21 May 2023

ACT Government has every right to want to unify health system

| Ian Bushnell
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hospital building

Calvary Public Hospital Bruce is a provider model the Government believes no longer suits the ACT. Photo: Claire Fenwicke.

Setting aside the way in which the ACT Government has gone about dropping its takeover bombshell on Calvary Public Hospital in Bruce, the hysterical and one-sided response to the plans to create a single healthcare system in Canberra makes some wrong assumptions about its motives and what government, in general, is there to do.

The Government wants to spend a billion dollars of our money on a new northside hospital, something anyone living north of the lake will agree is desperately needed.

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While acknowledging that Calvary Care has done a good job of managing a public hospital that is smaller and offers fewer services than the Canberra Hospital at Woden, the Government has every right to set the terms of that relationship so the outcome is in the best interests of the people the new hospital will serve.

Obviously, the Government concluded that such an outcome was at risk if it continued outsourcing such a significant resource for such a long time into the future.

Government is not there to govern in the interests of a private service provider, the Catholic Church, or even doctors or nurses, although health staff will have a crucial role in making the transition work and leading the development of the new hospital.

It also has to think from a Territory-wide point of view how the new hospital will fit into the overall health system, which, like those in every other jurisdiction in the country, has for years been struggling with performance, including unacceptable emergency waiting times and elective surgery waiting lists.

In such a complex environment, including the decline of Medicare bulk billing and primary care in general, there are no easy fixes, no matter how much political capital opposition parties make of it.

The ACT Government has been damned for both how it manages the health system and for the culture problems at Canberra Health Services, many of which are common to hospitals everywhere, being as they are institutions that have evolved out of rigid hierarchical systems, and where life and death decisions are made in highly taxing circumstances.

To its credit, the Government has fully accepted responsibility for this and is endeavouring to change that culture and improve performance.

man in suit

Canberra Health Services CEO Dave Peffer: “You do have to start asking the question about structure and systems.” Photo: Ian Bushnell.

But, as CHS CEO Dave Peffer says, it is bumping up against structural issues that are preventing change.

Mr Peffer says healthcare workers in the government hospitals are giving 100 per cent every day, but that effort is not translating into performance.

“When you’re in that situation, you do have to start asking the question about structure and systems because they are big contributing factors to overall performance and access to services,” he says.

It is not unreasonable to accept the Government believes that in such a small jurisdiction as the ACT the current model is no longer fit for purpose.

Now, no-one is claiming that the Calvary takeover will be a panacea for the health system, but a unified network will provide economies of scale, a greater ability to interchange staff and resources between campuses, more training opportunities and enable CHS to offer recruitment incentives – for example, hard-to-attract specialties – that it can’t do at present.

Calvary says this is about control, but that alone would not be enough for the Government to embark on such a risky and controversial path.

When Chief Minister Andrew Barr, Health Minister Rachel Stephen-Smith and health bureaucrats say they want to build a better health system to serve the people of Canberra, there is no reason to doubt them.

Even Calvary Care national CEO Martin Bowles, a former federal Secretary of Health, says government can do these sorts of things.

And they do, whether it is resuming land for a freeway or other public facilities.

There are those who raise private property above all else who argue government should not be allowed to do this.

But it will not be without compensation, and that is what it will come down to. How much.

It could become prohibitive, but that will probably be a matter for the courts, and the “just terms” phrase uttered by Chief Minister Andrew Barr has suggested there might be echoes of The Castle, the movie not the novel, here.

But it is not insignificant that Mr Barr notes that the land was gifted, and public money has built and maintained the hospital.

And contracts are breached and broken every day in the commercial world. and the disputes settled in the courts.

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Whatever the outcome, to reduce this conflict to that of the government bully grabbing a private asset simply because it can is nonsensical.

The shift to a single health system for the ACT makes economic and practical sense, and if a government is going to spend a billion dollars on something, it should probably be in charge of it.

Now, how the Government executes the takeover, manages the transition, builds the hospital and runs that system are different matters, for which it will be held accountable.

But the rationale for the Government’s decision is perfectly reasonable.

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Rather than feel sorry for the Catholic Church, I would like to see prosecutions for the politicians who granted them free land and development funds. This was always going to end badly.

It was pre self government in 1971 LanyonRegis that the federal government granted the land to the Catholic Church. I am not sure whether it was the Gorton or McMahon Liberal governments who sealed the deal! Both leaders are legendary and left significant marks in history but are long gone.
The public purse has funded the hospital’s activities ever since and ACT taxpayers continue to pay for its operations following self-government. This includes the hospital’s expansion and its buildings which the Catholic Church now owns!!

The ACT government motto “How to make a success in small business, start with a large one”

Martin Keast12:10 am 24 May 23

I strongly disagree with your headline that the ACT Government has every right to unify the health system if it desires. The main reason is that they are taking the property of a private agency using the coercive power of legislation because they want it. This is nothing less than theft of private property. They could easily build a second hospital in the belconnen area if they think one is needed on that side of Canberra, there is enough unused land in the city but no, they unilaterally force the owners of Calvary to sell. Bullying over-reach is what this is. Shame on the ACT government for going down this path.

Daniel O'CONNELL4:36 pm 23 May 23

If the rationale is reasonable why doesn’t the ACT Government just build the hospital some where else (eg on resumed UC land opposite the newish Rehab Hospital) and leave Calvary alone – noting the public hospital services contract with Calvary will have to be terminated when the new hospital is completed. To take over Calvary Public, largely knock it down and then build a new public hospital seems uneconomic and makes one think the motive is sectarianism (ie anti-Catholic).

I can’t believe that the ACT Government thinks that it can just take something that doesn’t belong to them by simply introducing legislation to make it so called ‘legal’ with no right of review – it is really a form of stealing.
If another hospital is needed, build one in Gungahlin on a green field site.

It sounds like Ian B is a mouthpiece for the ACT Govt

Or he’s just sane and makes good points. Yep, my assumption makes significantly more sense.

Martin Keast12:12 am 24 May 23

agreed – but sadly we are used to the media becoming the propaganda arm of the state nowadays.

bev hutchinson2:14 am 23 May 23

The ACT government was happy to accept Calvary hospital into the system and it has done a fantastic job. It’s not appropriate to now say it’s not fit for purpose. Calvary building is in very good condition but the plan is to knock it down! The University Hospital isn’t old, why didn’t the government build this bigger and why not build a brand new complex further north rather than central. What will happen during the demolition and building stages. This is not clever, it’s an over reach of power and misdirected and should not proceed.

Regardless of the merits or not of this acquisition, it is wrong to say the building is in good condition. It needs a lot of work. I recently spent time as a patient on the sixth floor and the corridor was full of equipment they didn’t have space to store anywhere else. The recent fire in a surgical theatre caused more damage than it should have because of the building design and the ease smoke was able to spread to other areas. The Zita Mary Clinic on the first floor recently lost its accreditation to administer cancer treatments because it needed too many modifications. The placement of the outpatients clinics in the Lewisham building doesn’t work because of the corridor through dingy unusable space and a long ramp which is difficult for elderly people and those with injuries/disabilities. The toilets in many of the public areas are in dreadful condition etc etc etc. The building has a lot of problems. And all that is on top of the fact it is now just too small to cater for the populations in Belconnen and Gungahlin.

The ACT Govt has not managed this process well nor sold the case to the public convincingly and has come out with a mixture of arguments like someone trying to get out of something with a story made up on the fly… If a new hospital is needed at a cost of $1b+ (if it doesn’t blow out, and they always do) which seems to be the main argument, then they should of come out with the idea for discussion, then invited tenders/proposals, and if Calvary didnt bid or win or they decided to go ahead with an own govt built hospital for the unified system benefits (albeit mixed providers work fine in other States)) they could of then negotiated with Calvary for its wind down/future. Instead we have this clumsy half baked rushed process that has a high chance of failure

Ian B suggests we set aside the ridiculous manner in which the Calvary takeover has been handled but surely that hysterical (to use Ian’s term) and botched approach on its own must ring alarm bells regarding their capacity to provide better health outcomes for the community. Why not address the chronic and long lasting problems at CCH first and create the goodwill and confidence that a combined system will be better. Or perhaps it’s the competition and better perception we have re care about Calvary that is driving the takeover. They simply don’t like being shown up.

Bob the impala4:12 pm 22 May 23

“… better perception we have …”
My anecdotal evidence begs to differ from your anecdotal evidence so we can drop that one, apart from which it is not the short term point of the takeover.

Ian Bushnell referred to an “hysterical and one-sided response” not approach as you have put it. I think that inversion sides you with the problem, higgo.

Canberra needs a larger hospital to cater for the booming Northside population and Calvary has refused to help. The ACT Government has funded necessary improvements after providing free land and buildings. The improvements include an ICU, ED expansion and multi-storey parking. Meanwhile the Catholic Church put the tax free profits into building a private hospital. Time for freeloading religious institutions to pay the piper.

waggamick, you do realize the Calvary Health Care is a not for profit organisation. St Vincent De Paul is also a Catholic not for profit organisation, do we also take them over and let the most incompetent Government in Australia ruin their good work as well.

As someone with complex health problems and who has had treatment at both hospitals as a public patient over the last couple of years, I would like to say I think ACT Health actually does a good job. Not everything has gone smoothly; but nor has everything gone wrong and when I’ve experienced complications, they have worked quickly to try to help. I’ve had four rounds of surgery (two at each hospital) including two as emergencies (one at each hospital). I also have follow-up treatments at four different outpatient clinics (three at Canberra & one at Calvary).

I don’t accept the argument that the standard of care at Calvary is somehow better than Canberra. It is about the same and most staff at both hospitals have been dedicated, professional and respectful. (I actually had two major post surgery complications at Calvary: a serious infection & a blood clot. I didn’t have these problems at Canberra, though I accept the Calvary complications could have been just bad luck and I don’t think the staff were at fault.)

In all other services, the quality of care was about the same. I think some of the criticism being thrown at ACT Health is unjustified. Mistakes do get made and some patients fall through cracks; but even if they throw a gazillion more dollars at the system, some things will still go wrong. Human error – including mistakes caused by the patient – will always happen in complex scenarios.

A side note: I would, however, ask that they do something about the food at both places – very ordinary at both, without much difference between either hospital. Though maybe, it is deliberate to encourage patients to go home as soon as possible :). (Calvary’s breakfasts are a bit better as they give you eggs while Canberra has just cold breakfasts, but lunches & dinners at Canberra are marginally better than Calvary.)

Would you describe the tragic deaths of two children suffering from treatable infections at TCH last year as “some patients fall(ing) through cracks”?
Do you think the current ACT Health Minister’s somewhat indifferent response to a question about paediatric deaths at a parliamentary hearing last year (“People die in hospitals, it’s part of delivering a hospital service”) was appropriate?
The CHS should concentrate on addressing the multiple, long-term problems at TCH as a priority!

Thanks, Ian – your article makes valid points to remind people that government decisions can actually be based on public interest (really, they can be), despite those suspicious of anything beyond the status quo. The idea of a unified health system, which offers (hopefully) consistent services across Canberra, makes sense.

I’ve experienced the current disparity when I broke my ankle a couple of years ago. I was admitted to Calvary who could take XRays, but was then referred to CHS as they could not do the surgery there. Days later, my break was repaired (at CHS). Sure, that’s just one example, and I can give some positive experiences at Calvary also, but my point is that health issues should be able to be dealt with without people being bounced around the territory.

That noted, I’d like to understand further from knowledgable sources (not keyboard warriors) why I have read that doctors and nurses at Calvary may not be keen on the idea. I would have thought that skill sharing across locations, the ability to gain wider experience, the ability to move locations for work, and knowing that your abilities could be applied where best needed, would be desirable to many health professionals.

Well written article Ian Bushnell and good response StuartM!
Since the announcement I have seen very little neutrality from the media on the government’s plans for Calvary. Opposition politicians as well as the management and Clergy of Calvary have been hysterical in their responses to the deal. Jeremy Hanson has been vocal in right-wing media. He even made the preposterous claim on Brisbane radio that the government was preparing to send police into the hospital to take it over!
As to your question, I read in the media that Calvary are refusing to cooperate with the government. Its management has been meeting with staff including doctors and nurses but are refusing the government and its representatives permission to meet with them!

Jack, the medical staff I’ve spoken with said that in theory they are not opposed to the change. Their main concern was the lack of warning to staff before this was announced rather than an objection to the concept.

Megsy, thanks – that makes sense. Any change impacting people must be managed with sensitivity, and it does sound like the Minister has botched that. Communication from ACT Health to Calvary professional staff Must be improved to allay concerns.

That said, I note Jack’s comments. Calvary leadership could well now be building roadblocks to prevent staff concerns to be heard and addressed. They now need to accept the situation and operate in the best interests of the professionals currently working to them.

Sometimes this happens with change Megsy. Workplaces and the way we do our work is always changing. Progress doesn’t stand still!
I have worked in the public service and there was always change. This was sometimes abrupt and ruthless but we were expected to accept, adapt and respond to it. Unfortunately this was extremely difficult for some people.
It doesn’t help when these issues become political and leads to hysterical, biased and false reporting from media and political opportunists!

“It doesn’t help when these issues become political and leads to hysterical, biased and false reporting from media and political opportunists!”

LOL, it also doesn’t help that the government were clearly planning the move for months in secret and engaged in exactly zero communication or consultation with the affected staff. But of course you’ll naturally excuse their woeful management of the whole situation.

Biased and hysterical reporting from political opportunists? Bahahaha, the irony, it burns.

Finagen_Freeman9:08 am 22 May 23

Ian, you should get a job with the Government. That cut and paste approach is pure laziness.

“ but a unified network will provide economies of scale, a greater ability to interchange staff and resources between campuses, more training opportunities and enable CHS to offer recruitment incentives – for example, hard-to-attract specialties – that it can’t do at present.”

What is lost in this assertive statement is performance is lacking now. Doubling poor performance does not bring economies of scale. Big corporations often split their business units to increase responsiveness and realise opportunities.

CHS operates near the bottom of Australia’s hospitals in terms of performance.

CHS contracts additional surgeries to Calvary because of their efficiencies.

LCM operates more hospitals than ACT.

Do some journalistic research Ian, you’d find taking over a hospital is no assurance of improved system performance.

A billion on a new hospital, a couple of billion on a toy tram, a billion here, there and everywhere. The money tree orchard is doing great this year

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