The new Dunedin Hospital has cleared all its planning hurdles and in August last year — 18 months after it had been due to be released — Cabinet finally signed off on its detailed business case and boosted its budget to $1.47 billion.
The state of play
Fast-track consent has been granted for the outpatient building, now being built at the north end of the site.
Designs exist for the inpatient building, which will stand on the former Cadbury site, but consent is yet to be applied for as planners and clinicians are still at loggerheads about proposed cuts to that building.
The cost of all building projects are burgeoning due to inflation, shortage of materials and labour, and the ongoing economic shocks being caused by the war in Ukraine, and earlier this year Health Minister Andrew Little asked for a review of the cost of all health infrastructure projects, hence the ongoing value management exercise.
The process has gone on behind closed doors but as it has, several sources have contacted the Otago Daily Times concerned that cost saving measures were too extreme.
Last week a copy of the Te Whatu Ora Health New Zealand Southern (HNZS) response to the value management exercise was leaked to the ODT, a document which shows just how drastically cuts to the inpatient building — which was planned in the detailed business case on the assumption that primary care would handle more cases in the future and the hospital fewer — could be.
On The Table
- Deleting a 24-bed mental health services for older people (MHSOP) inpatient unit, reducing the new hospital size from 410 beds to 386.
The southern response warned that doing so would most likely exacerbate bed block in the emergency department and inpatient units (where those patients would most likely end up), compromise patient and staff safety, and result in "poor outcomes" for patients with psychogeriatric issues.
- Reduce adult medical/surgical inpatient beds by 32, and losing three extra beds from the MHSOP ward deletion.
The southern response was adamantly opposed, warning there would be "critical loss of bed capacity leading to a sustained and high risk of patient harm, significant impacts on planned care and operational failure."
Losing the two wards would mean the new hospital would fail all the expected major benefits and investment objectives in the detailed business case, create public and clinical backlash, and mean with 192 medical-surgical beds it would have fewer of those than the 227 in the current hospital.
- Not build the planned logistics building behind the inpatient building.
The southern response said some associated proposals, such as cutting the number of lifts in the inpatient building, meant this could not be supported unless additional work was done to alleviate the likely inefficiencies that would be caused by having to move "back of house" services into the inpatient building.
- Not build a planned pavilion building, cut collaborative workspaces by 10% and shell one-third of the remainder.
The southern response said the effective 38% cut in workspaces was unacceptable and would also mean staff amenities would need to be reduced: "this scenario would result in a chaotic, dysfunctional and unworkable workspace."
- Cut two operating theatres.
The southern response said this too would change the scope of the detailed business case and would mean Health New Zealand would need to spend millions more on outsourcing procedures: it would be "operationally manageable" in the medium term but be problematic in the long term.
- Not install a PET scanner.
PET scanning is an important new tool in cancer treatment but there is just one scanner in the South Island, in Christchurch, although Pacific Radiology plans to install one in Dunedin.
Southern said that plan might fill a gap but it still strongly supported a scanner being in the new hospital too.
- Reduce on-site pathology services.
Clinicians were scathing of the proposal to cut lab space in the new building from 1300sq m to 180sq m and continue to work from the old hospital: "200sq m is not enough to run any sort of useful service."
- Not build a pharmacy aseptic production unit.
Southern said this proposal was possible but would lead to major inefficiencies and increased operating costs.
- Reduce backup systems and building services.
Southern could not comment until a risk assessment was done but warned the proposals could could cause issues with disaster resilience and inefficiencies relating to future maintenance need.
- Function changes, including moving several planned facilities, not building the planned bridges linking inpatients to outpatients and moving the kitchens.
Some proposed changes were to "permanent and critical" elements of the project and could not be supported; others were manageable but Southern wanted the flexibility to restore some — such as the deleted bridge — in the future, if possible.
What Happens Next?
The HNZ infrastructure committee is still to receive final recommendations from planners, which then have to be agreed by the board and recommended to Mr Little.
The minister has already stressed that if it is proposed that there be any changes to the size and scope of the new hospital that he is to be consulted first.
Sources have told the ODT that the most drastic proposed cuts to the hospital are likely to be rejected, but that cuts or delays of some kind are inevitable: the project is almost certain to run over budget and its planned 2028 opening is expected to be delayed.
However, the longer the process and the more details emerge of how the new Dunedin Hospital could be scaled back, the higher the concern as to whether Dunedin and the wider southern region will get the fit-for-purpose hospital that was promised.
