All too convenient to blame the Health bureaucrats

May 24, 2021

Caroline Edwards, Associate secretary of the Commonwealth Health Department may have seemed churlish in refusing to accept that her department’s efforts in organising coronavirus vaccinations, essentially under her control, had been an abject failure.

Under strict questioning from Kate Eastman, counsel assisting the royal commission into neglect of people with disability, the proposition had seemed to be self-evident, whether as a description of efforts to secure vaccines, to determine distribution prioritising, to organising the logistics of doing so, or in giving information about it.

The vaccine rollout is a big political problem for government, the more so after prime minister Scott Morrison assured Australians that they were at the front of the queue for immunisation against the worst effects of Covid 19. While the size of the problem for the government may decline if and when Australia gets new supplies by the end of the year, it would seem very unlikely that anyone is ever going to describe the operation as a success.

But it’s worth remembering that there’s a strong political constituency, particularly in the coalition, for saying that the public service, long in exile as political or policy advisers, cannot even manage things, or implement decisions anymore. That could be used as a staging point for suggesting that if there is another pandemic, the whole problem, including the organisation and management of another vaccination program, should be handed out to the private sector.

Indeed, the majority of the most serious problems have come from political decisions, some made in the face of medical advice, but not bravely repudiated, and from the serious failures caused by an outsourcing decision that could be justified in advance only on ideological grounds. In arrears, it was also a stupid decision, because the outside contractors were neither up to the jobs nor agile enough to deal with unexpected problems, not least of supply. And it looks very much as if the private sector contractors are the ones primarily responsible for the balls-ups caused by the nomination of only limited numbers of medical practices for supplies, and the poor performances in coping with aged care homes, aged folk in the community, and the badly administered scheme of vaccinating health care workers, disability workers and people with disabilities.

The poor performance came not only from the arrangements organised by the untrained private-sector substitute for a public sector workforce but from a host of consultants, including the coalition’s usual favourite cronies, advising the government what to do. Alas, it is going to be very difficult for quite some time to describe just how either of these groups let down the public, and incidentally, the government, even as they trousered hundreds of millions from the public purse. This is because the terms of the relevant contracts have not been disclosed, nor were they awarded via public tender. Consultancy reports, many no doubt have crafted to say what ministers wanted them to say, are described not only as commercial-in-confidence but as being cabinet documents, perhaps as a part of the new self-serving convention that any meeting at which the prime minister is present involves a Cabinet committee of at least one. This is a new system by which information and advice used in government decision-making processes are not independent, professional, transparent or accountable, even in arrears.

It is true that Ms Edwards was an attractive target for the royal commission. If one reads the early statements promising a fast roll-out of the vaccine, first to the 1A category (such as health workers, cops, and folk in residential homes) and 1B (including those over 70 and younger folk with medical conditions) a clear public impression was given that disabled people in residential homes and those with serious disabilities were either 1A or 1B, perhaps both. That also seemed to be the intention, until it had to face supply shortages, logistical problems and a failure to realise that dealing with folk in four-bedroom homes was a bigger and more complex task than a large aged-persons home.

Ms Edwards herself – not a doctor – made a decision that people with disabilities would have to join another line, one perhaps still in the 1 category but not one being processed as quickly as aged people. Disabled people, like people with auto-immune conditions and diabetes, were also a priority, but, on the evidence, not at as high a risk as the elderly.

Her decision was defensible – though the fact that it was not publicised was not. She was less than straightforward in conceding that pushing some people to the front of the line necessarily meant that those in other queues had to wait longer. But it was a bit over the top for it to be suggested that she had committed an unlawful act of discrimination in treating people with disabilities less favourably than another group – people in aged persons homes. First, people with disabilities in residential care (most of whom are under 50) are being treated more favourably than, say, people without disabilities under the age of 50: they are being treated in proportion to relative risk.

The real problem is not discrimination but poor organisation, aggravated as ever by overblown marketing by Scottie from marketing. By rights all people with disabilities – indeed all people in the 1A and 1B class – should have been vaccinated by now. But many in this class will not get their first vaccine before July (at least three months later than promised) and the second dose may take until September. And that is only of the cohort who want vaccinations or the ones on offer.

By way of masking these delays, politicians have opened fresh queues of even lower priority – people over the age of 50 – even as they are failing to do all of the work necessary to complete the higher priority task. What they are doing might be defensible if one could blame the more worthy classes for lack of initiative in getting themselves dosed. After all, one can now go to one’s doctor – assuming she has not used up her mediocre ration – or to a large-scale vaccination facility.  But leaving it to them ignores the fact that we – that is to say the less vulnerable part of the population – are at higher risk while a substantial proportion of the high-risk cases are not protected. And queues of the fitter and less vulnerable are pushing worthier cases out of the queue and using up what is still in scarce supply.

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