Former clinical director: hospital plan was only adequate, so where are we now?

Martyn Fields
Martyn Fields
Former Dunedin Hospital ear nose and throat department clinical director Martyn Fields was part of the early discussion about the size and scope of the new Dunedin hospital. He has now written to the Otago Daily Times in despair at the direction in which the project is heading.

During my time as the ENT clinical director in the Southern District Health Board, I spent many hours in meetings related to the clinical needs and design of the new Dunedin hospital.

I sat through three major reviews of services and watched with frustration and dismay as the proposed footprint shrank from the "minimum" 135,000sq m recommended down to 110,000, then 96,000 and finally 83,000sq m to fit in with the budget and so-called "right sizing" of the build.

Presumably, the latest version has an even smaller footprint.

Each group of designers/consultants etc. were experts on "positive spin", and I am disappointed to see [local advisory committee chairman] Pete Hodgson continuing this process when all the clinical advice is against these and further reductions.

The latest "value management exercise" appears to be the new way to avoid using the words "cuts" or "reduction".

I am no longer directly involved but know of no clinicians happy with the proposed hospital size/plans (even before these latest cuts).

Several years ago the 135,000sq m plans were barely acceptable, considering an ageing population, projected future needs and Central Otago growth. I have never heard of any hospital built anywhere that was later found to be bigger than required.

This is to be a major teaching hospital and needs the space to have medical, nursing and allied healthcare training occur, as well as to provide appropriate healthcare to the regional population. There is a growing world shortage of healthcare workers and we need to have the facilities to train our own. To do away with the "non clinical facility" does not make sense financially or clinically.

Have we learned nothing from Covid-19 and the Christchurch earthquakes? We need buildings that can cope with a future pandemic and environmental disasters and be able to continue to function.

Downsizing should be rejected at all levels and the previous (barely adequate) design be reinstated.

Cutting non-clinical workspaces is misleading — for example, these areas are used to check results, look at scans, dictation/phoning patients and GPs with results, telemedicine, reviewing trainee performance, teaching etc.

About 30% of a clinician’s time is spent in this sort of work and it is essential rather than optional.

By the time the building has been completed a PET scanner and third MRI scanner will be essential to have any chance of providing an adequate service. Current demand for scanning is only being met at present by using the private sector.

In the current economic climate (we all know that the final build costs will be considerably more than the planned budget and the build will take much longer that planned — just look at the Christchurch experience), why compromise the healthcare in the region for future generations?

They will be paying for it, so the least that can be done is to provide them with a building fit for purpose.

It won’t be long before I move from being a provider to a recipient of healthcare, so it is still in my interest to fight for what Otago/Southland needs for adequate healthcare in the future.

I note [Health Minister Dr] Ayesha Verrall visited Dunedin recently and spoke to the mayor and a few others. It doesn’t appear that she spoke to any clinicians.

Perhaps she could visit again and spend a few hours with the clinical directors to hear what the frontline staff concerns and solutions are. I would be happy to provide the ENT surgery perspective.