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Open Government + health reform « Previous | |Next »
December 8, 2009

The Draft Report of the Government 2.0 Taskforce has been released. It makes interesting reading in the light of CoAG stalling on health reform yet again by stating that it will take 3 years to produce a a health reform plan. This reform promises to deliver a new era of federal-state cooperation and to end the buck-passing and blame shifting that has characterised past state-federal relations.

The public service culture is one of secrecy and it instinctively resists becoming more open and transparent by releasing much of the information now kept secret. Reform here means a pro-disclosure culture. So what have the public servants been doing in crafting a response to the National Health and Hospitals Health Reform Commission's report, the draft National Primary Care Strategy, and the National Preventative Health Strategy

The Rudd Government basically accepts these reports. Where are the background papers that the public service has used to craft the government's response to these reports? Is there any indication of greater information disclosure, digital innovation and online engagement?

CoAG gives very little away in terms of openness and transparency. All we know is that state and federal leaders have agreed to work towards developing specific proposals in the first half of next year:

The Prime Minister will correspond with First Ministers by the end of December 2009 recommending a decision-making process on long-term health and hospital reform. In this process the Commonwealth will actively engage with the States on the range of reform proposals canvassed by the National Health and Hospitals Reform Commission and related proposals. The Commonwealth’s intention consistent with this process would be to put specific proposals to the States in the first half of 2010.

Which specific proposals are these? What are the arguments from the working groups? What are the working groups and what are they working on? What is the best available option, taking into account the current and future needs of the Australian community and the political and practical realities of implementing reforms?

We have no idea. The public service culture is one of secrecy not open access government, and the steps being taken to becoming more open and transparent are minimal. Federal and state bureaucrats talk to one another. The powerful lobby groups use their resources to gain insiders information and shape the discussions to protect their interests by blocking reform. Governments, even when in favour of public innovation, are not really comfortable being open with their inner workings on display. As Michael Richardson points out:

Openness can make life tough. Transparency opens the door to criticism; ending secrecy increases risk and exposure; accountability means being held accountable.

It is true that the old ways die hard within government and especially in health, which is run by medical experts within a heavily walled insider culture, despite the overarching policies of openness and transparency, the embrace of Web 2.0 by some government agencies, and the public interest in the quality and safety of our hospitals.

However, as Jennifer Doggett points out at Croakey the Rudd Government spent two years wooing health groups with promises of a partnership approach to restructuring the health system, then COAG has reneged on its obligations at the last minute.

The medical culture, deliberative democracy and Web 2. 0 just don't mix. What we have is the AMA, an anti-reform body, posing as the advocates for health workforce reform According to Melissa Sweet. at Croakey the spin from the AMA is one of:

the AMA as the advocate for health workforce reform, including using nurse practitioners to help alleviate workforce shortages. The AMA advocating for the end of the private health insurance incentives which have helped entrench the unfairness of our health system. The AMA advocating for a rebalancing of power within the profession and its structures, to give supremacy to the primary care end of town. The AMA advocating for doctors to work in areas of need, rather than in areas of comfort…

Web 2.0, plus openness and transparency, would help to break the stranglehold the AMA has over health policy and provide a space for other voices.

| Posted by Gary Sauer-Thompson at 9:10 AM |