Mark Butler confronts many challenges as Australia's new health minister but arguably none more than the decline of the agency that is responsible for supporting the implementation of his policy agenda.
The decline in the Department of Health's policy capability has been stark and made worse by a commensurate fall in standards of behaviour and administrative integrity.
It is hard to imagine they are not related.
Some might challenge the claim of a decline in policy capability. Fair enough. Feel free to identify areas where its performance has improved in recent years.
Yet surely the fact the military now appears more than once on the department's organisational chart says it all.
This presence can only reflect the agency's successive failures in response to the most serious public health crisis in a century.
It failed one of its most important jobs during the pandemic - the procurement and distribution of vaccines.
These failures warrant closer scrutiny by the new government if for no other reason than to ensure there is no repeat of a situation that left Australia at the very back of the global queue for COVID-19 vaccines and then saw the abject failures in distribution that led to the military takeover of a public health program.
Former prime minister Scott Morrison described the delay in sending in the military to run the vaccine rollout as his biggest regret over the past three years.
It was a staggering admission that surely sent shockwaves through the federal health bureaucracy.
Unfortunately, the failures on the COVID-19 vaccines are now being replicated with the treatments - just ask patients with heavily compromised immune systems trying to gain access to therapies in the National Medical Stockpile.
Regardless, the entire situation has serious implications for the new minister, particularly given the issues almost certainly reflect deeper problems that go well beyond the department's policy capability.
Of course, there has always been tension between stakeholders and a government agency that holds significant influence over funding and other policy outcomes.
Tension is fine as long as it is managed within a strong framework of standards.
In the case of the Australian Public Service (APS), it starts with a Code of Conduct that requires officials to "treat everyone with respect and courtesy, and without harassment."
Does a senior official openly sharing their stakeholder 'hit list' meet this requirement? What about not responding to a formal complaint from a patient group about being directly threatened for speaking to the media or telling an organisation to use a different representative to engage officials if one felt bullied during a meeting?
What about coercing and hectoring an organisation into accepting an outcome with extremely negative consequences for its future operation? The organisation was literally given an offer it could not refuse.
These are just some specific examples of actual recent occurrences. They alone should concern the new minister but he can rest assured there are many more.
Mr Butler might even ask his new department whether any organisations or stakeholder groups have simply refused to participate in meetings involving certain officials in response to bullying, threats and attempted coercion?
The new minister should in no way assume this behaviour is limited to the department's engagement with commercial enterprises, including biopharmaceutical and medical technology companies.
On the contrary, much of the most egregious behaviour has been directed at not-for-profits, including patient organisations.
Labor's pre-election commitments impact some of the most targeted groups. Can it really be a coincidence?
It is often a classic case of bullying the most vulnerable stakeholder groups with demands that effectively amount to 'toe the line' or suffer the consequences, including deliberate exclusion from consultative processes.
The new government has committed to augmenting existing accountability mechanisms, including the APS Code of Conduct, with the fast-tracked creation of a federal independent anti-corruption body akin to those maintained in state jurisdictions. These include the Independent Commission Against Corruption (ICAC) in New South Wales.
Labor has committed to creating a body with a "broad jurisdiction" to investigate ministers, public servants, statutory office holders, government agencies, parliamentarians, and the personal staff of politicians.
It will have the discretion to launch its own investigations or in response to whistleblowers and complaints from the public.
Stakeholders should welcome its creation as an opportunity to ensure and even restore integrity and accountability to decision-making in health.
A former New South Wales premier was forced to resign after the state's ICAC revealed he had failed to disclose the gift of a bottle of wine.
If that is considered corruption sufficient to demand resignation, what about federal decision-makers subverting an established technical evaluation process to achieve a particular result, then secretly constructing a justification, falsifying the outcome and misleading the applicant? More on that next week.
What about a federal official engaging Department of Health lawyers on how to do a workaround to subvert the confidentiality protections of pharmaceutical companies as a way to justify the release of highly sensitive commercial information without their knowledge?
What about secretly drafting legislation to completely remove confidentiality protections and then informing impacted stakeholders on the weekend before it was scheduled to be tabled in the parliament?
These examples may or may not meet the new body's definition of corruption but does anyone believe they are not deeply problematic, particularly in what they reveal about the culture of decision-making?
Mr Butler has an early opportunity to demand change and the highest possible standards from his officials.
This article was first published in BioPharmaDispatch.