Specialist Disappointed Older People Being Let Down Over Dunedin Hospital Revamp

Checkpoint

The
government is being unrealistic and ignoring the needs of an
ageing population, an associate professor of psychiatry
says.

Dr Yoram Barak – also a consultant
psycho-geriatrician at Dunedin Hospital – said the
government’s revised plan for the city’s replacement
hospital is wishful thinking on its part because there was
no way to wave a magic wand and make the growing health
needs of older people disappear.

Health Minister
Simeon Brown says the revised plan announced on Friday will
deliver the project within budget, and it has also been
future-proofed to allow for growth in the region.

The
rebuild was paused last year after a report estimated costs
could climb to $3 billion; the government’s budget is about
$1.9b.

Today the government confirmed the build will
go ahead at the former Cadbury Factory site.

The new
hospital will open with 351 inpatient beds – 59 fewer than
originally proposed, but with capacity to expand to 404 beds
over time.

There will also be a staged delivery of
more operating theatres and imaging services like Xrays and
MRI although no timeline was given.

Associate
Professor of Psychiatry and consultant psycho-geriatrician
at Dunedin Hospital, Dr Yoram Barak told Checkpoint
he was “leaning heavily” towards disappointment.

Otago
and Southland had populations that were ageing faster than
the rest of the country and both regions were “in dire
straits already” when it came to management of those
suffering from dementia.

While he had no official
confirmation, he believed psycho-geriatric beds had been cut
by 50 percent.

“So yes disappointed.”

On those
grounds the revamped design was an unrealistic decision by
the government, Professor Barak said.

“Cutting down on
older persons’ health is the worst decision possible when
we’re looking ahead into the future.

“The ageing of
the population is not going to go away. You can’t wave a
wand and just wish that Alzheimers disease and other major
mental health challenges for the ageing population will go
away.

“They’re here to stay and they will be
increasing tremendously.”

He said by 2035 the country
would be struggling with a shortage of 12,000 resthome beds
for elderly people with dementia, government data
showed.

If services at the hospital were reduced it
would not be able to deliver them in a safe way for its
community.

Around the world there was a tendency to
ignore the needs of older people and he was frustrated the
New Zealand government seemed to be following the same
pattern.

More than 60 percent of services across GPs,
outpatient clinics, inpatient services and surgery were used
by those aged over 65.

“The government is simply
ignoring that.”

Asked about his confidence in the new
health minister he said he was unhappy with Brown because he
did not believe he was prioritising the needs of elderly
people.

Changes are ‘nuanced’ – Health NZ
manager

The head of infrastructure delivery at Health
New Zealand Blake Lepper said it was an exciting day because
the project now had some certainty.

The hospital would
have many of the key features that had been promised
previously, however, clinical staff had been enlisted to
help determine which features could be dispensed with for
the initial phase.

Lepper told Checkpoint the
details of the changes had been made public but it was
difficult to describe them within an interview.

“A lot
of these changes are quite nuanced and hard to explain in a
building that is 70,000 square metres, 11 storeys, with
dozens of clinical specialities in there. A simple list is
not particularly easy for me to run through.”

He
agreed there would be fewer beds, fewer theatres, and fewer
geriatric mental health beds from what had been originally
proposed.

However, all the “core functionalities of a
modern tertiary hospital are still completely within this
hospital”.

The clinical leadership group had provided
feedback to Health NZ that they were confident it would have
what they needed to work effectively.

“We’ve
absolutely had to make trade-offs and we’ve had really
difficult conversations through this period as we’ve sought
to work within that budget that’s been given
us.”

Asked about timeframes of when some deferred work
might go ahead, such as extra patient beds, he said 351
would be enough at the time the new hospital opened and in
coming years the region would still need to pay for other
health services, including in areas such as Invercargill and
Central Otago.

Lepper refused to say how much it had
cost to have the project stalled for several
months.

The local clinical advisory group for the new
Dunedin Hospital has welcomed the government
announcement.

In a statement they noted the fit-out of
several areas will be staged, and there would be redesign
work to come. Members were confident the new design could
provide safe care, could be adapted in the future, and will
be efficient to run and staff.

Members would work with
the design team to deliver the best possible hospital for
the Southern community.

Mayor Jules Radich said he was
happy as could be expected with the announcement.

It
was pleasing to have confirmation that the build would go
ahead on the former Cadbury’s site as planned, and that the
size of the building remained the same.

“Clearly, we
are not getting all the services and facilities upfront, but
there is clear intention to provide them. So there is clear
intention to build all of the services and facilities that
the region needs. But the critical element for that is
having the full and complete structure.”

Radich said
he was confident demand would not reduce and additional
services would be needed.

‘A promise has been
broken’

Nurses Organisation president Anne Daniels
said she suspected the new plan was purposefully meant to
divide residents.

She said the region was not getting
what it was promised with the 2017 business case for a new
hospital.

“I understand that there is a feeling that
building a shell that would allow us to fulfil that promise
in the long term is something that some people think is a
good idea, but at the end of the day it is a promise that
has been broken. It is not going to be the hospital that we
need right now.”

Daniels said the new hospital would
open with 16 fewer beds than the existing hospital and even
after it was scaled up over time, it would have six beds
less than originally promised.

About 100 protesters
gathered at the site of the announcement, among them medical
student Kate Bryant.

She said the government was
selling the plan as good news, but they had not stuck to
their promises.

“This is a hospital. Isn’t this the
one thing you don’t undercut? This is for the health of the
people. This is one thing you are meant to give as much as
you can. It just shows how much this government doesn’t care
about its people.”

Bryant said she feared people would
die if the region ended up with a sub-standard
facility.

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