The federal Department of Health and Ageing has paid more than $2.8 million for a private communications company, McNiece Coms Pty Ltd, to run its crisis media management for the past five years.

According to the department, the value of the contract reflects that “there are four staff from the firm available 24 hours a day, 365 days a year”.

No doubt the company has been earning every cent in recent days, being closely engaged in managing the media response and information loop for jurisdictions and agencies involved in the national search for women who may have contracted HIV from a circus acrobat.

Details of the contract came to public attention when DOHA put out a tender for “media liaison and management services”. As Croakey reported recently, the tender (no longer on the department’s website, having closed on April 27), covers an exhaustive list of duties.

These include being the first point of contact for all media enquiries, handling media inquiries referred by the ministers’ offices, supporting the secretary and departmental executive, serving as the Chief Medical Officer’s primary media adviser, and providing advice to a many organisations and committees.

According to my sums, the contract equates to roughly $1800 a day (DOHA says the contract was worth $2,863,031 from October 2005 to April 2010), although it is unclear whether this amount includes the TGA’s media contract, also held by Kay McNiece and colleagues.

Given the media’s voracious, 24/7 appetite, and the breadth and complexity of the health portfolio, not to mention the exorbitant rates charged by many corporate PR agencies, this rate doesn’t seem excessive. At least it wouldn’t, if we were confident that the contract is aimed at serving public — rather than bureaucratic or political — interests.

This contract is just one piece of a huge pie. Health departments in all jurisdictions, area health services, and public hospitals invest many millions more of our money in media management and PR, whether it is provided in-house or by private consultancies.

As the DOHA tender documents suggest, much of this work is not aimed at promoting an open and informed debate so much as at keeping a firm lid on it. Risk management is the overarching media principle for most health bureaucracies.

Yet in all the talk about health reform, we’ve heard very little about the implications for how bureaucracies and services engage with the public. Will the move towards more local governance also enable services to be more open and responsive to their local communities?

We should be concerned that this is strongly discouraged by the current centralised command model of media management. As the writer John Ralston Saul argued on ABC TV’s Q&A this week, open debate is essential for a healthy society. He said: “You have to have the biggest and messiest possible debates, otherwise you can’t get ideas out.”

Governments are suggesting their Web 2.0 agendas will mean changes to the way they do business especially when it comes to public engagement. But they also acknowledge the huge barriers.

The official response to the Government 2.0 Taskforce  notes: “Leadership, and policy and governance changes are needed to shift public sector culture and practice to make government information more accessible and usable, make government more consultative, participatory and transparent, build a culture of online innovation within government, and to promote collaboration across agencies.”

In health, the barriers are particularly formidable, and a seismic cultural shift will be needed if the expertise that resides within bureaucracies and services is to be unleashed to help contribute to greater public engagement and debate.

However, it is not only health bureaucracies and services that could benefit from cultural change. The media’s “gotcha” mentality, fixation on the short-term political cut and thrust, and reluctance to dedicate attention or resources to in-depth examinations of the complexities of policy are also problems.

Perhaps the Web 2.0 push will help both powerful institutions — the media and bureaucracies — to be more responsive to the public’s need for a more informed and even messy debate. But perhaps I’m too much of an optimist…