Everyone agrees the run-down Dunedin Hospital clinical
services building needs to be replaced or completely
refurbished. But the go-ahead for the project depends on the
Southern District Health Board showing it can afford costs
that go with the price tag. Health reporter Eileen Goodwin
looks at the issues.
As rain lashed at the side of Dunedin Hospital on Good
Friday, a 13-year-old boy with a fractured spine lay there
waiting for surgery.
The boy had suffered an unstable fracture to his thoracic
Along the walls of the operating theatre block, hospital
staff deployed buckets and towels, as the rainwater seeped
inside and on to sterile surgical equipment.
Patient safety was threatened. Surgery would have to wait.
Details of the incident were spelled out in a letter from
anaesthetist Matthew Jenks and orthopaedic surgeon Bruce
Hodgson to chief executive Carole Heatly, released under the
Official Information Act.
The doctors' letter included a photo of the buckets and
towels. No doubt it helped jolt senior management from its
insistence the leaks could be managed and patched.
Commissioned in 1967, the seven-storey clinical services
building needs replacement or major refurbishment, until
which time as little as possible was to have been spent on
it. The April downpour proved a wake-up call, and $1.75
million has been allocated to fix the building's leaks.
The unwelcome and unplanned spending perfectly illustrates
the board's bind, its financial catch-22. Government approval
for funding to rebuild - which could be $200 million or more
- depends on the board showing itself on a path to surplus so
it can afford to service the $20 million a year or so
interest and depreciation.
While there is a sense of inevitability about replacing the
ageing infrastructure, the board, already weary from years of
cost cutting, has to show Wellington it has cut still
Old arguments between Wellington and Dunedin that the South
is chronically underfunded by population-based funding, the
formula used to dole out health dollars, have been dropped
and the board is urging staff that further cuts are essential
to affording a new hospital.
Acting health board chairman Tim Ward told the Otago Daily
Times the board will make cost reductions ''because we're
going to have to - it's as simple as that''. The Invercargill
accountant rejects suggestions the recent drive for yet more
cost cutting is straining the board's relationship with
doctors and nurses, some of whom do not accept cuts should be
the cost of essential infrastructure.
Support from clinical staff will be important in the design
phase of the hospital, and to cope with disruption during
Most crucially, sources have told the ODT there are no
indications rebuilding spells a downgrade of high-level
hospital services in Dunedin. Memories are still strong of up
to 10,000 people marching in Dunedin in 2010 over the
possible loss of neurosurgery, and there is perhaps little
political or bureaucratic enthusiasm for pushing southern
health services to bigger centres such as Christchurch.
The board's finance head, Peter Beirne, during an interview
with the ODT, was reticent about the early planning stage of
the new hospital,
emphasising it is at an early stage. All told, the new
hospital is eight to 10 years away.
Refurbishing the existing building is possible but unlikely -
it would create a huge logistical headache for a working
hospital, and its tall, thin shape is not in keeping with
modern hospital design. It might be refurbished as office
The most likely scenario at present is rebuilding on the
south side of the hospital precinct, adjoining the ward
block. The children's pavilion might be demolished to make
''The fit to the site is an interesting question. That is a
problem with any inner-city site,'' Mr Beirne said.
The new hospital would be short and wide, and only three or
four storeys, Mr Beirne said. Like-for-like replacement of
the building - which housed surgical theatres, the emergency
department, and radiology - is about $200 million (including
equipment). Whether the final amount granted is more or less
remains to be seen.
A short, wide building would reduce parking space, and that
was an issue to be resolved. The construction period of up to
four years would involve major disruption and parking issues.
But first the board has to determine exactly what it needs in
a future involving more older patients with many health
conditions. Long-term management of conditions, rather than
one-off events in people's lives, will feature more. A
planning exercise is being run to look at the whole southern
region, which will include public consultation.
One of the conditions attached to government funding is
looking at the role the private sector can play - and Mercy
Hospital confirmed to the ODT it would be interested in a
bigger role in Dunedin public sector healthcare.
Mercy chief executive Richard Whitney said the private
hospital would await details about the process.
A staunch critic of the health board, senior doctors' union
head Ian Powell says the board neglected to maintain the
building for many years in an ultimately fruitless attempt to
save money. Mr Powell believed rebuilding was now so pressing
it would go ahead regardless of whether the September
election delivered a National-led or Labour-led government.
Until now, there had been some ''not on my watch stuff going
on'', but the need was such that neither regime would be able
to ignore it.
Some ''scapegoating'' of the board was possible in the
process of funding the construction, involving more central
control, he suggested. Mr Powell said a downgrade of
high-level hospital services would ''always be the fear'',
but it was too early to say whether that was a factor. He
argued doctors should be involved in all stages of designing
the new building, and preferably be the project's public face
to explain the issues to the public.
Health Minister Tony Ryall is retiring at the September
election, and was not keen to answer fresh questions about
the issue. His office referred the Otago Daily Times to
previous answers given to the newspaper recently. Then, when
asked about the board's ability to fund rebuilding in the
wake of its now $13.9 million forecast deficit, Mr Ryall said
planning for the project would continue, and the board's
deficit was smaller than when National took office.
Approval from the capital investment committee, part of the
National Health Board, is required for the various stages of
gaining funding approval, before sign-off is needed from two
government ministers. The approval stage alone will take a
couple of years.