Patients are ill served by revolving door for health CEOs
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