Please wait. Contacting image service... loading

Article text

Ringing the changes at Health
By KERRY COYLE,
Public Service Writer
Mr Roche Mr McKay Mrs Kern Dr Deeble Or de Souza Dr Wells Dr Dodson Help
Mr Roche
Mr Roche Mr McKay Mrs Kern Dr Deeble Or de Souza Dr Wells Dr Dodson Help
Mr McKay
Mr Roche Mr McKay Mrs Kern Dr Deeble Or de Souza Dr Wells Dr Dodson Help
Mrs Kern
Mr Roche Mr McKay Mrs Kern Dr Deeble Or de Souza Dr Wells Dr Dodson Help
Dr Deeble
Mr Roche Mr McKay Mrs Kern Dr Deeble Or de Souza Dr Wells Dr Dodson Help
Dr de Souza
SlNCE February, with the fin
ishing touches applied only during
the past month, a whole new sen
ior structure in the Department of
Health has been inaugurated.
The number of departmental
divisions, a shambles of
overlapping jurisdictions, was
halved from 12 to six, in what, in
public-service terms, was re
markably quick time.
The Public Service Board gave
the green light to the restructuring
in March and by August the princi
pal oflicers of the Senior Executive
Service were in place.
The top structure of what used
to be called the Third Division has
almost been settled and the
"backfill" of vacancies in the de
partment should proceed quickly.
Not unduly significant perhaps,
given that both Trade and Com
munity Services have undergone
equally radical administrative up
heavals in the past year.
But for Health the trans
formation is thrown into sharp
relief by the fact that for years the
department has languished with a
generally mediocre (or worse)
managerial corps. There have also
been complaints from health-con
sumer groups about its pro
pensities to certain characteristics
of a "secret society"and allegations
that it is dominated by the in
terests of the medical profession.
The most profound changes
have been administrative. There
has been a more subtle, but no less
important shift in policy and style
as well.
"The whole thrust of the restruc
turing has been to reduce the span
of control at the top and focus the
organisation rather more ex
clusively on the policy objectives
of the department," division head,
Mr Michael Roche, said.
"While we have been in a hiatus
over the past seven months, I
think from here on in people out
side the department will start to
sw: the progress."
The restructuring caused trauma
for some of the staff Predictably,
the uncertainty engendered by
sweeping change and, in the minds
of some, diminished promotional
opportunities, caused much con
sternation.
At an SES conference held at the
Ainslie Hotel in July some of the
emotion spilled over.
Nobody had predicted the depth
of feeling aroused by some of the
personal assessments, especially
among the most senior stafT. In
siders later described the at
mosphere of the session as "quite
brutal," or more circumspectly, as
"free and frank". One said, "It was
a courageous thing to do. It in
evitably involved criticism of the
executive and how they were
operating and it might have been
damaging. But, in fact, it was good
for us all to get our gripes on the
tabic at the start."
The conference, while provok
ing wry comment outside Health,
appears to have created a new
basis for co-operation for the
people actually involved.
In an interview later, Mr McKay
said, "Risk-taking in this game is
necessary. If I had tried to do it on
a one-to-one basis with 50 SES
Mr Roche Mr McKay Mrs Kern Dr Deeble Or de Souza Dr Wells Dr Dodson Help
Dr Wells
people it would have taken time,
energy and might not have suc
ceeded. This way, if you light the
right fuse and get them on board,
you have got a chance.
"It also puts on the pressure on
them. I told them, 'The things you
are saying about me, people below
are thinking and saying about you,
so remember that'."
He said organisational change
was basically good "although
people might not think so at the
time".
"Having been through radical
restructuring three times, I know
the essence, the key, is to get it
done quickly because people are
concerned. Then they can settle
down and find a new direction.
They must be involved, otherwise
people sit back totally cynical and
counterproductive."
It was natural that a large group
of people who were feeling hurt
and worried should get certain re
sponses which you must be pre
pared to "cop". "But having got
over that, you get all the energy
together in one direction and there
is a chance to make the organisa
tion really work," he said.
The thrust of the restructuring
ordered by the Minister, Dr Neal
Dlcwett, and in the department by
Mr McKay, strongly supported by
deputy secretary, Mrs Ann Kern,
was to shift direction from pro
gram delivery to broader health
policy issues, and by plugging into
experience in the States and con
sumer groups, to turn health care
around.
To give effect to the new policy
the focus of the department's
activities will now be on disease
prevention in Australia rather than
pouring resources into ever more
elaborate systems of treatment.
To get its own house in order
first, the department argued suc
cessfully for a shift from a 1-3
division structure to more of a 2-4
structure for the SES.
The structure, of course, applies
to the levels within the SES of the
principal officers of the depart
ment - assistant secretaries, first
assistant secretaries and deputy se
cretaries.
A lot of prestige attaches to the
relative levels, not only between
officers, but between departments,
and the fact that division heads in
Health were reclassified to Level 4
has naturally added to resentments
in other departmental bureaucra
cies.
Another main feature of the re
organisation is to regroup func
tions under self-explanatory head
ings- health-serviccs financing,
therapeutics, corporate resources,
national health and medical re
search, health advancement and
the Australian Institute of Health.
With half the number of divisions
remaining, each FAS finds himself
(in this case, they arc all men
although the department has ap
pointed two talented women, Mrs
Kern and Ms Di Shogren, to more
senior posts) with more branches
than before.
"The FAS will be accepting a
heavy load with the flatter, broader
structure," Mr McKay said.
"We are trying to throw more
responsibility for policy for
mulation back on the divisions
rather than on the policy and plan
ning division as in the past."
Echoes of the Whitlam era of
community-health centres can be
detected in the team which is now
running Health, including the man
at the top.
Mr McKay, aged 45, former sec
retary and permanent head of the
NSW Department of Health, was
an assistant director of ACT health
services from 1972-74.
He then spent six years as a
regional director of the NSW
Health Commission. In 1980 he
became chairman and chief ex
ecutive officer of the South Aus
tralian Health Commission, mov
ing to the NSW Department of
Health in December, 1982.
The job of heading the Aus
tralian Institute of Health was giv
en to Dr John Decble, the architect
of both Medibank and Medicare,
who is regarded as enormously
capable of breathing life into the
Government's new research in
stitute.
The delicate job of getting the
changes to work was given to Mr
Roche, a highly capable and per
sonable man with a strong Financc
background.
Mr McKay has brought into the
department Mr Alan Bansemer,
from the South Australian Health
Commission. His appointment is
cxpected to boost the department's
hopes of forging closer links with
the States.
Dr Ron Wells, who headed the
review team which mapped out the
changes now being implemented
has vast experience both of health
administration and health-services
delivery in the ACT and the States.
Dr Wells and Mr McKay
worked together on the Whitlam
community centres when Mr
McKay was chief administrator
with the ACT Health Services.
They managed to convince the
Minister of the ACT, Mr Kep En-
derby, and the Minister for Health,
Dr Doug Everingham, to go ahead
with a crash program to design,
build, staff and operate two centres
within six months.
Mr Roche Mr McKay Mrs Kern Dr Deeble Or de Souza Dr Wells Dr Dodson Help
Dr Dodson
Melba opened on target; Scullin
was two weeks late.
The doctor's champion in
Health is Dr David de Souza, dep
uty secretary and Chief Com
monwealth Medical Officer. One
of the continuing problem areas
has been the acutely sensitive issue
of medical practitioners losing
some power in the health
bureaucracy. Dr de Souza has
urged doctors, pharmacists and
other professionals to undertake
executive development and man
agement courses in a fight-back.
He believes the department can
maximise health care only if there
is adequate medical and allied
health professional input.
Mrs Ann Kern, an expert in
health and welfare issues, also took
part in the early development of
the community-health program.
She was a first assistant secretary
in the Cabinet office until she took
up the deputy secretary Level 5
position in Health in February last
year.
Dr Leigh Dodson, another
division head, was the first direc
tor of the National Biological Stan
dards Laboratory
Mr Peter Pflaum progressed
mainly through resource and plan
ning in Health and is now FAS of
the new national health and medi
cal research divison.
Dr Leigh Dodson, the first direc
tor of the National Biological Stan
dards Laboratory, is due to retire
soon. And in November Mr John
Donovan will then be promoted to
FAS of the therapeutics division.
Another problem area has arisen
from the administrative arrange
ments of last December when
Health lost several functions. In
particular, the Government is fin
ding unexpected difficulties in sep
arating physically the functions of
human and animal quarantine.
The carve-up of duties between
Health, Customs and Primary In
dustiy is currently the subject of a
Public Service Board working
party.
So that change is yet to be set
tled.
While the changes have boosted
staff morale at Health, over at
Community Services they have
succeeded in arousing suspicion
and annoyance. In the tradition of
bureaucratic interdepartmental
back-biting (not to say "stab
bing"), some representatives of
Community Services resent the
"pretensions" of Health to a
broader policy function as if it
were the "senior" department.
Under the new regime, there will
attempts to break down the bar
riers - between departments and
between the health bureaucracy
and the States (a key feature being
increased staff interchanges or
"swaps"), and to increase com
munity participation in decision
making.
The setting of goals "toward the
year 2000", hopes of a politically
bipartisan health policy and Mr
McKay's own goal of building
links with other heads of depart
ment, are also important.
"In other words, we won't be
doing it all ourselves," said Mr
McKay.
"The end product is to be a
belter health system. That's what
it is all about."
Nobody would deny that there
are still problems in Health. Some
good people were among the ex
odus from central office while
others who have remained are not
universally well-regarded. The
restructuring has not yet shaken
down and whether all the man
agers can comfortably adapt to the
new "hands off" policy functions
has yet to be proven.
But after months of decisive ac
tion Health has another attribute
- an atmosphere of suspense.
$