Pa­tients are ill served by re­volv­ing door for health CEOs

The Weekend Australian - Travel - - Health - MIKE DAUBE

TRA­DI­TION has it that min­is­ters are ephemeral crea­tures who come and go, while bu­reau­crats — es­pe­cially at se­nior lev­els — last for ever. Min­is­ters are there for the short term, to de­ter­mine pol­icy, set di­rec­tions, make key de­ci­sions and pro­vide po­lit­i­cal lead­er­ship. De­part­men­tal heads pro­vide or­gan­i­sa­tional lead­er­ship, ex­pert ad­vice and con­ti­nu­ity.

In the West­min­ster sys­tem, as de­scribed by one text­book of by­gone years, ‘‘. . . few things are so per­ma­nent as the ten­ure of es­tab­lished posts in the Civil Ser­vice’’. Fur­ther, ‘‘ this per­ma­nence of the es­tab­lished Civil Ser­vice . . . is of in­es­timable ad­van­tage. With­out it, we might have to en­dure a civil ser­vice as am­a­teur­ish and tran­sient as many min­is­ters are’’.

That may have been true once, but no longer — and cer­tainly not in health.

Fed­er­ally, Tony Ab­bott — no ama­teur — re­placed Kay Pat­ter­son in Oc­to­ber 2003, and last year claimed vic­tory at the Na­tional Press Club, say­ing: ‘‘ Largely neu­tral­is­ing health as a po­lit­i­cal is­sue has been one of the Gov­ern­ment’s big po­lit­i­cal achieve­ments’’.

Around the states and ter­ri­to­ries, the vet­eran health min­is­ters are Vic­to­ria’s Bron­wyn Pike, who has held her po­si­tion since Novem­ber 2002 and West­ern Aus­tralia’s Jim McGinty, ap­pointed in June 2003. They are fol­lowed by Queens­land’s Stephen Robert­son (July 2005), South Aus­tralia’s John Hill (Novem­ber 2005), the ACT’s Katy Gal­lagher (April 2006), Tas­ma­nia’s Lara Gid­dings (May 2006), the North­ern Ter­ri­tory’s Chris Burns (Septem­ber 2006) and NSW’s Reba Meagher (April 2007).

Far from am­a­teur­ish, some at least are po­lit­i­cal heavy­weights ap­pointed to give health the pro­fes­sional po­lit­i­cal skills this huge and high-profile port­fo­lio needs. Their av­er­age term is 24 months.

Com­pare the longevity of min­is­ters with that of their CEOs. The long­est-lived sub­stan­tive health CEO is Uschi Schreiber in Queens­land (sub­stan­tive ap­point­ment July 2005), fol­lowed by Neale Fong (West­ern Aus­tralia, Oc­to­ber 2005), Tony Sher­bon (South Aus­tralia, Au­gust 2006), Mark Cor­mack (ACT, Novem­ber 2006), Fran Thorn (Vic­to­ria, March 2007), David Ash­bridge (NT, March 2007) and Deb­ora Pi­cone (NSW, July 2007). Tas­ma­nia cur­rently has an Act­ing CEO.

Some had acted in their roles be­fore for­mal ap­point­ment, but the av­er­age du­ra­tion of sub­stan­tive ten­ure in cur­rent state and ter­ri­tory CEOs is just over nine months.

Or­gan­i­sa­tional change can be re­fresh­ing and ben­e­fi­cial, but surely chang­ing health CEOs with this kind of fre­quency is too much of a good thing.

The rapid turnover of CEOs means that health de­part­ments around the coun­try are sub­ject to reg­u­lar dis­rup­tion and re­or­gan­i­sa­tion, while lack­ing the sta­bil­ity, con­ti­nu­ity, or­gan­i­sa­tional wis­dom and sub­ject ex­per­tise at the helm that once de­fined the pub­lic ser­vice. Ex­pert ad­vice may now come from the min­is­ter to the CEO, not the other way.

The 2006 WHO World Health Re­port shows that Aus­tralians’ life ex­pectancy, at 81, ranks us be­hind only Ja­pan. Our health sys­tem must take some of the credit for this, and is out­stand­ing by in­ter­na­tional stan­dards.

But health is con­stantly in the pub­lic eye. Our in­creas­ingly well-in­formed com­mu­nity de­mands ever bet­ter, more im­me­di­ate and more prox­i­mate care. Bud­gets are al­ways un­der pres­sure, head­lines about wait­ing lists and emer­gency de­part­ments are in­escapable, work­force short­ages are a con­stant, and the age­ing pop­u­la­tion cre­ates a range of de­mands for which there are no easy an­swers.

Health pro­fes­sion­als and con­sumers are adept at press­ing their cases through the me­dia, and there is in­creas­ing recog­ni­tion of the need to pro­vide a dif­fer­ent or­der of at­ten­tion to dis­ad­van­taged groups, par­tic­u­larly in ar­eas such as in­dige­nous and men­tal health.

CEOs face all this and the re­spon­si­bil­ity of man­ag­ing tens of thou­sands of staff and over­see­ing around 25 per cent of gov­ern­men­tal ex­pen­di­ture, while sub­ject to the many con­straints of work­ing within gov­ern­ment. Fur­ther, gov­ern­ment health sys­tems face a level of both scru­tiny and ex­pec­ta­tion that few, if any, or­gan­i­sa­tions could with­stand.

Small won­der that state and ter­ri­tory health ad­min­is­tra­tors face prob­lems, make mis­takes, be­come weary of the con­stant 24-hour, sev­en­day pres­sures and move on to a saner world.

While health at the Com­mon­wealth level is a large and com­plex port­fo­lio, where the re­doubtable Jane Hal­ton has been de­part­ment Sec­re­tary since Jan­uary 2002, there is much less by way of di­rect op­er­a­tional re­spon­si­bil­ity. Lo­cal com­mu­ni­ties and me­dia un­der­stand­ably fo­cus on the peo­ple run­ning lo­cal ser­vices. State and ter­ri­tory CEOs feel the heat.

As ever in health, there are no easy an­swers. Health sys­tems will re­main high-profile for the fore­see­able fu­ture, and it would be idle to blame the me­dia for their in­ter­est in an area that is so im­por­tant to the com­mu­nity.

But surely gov­ern­ments must look to find ways of mak­ing the key po­si­tions in health more at­trac­tive and less short-term — oth­er­wise they will find few high-cal­i­bre peo­ple will­ing to take on th­ese roles.

In fifth cen­tury Athens, the Athe­nian as­sem­bly — all males over 18 — ap­pointed of­fi­cials and au­dited them at the end of their one-year term of of­fice. Per­ceived poor per­for­mance re­sulted in penal­ties rang­ing from fines and ex­ile to death. Some of our health CEOs might feel that the world of the ad­min­is­tra­tor has not changed much. Mike Daube is pro­fes­sor of health pol­icy at Curtin Univer­sity of Tech­nol­ogy. He was Di­rec­tor-Gen­eral of Health for West­ern Aus­tralia from Oc­to­ber 2001 to Jan­uary 2005

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