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Our health industry needs a Commonwealth Integrity Commission

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Shadow Health Minister Catherine King recently announced a new Health Reform Commission (Screenshot via YouTube)

There have been calls for a Royal Commission into the health industry since a lack of integrity is evident in the field, writes Dr Leong Ng and Dr Anthony Pun, OAM.

“The desire for safety stands against every great and noble enterprise.” ~
Tacitus 5th Century.

Two Federal government inquiries have been launched recently to consult and debate about a potential “Commonwealth Integrity Commission”.

These are a Senate Inquiry on three Bills by the Standing Committee on Legal Affairs and the Constitution. This possesses the Parliamentary privilege accorded to such inquiries. Many pros and cons have been articulated and discussed in the 23 submissions

The authors contributed a submission in which we were critical of the health regulator, the Australian Health Practitioners’ Regulation Agency (AHPRA) and the Royal Australasian College of Physicians (RACP, a private entity), both of which were given their right of written reply published alongside the submission (no. 22).

A right of reply by AHPRA and the RACP is a fair process, however, it does have its disadvantages that any misleading and inaccurate statements, in our opinion, go unchallenged. In this context, the public may perceive such statements to be true when made by powerful and influential bodies.

For example, we do not accept the peer review process protocols as claimed by the RACP. In fact, it was non-existent as the first author had never faced them in 2003-2006. A review of a meta-analysis by the Australian Commission on Safety and Quality in Healthcare resulted in this publication,  from this which was published in 2009. These publications substantiate our claims of its inequity in process.

The second inquiry, the Commonwealth Attorney General’s Invitation for Submissions in a non-privileged inquiry, is equally evasive. To date, there is no response to our submission and perhaps the matter was quietly shelved amongst the election fever symptoms.

A cacophony of national non-partisan unofficial calls

There have been many and persistent calls for a Royal Commission into health matters in recent years. During this period, it has been found that many other aspects of life have suffered the same “lack of integrity”.

In both the Royal Commission into Institutional Responses to Child Sexual Abuse and in gross widespread dysfunction in healthcare, a common finding is the allegation of bullying and abuse that has occurred for a prolonged period of time. A third subtle one is the Banking Royal Commission. These are expensive to the taxpayer. This matter was first brought to the public attention by the Health Professionals Australia Reform Association (HPARA) and supported early on by IA.

A Commonwealth Integrity Commission?

Australia has slipped in Transparency International’s Corruption Perception Index (CPI). It is rightly very concerned about its image and both sides (along with other sides) may be taking this up as a Federal Election Issue. For example, Labor is keen on the formation (another) of an Australian Health Reform Commission as announced by the Shadow Health Minister, Catherine King. This same person had not acted when complained to regarding bullying in Ballarat in 2005.

Subsequently, this was independently confirmed in 2016 by two private entities when commissioned by the Victorian Minister for Health, Jenny Mikakos, to act. This is not enough. What political points can be scored or is this another promise? Incidentally, a recent survey by the Health Workers’ Union shows that a certain public hospital tops the list in the bullying culture in Victoria. It would appear that remnants of the bullying leadership at this hospital still exist.

The unintended consequence of a right of reply

The right of reply given to APHRA and RACP – a major Government agency and a “distinguished” organisation respectively – to allegations made by the Submission 22 is appropriate on grounds of natural justice. However, it does create the unintended consequence of creating a false public perception that the replies are true and accurate as it comes from “established” bodies. In this David vs Goliath contest, it is Goliath who is the victor.

However, if the allegations made by Submission 22 are upheld by a court of law in the near future, for example, who is then responsible for these bodies acting “above the law”?

Definition of corruption — a major problem?

There appears no universal definition of what is “corruption”. Entities may argue their way out if there is a good law practitioner. TI’s CPI definition is reproduced here and appears to hold water as it has been in use for a while.

This is summarised below with some minor additions.

How do you define corruption?

 

Generally speaking as “the abuse of entrusted power for private gain”, corruption can be classified as grand, petty and political, depending on the amounts of money involved and the sector where it occurs. It may not include monetary benefits.

 

Grand corruption consists of acts committed at a high level of Government that distort policies or the central functioning of the State, enabling leaders to benefit at the expense of the public good.

 

Petty corruption refers to everyday abuse of entrusted power by low and mid-level public officials in their interactions with ordinary citizens, who often are trying to access basic goods or services in places like hospitals, schools, police departments and other agencies.

 

Political corruption is a manipulation of policies, institutions and rules of procedure in the allocation of resources and financing by political decision-makers, who abuse their position to sustain their power, status and wealth. 

This definition is not without its flaws: for example, “petty corruption” cannot be petty in cases such as Melbournian, Belle Gibson. In our view, this is a case of grand corruption.

Much corruption: many “rules”

It was the Roman historian Tacitus who quoted that the more corrupt a process is, the more rules there are — Australia is a perfect example and it is ongoing. In NSW, the Independent Commission Against Corruption (ICAC) writes about the outcomes of corruption in its website.

There must be an Australian commission and commissioners with wide powers to deal with all sorts of issues regarding lack of integrity which are sorely missing or diminished in many spheres of life compared with several decades ago. This commission must have teeth and should be given powers to oversee other Government and private regulatory bodies acting as a “high court” of regulatory bodies. Sadly, the Senate Committee in its report was negative (and rushed). Until such reforms are forthcoming, the public confidence in this area remains dwindling.

Dr Leong Ng has for several years persistently and voluntarily worked to assist colleagues who have been damaged by colleges or medical boards via frivolous allegations and complaints. Working with his friends and colleagues, this has now resulted in the registration as a not-for-profit organisation, the Health Professionals Australia Reform Association (HPARA) and the public revelation of an increasing number of many "closet" cases.  He is a Committee Member of HPARA and also chairs the Honest Peer Review Group.

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