How the ACT government deserted public health

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IF the current government leadership hadn’t abandoned the budgeted ACT Health Capital Asset Development Plan, then Canberra would have an almost-built state-of-the-art hospital, according to a document released under freedom of information. 

The document reveals a detailed three-phase plan that was cabinet approved and had it run its planned course, would have seen Canberra Hospital’s main buildings refurbished or rebuilt by 2022 at the latest.  

Years of work and millions of dollars had gone into the plan, according to the chief minister of the time, Jon Stanhope, after the then health minister Katy Gallagher, in 2005, requested ACT Health commence a structured approach to “build a sustainable and modern health system to meet the needs of the population into the future”, the document states. 

The response to this request became known as the Capital Asset Development Plan (CADP). 

Reflecting on the plan, Mr Stanhope says: “[It’s] probably the most significant piece of planning work done by any ACT government at any time since self government.

“The indicative cost for the entire plan was $2.8 billion to be delivered between 2008 and 2021/22. 

“So by next year, $2.8 billion would have been expended on health infrastructure, and accompanying that massive expenditure over the space of 12 or more years, but consistently throughout that entire period, our health infrastructure would be fit-for-purpose, it would be state-of-the-art, it would be meeting all the needs of the people of Canberra.”

The release of this document, which took a “long and tortuous” five months to be released under the FOI Act  (the baseline is four weeks) and only following intervention of the ombudsman, and conveniently was not accessible until after the October election, Mr Stanhope says. 

“One is entitled to ask what was it about this document that the government was so determined the people of Canberra not see,” he says.  

“What it is, is that this document provides in stark detail a detailed plan for meeting the healthcare needs of the people of Canberra, which the ACT government abandoned about six years ago. 

“This document will be embarrassing for the government, that’s why they fought so hard against its release.” 

But the bigger, more important question, according to Mr Stanhope, is why a major cabinet-approved, public health infrastructure commitment was abandoned, and where did the money go instead? 

“If you look at the program, you can see the progress that was made in the early years. We did the multi-storey car park, the Centenary Hospital for Women and Children, we started the walk-in centres and we began the process of providing a health centre in every one of the town centres, and for those that had a health centre, we replaced them or refurbished them,” he says.

“The most significant part of the plan was the refurbishment and/or replacement of the three major buildings of the Canberra Hospital.

“Sixty-six million dollars was included in the 2011/12 budget, for design and planning, staging, decanting and continuity of services in anticipation of the process for the restoration of the entirety of the Canberra Hospital precinct. The most important aspect of which was to replace the central tower that’s still there, where most of the wards are. 

“That’s the big problem with the Canberra Hospital now. That building is way past its use-by date.”

Mr Stanhope, who retired in 2011, not long after the budget, says he doesn’t know what happened after that.

“The government basically realigned their priorities and the question that should be asked is not just ‘why was the plan abandoned’, [but], with the money that was earmarked, ‘what did you spend it on instead?’,” he says. 

“If one looks at the government’s major expenditure over the last six years, it has, of course, been on public transport. 

“It’s not being cynical or unreasonable to suggest that somewhere around 2013/14, the ACT government took a decision, as it was entitled to do, that public transport was a higher priority than public health.”

“CityNews” put these questions to the current Health Minister, Rachel Stephen-Smith. She had not replied before the deadline.

And now, with plans for the Canberra Hospital Expansion, formerly known as SPIRE, Mr Stanhope says it’s a belated and completely inadequate attempt at meeting the needs that were identified through the CADP in 2008 and 2009. 

The currently planned Canberra Hospital Expansion is no more than a Band-Aid, according to Mr Stanhope. 

“What they’re doing is half-hearted, and is about a quarter or a third of the infrastructure of the Capital Asset Development Plan, which after an exhaustive planning exercise was determined as necessary.  

“The minute it’s built, it will be full and will have minimal impact on waiting times or the culture of Canberra Hospital.

“If you can’t afford private health insurance, you and your children wait five years just for an appointment with a specialist at Canberra Hospital, let alone remedial surgery and that’s in large part because this work wasn’t done,” he says.

“However, not only was the Capital Asset Development Plan abandoned but the second string was a funding formula for recurrent funding for health services in the ACT, which was based on advice from the functional review in 2006/7. 

“It took into account the needs of the growing and ageing community, and we had a funding formula that ensured an appropriate growth rate in recurrent funding to staff, [which also funded for] up-to-date changes in medical practice, and the government has abandoned that as well. 

“An analysis which Dr Khalid Ahmed and I have done, published on ‘The Policy Space’ at the University of Canberra website shows that in each of the last six years, at least – and it’s a minimum – $100 million has been, in real terms, cut from the health operational budget. 

“Nothing of substance will change until the government actually provides appropriate infrastructure and an appropriate recurrent funding framework to meet the needs of Canberra’s ageing and growing population.

Mr Stanhope recommends reading this document to understand what the health system might look like as opposed to what it does look like.

“Now that this document has become public, it behoves the Minister for Health to explain why it was that they chose to abandon it” he says. 

“The major shortfall is, of course, that they have not refurbished or replaced the ‘not-fit-for-purpose’ infrastructure at the hospital and they have not provided the 400 extra beds that the plan anticipated.” 

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Danielle Nohra
Danielle Nohra is the assistant editor of "CityNews".

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