Call him Tom. He is 61 and drives in from Queanbeyan, New South Wales, because the nearest full emergency department to his home is across the border in Canberra, not in Sydney. One winter Tuesday a chest pain that would not ease put him in the back of an ambulance bound for Canberra Hospital. The crew radioed ahead; on arrival they waited beside their own stretcher in the ambulance bay for the better part of an hour before an emergency nurse formally took his handover, because every treatment space inside was already full. Tom eventually got the cardiac work-up he needed. His ambulance, and its crew, sat idle outside a hospital that had nowhere to put him in the meantime.
Tom is a composite, not a named patient, built from the pattern that the Australian Institute of Health and Welfare's emergency-department data and the ACT's own ambulance-turnaround figures describe. He could as easily have driven in from Yass, Bungendore or Goulburn — towns whose nearest tertiary hospital is Canberra's, not their own state's — because the strain he represents runs through an entire catchment far larger than the territory's resident population of roughly 470,000.
What the government did
Health in the ACT is delivered through Canberra Health Services (CHS), a statutory authority answering to the Barr Labor government's Health and Community Services Directorate, under a parliamentary agreement with the ACT Greens that has run continuously since 2020. Over the past decade the government's central bet has been physical expansion: the Canberra Hospital Expansion Project, budgeted at $500 million and delivered for a final $660 million (approx.), built the nine-storey, 44,000m² Critical Services Building (CSB) — a larger emergency department, a dedicated paediatric emergency area, more operating theatres and more intensive-care beds — which opened in stages from 2023 and was described by the government as the largest health-infrastructure investment since self-government in 1989.
The government also moved to consolidate control of the territory's second public hospital. Under the Health Infrastructure Enabling Act 2023, passed in May 2023, the ACT compulsorily acquired Calvary Public Hospital Bruce from its long-time Catholic operator; CHS took over its operations on 3 July 2023 and renamed it North Canberra Hospital. The takeover was contested, and the compensation dispute that followed was settled only in 2025, with the government paying $65 million (plus interest) on top of $23.2 million already advanced — total transition costs that media reporting has put as high as $164.5 million (approx.).
On workforce and culture, the government's response has been a further external review rather than an internal fix. In August 2025 it commissioned an independent Inquiry into ACT Health System Data, Demand and Processes, chaired by Michael Walsh PSM, which consulted 259 people and examined dozens of earlier reviews and audits before its Final Report was tabled in the Legislative Assembly on 10 June 2026 with 49 recommendations. That inquiry followed an earlier, 2018–19 independent review into workplace culture at ACT public health services, which had made 20 recommendations of its own.
The strongest case
A small jurisdiction carrying a region's hospital load, with genuine gains to show for new investment
The ACT is Australia's smallest self-governing jurisdiction by population, yet it runs the only tertiary-level public hospital network for a functional catchment several times that size. NSW residents accounted for about 17% (25,800 admissions) of hospitalisations at ACT public hospitals in 2023-24, and roughly 29% (approx.) of surgical patients at the territory's public hospitals — people from Queanbeyan, Yass, Goulburn and the Snowy Monaro with no equivalent tertiary alternative on their own side of the border, because NSW has not built comparable acute capacity in the immediate region. Under the cross-border health agreement, NSW reimburses the ACT for treating its residents — a net $97.3 million in the most recent year reconciled (NSW paid the ACT $121.8 million; the ACT paid NSW just $24.5 million for the 4,300 ACT residents treated in NSW hospitals, under 1% of NSW admissions) — but the ACT government has long argued the national pricing formula behind that reimbursement undershoots the true cost of running a full trauma, cardiac, cancer and maternity service for a small population base, since NSW contributes nothing to the capital, equipment and specialist recruitment a full-service hospital requires. Real progress accompanies that real strain: the median ED wait fell from 36 minutes in 2022-23 to 25 minutes in 2023-24, the largest single-year improvement of any state or territory, and the share of patients seen within the clinically recommended time jumped 11 percentage points to 62% over the same period — even as ED presentations rose 7% in 2023-24 and a further 7.4% in 2024-25, among the fastest growth rates in the country. The Critical Services Building delivered exactly the kind of extra capacity a fast-growing catchment needs, and CHS beat its own efficiency-savings target in 2024-25 partly by cutting reliance on costly agency nursing, a sign the government is not simply asking for more money without also trying to spend what it has more carefully.
The evidence
Despite that improvement, ACT emergency care still runs behind the national benchmark on every headline measure the AIHW publishes, and the gap has not closed since the CSB opened. In 2024-25 the average ED wait in the ACT was 25 minutes against a national average of 18 minutes — unchanged from the year before — and 62% of ACT patients were seen within the clinically recommended time against 67% nationally. A February 2025 snapshot showed Canberra Hospital's average wait running at 30 minutes, half again as long as North Canberra Hospital's 20 minutes on the same measure, with the lowest-urgency patients waiting 46 minutes on average (approx.) — a sign the newer capacity has not evened out performance across the territory's own two public EDs, let alone closed the gap with the rest of the country.
Ambulance handover — the metric that turns an ED queue into a shortage of ambulances on the road — has moved the wrong way even as the fleet answers relatively few calls per person. The median ACT ambulance turnaround time, the time a crew is stuck at hospital before it can clear for its next job, was 39.8 minutes in 2024-25, up 12.7% from 35.3 minutes in 2020-21; for the slowest one in ten handovers it stretched to 64.8 minutes, up from 58.9 minutes over the same period. That deterioration came despite the ACT recording the lowest rate of ambulance call-outs per person of any Australian jurisdiction — 116.2 incidents per 1,000 people in 2024-25 — which undercuts any suggestion that Canberra's ambulance strain is simply unusually heavy road-side demand; the bottleneck sits inside the hospital, where beds are not clearing fast enough for crews to hand over and leave.
Canberra Hospital got a bigger emergency department; ACT patients still wait longer to be seen than the national average that includes it.
The critique
The strongest case for the government does not survive contact with three parts of its own record. First, new capital has not translated into matching performance. The CSB added floor space, beds and treatment bays, yet the average ED wait in 2024-25 was identical to the year before, and the seen-on-time rate did not move at all — it plateaued at 62% rather than continuing to close the five-point gap to the national average. That points to a constraint deeper than square metres: patient flow through the wards, discharge planning and staffing rosters behind the ED doors, which is precisely the kind of operational and cultural weakness the 2026 Walsh-chaired review flagged, not a bricks-and-mortar shortfall a new building alone can fix.
Second, the workforce-culture problem is not new and is not resolved. The 2018–19 independent review found troubling levels of bullying and mistrust and made 20 recommendations; a follow-up assessment some years later found only a minority had been fully implemented (approx.). In June 2026 — nearly eight years on — a second independent inquiry again found "persistent cultural challenges," clinicians who lack confidence that raising a safety concern will be acted on rather than held against them, and an over-reliance on "cumbersome" internal quality-assurance committees that restrict information sharing, prompting 49 further recommendations. A health system that needs two external reviews the better part of a decade apart to diagnose the same underlying problem — staff who do not feel safe escalating concerns — has a governance failure that has outlasted several ministers and one entire hospital rebuild.
Third, the government's money management has been erratic rather than merely tight. Health has required supplementary funding beyond its original budget in at least four of the six years to 2024-25 (approx.), even as it now consumes roughly a third of the territory's entire annual budget and needed a further $227 million top-up (approx., 2025) to keep pace with demand. Over the same period, a further $164.5 million (approx.) was consumed settling the compensation dispute from the contested 2023 Calvary acquisition — a fight the government chose to start rather than one forced on it by a court or a federal body, and money that could otherwise have gone toward the ward staffing and bed-flow problems the evidence above points to.
What they got right
Credit belongs in specific places. The 2023-24 fall in median ED wait was the largest single-year improvement of any Australian jurisdiction that year, delivered while presentations kept climbing faster than almost anywhere else in the country. The Critical Services Building was substantially delivered, adding real clinical capacity a growing catchment needed. And commissioning a genuinely independent, externally chaired review of the health system's culture and processes — rather than relying on internal reporting — is a harder scrutiny to invite than to avoid, and this government has now done it twice. The caveat is durability, not sincerity: judged against the 2018–19 baseline, the pattern across two independent reviews is recommendations accepted, only partly implemented, and then rediscovered by the next inquiry.
The risk to the future
A budget that keeps needing top-ups, in a system that keeps needing external reviews to say the same thing twice
The structural pressures on Canberra's hospitals are not shrinking. The NSW border communities that supply roughly a sixth of ACT hospital admissions keep growing, and none of that growth brings ACT capital funding with it — only reimbursement at a national pricing formula the ACT itself argues undershoots the real cost of running a small, full-service tertiary system. Health already absorbs about a third of the territory's own budget and has needed emergency top-ups in most recent years, leaving little room to move if ED presentations keep climbing at the 7%-plus annual rate recorded in 2023-24 and 2024-25, a pace that would roughly double demand within a decade if it persisted unchecked. Layered on that fiscal strain is a workforce risk money alone cannot fix: the June 2026 review found clinicians still lack confidence to escalate safety concerns nearly eight years after the same complaint first triggered an external review, and a health system that cannot secure staff trust internally will struggle to retain staff externally, in a national market where every other jurisdiction is recruiting from the same limited pool of nurses, doctors and paramedics. If the pattern holds — genuine capital investment paired with slow, partial follow-through on culture and governance recommendations — the likely failure mode is not sudden collapse but a slow drift: a rebuilt hospital with newer walls, an unchanged wait-time gap to the rest of the country, and a third independent review in another five to seven years telling Canberra's health workforce what the first two already did.