While the report of Victoria’s hotel quarantine Board of Inquiry is still a few weeks away, its hearings have underlined the wide range and complexity of functions needed to respond to outbreaks of highly infectious diseases.
The inquiry has shone a light on understandable uncertainties over who is best placed to exercise which responsibilities; if we take the hotel quarantine example – there have been nurses, other healthcare professionals, public health practitioners, police, military personnel and private security.
There’s also the challenges of coordinating activities across different agencies, mandates, areas of expertise and institutional cultures.
These challenges bedevil most areas of modern health governance, but they are accentuated in times of emergency.
This is because decisions need to be made quickly and in the face of significant uncertainty, and because the ideal workforce may not exist, or at least may not be able to be mobilised in sufficient time.
The consequences of these challenges, and the decisions taken, can be grave – as Victoria’s second wave has demonstrated.
Likewise, the COVID-19 Omnibus (Emergency Measures) and Other Acts Amendment Bill 2020, which is currently the subject of considerable controversy, highlights the challenge of mobilising an appropriate workforce in a time of emergency.
A number of criticisms have been levelled at the Bill.
A particular criticism is of its proposal to temporarily (until 26 April 2021) expand the range of people who may be appointed as “authorised officers” under the Public Health and Wellbeing Act 2008, the primary piece of legislation governing Victoria’s public health response to COVID-19.
The Bill proposes to allow the Secretary of the Department of Health and Human Services to appoint as an authorised officer “a person the Secretary considers appropriate for appointment based on the person’s skills, attributes, experience or otherwise”.
Critics of the Bill have expressed concern over who may come to be appointed to exercise powers under the Act, focusing on the Act’s powers to “detain”.
It has now been reported that the Government will amend the Bill to clarify the powers of the new authorised officers.
Unfortunately, none of the criticism, nor the public debate it has generated, appears to have paid any regard to the critical workforce challenges that the Bill might be intended to address.
An indication of these challenges can be found in the Minister’s Second Reading Speech:
The broader class of persons who may be appointed as authorised officers may include public sector employees from Victoria and other Australian jurisdictions. For example, health services staff, WorkSafe officers such as Inspectors, Victoria Police members and Protective Services Officers.
The Bill will also enable the appointment of individuals with particular attributes, such as connection to particular communities, to ensure that certain activities, like contact tracing, can be conducted in a culturally safe manner. For instance, the Secretary will be able to appoint individual employees of Aboriginal Community Controlled Organisations (ACCOs) as authorised officers.
This will enable ACCOs to undertake activities such as contact tracing within the Aboriginal Community in a culturally appropriate manner. It would also enable appointment of individuals from appropriate multicultural health organisations to contact relevant communities.
This underlines that the Act covers a broad range of public health and enforcement functions, which includes: collecting and communicating information, inspecting premises; requiring their cleaning or disinfection, or their closing, restricting movement, detaining people and enforcing legal requirements.
These are all very different functions, requiring varying kinds of skills, attributes and experience.
It also reminds us that it is essential that we are able to work in appropriate ways with Victoria’s diverse communities if we are to be able to control COVID-19, provide treatment and support to those affected by it and respond adequately to the enormous dislocations the virus has caused.
By now, we all know that COVID-19 has had different impacts on different parts of our community.
These communities have different vulnerabilities both to being exposed to COVID-19 and to the consequences of the measures introduced to prevent its spread, as well as varying levels of access to health and other vital services.
For those who work in public health, this is no surprise.
The relationships between social and economic inequalities and health are at the core of public health practice.
The absence of this kind of context impoverishes what could otherwise be a vital debate for our current COVID-19 response, for our recovery and our preparedness for future pandemics.
Reflecting this, the media release issued by the Victorian Bar Association and the Australian Bar Association states:
The proposed criteria potentially open the door for those who are not trained as health professionals to be appointed as “authorised officers”. This is of significant concern as it is imperative that the qualifications of these officers are relevant to the public health functions that they are intended to perform.
By contrast, a letter sent to the Victorian Premier by a group of retired judges and current QCs states:
There would be no requirement that persons authorised be police officers, or even public servants.
But a more constructive starting point might be to note the functions that need to be performed.
From there, it’s a process of sensibly identifying what skills, attributes and experience are required, and then working out how these should be provided for and how their exercise should be managed.
The central challenge here is about mobilising, and appropriately managing, the workforce needed during a public health emergency.
It’s thinking about what to do when the required skills, attributes and experience either do not exist within government, do not exist in sufficient capacity, or do not reflect the diversity needed to be able to work constructively with diverse parts of the Victorian community.
To some extent, this reflects broader problems of under-resourced public services – particularly government public health capacity.
But this is only part of the story.
The workforce required in more ‘normal’ times is not the same as the workforce required in emergencies. On top of that, there may be critical functions that are better performed by people who are not ordinarily government officials – for example, leaders who are trusted within their communities.
These are matters that require careful reflection, including detailed consideration of which precise functions should be given to whom, for what reason, and how their exercise should be overseen.
In working through this, the challenges should not be conflated with those relating to the contracting out of government functions to private contractors in commercial arrangements – which the hotel quarantine inquiry has already laid bare.
Rather, the concern here is to be able to engage individuals on the basis of their skills, attributes and experience to ensure we have the capacity needed to respond to a public health crisis.
As the debate about the Bill continues, consideration of the wider challenges could lead us to an understanding that serves the Victorian community well – both in our immediate COVID-19 response and in the longer-term future.