Questions remain on hospital capacity

Almost four months after the announcement of the coalition government’s decision on the inpatient building for Dunedin hospital, the make-up of the beds has been released.

But, while it is good to finally receive this information, it does not seem an occasion for a universal hooray.

The government says it has moved from 20 different approaches to planning under the previous district health board system to one designed for consistency across the country.

We are told applying the new modelling has resulted in about the same number of beds but a change in the mix of bed types required.

The brief preamble to the 10-page document containing the capacity comparison tables of the existing hospital, the detailed business case for the new hospital, and the new hospital on opening, specifically mentions decreased intensive care unit beds.

There is no detailed information in the document to help us form an opinion about how rigorous the thinking behind the universal approach is and how practically it is expected to work.

It seems like a continuation of the "we are from Wellington, and we are here to help" approach to communication around the Dunedin hospital rebuild we have come to expect from the current government.

For instance, it is hard to grasp how an increase in acute and elective operating theatres from the existing 10 to 12 will only involve more than a demand for an extra four resourced ICU and surgical high dependency unit beds on opening. Sixteen such beds are resourced at the moment, although the existing hospital has the capacity for 22.

The document also confirmed the cut we had already exposed to the beds allocated for the mental health for older people from the business case number of 21 down to eight on opening, bizarrely one fewer than the existing resourced beds (although the current hospital has a built capacity for 12).

We are told the new model of care places greater emphasis on community-based care for long-term patients and focuses inpatient services at the new hospital on acute mental health needs.

This would truly be marvellous if anyone had any confidence in a mere six years there will be enough community care available which is well-resourced, well-staffed and safe.

Is there any evidence this is happening?

Health NZ has released the breakdown in bed numbers for the new Dunedin Hospital. Image supplied
Health NZ has released the breakdown in bed numbers for the new Dunedin Hospital. Image: supplied
It seems unbelievable from a staffing position alone when the wages in the community care sector are lagging well behind those in Health New Zealand Te Whatu Ora.

The government’s pay equity slash and burn legislation will only prolong the agony for those community organisations already struggling to find staff.

Similarly, the move to cut rehabilitation beds from the existing 24 to 16 when the hospital opens is also relying on "enhanced care in the community including ‘hospital in the home"’.

The final detailed business case set the number of rehabilitation beds at 40.

We note the number of endoscopy rooms is down from the three existing to two on opening, compared with the four in the final business case.

Given the difficulty people in the South have had with access to publicly funded colonoscopies in recent years, this seems shortsighted.

Clinical Transformation Group chairwoman Dr Sheila Barnett has been measured in her comments about the changes, saying the group was comfortable with the build because the floor area of the hospital was not changed.

The areas indicated for the fit-out on opening aligned with the new modelling and the budget.

But, as she pointed out, as time went on, including before the opening, and the need became clearer, more areas could be fitted out.

That, of course, would require more money.

The real risk with all this is that the hospital will be built with many empty spaces which over time will end up being used for storage because there is no proper process to align funding with need.

As well as the uncertainty around the adequacy of the new hospital on opening, there are still concerns about the contracting process and how realistic the government’s fixed price expectations are.

The government has talked up its building infrastructure ability, but as the Dunedin hospital rebuild illustrates, the reality has a long way to go to match the rhetoric.