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Email 29 November 2006

Mr Tony Morris QC

Patel 'fall guy' for bureaucrats

I noted with interest your reported critical comments about Queensland Health, and would like to provide a little feedback.

My interpretation of an article in which you were quoted: Tony Morris QC has labelled Jayant Patel (who is wanted on manslaughter charges) as a scapegoat for Queensland Health. Bureaucratic over-administration was at the heart of the problem. He criticized Queensland Health for not implementing real reform since Bundaberg crisis. Individuals whose apathy and dereliction produced the disaster continue to be re-cycled. (Giles D ‘Patel ‘fall guy’ for bureaucrats’, Sunday Mail, 26/11/06).

It is indeed possible (as you suggested) that Dr Patel is being made to take much of the blame for what went wrong at Bundaberg Hospital, when many others and Queensland Health itself were also culpable.

However there is a larger issue - namely that Queensland Health (and the many other agencies that have suffered crises in recent years) are being made scapegoats for those who created Queensland's current government machinery in the early 1990s - arrangements which one expert observer described as the most complex in the Western world and which have proven dysfunctional and crisis prone (see Queensland's Worst Government? and Intended Submission to Health System Royal Commission).

While Queensland Health may not have adequately reformed itself following the Bundaberg Hospital inquiry, I submit that it will remain virtually impossible to prevent 'bureaucratic over-administration' until the highly politicized and centralized environment in which state agencies are required to operate is reformed to make effective administration possible (eg see Improving Public Sector Performance in Queensland).

I would be interested in your reactions to my speculations.


John Craig

Reply 1/12/06 Unfortunately, the item in the Sunday Mail was taken out of context ... a copy of the entire speech is attached.
Response 6/12/06

Email 6/12/06

Mr Tony Morris QC

Thanks for the copy of your complete paper ('What have we learned about whistleblowing'). As you suggested Darrel Giles' report was a bit oversimplified, as you had taken a quite penetrating view of institutional dysfunction in relation to Queensland Health.

I should like to make a couple of observations by way of feedback.

While I have no direct knowledge about the situation in Queensland Health, you are probably right about its institutional dysfunction and I am more than willing to accept (in general terms) the parallels that you drew with the British Army medical corps at the time of the Crimean War (in relation to which Florence Nightingale was both a 'whistle-blower' and reformer).

However I reiterate the point made in my earlier email - namely that the core of the problem is unlikely to lie in Queensland Health but rather in Queensland's overall system of public administration. Your article suggested four primary causes of problems in Queensland Health, namely: (a) individual incompetence - which you regarded as a relatively minor factor (b) the size of the bureaucracy - perhaps a consequence of Parkinson's Law (c) an inability to make decisions - perhaps because the wrong type of people are in charge and (d) misplaced loyalty to the organization.

The problem is not likely to be that the people involved are the wrong type to make decisions, but rather that they are working in a government-wide environment (which was created in the course of 'reform' by the Goss administration) that virtually does not allow any other outcome. Governments deal with very complex issues - and can do so fairly effectively if (a) individuals are professionally competent and professionally motivated and (b) top officials create 'space' for initiative by others. Unfortunately in the process of 'reform' in Queensland:

  • legislation was enacted which (in the Ombudsman's opinion) made it unnecessary to consider professional merit in making 'senior' public service appointments. This radically altered the environment in which staff work eg it made appearances more important than performance. Contrary to the reform process which Florence Nightingale favoured, ie that staff would be appointed on merit, 'reform' had the effect of eliminating staff with highest levels of knowledge and experience, in order to protect the credibility of the half-smart political cronies who were installed in top management positions;
  • administrative machinery was then created (by the inexperienced cronies) that was essentially unworkable because of its complexity, centralization of decision making and political orientation.

How 'the wheels fell off' is discussed in more detail in Towards Good Government in Queensland (1995) and Queensland's Worst Government? (2005). I have been 'blowing the whistle' on the consequent institutional dysfunctions for almost 15 years (see Chronological Summary of documents) and during that time have found few people who showed more than a pretence of interest in the need for competence or effectiveness in public administration.

Another thought may also be relevant, The proportion of resources devoted to medical services may not the best measure of the effectiveness of a health administration (see Is a National Health Model the Best Remedy?). It appears possible that prevention (eg by reducing the nutritional deficiencies which seem to play a large part in the chronic degenerative conditions that are the main area of spending growth) may provide a method of controlling the ultimately unaffordable explosion of medical services costs. If non-medical activities by a Health Department were contributing to such outcomes, then this might well reflect a better usage of resources than simply providing medical services. Furthermore ordinary medical services (not just those associated with rogue doctors) are apparently a major cause of death in Western societies. The side effects of properly prescribed medication, medical errors etc seems to result in something like 100 deaths each day in Australia (which eclipses Dr Patel's efforts by a large margin).


John Craig