Beds disappear in major hospital shift

By MARTIN JOHNSTON, health reporter

The biggest upheaval of hospital services in New Zealand history starts tomorrow with the opening of Auckland's new $200 million super-hospital.

Auckland City Hospital - the country's largest public building - will get its first patient as health planners try to cut costs and use more day-care services.

By May, the city's adult acute and inpatient services will be concentrated at the Grafton site in a shift that will deprive central Auckland of 73 hospital beds.

The Auckland District Health Board's four hospitals, on average, have 1062 beds "resourced" and in use this year - although they have space for 1206.

Bed numbers fluctuate daily and seasonally, but the number in use is expected to drop by 7 per cent to an annual average of 989 on completion of the move next May.

Green Lane and Auckland hospitals together are expected to lose 53 beds. National Women's stands to lose 16, and Starship 4.

The deficit-ridden board, which employs about 7000 fulltime-equivalent staff, is also slowly shedding nearly a tenth of these jobs as part of its promise to the Government that the changes will save $40 million annually by next year.

The board says the bed reduction will be offset by more efficient treatment of patients and the shifting of some services to the Waitemata and Counties Manukau health boards.

Included are some acute orthopaedic surgery at North Shore Hospital in return for some elective surgery - but not until next June - and from Monday a special care unit for some of the sick Waitemata newborns now cared for at National Women's.

Another of these neonatal units will be built at Waitakere Hospital, which is also being upgraded to a general hospital with 134 new beds for opening next November.

But some Auckland board staff oppose the bed cut.

The director of orthopaedic trauma, surgeon Bruce Twaddle, said his service was being reduced from 54 beds at Auckland Hospital to 50 at its successor. "If anything, our numbers of patients are going up. We have 70 patients under our care now, so we will start in the new hospital with something like 20 outliers [patients spread around other, non-orthopaedic wards]. It's very disappointing." Mr Twaddle said.

"It means patients aren't getting looked after by orthopaedic-trained staff in an orthopaedic-designed unit. It's not ideal.

"It comes down to a lack of beds in the new hospital to accommodate the population it needs to service ... The restriction of resources that we will continue to face compromises the care we can give to our patients."

Building programme general manager Nigel Murray, defending the bed cut, said all public hospitals had "outlier" patients. The four beds lost from orthopaedics were going to the admissions and planning unit.

A beefed-up, 45-bed unit in the new hospital, it is designed to quickly start assessing and treating certain patients. It is intended to avoid some admissions to wards and help reduce the average length of stay in hospital.

Dr Murray said that despite the bed reduction, he was holding as a "strategic reserve" a whole floor of the existing Auckland Hospital until the regional reshuffle had been fully implemented.

He said efficiencies permitting the bed reduction included reducing overnight stays by increasing the amount of day surgery and, for patients given planned surgery on the day of admission, running blood tests and other checks in advance.

Chief executive Garry Smith said the board would have shed 346 jobs by June. He would not say how many would go later. Much of the reduction was due to natural attrition.