The ACT government's move to compulsorily acquire Calvary Public Hospital Bruce has sent shock waves through the Canberra community in the two weeks since it was announced.
There has been no shortage of debate around the move.
There have been hundreds of arguments both for and against the move. Debates have been centred around the role of religion, hospital performance and the culture at the hospitals.
But how do the arguments stack up?
Hospital performance
Canberra Hospital and Calvary Public Hospital Bruce are very different hospitals.
Canberra Hospital is a major tertiary hospital and is a trauma hospital which also services a large part of south-east NSW.
Canberra Hospital is also nearly triple the size of Calvary with 672 beds. Calvary only has 250 beds.
Canberra Hospital treated more than 22,000 patients between July to September last year whereas Calvary treated 7745 patients.
The difference in size also means Canberra Hospital has many more services and complex illnesses or injuries are often diverted from Calvary to Canberra Hospital.
Emergency department wait times and elective surgery waiting lists are often used to measure hospital performance.
The most recent figures show Canberra Hospital and Calvary have similar results for their emergency departments with Canberra Hospital performing slightly better.
The percentage of patients seen on time at Canberra Hospital between July to September last year was 45.1 per cent, the latest quarterly report from ACT Health shows.
At Calvary, 40.9 per cent of patients were seen on time over the same period.
Calvary performed slightly better for elective surgery waiting times. In the past financial year, 64 per cent of semi-urgent surgeries were done in the clinically recommended timeframe at Calvary, compared to 49 per cent at Canberra Hospital, based on data from the Australian Institute of Health and Welfare.
For non-urgent surgeries 88 per cent were completed on time at Calvary and 64 per cent were completed on time at Canberra Hospital.
Calvary completed 99 per cent of urgent elective surgeries in the recommended time whereas this was 98 per cent at Canberra Hospital.
Cultural issues
Opponents of the move to compulsorily acquire Calvary have been citing a major 2019 review into workplace culture in the ACT's public health system.
The report found widespread bullying and harassment, inefficient procedures to deal with complaints, poor leadership throughout the territory's health system and inappropriate human resource practices.
Opponents have pointed to this report to say that Canberra Health Services cannot be trusted to run the Bruce hospital. However, Calvary Public Hospital Bruce was also included in this review and 17 per cent of all those surveyed worked at the Bruce hospital.
Many of the report's findings and recommendations applied to the system as a whole and did not differentiate between Canberra Health Services and Calvary.
"The survey results were similar across all three arms of the ACT public health system (i.e. Canberra Health Services, Calvary Public Hospital and the Health Directorate)," the report said.
However, the report did say there was alleged inappropriate behaviour and disrespect to Calvary executives by senior ACT Health executives. But there were also allegations of Calvary executives acting inappropriately towards executives in ACT Health and Canberra Health Services.
The report said there was a lack of coordination between the two hospitals and there needed to be greater employment flexibility between the two hospitals.
"Reportedly, clinical service planning has historically been disjointed, overly prolonged and uncoordinated," the report said.
"This has created a high level of distrust, confusion and angst from clinicians who are asked to deliver services in an environment that they either do not understand or have had little opportunity to be consulted on."
In a more recent culture review, there were suggestions that the separation of the two hospitals hindered cultural reform.
"Some stakeholders suggested the structure of the agreement along with associated funding, governance and contract management arrangements were constraints on cultural reform across the ACT public health system," the January 2023 report said.
The report said the Calvary ACT regional chief executive Ross Hawkins had been consulted on this but he did not believe the current contract was an impediment to cultural reform.
Abortion inquiry
In the weeks before the ACT government announced it would compulsorily acquire Calvary, the Legislative Assembly's standing committee on health released a report into abortion access in the territory.
The report took aim at Calvary, saying it was "problematic" the hospital was restricted in the services that can be delivered to the ACT community due to an "overriding religious ethos".
There was a submission in the inquiry from a woman who had experienced an incomplete miscarriage and she needed a procedure called a dilation and curettage where tissue is removed from a uterus.
She said she was told Calvary did not perform the procedure.
The report concluded the patient had been "refused critical medical treatment following a miscarriage".
But Calvary has strongly condemned the report and said this procedure is offered in the hospital in circumstances where a person has experienced a miscarriage.
The organisation has asked for a retraction and for the report to be amended but the committee has refused to do so.
This report has been heavily scrutinised by opponents who have said the report showed the government's bias against Calvary and the Catholic Church. They have questioned the timing of the report and have suggested this indicated the government's intentions.
However, this was not an ACT government report. The report was handed down by a parliamentary committee. Each of the Assembly's standing committees has one member from each of the parties and only government backbenchers serve on committees.
The role of a committee is to review legislation and other matters related to the governance of the ACT. The inquiry into abortion access was announced following the overturning of Roe vs Wade in the United States.
The standing committee on health is chaired by Greens member Johnathan Davis, the co-chair is the Liberals' James Milligan and Labor backbencher Marisa Paterson replaced her colleague Michael Pettersson on the committee for this inquiry.
The report was tripartisan. Opposition members often write dissenting reports but in this instance there was not one. However, Mr Milligan, following the backlash, did say he did not fully agree with the recommendation related to Calvary.
Calvary did not make a submission to the inquiry. The organisation said it did not do so as it believed its role and views on termination fell outside of the terms of reference.
Reproductive services and voluntary assisted dying
Many have questioned whether the acquisition of Calvary is related to the organisation's stances against abortion and voluntary assisted dying. The government has strongly denied this is the case.
The ACT government has recently announced a policy to provide free abortions and legislation is expected to be introduced later this year for voluntary assisted dying.
Calvary does not perform abortions and it does not offer elective reproductive services, such as contraception or tubal ligation surgery. In circumstances where a mother suffers an urgent and life-threatening condition the hospital will provide treatment even if it poses a risk to the baby.
But Canberra Hospital does not perform abortions either, the hospital will only do so in certain circumstances such as when a patient's life is at risk. Canberra Hospital does provide elective reproductive services and a spokesman from the organisation said these services will be provided at Calvary when it is acquired.
Coincidentally, a federal Senate inquiry handed down a report on Thursday recommending that all public hospitals in Australia should be equipped to provide surgical abortions.
Voluntary assisted dying laws are expected to pass the territory's parliament either late this year or early next year. Calvary would not offer voluntary assisted dying and it's unclear how such laws would work in relation to Canberra Hospital.
However, experience shows that most people who apply to access voluntary assisted dying live at home. Statistics from Victoria, from between July 1 to December 31, 2020, showed 87 per cent of those who applied were living at home.
This issue is more likely to be faced by Clare Holland House, also operated by Calvary but funded by the ACT government, which is a hospice providing end-of-life care. The future of Clare Holland House remains uncertain.
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