Ian Ring | A Voice to Parliament is a must - and a complete overhaul of ineffectual processes

It is now over 15 years since Australian governments first collectively committed to closing the gaps. Much of the original policy direction was soundly based and the initial injection of funds was a significant step in the right direction. But progress was bedevilled by flawed implementation and lack of continuity consequent to changes in government.

It is not as if the fundamentals for success were not known. In 2008, Tom Calma, then Aboriginal and Torres Strait Islander Social Justice Commissioner and recently appointed Senior Australian of the Year, oversaw the development of a set of targets required to close the gap. That process involved every mainstream and Indigenous health organisation that had anything to do with Indigenous health - except the Commonwealth government, which declined to participate. Pity, as if they had participated, they might have learnt a lot about successful program implementation.

The core underpinning behind the National Indigenous Health Equality Targets developed by Tom Calma's group, was the need not simply to focus on the desired results but crucially, what had to be done in order for the targets to be achieved. So there were five interlocking sets of targets, the first of which was partnership - genuine rather than token partnership. The other targets were the health status targets, particularly for mothers and babies and chronic disease, then the primary health care and other health service targets required to achieve those health status targets (including capacity building plans for Aboriginal community controlled health services, requirements for mainstream services and specific programs for main health conditions), the infrastructure required (including workforce, capital works and information) and finally the social determinants (culture, education, employment, community development and criminal justice reform). A 10-point plan by the National Aboriginal Community Controlled Health Organisation was on similar lines and emphasised the importance of culture, self-determination, and Aboriginal health leadership.

All pretty obvious you might think. But not to the government that wandered off into a fog of bureaucratic processes involving tokenistic partnership, glossy plans that weren't plans in any meaningful sense, magical self-achieving and often unresourced targets, and dysfunctional reporting processes that simply ignored the services required to achieve targets and induced responses characterised by a sense of despair rather than constructive political and administrative changes required to achieve the national goals. So no surprises that progress in closing the gaps has been glacial and indeed, progress without the necessary services would have been little short of miraculous.

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But there have been welcome developments in recent times, particularly with the National Agreement on Closing the Gap between Aboriginal and Torres Strait Islander Peak organisations and all Australian governments, and incremental increases in funding in the last two Commonwealth budgets. Welcome developments, but not enough.

What would a fundamental overhaul of dysfunctional and ineffectual government and related processes involve? Again, it's not magic, abstruse, unknown or impossible to achieve. Of course, the fundamental prerequisite is genuine partnership and the Voice. But as for government processes themselves, it is mainly a question of governments following practices long used by successful businesses and enterprises around the world. Key elements are planning and logistics. There is no mystery as to why every time the government finds itself in difficulty on a tricky issue, think vaccine rollout or responding to natural disasters, it has to call in the military. That tells you two essential points - firstly governments, and particularly the Commonwealth government, doesn't really get service delivery and currently lacks the necessary skills but importantly, the military does have the skills because the consequence of lacking them is certain defeat.

What would have to go? Firstly, the bizarre notion that all that is needed is a set of targets - no need to worry about what needs to be done to achieve the targets, what services are required, what would they cost, who would deliver them, or what infrastructure would be required. Secondly, in complex issues, anyone on the gazette ladder can do anything, that expertise, training and practical experience in service delivery are optional frills. Thirdly, annual progress reports can simply focus on outcomes, be based on inappropriate use of statistics that misrepresent statistical artifact as real progress, and totally ignore the funding and services required to achieve the national goals and targets. Finally, that there is no need for formal decision-making processes at all levels from service delivery upwards to national leaders, that review progress, decide what is working and what needs to be changed and improved to achieve the desired results. In short, simply setting out a set of aspirations, not figuring out what has to be done to achieve them and then being dismayed at the lack of progress is a doomed process and has to go.

Importantly, real planning requires development of the interventions or services needed, determination of resource requirements, systematic monitoring and evaluation and above all, planning is a circular ongoing process that doesn't just end with the production of a glossy. Evaluation needs to be an integral part of service delivery, and formal decision-making processes need to be instituted at all levels with regular quarterly and annual reviews of progress, whereby the results of these reviews feed into management and budgeting processes.

What this also requires is a national training plan so that policy makers, administrators and service delivery staff involved in the planning and delivery of programs for health, education, housing, justice reinvestment and other issues, all have the various skills and experience required to fulfil their roles. Changing flatlining processes into successful outcomes for Australia's First Peoples requires the Voice and a complete overhaul of the current processes for government and other organisations involved in closing the gap - and real, rather than pretend, planning.