DoHAC review identifies ‘critical’ work to be done

5 minute read

The independent review contained plenty of food for thought when it came to aged care and the primary care workforce.

The first independent capability review of the Department of Health and Aged Care in almost a decade has found staff have “good reason to be proud” but also identified a list of “critical capabilities” that must be developed over the next four years and beyond.

AMA chief Professor Steve Robson welcomed the report and the timing of its release, telling HSD there were not any major surprises.

“The report confirms what we all knew – the department performed well, considering the circumstances, during the early pandemic,” he said.

“But other huge challenges still need to be faced – everything from new mRNA technologies to AI to the health workforce and challenges in aged care.

“As we suspected, the department has been under-resourced. You don’t have to be Einstein to work that out.”

The report lists aged care at the top of the list of critical capabilities that need attention, closely followed by the primary care workforce, the growing cost of hospital care and the need for a return to focus on preventive healthcare.

“Over the excellence horizon of the next 4 years there will be enormous strains across the health and aged care system,” wrote the reviewers led by Australian Public Service Commissioner Dr Gordon de Brouwer. Former senior public servants Andrew Tongue and Larry Kamener conducted the review alongside Infrastructure deputy secretary David Hallinan.

The most “critical challenges” were identified by the trio as:

  • The growing demand for aged care with an ageing population, while making the quality improvements recommended by the Aged Care Royal Commission, compounded by increasing workforce shortages, and the need to build an interface between aged care and the hospital system;
  • The health workforce, particularly in primary care and rural settings – “This is unlikely to be resolved simply by increasing numbers, given the declining percentage of medical graduates wanting to work in primary care. It will require rethinking and changing the roles played by the different elements of the health workforce including allied health”;
  • The growing cost of hospital care, and the subsequent need for collaboration between Australian, state and territory governments;
  • Increasing the focus on preventive care;
  • Preparing for “global mega-trends”, such as climate change, supply chain disruptions, and geopolitical shifts;
  • Preparation for the next global pandemic.

“First, while we identify policy challenges facing the health portfolio, and requisite uplift in policy leadership, this should also be reflected in a deeper policy expertise of the health system in other Commonwealth agencies, in particular central agencies,” they said.

“Second, the department’s large and growing investment in service delivery enabled through information and communications technology (ICT) in the aged care sector should be considered alongside the need for the same services through the Department of Veterans’ Affairs and the National Disability Insurance Agency.

“Third, while we note that First Nations health outcomes are lagging, we consider this to be an area where much of what needs to be done relates to the socioeconomic determinants of health. There could be high value in the use of data and analytics to identify the areas that would most improve health outcomes.”

According to the Canberra Times, DoHAC had “failed to consistently play a leading role in major system reform of the health and aged care sectors”.

“It lacks capability in integrated policy development, which addresses the interactions between various parts of the health and aged care systems.

“This may be because previous ministers have not asked the department for this advice, and capability in this area may have declined,” the reviewers wrote.

“However, the department should maintain system reform policy capabilities regardless of the needs of the minister of the day.”

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Nearly everyone the review spoke to, wrote the authors, recognised a need to increase the DoHAC’s leadership in key areas.

“Stakeholders from across the Australian Government and from outside the government told the review that the department has not been consistently playing a leading role here for many years,” wrote the authors.

“There have been notable exceptions … but broad whole-of-system reform initiatives have been limited.

“In part this is because, despite strong policy capabilities in particular areas, there is lack of capability in integrated policy development addressing the interactions between the various parts of the health and aged care systems.

“The department is not seen to have put forward systemic reform options to government or lead this discussion with the states, territories and other stakeholders.”

Professor Robson told HSD the AMA supported the recommendations for broader stakeholder engagement.

“The AMA has always worked with the department and we’re ready and willing to provide assistance as needed,” he said.

“I met with the new secretary [of the DoAHC] Blair Comley only this week, and gave him that assurance personally over a handshake.”

Still a notable challenge is the continued operation “in silos”.

“The following quote represents a typical response from stakeholders. ‘I deal with four separate silos in the department, and I’ve asked who has the horizontal view in the department, and they don’t.’

“Finding effective ways to work across groups will be critical to building strategic policy and user-focus capabilities.”

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