An epidemic of new hospitals

It is the biggest health revamp in the history of Auckland. In the first of two articles, health reporter MARTIN JOHNSTON examines what is happening and why.

Auckland's burgeoning population - now almost 1.2 million - is promised a safer and more efficient health service, courtesy of a $660 million outlay on hospitals.

The explosion of public-hospital building in every part of the region is designed to cope with a ballooning ageing population and its ever-more-complex medical needs.

The population, which was 1,030,300 in June 1996, is growing at 2.5 per cent a year. It is predicted to reach 1.5 million by 2012.

A new 710-bed hospital to be built at Grafton in central Auckland will be the most advanced in New Zealand. Staff in the new facilities will handle highly complex operations, such as the liver transplants now done at Auckland Hospital and the heart transplants performed at Green Lane.

What is planned for central Auckland?


The biggest changes are in central Auckland, where the Auckland District Health Board is spending $423 million.

The board now runs four big hospitals - Auckland, Green Lane, National Women's and the Starship - and a host of smaller clinics and services.

The hospitals are some of New Zealand's largest and most specialised. Green Lane is the pioneering centre for heart surgery and National Women's the country's leading women's hospital.

A new and still unnamed hospital will be built beside Auckland Hospital in Grafton to cater for some of the country's sickest patients, from Siamese twins to people undergoing brain surgery.

Piles are being sunk and the nine-level building is scheduled to be finished in August 2003 and taking patients by October.

What will the new Grafton hospital do?


It will be an acute services hospital - taking emergency cases and people needing treatment which is more specialised or requires longer stays than available at outpatient and day-stay clinics.

It will take virtually all the acute inpatient services - such as lung-disease treatment, cervical-cancer care and kidney transplants - from Green Lane, National Women's and Auckland hospitals.

The children's heart service will go from Green Lane to the Starship.

Grafton is crowded. Where will people park?


Three parking buildings - two at Grafton and one at Green Lane - will be erected. The first Grafton building, for 1000 cars, is almost finished.

What are the plans for Green Lane?

The present hospital at Green Lane will be refurbished and a new building erected alongside it. Together, they will become New Zealand's biggest centre for day-surgery (a growth area with new minimally invasive surgical techniques), outpatient clinics and rehabilitation.

National Women's will be demolished, possibly in 2004. Designed in the 1940s and built in the 1960s, it is run down and out of date. Its wards, some as long a football field, make it daunting for patients and tough for nurses.

The existing Auckland Hospital will be used mainly for administration and support services. Some wards will be mothballed for possible use - if the acute hospital cannot handle winter flu epidemics, for instance.

Why is the Starship being expanded?


The children's hospital, not a decade old, will be linked to the new acute hospital to accommodate the paediatric heart service. Some areas will be refurbished as services are shifted.

Many doctors have complained that the Starship is not getting enough attention in the rebuilding programme. Board officials are discussing these concerns with them.

The Starship will also get a new emergency centre, alongside but separate from the new one for adults which will replace Auckland Hospital's busy and poorly laid-out emergency department.

The Starship was built without an emergency department - the present one was an add-on.

What improvements will the new main hospital have?


All patients will benefit from the improved layout in the acute hospital, which will keep like with like, says Dr Nigel Murray, the board's chief planner.

The cardiac unit, for instance, will have operating theatres, wards and intensive care on one floor. Patients will not have to rattle up and down on their beds in the lifts.

The new theatres will be larger, some by more than 10 sq m. Their air filtration and temperature control will be better, quieter, and cheaper to run.

All patients' bedrooms will have ensuite bathrooms and toilets. The hospital will be configured with single and four-bed rooms, apart from the maternity section, where the aim is to have "as many singles as possible," says Dr Murray, although some doubles will be inevitable.

The Government has decreed that the user-pays Cornwall Suite at National Women's, where women pay for bigger beds and other higher-quality postnatal "hotel" facilities, must end when maternity services shift into the new hospital.

The new hospital will also incorporate labour-saving computer facilities, such as fully electronic patient records, and the planners are considering computerised prescribing, which can reduce potentially fatal errors such as patients receiving the wrong drug because of a doctor's bad handwriting.

As well as rebuilding hospitals, the board has built a $20 million laboratory combining 13 separate labs - the controversial LabPlus, which lost its accreditation in two areas soon after it opened in December.

The Conolly Unit at Grafton for acutely ill psychiatric patients will be replaced.

What are the plans for North and West Auckland?


The Waitemata District Health Board is spending $120 million redeveloping North Shore Hospital, built in 1984, and upgrading Waitakere Hospital to a general hospital.

For Hibiscus Coast outpatients, it will lease from the private Calan Group a new clinic it has agreed to build, to the health board's specifications, at Red Beach.

Waitakere contains a maternity unit, but it also caters for others including the elderly, the mentally ill and outpatients.

By 2004, improvements will include an emergency department, medical and surgical wards, a paediatric assessment unit, a special-care baby unit, and a coronary unit.

North Shore Hospital is having a major redevelopment. Wards are being rejigged and refurbished to take more patients.

Will patients receive more services closer to home?


Yes. The number of inpatient beds at central Auckland hospitals will fall from about 1200 to 1000, partly because some services they provided for North Shore and West Auckland patients are moving to Waitemata.

Waitemata expects its medical and surgical inpatient bed numbers to rise from 540 to 670 by 2004, and annual outpatient visits to increase by 160 per cent.

Services shifting to Waitemata include ear, nose and throat, haematology, cardiology, respiratory and urology. Some others marked to move are ophthalmology, neurology, special-care baby units, paediatrics, orthopaedics, endocrinology and oncology.

Auckland's three health boards and the old Health Funding Authority agreed that all "secondary" or general-hospital services should be provided in patients' home areas.

What are the plans for South Auckland?


Some of the Counties-Manukau District Health Board's $120 million list of redevelopment projects are already complete. One is the Kidz First children's hospital at Middlemore, opened last year.

Middlemore Hospital's new emergency care centre also opened last year. It takes up the ground floor of the $31 million "acute hub," which when finished will also house coronary care and hospital management.

A new adult inpatient building at Middlemore, now under construction, will open this year, replacing wards more than 60 years old.

A new $20 million hospital for non-urgent or "elective" surgery is being built near the Manukau SuperClinic on Great South Rd. Due to be finished in August, it will have four theatres and 40 beds, with a possible expansion next year, depending on the number of operations to be performed. The elective surgery hospital will enable Middlemore to concentrate on acute patients.

Plans include a possible new acute hospital at the Manukau SuperClinic site, but officials are trying to avoid that by integrating hospital and community-based care.

"Integrated care" aims to catch people before they become so sick that they have to be treated as hospital inpatients.

Why change hospitals so radically?


To cope with an ageing and rapidly growing population, to save money, to provide treatment more efficiently and to replace old and unsuitable buildings.

Modern medicine keeps people alive longer. Already, most of Auckland Hospital's patients are over 65. Older patients are more likely to have more than one illness, making them harder to treat - especially if they are in Auckland Hospital for, say, cancer, then develop a heart condition best treated over at Green Lane.

How are the boards paying for it all?


The Auckland board is receiving 40 per cent of its $423 million from the Government and is raising bank loans for the rest.

Waitemata is financing all its $120 million from loans. South Auckland, for its $120 million, has raised loans, used annual surpluses and relied on fundraising.

What savings may be made?


The Auckland board, which spends $580 million a year on healthcare, estimates that its plans will save taxpayers at least $27 million a year in efficiencies by consolidating acute services on one site and outpatients and day surgery on another.

With its hospitals now at two sites, 4000 trips a year are needed to transfer patients.

Since Green Lane and National Women's do not have emergency centres (the one at Green Lane closed more than 10 years ago), some patients are forced to lie, desperately sick, in ambulances as they are shuttled from the Auckland Hospital emergency department to the other hospitals for heart surgery, for instance, or an emergency birth.

Some services will move out of cramped facilities which restrict the number of operations they can do. The eye department, when it moves to Green Lane from an old building at Grafton, will gain a third theatre, allowing it to increase cataract operations using ultrasound techniques.

But won't some operations still be delayed?


Dr Murray says that by separating acute care from day-surgery clinics, the days of patients turning up for elective (not urgently necessary) surgery only to have it postponed, because an emergency case takes precedence, will end.

How many old buildings are going?


National Women's is not the only building destined to be reduced to rubble. The Islington building has already gone from the Grafton site; it will be followed by the Wallace building and others.

The board faced costs of $180 million to bring old and crumbling buildings up to earthquake and safety standards.