Introduction by Croakey: The impending retirement of Professor Brendan Murphy as Secretary of the Department of Health and Aged Care is an opportunity to reflect on the types of people, policies and structures that might help address the wide-ranging challenges we face.
Croakey’s managing editor Alison Barrett has surveyed health leaders for their views about the qualities they’d like to see in the next Secretary, the type of expertise required, what their priorities should be, and the risks and opportunities ahead, as well as providing some advice for the interview panel.
Below is our second story in a series reporting on the survey’s findings, featuring comments from Alison Verhoeven, Professor Sharon Friel, Dr Martin Low, Peter Breadon and Jennifer Doggett.
They highlight the importance of innovation, new approaches, systems thinking, prevention and public health, and integrity and transparency. In short, we need a ‘burger with the lot’, suggests Breadon.
Read the first article here: It’s a critical time for health leadership. So who should replace Brendan Murphy?
Prioritise innovation and new approaches
Alison Verhoeven, health policy analyst, Director of Croakey Health Media, former Chief Executive of the Australian Healthcare and Hospitals Association
Department secretaries are at the interface between policy and politics, and therefore must be highly skilled at guiding policy development, communicating it without fear or favour to their minister and the government of the day, and then leading the implementation of decisions taken by government. The Royal Commission into the Robodebt Scheme highlighted just how important it is for secretaries and their senior executives to provide frank, fulsome and well-informed advice to ministers, notwithstanding the political pressures which may exist. Sensitivity, courage, vision and determination are some of the qualities which might be expected in the next Secretary.
I hope the next Secretary has the expertise to negotiate a new approach to the funding and provision of both health and aged care in Australia. The Royal Commission into Aged Care, the COVID pandemic, a struggling primary care sector, and public hospital funding arrangements which are barely adequate demonstrate the urgent need for a changed approach to health and aged care policy. There are many stakeholders seeking to influence policymakers and politicians, and the Secretary will be key to ensuring that policy decisions will not simply be a sop to the loudest voices, but will actually benefit and drive positive change for health and aged care consumers.
Rethinking the way primary care is funded and delivered, and renegotiating the public hospital funding arrangements with the states and territories, have to be at the top of the list. Ensuring the recommendations from the Royal Commission into Aged Care are implemented must also be a priority. Understanding and responding to the lessons from the COVID pandemic must be high on the list, as must the development of policy to support the health sector as it responds to climate change.
With any appointment of this nature, there is a choice between steady hands and public sector experience, and fresh new thinking. Given the very significant challenges in the health system, innovative approaches are urgently required. This may be an opportunity for the government to bring in a new type of leader – one who is not beholden to any particular professional group, who appreciates the challenges facing the health system, and who has the strength and courage to do things differently.
The risk of appointing someone from outside of the health bureaucracy is the potential loss of knowledge, relationships and stability. This needs to be weighed against the risk of appointing someone from within the current bureaucracy who will just bring more of the same to the role.
Tips for the interview panel
Think about the tipping point at which the Australian health and aged care sector currently finds itself. Is the person you are interviewing able to bring new vision to the Department, while meeting the very significant leadership requirements of the role?
Systems thinker with a focus on innovation
Professor Sharon Friel, Professor of Health Equity, Director, Menzies Centre for Health Governance, School of Regulation and Global Governance, Australia National University
Compassionate; embeds principles of social equity and effectiveness across the institution; not driven by efficiency arguments; evidence informed; truly inclusive; respectful of different knowledge systems.
Systems thinker; able to equally embrace a social and biomedical model of health; understands and believes in intersectoral action; good negotiator across government departments (essential for health equity).
Ensure a much greater focus on prevention; take the wider determinants of health and health inequities seriously and reach beyond the department of health; make climate change and health a priority but not just focusing on the health system; embed a wellbeing economy; set up a governance structure that is inclusive, diverse, cross departmental and cross sectoral.
Be a world leader in health promotion and disease prevention; actually reduce disease burden and health inequities.
Tips for the interview panel
Don’t give the job to your mate.
Who would you most like to see in that position?
Not an older white man; a non-medic.
Integrity and transparency to rebuild trust
Dr Martin Low, Rehabilitation Specialist based in Sydney, New South Wales
- high moral and ethical standards
- a good listener and communicator (at all levels)
- a team player
- modest but realistic
- an optimist
- real-life experience as patient, consumer, especially if from a position of disadvantage including non-English speaking background, CALD, First Nations, gender and poverty
- medical/nursing (but not necessarily exclusive)
- high clinical acumen
- academic achievements eg PhD
- admin experience and expertise
- experience in advocacy and political engagement
- COVID – emergency, vaccinations, mitigations
- Medicare – bulk-billing rates, Medicare rebates
- Residential Aged Care – staffing (levels and qualifications), funding, accreditation, integration and holistic care (GP, medical specialists, Allied Health, hospitals, oral health)
- Quality and equity of care across regions
- To improve the health of the nation and win back the trust of the community.
- Ongoing cynicism and mistrust arising from the previous appointments and performances of recent Chief Medical Officers and current Secretary.
Tips for the interview panel
- As Health Minister statement points out, must be merit-based.
- Don’t appoint someone for political purposes or reward previous political subservience.
- Need clear evidence of successful applicant’s achievements and real clinical improvements, an applicant who acts with integrity and transparency.
A ‘burger with the lot’
Peter Breadon, Health and Aged Care Program Director, Grattan Institute
It’s an enormous job and moment full of risk and opportunity, so the new Secretary will have to be a ‘burger with the lot’: a bold reformer who can forge strong partnerships, manage risk, and protect and develop their staff.
The health and aged care systems are close to breaking point because so many structural reforms are long overdue. This Secretary will get an historic opportunity to help achieve those reforms. The Health Minister has signalled that he’s up for challenging changes to primary care funding and workforce.
There is a deal on hospital funding and reform with the states to negotiate. And the Aged Care Royal Commission’s recommendations remain a massive challenge, and a massive opportunity to improve the system.
To help get these reforms over the line, the new Secretary will need to be creative, think big and take risks. It will also be crucial to manage risk well, particularly by making sure the department is monitoring implementation and adapting quickly to inevitable setbacks.
This reform agenda needs partnerships with states and the private sector to succeed. That will require shrewd negotiation, but also the ability to find common ground, develop trust, and be a persuasive champion for change.
Finally, supporting and building up the department will be crucial. A capability review back in 2014 found deficiencies in several areas that will be key to delivering the government’s agenda. It highlighted the need to develop strategic capability, a culture that embraces and manages risk, and purposeful engagement with stakeholders.
That was almost 10 years ago, and there has no doubt been progress, but many of these areas will still need work. And given the huge challenges the department has lived through during the pandemic, and with mountains of important and challenging work ongoing and coming up, protecting staff wellbeing should be a big focus too.
Priorities and opportunities
There are a lot of priorities and opportunities, and they span the full continuum of care. Leaders are often advised to only focus on a small number of things. I think the Secretary should try to make progress on all of the things listed below. But if I had to choose three, it would be workforce, primary care reform, and improving hospital productivity, with an eye to system integration when tackling all three.
System enablers – Workforce and digital capabilities underly pretty much everything. On workforce, Australia needs a pipeline that better matches workforce supply with demand, bolder policies to get workforce where they’re needed most, and reform to unlock the skills of people who are not working at the top of their scope of practice. We also have a long way to go in improving clinical information sharing by providers, and in making health information accessible and useful for patients.
Building a high-functioning primary prevention system with the new Centre for Disease Control at its core – Australia is way behind on prevention, and this is key to the nation’s long-term health and wealth, and the sustainability of our health system.
Primary care reform – Realising the Strengthening Medicare Taskforce’s recommendations, and making sure they are transformative, not watered-down.
Improving hospital productivity – Hospital demand and cost keeps growing. Without an effective national strategy to divert demand and improve productivity, access and quality of care will ultimately suffer.
Delivering the Aged Care Royal Commission recommendations – this will be complex to coordinate and deliver, and, like with primary care reform, it will be important to ensure the spirit, not just the letter of reforms are achieved.
Prioritise public health expertise
Jennifer Doggett, Croakey editor, health policy consultant and Fellow at Centre for Policy Development
Qualities and expertise
I think the Secretary needs a range of skills – internally they need to be able to manage a large department with staff spread across the country in multiple offices, plus deal with the fallout of COVID including stress, burnout and trauma. Externally, they need to be able to engage with stakeholders and work collaboratively with the Minister and broader government.
No single individual is going to have all the skills and qualifications needed – but I would make a case for the following:
1) public health expertise – given the impacts of COVID and climate change and the need to increase our focus on preventive health, I think it is important to have someone with experience in public health.
2) health economics – this underpins the work of the health portfolio but expertise in the department is limited. An understanding of health economics is particularly important in the context of Medicare reform and a secretary with expertise in this area could compensate for the lack of knowledge within the department more generally.
3) connections with under-served communities – a key priority in the health portfolio should be to address Australia’s poor record of health equity. Lived experience or a personal or professional connection with groups currently under-served by the health and aged care system (Aboriginal and Torres Strait Islanders, people with disability, people with mental illness, rural and regional communities, low SES communities etc) would help inform the department’s advice to government on this important issue.
Stay tuned for more perspectives in the next article in this series.