Introduction by Croakey: Primary healthcare reform, health promotion, equity, workforce development and a rapid transition to sustainable, climate-resilient healthcare must be priorities for the successor to Professor Brendan Murphy, who is due to retire on 6 July as Secretary of the Department of Health and Aged Care.
The suggestions emerged from a survey conducted by Croakey’s managing editor Alison Barrett, who asked 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.
Adjunct Professor Judith Dwyer, College of Medicine and Public Health at Flinders University, said the electorate is looking to the Government for real improvement in this critical portfolio.
“The Government is engaged in the very difficult task of rebuilding capability in the national public service, including in the health and aged care portfolios,” she said. “The new Secretary must be able to make a major contribution to this rebuilding if the Government is to retain its reputation as the better steward for health and aged care.”
Below is our third and final story in a series reporting on the survey’s findings, featuring comments from Professor Andrew Wilson, the Aboriginal Medical Services Alliance Northern Territory (AMSANT), Dr Gemma Crawford, Rebecca Zosel, Professor Judith Dwyer, and Dr Genevieve Cowie.
Team matters
Professor Andrew Wilson, Co-Director of the Menzies Centre for Health Policy and Economics at the University of Sydney, and Co-Director of the NHMRC Partnership Centre on systems perspectives on prevention of lifestyle-related chronic disease
While ‘Health and Aged Care’ sounds like a relatively defined government portfolio, the way the Australian health system is structured means it is very complex.
The Secretary leads a portfolio that is continuously dealing with immediate issues – for example, in aged care and workforce – in shorter term issues in funding and access to private healthcare, which includes much primary medical care and mental health, and longer-term issues such as funding share with the states and territories and adequate funding of prevention of chronic disease.
The interactions for day-to-day business include those with Services Australia and in the public health space inter-sectoral interactions and coordination with portfolios as diverse as agriculture, trade, transport, and of course finance and treasury.
Many of the issues arise from policies, programs and processes from bygone eras before the digital revolution, and the growth of health corporations. But achieving change is hard with powerful vocal stakeholders and armies of lobbyists.
When I think of the assistant ministers working with Minister Butler, just managing ministerial business is complicated. And then there is the challenge of doing nationally, important in a federation – eight fellow secretaries each with their own political masters.
It is impossible for the Secretary to be across everything all the time. So a key attribute of a Secretary is being able to lead and manage in complexity. They need to be good at identifying their own strengths and ensuring they have a management and leadership team that fill in the gaps including being good problem solvers.
They need a track record of fostering sustainable teams to tackle enduring problems to find and implement longer term solutions. They need experience in working with but effectively negotiating outcomes with external stakeholders.
My preference, although it clearly isn’t common, is that they have experience at senior management level in the health system.
On top of all that, they need to articulate and demonstrate a commitment to improving the Australian healthcare system to achieve better, more equitable patient care, and to proactively improving the health and wellbeing of all Australians.
Not much to ask really!
Equity, evidence and primary healthcare
Aboriginal Medical Services Alliance Northern Territory (AMSANT)
Qualities
- Commitment to equity and fairness.
- Commitment to an evidence-based approach.
- A person who demonstrates cultural responsiveness and respect to Aboriginal and Torres Strait Islander people.
- A person who can listen to diverse views.
Expertise
- Broad health system expertise including deep understanding of centrality of primary healthcare to an effective health system.
- Public health expertise or at least understanding of public health principles and the impact of social and cultural determinants of health on health outcomes.
- System reform expertise.
- An understanding of Aboriginal health.
Priorities
- Improving equity of health outcomes in Australia including through health system reform.
- Addressing key workforce shortages and addressing maldistribution of health professionals.
- Addressing issues with general practice remuneration and reduction in GP registrars entering training particularly in rural and remote areas.
- A commitment to ensuring that Aboriginal community controlled health services (ACCHSs) are supported to play their vital role in closing the health gap including through:
- Ensuring a stable, well-trained primary healthcare workforce for Aboriginal community controlled health services
- Ensuring funding for ACCHSs is sufficient to meet needs in a time of rapidly rising inflation and growing health needs.
- Supporting and advocating within Government for concerted action to address the underlying determinants of health.
Opportunities
- Ongoing commitment to Close the Gap principles including expansion of community controlled health services and appropriate resourcing of the sector commensurate with the high and growing health needs.
- A new approach to primary healthcare reform with a long term view and a commitment to improving outcomes and equity of the system.
- A long-term approach to solving entrenched and worsening health workforce challenges, and addressing severe maldistribution of health professionals that is particularly affecting very remote areas.
Risks
- A narrow focus on budget repair rather than taking a long term view of health challenges.
- Risk aversion to undertaking systemic health reform and addressing maldistribution of health professionals.
Tips for the interview panel?
Inclusion of a key Aboriginal health leader on the panel.
Commitment to prevention and health promotion
Dr Gemma Crawford, National President, and Rebecca Zosel, Executive Officer, at Australian Health Promotion Association
It would be fantastic to see someone with strong expertise and experience in health promotion and illness prevention as the next Secretary of the Department of Health and Aged Care. Health is our biggest asset, and there is no wealth without health.
As Australia and indeed the world moves beyond measuring success and progress by GDP to recognise the pivotal role of the nation’s health and wellbeing, we need someone in this role that understands the range of determinants on health that often sit outside of the health system, and who can drive a renewed focus on promoting health, preventing illness and building a healthy, equitable Australia.
Health promotion’s role has never been so significant.
Real improvements needed
Adjunct Professor Judith Dwyer, College of Medicine and Public Health at Flinders University. Former Director of Research in the Department of Health Care Management in the College of Medicine and Public Health, and a former CEO of Southern Health Care Network in Melbourne.
Qualities
I’d like to see someone who can ensure that there is national stewardship for the health and aged care systems, which has been sorely lacking particularly for aged care, where it seemed as if the Commonwealth thought being an efficient purchaser of particular services was almost all it had to do; as if it didn’t recognise it was in charge of a system that needed to have the right infrastructure, workforce, policies etc as a system, rather than as a set of contractors. COVID gave the lie to that, but what a terrible pathway for change it was.
Expertise
They need to know how governments work, and how the health and aged care systems work. We have the foundations of a good system, but it is creaking under its current load. The new Secretary needs to believe that Australia can do better for its people.
Priorities
Building an approach to care for the ageing that is fit for current needs and priorities.
Re-building the primary care system for all of us, and especially for people who are managing ongoing conditions and need ready access to expert GPs and related services.
Re-building the analytical capabilities of the Department itself, and its expertise base, so that it is possible for good policies to be developed that can feasibly be implemented throughout the systems.
Focusing on public health, not just for the next pandemic, but also so that, for example, the national policy goals in HIV prevention and control can be met; and all Australians have access to safe drinking water.
Opportunities
I think the electorate is looking to the Government for real improvement in this critical portfolio. The priorities outlined above are opportunities to make a tangible contribution to national wellbeing.
Delivering on them will require a strong focus on workforce development and optimal deployment; and on the use of modern techniques, including, for example, telemedicine which has huge potential in timeliness, efficiency and outcomes for patients. These system infrastructure things require national leadership.
Risks
The Government is engaged in the very difficult task of rebuilding capability in the national public service, including in the health and aged care portfolios.
The new Secretary must be able to make a major contribution to this rebuilding if the Government is to retain its reputation as the better steward for health and aged care.
Reorient towards prevention and sustainability
Dr Genevieve Cowie, Convenor of the Research, Education and Advocacy Committee of Doctors for the Environment Australia, a specialist public health physician with a background in public health policy and health protection, including environmental health.
Qualities
A compassionate and ethical systems thinker who understands the broader context of health and healthcare.
The ability to work with and understand a wide variety of people from different backgrounds from across the country.
The ability to take the hard decisions needed to prepare the health system for further shocks, including those caused by our changing climate.
Expertise
Public (including preventative) health together with its evidence-base and a wider understanding of the social, environmental and commercial determinants of health, most of which lie outside the healthcare sector. This will assist in inter-sectoral partnerships and advise to government that will improve the health and wellbeing of all Australians.
A firm understanding of the entire health system is needed, along with a deep appreciation of the health impacts of climate change and the urgent need to prepare the health sector for them.
Training and experience in hospital administration alone will not be enough. The Secretary will need to understand the importance of supporting general practice/primary care services and their pivotal role within the health sector. General practice is under immense strain. It’s poorly resourced financially, many GPs are wearing out and there are very few trainees coming through. If patients don’t have their problems dealt with at their local GPs, they end up presenting to overworked hospital emergency departments with usually more advanced disease. This will result in more suffering, more cost to the health sector- and it also much more carbon-intensive.
Experience in working in government, its processes and legislated responsibilities would assist the new Secretary in quickly becoming effective in their work.
Priorities
To provide policy direction to rapidly improve the climate resilience of all parts of our healthcare system. Healthcare needs to be able to cope more effectively with increasing extreme weather events and the toll that they take on people and infrastructure, including on healthcare workers and facilities themselves.
To provide policy direction to the Australian healthcare system for a rapid transition to environmental sustainability. This will reduce the harms to people and our planet caused by the high carbon footprint of the healthcare sector which is a hefty seven percent of the nation’s total emissions.
To reorient the health system towards preventing illness and keeping people well – this will promote and enhance the health and wellbeing of all Australians, reducing human suffering along with the need for costly, curative and carbon-intensive healthcare.
Groups who are disproportionately affected by poor health outcomes need to be prioritised, such as those in low socioeconomic groups, Aboriginal and Torres Strait Islanders, older people and those with disabilities. Our changing climate also disproportionately affects such groups, aggravating existing social inequity.
Opportunities
A fresh start and new direction to bring our health system into the 21st century through ambitious policy to build the system’s climate resilience whilst also reducing the harms that the healthcare sector itself is causing to our people and planet.
Risks
Continuing with more of the same will increase the human and economic cost of our healthcare system. Our healthcare system will be unprepared for further public health emergencies, as it attempts to manage the ongoing COVID pandemic along with increasing climate-related disasters.
Tips for the interview panel
Look for broad training and experience in public health, administration and government experience along with a firm understanding of the public health implications of the current climate emergency.
Who would you most like to see in that position?
Prof Brett Sutton, Victoria’s Chief Health Officer
Prof Paul Kelly, Chief Medical Officer of Australia
Prof Michael Kidd, one of Australia’s Deputy Chief Medical Officers.
Note from Croakey: We asked the Deparment of Health and Aged Care if Professor Brendan Murphy would like to contribute an article to this series, including his reflections and recommendations. The offer was declined.
Read the first article in this series here: It’s a critical time for health leadership. So who should replace Brendan Murphy?
Read the second article here: Looking for fresh leadership in health and aged care.
