National’s Hospital Rebuild Commitment Lacks Rigour

Wednesday, 9 September 2020, 6:32 pm
Article: Ian Powell

On the election hustings in Hastings current National Party leader Judith Collins committed a National led government to investing between $400 to $500 million in a much needed upgrade to Hawke’s Bay Hospital.

The focus would be on the main building and emergency department plus the shocking state of air conditioning forcing staff to resort to consume ice blocks during hot summer days. Collins has decreed that, if she comes prime minister, design and development work would commence next year and the “diggers would be on site in 2025.”

Sounds good but!

This sounds great. Decisive. No argument about the need. But let’s step back a bit. There is no question that Hawke’s Bay Hospital requires a major upgrade. But is it greater than the business case for the building of 2 tower blocks at Christchurch Hospital (the first hospital rebuild business case deliberated on since the 2010 earthquake) that was slashed by two-thirds by the Capital Investment Committee, the central government agency responsible for advising cabinet on major capital works? Would reversing this horrendous decision be given the same or greater priority as Hawke’s Bay Hospital?

If, as anticipated, the bureaucratic hatchet is allowed to similarly slash the business case for the massive rebuild of badly rundown Dunedin Hospital, would retrieving this situation have at least the same priority? Where would other desperately needed hospital upgrades in cities such as Whangarei, Palmerston North, Nelson and Invercargill rank?

The Labour led government’s handling of hospital rebuilds has been poor. Although not a justified excuse for this performance, it is dealing with nearly a decade of shocking neglect of hospital upgrades and delayed maintenance due to the accumulative impact of underfunding by the cabinet that Judith Collins was a senior member of throughout. The one thing the Labour led government has done well was been to halt the former National-led government’s promotion of Public Private Partnerships which would have negatively affected design and been much more costly for DHBs.

Address systemic causes

The National Party would have been better to have focussed on the systemic underlying causes of the rebuild crisis in New Zealand’s public hospitals. I have written on this in greater detail elsewhere.

In essence, expensive hospital upgrades become even more expensive because of short-term decision-making based on a narrow conceptual lens. Public hospitals are upgraded for the short-term, not the long-term. It means that hospitals invariably lack sufficient capacity such as bed numbers at the time they are upgraded. This is the case for the most recent rebuild – the much delayed (and still yet to be opened) acute services block known as Hagley in Christchurch). To cap it off, upgrades have to be upgraded much earlier than they should be.

How financially wasteful is this? DHBs can’t be blamed for this scandal. Major capital works are managed by the Ministry of Health.

National (as well as Labour and other political parties) should commit to addressing this crisis. Public hospital upgrades should be based on strong epidemiological and clinical expertise. These rebuilds should be environmentally sustainable and have sufficient capacity to meet known and anticipated patient needs (including unmet need) for the long-term rather than the short-term.

In the context of the anticipated Covid-19 recession at least, this approach offers much for both the health and wellbeing of New Zealanders and the country’s economic recovery.

After all, what could be more ‘shovel ready’ and job rich as well as a better public good than hospital design and construction.

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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