Who is in charge?
Two recent Australian inquiries should give us cause for concern because in both instances and during a crisis the unanswered question has been ‘Who is in charge?’ In fact, the Royal Commission into Aged Care Quality and Safety used precisely those words in its report to the federal government.
This and the Victorian judicial inquiry into the hotel quarantine fiasco, to which over 700 deaths and 18,000 COVID infections have been directly linked, saw a procession of government ministers and public servants, including the Victorian Premier, Daniel Andrews, unable to name the individual, committee or organisation that decided to contract private security firms to secure returning travellers in isolation hotels.
The politics of this have been endlessly raked over and there’s no need to elaborate further. But there is a more concerning issue. It has laid bare the poor governance that has resulted in complete inability to tell us who’s in charge during the biggest global crisis since World War II. There is effectively no one accountable for for things going wrong - or right.
The accountabilities lie at the door of the Australian national and Victorian state governments and judgement may be made at the ballot box, but can we have any confidence that any future government will have a better handle on governance during a crisis than what we have now?
While the final report of the aged care Royal Commission is still fermenting, the Victorian inquiry has claimed the scalp of Victorian Health Minister, Jenny Mikakos. The bizarre aspect of this is that no one believes she decided to employ private security guards at Melbourne’s quarantine hotels. There’s a platoon of more likely candidates at the top levels of the public service and in the Department of Premier and Cabinet (DPC). But which person was it? Nobody knows, or at least nobody is telling.
It is somewhat ridiculous that the entire discussion has been reduced to a particular six minutes during which Victoria’s then Chief Police Commissioner, Graham Ashton, apparently had a change of mind about the use of private security in lieu of police at the quarantine hotels. Due to quirks in Australian legislation, which does not allow access to inbound phone records, no one can confirm who may have called him during that period.
It’s not to dwell on here, but the issue misses that point that, regardless of phone records and failing memories, how can governance and accountability during a pandemic boil down to what happened in six minutes? It’s like blaming the player who missed a kick to win the game after a siren for the failure of an entire footy team to win the game earlier.
Perhaps one of the reasons our politicians are so vague as to the governance process is reflected in the comments of senior public servants to the inquiry that they had not informed ministers of decisions. The unaccountable not informing the accountable. For those old enough, it conjures up the ghosts of Alan Reid’s ‘faceless men’ reflection of Labor Party politics in 1963.^
Let’s put aside the political commentary on this, because pot shots from bystanders, including opposition parties and the Twitterati, are cheap. Consideration of the underlying drivers for this failure of governance may reveal some uncomfortable truths about personal risk averseness (some would call it ‘arse protection’) and our penchant across every activity for consensus management.
Evidence from the Victorian inquiry suggests that decisions, or at least accountability for them, was shared across more than one department and ministerial portfolio.
You’ll have to excuse the language, but in the 1980s, I did ask a senior executive why a business plan required so many signatures on it. In that instance, the document required eight. His answer: “So when the shit hits the fan, it’s spread evenly around the room.”
I’ve never forgotten it. A brazen admission that if a particular program went pear-shaped, no one could actually be held responsible. Accountability would be shared, the underlying philosophy, perhaps even strategy being and ‘you can’t sack all of us’. OF course, for politicians n a democracy, it is possible to sack all of them.
Consensus management may be very egalitarian and politically correct, but ignores the fact that, while we can engage with all stakeholders as we formulate strategy, pleasing all stakeholders rarely leads to a satisfactory outcome.
There’s a huge difference between listening and pleasing, with the latter usually leading to excessive compromise and beige decision-making. This in turn leads to lack of strategy conviction and therefore an understandable unwillingness to own decisions and be accountable.
The Victorian Government has not waited to receive the inquiry report on hotel quarantine to announce that Attorney General, Jill Hennessy, will be responsible for the on-going hotel quarantine program.
"I’m very clear about what my accountabilities are and my responsibilities are. I am absolutely determined and focused to that end, as is the team that I work with. I don’t step back at all from my responsibilities and my accountabilities. And nor does the team that I work with. Ultimately I’m accountable." Ms Hennessy said.
Refreshing, but accountability assumes that the underlying structures and communications channels from all relevant departments and ministers are in place to ensure Ms Hennessy actually knows what is happening.
The aged care Royal Commission’s interim report underscores that the Victorian experience is not unique. It said: "All too often, providers, care recipients and their families, and health workers did not have an answer to the critical question: who is in charge?
It reported that the federal government and the regulator had no crisis management plan for a pandemic - and still doesn’t. You’d think this would be a fundamental requirement for a sector caring for people most vulnerable to infection of any sort. This is despite endemic failures in the aged care sector across multiple metrics for more than two decades.
Background Paper 8 - A History of Aged Care Reviews prepared for the Royal Commission said: “Successive Australian governments have shown a lack of willingness to commit to change or to adopt recommendations from a multitude of reviews and inquiries into aged care over more than 20 years.”*
It notes there have been 18 reviews since 1997 covering multiple aspects of the system addressing multiple aspects of the aged care system, including funding, workforce, the regulatory system, young people in residential aged care, palliative care, dementia care, and quality and safety.
The COVID-19 experience has ripped the bandaid off the sector, exposing an ugly wound oozing poor regulation and health controls, overworked and underpaid staff, unkindness and even cruelty in resident care and, separate to the commission, viable suggestions of profiteering by unscrupulous operators in the privatised sector.
Department of Health Secretary and former Australian Chief Health Officer, Professor Brendan Murphy, has conceded that the federal government should have ‘stood up’ an aged care response earlier in the COVID crisis and that: “Potentially, maybe, there could have been some avoided deaths, but we were not in a position to act earlier. I wouldn’t want it to be implied that we were slow in reacting. We reacted as soon as we were aware that the public health response in Victoria was failing.”
Hang on a minute - who is in charge? There’s an inference here that the Victorians were notionally in charge. Only their failure would trigger a federal intervention, despite the fact that regulatory oversight of the aged care sector lies with the federal government.
The tangle of often overlapping state and federal responsibilities, with the states broadly responsible for community health, makes it easy to handball accountability from one jurisdiction to the other. This is not unique to aged care, but is a governance morass into which all manner of issues wade.
Unfortunately, none of this matters in a time of crisis. The public is impatient for someone to take responsibility and indeed suffer the consequences of that when things go wrong.
Taking ownership of issues is one of the core rules of effective crisis management, a priority amplified over the past two decades by exposure and commentary on events through social media.
Across the spectrum of Australian leaders addressing COVID-19 and related issues, only one, Victoria’s Premier, Daniel Andrews, has declared ultimate responsibility for the results of decisions and policies relating to them. Unfortunately, he’s stopped short of providing the public with a clear line of sight to what this means. Accountability goes with personal and career consequences and Andrews has not made clear what these are for him.
Australia’s COVID-19 experience has revealed an opaque governance structure and processes. The lack of delineation of roles and responsibilities, a basic requirement for any organisation and especially one properly prepared for a crisis, has created a fertile environment for obfuscation, blame, politicisation and lack of accountability.
Let’s hope the findings of the two inquiries that have so far examined governance effectiveness during this pandemic pull no punches. The answers and solutions will go to the heart of the structure and operation of our federation.
* https://agedcare.royalcommission.gov.au/news-and-media/background-paper-8-history-aged-care-reviews
^ https://www.dailytelegraph.com.au/news/opinion/meet-the-original-faceless-labor-men/news-story/5cb27c0718ab93caf21574684a630c2b