Top bureaucrats warned a year ago Victoria's key public health team was starved of money and staff - The Age

Several DHHS sources claim the government’s difficulties in getting the second deadly wave of coronavirus under control could be linked to ongoing problems with contact tracing, including the recruitment of inexperienced staff and reliance on an outdated and inefficient phone and paper-based IT system.

Public health officers in the department's communicable disease and prevention control unit had been managing high case loads for many years, according to the documents.

“PHOs [public health officers] in the CDPC [Communicable Disease and Prevention Control] Unit in Victoria have been managing much higher case load numbers and had higher population ratios than similar staff in other states and territories, with the number of PHO staff in Victoria half the size of ... (New South Wales),” it warned.

“In other words, a doubling of current staff numbers would still see Victoria as the least resourced state in terms of staff undertaking public health officer duties.”

Senior government figures told members of Victoria's public health team that the state was achieving the same outcomes as other jurisdictions without committing the same resources.

“Unfortunately the main outcome for successful public health is the absence of disease, and it has taken the pandemic to lay bare the true deficiencies in the Victoria system,” a DHHS source said this week.

According to the documents, Victoria had just six physicians in its health protection branch compared to 24 in NSW and 17 in Queensland.

Victoria's contact tracing deficiencies have been exposed during the second wave of the pandemic, in which close contacts of confirmed COVID-19 cases report waiting days and weeks to be notified by DHHS. A DHHS spokesman said there were about 2000 people “supporting” the contact tracing team since the coronavirus outbreak.

“Our massive team of disease detectives is working around the clock to find and contain coronavirus – and we are grateful for the recent support provided by our interstate and federal colleagues to boost our contact tracing efforts,” the spokesman said.

“We’ve deployed doctors, nurses, medical students, and now paramedics and ADF personnel as part of our growing contact tracing team – with well over 2000 people now undertaking this vital work.

“All positive cases are interviewed by the contact tracing team, and we’ll continue to provide the team with the resources they need to manage this unprecedented global pandemic.”

The DHHS spokesman said new contact tracing staff were given a full induction, as well as technical training conducted by specialists.

"The department uses a proven infectious diseases surveillance system, which is also used in NSW and other major jurisdictions internationally, such as the state of New York, which was a major centre of infection in the United States," the spokesman said.

Despite the warnings that Victoria needed a bigger public health team, the number of staff had been in decline for at least 18 months before coronavirus hit Australia. In September 2018, there were 20 public health officers (including after-hours part-time staff), and three team leaders. This was down to 14 officers (with no after-hours staff) and two team leaders by March 2020.

Only about half of the public health officers in March were nurses, and the remaining team had people who usually deal only with food-borne outbreaks, such as salmonella.

“The bungling of hotel quarantine is a major factor in Victoria’s case numbers, but even before that we were struggling,” another department source said.

“So even half the staff [in March] were not experienced in infectious diseases. So, essentially, six nurses and a few team leaders had to set up the entire case management, outbreak management and contact tracing groups, train up all the new people, ask for physical space, computers ... fix all the mistakes of the new people.

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“The new staff were making mistakes. They’re getting better, slightly, but part of the reason why Victoria struggled was because of that. We haven’t had experienced people to do the volume of work and the variety of tasks.”

Public health professionals seconded from interstate have been “aghast” at Victoria’s clunky and antiquated IT systems, according to one source, in which DHHS staff still rely on paperwork.

Once a person is confirmed as contracting COVID-19, their doctor or lab technician contacts the department, and relays to a staffer their details as well as the details of the patient.

The staffer fills out the paperwork, and hands the form to another team to manually enter the details onto the computer. The department has routinely faced a backlog of data entry.

The internal DHHS documents, dated September 2019, also highlighted the flaws with Victoria’s “centralised” public health team, and pushed for a NSW and Queensland-style model, in which there are 15 local health districts, each with their own public health units.

In an interview with ABC Radio National earlier this year, Professor Sutton acknowledged that while Victoria’s centralised public health structure had proven efficient, it had struggled to meet the demands of the pandemic.

“We've done it with much lower per capita public health workforce. But in terms of being able to surge, we don't start at the same kind of base in terms of the size of the public health workforce as decentralised models,” he said.

“But it's true, there's a bigger business-as-usual workforce that could be mobilised when you've got local health districts that you can call on to step up in cases like coronavirus where you really need people who have had long-term experience stepping into the fray and responding.”

The Victorian government has been contacted for comment.

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2020-07-29 13:30:00Z
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