In an email to board members a month before the National Health Board's critical August report on Dunedin Hospital systems chief executive Brian Rousseau (who has now left the board for a position in Australia) described a "very constructive meeting with the NHB".
The four "big-ticket projects" recently discussed by the board - "the gastro unit, acute theatres, ED and the putting-the-patient-first initiatives" - had been discussed.
"The NHB have said that these projects are well aligned with some of their thinking, and can and indeed must proceed, irrespectively of the Annual Plan position."(The board expects to incur a deficit of about $10.4 million this year.)Accordingly, he and chairman Joe Butterfield had given staff "the green light to proceed".
Board member Richard Thomson responded by asking if the funders had been told "or will we find ourselves being blamed for blowing our budget?"
After the report came out, however, the NHB and the Minister of Health, Tony Ryall, made it clear there would be no extra funding and the board must fund any improvements from internal savings. The amounts required have not yet been spelled out.
An email from Mr Rousseau to his executives, written four days after the report's release, shows he planned to provide the board with a report listing the NHB recommendations beside the money required to implement them. That report never eventuated.
However, in the draft of the report he wrote but which was not made public until released under the Official Information Act, Mr Rousseau indicated the extra cost of some of the major projects necessary to meet the NHB recommendations would total about $13.75 million.
This figure was made up of $4.05 million in operating costs and $9.7 million in capital expenditure.
Chief nursing and midwifery officer Leanne Samuel was clearly surprised there would be no additional funding.
In an email to the executive management team four days after the report's release she said there needed to be an urgent communication from the NHB or the ministry about "exactly what we are being expected to do around several major projects". She asked Mr Rousseau if the board was given certainty regarding funding for these things.
"I must say I had assumed so given the board so readily seemed to sign off on the same when there is no work done internally on how we would self-fund these projects?"
Mr Rousseau responded: "Yes, NHB said that additional investment was necessary, however, the minister has now said no, so the official answer is 'no'.
Don't lose hope ... I have a few strategies to address this; will discuss on Friday!"
The meeting referred to was the executive management team's meeting, but the correspondence does not reveal what took place there.
In an email to Mr Rousseau and members of the executive management team chief operating officer (Otago) Vivian Blake said it was disappointing to hear the NHB review leader Jill Lane advise there was no extra funding for the work sought.
"I think there has been a breakdown in communications between the NHB and the minister's office on this."
Referring to the suggestion that all of the changes required could be funded from within, Mrs Blake said there would be "efficiencies gained" but these needed to be "translated into dollars which I seriously doubt will cover the significant transformational change and building development required".
