Cardinal Pell succeeded in a bid to remain in Rome after the inquiry accepted a doctor's report which said he was too sick to return to Australia to testify. The inquiry also decided terminally ill Bishop Ronald Mulkearns should give evidence after the commission starts hearings into child molestation and the clergy’s response to sex abuse allegations in the Ballarat diocese on February 22.

Ballarat clergy abuse survivor Peter Blenkiron called for an end to church’s denial of the past. He said the Catholic Church continued to protect clergy hierarchy, including Cardinal Pell, over the lives of victims and safety of children.

“I don’t want blood...I want healing for people suffering to happen,” Mr Blenkiron said. “I want some good to come from all of this. It’s about making sure the truth comes out and concrete procedures are put in place so we never, ever, have children being raped by organisations that misuse their power and damage people for life."

 Mr Blenkiron said there had to be way out of the darkness for sex abuse survivors left crippled by their abuse.

 “The church needs to stop spending money on denial and protecting their brand,” he said. “It needs to start supporting governments around the world to implement support systems for survivors and procedures to protect our children.”  

He said the support of the wider Ballarat community including schools and current clergy helping with the healing process and the Loud Fence movement kept his “hope afloat.”

“Without it I’d be so despondent,” he said.

Moving Towards Justice president Frank Sheehan said many lost hope the Cardinal would return to face past wrongs before the decision on Monday. 

"Throughout this entire process he (Cardinal Pell) has held himself back on issues related to this whole discussion," Mr Sheehan said. "I think it's questionable what value he will even offer when he does give evidence."

In another blow, a hearing for the Cardinal’s evidence will be held in Sydney and survivors would be forced to travel interstate to attend.

But Mr Sheehan said Cardinal Pell should not be a scapegoat for the church's cover-up of child sexual abuse by clergy.

"He is one piece of the big picture," he said. “The focus needs to remain on changing the existing structure and procedures of the church and ensuring the roll-out of a national redress scheme to help all the people damaged.”

David Ridsdale, victim and nephew of disgraced priest Gerald Ridsdale criticised the lack of transparency surrounding Cardinal Pell’s medical records.

 He said it was deplorable considering the level of scrutiny placed on survivors. 

Mr Ridsdale implored the inquiry to push for the Cardinal to give evidence outside of the Vatican.  “It should be from the Australian embassy or somewhere broadcast quality connection can be guaranteed,” he said. “It must replicate a court setting.”  

Ballarat mayor Des Hudson voiced disappointment Cardinal Pell would not return home to give evidence but he said past abuse had highlighted the community’s profound empathy.

In a written statement from the Vatican, Cardinal Pell expressed concern survivors had faced long delays to hear his evidence. 

"Survivors and the general public deserve a complete response and should not be subjected to further delays,” it read.

“I look forward to showing my continued support for all victims, especially those from my hometown of Ballarat.”

 Details of the testimonies of Bishop Mulkearns and Cardinal Pell will be finalised in the coming weeks.