Machinery of Government reform in health and social care: Australia's Administrative Restructure

Across Australia, governments have re-drawn the administrative map of health, disability, aged-care and related portfolios at an unprecedented rate over the past two years. Western Australia’s decision in March 2025 to distribute health responsibilities across four ministers is only the most visible example. In Canberra the Commonwealth has folded disability policy and the National Disability Insurance Scheme (NDIS) into a newly named Department of Health, Disability and Ageing, while Victoria, Queensland and New South Wales are all embedding recent restructures of their own. The common intent is sharper focus and clearer accountability, yet the practical result can be a thicket of new funding lines, reporting relationships and transition risks.

Why the machinery keeps moving

“Machinery of Government” (MoG) describes the way executive governments arrange portfolios, departments and agencies to deliver on priorities first set out in Edward Haldane’s 1918 report for the British Cabinet. In Australia the machinery has been in near-constant motion since the 1980s, following a pendulum between centralisation (to curb fragmentation and drive system-wide direction) and decentralisation (to promote flexibility and specialist focus). Health and human services exemplify the pattern because policy, regulation and service delivery are split between the Commonwealth, eight states and territories and an array of statutory bodies and contracted providers. When the machinery moves in one jurisdiction it rarely stays still elsewhere for long.

^{Table 1 A snapshot of recent changes}

Source: ACIL Allen 

Note: Similar restructures have occurred in other jurisdictions (for example South Australia’s 2022 health governance review), underscoring the national momentum toward specialisation.

How this impacts health and social care stakeholders

System managers (departments and directors-general)

Multiple ministers now speak for different slices of the same policy puzzle. For a director-general or secretary this means forging a single narrative – budgets, public-facing commentary, performance targets – that can satisfy sometimes competing portfolio imperatives. Without disciplined coordination fragmented directives can drain resources or invite blame-shifting. Nationally consistent digital standards, shared clinical-governance benchmarks and joint funding guidelines are becoming essential tools to keep a dispersed system coherent.

Service providers – public, private and not-for-profit

Hospitals, community health services and disability or aged-care providers face duplicated reporting lines and contract managers whenever portfolios split. At the same time, narrower portfolios can be a doorway to fresh investment: rural aged-care consortia in Queensland, for instance, have secured additional infrastructure grants by aligning bids with the new Housing and Communities ministerial agenda. The golden rules are to track where legislative authority now sits, confirm which budget line funds each service stream, and stay visible during the first-year “settling period” when new teams are still mapping their stakeholders.

Consumers, professional bodies and unions

Fragmented accountability can marginalise voices that work across silos – carers’ groups that span disability and aged-care, or unions representing multidisciplinary teams are two such examples. Conversely, a well-timed submission backed by hard evidence can travel further when it lands on the desk of a dedicated Minister for Preventative Health or Mental Health rather than being diluted in a mega-portfolio. The advocacy challenge moves from “one big table” to “many smaller tables”; disciplined messaging and coalition-building are therefore critical. 

Risks that recur (and how to manage them)

As multiple jurisdictions have learned, the success of MoG reforms often hinges not just on structure, but on disciplined execution. Experience from Victoria, NSW and Queensland shows that early planning, clear roles, and transparent cost tracking can materially reduce disruption and improve outcomes. Building on this, the table below outlines four of the most common risks observed during administrative transitions, along with early mitigation strategies that can help stakeholders stay ahead of potential pitfalls:

^{Table 2 A snapshot of recent changes}

Source: ACIL Allen 

Western Australia in the national picture

WA’s four-minister model remains unique, particularly the creation of Australia’s first Preventative Health portfolio – welcomed by the public-health community as a chance to “create the healthiest jurisdiction in the nation”. While the state’s statutory Health Service Providers must now brief four ministers instead of one, they also report early wins: quicker traction on long-delayed public-hospital maintenance through a clear line to the Health Infrastructure Minister, and a more prominent seat for community services in aged-care policy design. For interstate observers, WA provides a live demonstration of the trade-off between sharper focus and heavier coordination load.

Positioning for success — five practical steps

• Map the new landscape: Chart which Acts, budget lines and performance frameworks have moved and which remain unchanged. 
• Re-contract early: Seek confirmation in writing that existing service agreements roll over intact or agree interim arrangements.
• Synchronise data and reporting: Align KPIs and data definitions with any new departmental templates to avoid duplicate submissions.
• Align your narrative: Re-frame business cases and advocacy so they speak directly to the language of the new portfolio (e.g. prevention, infrastructure, lived experience).
• Invest in relationships: Schedule introductory briefings with ministerial offices and senior officials while their strategic agendas are still forming.

How ACIL Allen can help

ACIL Allen supports government agencies, providers and peak bodies across Australia to decode MoG change and use it as a springboard, not a setback. Our national practice pairs deep policy expertise with economic rigour to:

• Understand costs, risks and outcome pathways under new administrative architectures – for example, mapping post-transfer NDIS fund flows inside the Commonwealth’s health portfolio.
• Improve operating models by clarifying roles, removing duplication and embedding continuous-improvement tools drawn from successful restructures interstate. 
• Decide where to invest scarce capital and workforce resources through robust cost-benefit analysis and scenario testing.
• Advocate persuasively by quantifying social and economic impacts and aligning them with emerging ministerial priorities.

Talk to us about reducing uncertainty and positioning your organisation for influence and impact in Australia’s evolving health and social-care landscape.