that date is the one that aligns with my understanding of when we made an exemption in relation to stuff coming into the National Medical Stockpile and not something else. Bear with me one second while I find the right brief, but that's the only exemption we have made and it wouldn't have applied to things being sold directly to a hospital or other provider.

Prof. Murphy : Senator, there's been no change to the TGA regulatory requirements for private hospitals. There has been no exemption on the TGA in relation to medical-grade PPE purchased by private hospitals. That's an incorrect statement in the article.

Senator WATT: Okay—

Ms Edwards : And it was 22 March that we made an exemption, which was only in relation to purchase into the National Medical Stockpile.

Senator WATT: So you're confident then that all of the masks that are being used in Australian hospitals and by health workers are safe?

Ms Edwards : We're confident that the rules apply and that we will investigate any suggestion that inappropriate masks are being used for therapeutic purposes.

CHAIR: Ms Edwards, did any fail the post-market review of what you purchased for the National Medical Stockpile? Were any found to be not of sufficient quality?

Ms Edwards : Not that I'm aware of. We would not have done post-market review of everything we've acquired yet but, in terms of what's been dispatched, I'll take on notice whether there was some element of inadequate product. But I'm not aware of any.

Senator WATT: In a similar vein, there have been a number of media reports of what are being described as dodgy antibody tests being ordered at taxpayer expense. In March this year, Minister Hunt announced that Australia had ordered 1.5 million point-of-care antibody tests. Can you just briefly explain what those tests are and how they differ from typical laboratory tests.

Prof. Murphy : These point-of-care tests are what we call a serological test. They measure the antibodies that are produced after someone's been infected. The earliest you detect these antibodies is usually about a week after you've contracted the infection, and the antibody peaks generally about three to four weeks afterwards. By about a month after you've had the infection there's a pretty high chance that this antibody test will be positive, so they are not particularly valuable in diagnosing acute infection. The gold standard is the PCR test done on the swab.

The reason those tests were bought at that time is that we were in a situation where there was a very serious risk that the PCR tests supply line would be interrupted and not be able to be fulfilled. So we may have had none of the tests that could do all of the testing we wanted to do, and these were bought as a form of insurance policy. They still could be of value in doing what we call serosurveys down the track, if we want to detect in a given community how many people have had the infection in the past, but at the moment they're being held in the stockpile. We've managed by a range of means to secure a very strong supply line for the PCR gold-standard test, and because we've had such low case numbers we're not really in a position to do serosurveys to look for past infection. They're being kept in reserve.

Senator WATT: Thanks, Professor Murphy. Which companies has the government ordered these point-of-care tests from and for how much?

Ms Edwards : We went into discussion with three companies, which I'll pull up—Professor Murphy might find them quicker than me—for 500,000 tests each. I have to say that I, Professor Murphy and many other people were approached by dozens and dozens and dozens of companies wanting us to procure large amounts of these sorts of tests—

Senator WATT: I'm sure they did.

Ms Edwards : so we were very careful in who we approached. We bought modest amounts—it was a total of 1.5 million—as Professor Murphy says, as part of our numerous streams of activity for procuring tests and which are what's got us to the position we're in today and the access to testing that we have. As it turned out—and we did it within strict contracting—one of those contracts did not proceed; it didn't meet the requirements. So there are a million of the tests through two providers, which one of us will pull up quickly.

Prof. Murphy : Yes: the two we purchased were the OnSite COVID-19 IgG/IgM Rapid Test purchased from MD Solutions—and that was half a million—and the VivaDiag COVID-19 IgM/IgG Rapid Test kit from Endo X Pty Ltd.

Senator WATT: And at that stage each of them was 500,000?

Prof. Murphy : Correct. Only a million have been purchased—so 500,000 of each.

Senator WATT: Who in the department signed the contracts for those tests to be ordered?

Ms Edwards : I think I did.

Senator WATT: Okay—maybe take that on notice in case.

Ms Edwards : I'm doing that from memory. I remember one Saturday afternoon in the office when I think we went through it in detail and I signed those contracts, but I'll take it on notice.

Senator WATT: If you could take on notice and table all correspondence between the department, the minister and his office and the three companies that were initially approached or that contractual negotiations began with.

Ms Edwards : If any. We'll take on notice what—

Senator WATT: Yes, if you could table whatever you do have. Just in terms of the dollar figures, the 5,000,000 per company, there have been some reports that—

Ms Edwards : 500,000 tests per company.

Senator WATT: Tests, not dollars?

Ms Edwards : No.

Senator WATT: And the total value?

Prof. Murphy : The total value for one of the contracts was $9,925,000 and the other was $9 million—so it's $18,925,000 in total.

Senator WATT: Which one was which? Which was 9.9?

Prof. Murphy : MD Solutions was 9.9; and the Endo X was 9.

CHAIR: Senator Watt, you're running out of time, sorry.

Senator WATT: You will have seen some of the reports about concerns about the accuracy of these tests. Has the department got any reason to doubt the Doherty institute's findings as to the accuracy of the tests?

Ms Edwards : I think Professor Murphy can talk about the science of it but, from a lay point of view, I think one of the issues that have arisen is that people have understood this to be a test they could use at any moment to tell them if they're sick and so on; whereas, as Professor Murphy's said, they're tests of antibodies, not of virus. The most fantastically accurate serology test wouldn't show you virus; it would show you an antibody. So it's a function of how long. This has been confused because there have been reports overseas also of some serology point-of-care antibody tests which turned out not to be effective even when antibodies may have been developed. That's why we were so careful in the contracting, the modest amount and who we were contracting with for these the tests. We understand the Doherty work has given us assurance—

Prof. Murphy : We commissioned the Doherty work, Senator, because—

Senator WATT: Yes.

Prof. Murphy : It's true that—

Senator WATT: To cut to the chase, given my time is fairly close to running out—or is out—my concern is that we've seen $18.9 million of public funds spent on tests that are potentially not accurate and have just been shelved in the stockpile never to be used. Is my concern justified?

Prof. Murphy : No. The Doherty report did suggest that they didn't perform up to specifications, which was in terms of the positivity rate at one week; however, it did show that by three to four weeks out they had a close to 90 per cent sensitivity, which is probably fine for using in serosurveys later down the track. They could well have a use when we're doing population surveys of people who may have been infected, and we may well use them in the future. They were purchased, as I said, at a time when we may have had no diagnostic tests and it was a very reasonable insurance policy to have some testing so that we could at least confirm whether someone who'd had symptoms in fact had coronavirus.

Senator WATT: Very last question about the third contract, which we did not proceed with, which I think involved the company called Promedical. What would have been paid for that third set of 500,000 tests if that contract had gone ahead?

Ms Edwards : $6,950,000.

Senator WATT: Thank you.

CHAIR: Thank you, Senator Watt. Senator Di Natale, I hope you are joining us on the phone.

Senator DI NATALE: I'll try to be a quick as I can. How much of the $2 million in funding from the Medical Research Future Fund that was announced for that research has been spent and where has it been spent?

Ms Edwards : I will check to see whether we have that information on us.

Prof. Murphy : We will have to take that on notice.

Senator DI NATALE: In the interests of time, I'll let you take that on notice and come back to me.

Ms Edwards : We'll do that.

Senator DI NATALE: Can you tell me whether any of that has been spent on hydroxychloroquine?

Prof. Murphy : I don't believe we spent any money on hydroxychloroquine.

Ms Edwards : I think we spent a small amount on hydroxychloroquine, but none of that research money has been spent on hydroxychloroquine.

Senator DI NATALE: So what amount has been spent on hydroxychloroquine, and what is the government's current recommendation?

Ms Edwards : Professor Murphy might go to the recommendation, while I pull up the details.

Prof. Murphy : Our current recommendation remains that hydroxychloroquine is only an investigational drug that should only be used in clinical trial circumstances. Early on, there was a suggestion that it could be used in some severe diseases in an off-label, but only in a clinical evaluation sense—in a clinical trial or proper controlled evaluation. At the moment, there is increasing data on the lack of efficacy and the risk of hydroxychloroquine. Early on, as you know, Senator, there was some quite promising data out of small trials in France, but the more recent data suggests that there's no current evidence of efficacy and that it does have risks. We would not be recommending it be used in any circumstance other than a properly controlled, ethics approved clinical trial.

Senator DI NATALE: I want to go back to the question of pandemic preparedness. I understand CSL is Australia's biosecurity partner and our partner in regard to influenza pandemic preparedness. Is that correct? Can you tell me anything about that relationship?

Prof. Murphy : We have a longstanding relationship with Seqirus, a subsidiary of CSL, to have a preparedness to manufacture pandemic influenza vaccine. We contract with them and they have a state of perpetual readiness for an egg based influenza vaccine so that, if a pandemic influenza appeared, we would identify the candidate virus and they would turn that plant over to producing pandemic vaccine for us within a 12-week period. They did that in the swine flu pandemic in 2009. That's a longstanding relationship.

Senator DI NATALE: I'm interested in why that pandemic preparedness, specifically in regard to vaccine capacity, is limited to influenza when we had, for example, SARS and MERS and novel coronavirus emerge in the past. Why haven't we broadened our preparedness to include that potential vaccine readiness for things beyond influenza?

Prof. Murphy : It's known that, in a pandemic influenza, a vaccine will always be produced.

Senator DI NATALE: Understood, but this is a broader question about pandemic preparedness. I understand that CSL has had a longstanding role in the manufacture of an influenza vaccine. Would it not have been prudent to at least have a plan with CSL or another partner to ensure that we were able to ramp-up the production of a vaccine for a novel virus that was something that was beyond our influenza capacity?

Prof. Murphy : Certainly, we have already had discussions with CSL about the potential if a recombinant coronavirus vaccine appeared. They have already got advanced plans to turn some of their bioreactors that produce recombinant blood products that they could very rapidly turn into production of recombinant protein vaccines. They have onsite finish and fill in Seqirus, and they are already working with UQ, who are developing a candidate protein vaccine. They are prepared to help, if we get a recombinant protein vaccine.

Of course, there are other types of vaccines, such as viral vector vaccines and RNA vaccines. We are one of the few countries in the world that have onsite vaccine production. Certainly it's focused on pandemic influenza. Seqirus are also keen to transition their egg based influenza vaccine technology into a broader platform in coming years.

Senator DI NATALE: Would you expect in any pandemic preparedness to have a relationship with a biosecurity partner that ensures that we have capacity—obviously, if we don't have a vaccine available at the time—to use the technical expertise of a biosecurity partner like CSL into the future for broader pandemic preparedness? Should that relationship be formalised rather than the more ad hoc one that appears to be the case at the moment?

Prof. Murphy : It's a very strong relationship. Very early in this pandemic we engaged them, because it's a very, very close relationship in pandemic influenza and general preparedness, antivenoms and other things. So we engaged them fairly early on. I don't know if it would be any stronger if formalised. But, certainly, as they transition into new technology, that will be something where we look at the broader range of pandemic preparedness. But I say again that there is only a handful of countries in the world that have onshore vaccine production capability, and we're fortunate to have that and have that partnership.

Senator DI NATALE: I have a couple of more general health questions. I want to talk about the private health insurance rebate. Given that we've seen a ban on elective procedures, there's a lot of public money going towards the private health insurance industry, which is currently not performing elective procedures. So it is really just going towards their bottom line. You might want to take these questions on notice. Can you tell me how much taxpayer money has gone to private health insurance via the rebate since the pandemic was declared here in Australia? I want to know whether there's any request of the private health insurers that those taxpayer dollars be recovered rather than effectively being gifted to the private health insurance industry. Perhaps you can tell me whether there's been any discussion around a potential freeze on health insurance premiums given that there's been a delay on elective surgeries?

Ms Edwards : We'll take on notice the amount of funding. Which date did you want—the date that Australia announced it to be pandemic?

Senator DI NATALE: Yes.

Ms Edwards : Our dates may or may not line up exactly with that in terms of our accounting, but we'll give you as close as we can to that. I'm not aware of discussions with private health insurance over the last few months about how money is or isn't dealt with—we have been very occupied with other issues—but we will take on notice to check if anyone else has had such discussions. In relation to reforms to private health insurance generally, we have had less focus on that over recent months but we will be returning to our reform process in due course.

Senator DI NATALE: Okay. I again highlight that there are billions of dollars being poured into an industry that is not delivering value for money for consumers, particularly at the moment. So I don't understand what the policy rationale is behind that. I want to go to some of the pathology MBS item numbers.

CHAIR: You're almost out of time, Senator Di Natale.

Senator DI NATALE: I understand that the MBS item number for processing COVID tests is $100 for the private providers and $50 for public providers.

Ms Edwards : Yes.

Senator DI NATALE: What is the rationale for that discrepancy?

Ms Edwards : The rationale of fifty-fifty correlates to the fifty-fifty cost-sharing relationship arrangement we have with states and territories in relation to all COVID related expenditure through the national partnership agreement which was agreed in relation to COVID. So it is on the same basis. We are sharing with the states and territories the healthcare costs of this pandemic, and we are doing it equally in the private pathology labs.

Senator DI NATALE: There are a number of other MBS item numbers where there isn't a discrepancy between public and private providers. They're basically being given the same reimbursement, regardless of where they deliver those services. So why specifically for pathology and not for other areas of the MBS?

Ms Edwards : We are in unusual specific times.

Senator DI NATALE: Sorry—that's a really glib answer. Could you please take the question seriously.

Ms Edwards : I don't think I can add anything to my answer.

Prof. Murphy : I think what Ms Edwards is saying is that the COVID tests are specifically covered by this partnership agreement with the states and territories, so they are funding half of everything, even though in other pathology tests when they do private work they get the full benefit of the MBS fee, even though it may be that they're covering some of those costs of these public labs themselves. In this particular circumstance we have a deal across all the states and territories that everything we spend is split down the middle, and that applies to these specific COVID tests as well as everything else.

Ms Edwards : That's right.

Senator DI NATALE: So has the department actually secured an agreement that the states are going to fund the second half of that fee for the public providers?

Ms Edwards : The states are aware that it's a 50 per cent reimbursement for these tests when they're done in their labs, and they've been content with that arrangement.

Prof. Murphy : The public labs are largely funded by public hospital core funding. Their private work is money on top. I used to run one of them. They would be very happy to be able to fund the other half of the cost, I think. It's just part of the general, overall principle of the COVID cost sharing, which has worked well.

Senator DI NATALE: Can you just tell me how you came to the $100 figure? What was the basis for that?

Ms Edwards : I think I'd have to take that on notice and get back to our specific costing team about that.

CHAIR: Ms Edwards has taken that on notice. Senator McKim, can I go to you for five minutes.

Senator McKIM: Professor Murphy, the context for my bracket of questions is the fact that there are large numbers of temporary visa holders who are stuck overseas and being denied permission to return to Australia. Many of these people have jobs here, homes here, families here, and their kids go to school here. Have you provided any specific advice to government around the health risks associated with temporary visa holders returning to Australia?

Prof. Murphy : Obviously the Department of Foreign Affairs and Trade is dealing with them. Our advice is simply that obviously any Australian citizen or permanent resident may return to Australia. I absolutely accept that it's difficult sometimes for them to return to Australia, although we have had a very large number of chartered flights that have been coming in—several every week—bringing in people from various parts of the world. Our health advice has simply been that obviously we can't deny the return of any of our citizens or permanent residents but they must be quarantined in a state-run quarantine facility when they come and that quarantine is provided currently at the expense of the state governments.

Senator McKIM: Just for clarity: you've provided no advice specific to temporary visa holders?

Prof. Murphy : We don't deal directly with temporary visa holders. The Department of Foreign Affairs and Trade deals with Australian citizens. What particular circumstance are you talking about? These are people who aren't citizens and permanent residents, who are overseas—is that who you're referring to?

Senator McKIM: Yes, exactly.

Prof. Murphy : We haven't provided any specific advice other than, if asked about the health risks in a particular country, being able to comment on the epidemiology. But we haven't provided any specific advice, no.

Senator McKIM: If people come to Australia from overseas—regardless of whether they're citizens, permanent residents, temporary visa holders or international students—and go into isolation for two weeks, does that deal with the health risks?

Prof. Murphy : Essentially, yes. If you've been in proper quarantine for a two-week period, which is beyond the incubation period of the virus, our view is that there is no health risk in being returned to the general community. Clearly there is a real issue about the capacity of Australia to quarantine, in a supervised manner, a lot of people. If we reopened our borders to the 200,000 people a week who were coming here, there is no way we could quarantine that number.

Senator McKIM: No, I'm specifically asking in regard to people who have a moral right to be in Australia—that is, they currently have a valid temporary visa. But I wanted to ask you whether you or your office provided government—Home Affairs or government more broadly—with advice around returning AFL players from Ireland. There have been reports in the last 24 hours that a contingent of Irish AFL listed players have been given permission to return home, and I'm wondering whether government sought your advice on any health risk that may be associated with their return.

Prof. Murphy : The Border Force commissioner did discuss that issue with me and my advice was that, even though Ireland has a relatively good epidemiology at the moment, if they were granted permission to enter they should be formally quarantined for two weeks like anybody else. That would be the only basis upon which I would support them being allowed back in.

Senator McKIM: There's no difference in health risk between an AFL player and someone who might be a doctor or a health worker on a temporary visa, is there?

Prof. Murphy : No, and there are many temporary visa holders providing essential health services who have been allowed entry by Border Force. In fact, we have a large number of junior doctors working particularly in Western Australian and other hospitals who are Irish and UK citizens who come for a year or two to work in our hospitals. The Border Force commissioner has let them in because they're providing an important service, but they also have to quarantine for two weeks.

Senator McKIM: Understood. Thanks, Chair.

CHAIR: Professor Murphy, there's a story just breaking now—

Prof. Murphy : Oh dear—

CHAIR: about the livestock ship. You just said, 'Good.'

Prof. Murphy : No, no—

CHAIR: Why is that good?

Prof. Murphy : No, I didn't say 'Good.'

CHAIR: Okay. I'm sure I heard you say, 'Good.' It has docked at Fremantle with reports of six positive COVID cases and potentially more to come. When did you become aware of this?

Prof. Murphy : At lunchtime today, at the AHPPC meeting. The Western Australian Chief Health Officer informed us of this event.

CHAIR: The ship docked on 22 May, according to media reports. Is that correct?

Prof. Murphy : All I know is that the Western Australian Chief Health Officer informed us that there was a livestock ship that had some crew on board who had tested positive and that they were working out how to deal with them and deal with the ship, but that's all the information I have at the moment.

CHAIR: Under the Biosecurity Act you're the Director of Human Biosecurity, and ships docking in Australian ports are required to provide health reports to the federal department of agriculture. Did that occur?

Prof. Murphy : Again, I don't have any further information other than what I've told you. We could take all of that on notice for you and provide information, but all I have is that very preliminary information told to me at lunchtime today.

CHAIR: Is it a concern that, four days after a ship docks, you're being made aware of it at lunchtime?

Prof. Murphy : I'm not even sure when these positive tests were confirmed. I suspect that they've only had the results today. But, again, we're speculating at the moment. I've got some early information from the WA Chief Health Officer as of an hour or so ago.

CHAIR: You haven't been able to have any discussions with the department of agriculture, with Mr Metcalfe or Mr Pezzullo, around whether or not they were aware of this?

Prof. Murphy : No, because as soon as AHPPC finished I came here to attend this hearing. I haven't done anything else but come straight here.

CHAIR: Senator Keneally, I might hand to you. Do you have some further questions on this?

Senator KENEALLY: Professor Murphy, it might help if you could clarify: this is a ship with livestock on it, but it would be required to provide a human health report to the federal department of agriculture—yes or no?

Prof. Murphy : I believe so, yes. That would be the normal requirement: any maritime vessel has to provide a health report.

Senator KENEALLY: I think this is useful for public education as well as for the committee: it's not just cruise ships or aeroplanes with people on them but also other types of vessels such as a livestock ship that has a human crew.

Prof. Murphy : Yes—any commercial vessel.

Senator KENEALLY: And those reports go to the federal department of agriculture.

Prof. Murphy : They go to the department of agriculture, yes.

Senator KENEALLY: I think last time we had testimony from the federal department of agriculture that they were a bit more than a postbox in terms of processing those reports. Are you not able to tell us any more as to when those reports were received by Agriculture and what they did with them?

Prof. Murphy : No. As I said, I have no further information. Generally, as I think I said at the first hearing, the human health risk assessment is delegated to the state and territory directors of human biosecurity—in Western Australia, that would be Professor Armstrong. If there were any human biosecurity issues, Agriculture would have dealt with him, as the delegated responsible person.

Senator KENEALLY: Just so we're clear: the reports go to Agriculture and then get sent to Western Australia?

Prof. Murphy : There are a range of protocols. If they believe there are any human health risks in a state, they are required to consult with the director of human biosecurity in that state. Again, we are speculating about what has happened with this ship. We'd be very happy to provide you, on notice, with full information about the time line. All I know is what I've told you already.

Senator KENEALLY: Premier McGowan has literally just finished a media conference. He's saying that the state only found out by word of mouth, from the docks, that there were crew members on board who were sick, and that the state government then got tests done. His claim is that the federal authorities—whether that's Border Force or Agriculture—knew that there were sick people on board but didn't tell the Commonwealth. Could you please take that on notice, if you're not able to answer now?

Prof. Murphy : We can certainly take that on notice.

Senator KENEALLY: Thank you.

CHAIR: I've got some questions on an unrelated matter; I appreciate you coming back to the committee as soon as you can on the other questions we've asked. Professor Murphy, I've heard you say a number of times that the international border closures were key to some of the success of Australia's response to COVID-19. I note that over the period from 1 February the China restrictions came in more formally—there had been ones previously—and then there were restrictions on Iran and, I think, South Korea from 5 March. I just noticed that in the AHPPC statement of 4 March, just prior to the South Korea restrictions coming in, there's an interesting paragraph:

AHPPC believes that, in general, border measures can no longer prevent importation of COVID-19 and does not support the further widespread application of travel restrictions to the large number of countries that have community transmission. COVID-19 transmission is well established in several geographical regions globally.

That paragraph just seems to be at odds not only with the decisions that were subsequently taken over the next week but also with what you say has been one of the most successful restriction measures. Can you reconcile those two things?

Prof. Murphy : I think the view was that, country by country, progressive border restrictions were of diminishing value. But we did impose some additional ones because of the very high risk associated with them. Ultimately, when community transmission was so widespread across the US and Europe, we closed the borders to everywhere, because it got to that stage. Initially it was highly targeted, but there was a phase where—you're right—the AHPPC in general felt that going country by country was of limited value. There was such a high risk in some of those other countries, particularly Iran, northern Italy and South Korea, that there were some temporary restrictions. But the really big decision was to close the borders completely, which was probably the most effective measure. I keep having to remind everyone that we can only close the borders to foreign tourists. We can't close the borders to Australian citizens and permanent residents.

CHAIR: So there was clearly a change in view by the AHPPC. On 4 March there were 50 cases of coronavirus in Australia. By 19 March, when you'd gone full circle to that paragraph and you were closing all the borders, there were 755 cases.

Prof. Murphy : The risk was evaluated on a daily basis. If we saw a particular country with very large numbers of imports, it became relevant.

CHAIR: Thank you, Professor Murphy. We might have a look at that in a bit more detail.

Can I go to private-hospital arrangements—perhaps this is for you, Ms Edwards. The cancellation of elective surgery at the time was, I think the Prime Minister said, essentially to preserve hospital capacity and PPE. The original suspension was from 25 March, but that was later pushed back by a week to 1 April. Was that suspension recommended on health grounds or for other reasons? When it was announced, it was due to come into effect at midnight on 25 March, and then it got pushed out by a week.

Ms Edwards : Professor Murphy might remember as well, but I think there were practical reasons for how quickly we could put it into place in terms of the health advice.

Prof. Murphy : The health advice was largely on the basis of PPE. We were worried about the potential continual consumption of PPE while we hadn't ensured our supply lines and also, as you said, about the potential to particularly preserve ICU capacity. But we decided that it had to happen. The national cabinet made a decision. I think the feeling was that there was a lot of elective surgery booked; that, practically, it was very difficult to stop it suddenly; and that the risk to PPE by going on for a few more days was not material. These people had their surgery booked; they were ready to go. It seemed unreasonable to stop it, and it probably didn't materially change the consumption of PPE by going on a bit longer.

CHAIR: So it was feedback from private hospitals saying, 'You can't do this to us with a few hours notice'?

Prof. Murphy : And the states and territories, too, had similar concerns.

CHAIR: The viability guarantee was estimated at $1.3 billion. In answer to a question on notice, you said health actuals to 22 April are $268 million.

Ms Edwards : What is the question number, please?

CHAIR: You just tabled it today, as a correction.

Ms Edwards : Oh, that one. Yes, I've got it.

CHAIR: It is IQ20-000013.

Ms Edwards : Yes.

CHAIR: According to that answer, you've spent almost $270 million of that $1.3 billion. Can you give me an update of where that is up to today?

Ms Edwards : The private hospital—

CHAIR: Harnessing private hospital capacity.

Ms Edwards : The first thing to note about harnessing private hospital capacity is that we pay on estimates, and they're then reconciled. We have an agreement with the states and territories, who then have agreements with the private hospitals. What we're guaranteeing is minimum operating viability to stay in business, which is that amount less any money that the private hospital might have made through elective surgery and any money paid to do public work in accordance with the agreement. The states make an estimate at the beginning of a month, and we make the payment though the states—we've made payments to the states; we don't make them direct to private hospitals—and then, at the end of a three-month period, there's a reconciliation done to see how much of the estimate it is. Now, the estimates that we have paid on so far have been at times when we feared we might be in a much worse position than we are now. So we expect the amount we paid out to be reconciled down when we do the reconciliation.

CHAIR: So, at the end of that, I think the answer is you think it's going to be less than $1.3 billion.

Ms Edwards : Yes.

CHAIR: Right. Do you know how much?

Ms Edwards : No, we don't know how much, because we'll do a complex reconciliation.

CHAIR: Do you have an end-of-May figure or an update on the one you've given me, which is 22 April?

Ms Edwards : I don't think that I do have one here, but I can definitely take it on notice. I might—just a moment. This is at 24 May.

CHAIR: Yes.

Ms Edwards : I've got an actual—so, moneys paid to states and territories—of $1,136,284.

CHAIR: What was the $1.3 billion? Was that the figure for up to the end of this financial year?

Ms Edwards : Yes.

CHAIR: Yes. So you're tracking pretty close, considering you've got another month to go.

Ms Edwards : Well, we don't know how the reconciliation will work out, so it's hard to say. But we're tracking pretty close—if the actuals are the same as what we expect to be reconciled, but, for the reasons I said, we don't think they will.

CHAIR: Okay. What work is going on around resuming elective surgery? I know the AHPPC has issued the 25 to 50 to 75 to 100 per cent steps, and states are going at their own pace on those. But the practical implementation of getting elective surgery back on track is much harder than that, particularly with social-distancing requirements, PPE, how the theatres are going to have to run and how the patients are going to be accommodated, particularly for high-volume throughput. What's the plan nationally around how to get elective surgery back—because I would imagine there's going to be a backlog that's going to take considerable time to work through.

Prof. Murphy : There will be a backlog. At the moment, the aim is to get it back to 100 per cent of activity over the period of the sort of three-step resumption of economic activity. Some states have gone already to 100 per cent. South Australia has really recommenced. They've opened all their theatres, and their private hospitals are moving in that direction. Other states are more cautious—Victoria, I think, has gone to 50 per cent; New South Wales has gone to 50 per cent—but they all have plans to ramp up. As you say, they've had to do a lot of work on their processes and their patient flow, making sure that all the physical distancing measures are in place, and some of the bigger states are wary about consuming all of the ICU capacity in the private hospitals—just to keep that in reserve.

CHAIR: I guess I'm asking if there's a national strategy across private and public hospitals, because—

Prof. Murphy : Yes.

CHAIR: Right. There is one being worked on?

Prof. Murphy : No, but there is a strategy that was published, and it was these three steps, with each jurisdiction going initially to 25 per cent and now most going to 50 and some up to 100, and in those states generally the private sector has agreed to move along with the public sector at that level of activity.

CHAIR: It's going to have viability issues, I imagine, for the private sector, which I presume is of interest to the federal government.

Prof. Murphy : Absolutely. The national cabinet and the Prime Minister are very clear that the health risks are the paramount ones. But, as long as we're confident that there isn't a health downside to resumption of full elective surgery, that's what we're encouraging. My view is that we'll probably be back to pretty much full baseline activity by the end of June, or sometime in July perhaps. What strategy there might be to clear some of the backlogs will be a matter for states and territories. The private sector generally has good capacity to clear backlogs. The major problem will be in the public sector, I think.

CHAIR: Yes, it's a complicated process. This is my final question and then I'll hand over to Senator Paterson. The national performance reporting was suspended on the decision of health ministers. Have there been any developments on that—like when national performance reporting will be recommenced?

Ms Edwards : Ms Rishniw—given she's here, just by luck—may know more about this. The discussion we had at AHMAC was that the activity that was happening in public hospitals during March and April was just not meaningful in terms of the way activity based funding works at the moment, because everyone had stopped elective surgery and made themselves available and were turning to COVID. So we agreed that they wouldn't be required to report; it wouldn't be useful for the moment. We think this financial year will be a very unusual financial year for hospitals funding and for reporting. We would expect it to be occurring again early in the new year. That would be sort of our aim, on 1 July, but it's something we'll have to talk to AHMAC colleagues about and then, through them, to health ministers. Is there anything else you want to update, Ms Rishniw?

Ms Rishniw : I'd add that, while that activity reporting was suspended in recognition of COVID, the level of activity and the need to free up capacity, obviously, in ICU beds, that was replaced with a range of different daily reporting of ICU capacity and a range of reporting undertaken with the AIHW and through the CHRIS system, which actually looks at real-time reporting of hospital activity, gives us a better sense of activity reporting at the hospital level, in real-time, to respond to COVID.

CHAIR: No, I understand that. I think it's just going to be part of the strategy of coming out of this, and dealing with elective surgery in particular is going to be very, very challenging. Senator Paterson, I hand over to you.

Senator PATERSON: Professor Murphy, thank you for your time before the committee again. I think it's your third appearance and, as you noted, you've just came straight from AHPPC. So we're grateful that, with the other duties you have, you're taking your obligations to the Senate process as seriously as you are.

In your opening statement, you noted that, if Australia had a similar rate of infection and fatality as the UK, we'd have about 15,000 fatalities rather than 100. That's a very sobering and very timely statistic because, looking back at some of the modelling that we did in the early stages, we did fear that we would be on a trajectory like that—in fact, even worse than that at one point. I don't want to rehash all the things we've previously discussed in the committee about why that's not the case, and I certainly don't want to do, to use an American expression, a Monday-morning quarterbacking on the modelling that was done early on, because obviously, under extreme pressure, it had very limited data. But—touch wood—thankfully, in Australia what eventuated is nowhere near even the best-case scenarios outlined in that early modelling. Is that a fair observation?

Prof. Murphy : Yes, Senator, although that early modelling was really designed to give us a sense of what an unmitigated outbreak would do—we didn't ever believe we would have an unmitigated outbreak—and then to apply, based on that early modelling, a series of mitigations to get to a situation where we thought we could manage within an expanded health system capacity, particularly in a critical-care capacity. We put a range of mitigations around the model so that we knew we would be able to manage within a ventilator capacity of 7,000. That was what we set up as our worst-case scenario, which was a lot better than for an unmitigated outbreak, and then we set out to beat that as much as we could by aggressive suppression.

So it is true to say that we've done as well as I could have expected, because of all of those things we've talked about before—the widespread testing, the early testing, the border measures, the physical distancing, the quarantine and isolation. But the modelling was never real world. It was designed to give us a sense of what we had to do to have a health system that was not going to be overwhelmed, because no Australian would have tolerated the sort of tragedy we've seen in places like New York, where they've had mobile morgues and horrible situations. We were determined we were never going to be in that position.

Senator PATERSON: I think you're right, Professor Murphy. Even countries that have had it much worse than Australia but much better than New York have had death rates much higher than Australians would be willing to accept. In fact, Australians would be aghast and horrified if we had the death rates of almost any other country we're compared to.

I will just very gently challenge that final statement you made—and I say 'gently' because not only am I not an epidemiologist but I'm not anything approaching it; I am not in any way medically qualified. But, as I understand it, the early modelling was of a range of scenarios, and the modelling was predicated on high levels of social distancing and lower levels of social distancing. For example, assuming a relatively high degree of control, ICU daily demand ranged from 5,000 at the low end to 35,000 at the high end, and the death rate ranged from 50,000 at the low end to 150,000 at the high end. That was from making different assumptions about how effective social distancing was. Thank God, we haven't come anywhere near the worst-case scenario, but policy was predicated on that. That was the only information available at the time for policymakers, wasn't it?

Prof. Murphy : Policy was predicated on that as a 'manage worst case'. The lower end was what we planned as our worst-case scenario. We wanted to know that we had the tools in place to manage within a maximal ICU expansion capacity. We calculated, from the ground up, that we just couldn't staff anything more than 7,000 ICU beds. So we looked at the modelling and said, 'What do we have to do, in this somewhat artificial situation of a community-wide outbreak, to bring it down to that level?' That was really the purpose of that modelling. We wanted to reassure governments, collectively, that we had the tools in our kitbag to manage down to within health system capacity. That was the main purpose of that modelling. It wasn't a prediction; it was to say, 'We've got these tools and this is how each of them will work.'

And it was really important to convince governments to do physical distancing. It was a huge challenge for all of our governments to cancel major events, close restaurants—put people out of work. We had to show the impact of physical distancing from modelling work.

Senator PATERSON: I think it was a useful illustration of the range of possibilities available to us, depending on the different approaches that government took but also on the different approaches that citizens took and their compliance with those directions. Obviously, though, on the basis, in part, of that modelling, governments envisaged that we would have quite serious restrictions in place, and the mantra at the time was that they could be in place for up to six months. Happily, that now doesn't appear to be the case. We're really only two months into those restrictions and now they're being eased. Policy that was predicated on a six-month restriction scenario is obviously going to be quite out of step for what ends up being a two-month scenario, isn't it?

Prof. Murphy : Correct, and I think we have reflected that we've done a lot better than we thought we would at this stage. The pandemic is under much better control at this stage than we thought, which is wonderful. Certainly there will be some measures in place for six months, but it was quite possible that we would have to continue quite severe measures for a lot longer than is currently the case; that's absolutely true.

Senator PATERSON: I don't want to ask you to stray too much beyond your area of expertise, and—correct me if I'm wrong—I don't think you have economics qualifications, do you?

Prof. Murphy : No, Senator!

Senator PATERSON: But, to tempt you just a little bit, economic policy that was predicated on six months of restrictions and far higher rates of ICU admission, infection and death—and formed on the basis of those models—is obviously going to need to change quite significantly, given that it hasn't turned out to be what we feared.

Prof. Murphy : I probably can't comment on economics. All I can say—

CHAIR: It's probably a matter for the Treasury secretary, wouldn't you say, Senator Paterson?

Senator PATERSON: We might yet have another opportunity, Chair.

Prof. Murphy : The challenge with this pandemic is that there's no clear model or path. We're all finding our way. Every country is finding its way. We're all looking at the data every day and re-evaluating our position in health as in all the other responses. It is a very uncertain time, and we still don't clearly have the endgame because we don't know about vaccines and the like. So there is a lot of uncertainty but we're very pleased to be in the position we're in at the moment.

Senator PATERSON: Looking back, knowing what you know now, what, if anything, would you do differently or advise governments to do differently?

Prof. Murphy : I would like to have formally hotel quarantined people a little earlier, because most of our cases at that time were coming from overseas travellers, but there wasn't the room in hotels to do it. I don't think it would have been practical. So we did it as soon as we could. Other than that, I—we question every one of our decisions, but in retrospect I think we look back pretty pleased with the way we've responded.

Senator PATERSON: You'd probably rather be in the position you're in today, maybe having gone harder than you otherwise would and now being in a position to relax things, than in the alternative position, which would be that, not having gone hard enough early, you now have to catch up and impose stronger and stronger restrictions because it hasn't worked as planned.

Prof. Murphy : I think the international evidence shows that that is a policy failure, because you can't bring it under control. Those countries that imposed restrictions late have terrible devastation as they bring the pandemic under control, and they still have not suppressed anywhere near the level we have. So moving early was clearly the right thing to do; there's absolutely no doubt about that.

CHAIR: Thank you, Senator Paterson. Senator Davey.

Senator DAVEY: I want to ask a few questions about our testing rates. I think we've now got the highest testing rate in the world. We've done nearly a million and a quarter tests across Australia. I hear my Premier, Gladys Berejiklian, out encouraging people, particularly people in hotspots, to continue to seek tests if they're feeling unwell. Are we still aiming to increase our testing rates, or, given that we're flattening the curve, are we looking to maintain current rates or return to a place where only people who are actually feeling symptoms go and get tested?

Prof. Murphy : It's a very good question. We are not, currently, testing everybody who has acute respiratory symptoms, and we want to test them all. That's the best way we'll pick up any new outbreaks. Our message is very clear that anybody who has a sore throat, a runny nose or a cough should get tested. We're getting a lot of them tested at the moment, but not all of them. That's the strategy we've adopted. There's a little bit of testing of contacts, there's testing of workers in high-risk settings and there are some cross-sectional studies of asymptomatic people, but the key to our testing is to test every single person with an acute respiratory symptom, and we probably need to do that for months.

I want to keep our testing rate up high, and I don't mind if it gets higher. That's the only way we can keep our outbreaks so easily detected and so quickly controlled, because there will be more outbreaks. This virus has not been eradicated; it is in the world. It might have been eliminated in parts of Australia for the time being, but you can't stop movements. So we need to keep testing. My message to every health practitioner in the country and every citizen is: please, if you have any sort of respiratory symptom stay away from work, stay away from school and go and get a test. It's almost certainly going to be negative, but if we find the one in 10,000 that's positive then we can get on top of outbreaks and not have it come out of control. That's the key to preventing a resurgence.

Senator DAVEY: Specifically for regional Australia: we rolled out some pop-up testing clinics in certain regional centres, but is it fair to say that someone in a regional area that doesn't have a specific COVID testing station should go to their local clinic or local hospital, and the test can be run there?

Prof. Murphy : Exactly. All of the private pathology labs—and all of the public pathology labs—have access to the tests. Those testing centres are obviously a convenient way to do it, but GPs are very happy to see people and send them to a testing station. As I said, the risk that people will be positive is so low now that people are less anxious about someone turning up to a general practice. We still suggest that you ring first in case the GP wants to refer you to a situation where you don't have to be in contact with other people, on the off chance, but every general practitioner is attuned to this now and every pathology centre is doing it.

Senator DAVEY: Great. Just looking forward, we are now seeing some states even moving to stage 2 of lifting restrictions and people are returning to the workforce. We've heard previously through this committee that you've been working with Safe Work Australia to try to implement processes for employers. Can you give us an update on how that work is going?

Prof. Murphy : Safe Work Australia have done a range of guidance material for COVID-safe workplaces, and that's been available on their website. The state and territory WorkSafe regulators are also providing advice and will be ensuring that those principles are adhered to. There are clearly two elements, though, to returning: there are the work-safe principles but there are also the public health principles. For example, in a restaurant, there's keeping the workers safe but also the patrons safe too. So there's a close intersection between the work-safe regulations and the state and territory public health regulations, and we're trying to harmonise them as things relax.

Senator DAVEY: I have one final question on that. So, if I'm talking to a small business operator who is preparing to reopen their doors, I could just advise them to go to Safe Work Australia and there will be all the fact sheets that they need to operate a safe workplace?

Prof. Murphy : From the point of view of a safe workplace for the employees. But, if they are a business that is open to the general public and could have public gatherings, like a restaurant, a cinema or an art gallery, they also need to consult their state or territory public health unit for the public health regulatory requirements as well. So they need to go to both.

Senator DAVEY: Thank you. That's great advice.

CHAIR: Senator Lambie?

Senator LAMBIE: Thank you, Chair. We closed schools and we closed our borders and public and sporting events and some of us went into pretty hardcore lockdown. Surely we cannot go into lockdown up and down and wait for some sort of vaccine to come, which could be next year, this year or never. The reason that we all did this stuff was that we were not prepared. So my question is: are we now prepared with the PPE gear? Is our public health system now prepared to take an overload for a second wave?

Prof. Murphy : We've never liked the term lockdown, but the reason we introduced significant physical distancing measures was partly for preparedness but also to actually control the outbreak we had. We had up to 400 cases a day when we introduced these measures. So it was very much about bringing the outbreak under control. We've now had only eight cases a day, so it has been brought under control. It was also about preparedness. It was about preparedness to make sure our public hospital capacity and our ICU capacity were enhanced, and we've done that. It was to make sure we had all the PPE, and that's been achieved. It was also to make sure that we had a very expanded public health workforce. It has gone from a few hundred to several thousand across the country. So that contact tracing can happen very quickly, we had to expand our testing platform and our testing capacity. We had to get into a position where, as we relaxed these physical distancing measures, we will be able to (a) detect very quickly the inevitable outbreaks that we will see and (b) respond to them without having to do community-wide lockdowns—which is the point you're getting to.

The national cabinet has been very clear about not relaxing measures until we are confident that all of those conditions precedent, as I've called them, were in place. I'm reporting to them at every national cabinet meeting on how they're tracking, because we will get more cases. And we are now much better prepared—you're absolutely right.

Senator LAMBIE: Professor Murphy, I'm not sure if you are aware of this but in New South Wales they have just shut down three schools again. So this is going to be an educational problem. I guess my question is: what are you doing to manage the risk that there might be a second wave? How are we going to deal with it, rather than saying that everything has to shut and lock up again?

Prof. Murphy : That's what I was suggesting before, Senator. The strategy is to do exactly what NSW Health have done. If they find one child in a school, they shut the school down for a couple of days, they ensure that every contact is traced, they clean the school and then they reopen it. The Cedar Meats outbreak in Victoria was a relatively large outbreak. They tested several hundred people, locked the facilities down, quarantined all the contacts and brought it under control. That's the strategy now—not to lock down the whole community but to lock down a workplace or a school, for example, and isolate every possible contact. As you know very well, in north-west Tasmania a town was pretty much locked down for a period, but not the whole of Tasmania. That was a very large outbreak.

So the strategy is to detect as early as possible, contact-trace and test everyone you can think of, pick up every case you can, symptomatic or asymptomatic, quarantine people, clean and close facilities and respond in a very quick and aggressive local fashion. That's the strategy. None of us want to go back to community-wide measures, because we know that many businesses couldn't tolerate it twice. So we have to have really good testing, tracing and management capacity—which we are very confident about at the moment.

Senator LAMBIE: Have we done any modelling on the potential rate of new infections as we wind back the social-distancing measures?

Prof. Murphy : We have done some modelling. The Doherty institute have done some modelling, which I think they have published, on what would happen if you had various scenarios of reproduction rates in an outbreak again and how long it would take before you had really large numbers and how quickly you have to bring it under control. So we have done some modelling on that. It's highly theoretical, but, essentially, if you had an uncontrolled outbreak in a city and none of those things that I'm talking about, it would only take four or five weeks to get a very large outbreak. But we don't expect to be in that position. We want to detect the first and second cases and go in really hard, test every contact, isolate every contact and bring it under control locally.

CHAIR: Thank you, Senator Lambie. Senator Patrick?

Senator PATRICK: Is Ms Anderson still there?

CHAIR: Yes, she is. She's been very patient.

Senator PATRICK: Fantastic. In relation to the statistics you were talking about at the start of the hearing, in terms of complaints going up, have they predominantly been around lack of access to the elderly?

Ms Anderson : Yes. Visitor access to older Australians in residential aged care has certainly been dominant. There have been a number of other issues as well, but 45 per cent of the number of contacts we've received since 1 January—so over the period 1 January to 17 May—are in relation to the visitor restrictions specifically. Another 17 per cent relate to concerns about preparedness and prevention for an outbreak. The third highest is the impact of the restrictions on the quality of care. So those three feature fairly prominently in the statistics.

Senator PATRICK: Okay. In standard 1 of your standards, there are matters that relate to making sure that people can 'make decisions about when family, friends, carers or others should be involved in their care' and 'make connections with others and maintain relationships of choice, including intimate relationships'. That's part of the standard. Throughout this, is it going to be a situation where we go back and look at this and at how that particular standard was or was not met in cases where people have made complaints? Then the question is: how do you remedy that, particularly noting that in some sense the horse has bolted and we're back into a much more liberal scenario?

Ms Anderson : When we receive a complaint, we look into it as quickly as is necessary. We certainly don't hold onto them and wait for six, eight or 10 months to deal with them. So this is a very real-time process that we have. When we receive a complaint about visitor access, the first thing we do is talk with the complainant and understand the particular issues about which they have a concern. We then take that list to the provider and ask them to explain their actions: do they understand this presentation of issues, how do they respond to those issues, and is there something that they could consider doing which would address the concerns that have been raised with us and that we're now putting to them? In a number of instances, the provider comes back very quickly and says: 'We didn't understand it that way. We can do the following. We're happy to reach out to this complainant and to resolve the issue in a way which is mutually satisfactory.' In other circumstances, it takes a bit longer. Where the provider is a bit more determined or does not see it in the same way as the complainant, obviously some further negotiation and discussion is sometimes required.

As I said in an earlier answer, we now can have regard to the industry led code as evidence of a nationally consistent consensus position on good practice for visitor access. We also have regard to the standards which you've already mentioned and also the Charter of Aged Care Rights. So, when we are looking at a complaint, those are the lenses we use as we seek to sort it out. Our fundamental motivation in managing complaints is to achieve a good outcome for the complainant. So, in our engagement with the providers, we're dealing with it in real time as best possible and seeking to understand the issues from their perspective and see if we can reach some accommodation.

Senator PATRICK: On notice, can you go back and look at those complaints, particularly in relation to access, and perhaps give the committee a distribution of where you got resolution quickly, where it took a little while and where you didn't get resolution.

Ms Anderson : I'm happy to take that on notice.

Senator PATRICK: Thank you. I want to switch now to the COVIDSafe application. This is to the secretary. I know she'll want to tell me how many people have downloaded the application thus far, so I'll let her do that.

Ms Edwards : It's just over six million. I think that at 7.30 yesterday morning there were 6,027,505 downloads and registrations on the app.

Senator PATRICK: Fantastic. You've got that out of your system, Secretary.

Ms Edwards : You asked, Senator.

Senator PATRICK: My understanding is that there was a release just recently that resolved the situation about the app not working properly in the background on iPhones, yet there's been no, if you like, advertising about that. Do you want to comment on that?

Ms Edwards : All that work, of course, is done by our partners at the Digital Transformation Agency. I understand there's recently been a release which has improved the operation of it on iPhones, but I'm not sure what. As we said, we're continuing to improve it.

Senator PATRICK: Sure. All the people who have been looking at the source code have noticed that there are sections around the way in which the application does its scanning—I understand the problem was that it did a scan about every two minutes and once it was locked it stopped doing the scan. It really just comes down to keeping people informed about what improvements you've made to the app along the way as you release a new drop of the application.

Ms Edwards : We've always said it worked much better on the Android phones, and we were continuing to make improvements on the Apple phones. One of those improvements has been made. We'll continue to do that. I might take it as a suggestion that you think we should advertise each update to the app more widely.

CHAIR: Final question, Senator Patrick.

Senator PATRICK: The source code on the server app is not available. Is there an intention to release the source code in relation to that?

Ms Edwards : I'll have to take on notice any technical answer, because obviously I'm not across the detail, but I think what we've been clear about all along is that we've released the code to the greatest extent possible within cybersecurity constraints. So, if there are elements of it not available, I would expect that's because of our cybersecurity advice, but I'll take on notice the technical answer, Senator. You're more across that than I.

Senator PATRICK: The source code is released in relation to the application as it sits on the phone but not the application that sits on the server.

Ms Edwards : I can only expect that's to do with the security aspects, but I'll take the explanation on notice.

CHAIR: I will hand to Senator Keneally for the final few minutes, but before I do I have a question for Professor Murphy. I think some of the various models that you've done over time as you've flattened the curve have been released publicly. I presume you've been briefing the National Security Committee of cabinet on those improvements in the modelling of the health data over the last eight weeks.

Prof. Murphy : The national cabinet has been briefed on those and the National Security Committee less so. At the national cabinet, the premiers and the Prime Minister generally get an update on the modelling at every meeting.

CHAIR: What about the federal cabinet?

Ms Edwards : Of course, Professor Murphy is not really at liberty to discuss what advice he's given to cabinet.

CHAIR: I'm talking about the modelling and whether or not that's been provided. I'm not asking what the modelling is and what it's saying and what might not have been released. I am asking whether the Chief Medical Officer has provided modelling to the NSC.

Ms Edwards : To government?

CHAIR: Well, through to the cabinet. One would hope so.

Prof. Murphy : Certainly, as I said, it's coming out. We know that it's released after each national cabinet meeting.

Ms Edwards : Very comprehensive advice is provided to government at all stages through the ordinary processes, including the confidential cabinet processes.

CHAIR: But you won't confirm whether the modelling has been provided to the cabinet?

Ms Edwards : In accordance with the standard practice, we don't provide detail of what advice has been provided to cabinet in confidence.

CHAIR: No, the committee hasn't accepted that, and we have repeatedly made it known to witnesses that if you are going to deny an answer to questions then you must indicate whether you are going to seek public interest immunity. You need to explain the public harm that comes from letting us know whether the cabinet has received modelling information as the health curve has been flattened. That is the question. If you think that's a harm to public interest then refer it to your minister and go through that process, Ms Edwards. I would think it's a fairly straightforward question for this committee to ask.

Ms Edwards : We'll refer to the minister whether he wants to claim public interest immunity in relation to what's been provided to cabinet.

CHAIR: About whether they're doing their job properly.

Ms Edwards : But you might like to ask Professor Murphy what advice and modelling he's given to the government, which of course is a broader question.

CHAIR: No, that's not my question. That's your question to him.

Ms Edwards : Well, we'll have to refer it to the minister.

CHAIR: My question is whether the NSC of the federal cabinet have been briefed on the modelling as the curve has flattened. That is my question. If you're unable to answer that simple question today and it needs to be referred to your minister, please indicate if that's the case.

Ms Edwards : That's what we'll have to do.

CHAIR: Right. It really makes the scrutiny role of this committee an absolute joke. Senator Keneally, I've run over time. I'm sorry. I've taken your time now, but you can just have a couple of questions and then we'll finish.

Senator KENEALLY: Thank you. I will. Back to you, Professor Murphy. After the Ruby Princess, the Australian Border Force made some changes to how they process and understand the risks on cruise ships. In your role as Director of Human Biosecurity, have you made any changes to the way that you or human biosecurity officers process information in relation to ships when they arrive?

Prof. Murphy : The directors of human biosecurity—who, as I say, are the state and territory officials that I appoint—have had a lot of discussions, both before and after Ruby Princess, on the processes and their interaction with ABF. In my particular role, as I've said already, I appoint the chief human biosecurity officers, I chair the meetings of the human biosecurity officers and obviously I have oversight of the policies. I'm aware of a number of, as you say, those changes that NSW Health in their role—

Senator KENEALLY: No, I'm not talking about NSW Health. I said that the Australian Border Force had made some changes. Commissioner Outram has outlined them. I'm asking: Have you, in your capacity as Director of Human Biosecurity, initiated any changes in how arriving ships, and the risk they pose in terms of COVID-19, are managed? Has the Ruby Princess made any change in practice in terms of human biosecurity?

Prof. Murphy : The reason I was referring to NSW Health is that they are my delegated authority in terms of human health risk assessment.

Senator KENEALLY: But they operate under the federal act.

Prof. Murphy : Absolutely they do, and we have—

Senator KENEALLY: And you are the director.

Prof. Murphy : Correct, yes.

Senator KENEALLY: I'm not asking about New South Wales. We have a live example unfolding right now in Western Australia where the Western Australian Premier has said that the only way his state found out about illness on board, elevated temperatures and sick passengers—or, in this case, crew—was through word of mouth on the docks, not through any federal government agency. He also says that the department of agriculture and the Australian Border Force cleared this ship to dock. So I'm trying to understand: what is the point of ships filing human health reports with the federal department of agriculture if, on both the Ruby Princess and now this other ship, we've had people arrive who are sick and there haven't been the proper precautions put in place?

Prof. Murphy : I don't think it's fair to comment on the circumstances of the Western Australian ship. I don't know what that ship told Agriculture or Border Force. We'd have to find out all of those circumstances. We've already said we'll take on notice all of the circumstances in which the Commonwealth was involved in the arrival of that ship, but I really can't comment without knowing the details.

Senator KENEALLY: You do accept that the Commonwealth have ultimate responsibility for what happens at our borders, though, and that it can't just be punted home to a state health department?

Prof. Murphy : Absolutely. We have absolute responsibility, but we do not have public health officers on the ground, and we delegate under what is usually an extremely effective partnership with the state and territory public health officers whom I appoint as chief human biosecurity officers. So it is a partnership. Our entire public health response is a partnership. We coordinate, and the states and territories deliver. But I absolutely accept we need to look into what's happened with this livestock vessel.

Senator KENEALLY: Thank you very much. I understand, Chair, that our time is up.

CHAIR: It is. We've just run over.

Prof. Murphy : Can I just clarify one question that Senator Di Natale asked about funding for hydroxychloroquine research. I think we did fund a preventative trial. That wasn't a treatment trial. Ms Rishniw might want to clarify that.

Ms Rishniw : That's right. Thanks, Dr Murphy. In response to the question about whether we've funded any hydroxychloroquine trials under the MRFF: we've spent $3 million through the Walter and Eliza Hall Institute of Medical Research to assess the effectiveness of hydroxychloroquine for prevention of COVID-19 infection amongst healthcare workers, so it's very much looking at effectiveness and testing that. Senator Di Natale also asked about funding for vaccines. If I can quickly cover that, it will save taking it on notice.

CHAIR: Sure.

Ms Rishniw : Under the MRFF, we've provided $3.35 million in vaccine research and clinical trials through the University of Queensland and $2 million in competitive grants rounds. The outcomes of that grant round haven't been announced yet. There are a range of other vaccine commitments that we've made in terms of supporting funding through CEPI internationally.

CHAIR: Thank you very much for that. This concludes today's proceedings of the committee's inquiry into the Australian government's response to the COVID-19 pandemic. I thank all witnesses for the time they've given the committee today and for the evidence to the committee. Witnesses are reminded that the answers to questions taken on notice are due in 10 working days.

Committee adjourned at 16:35