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.
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.
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.
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.