Here it is in black and white, and crystal clear how the ACT government has, through financial deception and spin, nonchalantly taken the state of hospital care in the ACT to a dangerous low. 

JON STANHOPE & KHALID AHMED masterfully reveal the shocking reality of clinical priorities in ACT public hospitals being set by bureaucrats, not doctors, looking to save $27 million from the hospital budget.

“There comes a time when interference with my capacity to offer care, by [an] external Operations Centre, is now reaching a point where I can’t put my hand on my heart and offer the care that I believe that our community deserves, because of budgetary constraints.” 

These are the words of surgeon Dr Sindy Vrancic, working in Canberra’s hospital system in the face of a serious ethical dilemma.

Already six orthopaedic surgeons and two anaesthetists employed in the Canberra Health Service, including Prof Paul Smith, head of orthopaedic surgery and one of the most experienced and highly regarded surgeons in Australia, have resigned. 

Before the resignations, 15 surgeons signed an open letter to Health Minister Rachael Stephen-Smith expressing, in effect, a vote of no confidence in the management of ACT Health and the Canberra Hospital.

The response of the ACT government in the media about the loss of these specialist surgeons was disappointing. Canberrans were variously advised that the government spends a lot of money on orthopaedics and these clinicians were simply focused on protecting their incomes. 

An indictment of ACT Health

We were also told their departure would have minimal impact on hospital capacity, ie wait times, because these specialists allegedly performed very little work in the public system.

If this later assertion is true, it is of itself an indictment of ACT Health, and clear evidence of underfunding, in light of the existing extraordinarily long wait times – up to six years in some cases – to not employ leading surgeons to address the backlog.

The media management that outrageously painted the clinicians as driven by self-interest and not willing to engage with the system has been cynical and unhelpful in resolving the complex challenge of balancing patient-centric care with the pursuit of efficiency.

The ACT government’s nonchalant response to this latest crisis in health care is further evidence of the degradation of Canberra’s hospital system, which began in 2016 with the repeated deferral of the long-planned investment in infrastructure and cuts in real terms in operating funding.

The concern of clinicians

Unaddressed concerns about patient safety, a blowout in wait times, clinicians’ disengagement, increasing tension in the operating environment, and now these resignations are the unfortunate but not unexpected consequence of the government’s warped priorities and mismanagement.

The catalyst for these latest developments is apparently the concern of clinicians about the role and functioning of the newly established Operations Centre. 

The main purpose of the Operations Centre is allegedly the management of patient flows, resource allocation, and overseeing overall hospital operations. 

Relevantly, the ACT government is, because of the dire state of the territory’s finances, also reportedly pursuing $27 million in savings in the hospital budget.

Not an isolated case

Hospitals are complex environments and implementing efficient clinical, co-ordinated pathways is beneficial for frontline clinicians and patients. However, if administrators and co-ordinators impinge on frontline clinicians’ work, it is inevitable that tensions will rise.

The minister has acknowledged in at least one instance, that the priority assigned by a treating clinician, involving surgery, was changed by the Operations Centre. Unfortunately, this was not an isolated case, highlighting a fundamental problem with the concept of the centre.

The latest edition of Canberra Doctor, a publication of the Australian Medical Association’s Canberra chapter asserts that the model adopted by ACT Health has not been successfully implemented anywhere in the world, and doctors say it’s been interfering with and over-riding their clinical decisions.

The latest Canberra Doctor contains the following damning comments and feedback from local clinicians: “Speaking off-the record, several surgeons including VMOs and salaried specialists, told Canberra Doctor the Operations Centre has prevented surgeons from attending certain procedures where their expertise was required; from prioritising patients they deemed more urgent; and from performing operations in circumstances they strongly believed were best for patients.

“Several of these surgeons said they were aware of situations where they believed the Operations Centre’s decision-making led to adverse outcomes for patients. AMA ACT has also been contacted by doctors in other areas of the health system, angry at how the Operations Centre is eroding clinical autonomy.”

Stephen-Smith acknowledged the government needed to “take a pause in this conversation about how the Operations Centre and the planned care work is being implemented”. 

Really? Consultation on the functions, roles and processes of the Operations Centre needed to be incorporated in its business case – if one was prepared – and implementation plan. 

Pull the other one

In extraordinary evidence, a Legislative Assembly inquiry was told that the first time the Treasury became aware of the cost pressures in health was on October 18 2024, ie just one day, coincidentally, before the ACT election. Pull the other one.

In early 2024, we highlighted a blowout of $340 million in the 2023-24 Budget Review which was, in the main, due to the need to provide additional operating funding for health, albeit, packaged as new initiatives. 

The additional funding was initially for one year, and hence did not address the underlying budget shortfalls in the forward years. It was, therefore, no surprise to us that the 2024-25 Budget Review recorded a blowout of $374 million largely driven by, yes you guessed it, a blowout in health costs.

Accepting Treasury’s advice to the committee, it seems strange to us that relevant officials and the Cabinet would not have known well before the election that the underfunding of health would lead to clinicians rationing services.

Pursuing savings through the Operations Centre appears, therefore, to have been an unprepared and kneejerk response to a cost blowout that should have been foreseen.

There are several prerequisites to realising potential efficiencies in the hospital system. 

Firstly, it should be properly funded to deliver timely patient care at clinical and national standards. Demanding savings in a financially stressed system inevitably increases tensions in the operating environment and results in adverse outcomes. 

Secondly, clinicians should be engaged, not just superficially but substantially, in a program of continuous improvement in clinical practices and pathways. 

Thirdly, however, they should not be placed in the invidious position highlighted above by Dr Vrancic in Canberra.

We acknowledge that patients do not get a choice of doctor in the public system. However, they are entitled to continuity of care from their treating clinician. 

Bureaucrats pursue quick savings

It is wrong to think of patient treatment as an industrial assembly line process. 

It is difficult to see how autonomy to the treating clinicians and continuity of care can be ensured as the bureaucrats in the Operations Centre – and this includes clinicians undertaking bureaucratic roles – pursue quick savings.

It seems obvious to us that the next steps in addressing the shortcomings regularly exposed in our health system is to start a genuine consultation with clinicians and go back to the drawing board on the functions of the Operations Centre.

It would also be appropriate to undertake a serious rethink of the decision to prioritise a multi-billion dollar tram line that will increase travel times over the provision of hospital beds and employment of clinicians.

Jon Stanhope is a former chief minister of the ACT and Dr Khalid Ahmed a former senior ACT Treasury official.

Excuse after excuse but hospital misery remains