John Menadue, the former head of the Department of Prime Minister and Cabinet in the Whitlam era, ex-general manager of News Ltd and a former Qantas CEO, has blasted ministerial micro-management of the NSW Health Department in a submission to the hospital commission of inquiry being conducted by Peter Garling SC.

Menadue has given the inquiry a highly critical analysis of the department saying that it was crippled by administrative dysfunction and falling morale.

He warned the Iemma Government-appointed lawyer that there had been previous health reviews but they had all ended up in filing cabinets buried in the department:

A great deal of good public advice has been received, but the failure has been in implementation and in political will.

Most enquiries to date have been principally designed to fix a political problem rather than a health problem.

If the government failures of the past are repeated, your recommendations will have little chance of success.

Menadue, who chaired an earlier review for former health minister Craig Knowles in 2000 and a South Australia generational health inquiry in 2003, said the executive governance of each hospital should be placed in the hands of a small group of senior executives and clinicians.

At present, the executive and clinical personnel in hospitals work separately or even against each other, but rarely in harness together.

In acerbic advice to politicians Menadue said:

Ministers, their staff and the Department of Health should stand back from the management of hospitals and let executives and clinicians in hospitals get on with the job. Micro-management must stop. The department should be substantially downsized to focus on policy, planning and resource allocation.

Without mentioning Health Minister Reba Meagher or her director-general Deb Picone or any of their predecessors by name, Menadue took aim saying:

Ministers and the Department of Health compound the governance confusion by centralising decision-making and attempting to micro-manage in response to media pressures. They mainly succeed in confusing their health units even further, making senior executives gun-shy in making decisions, and frustrating clinicians. Senior executives spend a great deal of time “managing up” to the minister and the department, rather than managing their own health units.

According to health professionals, Garling has already formed a poor opinion of the department’s management style and its bloated bureaucracy. He has made unscheduled visits to hospitals across the state talking informally to cleaners, maintenance workers, security and clerical staff and other ancillary workers normally ignored when health service delivery is under the microscope.

His eagerly awaited report and its recommendations, due to be delivered mid-year, are expected to provide a blueprint to reform the public hospital system from top to bottom.

However, there has been a disconcerting intrusion: Reba Meagher and her advisers are spending most of their time negotiating with federal Health Minister Nicola Roxon on a new national health plan, and that threatens to make redundant, or at least marginalise, anything Garling comes up with.

Which prompts the question: is the conscientious Garling, previously involved in public inquiries into the 1996 Sydney bushfires, the collapse of HIH and the Thredbo landslide, wasting his time or what?

Peter Fray

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