Delivered as a keynote to the Women Leaders Forum at Keble College, University of Oxford, this address argues that most crises in health, disability and social care are failures of connection rather than failures of care. Drawing on her work in complex disability support in Western Australia, Christina Papafilis makes the case for designing systems around prevention, and for leadership that brings advocacy, education and governance into the same room.
Presented as a keynote linking into the United Nations Sustainable Development Goals, particularly good health and wellbeing, reduced inequalities, and partnerships for the goals.
Lord Mayors, distinguished guests and members of the Women Leaders Forum.
Good afternoon, one and all.
Thank you to the organisers for the honour and privilege of addressing so many remarkable people, from near and far and across so many industries, gathered here at Keble College. It is a rare opportunity to be among so many women achieving so much in their own fields, and I am grateful to be part of it.
I work in complex disability support and advocacy in Perth, Western Australia.
My work as a complex service provider began, sadly, with a tragedy.
I was twenty-four when I stood outside a house with police cars parked in front of it.
A few days earlier, the young man who lived there had been discharged from hospital. He had very complex needs and he was highly suicidal.
He was discharged without the right paperwork, without the right preparation and without the support he clearly needed.
He needed someone with him around the clock for a few days, just until the funding came through for the care he required. I asked the organisation I worked for to cover the shortfall in hours. The answer was no. It came down to cost.
And while we waited, he took his life.
That was the first time I understood what a disconnected system can cost. And the cost doesn't stop with the person. It stays with the workers who carry it home. With the families who lose someone they love and the community around them. With a system that absorbs one more loss, and carries on.
Not everyone in that system did what they should have. But what I came to understand was that this was bigger than any one decision.
What was missing was connection.
Information sat in one place. But decisions were made in another. The people who could see the risk were not the people who could release the resources. And no one was looking at the whole picture.
That experience has stayed with me.
And disappointingly, over the years of my work in the disability sector, I have continued to see the same pattern.
Our systems respond most intensely after problems have escalated. They rarely respond early enough to prevent them. Information doesn't travel. Frontline staff are asked to make very serious decisions without the preparation or support to make them well. And the people designing systems can drift a long way from what actually happens on the ground.
When I built Connective Services Group, the name wasn't an accident. I wanted to build something around connection: connecting the systems around a person to create improved and sustainable outcomes.
That meant starting with a different question. Not just "What do we do now that this person is in crisis?" but "What do we put in place earlier to support this person? Who do we need to be connecting with? What can be done differently so it doesn't reach this point?"
As leaders, whatever our industry, we have a responsibility to ask the hard questions and to advocate for the changes they point to.
And the question I keep coming back to is this. Why do we keep designing systems around the crisis, after the fact, instead of around preventing it?
Someone becomes critically unwell, and we send them to hospital. Someone reaches a mental health crisis, and we send an emergency response. Someone with a physical disability develops a preventable pressure injury, and an ambulance arrives. We have come to treat this as inevitable.
It isn't always so.
Many crises have warning signs that are missed. Not because people don't care, but because dedicated professionals are working in silos, and are not in a position to connect those warning signs and bring in extra help.
It is also a question of sustainability. We often talk as though prevention is the expensive option. But the failure to prevent is rarely cheap. We pay for the crisis either way. The question is whether we pay earlier, in education, community support, nursing, coordination and treatment, or later, in the most expensive and least humane way possible.
In Australia, the Australian Institute of Health and Welfare, our national health data agency, found that in 2023-24 hospital admissions that could potentially have been prevented cost 7.7 billion Australian dollars. That is money we are already spending. We are just spending it at the point of crisis.
Around the world, health, mental health, housing, policing and social care are under enormous strain. We call them sectors. But a person in crisis doesn't live their life in government departments. They live one life, and it often runs through many of these systems at the same time. Our systems need to reflect that.
So what does leadership that connects actually look like?
To me, it means that advocacy, education and governance can't sit in separate rooms. Advocacy tells us what isn't working. Education makes sure people can act on what we know. And governance has to be more than a policy in a folder. If a policy says something about duty of care, risk or safeguarding, the person standing with that individual at two in the morning needs to understand what it means in practice.
Because when something starts to escalate, it's not the board members that are in the room. It's the frontline worker.
Governance without education doesn't become safe practice. It stays on paper.
It also means moving past the false choice between compassion and sustainability. If the organisations delivering support aren't sustainable, the people who rely on them feel it first. Purpose and commercial discipline. Empathy and accountability. They belong together, because sustainable organisations are what make sustainable social change possible.
I've learned that leadership isn't always about having a seat at the table. Sometimes it's about deciding that the table itself needs to be redesigned.
So look at your table. Who is sitting at it? Who understands the policy? Who understands the frontline? Who understands what it is like to live with the consequences of the decision? And are those people actually talking to each other?
Not everyone needs to be in every meeting. But someone has to connect what each of them knows.
That is leadership.
I haven't fixed this. I'm still advocating, still documenting what I see and still bringing the frontline into rooms where decisions are made.
The work is unfinished.
But what I have come to understand is that leadership isn't only about celebrating what you've already changed. It's about having the courage to keep challenging what isn't working.
I still think about that young man, his mother and his family. I think about the days we spent waiting. About how many good people were close enough to help, and not connected enough to do it.
So when you go back to your organisations, your boards and your governments, look again at your table.
Connect the people who can see the risk with the people who can act on it.
Because that is where leadership that connects begins, and where sustainable social change becomes possible.