Issue 2 • 2021

College experts advising Disability Royal Commission

The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability was established in April 2019 in response to community concern about widespread reports of violence against, and the neglect, abuse and exploitation of, people with disability. In April 2021, the RACP provided its submission to the Commission, which was developed in consultation with members from a range of specialties.
The Commission commenced its public hearings in September 2019 and continues to hold public hearings around the country. It plans to deliver a final report to the Australian Government in September 2023.
Through this process, in addition to interviewing people with disability, their families and carers, the Commission has turned to specialists from the Royal Australasian College of Physicians to provide expert insight and guidance on the current healthcare system and how we can better support people living with disabilities.
One of the experts who has presented to the Commission so far includes RACP President-Elect Dr Jacki Small FRACP, a paediatrician with over 37 years’ experience and particular expertise in children with intellectual disabilities.
Alongside Dr Small, RACP Fellow and Associate Professor Mitra Guha FRACP has also presented at the Commission, bringing to the table her decades of experience in endocrinology and medical education, including as Chair of the College’s Education Committee.
Associate Professor Guha provided critical insight into training pathways for physicians and helped the Commission to understand how we can improve the medical workforce to better support people with disability.
Dr Small and Associate Professor Guha also presented alongside a representative of the Royal Australasian College of Psychiatrists, Associate Professor Beth Kotze.
For this issue of the magazine we asked Dr Small and Associate Professor Guha our top questions on what it’s like to present at a Royal Commission.
Dr Small, how did you get selected to present at the Commission, and what was that process like?
“I was selected as an Expert Witness for the Health Public Hearing in February 2020. At that time, I was President of the Australian Association Developmental Disability Medicine, and we had been very active nationally in advocating for improving the health of people with intellectual disability. This included raising awareness of the abuse and neglect that people with intellectual disability experience.
"Through the preparation process, I was well supported by the lawyers for the Disability Royal Commission (DRC), who assisted with ensuring my statement met the legal requirements of a Royal Commission. They were well prepared and had areas that they wanted to focus on, such as transition from paediatric to adult healthcare, that were relevant for my expertise. I was confident that the issues I wanted to raise were important and that this was a process that might lead to significant change.”
Do you think Royal Commissions are useful and can make a difference?

Dr Small
: I can only reflect on my experience and the reporting that I have read from this Royal Commission. The DRC is elevating the experiences of people with lived experience of disability whose stories can often be overlooked. It is centring the need for change in the scientific evidence of poorer health and what works. It is serving as a driver for change from governments and other organisations such as our College. That is important for people such as those with an intellectual disability who have often been overlooked.
We asked Associate Professor Guha for one piece of advice to a Fellow who is asked to present at a Royal Commission or a big Inquiry, and that was:
“I think it is important to stick tightly to one’s area of expertise and not try to venture out of one’s field, as you may be pushed into answering queries on which you have little knowledge or expertise.
"It is also important to realise that the Commissioners do not have any knowledge of matters which we take for granted, therefore it is important to explain even the most basic information to start with and avoid medical jargon as much as possible. For example, people tend to conflate medical students with physician trainees.”
And lastly, we asked both experts, what change would you like to see to improve the care and support in the medical system for people living with disabilities?

Dr Small said “People with disability, especially those with intellectual disability, ought to be more visible within our health systems. We need to acknowledge their poorer health, and how our health systems may contribute to that, and strive to use our influence for change. Our attitudes make an enormous difference. Even by showing a deeper respect and value for people with disabilities, we can start to transform their experiences of healthcare.”
And Associate Professor Guha reflected that “I’d definitely like to see better hand over of patients with disability across paediatric and adult medicine care, with a recognised group and/or physician clearly identified as a point of contact. Better organisation, co-ordination and availability of multi-disciplinary care would also complement this, as it is impossible for any one group to provide all aspects of care.
"I would also suggest debriefing and support processes for practitioners working in this field, which can be very demanding. This could also include training for all doctors on the avoidance of preconceptions and an awareness of unintentionally pejorative terminology. For example, saying something “fell on deaf ears” is unfair to people who are deaf.”
The RACP gives big thanks to Dr Small and Associate Professor Guha for their contributions to the Royal Commission on behalf of the College. The advice our College experts provide to national inquiries and Commissions is incredibly valuable to their fields and to our society.
Further information is available on the Royal Commission’s website.
© 2021 The Royal Australasian College of Physicians