On 1 March last year, in the lead up to the May federal election, Mark Butler committed Labor to expand the Patient Pathways program with $2.47 million.
The program is a collaboration led by the Centre for Community-Driven Research (CCDR) that places nursing specialists within patient groups to provide health system navigation and other support to families and patients.
Mr Butler announced the commitment at the annual conference of the National Patient Organisation Network.
"Labor has decided, I'm pleased to announce, that if we are elected at the election that takes place probably in May this year, then we will adopt the case that's argued in the pre-budget submission and ensure that Patient Pathways is funded for another three years in the manner and to the amount that is set out in the pre-budget submission, which is, I understand, it is a little less than $2.5 million," he told the conference.
CCDR's chief executive Kate Holliday told BioPharmaDispatch that Mr Butler won significant kudos personally and for Labor amongst patient groups for the commitment, not least because the former government allowed officials to obfuscate on commissioning an evaluation of the program that has now supported over 3,000 Australian families through almost 27,000 interventions since 2019.
"After the election, and once Mr Butler was confirmed as health minister, we started the process of preparing to implement the expanded service on 1 July consistent with the commitment. Part of that was engaging new nurses," she said.
Yet within weeks of Mr Butler's appointment and only 15 days before the program's funding was due to end, officials told Ms Holliday that implementation of the pre-election commitment would be delayed pending its endorsement in the 2022-23 Budget and completion of the delayed evaluation. The Budget was planned for October.
The decision confused Ms Holliday, CCDR and patient groups because at least one other much larger election commitment was implemented ahead of the Budget. Mr Butler announced the $275 million expansion of access to continuous glucose monitoring from 1 July.
Officials from the Department of Health and Aged Care (department) offered CCDR $150,000 as interim funding for the six months from July to December last year. This fell well short of the $270,000 required to maintain the program, let alone the $400,000 necessary to expand its service to new patients consistent with Labor's election commitment.
Ms Holliday wrote to Mr Butler in July to express concern over the uncertainty created by the delayed implementation of the election commitment. She offered a potential solution.
She said CCDR would continue to centrally administer the Patient Pathways program but forgo its own government funding. She suggested that the department directly contract and provide the $150,000 to individual patient groups.
This offer has been consistently misrepresented by officials and now potentially by Mr Butler in recent correspondence to his parliamentary colleague, Dr Mike Freelander.
In the correspondence dated 7 February 2023, Mr Butler told Dr Freelander, "In late July 2022, I received the CCDR's decision to not accept the funding to deliver the election commitment."
The use of language does not reflect the substance of CCDR's correspondence, its proposal, or the status of the election commitment.
In fact, the election commitment had not even been confirmed in July last year with officials telling CCDR that it was subject to the October Budget process and the evaluation.
The organisation's correspondence to Mr Butler was in response to this uncertainty and frustration over its dealings with departmental officials. It told Mr Butler that the $150,000 offered fell significantly short of that commitment and what was required to deliver the existing or expanded program. As a solution, it said it would administer the program in return for no government funding pending the Budget, and that the available $150,000 should be directed to individual patient groups.
"Following the Government’s decision to set aside its election commitment to fund an expanded Telehealth Nurses - Patient Pathways program from 1 July 2022, the Centre for Community Driven Research (CCDR) has decided that the health of the people we help support and care for must come first and are withdrawing our component of the request for funding in this program so that our portion of the ‘tide over’ funds offered by your Department can be used to fund all patient groups immediately, consistent with your election commitment," said Ms Hoilliday in the July correspondence to Mr Butler.
She continued, "CCDR will instead seek public and philanthropic funding support for our work as the owners of the Pathways Program, and leave the department to negotiate and manage the grant service delivery arrangements with individual patient pathway providers.
"This has been a difficult decision, but our focus is always the patients and their care. They cannot continue to go unfunded and unsupported."
Ms Holliday added, "Our decision to seek independent public funding for our work will allow us to remain involved in the Patient Pathways Program we designed, and which has become a model for several other government-funded programs. Our continued engagement is important to our partner organisations and we take that responsibility seriously."
Neither Mr Butler nor departmental officials have ever acknowledged this proposal or CCDR's sacrifice of government funding and ongoing commitment to the delivery of the Patient Pathways program.
They have preferred to completely mispresent the correspondence and CCDR's proposal.
CCDR subsequently wrote to assistant health minister Ged Kearney in October to reiterate its ongoing commitment to program delivery, including its central administration. Minister Kearney has not responded.
The department has ultimately failed to provide the $150,000 funding to individual patient groups, as proposed by CCDR. CCDR and individual patient groups have been delivering the program with no direct government support since July last year.
The misrepresentation of CCDR's offer was repeated at Senate Estimates last Thursday with officials struggling to explain the situation under questioning from shadow health minister Senator Anne Ruston.
First assistant secretary Simon Cotterell said, "So Senator, as I said, the government decided it was confirming its election commitments in the October budget. There was an iterative conversation between the department and the minister about what to do in the interim [with Patient Pathways].
"The department had $150,000 available to support an extension of the program while the commitment was confirmed in the Budget that was offered to the Center for Community-Driven Research, they decided to withdraw from the program in July."
His statement that CCDR "decided to withdraw from the program in July" clearly misrepresents the organisation's offer of a solution to the funding shortfall. In fact, rather than withdrawing, CCDR offered to continue its administration of the program but forgo its own funding in favour of the individual patient groups.
The department chose not to adopt CCDR's proposal, including directly contracting the individual patient groups. Instead, officials have privately and publicly mispresented CCDR, revealing a pattern of behaviour that arguably has the characteristics of bullying and even gaslighting.
Ms Holliday has gone as far as formally raising concerns about the conduct of individual officials.
In a response to CCDR dated 26 October 2022, health department secretary Professor Brendan Murphy AC acknowledged the code of conduct complaint but told Ms Holliday to keep working with the relevant official and, in fact, directed her concerns to that official.
"I understand that you have been advised that [officials name redacted] remains the point of contact in the Department for all matters associated with the grant, including its acquittal. Accordingly, I ask that you communicate with [redacted] on these issues, including the assessment of any documents provided in response to his letter of 14 September 2022 regarding the outstanding reporting material and other information requested under the grant agreement," said Professor Murphy.
He went on to confirm that the complaint against that official was the subject of an investigation by an external legal adviser.
Professor Murphy's direction that Ms Holliday continues to engage the official who is the subject of her complaint was set against the backdrop of the Albanese government's publicly stated commitment to demand the highest standards of conduct from itself and its officials.
Ms Holliday responded to Professor Murphy, copying Mr Butler's chief of staff, expressing concern over this requirement. Mr Cotterell replied on 1 November, reiterating the requirement but tacitly acknowledging the organisation's complaint against the official.
"The Department considers that [officials name redacted] is not affected by your complaint to the extent that [redacted] would be required to excuse himself from the grant acquittal process," he said.
The October Budget confirmed the $2.47 million election commitment and the department recently published the grant opportunity. It has changed the name of the program, from Patient Pathways to the Rare and Complex Disease Telehealth Nurse Program, but given organisations just two weeks to respond.
Mr Holliday told BioPharmaDispatch that the two-week timeline is "impractical" and that the department's handling of the program has almost certainly undermined its ongoing viability.
Senator Ruston suggested at Senate Estimates that the administration of the grant application process might suggest a pre-ordained outcome.
Mr Cotterell denied the suggestion but acknowledged that some organisations had been consulted in advance of the formal application process because "CCDR chose not to continue with delivering that program."
Once again, this statement is false. It misrepresents CCDR's statements in correspondence to Mr Butler, his officials, other ministers and senior bureaucrats, and members of parliament.
In fact, CCDR and individual patient groups continue to deliver the program with no government funding, and the organisation is still in a position to "continue with delivering that program."
The department's external evaluation of the Patient Pathways program has confirmed the value and merits of the program, including the use of a central administrator, and telehealth as a delivery model.
Mr Butler had not responded to a request for comment at the time of publication.
Paul Cross (paul@dailydispatch.com.au)
