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With political parties, lobby groups, clinicians and patients all stepping into the debate on the state of Dunedin Hospital and the Southern District Health Board, the man in the hot seat is focused on getting the job done.
SDHB chief executive Chris Fleming says having a firm commitment to the Dunedin Hospital rebuild and a rough time-frame from both major political parties means detailed planning can begin.
"The trick will be to make it happen quickly and get it right, and to do that we will need to have a lot of public discussion and debate,'' Mr Fleming said.
"If it [the new hospital] is too big, our community will be facing the cost forever ... if it is too small, we will be gridlocked.''
Both parties seemed committed to a central city approach, but where in the CBD was the "million-dollar question'', he said.
That aside, Mr Fleming expected there would be debate on every aspect of a new hospital, from the number of beds and operating theatres to the size of ED and whether day surgery and in-patient surgery should be separated.
The SDHB was already working on a detailed business case, involving about 70 user groups looking at detailed models of care, he said.
In the coming years, while work continues, improving and maintaining staff morale will be one of Mr Fleming's biggest challenges.
"We still have facilities that are severely impacted by asbestos, severely impacted by a lack of infrastructure investment over many years, bottleneck constraints in theatres, ED pressure and - in the peak of winter - bed pressure.''
To get Dunedin Hospital through the next seven to 10 years, decisions needed to made about how much of the failing infrastructure to fix and how to increase operating theatre capacity.
"We can't just limp through the next decade with the number of theatres we have got.''
Creating theatre capacity could involve a combination of improving Dunedin Hospital theatres, but also of working with private health providers in Otago and Southland to access extra capacity, Mr Fleming said.
It was also important to give the SDHB's clinical council "some real teeth'' and involve health workers in decisions.
"There is never going to be enough money to invest, but we need to have clinical leadership involved in those decisions.''
The SDHB must also continue to work closely with the recently established Community Health Council.
"This is a critical component, because you must involve the community in the tough conversations and the tough decisions."Because, for good or bad - and no matter who is in government - we live with a rationed health system.''
Apart from the Dunedin Hospital rebuild, Mr Fleming said areas of urgent need included improving access to some hospital-based services. These included the urology and ophthalmology services, along with general surgery.
"We are also under-investing in primary mental health,'' he said.
While services were doing "quite well'' with people at the severe and mild extremes of mental illness, those in the middle needed more support.
"That's not good for them or their families and not good for us.''
Also pressing was the need to improve primary community health-care services.
While "every dollar the Government could give me could be invested in hospital-based services'', Mr Fleming said "upstream'' strategies such as encouraging physical activity and prevention were vital.
On average, a patient's visit to a GP cost about $70 in funding, while the average hospital admission cost $5000.
`When you look at it like that, it pays to invest up-front.''
The DHB was developing a strategy and action plan in partnership with the primary health organisation, which would go out for public consultation in November.