Dunedin Hospital: facing reality

Dunedin Hospital. Photo from ODT files
Dunedin Hospital. Photo from ODT files
While much of the detail contained in the ``strategic assessment'' of the Dunedin Hospital redevelopment was previously known, seeing the cold hard facts grouped together is confronting.

The report - written by consulting firm Sapere Research Group for the politically appointed Southern Partnership Group - was released last week. It marks a major step towards getting the $300million project off the ground and has been anxiously awaited.

However, those hoping for clarity around timing, size, make-up and location of the rebuild or reassurance around other contentious issues will be disappointed. If anything, the prognosis seems bleaker: no obvious pathway out of the huge deficit, no indication of the rebuild options until next year or the details for a further year after that . . . all delaying the build time.

And yet, what emerges clearly is that time is definitely not on our side.

In fact, the assessment paints a frightening picture of the state of the hospital. It says facilities are ``not just in poor shape but are crumbling'' and this poses a ``clinical, financial and organisational risk'' to the Southern District Health Board, staff and patients.

The most significant building on the Dunedin Hospital campus, the ward block, is viable but needs renovation.

While the dire state of the clinical services building has long been flagged, the children's pavilion, the Fraser building, and the psychiatric services building have all also been listed as ``uneconomic to repair''.

The extent of the problems facing the clinical services building are shocking. The assessment states the building could be forced to close if a ``significant defect'' were to be found, leading to ``significant disruption''.

While no-one can be unaware of the pressures on the hospital and some of the building issues, the report has to be a real wake-up call.

The stark prognosis raises questions. How could a teaching hospital in one of our main centres ever be allowed to get to this state? Is it the result of negligent management and maintenance or of drastic underfunding. Is it a bit of both? Worse, some will inevitably wonder: has the deterioration been part of a greater plan? Are we being set up to fail? Set up at least to being forced to accept compromises and service downgrades?

The assurances to the contrary continue to be made: we will get a brand new hospital, the Government is committed to the region. Yet the language in the assessment holds little comfort.

The document warns not to expect more money for services. Rather, it states the share of funding under the population-based funding formula is likely to reduce. More privatisation is encouraged. The spectre of ``centralisation'' raises its head in comments about links with other ``tertiary service centres''. People are also likely to worry about the mention of the need to consider highly specialised versus generalist medical models.

There are positives. One is undoubtedly what seems to be a better working relationship between the Southern Partnership Group and the University of Otago than some have been led to believe. This, together with an indication the university might contribute to the capital cost of the rebuild, is encouraging and a huge relief.

Nevertheless, Southerners will remain wary. They have been forced to fight to retain various services and have lost others. They often feel - rightly or wrongly - overlooked. The public will not be easily reassured until the details are known.

For the moment all anyone can do is wait. The assessment has been signed off by Health Minister Jonathan Coleman and Finance Minister Bill English. The indicative business case for the redevelopment is due to be released by the middle of next year.

It seems safe to surmise Southerners should use the time to prepare themselves to face a new, harsher healthcare reality.

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