Good points. The third was a failure of leadership to learn / take responsibility (health minister). NSW repeating those mistakes. This is the most important as it covers every issue.This is such a good table. Probably done a little while ago as the current NSW breach cases would be much higher that this now.
In many ways this brings into context the hysteria of the security guards breaches last year. The fact is that breaches are inevitable but it has always been about what happens afterwards. That was the real failure in Victoria last year, the contact tracing and the failures in aged care.