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health & medical marketing
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private health insurance
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What does killing off COAG mean for health, climate change, transparency and much more?

Marie McInerney writes:

Some Australian health experts are concerned the decision to kill off the Council of Australian Governments (COAG) as the country’s peak intergovernmental forum will lead to far less focus on climate change and the social determinants of health, such as poverty and food security, and worryingly less transparency in national decision-making.

One health official, who asked not to be named, said the replacement of COAG with the streamlined National Cabinet that has steered Australia’s responses to the coronavirus pandemic will allow the Commonwealth Government in particular to set the agenda, and likely a very narrow one. The official told Croakey:

At the moment, this looks like a single agenda (jobs).

Not even a triad of, for example, jobs, social inclusion and environmental sustainability.

It allows for other topics to simply be excluded (for example, reconciliation, climate action etc) under cover of lack of time.”

In response to Friday’s announcement from the Prime Minster (which included news that National Cabinet had finalised the 2020-2025 National Health Reform Agreement), Croakey asked a number of health sector leaders and more broadly via Twitter for thoughts on the following:

  1. What are the main questions the replacement of COAG raises for you?
  2. What opportunities might arise? What are the concerns?

The responses and other statements from stakeholders have been been varied, though with a number raising questions and concerns around transparency, governance, representation and a limited agenda. However, the Australian Medical Association, was unequivocal in its praise for the new arrangement, after having earlier urged the replacement of the “moribund” COAG process in favour of the “more agile and cooperative National Cabinet”.

The National Aboriginal Community Controlled Health Organisation (NACCHO) and the Coalition of Peaks expressed satisfaction that Closing the Gap remains a critical national agenda under the changed arrangements – “we would expect nothing less”, they said.

But there are also concerns that the reported benefit to politicians of not having public servants in the room will lead to poorer decision-making and a process that favours short-term outcomes. Australian Healthcare and Hospitals Association Chief Executive Alison Verhoeven cautioned that “these bureaucratic manoeuvres” do little to address the serious governance challenges in our health system.

“What is needed is a structure which provides a voice at the table for primary and acute care funders and providers, the private and public sector, researchers, clinicians and consumers,” she said.

There’s also skepticism that the ‘get things done’ approach of the National Cabinet in a global pandemic will continue  when ‘politics as normal’ resumes – signalled in this article at Croakey last week from the Grattan Institute’s Stephen Duckett and Anika Stobart, who wrote:

The pandemic created a peculiar dynamic which allowed this cooperative regime to flourish, but those conditions will quickly fade as the motivations for cooperation dissipate and the old dynamic of premiers with begging bowls comes to the fore again.”

See below for more responses, and other statements issued about the changes.


The details so far

Chart tweeted by @MattDoran91, ABC political reporter

“COAG is no more,” declared Prime Minister Scott Morrison last Friday, later issuing a statement saying the inter-governmental body (Federal, States/Territories/Local Government) will be replaced by the National Federation Reform Council, led by the National Cabinet, and driven, he said, “by an initial single agenda – to create jobs”.

He released the following details:

  • During the COVID-19 period, National Cabinet will continue to meet every two weeks. In the future, these meetings will take place once a month.
  • The Council on Federal Financial Relations (CFFR), which is essentially a meeting of all Treasurers, will report to National Cabinet. CFFR will take responsibility for all funding agreements including National Partnership Agreements.
  • Once a year, National Cabinet, CFFR and the Australian Local Government Association will meet in person as the National Federation Reform Council with a focus on priority national federation issues such as Closing the Gap and Women’s Safety.

“Important taskforces will continue in areas that are critical to our National Agenda. The taskforce on women’s safety and domestic violence will continue their critical work, as will the Indigenous affairs taskforce with a particular focus on Closing the Gap,” Morrison said, adding that the new model will “streamline processes and avoid endless meetings that do not result in action”.

“This is a congestion busting process that will get things done with a single focus on creating jobs.”

See political journalist Michelle Grattan’s article at The Conversation, Scott Morrison strengthens his policy power, enshrining national cabinet and giving it ‘laser-like’ focus on jobs.


NACCHO and Coalition of Peaks

Pat Turner, CEO of NACCHO and the Lead Convener of the Coalition of Peaks

“It is good to see that Closing the Gap remains a critical national agenda under the changed arrangements – we would expect nothing less.

Closing the Gap must remain a national priority if governments are serious about overcoming the entrenched inequality faced by too many Aboriginal and Torres Strait Islander people so that their life outcomes are equal to all Australians, including respecting and strengthening our cultural heritage.

First Ministers and the President of the Australian Local Government of Australia, in full partnership with our people, must mobilise all avenues and opportunities available to them to close the gap.

The Coalition of Peaks look forward to finalising the new National Agreement on Closing the Gap with all First Ministers and the President of the Australian Local Government of Australia before the end of July. We expect that the National Cabinet and the National Federation Reform Council will have a regular role in driving and monitoring the implementation of the new National Agreement, supported by the Joint Council on Closing the Gap.

The Partnership Agreement on Closing the Gap between the Coalition of Peaks and Australian Governments, including the Australian Local Government Association, remains unchanged and is fully committed to by all Parties.”


Australian Healthcare and Hospitals Association

CEO Alison Verhoeven

While Australians have been impressed by the level of cooperation between the Commonwealth and state and territory governments in the past few months, achieved through the National Cabinet, the ceasefire in the usual inter-jurisdictional arguments has been driven by the shared interest in controlling the impact of coronavirus.

It’s unlikely this level of shared interest will be found in the longer term across the usual issues that governments need to negotiate. And worryingly, we are unlikely to have the opportunity to scrutinise those negotiations and decisions, being cabinet-in-confidence and not subject to usual Freedom of Information arrangements, at least if current practices continue.

There is scant detail on how national health policy will be governed in the future but it appears there will be a mechanism for the Australian Health Protection Principal Committee to report directly into the National Cabinet, and a national health committee presumably at ministerial level and likely to continue with sub-committees of officials.

So on the surface, this does not appear to be too different from current arrangements. Interestingly though, a Council on Federal Financial Relations will have responsibility for National Partnership Agreements, and there may be a strengthening of powers for central agencies in oversighting the funding and performance of policy areas such as health. 

These bureaucratic manoeuvres do little to address the serious governance challenges in our health system. What is needed is a structure which provides a voice at the table for primary and acute care funders and providers, the private and public sector, researchers, clinicians  and consumers. An independent body with broad representative leadership could strengthen our health system in ways we have been unable to achieve through traditional political and bureaucratic structures. 

At the Australian Healthcare and Hospitals Association, we have worked with stakeholders across the health sector to propose a blueprint for health reform, including an independent governance body (see www.ahha.asn.au/blueprint ). 

If the National Cabinet is serious about doing business in a new way, it could look to our proposal as a way to structure the membership and terms of reference for its health committee. And for the sake of democracy, opening itself to public scrutiny through Freedom of Information processes is a must.


Health official (anonymous)

OBSERVATIONS

  1. Transparency. As noted in the newspapers, COAG minutes etc were subject to Freedom of Information (FOI), whereas these ‘national cabinet’ processes are said to be confidential under usual cabinet rules. I am not a lawyer, but I do think this interpretation could be challenged, as such an amalgam of Prime Minister, Premiers, Chief Ministers etc is not in the Australian Constitution, as far as I know.
  2. Speed and efficiency are two elements of good decision-making, but so are ‘getting it right’, effectiveness and minimising unintended consequences.
  3. Some leaders have said that they quite like there being ‘no public servants in the room.’ The potential downsides of that are they may not be taking decision based on the best advice. In particular this kind of decision making favours short-term outcomes and runs the risk of not identifying potential medium and long term outcomes.
  4. National Cabinet may be fine if all jurisdictions agree, but detailed policy advice is even more important to tease out issues where not everyone agrees.
  5. Current COAG arrangements allow for ministers from each sector (health, education, housing, etc) to meet regularly as well as the DGs or CEs of their respective departments. In health, these two bodies are called COAG Health Council and the Australian Health Ministers’ Advisory Council (AHMAC). Indeed the Australian Health Protection Principal Committee (AHPPC), the main advisory committee to National Cabinet on COVID, is itself a subcommittee of AHMAC.
  6. If all COAG arrangements are suspended, this might impact disproportionately on the smaller sectors in terms of being able to share information and ideas across the federation, especially when these smaller sectors have been hit particularly hard by COVID.
  7. This same point about small sectors also applies within big sectors, that is in Health, an item on hospitals funding is going to be much more likely to be placed on the agenda than something on health of prisoners.
  8. Which gets me to my last and I think most important point, which is this new arrangement puts a lot of emphasis on a relatively short (few hours) meeting of leaders every two weeks (during COVID) or every four weeks (post-COVID), which is simply too short a time to discuss all the important issues in all the different portfolios.
    It will allow the Commonwealth Government in particular to set the agenda. At the moment, this looks like a single agenda (jobs). Not even a triad of, for example, jobs, social inclusion and environmental sustainability. It allows for other topics to simply be excluded (eg reconciliation, climate action etc.) under cover of lack of time. The existing status quo and new problematic bodies like the COVID Commission are given extra power, simply by being there now, with less opportunity for change or challenge.
  9. There has been some talk of local government being involved ‘once a year’ with National Cabinet, which I think is much less than they are involved currently under COAG.
  10. In terms of opportunity, if you can get something supported and on the National Cabinet agenda, maybe it’s got a better chance of getting supported and implemented.

QUESTIONS

  1. Has the Commonwealth Government obtained legal advice as to the status of National Cabinet under the Constitution, and can that advice be released?
  2. Has the Commonwealth Government obtained legal advice as to the confidentiality of National Cabinet deliberations and documents, and can that advice be released?
  3. What is the official status of AHPPC now that COAG has been suspended? Given that it was previously an AHMAC subcommittee and its documents subject to FOI, has that status now changed as a result of the new National Cabinet? In other words, have AHPPC deliberations now become ‘cabinet in confidence’ when previously they were not?
  4. What will be the arrangements going forward for Ministers and CEs in all portfolios to meet on a regular basis, as is desirable in a Federation?
  5. How will the National Cabinet agenda be constructed? Who will have an opportunity to put forward agenda items, and who will decide on acceptance of such items? In other words, what are the terms of reference for National Cabinet, meeting procedures etc and will these be made public?
  6. Does the new National Cabinet process strengthen or diminish the role of local government?

Professor Sharon Friel, Australian National University

Sharon Friel is Professor of Health Equity and Director, Menzies Centre for Health Governance, at the School of Regulation and Global Governance (RegNet), at the Australian National University.

What are the main questions the replacement of COAG raises for you?

Fundamentally, is this a power grab by the Feds, aiming to control the policy agenda? COAG was a diffused power structure. National Cabinet has concentrated that power.

The proposed committees are similar to the COAG councils. But as long as they have the same standing. Otherwise they have been weakened. How will these issues be deliberated given the narrow focus of the NC?

What are the new governance arrangements for intergovernmental policy development for everything other than jobs? Who gets to decide the policy focus of these other issues?

What are the mechanisms for non-state actors to feed in to the NC? How are their interests heard.

What opportunities might arise? What are the concerns?

I don’t see too many opportunities. A major concern is the very narrow focus of the National Cabinet agenda. COAG’s agenda focused on the current and future wellbeing of all Australians – that was good, it meant every policy issue had to be dealt with.

National Cabinet focuses only on jobs. Jobs are important but they must be good quality jobs. We know that in Australia, precarious employment and the associated poor working conditions are worse for your health, especially mental health, compared to no job at all. Poor working conditions are found in jobs that are more likely to employ women and lower socioeconomic groups – and so the chances of increasing social and health inequities are high.

If the National Cabinet focuses only on jobs, that keeps all other policy issues off the agenda. That is very concerning for social, environmental and health outcomes. Where are the deliberations about climate change policy, urbanisation, food systems, social welfare etc. The NC allows all of these other issues to become less important. That is a disaster for Australia’s current and future wellbeing.


Australian Medical Association

AMA President, Dr Tony Bartone, congratulated the Government “on its strategic decision to replace the moribund Council of Australian Governments (COAG) process” with the more agile and cooperative National Cabinet”, noting the AMA had called for the move last month.

“Above all, (the National Cabinet) has been informed by the best available medical advice from the Australian Health Protection Principals Committee (AHPPC), which is made up of Chief Medical Officers from the Commonwealth and the States and Territories.

The successful approach to this major health crisis sets an example for future responses to other areas of policy and politics that affect all Australians. Put simply – listen to the experts.

 Coalition and Labor Governments have worked in unison to provide the best possible responses to help their local communities.

 They have acted quickly, cooperatively, and effectively to protect the health of the Australian people. “There has been a minimum of red tape and bureaucracy, and a minimum of dispute.

 This is what good government can achieve.

 More than ever, we need to continue with this level of cooperation going forward. We need to ensure ongoing patient care and easy access to care in a period of significant transformation and enormous challenges for our health system as we come out of COVID-19.”


National Rural Health Alliance

CEO Gabrielle O’Kane

“It’s too early to tell what the abolition of COAG and the continuation of the National Cabinet means for rural health. On the face of it, it looks like good news that the states and territories will meet more regularly, and we welcome the establishment of a standalone rural and regional subcommittee under the National Cabinet framework. 

When it comes to the delivery of quality health care in rural and regional Australia, it’s vital that the Australian Government and the states and territories work together cooperatively, so we welcome any improvements to the way this happens.

But we would also urge the new National Cabinet to not just focus on health in isolation, but to consider social determinants of health as poverty and food security.  

The National Cabinet’s focus on jobs is welcome and much-needed in the wake of COVID-19. We hope that this focus on jobs includes ensuring we get jobs back into rural, regional and remote Australia and includes addressing the maldistribution of health professionals in these areas.”


Professor Andrew Wilson, University of Sydney

Director of the Menzies Centre for Health Policy, School of Public Health, University of Sydney.

Quick thoughts:

  1. There is no legislative basis for governance other than by national or state/territory governments and their defined responsibility. Consequently we need to keep inventing arrangements to do the things that require collaboration. This has a downside of creating institutional instability but the positive is that the mechanism can be refreshed and better aligned with contemporary needs and personalities. 
  2. Leaders don’t just meet and make decisions – depending on the complexity of the issue there maybe substantive background and negotiation that has to happen. We don’t know what those mechanisms will be yet.
  3. Under COAG much of this negotiation and background paper development was not publicly transparent. Any new arrangement should aim to be more transparent. This will be even more important if the new Cabinet will hear from outsiders so that we don’t see even greater influence of lobbyists and interest groups.
  4. There will be a continuing need for portfolio collaboration – for example, or health – both at administrative and ministerial level – I think this is intended to continue but it is not yet clear how.
  5. Some of the major issues we face nationally are complex and wicked, for example Indigenous health, inland water, climate change – this is what we need national leadership on long term.

Australian Local Government Association (ALGA)

In a statement, ALGA President David O’Loughlin said the Association is very disappointed to not be part of the National Cabinet structure as it was with COAG.

“The National Cabinet is continuing with a broader remit than the health response for which it was first established, and ALGA, as the national voice of Local Government in Australia, must be a foundation member – just as we were of COAG.

ALGA has been a Council of Australian Governments member since its inception in 1992, representing local communities, contributing to national policy development, and partnering with other levels of government to get the job done.

Ranging from infrastructure and road safety policy to Closing the Gap, reducing violence against women, and embracing the waste export ban, ALGA has listened to grassroots government and influenced decision-making and implementation at the peak decision-making level for the betterment of the nation for nearly 30 years.

The priority was on the three levels of government working together for the benefit of communities.

In this new environment, with the coronavirus pandemic largely suppressed and where the emphasis is now shifting to economic recovery, it has never been more vital for the three tiers of government to be aligned to support and facilitate jobs growth and to get our economy back on track.

We would have expected the new architecture outlined today by the Prime Minister to fully reflect local government’s role in our federation structures.

During the coronavirus pandemic, every council nationwide has stepped up to play an important role in containing the virus and supporting the community to minimise the social and economic impacts.

In many ways, we were the ‘boots on the ground’, providing health inspections and community education, monitoring compliance, supporting businesses in difficulty, powering on with development assessment and business networking, keeping in touch with vulnerable citizens in isolation, delivering meals and shopping, even library books, to make our communities as safe and connected as possible during difficult times.”

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