Sunday, December 13, 2015
This Is Certainly Part Of Why Australian E-Health Is In Such A Mess. Corporate Memory Matters!
This appeared a few days ago.
Date December 7, 2015 - 8:43AM
There's no bigger question in politics today than why our governance has become so bad. Why our discussion of policies is so superficial and how any government could come up with so many ill-considered policies as we saw in Tony Abbott's first budget.
No doubt the answer has many parts, but the more I think about Laura Tingle's Quarterly Essay, Political Amnesia, the more I think she's identified a key but neglected part of the explanation.
She says our politicians and public servants have forgotten how to govern. In particular, the public service has lost much of its policy expertise – including its memory of what works and what doesn't.
And the politicians have forgotten that they can't do their job to the electorate's satisfaction without the guidance of an expert public service. That's what the bureaucracy is for.
Relations between the politicians and their bureaucrats are so little discussed by the media that I suspect many people still have a Yes, Minister view of what goes on in Canberra: the public servants pretend to be the servants of the politicians, but they're actually the bosses. Government is run by a bunch of Sir Humphreys who manipulate their ministers, pollies who come and go without making much difference.
It did indeed work like that in Canberra as well as Whitehall, but that's been becoming less and less true since the 1970s. By now it's the very opposite of the truth. These days, ministers and their private office advisers have most of the power and their departments have surprisingly little.
I might have said Treasury was the major exception to the new rule, were it not for the unprecedented disaster of the 2014 budget.
No influential Treasury and Finance departments could have handed their political masters such a booby trap. It had to be largely the pollies' and their advisers' own incompetence.
The move from Yes, Minister to Be It On Your Own Head, Minister has come in stages, starting with the decision of the Whitlam government to allow ministers a much greater personal staff of (unaccountable) policy advisers and media managers. The Fraser government perpetuated this "reform" with enthusiasm.
The Hawke-Keating government's main contribution was to replace "permanent heads" of departments with department secretaries on five-year contracts. After five years heading one department you'd be moved to heading another.
Thirty-odd years of this and now senior bureaucrats rarely stay long in any department, but climb the ladder by moving from department to department.
They've gone from being long-experienced experts in particular policy areas to "universal managers". I may not know much about health or finance, but I know how to run a department. Great.
Fortunately, there are signs Malcolm Turnbull has learnt this lesson. He has just appointed his former department secretary in Communications as his chief-of-staff, and brought sacked Treasury secretary Dr Martin Parkinson in from the cold to be secretary of Prime Minister and Cabinet.
He's too smart to think he doesn't need the bureaucrats' advice.
Ross Gittins is the Herald's economics editor.
The full article is found here:
There is a great deal that is very true in this article.
To the issues raised by Ross Gittins I would raise the issue of over dependence on consultants. Just think about how many of the consultants who have worked, and learned, with either DoH or NEHTA are still involved and able to advise and warn as new policy is considered, rather than now being elsewhere and not involved in policy formation. I also suspect the present Secretary of the Department of Health might have offered better advice on e-Health had they been steeped in the Health sector for many years rather than being only recently joining the sector.
We would never have found ourselves with a PCEHR I reckon if the ‘corporate memory’ and expertise in DoH especially had been retained for the long term. We may also have not had such emphasis on technical matters rather than clinical value of some of the earlier experts who had been involved with NEHTA has been retained for longer and had more influence - but that is maybe not as certain.
Any real understanding of the last two decades of Australian e-Health would have suggested very different approaches to how the PCEHR was planned and implemented.
For those interested you can view some of the historical documents here:
Posted by Dr David More MB PhD FACHI at Sunday, December 13, 2015