3 October 2018

Structural roundabout does nothing for crisis in health

| Vicki Dunne
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It is obvious that the problems of ACT Health are deep-seated, and involve issues of culture, accountability and performance - and frankly a lack of hands-on management.

It is obvious that the problems of ACT Health are deep-seated, and involve issues of culture, accountability and performance – and frankly a lack of hands-on management.

On any analysis, ACT Health is in deep trouble.

Waiting times in accident and emergency and for elective surgery have gone from the best in the country to among the worst, despite being the nation’s highest per capita in spending and in the number of administrative staff.

Bullying is rife at all levels of Canberra’s hospitals; we can’t staff medical imaging units, and their accreditation is being downgraded; maternity facilities face “unrelenting pressure”; staff in facilities management face abuse, and; in the mental health unit staff face literal beatings.

So what is the government doing? In time-honoured public-service tradition, they’ve had another restructure by splitting the Health Directorate into two separate agencies.

In her media release announcing the changes, Health Minister Meegan Fitzharris said:

…now is the perfect time to move towards a more contemporary health system. This separation will enable a clearer focus on operational effectiveness and efficiency, and improve accountability for health service delivery.

Long-time bureaucracy-watchers will be experiencing déjà vu: not only another restructure as a distraction from systemic failures, but the specifics of the proposal are familiar.

In 1996, Liberal Health Minister Kate Carnell separated ACT Health, with policy and funding responsibility, from ACT Health and Community Care, responsible for service delivery, including the hospital board.

In 2001, Labor Health Minister Jon Stanhope commissioned Mick Reid to look at the structure. In 2002 he recommended that the two-part structure be discarded in favour of a unitary health administration. The rationale sounds eerily similar to the current Health Minister’s – for the opposite decision, it would:

  • simplify the administration of the health system;
  • clarify the lines of responsibility and accountability; and
  • make the delivery of services more efficient.

Since then, the wheel has gone full circle again, with another split in 2011, and another merger by 2015.

But we’re not just going around in circles; in some respects we’ve gone backwards. In 2002, there was at least an attempt at consultation when Jon Stanhope commissioned a structural review before making the decision.

By contrast, on 15 March 2018 Chief Minister Andrew Barr received a memo from the Head of Service with a recommendation which it admitted was based on no internal or external consultation – just a “scan” of governance arrangements in other jurisdictions.

He endorsed it the same day, apparently asking no questions, seeking no information.

It was only after the decision to split the directorate that Minister Fitzharris sought any stakeholder input.

Consultation issues aside, it’s not clear how this latest restructure is “a move towards a more contemporary health system”, or offers any advantages, given the model has been tried twice before in the relatively short history of ACT self-government, and abandoned both times.

Apart from the removal of the former Director-General, the only tangible effect of this restructure identified to date (in documents obtained under Freedom of Information and otherwise) is that it will create uncertainty and anxiety for staff: some don’t know where they will be working; others don’t know if their pay and conditions will be the same; still others are wondering if they’ll have a job at all.

It is obvious that the problems of ACT Health are deep-seated, and involve issues of culture, accountability and performance – and frankly a lack of hands-on management.

It is obvious to anyone who has any knowledge of the system that these cannot be fixed by high-level structural reorganisation – so obvious that it is clear to all that this is simply an exercise in misdirection.

We must do something; this is something.

As a postscript, it is interesting to note that Mick Reid, the man responsible for the 2002 structural review which recommended the opposite of the split now being implemented, has been commissioned after the event to chair the Independent Review of Workplace Culture in ACT Public Health Services, and examine workplace bullying.

It will be interesting to see whether he identifies any connection between these (real) issues for ACT Health, and the endless cycle of deckchair rearrangements on the top deck while the navigator has lost his compass, and down below there are clouds of steam – but the propellers are barely turning.

Vicki Dunne is the ACT Shadow Health Minister.

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would trust the peanut gallery of social media commentators here on riotact before i would place any trust in the ‘healthcare management’ experts in ACT Health.

More management and bureaucrats is always their proposed solution. Just wait for the expensive review process to finish and inevitably recommend a $200k p.a. ‘commissioner for bullying in ACT Health’, $150k p.a. manager of radiology services’, and no improvement in front line staffing. real change should be lead by clinicians

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