Collaboration between Australian peak bodies and governments in the context of the COVID-19 pandemic: New ways of interacting

Peak bodies ("peaks”) are funded by Australian governments to fulfil a multifaceted role, including presenting a collective voice to government on behalf of their nongovernmental service provider members and the vulnerable client populations they serve. However, the relationship between peaks and governments has been fraught, with governments imposing contractual conditions in exchange for funding, thereby constraining advocacy. During the COVID-19 pandemic, the nongovernmental sector provided vital services, including care and support for children and families, and dispensed emergency funding through their service networks. This research investigates engagement between peak bodies and governments during the COVID-19 pandemic in 2020–2021. Nineteen CEOs and senior executives were interviewed from 16 peak bodies. Additionally, 27 surveys were completed by peak and nongovernmental sector representatives. Interview transcripts were coded using NVivo and thematically analysed. Four types of interactions between government and peak bodies were identified: collective leadership;partnership;advocacy to influence;and advocacy designed for public pressure. These four types of interactions formed a public advocacy continuum. In some Australian jurisdictions, the study showed that collective and partnership mechanisms between peaks and government were strengthened or revived, yet sustained work will be needed to entrench these positive developments in a postcrisis environment. © 2023 The Authors. Australian Journal of Social Issues published by John Wiley & Sons Australia, Ltd on behalf of Australian Social Policy Association.

Ethical decision-making during a health care crisis: a resource allocation framework and tool

Background: The COVID-19 pandemic has strained health care resources the world over, requiring health care providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave of the pandemic, we sought to make such ramp-down decisions more prudently and ethically. Methods: We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that the diverse range of stakeholder perspectives were represented in this development process. This team, called the Clinical Activity Recovery Team (CART), established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria using the accountability for reasonableness ethical framework. The result of this is a stepwise, semi-quantitative, ethical decision tool that can be applied to proposed solutions to problems of resource allocation to reach a fair and ethically defensible decision. This ethical decision tool can be applied in almost all conceivable contexts and scales, from the multi-institution level to the provider level, and indeed this is how it is applied at our institution. As the second wave of the COVID-19 pandemic strains health care resources, this tool can help clinical leaders to make fair decisions.