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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.

Broken public service leads to broken governance

Date December 7, 2015 - 8:43AM

Ross Gittins

The Sydney Morning Herald's Economics Editor

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:


Anonymous said...

I have been having the same conversations in the ehealth arena for nearly 20 years - Howard Rudd Gillard Rudd Abbott Turnbull and their Departmental Secretaries and assorted underlings. Sadly, the Feds are nowhere near as bad as their S&T counter-parts. And I so enjoy the new-comers, who have managed to convince themselves that they have all the 'new solutions' for problems they only half understand! Amazing! I'm STILL having exactly the same conversations now that I had 20 years ago. Nothing learned, nothing new, not just amnesic, but wrong-headed (not to mention boring).

John Scott said...

I agree with David's comments.

I would add the following:
1. Government has an over reliance on process as opposed to whole-of-system thinking.
2. Since no system assumes its own failure, there is confusion and unpredictability for those trying to work from within the system when something goes wrong. Think Pink Batts; think PCEHR.
3. Government has a critical role to play in society; that role is changing; government needs to be more open to re-defining its role and the manner by which collaboration is achieved and sustained over the long-term. The governance of the eHealth initiative is a case in point with the private sector of health care effectively excluded from consideration.

Anonymous said...

December 15, 2015 9:15 AM " The governance of the eHealth initiative is a case in point with the private sector of health care effectively excluded from consideration. "

It isn't the private sector that was excluded, it was everybody. Consumer, industry, academia, clinicians. The whole thing has been driven by bureaucrats and technocrats with cash to splash on glossy consultancy advice to give a veneer of independent thinking. They are so clever that there was nothing that possibly could go wrong as they refashioned Australia's health system with a billion or two of tax payer money, and the white heat of technology. I'm thinking a Nobel prize is in order for the architects of the PCEHR? And rewards aplenty must be in order for all those who played the game, manning the barricades as the rest of us poor supplicant sods tried to find a way in, and taking fat pay checks whilst they did. How do they sleep?

Anyway, its christmas, so enough. I'm sure next year will be very different ...