The Future of the Catholic Health Care Sector
A speech by Paul McClintock at Catholic Health Australia Conference on 24 August 2022
St Vincent’s Health Australia chair Paul McClintock AO (right) in conversation with former PM John Howard.
What a pleasure to share the podium with the wonderful Sister Clare Nolan RSC, our Sister Maria Cunningham Lifetime Contribution Award winner who we acclaimed last night. Sister Clare was part of the group responsible for bringing me to this topic - the future of our sector - and always while Congregational Leader encouraged this journey. So, I feel I have adult supervision today.
Some decades ago I had my first day at a real job, article clerk to a prominent liquor licensing lawyer. I inherited for a year the desk outside his office, full of files on the layout of bars and restaurants. I was not sure this is what called me to the law, when to my delight I found a fascinating file in my bottom drawer on industrial property, much more in line with my new found standing. I shared my excitement with the desk’s predecessor, who, horrified, told me that this was the case that never should be opened – my sole task was to hand it on untouched to my successor. That I did, quite well – I had discovered my first gorilla on my first day, not in the room in this instance but in a drawer.
Over subsequent years I have noticed many such gorillas, normally sitting quietly, sometimes benign, sometimes menacing. But always asking for an answer to a tough question. I believe many in this room will recognize the topic of this address is our shared gorilla, waiting in the same spot where we inherited it, but perhaps beginning to look hungry. So, is this the time to approach it, and how can we do so without the risk of being crushed?
These remarks detail the journey of SVHA asking those questions, but forgive me if I need to start with my own personal journey to put them in context. Three years ago, at the Mary Aikenhead Conference, I shared my response to the challenge from Fr David Ranson a year earlier that all of us in positions of responsibility in the various ministries had become, by those positions, leaders of the Church. In my remarks, titled “A Church Leader – Surely not I Lord?” I admitted that I had happily and comfortably seen the Church’s leadership more in terms of structures and hierarchies, not in terms of Vatican II’s definition of the church as the people of God. I acknowledged there were many good reasons to reject, or at least avoid, this leadership burden, and to stay in the apparently safe seats at the back of the hall, watching with a critical, or even cynical, eye.
But by then I had come to the conclusion that David Ranson was right, and that my performance in this ministry had to be judged primarily in terms of this wider role, a concept well outside my comfort zone and experience. I acknowledge those of you who have come to this insight years ago, but you will know, as Fr Ranson knew, that once you fully embrace this leadership everything changes quite radically.
In particular I concluded that “we must master the art of humbly acknowledging our failures, continuing to debate robustly areas where change may be required, and defending the inspired work we do and the truly amazing people – including our clergy and religious – who do it. You may say it is impossible to do all three together – I would say that none have any chance without the other two. …If we do not do much better at this we will stumble out of our decades of introspection and find by then no one else cares.”
A year later I responded to the challenge of St Aloysius’ Headmaster Mark Tannock in the College’s Campion Lecture who put to me that the call to church leadership required too great a leap for his young leaders. I suspect that this address is remembered, if at all, by the interplay of three ships – the Titanic, the Californian and the Carpathia, but it was designed to put to that audience that leadership of the Church was being shared by all of them too, and it was worth doing. By arguing that we should all be on the Carpathia – the hero ship that at real risk steamed through those dangerous waters at night and saved 710 people in the lifeboats, and not on the Californian that was closer, saw the distress flares, did nothing and saved no-one, it was also a call to action.
Now why I would trawl back through this personal journey with you today, even very briefly, and the reason is that I wanted to share a program that the Board of SVHA has embarked on to reimagine our organization, and Catholic Healthcare generally, through the prism of our duty as leaders of the Church. We devoted much of the spiritual formation in the Board’s program for the last 18 months to this process of discernment, asking whether our own vision, and our deepest hopes and aspirations for our extraordinary ministry, reflect our prime purpose to witness Christ’s healing presence and the power of the Spirit in our contemporary society. We also invited the Trustees of Mary Aikenhead Ministries to join us in this journey, knowing their key role in any decisions and the impact it could have on their task, and in spite of Covid’s best efforts we have sought to travel together.
You may ask why St Vincent’s put so much emphasis on redefining our mission in terms of Church leadership, particularly in the middle of a pandemic. There were two drivers – the first being what is happening in the Church where we share this leadership.
There can be no doubt that the Church we lead is in crisis, even if the part for which we are directly responsible appears less challenged. The privileged position we in the Church have held since early days is under great challenge, partly through the failures of the current structures and partly through the collapse in trust of all institutions and the associated secularization of western societies. That secularization is increasingly malignant, strident and well resourced – and aided by Australia’s decline in Christian affiliation over the past 25 years from 80% to 44%. The Plenary Council is a sign of that crisis and of the difficulty of the response. The relationship between the Church and the state is being renegotiated, and we come to that in a place of real weakness, in spite of our belief that our Church remains one of the most powerful forces for good in contemporary society. That is the Church context we need to understand as we seek to thrive and grow our role in society and to nurture our particular ministries.
If we are tempted to be complacent as the current focus is not on us in health and aged care, think about the limited influence we have had in institutional conscientious objection in assisted dying, or the limited success we have had in keeping our position relatively steady in the area of public health, where new opportunities rely upon community support. There is no lack of signs that the strong position of the Church which has defended our role and helped us to grow, is significantly diminished. Or even look at ministries in places like Ireland and Canada.
If the first basis of this emphasis is the current position of the Church, the second is the growing awareness amongst us all that our business models are challenged by the changes in the expectations of the health and aged care systems, and the doubt that even the largest players are well equipped to ensure sustainable growth through these changes.
This awareness was heightened for us at St Vincent’s by our most recent strategic planning refresh which I suspect came up with similar conclusions about the changed environment that flowed from the same work going on in all your organizations. In particular we saw that none of our three businesses – public health, private health and aged care – were at the scale where we could confidently impact on our environment to ensure the sustainability of any of them. None were in difficulty, but none were at scale. And then we factored in the capital demands of remaining at the forefront of each of those activities, maintaining relevance to the communities we serve, providing some confidence that we could grow through these barriers and at least maintain our relative position. The strategy concluded that we needed change well beyond the reach of our current structure.
And there sits our hairy friend, at the intersection of a Church in crisis and a sector facing profound dynamic challenge.
Now the joy of becoming a chair of a CHA member is that you get a sense very early that this concern about scale and structure is a commonly held view – it gets raised with you pretty quickly. So once our strategic thinking confirmed that this was a discussion our long-term future demanded we shifted our formation program to ask – through a structured discernment – how would we define the goals we sought from any change. We asked Dr Christiaan Jacobs-Vandegeer and Dr Maeve Heaney from the ACU to help us through the process and we knew we had to start with the question of whether we were approaching our future and any possible discussions with our sector colleagues as leaders of St Vincent’s Health, seeking to ensure that its interests were protected, or as leaders of the Church with the much broader shared brief. That may seem easy and obvious, but it isn’t – we all have built in experience of dealing with such structural issues and applying that approach to this task did not seem promising.
After collating the expectations of each director for the journey, our next session was around the promise – to whom are we promised, what have we promised, and how do we ensure we are trustworthy holders of the promise? I thought it was a strange place to start, but not so – it is a familiar challenge to all of us who govern activities for others. It certainly is now front and center for all corporate directors, as we grapple with many promises and expectations. Church leadership is even more complex – is our promise to the Trustees, or the Congregation, or the Foundress and her charism, or our society, our patients and residents, our own people – or all of the above? Can they all be incorporated under our promise to the Church as the people of God?
Another highlight was our discernment with Archbishop Coleridge on the state of the Church, and what leadership he thought we could provide in such an environment. His challenge was what can we do to ensure our society sees the Church as something more than an old, weary, wounded institution? In setting that challenge he also endorsed the Vatican II view of the Church, and our leadership role – the power of a loving Spirit of God alive in our community cannot be achieved by clerical leadership alone. Some responsibility and hope clearly has to sit elsewhere.
Later in the year we had a beautiful session on charism, a specific calling, recognized by the Church and approved as authentic. We all have them and they are cherished – for the Sisters of Charity it is focused on our service to the poor. We all understood the importance of identifying how to nourish these charisms, as we knew that any discussion around structure must find its true compass from our spiritual heritage and charisms.
Finally, we looked at the central role of the Spirit as the presence of God in our world today, the manifestation of his love and what brings Christ’s healing presence to reality. Our discernment throws up many complex promises and goals, but none more powerful than witnessing to the presence of the Spirit as a vital pillar supporting what is best in our wonderful Australian society.
Clearly this journey does not replace the promise of achieving and sustaining excellence in health and aged care – that remains the essential base – but it enriches the promise at the second level of our promise to the Church as the people of God in this cultural moment, and then ultimately to a third level of our promise to our whole community and beyond. It builds on excellence in the task we have been given – we all understand that we are not effective leaders of anything if we neglect our own ministries.
This may seem a leisurely timetable for preparing an approach to this question – gorilla or not – and it is true that Covid may have prolonged the effort. But we are now ready with our Trustees to look at different structures and test them against our responsibility as leaders of the Church, trying to see if the power of the Spirit will be released by change, whether the healing power of Jesus will be more clearly understood and respected by our community if we all carry out our ministries in a different way. If the answer is yes then the call to action is unavoidable – if no then all the synergies in the financial model may not justify the effort.
It may seem strange that I argue this is urgent, and then say we have put aside more than a year to discern the mission definition against which we will judge our alternatives, and the promise we will take into the process. But I think that is classic Catholic discernment – a sense of urgency but not rushed. The discernment does have a purpose, however, as it drives how we move forward in two profound ways.
Firstly, if we all approach these issues representing our different entities it will lead us to fairly conventional merger discussions which will over time, in a rather random way, put like-minded entities together. It will be a process of the kind we are used to, cutting deals and making compromises. It is an entirely practical way forward.
But if we approach the questions jointly as leaders of the Church, then we start from a very different base – we are already merged, we always have been, as part of a single unified Church. If so most of the separate agendas can be put aside and those taking part have a single role of discerning and deciding what structure best meets our shared mission, and then our other obligations. It is a very different process and could avoid the sense of obligation to fight battles on behalf of structures that no longer exist, and to win victories along the way that will be quite pointless.
I stress again, however, that coming from the perspective of Church leadership does not compete with health services leadership, and no discernment on mission will be complete without considering all the strategic health challenges I listed earlier in these remarks. But the focus is broader, and different.
Secondly, if the task is really one of joint discernment on how to respond vitally to the power of the Spirit, then doing it one by one makes little sense – if we have a single task of deciding what Catholic health and aged care should look like on the basis of its core mission, then that discernment should be better done by us all - together.
That does not mean, of course, that any conclusion would commit all those involved to some action – that is a different question. Nor does it assume that such a process would call for any change at all – it may decide that our structures, the product of our remarkable history, are fortunately ideally placed for the next few decades. For my part I would be somewhat relieved if that is where we reached, as long as we all agree it is our refreshed vision and not just the default option!
Before we committed all our formation resources over a year to this journey we needed to answer two practical questions, and I would like to finish my remarks dealing with both of them. Firstly, is there any chance that the conditions that are required for change exist – is there some prospect that if we call for change can it happen? Secondly, are we confident that a different structure might give us the opportunity to do anything inspirational and new with our mission that might justify the effort?
On the first question, whenever significant change is contemplated the immediate and most powerful barrier is always “This seems too hard”. The Church has refined this pessimism to an exquisite degree. So, we need to face it openly, and ask whether we have a chance to make significant change to our structure if we decided that our mission, and our business, would benefit profoundly?
Can we hope to put aside the decades of competition, rivalry amongst services and even charisms, and come to this process as equal players with a common purpose? Can we leave our loyalties at the door, and work as leaders of a single Church? My sense is that the answer until a few years ago might be “courageous” in its’ Sir Humphry meaning, with all the history of the different religious orders who founded our ministries too strong to share the space with a general promise to Christ at the heart of the Church as a whole. But the balance has changed, and these ministries are now given to us to reenvisage their futures and their roles. If there are barriers which cannot be overcome, they will be found here in this place, in this room. And for my part I have not met one leader since getting involved with CHA who I would not feel privileged to walk with on such a journey – as Sister Clare and her fellow Sisters have made clear we are given this responsibility not to preserve the ministries, but to nurture and nourish – and if called by the Spirit, to reinterpret.
Another way of posing this question is to ask why start now – surely it would be better to wait for a crisis so that the need for action would be obvious? But that is the only advantage – discerning the path to deliver our mission most powerfully can best be done when the parties have real options, coming from strength and mutual respect. I personally wonder whether now may be the last opportunity to have such equal discernment.
The second question is whether there is any evidence that there are sunlit uplands worthy of the effort – how confident are we that doing things differently might impact on how well we lead the Church?
Whilst the answer to that question lies in the discernment I am suggesting, you can identify the importance of scale. Our sector has revenues of over $8 billion, 27% market share in private hospitals, 62 hospitals across all states, 80,000 workers and operates over 12,000 beds. If our aged care providers are included it would be one of the largest in the country in both residential and home-based care and its’ annual procurement spend would be around $1 billion. So, it has scale – a lot of scale.
Scale has financial benefits, which would be identified in any review done by our managements as part of this discernment, but the focus of these remarks is more on how it can strengthen the mission we have defined, above and beyond those benefits. Some of the areas to which we could see that strength applied would include:
Advocacy for systemic changes to the health system to ensure it can use emerging technology to provide a seamless patient centered experience
Ensuring that the poor and marginalized are at the center of any reform, including building from the determinants of health
National leadership of ESG in health care, responding to the call of Laudate Si.
National leadership in combatting modern slavery, giving a solid base to the great start ACAN has made
National leader in reconciliation, caring for and employing our indigenous community
National leadership in palliative care
Global best practice in technology, integration across all areas of care, excellence in research and its rapid application
Leverage of other Church entities, especially in education, to ensure the best future workforce
The list has a Mikado feel – it is as long as you want to make it and nothing will be missed – from a starting point of generating adequate funds to survive, through to witnessing powerfully to the value of faith-based community services. Our aim is to be a recognized beacon for the Church’s impact on society, and move the perception of the community where CHA’s latest research showed that only 30% knew the Church was involved in public health.
This analysis seeks to show only one thing – a change in structure will profoundly change capability. I stress, however, that different does not mean better, and that is where discernment from this point should lie. I could give a glowing report on how a new structure would emerge as a powerful new voice for the Church and the healing power of Jesus, meeting all Archbishop Coleridge’s aspirations, but equally I could denounce it as a cumbersome and bureaucratic nightmare that has squeezed the spark out of the original charisms of the component parts. Both versions are possible, particularly if we approach the issue from the wrong perspective, but prayerful discernment, listening to the Spirit, should lead us to the better path.
Knowing I was going to put this invitation to you today you can imagine the joy of listening to Archbishop Costelloe yesterday at the first day of our Conference. His hope for a Church after the Plenary Council that listens, acts together, walks as disciples, seeks the synodal path to evangelization and seeking to read the signs of the times in light of the Gospel. Such a powerful call to action for us all.
Let me conclude by going back to my opening remarks – we have all found ourselves as leaders of the Church during an extraordinary time, for the Church and for our ministries. Discerning how we can all play the most powerful role requires wisdom and courage – and I suspect some persistence. It also requires balance, to be open to the Spirit but also able to identity early the outcomes – perhaps the charisms or brands – that must be defended and preserved.
My purpose today is to give you an insight into our program, and provide transparency to what we will do next. But it is more than that – it is an invitation to join us and help shape the next part of the journey together, with the only conditions that we all do it as leaders of the Church, and we focus first on what will ensure our witness to the power of the Spirit, and the healing power of Jesus, is the defining charism of the future of these ministries.
Thank you.
Paul McClintock
Director, Catholic Health Australia
Chair, St Vincent’s health Australia
