The Main Entrance to Canberra Hospital. The new Critical Services Building is bringing some necessary but painful change. Photo: Michelle Kroll.
The ACT is investing a lot of taxpayers’ money in ACT hospitals – $661 million for the new Critical Services Building at Canberra Hospital and probably about a billion for the new Northside Hospital to come.
After years of bad performance data for the ACT’s Emergency Departments and elective surgery, there are signs that the money and efficiency measures are bearing fruit.
Yet Health Minister Rachel Stephen-Smith is facing more strife, this time over the six-month-old operations centre at Canberra Hospital which has upset orthopedic surgeons and probably others.
The head of orthopedics, Professor Paul Smith, has resigned after 25 years and two others have also given notice, claiming interference in their clinical decision making and a tightening of resources.
Simmering away in the background is a dispute over the Minister’s plan to change the way Visiting Medical Officers – surgeons and specialists – are paid, as part of cost-cutting across the hospital system after having to inject a further $227 million into the system to keep it running.
Ms Stephen-Smith says moving away from fee for service to sessional contracts or employed staff will bring VMO pay into line with other jurisdictions and save the hospital and taxpayers money.
The VMOs are crying foul and claiming a lack of consultation.
Lack of consultation – Canberra’s favourite pastime – is also being thrown at the government over the operations centre, and the Minister has also had to debunk claims of bureaucratic overreach and decisions by algorithm.
It seems the operations centre is staffed by clinicians, not bureaucrats, with oversight over the whole of the hospital and triaging surgery according to need, which means some surgeons with their own patient lists are being put out.
Ms Rachel-Stephen Smith is saying that, in effect, there should be one list that everyone is aware of so that there is a level playing field and no queue jumping.
It should, in fact, mean that patients will be treated equitably and in the most efficient manner.
Whether that is happening or not remains to be seen, but it is clear that with health consuming a third of the ACT Budget and millions of dollars being poured into the hospital system and it is still struggling to keep up, something has to be done.
The government through Canberra Health Services is trying to exert greater control over the system to, yes, save money, but also to make it more efficient and provide better and more timely care.
This drive for more centralised control, instead of a patchwork of power centres, is bumping up against entrenched interests used to operating autonomously within our hospitals.
Hospitals traditionally have used surgeons and specialists with private practices who wield a great deal of influence and whose interests don’t necessarily match that of administrators with overarching responsibilities or governments grappling with constrained budgets and rising costs.
Even the language used by the Minister when talking about different ‘craft’ areas sounds medieval rather than evoking the ethos of a modern institution.
These specialists also operate closed shops, restricting the numbers of doctors who can train and join their private clubs (or ‘colleges’), increasing their demand and pushing up costs.
Canberra’s hospitals have always, it seems, had their troubles, whether it be the EDs and waiting lists, the awful culture or inevitably the tragedies that come with the territory.
They can be graveyards for ministers and political ambition, but Ms Stephen-Smith has shown staying power and seems determined to bring about lasting change for the better.
Whether she can pull off this particular reform phase remains to be seen. Both parties say patients come first, but they will have different views of how to achieve that.
The bottom line is that the ACT Hospital system can’t continue as it is, and neither should archaic structures that are no longer fit for purpose.
