Council Of Australian Governments Research Articles

Pathogen security and human biosecurity for microbiologists

The Security Sensitive Biological Agents Regulatory Scheme was implemented in 2009 after a Council of Australian Governments’ report in 2006 recommending the establishment of a biological threat agent regulation and control framework. Legislative authority for the SSBA scheme is provided by the National Health Security Act 2007.

Benchmarking government: Report on government services (RoGS) – 25 years on

AbstractRobust indicators and measures for outputs and outcomes against agreed objectives are the holy grail of performance reporting. Transparent performance reporting can be a means to improving accountability to taxpayers for public funds and responsiveness to users. The Report on Government Services (RoGS) for the Council of Australian Governments (COAG) is widely seen as ‘an exemplar of benchmarking in a federal system.’ Twenty‐five years on, RoGS has been institutionalised and the approach to performance reporting was central to the COAG reform agenda. Annual reports compare the equity, effectiveness, and efficiency of outputs and outcomes across governments in six key areas – childcare, education and training; health; justice; emergency management; community services; and housing and homelessness. Performance indicators and measures have increased the accountability of state and territory governments for their management of public funds. The significance of RoGS is the unprecedented scale and scope of performance indicators and its longevity. The services benchmarked in the 25th report in 2020 accounted for $247 billion, representing 70% of government recurrent expenditure and 13% of GDP.

Use of Data Linkage Method to Compile Life Tables for Aboriginal and Torres Strait Islander Australians

IntroductionAlmost all deaths of Aboriginal and Torres Strait Islander Australians are registered, but some are not identified and recorded as such when registered. Therefore, registration data underestimates the actual number of deaths and death rates of Aboriginal and Torres Strait Islander Australians, and consequently their application can result in overestimates of life expectancy.
 Hence registered deaths needs to be adjusted before deriving life tables and life expectancy estimates.
 Objectives and ApproachObjective: To develop a data-driven method for estimating factors for adjusting registered deaths.
 Approach: The Australian Bureau of Statistics (ABS) linked Census records to all deaths that were registered within a year following the Census. Adjustment factors were estimated by directly comparing Indigenous status of a person reported in Census and death registration data. The ABS then used an established and widely used method to compile life tables, by making up-front adjustments to registered deaths by the factors derived from the Census and deaths linked dataset.
 ResultsAboriginal and Torres Strait Islander deaths identification rate in registration data was estimated to be 89% at the national level in 2016-2017. Over the same period, identification rates varied considerably by state/territory and ranged between 0.69%-1.04%. It clearly showed the need to adjust for under/over identification in Aboriginal and Torres Strait Islander death registrations.
 Conclusion / ImplicationsStatistical data linkage methods can successfully be used to improve Aboriginal and Torres Strait Islander Australians life expectancy estimates. This has implications for accurately measuring and monitoring the Council of Australian Governments’ ‘Closing the Gap’ target in life expectancy estimates between Aboriginal and Torres Strait Islander and non-Indigenous populations.

Contracting treatment services in Australia: Do measures adhere to best practice?

BackgroundContracting non-government services to provide alcohol and other drug (AOD) treatment requires the specification of performance measures to ensure accountability for public funds. There is currently no standardised approach by funders to the measurement of performance of AOD treatment in Australia. Funding to non-government organisations (NGOs) is complex, with NGOs managing funding agreements from a range of sources that contain a large number of differing performance measures. This study aimed to assess performance measures used in contracts for NGO AOD treatment providers and how they align with best practice. MethodsPerformance measures contained in funding agreements for treatment providers were collected from a diverse sample of both funders (n=8) and treatment providers (n=20) resulting in more than 1,100 measures. The list of measures was synthesized to a finite, non-duplicative list (n=537). Measures were assessed by three raters against 11 criteria (for example, measurable and timely) documented as best practice elements of performance measures (Council of Australian Governments, 2011a). Measures were also coded into different measurement types (such as outcome and process). ResultsNone of the 537 unique performance measures used in funding agreements for treatment providers fully met the criteria for best practice in performance measurement. Whilst the literature and government policy is being directed towards outcomes-based funding and reporting, only 7.6% of measures were classified as outcome measures. The majority of measures were classified at output (41.3%) and process (23.6%) measures. ConclusionCurrent measures in contracts applied by funders to treatment services do not adhere to best practice. The development and implementation of new performance measures is required to inform AOD policy and accountability of public funds. Further, identifying more robust performance measures has the potential to lead to reduced reporting burden on service providers and better monitoring of service quality and outcomes.

Acting in the Public Interest: Learnings and Commentary on the Occupational Licensure Literature

There is increased interest in reforming the way occupations are licensed. However, most of the current dialogue focuses on the rapid growth in the number of people who need a license to pursue their chosen occupation. Consequently, significant questions are being raised as to the appropriateness of such requirements for groups that do not appear to present any tangible threat to public safety. Recent research has demonstrated that health professions have failed to articulate the need and value for licensure and how health regulators are addressing the many concerns being raised by the current debate. This study identifies dimensions or aspects of nurse licensure congruent with acting in the public interest and starts to curate (ie, to select, organize, and present) evidence related to each dimension, thereby identifying the current impact and highlighting opportunities for further research. This study utilizes a mixed-methods approach that combines documentary analysis, focus group discussion, and related literature associated with the various dimensions of acting in the public interest to highlight how nurse licensure addresses the current drivers for regulatory reform. A total of 99 documentary sources (ie, papers, articles, reports, and opinion editorials) were uploaded to NVivo 11 Plus for analysis. The analysis generated four overarching themes: (a) licensure reform, (b) impact of occupational associations, (c) occupational licensure issues, and (d) contemporary issues. Associated with these themes, 22 subthemes were also identified. The findings demonstrate there is clear evidence to support the fact that nurse regulators are acting in the public interest. However, further research is needed to provide definitive evidence to inform best practices in regulation and to offer direction for improved nurse regulatory reform. Furthermore, it is suggested that nurse regulators create and effectively maintain a global community capable of learning from one another and driving continuous improvement to better serve the public.

Apples for Oranges: Disparities in Offset Legislation and Policy among Jurisdictions and its Implications for Environmental Protection and Sustainable Development in Australia

As a signatory to Agenda 21, the Rio Declaration on Environment and Development, the 2030 Agenda for Sustainable Development (including the Sustainable Development Goals) and the Convention on Biological Diversity, Australia has an international obligation to ensure sustainable development. Biodiversity offsets are one tool used by Australian regulators to allow development to continue, whilst ensuring international obligations for sustainable development are met. In this study, legislation, policy and published guidelines for the Australian Commonwealth, states and territories were analysed to determine if the application of biodiversity offsets was consistent with the principles of sustainable development (environmentally, socially, economically) and if the allowance of biodiversity offsets in different jurisdictions created gaps in biodiversity and environmental protection across Australia. Regulation of biodiversity offsets was found to be inconsistent between the Commonwealth and the states and territories, with most jurisdictions having less than 50% similarity. This inconsistency in offset policy and legislation between jurisdictions could lead to loss of biodiversity. Additionally, jurisdictions did not adequately consider the social and economic aspects of sustainability in relation to biodiversity offsets, meaning that, through the allowance of biodiversity offsets, Australia may not be meeting their international obligations related to sustainable development. Further legislative development for biodiversity offsets is required in Australia to improve environmental protection and to adequately consider all aspects of sustainability. The Council of Australian Governments is a mechanism that could be used to ensure all jurisdictions consider the aspects of sustainability consistently in relation to biodiversity offsets.

National Quality Standard in Schools: Leadership Enabling Power and Agency

THE POLITICAL IMPERATIVE that underscores the quest for continuous improvement and quality provision of early childhood education and care in Australia has seen the unparalleled development of a federal policy framework for children's services. The Council of Australian Governments (COAG) agreed to a National Quality Framework (NQF) and, as part of this, the National Quality Standard (NQS) was developed to drive continuous improvement and set a national benchmark for the provision of children's services outside the schooling sector. The Western Australian Minister for Education required not only prior-to-school children's services to meet the NQS, but also the early years of school that cater for children aged four years to eight years (Kindergarten to Year 2). This research project followed the journey of four schools that implemented the NQS in 2016, in the first year of mandatory use. A case study approach using qualitative methods of individual and focus group interviews of principals, teachers, teaching assistants and Department of Education consultants was undertaken. The data was analysed by the coding of common themes and by completing a cross-case synthesis. Leadership was the most common theme for successful implementation of the NQS. This paper reports on the aspects of leadership across multiple layers that represented the involvement of Department of Education consultants, principals and staff at four public schools. Essentially, the NQS increased staff power and agency, and united their vision for continuous quality improvement that contributes to the national quality agenda for children.

Reconciling hospital-acquired complications and CHADx+ in Victorian coded hospital data.

The Council of Australian Governments has focused the attention of health service managers and state health departments on a list of hospital-acquired complications (HACs) proposed as the basis of funding adjustments for poor quality of hospital inpatient care. These were devised for the Australian Commission on Safety and Quality in Health Care as a subset of their earlier classification of hospital-acquired complications (CHADx) and designed to be used by health services to monitor safety performance for their admitted patients. To improve uptake of both classification systems by clarifying their purposes and by reconciling the ICD-10-AM code sets used in HACs and the Victorian revisions to the CHADx system (CHADx+). Frequency analysis of individual clinical codes with condition onset flag (COF 1) included in both classification systems using the Victorian Admitted Episodes Dataset for 2014/2015 ( n = 2,623,275 separations). Narrative description of the resulting differences in definition of "adverse events" embodied in the two systems. As expected, a high proportion of ICD-10-AM codes used in the HACs also appear in CHADx+, and given the wider scope of CHADx+, it uses a higher proportion of all COF 1 diagnoses than HACs (82% vs. 10%). This leads to differing estimates of rates of adverse events: 2.12% of cases for HACs and 11.13% for CHADx+. Most CHADx classes (70%) are not covered by the HAC system; discrepancies result from the exclusion from HACs of several major CHADx+ groups and from a narrower definition of detailed HAC classes compared with CHADx+. Case exclusion criteria in HACs (primarily mental health admissions) resulted in a very small proportion of discrepancies (0.13%) between systems. Issues of purpose and focus of these two Australian systems, HACs for clinical governance and CHADx+ for local quality improvement, explain many of the differences between them, and their approach to preventability, and risk stratification. A clearer delineation between these two systems using routinely coded hospital data will assist funders, clinicians, quality improvement professionals and health information managers to understand discrepancies in case identification between them and support their different information needs.

Australia’s Counter-Terrorism Policies Since September 11, 2001: Harmonising National Security, Independent Oversight and Individual Liberties

Australia has remained insulated from mega terrorist attacks, but post-September 11 its involvement in the war on terror in Afghanistan, Iraq and against the Islamic State in Iraq and Syria (ISIS) has brought terrorism into its backyard. In the wake of these emerging threats, particularly home-grown terrorism (HGT), successive governments have introduced changes in the counter-terrorism (CT) laws, and expanded the Criminal Code Act 1995 (Commonwealth-Cth) at the recommendations of the Council of Australian Governments (COAG). Former prime minister Tony Abbott and his successor Malcolm Turnbull have introduced a series of significant policy measures to curb terrorism in and from Australia. These measures have also stirred up a debate among experts and civil society members, who consider them as being detrimental to civil liberties. The article undertakes a critical review of the evolution of CT laws and measures in Australia since September 11, to understand the criticism of the legislative changes, and to what extent has Australia succeeded in harmonising national security and individual liberties with an effective oversight mechanism.

Intergovernmental councils and centralization in Australian federalism

ABSTRACTThis paper explores how a high level of vertical intergovernmentalism and a low level of horizontal intergovernmentalism reflect as well as contribute to a high degree of centralization in Australian federalism and in the role and activity of intergovernmental councils (IGCs). Pre-eminent among the latter is the Council of Australian Governments (COAG), which sits at the apex of a system of ministerial councils and attendant agencies. Policy coordination is the principal motivation behind the Commonwealth’s use of COAG. The States established their own horizontal body in 2006 but that faded quickly in an experience that confirmed the underlying realities of Australian federalism.

Federalism and Australia’s National Health and Health Insurance System

While health reform in Australia has been marked by piecemeal, incremental changes, the overall trend to increasing Commonwealth involvement has not been accidental or driven by power-hungry centralists: it has been shaped by broader national and international developments including technological change and the maturing of our nation and its place internationally, and by a widespread desire for a national universal health insurance system. In many respects the Australianhealth system performs well, but the emerging challenges demand a more integrated, patient-oriented system. This is likely to require a further shift towards the Commonwealth in terms of financial responsibility, as the national insurer. But it also requires close cooperation with the States, who could play a firmer role in service delivery and in supporting regional planning and coordination. The likelihood of sharing overall responsibility for the health system also suggests thereis a need to involve the States more fully in processes for setting national policies.
 This article draws heavily on a lecture presented at the Australian National University in October 2015. It includes an overview of Australia’s evolving federal arrangements and the context within which the current Federalism Review is being conducted. It suggests Australia will not return to ‘coordinate federalism’ with clearly distinct responsibilities, and that greater priority should be given to improving how we manage shared responsibilities.
 There is a long history of Commonwealth involvement in health, and future reform should build on that rather than try to reverse direction. While critical of the proposals from the Commission of Audit and in the 2014 Budget, the lecture welcomed the more pragmatic approaches that seemed to be emerging from the Federalism Review discussion papers and contributions from some Premiers which could promote more sensible measures to improve both the effectiveness and the financial sustainability of Australia’s health and health insurance system.
 The Commonwealth’s new political leadership in 2015 seemed interested in such measures and in moving away from the Abbott Government’s approach. But the legacy of that approach severely damaged the Turnbull Government in the 2016 federal election as it gave traction to Labor’s ‘Mediscare’ campaign. In addition to resetting the federalism debate as it affects health, the Turnbull Government now needs to articulate the principles of Medicare and to clarify the role of the private sector, including private health insurance, in Australia’s universal health insurance system. Labor also needs to address more honestly the role of the private sector and develop a more coherent policy itself.
 Abbreviations: COAG – Council of Australian Governments; NHHRC – National Health and Hospitals Reform Commission; PHI – Private Health Insurance; VFI – Vertical Fiscal Imbalance.

What Problem is Being Solved? ‘Preventability’ and the Case of Pricing for Safety and Quality

One of the critical issues facing healthcare systems internationally is to improve safety of care. Unfortunately, safety discussions, both in hospitals and in policy documents, often quickly turn to identifying and acting on ‘preventable’ mishaps. But preventability is a slippery concept, which this paper discusses. A contemporary policy response is to introduce financial incentives in hospitals and/or states to improve safety, proposed for national implementation in Australia from 1 July 2017. This has the potential to change the internal dynamic of hospitals to enhance the focus on safety. The implications for hospitals of this change are also discussed.
 Abbreviations: COAG – Council of Australian Governments.

Does evidence influence policy? Resource allocation and the Indigenous Burden of Disease study.

Objective The Indigenous Burden of Disease (IBoD) report is the most comprehensive assessment of Indigenous disease burden in Australia. The aim of the present study was to investigate the potential effect of the IBoD report on Australian Indigenous health policy, service expenditure and research funding. Findings have significance for understanding factors that may influence Indigenous health policy. Methods The potential effect of the IBoD report was considered by: (1) conducting a text search of pertinent documents published by the federal government, Council of Australian Governments and the National Health and Medical Research Council of Australia (NHMRC) and observing the quantity and quality of references to IBoD; (2) examining data on government Indigenous healthcare expenditure for trends consistent with the findings and policy implications of the IBoD report; and (3) examining NHMRC Indigenous grant allocation trends consistent with the findings and policy implications of the IBoD report. Results Of 110 government and NHMRC documents found, IBoD was cited in 27. Immediately after publication of the IBoD report, federal and state governments increased Indigenous health spending (relative to non-Indigenous), notably for community health and public health at the state level. Expenditure on Indigenous hospital separations for chronic diseases also increased. These changes are broadly consistent with the findings of the IBoD report on the significance of chronic disease and the need to address certain risk factors. However, there is no evidence that such changes had a causal connection with the IBoD study. After publication of the IBoD report, changes in NHMRC Indigenous research funding showed little consistency with the findings of the IBoD report. Conclusions The present study found only indirect and inconsistent correlational evidence of the potential influence of the IBoD report on Indigenous health expenditure and research funding. Further assessment of the potential influence of the IBoD report on Indigenous health policy will require more targeted research, including interviews with key informants involved in developing health policy. What is known about the topic? There are currently no publications that consider the potential effed of the IBoD study on Indigenous health expenditure and research funding. What does this paper add? This paper offers the first consideration of the potential effect of the IBoD report. It contains analyses of data from readily available sources, examining national expenditures on Indigenous health and NHMRC Indigenous research, before and after the publication of the IBoD report. What are the implications for practitioners? The paper is relevant to analysts interested in drivers of Indigenous health policy. Although it finds correlations between the release of the IBoD report and some subsequent health spending decisions, other factors should be investigated to better understand the complexity of processes that drive government efforts to improve Indigenous health.

Promoting the uptake of preventative Aboriginal child health policy in Western Australia

Australian Aboriginal children are over-represented on all negative health indicators compared with non-Aboriginal children.Contributing factors to the disparity include the impact of historical events, racism and social determinants of health. Despite the benefits of child health checks, offered through the Medicare Benefit Schedule and community health services, uptake of these is low. In 2012, Western Australia Health implemented the Enhanced Aboriginal Child Health Schedule (EACHS) policy to address specific health needs of Aboriginal children. The Aboriginal Child Heath Project (the Project), was a five-year initiative funded through the Council of Australian Governments. Project staff promoted the profile of preventative child health and the uptake of the EACHS policy across the state by agencies operating in the sector. Western Australia. Reach of the implementation workshop was measured by the number of staff attending policy implementation and the total number for agencies represented. One measure of impact was the number of agencies requesting the EACHS policy who adapted or adopted it to deliver evidence based comprehensive child health programs. The Project offered policy implementation workshops to health staff delivering services to young Aboriginal children. In addition to the evidence-based policy, a suite of resources were made available to support service delivery. The EACHS is a framework used by agencies to deliver consistent care and support governance when providing child health services to Aboriginal families across Western Australia. Providing a policy that was consistent with identified service strengths allowed agencies to individually build their capacity to deliver child health checks, using existing resources, at their own pace.

Alternative routes: Intergovernmental relations in Canada and Australia

AbstractCanada and Australia bear many similarities, but historical developments have affected the way each country practices federalism. This article seeks to answer the following question: Why have institutionalized horizontal relations been present in Canadian intergovernmental relations (IGR), while they have generally not in Australia? Developments in each country have produced different dynamics in intergovernmental relations which serve to favour vertical relations in Australia and open up space for horizontal relations in Canada. These dynamics become especially apparent when the histories of the institutions for facilitating intergovernmental relations in each country, notably the Canadian Council of the Federation and the Council of Australian Governments, are considered.

Intergovernmental Relations and the Role of Senior Officials: Two Case Studies and Some Lessons Learned

The Council of Australian Governments (COAG) is the most important forum for intergovernmental relations in Australian federalism. Though decision‐making processes in intergovernmental relations in Australia have been well documented in recent research, the role of senior officials within the COAG process is less often studied. Though not the primary decision makers, this article suggests senior officials play a significant role in intergovernmental outcomes through advice provision and ‘bargaining in the margins’ of COAG. Case studies of the National Competition Policy and the development of the Intergovernmental Agreement on Federal Financial Relations suggest both the contribution of senior officials and the constraints on their contribution to intergovernmental decision making.

Constitutional Incongruence: Explaining the Failure of the Council of the Australian Federation

The establishment and rise of the Council of Australian Governments (COAG) is, on balance, a story of the successful development of an executive-based institution for cooperative governance in the Australian federal system. By contrast, the Council of the Australian Federation (CAF), created in 2006 as a forum for interstate co-operation and policy development, has been far less effective. This article explores the reasons behind CAF's difficulties after a very short-lived initial impact. Integral to this account is the significance of Canadian experience of horizontal intergovernmental relations, which directly inspired the Australian Premiers to found CAF. The numerous indications of political congruence – some temporary, others systemic – between the Canadian and Australian settings obscured a deeper constitutional incongruence between the two jurisdictions and this is fundamental to appreciating CAF's failure as a transplant. CAF's ability to operate effectively as a significant institution was inevitably constrained by the parameters of the Australian federal system that its establishment was, in many ways, seeking to transcend.

Introduction of time-based targets has improved the training environment for emergency medicine: No.

Introduction of time-based targets has improved the training environment for emergency medicine: No.

Teaching and learning in an era of time-based access targets: Impact of a new model of care on junior medical officers.

Teaching and learning in an era of time-based access targets: Impact of a new model of care on junior medical officers.

The Council of Australian Government Reforms [2007–2013]: a critical juncture in Australian early childhood education and care (ECEC) policy?

Between 2007 and 2013, the Council of Australian Governments (COAG) introduced major national policy reforms to improve quality in early childhood education and care (ECEC) (Brennan and Adamson, 2014). By analysing policy documents underpinning the COAG reforms for early childhood, this article contends these reforms have been so far-reaching that, conceivably, they could have a lasting impact on systems and structures designed to improve quality in ECEC and fundamentally alter the trajectory of future policies. To this extent, they could eventually prove to constitute a critical juncture (Hogan and Doyle 2009; Pierson, Politics in time: history, institutions, and social analysis, 2004) in Australian ECEC policy history. In this article, we speculate about whether history will position the COAG reforms as a critical juncture in policy or see them weakened by policy moves that erode provision of quality in ECEC. We argue that studying the potentiality of critical junctures in ECEC policy illuminates the complexity of policy production and provides insights into the nature of future policies.