Two weeks ago, the seventh edition of the Australian Policy Handbook was launched at ANU before an audience of luminary academics and public servants, including the book's most famous co-author, Glyn Davis, now secretary of PM&C.
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Since 1998, the book has been widely accepted amongst public administration practitioners as offering excellent advice on best practice policy processes. Its ideal "policy cycle" emphasises careful evaluation of current policy before analysis of new policy options followed by consultation and co-ordination, including consideration of implementation risks, ahead of government decisions.
While the real-world of politics and responding to current events may depart from such an ideal framework, the principles involved are important in our democratic system: decisions should be made on the basis of good information and after genuine consultation with stakeholders and the public.
If ever there was an example of failure to apply good policy processes, it is the decision by the ACT government to compulsorily take over Calvary public hospital and to merge Canberra Hospital and a new major hospital in Belconnen. This is not to say the decision is definitely wrong, but in the absence of good process there is every reason to suspect it may be wrong.
A range of issues should have been carefully considered and made the subject of consultation with both the Canberra public and the various stakeholders - not just Calvary management but also the doctors, nurses and other staff at both Calvary and Canberra Hospital, the GPs and other non-hospital healthcare providers whose patients receive hospital care, and the hospital patients and their families as well as the consumer organisations that represent them.
First, where is the evaluation of current hospital performance? We know that the ACT's public hospital system performs poorly compared to many other jurisdictions' and against independently set standards, but how do Calvary and Canberra Hospital compare?
Secondly, where is any public assessment of the various policy options? No doubt there are potential benefits from a merger, including better management of emergency departments and ambulance services, and better allocation of specialist resources; there might also be some economies of scale.
On the other hand, the takeover will clearly require the full attention of hospital management with the real danger of diverting attention away from serious existing problems, particularly at Canberra Hospital.
No doubt the ACT government and senior management in ACT Health see the merger as providing more direct control of the public hospital system. This is often the view of state and territory governments whose focus is on public hospitals. It is not so much an ideological view, but is an overly narrow view of our health system as a whole.
The health system is not just another government program suited to top-down control: it has a wide range of players including independent doctors and other healthcare professionals, corporate private practices and charitable organisations including churches.
The services provided are mostly government funded but they are not all government run. There are benefits in this including for consumers: from competition and innovation and also from the interplay of professional, charitable and public sector values.
Interestingly, states which have been most successful over recent decades (Victoria since the 1990s and NSW more recently) have given their public hospitals more autonomy including over clinical management, subject to performance reporting and budget controls. That does not seem to be where the ACT is heading.
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A wider perspective of the health system is particularly important to addressing the challenge of co-ordinated care and patient-oriented services. This is not about coordination between hospitals but between hospitals and primary care. In Canberra, this challenge is particularly acute because our primary care is inadequate - too few GPs and too much reliance on patient contributions.
No doubt we do need a bigger hospital in Belconnen, but we also need more investment in primary care.
The lack of consultation makes suspicions of other agendas understandable, despite ACT government denials. Are Calvary's religious beliefs a contributory factor in the decision? If so, let's be open about the matter and tease out the impact, if any, on access to abortion and (in future) voluntary euthanasia. My understanding is that such services are more likely to be offered outside our main public hospitals so that Calvary's attitude would not limit access.
In 2011, I questioned the then proposed sale of Calvary public hospital to the ACT, raising similar concerns to the ones here. I also suggested that keeping Calvary separate from the Canberra Hospital might be more consistent with the then federal (Labor) government's reform directions involving local hospital networks and new primary health networks (Medicare locals).
It is now 12 years later, Canberra has grown and federal reform directions may have changed. It is possible that the case for transferring Calvary to the ACT government is stronger now. But I still see benefits in retaining a separate, independently managed Calvary public hospital, and am uncertain that the claimed advantages of a merger outweigh such benefits.
What I am certain of is that the process has been appalling. Sadly, it may be too late now to expect full suspension of the merger to allow a proper process to proceed, but a delay, say to early next year, may help to smooth the transition, facilitate wider engagement, clarify future management arrangements and allow a start to serious consideration of related reforms to the health system in the ACT and surrounding area.
Acknowledgement: I am not a Catholic.
- Andrew Podger is a retired Australian senior public servant. He is currently a professor of public policy at the Australian National University.
