Community Health and Hospitals program's $2b of promises largely ignored

With no dedicated bulk-billing diagnostic mammography services in Tasmania, and only two private providers in her area, the Hobart woman had to pay hundreds of dollars and wait two months for a scan. In that time, the lump grew from the size of a 5c piece to a 50c piece.

The federal government has been well aware of the lack of diagnostic services in Tasmania for years. In April 2019, weeks before the federal election, the Morrison government promised two mammography units for Hobart and Launceston.

Four-and-a-half years later, the promised services are still not up and running.

They aren't the only ones.

The Tasmanian services form just one of 171 projects promised to communities across the country under the federal government's $2 billion Community Health and Hospitals program - a program first announced by the Morrison government in December 2018. A program the national audit office earlier this year said was plagued with ethical and legal concerns, in a scathing review.

ACM, publisher of this masthead, can reveal just one-third of these projects are up and running, almost five years after the Morrison government first announced the funding.

As of August 30, 2023, the Department of Health confirmed just 63 out of the 171 projects were operational.

Ms Bain was diagnosed with stage three multifocal triple negative breast cancer in May 2022. It's an aggressive form of cancer, which had also spread to her lymph nodes.

Speaking in Launceston back in April 2019, then-prime minister Scott Morrison - joined by then-health minister Greg Hunt and several Liberal candidates - had promised the two diagnostic mammography units would change lives.

"No more waiting to know whether it's benign, or cancerous," Mr Morrison said of the $3 million commitment.

"Yes it's money and yes it's machines, but what are we investing in? Removing that anxiety and heartache that comes from not getting access to those services as quickly as you need."

Asked to explain the missing mammography services, a Department of Health spokesperson said "states and territories have responsibility for the delivery of publicly-funded hospital based services, which may include diagnostic mammography".

But current federal Health Minister Mark Butler has slammed the Coalition government health and hospitals program, adding just half of the promised $2 billion has actually been spent on delivering these projects.

"This taxpayer money was so poorly allocated that years later, at a time when Medicare and the health system are under such strain, just half of the $2 billion has actually been spent," Mr Butler told ACM.

"This program exemplifies the Morrison government's time in office - one plagued with waste and rorts. A government that was all announcement and no delivery."

In its report published this June, the national audit office found the administration of the Morrison government's $2 billion local health and hospitals program was ethically unsound, and there were cases where rules and finance laws were deliberately breached.

The report revealed most recipients were selected by government without assessment or guidance, and at such speed the department was forced to monitor the media to keep track.

The Community Health and Hospitals Program was announced back in 2018 as a way to to provide local health services across the country - including cancer treatments, drug and alcohol clinics, chronic disease management programs, mental health services - and help alleviate pressure on communities and hospitals.

Projects were funded through national partnership agreements with states and territories, and grants to primary health networks and organisations.

But the report found initial national partnership agreements were developed "as projects were announced by government", and with "limited consultation" with states and territories. Only two proposals were assessed by the Health Department to be "highly suitable", even though the plan stated only "highly suitable" proposals should be shortlisted.

The auditor general also found the department failed to develop guidelines for seven grants and "in at least three instances this represented a deliberate decision by senior management to not comply with finance law".

Asked by this masthead to respond to the fact only 63 projects were complete, a spokesperson for Mr Hunt said "the CHHP is a seven-year program and is ongoing".

The spokesperson pointed to the ANAO report's finding that, as of November 2022, 90 per cent of service delivery projects were under way or complete, adding: "It is heartening to see well over 90 per cent of service delivery projects completed or significantly under way."

The ANAO report said this figure of 90 per cent appeared to be out of just 55 CHHP projects involving service-delivery. The report stated 7 per cent of those 55 projects had been completed as of last November, while a further 83 per cent of 55 projects had commenced delivery.

Among the list of 171 projects were 13 new radiation services for regional towns across the country. Patients would no longer have to travel to major cities while sick in order to receive life-saving treatment.

The $63.4 million initiative was announced by the Morrison government in April 2019, promising new centres delivering comprehensive radiation treatment in 13 locations: Bega/Eurobodalla, Grafton/Clarence Valley, Tweed, Nambucca/Kempsey, Taree, Armidale, Griffith, Gladstone, East Gippsland, South Gippsland, Mt Gambier/Limestone Coast, Burnie, and Geraldton.

"It is vital that we do all we can to provide cancer care for patients living in Australia," a government press release at the time read.

"Through this funding, we can help patients to overcome these issues, so they and their families can focus on what matters - fighting and beating cancer."

But the Department of Health has confirmed only three of the 13 promised radiation services were in operation, as of August 30, leaving regional and rural towns waiting for essential care.

In some cases, there are questions around whether communities will ever see the services they were promised; and whether they should have been promised in the first place.

ACM understands in Bega - located in the marginal seat of Eden-Monaro the Coalition was trying to win off Labor at the 2019 election - none of the $5 million promised under the Morrison government has been received, nor allocated.

Four-and-a-half years since the region was promised radiation services, the state government is finalising consultations into whether the community needs them.

Bega resident and cancer survivor Nigel Wiggins said the community was "pissed off" with the lack of delivery, saying the government is just full of "promises, promises".

"Nothing at all has come from it. There is no promise of radiation. They've talked and talked and talked," he said.

The closest radiation services to Bega are in Canberra, or Nowra. So when Mr Wiggins was diagnosed with colon cancer in 2021, he was forced to drive three hours to Canberra every Monday and fork out for a motel until Friday, for six weeks straight, to receive treatment.

"You're not in your own bed, you're not in your own environment ... it's bloody awful," Mr Wiggins said.

"But then these jokers think that we don't need this radiation. I've had my radiation, my tumour's been removed, I'm cancer-free. But there's a lot of other people still going for this treatment."

Mr Wiggins said he stopped adding up how much he was paying out-of-pocket on travel and medical bills because "it was upsetting me", but said the figure was in the thousands.

Meanwhile, over on the Limestone Coast in South Australia - another location listed in the Morrison government's announcement - the current state government was commissioning a feasibility study into radiation services for the area.

In Clarence Valley, a portion of the federal grant funding has been allocated to replace an existing radiation machine at Lismore Base Hospital, around two hours' drive away, according to the Northern NSW Local Health District. A spokesperson said the NSW government was considering whether to include radiation therapy services at Grafton Hospital.

As for the remaining 108 CHHP and associated projects, Mr Butler said the department was "running the ruler over the remaining projects that have stalled to ensure that Australians get value for money".

Shadow health minister Anne Ruston noted "the Albanese Labor government's continued to use the grant program to support health services across the country", saying she hoped the government would work with states and governments to further existing projects.

"While project commencement and completion is progressing, I hope the federal government will urge the state Labor governments in WA and Victoria to commit to advancing Commonwealth projects for eating disorders and disability support," she said.

In the case of Tasmania, ACM understands the state health department has entered into a contract with a private radiology network to provide bulk-billing diagnostic mammography services to some patients, while it works on a long-term solution.

But Ms Bain was worried about what the wait for services has meant for other cancer patients, who may have had to wait for a scan, or may not have been able to afford one in the first place.

"This is people's lives," she said.

"And cancer does not wait for anyone. It does not wait."