Shaping Policy Frameworks for Crisis Preparation: The Case of the Australian Health Care System
The COVID-19 crisis along with the problems of over-reliance on an authoritarian power like China have underscored that crises need to be prepared for and not just suffered through.
My colleagues John Blackburn and Anne Borzycki have spearheaded an effort with the standing up of a new Institute to focus attention on crisis preparation.
I end my forthcoming book on the evolution of Australian defence strategy by bringing a number of pieces together where they focus on supply chain security, smart sovereignty and crisis preparedness, for that is a key part for shaping a national security strategy, rather than a narrowly defined understanding of defence.
I am currently in France, and as an American, it is great to be in a foreign country. But to reach Australia, something I normally do twice a year, now requires the magic of Zoom. So through that magic John and I hooked up on December 17, 2020 to discuss the new report and the approach of the team.
Blackburn emphasized that crisis preparation is not going to be done by politics as usual in Australia or simply relying on the currently configured Federal system. Australia, like the United States, relies on the states to deliver health care, with the federal government playing a funding role and providing some policy direction.
But to get to the point where crisis preparation is possible with regard to the health care sector requires states to work together and to be able to work with health care professionals to address the realities of the health care system and to match those realities up against crisis preparation models.
The current framework for delivering health care capabilities is “not fit for purpose,” according to Blackburn.
What would a fit for purpose” framework look like?
It would be one in which information about the actual system was not repressed but encouraged to inform the policy debate.
To do so, means that expertise needs to be tapped rather than repressed.
According to Blackburn: “You’ve got to allow for bottom-up innovation, you’ve got to allow the people actually doing the job to be able to inform policy designs.”
Shaping policy design this way would be very different from one relaying simply on top down bureaucracy and direction or control.
To get to strategic re-design, Blackburn argued for the importance of empowering state government collaborative efforts informed by practitioners and experts who would provide a clear sense of the realities of the system.
The challenge will be to move this capability to then prioritize the choices one makes with scarce resources to determine what investments government would make to allow for the buffer capability which could be activated in a crisis,
Blackburn has an ambitious agenda in mind.
Rather than simply “fixing” health care, the focus is upon understanding the interactive and interlocking pieces of the national resilience puzzle.
This means looking at a number of sectors, discerning what needs to be done within those sectors for crisis preparation.
But this would be done by looking for the macro drivers which would allow for a national crisis preparation and management capability going forward.
And this clearly is part of the “smart sovereignty” model which Blackburn has championed as well.
The report is to be found in both PDF and e-book format at the end of this article, but the Executive Summary of the Report follows:
The Coronavirus pandemic has exposed a global lack of resilience as a result of a collective failure to assess and act on national risks and vulnerabilities in the face of a rapidly changing world. The pandemic has also exposed both unrealistic social expectations and political leadership shortfalls in coming to grips with the crisis, as opposed to managing prosperity. The erosion of faith in, and effectiveness of, domestic and international institutions has also been under the spotlight as a result of the pandemic.
Australians have been complacent with respect to the significant exponential changes occurring in the world and our growing lack of national resilience. We have reacted very well to the pandemic; but were we adequately prepared for this or a range of other significant risks that have either already manifested or could still eventuate.
Australia has a world-leading universal healthcare system, the foundations of which came from the 1953 National Health Act that was based on the principles of equity of access to healthcare for all Australians. However, missing from this Act, as well as from other core aspects of legislation, systems and governance in Australia, is the concept of resilience and sustainability across the entire healthcare sector.
The pandemic has brought into sharp relief the inadequacies of Australia’s healthcare system in the broadest sense. The professionalism of our health practitioners has been extraordinary; however, the problem does not lie with them. Rather the ‘health system’ has been found wanting. We lack resilience because we do not adequately prepare for such predictable events. For example, we have experienced medicine shortages, supply chain disruptions, loss of domestic manufacturing capability, tribalism and cultural impediments to teamwork and Federal versus State governance disconnects. These systemic failings are discussed in this report.
This report is framed by the biomedical provision of western healthcare; however, it should be acknowledged that supply of goods and services to facilitate equitable access to housing, energy, food and water are fundamental to the health and wellbeing of all Australians, and that focusing on equity is a most effective way of improving public health.
The principle of “equity of access to healthcare for all Australians” has slowly unravelled as inequity more generally has increased across Australian society over recent decades. This decline was not the result of one single policy failure or event, rather a gradual disintegration of Australia’s social contract as the influence of free-market ideology seeped into every aspect of our lives. Our healthcare system was not immune to the impact of this ideology.
The “just in time” free market philosophy may have resulted in cost efficiencies, but it has also resulted in significant erosion of healthcare systems resilience as our nation gradually lost manufacturing capacity to the point where we now import more than 90% of our medicines and virtually all of our Personal Protective Equipment (PPE), whilst at the same time having no stockholding mandates. Lower cost can come at a very high price in a crisis.
We need to determine how we better react, prepare for, adapt and where feasible, prevent disasters and crises, such as those we have experienced throughout 2020. We should not try to replicate the pre-COVID-19 Australia in the recovery. We need to capitalise on the many positive aspects of our response, such as the social solidarity and the Federal / State political collaboration initially displayed in the early stages of pandemic, and learn from the negative, such as the fragility and opaque nature of our supply chains and the lack of preparation in critical areas such as in our health infrastructure and parts of our economy.
The contraction of the global economy that has followed the pandemic, combined with other emerging global crises such as climate change, will require us to reshape Australia’s healthcare system to ensure it can withstand a range of future shocks. There needs to be a renewed focus on resilience in healthcare that recognises its central role in the security and wellbeing of all Australians. A resilient health system cannot be based on a “just in time” philosophy; there must be a degree of “just in case” thinking to deliver a balanced and resilient system.
Whilst there is this need to reshape our healthcare system, there are fundamental blockages to building resilience, even though the knowledge and expertise to make this shift already exist across the healthcare sector. We need to listen to our experts, not just during a crisis but in preparing for the next one. We need to identify those elements essential to ensure the health outcomes needed by Australians and then, cooperatively and collaboratively, determine how they are to be realised and maintained.
The vast majority of people working in the healthcare arena are overloaded in dealing with daily issues and reacting to each crisis as it occurs, without assessing the broader horizon of opportunities and threats. Most do not have the time available to plan to prevent adverse health threats. The most complex issues regarding Australia’s healthcare system are related to the structure, governance, culture, economics, and workforce which are managed in stovepipes in a disaggregated system with little capacity to address future resilience and preparedness issues.
Given the propensity of the Federal political level to market success stories and dismiss discussion of risks and vulnerabilities for short term political gains, the leadership will need to come from those in our nation who are actually delivering healthcare to our people. That is at the State/Territory Government and at Hospital / Industry levels. A willingness to act together for the common good to achieve shared goals can only be built through practice and demonstration. We need leaders at these levels to demonstrate this willingness to work together and then to act.
Our politicians have rightly applauded our nation’s health workers outstanding performance and dedication to their duties throughout the pandemic. However, plaudits are not enough. We, as a society, owe it to our healthcare professionals to do whatever it takes to enable and empower them to do their jobs, to ensure our healthcare system is genuinely resilient. The health and wellbeing of all Australians, and therefore the security of our nation, depend on it.
Healthcare System Report Dec 2020The Institute for Integrated Economic Research, Australia
The Institute for Integrated Economic Research (IIER), Australia, was founded in 2018. It conducts and supports research in order to contribute to an improved understanding of how Australians can plan for, and navigate, the significant transitions in energy, environment, and economic systems over forthcoming decades whilst maintaining the stability and security of our society.
These three areas are closely interlinked, but largely managed as separate competing issues, as a result of near-term political goals. We need a national security or sovereignty strategy that integrates these and other related systems, such as information and infrastructure, under a national resilience framework.
To address this challenge, the institute will engage with a range of Australian think tanks, universities, federal and state government department representatives, as well as media and relevant community groups. The institute is an independent, non-partisan, not-for-profit organisation. It will not lobby for, nor represent, any specific industry sector or business.[1]