The new Secretary of the federal Department of Health will have to be a ‘burger with the lot’: a bold reformer who can forge strong partnerships, manage risk, and protect and develop their staff.

The health and aged care systems are close to breaking point because so many structural reforms are long overdue. The Secretary who replaces Professor Brendan Murphy (who has announced his retirement) will get an historic opportunity to help achieve those reforms. Health Minister Mark Butler has signalled that he’s up for challenging changes to primary care funding and workforce.

There is a deal on hospital funding and reform with the states to negotiate. And the Aged Care Royal Commission’s recommendations remain a massive challenge, and a massive opportunity to improve the system.

To help get these reforms over the line, the new Secretary will need to be creative, think big, and take risks. It will also be crucial to manage risk well, particularly by making sure the department is monitoring implementation and adapting quickly to inevitable setbacks.

This reform agenda needs partnerships with states and the private sector to succeed. That will require shrewd negotiation, but also the ability to find common ground, develop trust, and be a persuasive champion for change.

Finally, supporting and building up the department will be crucial. A capability review back in 2014 found deficiencies in several areas that will be key to delivering the government’s agenda. It highlighted the need to develop strategic capability, a culture that embraces and manages risk, and purposeful engagement with stakeholders.

That was almost 10 years ago, and there has no doubt been progress, but many of these areas will still need work. And given the huge challenges the department has lived through during the pandemic, and with mountains of important and challenging work ongoing and upcoming, protecting staff wellbeing should be a big focus too.

Priorities and opportunities

There are a lot of priorities and opportunities, and they span the full continuum of care. Leaders are often advised to only focus on a small number of things. I think the Secretary should try to make progress on all of the things listed below. But if I had to choose three, they would be workforce, primary care reform, and improving hospital productivity, with an eye to system integration when tackling all three.

System enablers: Workforce and digital capabilities underly pretty much everything. On health workforce, Australia needs a pipeline that better matches workforce supply with demand, bolder policies to get workforce where they’re needed most, and reform to unlock the skills of people who are not working at the top of their scope of practice. We also have a long way to go in improving clinical information sharing by providers, and in making health information accessible and useful for patients.

Building a high-functioning primary prevention system with the new Centre for Disease Control at its core: Australia is way behind on prevention, and this is key to the nation’s long-term health and wealth, and the sustainability of our health system.

Primary care reform: Realising the Strengthening Medicare Taskforce’s recommendations, and making sure they are transformative, not watered-down.

Improving hospital productivity: Hospital demand and cost keeps growing. Without an effective national strategy to divert demand and improve productivity, access and quality of care will ultimately suffer.

Delivering the Aged Care Royal Commission recommendations: This will be complex to coordinate and deliver, and, like with primary care reform, it will be important to ensure the spirit, not just the letter of reforms is achieved.

Peter Breadon

Health Program Director
Peter Breadon is the Health Program Director at Grattan Institute. He has worked in a wide range of senior policy and operational roles in government, most recently as Deputy Secretary of Reform and Planning at the Victorian Department of Health.

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