24 July 2020
Dear Brendan: re this Secretary of Health thing
Dear Professor Murphy,
When I first heard you were next in line for the Secretary of Health job I was intrigued that the government had gone for an actual doctor, not another career bureaucrat. Way back then I really wanted to ask you a few questions around how you got the gig and what you think you might bring to it, having had coalface experience and all as a doctor, and not having been brought up in the public service like nearly all department secretaries of the past.
But then a global pandemic intervened, and you were asked to stay on for a bit in your chief medical officer role.
There is nothing good you could say about COVID-19 but I try wherever I can to look for silver linings, and I suspect a big one might be that you really rocked as a healthcare leader in this crisis.
To start with you weren’t the average overly serious self-important health expert from government. You stepped up to the cameras, presented humbly but with authority and skill, and somehow gained the immediate trust of the cabinet, the prime minister and the public – we needed someone who was calm and looked like they knew what they were doing in this uncharted territory.
When COVID-19 started you faced so many complex issues coming at you at such speed within a highly politicised environment, and you stayed so calm and collected and there for everyone, that it is hard to think of a leader in Canberra in the last decade or so who has a achieved your profile and level of public respect.
Has Barry Cassidy called you yet to do his show One Plus One about “real” Australian leaders?
Now you are Secretary of Health for the country.
I’m not saying that past secretaries have been bad. Some state-based ones are some of the brightest minds I know in health, and you can’t really say your predecessor Glenys Beauchamp did anything wrong, she just wasn’t there long and came to the job without much grounding in health.
And she was a career Canberra bureaucrat, so what did anyone expect really?
As soon as you announced you were returning to the job you were supposed to take up earlier in the year, our team got excitedly on to the department to try to organise a quick interview.
Alas, your media person is clearly a long-term well-trained bureaucrat bulldog media minder. That and we are but a minnow in the world of media brands that he clearly had never heard of, so was suitably dismissive.
We tried a few times but got such oblique responses as “he’s not currently available to do media …”, “no he won’t be available in the future either…”, and, “listen, just go away will you…” – OK I made the last one up, but such was the vibe that we immediately feared you might be about to disappear into the dark realms of high-end Canberra politics and bureaucracy, not to be heard from again. Certainly your media guy doesn’t want anyone to hear from you.
I express this fear in part because over the years health secretaries have gained a pretty good reputation for being invisible to anyone outside Canberra’s sphere of influence. I won’t call it a“bubble” as that’s a bit cynical and Canberra bureaucrats can do a great job, even when we can’t see or hear from them.
Also, over the years I’ve heard the same story several times about a quite accomplished and famous past federal health secretary who used to say in private that his one and only job was to keep his minister out of the proverbial.
Which of course should be part of your job description. But surely not your main job.
You come to this job better qualified, and better positioned to alter the course of the Australian healthcare system, than perhaps any other bureaucrat in history.
No pressure, just saying.
I hate to put this on you, as it must seem like you just achieved a lot already, and you’ve earned some time contemplating things out of the harsh glare of senior Canberra politics.
But many of us are now counting on you to lead us, not out of the wilderness exactly – we have a pretty good health system still – but at least off the current trajectory we’re on, which has the whiff of a slow boiling frog about it.
Think of it as subtly tilting a healthy planet out of its current orbit, which happens to be in the path of giant meteor, into one that’s safer long term.
Here’s a few things that are aligning for you:
- You are our first Health Secretary with serious coalface experience of healthcare in Australia – from a lowly registrar, slaving your way through a hospital system, to a specialist, and ultimately to running one of the largest and most complex regional healthcare organisations in the country.
- COVID-19 challenged you as a CMO and you stepped up to that challenge in a way we’ve never seen before. If it was a CMO beauty contest, you’d be hands-down winner ( Dr Nick Coatsworth is only a deputy CMO of couse, as with his looks and presentation you might get pipped). You managed the pollies and the public almost flawlessly. Who does that in this day and age?
- That stint as CMO during COVID-19 has earned you a huge emotional and trust bank account with the public, and politicians from both sides. You’ve got some room in that to make some people uncomfortable when you need to, as you can swing your public trust around a bit like a baseball king hitter in the practice pen before he steps up to the plate. You have presence and the attention of many.
- The Health Minister you report to isn’t an idiot (don’t laugh, it’s happened). Quite the opposite. Greg Hunt is smart, has handled himself well and he gets the game. He is also that rare breed who doesn’t see this portfolio just as a stepping stone. He genuinely wants to make things better. Which is a little ironic, because if ScoMo was hit by a bus (or a virus) my bet would on Mr Hunt being our next liberal PM. Then we might really be in business.
- COVID-19 (silver linings again), has revealed government at both state and federal levels to be unusually competent when you really put their backs against a wall. Not only do you have a good track record, you’ve got whole teams in various levels of government, who, given the go-ahead to stop stuffing around and playing “let’s protect everyone’s backside all the way to the top of this department”, got more done for the healthcare system in three months than was done in perhaps the previous 30 years. There’s a good and capable group of doers out there, should someone choose to lead them slightly differently now.
- We are at a technology inflexion point for healthcare and because of COVID-19, we’ve thrown just a little more caution to the wind on technology, and taken risks – telehealth being the biggest example – and discovered that the system can take a lot more technology-led change than we might ever have suspected. We aren’t going to crash the MBS. If we keep our eyes on things, and iterate and constantly keep tuning, then the upside is oh so high up. Technology can make healthcare enormously more effective and efficient and the system can stand the changes.
- Government co-operation has been tested in a new “all in the same boat” paradigm – the National Cabinet and the Australian Health Protection Principal Committee – which is surely going to have some carry over beyond COVID-19. Be quick though. It’s not likely to last forever.
- What I like to call the “COVID did it” syndrome – the pandemic version of “the dog ate my homework” – is running strongly in your favour. This is simply that if anything goes wrong anywhere or anyhow in Australia these days you can blame COVID and people are reasonably accepting of the excuse. So where you might normally get a particularly aggressive and politically vicious lobby group – let’s say, randomly, anaesthestists – and they get upset at some change you make on the MBS that is perfectly sensible but might drop their average income per year by less than 0.001 per cent, you can say, “Oh, sorry chaps [they are mostly chaps btw], COVID and all, you know… get on board…” and you’re likely to get away with it.
- One of the most important medical organisations that can help catalyse change, the Royal Australian College of General Practitioners, is going through changes that could make it a highly effective partner in any changes moving forward. It might be functional for the first time in 10 years or so.
You know much better than I do what new orbit healthcare in this country needs to be set on a path towards. But I’ll map it out a bit for my own piece of mind and maybe that of our readers:
- Chronic care is coming at us like a freight train and our funding system and structure to manage this impending crisis is still stuck in the 60s and 70s. State governments managing hospitals and the federal government managing primary and allied care, and funding, was never really fit for purpose, but now it’s heading towards that meteor. We need something far more vertically integrated and synergistic. Maybe the AHPPC and the National Cabinet are the larvae of something new that can move us down this path?
It feels like, with all the above points aligned, it could be done subtly without scaring state governments and the like into some form of rebellion. It’s going to take time, care and wisdom, but somehow, state governments and their obsession with building more and more giant, expensive, shiny, election-winning hospitals, has to be quietly dampened into something more practical overall.
- Telehealth was always an obvious, important and a very practical addition to our system both for tertiary and primary care. It’s here now, we need to keep it, and make sure it moves forward to fulfil its enormous promise of vastly improving patient and doctor experiences in health, without costing a bomb.
- Digital health isn’t really digital health. It’s health. Putting digital in front of health is like we’re stuck in the early 2000s. I think we do it because at the top we are all still baby boomers pining for the 60s when technology wasn’t at the centre of our lives. Integrate digital health policy and strategy effectively into the whole of healthcare system strategy, don’t treat it like it’s dangerous. It’s just life these days.
- Take general practice more seriously. I’m biased here, as the publisher of a media group that serves a lot of GPs, and not as many hospital-based doctors or specialists and digital health professionals. But you have to admit that if you can somehow wrangle a few subtle but meaningful changes to the MBS, align federal and state funding objectives better, curb our state governments’ obsession with building expensive hospitals, then a pretty good investment for the long term would be into general practice, and its connectedness with allied health and the tertiary sectors. At least pay GPs properly if you can, please.
I could go on here, as I’ve been known to do, but I’m sure, if you haven’t stopped reading already, you get the point.
Don’t blame me for putting you on the spot here. Blame yourself for doing such a good job as CMO, and your media guy for being so stubborn and refusing to give us any access to you.
Thanks for all you have done so far. You do rock.
We are here to help if you need any. Just call.
And lots and lots of good vibes for success here.
We’re all counting on you.
(Publisher – The Medical Republic and Wild Health)