How big should the new Dunedin hospital be?

A drilling rig operates in Cumberland St outside the former Cadbury factory. PHOTO: GERARD O'BRIEN
A drilling rig operates in Cumberland St outside the former Cadbury factory. PHOTO: GERARD O'BRIEN
The overall shape of the new Dunedin hospital is taking shape. In the first of three articles by  Pete Hodgson, chairman of the Southern Partnership Group which is overseeing the construction of the new hospital, he gives an insight into the planning debate and difficulties. Any views expressed are his own.

Pete Hodgson
Pete Hodgson
Dunedin has a small tertiary hospital servicing a small population living in a large area. Should the new Dunedin hospital be much smaller or larger than the one we have at present, and if so why?

Answering that question has taken a couple of years of analysis and debate. Some things are easy to conclude. The most obvious is that we are building a hospital for a 21st century health system. We are not building a shiny 20th century hospital that would be out of date before it opened. It is hard to accurately foretell what our health system might look like 25 or 50 years from now, so that leads to a second conclusion. We must build a hospital that is able to flex as the decades go by, and to expand if and where it needs to.

Society commonly discusses health by assuming that more of the same thing is better. Often that is not the case. People now stay in hospital for shorter periods, or not at all. The days of long-stay pavilion wards or huge psychiatric hospitals are, thankfully, gone. Those trends away from big hospitals continue today, perhaps more subtly. Primary health care is increasingly important, day surgery is more common, outpatient treatment replaces some inpatient treatment, clinicians travel to patients more, telemedicine is arriving, as has Google.

There are also opposite trends. We are living longer, there is an increased burden of chronic disease, medicine can do more, there is a current under-supply of some services in the existing hospital, and social expectations are rising.

In summary, all of those trends and factors add up to a new hospital that will not be a lot bigger. It will not have a lot more beds in total. However, some services must be expanded significantly to meet predicted future needs. Operating theatres, the emergency department [ED] and intensive care [ICU] services are three important examples.

The two buildings being replaced are the current ward block and the current clinical services building. They total about 63,000sqm, and they contain nearly all the services that are being provided in the new hospital. However, if one adds all the buildings where only some services will be replaced, like the current children's pavilion and the Fraser building, the total climbs to nearly 90,000sqm, which is a much closer approximation of the size of the new facility.

The number of operating theatres is set to rise, by 50% or more. Forecasts firmly predict that surgery will achieve more improvements for more people in coming decades. Surgical techniques continue to evolve, so that more operations can be done as day surgery, and more conditions that once required major surgery can now be treated with much less intrusion. The way theatres are used in the course of a day or week may also change.

The emergency department will be a lot bigger, which will come as no surprise to anyone. But just as importantly, it will also be differently run. There will be a large medical assessment and planning unit [MAPU] right next door, not up on the seventh floor as is the case at present. This is effectively the front door of the hospital, where urgent matters should be efficiently sorted out. Many people presenting to ED do not need to be admitted as inpatients. Some need to watched in the MAPU for a few hours, or overnight, to make sure it is safe for them to return home. Some of the other details of the new hospital's front door, such as surgical pre-assessment, are still under active consideration.

The intensive care unit [ICU] will also be a lot bigger. Even though people generally spend less time in hospital, medicine is able to save more lives with good intensive care, and the need for such care is growing for many reasons. For example, there are more open-heart surgery patients than yesteryear, and their recovery typically includes time in ICU or the surgical High Dependency Unit [HDU]. Also, there are more critically ill road accident victims reaching hospital alive these days, thanks to helicopters. The need for more intensive care has been so pressing that the facilities in the existing hospital have recently been expanded, up from just eight beds a year ago. By the time the new hospital opens the number of ICU/HDU beds will be more than three times that.

The new hospital will be able to make much more efficient use of space. Hospitals easily become rabbit warrens and they easily develop countless choke points. With careful attention to design we hope to avoid those pitfalls, which plague the current hospital. Still further efficiencies will become possible by the much greater use of digital technology.

Just how things fit together is the subject of much current debate and refinement. Different services have a reason to be adjacent to one another to improve the patient journey, or for staff convenience, or for improved clinical safety. There are constraints on the building footprint and height, as well as budget constraints. In particular, passionate clinicians can be expected to start from the standpoint of what works for their service and their patients. Those positions then have to be fashioned and forged into a coherent whole, which can be pretty challenging.

The picture becomes clearer as more decisions become settled. For example, about six months ago we were planning three day-surgery theatres. Now it looks like four, and that is unlikely to change further.

There are hundreds of small and large decisions to be taken, some of them many years from now. But the overall picture is taking shape. The new Dunedin hospital will be a small tertiary hospital servicing a small population living in a large land area, just like it always has been.

What is different is that it will be built for tomorrow's health system, not yesterday's.


Who cares how big it is. What services are going to be provided? How many people are going to be forced to go north to get medical care? Work that out and the size of the building flows from there.
And this far into design someone has made the decision on services. How about telling us that. Now.
We don't need 3 articles of waffle and prevarication. Just a few works of the truth.


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