Too much red tape is hazardous to health

Parliament House in Canberra.

Ten years ago I packed my bags for Canberra. Just out of university, I was eager to move to the nation’s capital to work for our federal government. I had studied psychology and had completed a thesis with South Australia’s Cancer Council, so the Department of Health seemed like a natural fit and I was excited about the prospect of joining the public service.

The Health Department is in Woden, in the south of Canberra. It is housed in the Sirius Building, and each level of the department has an open office floor plan with partitions separating workers who belong to different teams for each different policy division.

There are dozens of policy divisions in the department, in areas as diverse as international illicit drugs policy, the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. Each division is composed of a team of staff who have different rankings, ranging from a graduate – who sits at the bottom of the pecking order – to the director of the division, who enjoys the privileges of having a walk-in office and a full-time executive assistant.

A decade ago I was part of a graduate cohort, 100 or so new hires who were supposed to bring some fresh eyes into the department. But it took only a few weeks until I had a disquieting realisation. It became clear early on that the department had little use for us. It was overstaffed already.

Rather than compiling research and writing briefs – which is what we all expected – we were consigned to filing, photocopying and note-taking. When the filing and photocopying ran out, we just had to look busy. I remember writing endless shopping and to-do lists, sitting at my desk trying to find something to do. Another graduate I knew was so distressed about not having any work she would hide in the toilets and cry.

A Medicare and Centrelink office sign at Bondi Junction.

I lasted only a year. I felt like a burden on the taxpayer and was miserable. The impression of the department I was left with was that it was vastly overstaffed, over-funded and had a work culture that was deliberately slow, wasteful and inefficient.

I’ll give you an example. One of the more interesting tasks of a graduate was to write a ministerial letter, a letter from the department written on behalf of the health minister in response to a query sent by a constituent. Most of the time a ministerial letter simply consists of formulaic verbiage and generic information. Yet, despite this, every letter I wrote had to be approved by several layers of management – my supervisor, the team director and the division’s director – before it was sent out.

This triple-handling was justified because it reduced the risk of a gaffe that might embarrass the minister. But such unwieldy processes for getting work done obviously become a liability in a time of crisis if they can’t be scaled back and discarded.

In an interview with the ABC’s Four Corners, Queensland Deputy Premier Steven Miles observed that “each of our jurisdictions are good at different things. The states are very good at service delivery, particularly health service delivery, and if we’d used the more established programs for rolling out the vaccine, I think we would be in a better place.”

On this, I think Miles is correct. Our federal public servants are somewhat disconnected from the realities of frontline service delivery. While the federal Health Department may be able to execute an updating of the PBS or the MBS, steering an emergency vaccination program involving thousands of general practitioners, millions of vaccine doses and nationwide coverage presented a level of logistical complexity heretofore unknown to the bureaucrats in Canberra.

Queensland Deputy Premier Steven Miles. Picture: NCA NewsWire / Dan Peled

It does not surprise me that the department failed to make adequate contingency plans for when the bets on various early vaccine candidates did not pan out. Or that it failed to allocate football stadiums as mass vaccination hubs when the first deliveries of Pfizer arrived in the country.

It does not surprise me that the federal government limited the delivery of Covid vaccines to GP practices, excluding nurse practitioners and pharmacies. Or that it underestimated the challenge of providing every GP in the country with the right number of vaccine doses at the right time. And it does not surprise me that the military ultimately was called in to fix the rollout when our recent outbreaks made its urgency more apparent.

As Sydney barrister Gray Connolly recently observed on the ABC’s The Drum, “The military are the only people in Canberra who actually know how to run anything.”

The main problem that arises in our federal departments is that there is little accountability for how money is spent. The Health Department employs more than 4600 people yet it outsources a huge amount of its work to consultants. What is the point of employing so many people if they’re not given enough work to do?

When departments are overstaffed, employees ultimately are trained to work at a glacial pace for their supervisors to justify the budgets they manage. I was shocked to discover in my time at Health that supervisors considered underspending to be more problematic than overspending. In my naive pre-public service world view, spending too much money and too much time on a task was considered wasteful. In the world of the federal public service, waste was often the point.

My experience was limited, and I do not wish to present a direct causal arrow from the inefficiency I witnessed in 2011 to what has happened in the past 1½ years. But my guess is that the culture is the same as it was 10 years ago. With Covid becoming a permanent fixture of life and the potential for years of booster vac­cines being necessary, voters will want to know from both sides of the chamber why they are funding a department incapable of delivering on its most basic function: to protect our public health.

Claire Lehmann is founding editor of online magazine Quillette.