Planning goes ahead on redesign for health services

Planning is going forward for a more compact hospital and more community-based health services in the Whanganui District Health Board region.
Public hospital and health services general manager Brian Walden has led the redesign project, and other staff have had input.
Mr Walden said the total number of hospital beds was likely to drop from 117 now to 109 in the future, but with the addition of six short-stay beds attached to the Emergency Department.
The changes would take several years and the board's preference was for jobs to be shed by not replacing people who left, rather than by making valuable staff redundant. Staff staying on would need to be able to work across a range of areas as needed. Mr Walden said some would relish this but others could dislike it.
The redesign project was needed because facilities were ageing and inconvenient, and also because the Health Ministry was putting pressure on the board to live within its $130 million annual funding.
The project addressed itself to the $50 million spent annually on inpatients, and not to the $15 million spent on mental health or the $12 million-$15 million spent on rest home care.
A report from the board to the ministry, dated October 14, stated "to achieve a breakeven result in 2004-05 would introduce unacceptable consequences in terms of reductions in services, service quality or staffing".
The aim was to run the same range of services, only more cheaply and efficiently.
According to census figures the Whanganui DHB was overfunded, Mr Walden said. The Health Ministry intended to claw this back by reducing inflation funding by 0.5 percent each year.
Another driver of the project was the sprawling layout of the hospital ? its related services needed to be closer together.
An Australian company that specialised in health projects had come up with ways to rearrange it, helped by Wanganui architect Craig Dalgleish.
Mr Walden said there were two or three building/alteration options on the table. They would all be presented to the ministry and the board would say which one it preferred.
At present the preferred option was a $20 million design, in which the 1950s maternity wing would be demolished and a new building added connecting to the two-storey theatre block. The tallest part of the hospital, the 1987 Ward and Administration Block, was a valuable and flexible building. It would be the focal point of any new design.
Earthquake assessment was currently being done. Mr Walden said hospital buildings had higher earthquake standards because they had to not only withstand earthquakes, but continue to function after them.
One proposed improvement for Wanganui Hospital was to move the private Whanganui Accident and Medical Clinic into the Ward Block, and position it near the Emergency Department, an acute unit for short-stay patients and the pharmacy. Another proposal was to have general and orthopaedic surgical patients in one large ward.
Another was to locate units for sick babies, sick children and maternity care close to each other. Mr Walden said these areas could all fluctuate wildly between full and nearly empty and having them close together would enable staff to move from one to another as needed.
Children's wards all over the country had fewer occupants, and Wanganui's was no exception, he said. Children tended to be cared for more at home, and to stay in hospital for less than 24 hours at a time.
However keeping sick babies and children in their own geographic area was important.
About 40 percent of the board's population was rural, with health centres in Raetihi, Taihape and Marton. Mr Walden said the Waimarino Rural Health Centre was progressing toward a one stop shop and no changes to it were planned.
However more services would be added to Marton's Rangitikei Rural Health Centre, in an effort to make patients choose Wanganui services over those of nearby MidCentral District Health Board.
People getting health care outside the region cost the board dearly - it paid $20 million annually for health care from other DHBs. Taihape Rural Health Centre had an annual deficit of $250,000 and was under review. One proposal was to merge it with local rest home Ruanui House, and the review group was getting more confident about the possibility, The resulting facility would have about 30 beds and provide all the services offered by both, but more cheaply and efficiently. Building plans were to be prepared in February. Residents would be consulted if building alterations were found to be affordable.
Mr Walden said most of the district health boards in New Zealand had either had major makeovers in the last three years or were looking for them in the next three years. This was caused by ageing facilities, population growth or decline, and the trend to look after people in the community.