A promise no one asked for and cuts no one wants to see

It was the cash splash no one asked for.

In the weeks leading up to the 2022 Victorian state election, Labor and the Coalition traded blows in the form of expensive hospital promises.

The government is heading into dangerous territory if amalgamations are a cost-cutting exercise, and patients will be forced to travel further for care.

Then-premier Daniel Andrews announced his government would build the biggest hospital project in Australia’s history, including two towers near the new Arden metro station, costing up to $6 billion. The Coalition pledged a new Royal Children’s Hospital in Werribee, with a price tag of $900 million.

Between them, they quickly racked up $23 billion in bricks and mortar health promises. The jarring thing though was that if you asked Victorians what they wanted, it wasn’t this. As part of its election coverage that year, The Age surveyed thousands of Victorians about what mattered to them.

Health was their top concern, along with integrity in politics and governance. But it wasn’t shiny new buildings they were calling for. They wanted timely access to healthcare. They were concerned about mental health, the shortage of staffed hospital beds, ambulances queuing at emergency departments and GP shortages, especially in rural areas.

Health leaders and economists were warning that more buildings weren’t going to fix the issues – it was already a struggle to staff the buildings that they had. And alarmingly, given the magnitude of the spend, the peak group representing the state’s public hospitals said they didn’t know how the political parties had been deciding which building projects to give money to.

Eighteen months and a new premier later, it’s unlikely Victorians have changed their views about what they want for the health system. The bravado, however, has gone from some of those election promises, as Jacinta Allan’s government attempts to rein in costs while the state’s debt rises. Significant problems with accessing timely healthcare remain.

Contained in last week’s state budget documents was the shock news that the promised biggest hospital project in Australia would no longer include its centrepiece – two medical towers at the new inner-city precinct of Arden.

Senior sources close to the project, requesting anonymity to preserve relationships with the state government, have been sceptical of the official line that hospital construction on this site became unviable because of electromagnetic interference caused by the new metro system. “This all comes down to them not wanting to spend the money building a new hospital,” one of the sources said.

A raft of other projects have been delayed, including a new hospital in Maryborough and the rollout of 35 local mental health and wellbeing hubs. The Victorian Comprehensive Cancer Centre Alliance lost 75 per cent of its funding, horrifying patient groups.

Perhaps these cuts might have been more palatable if it wasn’t for the waste and overspending that has occurred elsewhere.

As $23 million has been stripped from Victoria’s world-class cancer research alliance, it’s been estimated more than $589 million was squandered when the government signed up to host the Commonwealth Games using a flawed business case, before cancelling the event citing ballooning costs.

Last week’s budget offered more money to keep the state’s hospitals running, with the funds for admitted services rising from about $1.5 billion to $1.8 billion from this financial year to the next, but this cash increase was quickly followed by a warning. Hospitals won’t be bailed out if they run over budget warned Health Minister Mary-Anne Thomas in a letter to health services last week.

In the lead-up to the 2022 election, the government missed a golden opportunity, as it committed billions to hospital buildings without a vision for reform. It is likely to get a second chance this year, as it considers widespread mergers among Victoria’s 76 health services.

The difference with this plan is that, if done well, it’s likely to have the support of many health leaders, unions and staff, who believe 76 health services, each with different systems and competing for the same workers, is far too many.

“I look at colleagues who work in Queensland for example, and they have got one health record and one pathology service that everyone can link into,” said senior emergency doctor Simon Judkins this week.

As state political editor Annika Smethurst wrote on Friday, the absence of leadership or open consultation on the issue by the government has allowed the worst-case scenario to be presented to the public by those concerned about change. One hospital board member said they believed the decision to merge health services had been made before consultation began.

It’s hard to know exactly what the Allan government’s key motivations are for this reform, which now seems all but inevitable. There has yet to be any widespread consultation or communication about the plan. Indeed, it was only made public after The Age revealed at the end of last year that chief executives and board chairs were being quietly consulted on the issue.

Health is the last place Victorians want to see cuts.

However, the government is treading into dangerous territory if, as some fear, amalgamations are a cost-cutting exercise, and patients will be forced to travel further for care.

Although there have been some improvements, data shows that many parts of Victoria’s public hospital system are still under profound stress, as hundreds of patients still languish in emergency departments for 24 hours or more – and more than 62,000 wait for surgery.

Health is the last place Victorians want to see cuts.

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