What’s wrong with Health? Lessons from capability review


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The Department of Health has nowhere near the strategic policy capability it needs. While it has a strong track record of delivery, overworked and unappreciated staff need a break.

The Department of Health is a long way from where it needs to be, according to its recent capability review, which found it in dire need of the capacity to produce an overall strategic policy for Australia’s federated health system. That doesn’t come as a surprise to people who understand how the department works.

The process of developing a white paper on reform of the federation, the likelihood of the current fiscally restrained environment continuing and the High Court’s decision on the legitimacy of federally funded school chaplains — which could have implications for hospitals — are all listed as factors that presage a need for a transformation of the department and its role. The reviewers say the federation reform process, which progressed on Friday with the release of an issues paper on roles and responsibilities in health, is “a significant opportunity for the department to exercise strategic influence on future health system thinking and strategy”.

The department has been highly dependable when it comes to delivering on complex reforms and projects it has been tasked with, but the Australian Public Service Commission’s review team says its “strong focus on tactical, transactional and reactive delivery distracts from the development of a proactive, long-term and system-wide strategy”.

Of the 10 capabilities assessed, two are in urgent need of attention: there is almost nothing in place to motivate Health’s overworked and unappreciated staff, and it lacks an overarching “outcome-focused strategy”. UNSW associate professor of medicine and health policy expert Dr Tom Keating, who has considerable experience working with the department, says the review is “a pretty substantial indictment of the organisation”, but also a valuable tool for its leaders.

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