“Savings” mean Dunedin’s going to pay

Plans to shave $100 million off the price tag of the $1.4 billion New Dunedin Hospital (NDH) project put the entire project at risk of failure and represent a “broken promise” to the community.

Matt Shand | Journalist

Several months ago people involved in the four-year project to plan the New Dunedin Hospital were told to trim $100 million from the budget. Now a report from Te Whatu Ora Southern has revealed doing so will result in “significant reputational, operational and clinical risk.”

The proposed cuts and changes are known as Option 4.2. A 50-page report written by Te Whatu Ora Southern concluded Option 4.2 had potential risks still yet unidentified.

The report said, “Any change in the size or scope of NDH, and any demand for significant redesign with accompanying consultant costs and demands on clinical staff’s time, will have a widespread negative effect on the reputation and expectations of the NDH project and facility.”

Another passage referenced the proposed changes as a “broken promise” to the community and a reputational risk for the Minister of Health.

Most of the proposed cuts come from clinical services. These include inpatient, surgical and mental health beds, operating theatres, workspaces for doctors, the PET-CT scanner and pathology services.

“Everyone is frustrated,” ASMS Southern Industrial Officer Kris Smith says.

Kris Smith

“Someone receiving cancer treatment will need to be taken from that building, transferred in an ambulance with a nurse alongside them, and brought to radiology for treatment.”

“The delivery of the new hospital has been promised for years. Then there was nothing. Then there were plans and more plans and failed promises.”

Smith says changes to the hospital may save on capital costs but will inflate operational costs, as staff must work around poor design.

“Staff are concerned oncology will not be included in the new building,” she said. “Someone receiving cancer treatment will need to be taken from that building, transferred in an ambulance with a nurse alongside them, and brought to radiology for treatment.

“The costs of doing so, and returning the patient, will balloon out.”

Former elected Southern District Health Board member Dr John Chambers was aware, towards the end of his board tenure, pressure was being put on to make significant savings in the project but understood that efforts would be made to ensure that these did not involve clinical areas.

"Early in the planning process there had already been a process of reducing the number of beds,” he said.

“The reasoning for this was that ‘new models of care’ would develop, shifting elements of secondary care into the primary sector/community. Perhaps basing future calculations on carrying on with ‘business as usual’ could result in oversizing the new hospital."

Dr John Chambers

"To propose making cuts to the clinical area of NDH would surely be false economy and lead to problems of service delivery.”

Chambers considered this approach is not evidencebased and at best wishful thinking.

"To propose making cuts to the clinical area of NDH would surely be false economy and lead to problems of service delivery,” he said.

“It is not surprising that clinical leaders have questioned such a proposal.

"The NDH is not planned to replace all services in 2028. For example, the current cancer treatment facility will not be replaced for another few years which might surprise the public."

"A very current issue is the difficulty of meeting acute demand while continuing to provide elective procedures and surgery in the same building/theatre suite."

Chambers calls for the building of a sperate planed procedure hospital on the Wakari site. It is of note that one of the 101 recommendations (number 100 on the list) of the recent Connolly report on addressing waiting lists was to consider developing separate elective facilities."

Smith says there is real concern the costs involved in attempting to save the $100 million could cost more than the cut savings.

“Those costs will include architect’s fees, workshopping sessions, staff time and changes to construction prices,” Smith said.

“It also creates a loss in terms of the opportunity cost of the previous four years work setting the model of care and design fine tuning from clinical staff. They did all that work and we understand staff were largely happy with the proposal. To have that changed in the last few months seems improper.”

There are concerns Option 4.2 will ‘take the heart’ out of the hospital and the removal of 35 beds will mean the hospital can only cater for acute cases instead of elective cases.

“Patients will likely have their surgeries delayed and will eventually present as an acute when things worsen,” Smith said.

We need to leave the design the way it is and find a way to locate the money. “Any savings will be gone in a few years as operational costs increase.” ASMS shared the report and concerns about the NDH project with Te Whatu Ora CEO Margie Apa

. ASMS executive director Sarah Dalton said the people of Dunedin deserve to have a hospital that is fit for purpose and will serve the needs of the communities, now and into the future.

“Likewise, the doctors and nurses who will work in the new facility deserve the best workplace we can provide. With health resources already stretched thin we need the hospital design to cater to the needs of staff and patients - not work against them.

“There is a real risk the new hospital will not be fit for purpose. I urge Te Whatu Ora to stick with the original plan.”