New super hospital will mean fewer beds say doctors

By MARTIN JOHNSTON health reporter

The integration of four of the country's leading hospitals will reduce the number of public hospital beds in Auckland City by 7 per cent.

Doctors in charge of orthopaedics and other Auckland District Health Board services are worried the reduction will leave too few beds in the new Auckland City Hospital in Grafton, scheduled to open in October.

But board managers say the reduction will be justified by a new hospital to open next year in West Auckland and increases in the proportion of patients who have day-surgery, which does not require an overnight stay.

They will be treated at the new Greenlane Clinical Centre, part of which will open in October.

General manager of planning Nigel Murray said yesterday it was now intended to have on average, depending on the season, 1002 beds at the City Hospital, incorporating Starship, although the exact number was still being worked out. There was space for 60 to 80 more, but they were not intended to be commissioned yet. They were for future expansion to cope with population growth.

He was also holding a whole floor of the adjacent Auckland Hospital, enough space for 85 beds, as a "strategic reserve", but he did not expect it would be needed. Most of the rest of that building will be used for administration.

There will be 33 operating theatres altogether at Grafton and Greenlane compared with a planned 37. There are 29 at the existing hospitals. Doctors have expressed concerns about the intention not to commission four theatres, but the management says they will be fitted out and opened if needed.

This week, doctors have spoken out against the integration at City Hospital, which is expected to save $40 million a year, claiming it will erode the high-tech services that Green Lane, National Women's, Auckland and Starship Hospitals provide to regional and national patients.

They say the loss of their hospitals' existing names is just the publicly-visible exterior of the power struggle going on for years between staff and managers.

Bruce Twaddle, head of orthopaedic trauma at Auckland Hospital, said planners intended to give his service only 40 to 50 beds at the new City Hospital. It had 54 now at Auckland Hospital but routinely needed 65 to 85 and had to send its patients to other wards.

Similar concerns were held by other specialists about the future of their own services in the City Hospital.

He said orthopaedics was already struggling to treat many patients, who had broken bones, within the timeframes considered appropriate internationally.

Auckland and Middlemore Hospitals are now the region's two acute orthopaedic centres. North Shore Hospital treats virtually no acute orthopaedic patients, concentrating on the elective, non-urgent work, including Auckland Hospital's. But much of the region's work will be divvied up, closer to home for patients, with each of the three hospitals doing both acute and elective surgery.

North Shore says the plan was for it to start doing acute surgery in November next year, when the rebuilt and expanded Waitakere Hospital opens, with 134 extra beds.

Waitemata District Health Board chief executive Dwayne Crombie said yesterday he was "gobsmacked" to learn in the last few weeks that the Auckland board now wants the switch to happen this October.

Mr Twaddle said all three boards were concerned no extra money had been allocated for the major reorganisation required, both for equipment and staff training.

The new City Hospital is nearing completion.

It is the centrepiece of the Auckland board's merging of acute services and its controversial renaming of Starship children's hospital, first as the Children's Services of the new hospital, then as its Starship Children's Department.

The board has also scrapped the names of Green Lane and National Women's Hospitals, calling them Cardiac Services and Women's Services. Auckland Hospital becomes Medical Services and Surgical Services.

Green Lane and National Women's staff, emboldened by Starship's partial success, have resumed the battle to retain their names. They fear the loss of them downgrades their hospitals' status and will make it harder to attract research funding and to recruit and retain top staff.

A National Women's doctor said staff overwhelmingly wanted their service to be known by names such as "National Women's at Grafton"; and "National Women's at Greenlane" for the day-surgery and outpatients component.

Green Lane staff want something similar.

Starship and City Hospital are attached through the children's hospital's new emergency department. This is the first part of the major hospitals rebuilding project - approved by the Government in 1999 - scheduled to open on June 3. (The new laboratory and mortuary opened in 2000 and the new acute mental health unit this year).

The June 3 opening will kick off a gigantic "migration" involving the relocation of 6000 staff and 40,000 pieces of equipment, from chairs to x-ray machines.

Although City Hospital will open in October, its users will move in stages.

Auckland Hospital will be first, in October. Green Lane will move in during November and December, followed next April by National Women's.

At Starship, the expanded intensive care unit and the heart unit which is coming from Green Lane will open in November-December, following by the neurosurgical unit, coming from Auckland Hospital, in January.

The first part of the Greenlane Clinical Centre - which will become New Zealand's biggest centre for day-surgery and outpatient clinics - will open in October this year. The second part, in the Green Lane Hospital building, will be occupied progressively following refurbishment.

Some outpatients have already been scheduled for appointments at the new Greenlane centre.

* Starship is not the only name changing following the amalgamation of Auckland's hospitals. Internationally recognised Green Lane Hospital and National Women's Hospital will also lose their names in the merger. What do you think? Email the Herald News Desk with your views.