New hospital will still provide an incredible health asset

Dr Sheila Barnett, a senior anaesthetic doctor at Dunedin Hospital and  chairwoman of the Clinical Transformation Group, responds to an editorial in the Otago Daily Times last Thursday.

Despite our efforts to provide comprehensive details around the new Dunedin hospital (NDH) build, frustratingly, there is still misinformation. This generates alarm and distracts from key messages. I take this opportunity to reiterate the facts about our new hospital and highlight the work that still needs to be done.

We are now four months down the line from the decision made by ministers that the NDH project must make $90 million of savings (out of a $200 million cost escalation). The decision that money must be saved was not ours to make but we ensured that the full clinical impacts of changes or reductions were clear.

This December 2022 decision endorsed an option called 4.5a. This option was a significant improvement of the first iteration (option 4.2, first proposed in August 2022), due to the Southern team laying out risks in a 67-page clinical and operational impact statement. As a result, several major changes were reversed. These included reinstating a 32-bed ward, including a shell space for the PET scanner, and reinstating 12 of the 24 beds on the mental health services of older people ward (MHSOP).

The design team and clinicians then worked even harder to make the building as efficient as possible, by incorporating what had been housed in the staff pavilion and logistics building, into the main Inpatient Building and, to a lesser extent, relying more on shelled spaces.

This is where the NDH now sits under option 4.5a:

 - There are 410 overnight beds (compared to 367 beds at the current Dunedin Hospital). 22 of these 410 are shelled (the original 10 ICU beds, plus the additional 12 from the savings decision). These, as before, are supplemented by 20 new overnight short stay surgical beds.

 - There are 26 (down from 28) operating, endoscopy and interventional rooms, three of which are shelled (compared to 17 total in the current hospital).

 - Two MRI scanners, now with the third no longer fitted out (compared to two MRI at the current Dunedin Hospital) and one shelled PET-CT (currently none).

 - Retention of the staff/patient bridge between the two buildings but loss of the public connecting bridge with the potential to reinstate later. Keeping the public bridge would have been desirable but is not a clinical necessity.

 - All the staff facilities that were in the pavilion are now in the Inpatient Building, closer to clinical spaces (the loss of the pavilion has been disappointing for clinical staff and was a key feature of the cultural narrative).

 - There is an overall reduction of 6% of collaborative workspace area and further shelling of 1000m2 (around a third) in the Inpatient Building. The 6% is manageable — on replanning we have been able to achieve all meeting rooms, all staff facilities, and 95% of the individual workspaces needed. However, the further shelling of 1000m2 would present unacceptable clinical risk.

 - The space provided for the pathology lab now is significantly smaller than the current facility. Southern Community Labs (the current service provider) provides services to both the hospital and to the community, so there needs to be a thorough review as to whether this space can provide essential hospital laboratory functions and then how the remainder of services will be provided.

Since December, many of our teams have, again, been through redesign with their characteristic humour and good grace. Whilst there are still some areas that need to be resolved, the redesign has been smoother than expected. In some services, the old design is preferred; in others, there has been some gain in function. We also look forward to continuing to work with Aukaha and mana whenua in our ongoing codesign process.

We acknowledge that our community is frustrated and disappointed that the value management process was required. So are we. At this stage of the project however, further design changes (or reverting to the previous design) will only delay construction, delay completion, and add cost.

The design we sit with now, thanks to a huge amount of work from everyone involved, is getting closer to what was agreed in the detailed business case. The NDH will still provide an incredible health asset to the people of the Southern region. The buildings were always intended to be flexible as demand for healthcare services change in the future.

We encourage the community and [Dunedin City] Council to listen to the clinicians most actively involved in the project as we work through the unresolved impacts of the value management decision. If these are resolved, the NDH can, as part of a connected health system, deliver what was promised.

We want the community to understand the gains that have been made, and now focus support for our, and others’ work on the following unresolved risks:

1. A thorough review of the ability to provide essential pathology services within the space provided (350m2) and a clear plan for how and where the remainder of pathology services are to be provided and their integration with the NDH.

2. Development of a national plan for equitable access to PET scanning in New Zealand, correcting the current inequities of access for Southern patients, and how this can be provided in the public system in the future.

3. Regional and national support for undertaking a strategic model of care for mental health services of older people ward (MHSOP). This should ensure a connected and well-resourced service across community and hospital services, with adequate capacity for this growing need.

4. Reinstatement of the shelled MRI.

5. Reinstatement of the shelled 1000m2 collaborative workspace.

6. Due to the loss of two operating theatres from the NDH, there must be support for additional regional operating theatre capacity in the Southern region and Te Wai Pounamu.

7. The NDH should never find itself in this position again: a public commitment that this will be the last significant redesign of the NDH.

 -  Dr Sheila Barnett is a senior anaesthetic doctor at Dunedin Hospital and chairwoman of the Clinical Transformation Group, the clinical advisory group to the new Dunedin hospital. The advisory group has provided clinical oversight since the project began and supports more than 500 clinicians and non-clinical staff through user groups.