DoHAC in the dark on PHN performance

Thanks to a lack of ‘timely or informative’ reporting, it’s impossible to know whether the outfits are fulfilling their purpose.

---

The Department of Health and Aged Care has not demonstrated that the primary health network delivery model is achieving its objectives, according to a damning report released by the Australian National Audit Office yesterday.

The Effectiveness of the Department of Health and Aged Care’s performance management of primary health networks report made eight recommendations, seven of which DoHAC has accepted and one which it has agreed to “in principle”.

In the conclusion to its report summary the ANAO said DoHAC “had no evaluation plans for the PHN delivery model after 2018”.

“[DoHAC] has not conducted a comprehensive delivery model evaluation,” the audit team reported.

“A 2018 early implementation evaluation was inconclusive about the achievement of objectives at that early stage.

“Although there has been some improvement between 2018–19 and 2020–21 in PHNs’ average performance against some measures, no baseline data for these measures and the lack of relevant performance measures means that it is not possible to conclude if the PHN delivery model has met its objectives.”

Some basic things are not being done, according to the ANAO, including the lack of regular publication of annual reports, and the lack of timeliness of those reports.

“There was no requirement in the 2016 PHN Performance Framework for annual reports,” said the report.

“The 2018 PHN Performance Framework indicated that [DoHAC] would produce an annual ‘PHN Program Performance and Quality Report’. The reports are meant to provide ‘an overall assessment of the PHN delivery model’s performance in meetings its objectives’.”

The department had published three of these annual performance reports – for 2018-19, 2019-20 and 2020-21 – but published them very late, and had not published one for 2021-22 or 2022-23. 

“The delays in annual reporting are not consistent with public transparency over PHN performance,” said the ANAO.

In other areas, performance management of PHNs and the delivery model had been “partly effective”.

“[DoHAC] has established largely fit-for-purpose compliance and assurance arrangements for PHNs and the PHN delivery model”, although, the report detailed, those arrangement were not established until 2021, almost six years after the implementation of the PHN model on 1 July 2015.

“[DoHAC’s] performance measurement and reporting arrangements for PHNs are partly fit-for-purpose,” the report continued.

Performance measures assessed PHNs’ compliance with grant agreements rather than providing information about “achievements of outputs and outcomes”.

“Public performance reporting is not timely or informative about overall PHN delivery model performance, and does not include information about individual PHN performance,” the report said.

On the IT front the ANAO is equally scathing.

“IT systems for PHN performance reporting are partly fit-for-purpose,” it said.

“A system was developed in 2019 called the Primary Health Networks Program Electronic Reporting System. [DoHAC] has a range of guidance to support PPERS users.

“PPERS has limited capability to validate data inputs, analyse data and generate compliance and performance reporting.”

The ANAO made eight recommendations:

1. DoHAC should ensure that PHNs fully comply with transparency and accountability requirements established in grant agreements, including requirements to participate in and provide data and information for the purposes of evaluation.
2. DoHAC should establish performance measures that are clearly aligned to the PHNs’ and delivery model’s objectives.
3. Where there is a reliance on PHN-supplied data, DoHAC should establish a risk-based methodology for obtaining assurance over the data.
4. DoHAC should report on PHN performance as soon as practicable following the year to which the majority of the performance information relates.
5. DoHAC should publish individual PHNs’ performance data and analysis in annual reports.
6. DoHAC should publicly report on performance measures (a) in compliance with the PHN performance framework by reporting all performance measures; and (b) in a way that is consistent with the intended purpose of conveying information about performance in addition to compliance with grant agreement requirements.
7. DoHAC should implement a fit-for-purpose IT system for administering PHNs that supports the accurate capture and reporting of compliance and performance information.
8. DoHAC should (a) develop an evaluation plan for the PHN delivery model; and (b) evaluate the PHN delivery model to determine whether it is achieving its objectives.

DoHAC has agreed, or agreed in principle, to all but the last one.

In its one-page response to the ANAO report, Blair Comley, the Secretary of Health, said the Department “appreciates and acknowledges the observations and recommendations”.

“We recognise the need for stronger governance to ensure compliance with requirements, improved performance measures outlined in a stronger program logic, further data assurance and risk oversight, and enhanced performance reporting that is timelier, and more transparent,” said Mr Comley.

When it came to recommendation 7, which the Department only agreed to in principle, Mr Comley said:

“We are conscious that IT investments can be significant and implementation is contingent on funding decisions by the government.”