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27 May 2005
Mr Sean Parnell
More Silencing and Scapegoating of Public Service
Your report on the Queensland Premier's 'bid to take control of the crisis that has engulfed his Government' may provide a good illustration of the source of the administrative shambles that has emerged in the state's health system. It seems to reflect yet another autocratic action to prevent government employees having a fair say about problems they encounter.
My interpretation of your article: Taking advice from his wife (a nursing academic) Queensland's Premier proposed splitting the Health Department in two and increasing the role of nurses. The proposal (to take control of a crisis engulfing the government) would shatter the traditional power based of the health bureaucracy. This proposal comes despite the Premier's criticism of conflicting responsibilities for funding and delivery of services, and in spite of Forster review of state health bureaucracy. Proposal was said to give cabinet more scope to control the balance between preventative health spending and treatment. In addition to nursing practitioners, other medical practitioners could be retrained to help fill shortage of regional specialists. No significant input was allowed from Queensland Health in developing these proposals. Premier will also ask the Commonwealth for more funding for doctor training. Queensland Nurses Union supported the proposal, while AMA suggested that more attention should be paid to supporting doctors. (Parnell S., 'Beattie takes wife's health reform advice', Australian, 25/5/05).
The Health Minister reportedly accepts that Queensland's health system has
had a dysfunctional culture characterised by intimidation and secrecy (Thomas
H., 'Minister blames Health bullies', Courier Mail, 30/4/05). A major
feature of that dysfunctional culture seems to have been a refusal to listen
to, and a tendency to punish, staff who pointed out problems
Your article suggested that the Premier has prevented Queensland Health from making any significant input to a reform proposal, and this seems little different. That action prevents staff from getting a hearing, and implies that they are to blame for problems in the health system.
Furthermore the culture that reportedly exists in Queensland Health probably reflects the way in which the Public Service itself has been politically governed. Reasons for this are suggested in an Intended Submission to Health System Royal Commission, which draws attention to consequences of the collapse of the Westminster tradition of an apolitical, professionally-competent Public Service. Though some in the health system have presumably taken advantage of this situation, they did not create it. Moreover the underlying source of ineffectual administration can't be eliminated by blaming employees for the effects of bad governance of the Public Service as a whole.
History may be repeating itself.
A blank refusal to listen to, and demonising of, Public Service staff characterised the Goss Government's naive and autocratic approach to Public Service 'reform' in the early 1990s. The chronic dysfunctions that characterise Queensland's public sector today were generated by a hostile refusal to listen to staff who had been caught in a failing system through no fault of their own and had the most knowledge of the complex requirements to successfully make widely-supported reforms (see Queensland's Worst Government).
Despite the problems in Queensland Health, there will probably be many staff who have intimate knowledge of the situation and reasonable prospects of being best able to propose constructive solutions. Even Queensland Health corporately might have valuable contributions. But these contributions will be impossible to obtain unless there is more willingness to listen to Queensland Health employees than there has been in recent years to listen to hospital staff who tried in vain to draw attention to substandard medical practices. And even if their contributions are inadequate, autocratically silencing them will simply perpetuate the repressive culture that has apparently crippled Queensland's health system.