LCM response to HCCA comments on staffing

This week HCCA received a letter from the Little Company of Mary (LCM) in response to our blog post of 2 November 2009.  We will meet with representatives of LCM in January to discuss their position more fully.  In the interim we thought it would be useful to post part of the letter that relates to staffing, as it provides more detail than we initially had.

What follows is an excerpt from that letter:

"In the section Implications for governance and staff conditions you state “nursing staff resources available to provide palliative care in the community appear to be considerably less than when home based palliative care was part of ACT Health”.

• CHC received seven (7) Full Time Equivalent (FTE) nursing staff when it took on the home-based palliative service. This did not include any provision for clinical nurse consultant, managerial, allied health, medical or administrative support. Following representation to ACT Health in 2003, CHC received additional funding to provide a Clinical Nurse Consultant and administrative support for the home-based palliative care service.
• Currently, the home-based palliative care service has approximately ten (10) FTE including the Clinical Nurse Consultant position and one (1) FTE of administrative support. Supplementing these staff, and not included in the ten FTE, are management, allied health, medical and administrative support staff located at CHH or working at CHH as an extension of their role at Calvary Hospital.
• The model of care for home-based palliative care has developed since 2002 to focus on the provision of specialist palliative care services delivered by highly skilled clinicians. Non-specialist palliative care assistance in the home, as required by CHH, is provided by Community Health and also by the volunteer members of the ACT Palliative Care Society."

"Also in the section Implications for governance and staff conditions you state “but with the change of management will be employed by LCM and will be required to sign employment contracts agreeing to work to LCM values”.

• Staff at CHH and Calvary Public Hospital, whilst ACT public servants, are employed and managed by CHC. Under this arrangement it is already a requirement that staff observe and practice the Calvary values of Hospitality, Healing, Stewardship and Respect. A value based approach to management is considered normal and best practice in health care."

• "Further, no Clare Holland or home based palliative care employees will “be required” to become Calvary employees should the proposal proceed. If existing staff do not wish to become a Calvary employee (under the proposal) they can elect to remain in public employment with ACT Health.
• If existing staff do remain with Calvary, and for any reason wish to review that decision at any time in the future, they can return to ACT Health employment with full recognition of length of service etc. All existing entitlements of staff, and their current superannuation  arrangements etc, will be honoured.
• From the very first announcement of negotiations regarding the possible changes of ownership at Calvary Public Hospital and Clare Holland both parties clearly stated there would be no disadvantage to any staff. This commitment has been honoured to date and any representation to the contrary simply does not reflect the facts of the situation."

The need for compromise to solve the concerns regarding the sale of Calvary and Clare Holland House

HCCA has spent a great deal of time listening to and considering community views and concerns expressed regarding the possible transfer of ownership, governance and control of Calvary Public Hospital at Bruce to the ACT Government, with the ACT Government to transfer Clare Holland House Hospice to the Little Company of Mary Health Care.  

In summary the HCCA position is:

1. Support the transfer of ownership, governance and control of Calvary Public Hospital at Bruce to the ACT Government;

2. Oppose the transfer of ownership of Clare Holland House (CHH) to the Little Company of Mary Health Care Limited (LCMHC);

3. Oppose the offer of a contract for clinical service at Clare Holland House for a term of not less than 30 years; and


4. Oppose the nexus between the sale of Calvary and Clare Holland House and think that the issues need to be considered separately.

As set out in our submission, we find the arguments for the sale of Calvary very convincing and are fully supportive of the Government owning, funding and governing Calvary Public Hosptial. We consider there will be great benefits for consumers with the integration of the services across both the Canberra and Calvary hospital campuses. This arrangement will provide for more efficient use of public money, reduction in duplication and improved coordination with community based and ambulatory service - all leading to improve outcomes for consumers.

We do not support the sale of Clare Holland House to the Little Company of Mary Health Care.  We have not been convinced that the Government has demonstrated how the quality of care will improve as a result of the change in ownership. 

The provision of a clinical services contract of not less than thirty (30) years is a major concern for HCCA. We do not consider this to be good public policy practice. A contract for the provision of clinical services over such a lengthy period was seen as unrealistic given current and likely future health care reforms. Such a contract could well provide an unreasonable restriction on the ACT Government’s ability to adapt to changing funding and healthcare service models.  An extension of the clinical services contract to not less than thirty years could be seen as excluding other providers from the palliative care sector and creating a private monopoly in ACT palliative care.


We consider that the difficulties in developing and achieving integration of different palliative care services, including home based palliative care, respite care, community based services and integration with residential aged care facilities, need to be addressed.


We are of the view that consumers should be able to access secular palliative care and have the right to refuse pastoral care.  This is made more difficult to achieve when there is a religious provider of public palliative care services.  As once consumer commented recently: "I do not want to be in a place that imposes their ethics and limits my options".

We acknowledge that this is a very difficult position for the Government and the Greens to be in. We share the view that public services are best served in public hands. 

We do not understand why the sale of the two sites are linked in thie proposal and believe that they need to be considered separately on their merits. 


The palliative care approach is highly valued as a response to end-of-life care in the ACT community. However, not all patient groups are adequately served because of limited resource availability particularly for respite places. Before there is any transfer of ownership of the hospice consideration must be given to the establishment of an independent review team made up of individuals with expertise to build a progressive case for additional resources, and to examine the current mix.

We consider that there is a need to treat Clare Holland House separately to the sale of Calvary Public Hosptial as there is a need to reconsider and review the needs of our community in terms of palliative care. 

One aspect of this is the current staffing structure.  The staff complement in the a home based palliative care service is now 8.2 full time equivalents, i.e., 56% of what it was 13 years ago. There have been complaints from some consumers regarding the inadequacy of home based palliative care. LCM has recognised that the service is insufficient for the need and they have been pressing for increased funding for staffing for home based palliative care for some time - pre discussion of the sale.  We would like to see an independent review of palliative care needs and provision in the ACT before we are locked into a longer term arrangement.

It is interesting to reflect on the history of palliative care in the ACT which began as a community initiative with input from a range of people/organisations both secular and religious:
* started in 1985 (a home based palliative care service) run by by Community Nursing, ACT Health. At the same time, the ACT Hospice Palliative Care Society was given a $10,000 donation from the ACT Cancer Society to commence its first volunteer program.
* Following a decade of success of the home based palliative care service and the volunteer program, the ACT Govt agreed to fund a hospice inpatient facility which opened on Acton Peninsular on 1 April 1995. LCM won the tender to manage the hospice for a one year period but the contract was renewed on a regular basis and further tenders have not been advertised over the last 14 years. Home based palliative care continued to be run by Community Nursing.
* In 2002 the specialist palliative care nurses in the home based service run by Community Nursing were transferred went to the management of the LCM. The model of care has been changed from a nursing model under the Community Nursing service to a “support and consultative” model which requires less nursing staff in the specialist palliative care service.

HCCA will continue to put forward the views of our members and networks on this issue and are keen to hear.

The HCCA Executive Committee meets on Wednesday night (9 Dec) and will finalise our position on the Calvary proposal.

Proposed Sale of Clare Holland House

HCCA is opposed to the sale of Clare Holland House (CHH) to Little Company of Mary (LCM). We have a range of concerns relating to the continued integration of palliative care services, implications for governance and staff conditions, and the lack of considered analysis about current and future needs for palliative care in the ACT.

Integration of service:

Concerns have been raised that the proposed sale of Clare Holland House will create a private monopoly in ACT palliative care. At present the service is a tri-partite one, involving ACT Health, LCM, and the Palliative Care Society, which provides checks and balances on the quality of the services provided. What guarantees are there that this balancing mechanism will be maintained if the LCM becomes a monopoly provider of palliative care services?

Implications for governance and staff conditions:

Since home based palliative care management transferred to LCM, nursing staff resources available to provide palliative care in the community appear to be considerably less than when home based palliative care was part of ACT Health. Consumers are expressing concerns about these reductions in available resources while the need for palliative care is growing and the population increasing.

Staff are currently employed by ACT Health, but with the change of management will be employed by the Little Company of Mary and will be required to sign employment contracts agreeing to work to LCM values.

Future needs for palliative care in the ACT:

The palliative care approach is highly valued as a response to end-of-life care in the ACT community. However it is not all patient groups are adequately served because of limited resource availability (e.g. some cancer patients are well cared for but some people with other end of life conditions such as motor neurone are less well catered for; before any transfer of ownership consideration must be given to the establishment of an independent review team made up of individuals with expertise to build a progressive case for additional resources, and to examine the current mix.

Palliative Care Society meeting of friends and supporters

Last night I attended the information evening of the Palliative Care Society on the proposed sale of Clare Holland House (CHH) to the Little Company of Mary (LCM). It was held at the Ainslie Football Club.
















I counted well over one hundred people, and one organiser gave the figure of 143.

There was overwhelming opposition to the sale of Clare Holland House.

The purpose of the forum was to provide information and a range of perspectives on the proposed sale to encourage friends and supporters of Clare Holland House to share their thoughts with the Council of the Palliative Care Society. The feedback received will provide guidance to the Society on how to respond to the proposal.

The Palliative Care Society is a member of HCCA and a number of HCCA members were part of the audience. We will certainly be considering the feedback we heard last night in responding to the Government’s proposal.

There was a change in the format of the information evening. The Minister for Health, Katy Gallagher and the LCM were invited but the Council decided that, in the interest of open and frank discussion, to withdraw the invitation so that they could provide a forum where friends and supporters could freely discuss matters of concern on the proposed sale.

Shirley Sutton, Patron of the Society, spoke thanked people for attending and provided a history of the home based palliative care and shared with members of her distress at the sale of Clare Holland House.

Peter O’Keeffe, a volunteer with the Society for 10 years, spoke, in a strong and considered way about his concerns about the impact such a decision could have on our community. Peter is a member of the working group PCA set up to research implications of the proposal. He expressed his concern that Clare Holland House seems to have been thrown into the deal as a bargaining chip. Of particular concern is the 30 year exclusive service contract of clinical service to the LCM as part of the proposal. This was a major issue of concerns with those assembled. Peter ended with an impassioned plea to those in the audience to tell others about the issues.

Linda Denham, honorary secretary of the Society spoke on the clinical issues and concerns the staff. There are concerns about loss conditions of employment, and implications for care given the need to have an integrated palliative care as they work across a wide range of areas including radiation oncology, medical oncology, renal, neurology, pediatrics and cardiology. Integration will be more difficult with privatisation of the hospice. Linda also spoke of her concern around the monopoly of services that would result from the sale and the granting of the 30 year service contract.

David Lawrance, President of the Palliative Care Society, opened with comments that the alarm bells have started to ring and that many in our community are worried. He stated that the Society does not have a formal view on hospital sale but strongly oppose the sale of the hospice. He said that they Society considers it to be quite wrong to use CHH as a bargaining chip in negotiations in respect of purchase of the hospital and that they can see no reason for connecting the purchase of CHH and Calvary. David stressed that the current situation works very well and there is no reason to change it.

There was unanimous opposition to the sale and the audience will be supporting the Society in their fight to save Clare Holland House.


HCCA supports the sale of the hospital to the Government but not at the expense of Clare Holland House. We share many of the concerns of the Palliative Care Society. We question the nexus between the sale of the hospital and the hospice and think they are two very different issues to be considered separately.

We have had a number of meetings with consumers and have prepared a paper outlining the issues. We are running a workshop next Thursday to work through these.

ACT Health Calvary Consultations

I attended two ACT Health consultations on the proposed sale of Calvary on Friday 16 October 2009. The one at Calvary had around 40 people, including a few Calvary staff and other 'minders' and there were around 30 at The Canberra Hospital.

Katy Gallagher responded to many questions and comments. There were a wide range of issues covered.

Questions from the floor included were:

Were there complaints about the performance of Calvary? and is this what has prompted the Government to approach the Little Company of Mary to purchase Calvary Hospital?
How is the Catholic spirit and ethos going to be maintained in a government run hospital? Will the pastoral care team remain as it is?
Why wasn’t consultation started earlier in the process of discussion between Calvary and the Government?
Why are the times for consultation limited to day time? Will the Government consider running forums after hours or on the weekend?
Why is Calvary taking money for the sale when it was built with public money?
What will happen to the hospice f the sale of the hospital does not occur? Will the Government still want to sell it?
How do the Little Company of Mary Sisters feel about the sale of the hospital and Clare Holland House?
Can the costings be trusted? Would the Government consider a cost-benefit analysis?

The responses to questions were largely answered based on the material contained in the Government's information paper and other consultation documents