I’ve spent more than twenty years inside this system. I’m done describing the fire. It’s time to pick up a hose.

I have worked across the workers’ compensation ecosystem long enough to know every corner of it intimately. I have sat beside injured workers who couldn’t understand why asking for help felt like punishment. I have watched case managers drown under caseloads that would break anyone. I have stood with employers desperate for guidance that never arrived, and with clinicians who slowly stopped believing the system valued their expertise at all. I have worked closely with regulators, insurers, lawyers, unions and policymakers — good people, all of them — trying to do their best inside structures that make ‘best’ almost impossible.

And after 2 decades, I need to say something many of us feel but rarely say aloud: we have known what to do for a very long time, and we have chosen not to do it.

We have known. For 20 years, we have known.

By 2001, the evidence was already clear: compensable injuries produced worse outcomes than identical injuries outside compensation. The system itself was making people sicker. In 2010, the Australasian Faculty of Occupational and Environmental Medicine published Realising the Health Benefits of Work, and more than 170 organisations — insurers, regulators, unions, professional bodies — signed a Consensus Statement agreeing that good work supports health and prolonged absence harms it.

That was 15 years ago. I remember the optimism. I remember thinking: finally.

I was wrong.

Since then, we have produced more research, more guidelines, more frameworks, more conferences, more consensus. In 2022, the Faculty released It Pays to Care — a comprehensive, evidence informed blueprint endorsed by every national workers’ compensation authority and insurer. The stakeholders were aligned. The solutions were mapped. The evidence was overwhelming.

And still, nothing changed.

I think about the people behind the statistics, the ones whose stories stay with me.

The warehouse worker with a simple back strain who was sent for an MRI, told he had disc degeneration, and never returned to work because he became terrified his spine was crumbling. 

The nurse who needed 2 weeks of modified duties but waited 11 weeks for an approval that arrived with conditions nobody explained. 

The young apprentice whose anxiety was treated as a character flaw rather than a predictable response to a system that made him feel like a fraud for being injured.

These are not outliers. They are the system. They are what happens when we design processes around liability rather than recovery. When we prioritise documentation over conversation. When we treat injured workers as claims rather than people.

These harms are not inevitable. They are iatrogenic — caused by the very system meant to support recovery. Preventable. Predictable. And after 20 years of evidence, unforgivable.

I have watched the same cycle repeat so many times I could script it. Schemes point to clinicians. Clinicians point to funding models. Employers point to legislation. Regulators point to scheme autonomy. Everyone points. Nobody moves.

Nobody is wholly to blame. Everybody is partly responsible. And the net effect of shared responsibility, in practice, is that nobody acts.

We have mistaken activity for progress. We have confused describing the fire with putting it out. I have attended more conferences, roundtables and working groups than I can count, and I can tell you this with certainty: at some point, continued diagnosis becomes complicity.

I’m not asking for perfection. I’m asking for motion.

Change is hard. I know that better than most. It means confronting vested interests. It means tolerating imperfect first attempts. It means someone going first without a guarantee that others will follow. But we do not need another review. We do not need another framework. We do not need to wait for the perfect pilot or the next ministerial appetite.

We need one fewer unnecessary MRI this week. One approval process streamlined this month. One claim managed with psychosocial factors genuinely considered — not just ticked on a form — this quarter.

Because every week we delay, someone’s life gets smaller.

The alternative is another 20 years of inaction dressed up as deliberation. And that, to me, is unconscionable.

So, here is my challenge:

To every stakeholder in this ecosystem — every regulator, insurer, employer, clinician, case manager, lawyer and policymaker — I am asking you the same question I ask myself:

What will you do differently next week? Not next year. Not after the next review. Not once someone else moves first. Next week.

Pick one thing. Do it. Tell someone you’ve done it. Then pick the next thing.

I have given 20 years of my life to this system because I believe it matters. I believe we matter — all of us who work within it, and every worker who depends on it. But belief without action is just sentiment. And sentiment, after 2 decades of evidence, is not enough.

It’s time to pick up the hose.