In the health arena in 2007 there were great expectations for root and branch reform of the Australian health care system. Kevin Rudd simply wasn't able to deliver, writes one of his mental health advisers John Mendoza.
The defeat of Kevin Rudd was as assured as if he had gone to a caucus vote on the morning of June 24, 2010. The Australian public is now getting an insight into the reasons for the total lack of confidence in and a total repudiation of Rudd as prime minister. The stream of commentary provided by senior cabinet ministers over the past week has finally started to tell the real story of his time in the Lodge.
What has been extraordinary in the 20 months since he was removed has been the discipline and loyalty of the vast majority of federal Labor members towards Rudd. What makes this period of discipline and loyalty even more extraordinary is that Rudd has been running a relentless, very damaging campaign against Julia Gillard and the government.
The caucus seems to have formed the view that while Rudd wins in the celebrity stakes against Gillard, he is not seen as fit for the office of PM.
In the health arena in 2007 there were great expectations for root and branch reform of the Australian health care system. The Australian Health Care Reform Alliance lead by John Dwyer and others had set out a compelling case for reform and it was clear that federal Labor had adopted much of the AHCRA agenda for change.
Rudd established a raft of advisory and working groups in health, the most important being the National Health and Hospital Reform Commission. In related social policy areas, there were a bewildering number of other advisory and working groups. Elements of the federal bureaucracy scrambled to gain traction and maintain influence. For a while in 2008 it seemed the government may place higher value on this “independent” advice, but by late 2008, certainly in health, the bureaucracy was back in the ascendancy and gradually winding back the agenda for change.
In mental health, Rudd made numerous statements, further developed in speeches by Nicola Roxon, that real reform was a priority for the government. In June 2008, the government announced the establishment of the National Advisory Council on Mental Health. The “charter” for NACMH was clearly around the development of a new vision, a new architecture for governance and accountability and a determination to end the cycle of crisis around mental health services.
In the meetings with Roxon and senior staffers in the government over the later part of 2008 it became increasingly clear that the goalposts were shifting and zero very significant policy decisions were being considered with little or no advice. In December 2008, Rudd proposed handing over all federally funded community mental health programs with $1 billion in funding to the states/territories.
Rudd was trying to engineer a deal with the states for taking over other aspects health. Roxon and Families Minister Jenny Macklin effectively worked together to “push the pause button” and got agreement from Rudd to allow a whirlwind national consultation process over January and early February and prepare a paper for the first COAG meeting in 2009. The view of stakeholders in every jurisdiction, except Victoria, was overwhelmingly clear: that the Commonwealth had to maintain responsibility for these programs.
Throughout 2009, the government’s previous strong commitment to root and branch heath reform was diluted or the messages became confused or conflicted. No more clearly was this shown than in the interim reports issued by several the key reform advisory and working groups who were all endeavoring to read these messages from the PM’s office to ensure relevance.
In mental health, our charter was dumbed down to simply “providing advice on improvements to existing programs” — forget vision, accountability, or ending the cycle of crisis.
In the 2008 and 2009 federal budgets the appropriations to mental health programs were wound back. Some $350 million was cut from innovative programs such as the Mental Health Nurse Incentive program, headspace and the Rural and Remote Mental Health programs. In addition, the pre-election commitments to tackling the inequities in programs such as Better Access evaporated.
By late 2009, with the final Health and Hospitals Reform Commission report gathering dust, Rudd was running up and down the country playing dress-up with Roxon and turning up in every hospital (more than 100 in fact) where he could avoid access block. Following his national tour, on December 7 of that year, Rudd gave a speech to the John Curtin Medical School in Canberra where mental health was put front and centre in health reform.
This was certainly a fillip to those working for mental health reform. Ian Hickie, David Crosbie and I were then enlisted to rapidly develop a package of $400 million of immediate investments for the government. We were not permitted to discuss it with other NACMH members or the sector more broadly. We worked through the summer and met several times with senior staffers, but by March in the run-up to COAG it was clear mental health had moved from the foreword to a footnote of health reform.
As history now shows, Rudd’s health reform package was never accepted by COAG. His frosty meetings with premiers, public threats and grand statements made great television but Rudd did not know from week to week what he was proposing in terms of health reform. He was, in the popular vernacular, all over the shop.
Gillard and the rest of the government have spent most of the time and energy since Rudd’s removal cleaning up after the party. It remains to be seen whether she and her colleagues have the capacity to build confidence beyond the caucus across the Australian community and deliver on Labor’s reform agenda in health and social policy.
*John Mendoza was the inaugural chair of the Rudd government’s National Advisory Council on Mental Health and deputy chair of the Alcohol and other Drugs Council Board.