News
27 October 2023
Letter to The Border Mail:
It is with a great relief that the 2021 Albury Wodonga Health (AWH) Masterplan was finally released. Remember the Masterplan that was drawn up after AWH and the NSW and Victorian state governments committed to building a single site hospital? The Masterplan that the past AWH Chair of the Board, Mr Matt Burke, acknowledged had recommended a greenfield site. The Masterplan that was hidden, with all and sundry claiming it was “commercial in confidence”. The release confirmed what clinicians had long known. It also confirmed that the tale the Premiers told last year that their announcement was made based on the best advice, was just spin.
Its release provided a timely contrast to the mud map on a beer coaster that NSW Health Infrastructure released last week. It is staggering that departments serve up something that raises more questions than answers. The attitude is that we should be grateful. Their response to outrage certainly suggests they are not used to people taking notice. The difference here is that they do not understand that for a regional community, the hospital is at its core. Our people care about the facilities, they care about the people who work in it and the patients it looks after. Everyone has a family or friend who has had to have treatment at AWH, and they know the lengths that staff gone to to provide care. It is a fight worth fighting for. NSW Health have probably not come across a more starved, frustrated, and indignant community who know when they are being sold a pup.
The New Masterplan release came with a few banal statements without any facts. Nothing to shed any light on what we can expect out of the building. Of more concern is what the community is not being told...... It has been acknowledged to clinicians that the Clinical Services Plan- the key document that outlines how many beds and theatres we need to deliver health care for this community- has been slashed, AGAIN. It is astounding that another reduction was made, AFTER a funding announcement, and points out how money was slapped on the table to quell the masses without any consideration of what was really needed. Any reduction in the capacity makes it clear that those in “planning” have no understanding of our current deficits, nor the demand on our service, nor the vast region we serve. Effectively it leaves us planning for what we need now. It is open knowledge that AWH is housing admitted patients in overflow environments, and even then, drastic measures are needed to create capacity as admitted patients sit in emergency department
waiting rooms and surgeries are cancelled. The ability to consistently provide elective surgery is compromised. The elective waiting list for AWH for category three surgeries is now greater than the Alfred Hospital- one of the largest and busiest hospitals in the entire nation.
NSW Health Infrastructure have also told members of the Border Medical Association (BMA) that theatres, already reduced from the planning in 2021, will now have to remain across both Albury and Wodonga campuses. Couple this with the rhetoric from the Victorian Minister and it is clear they have no desire to see through a single site hospital as Mr Andrews promised.
Part of the planning, clinicians have been told, will be to replace the new cardiac catheter lab (which was built with capacity to develop another lab) with a new suite that can only fit one! The long- awaited emergency department will already have to be expanded as it will be too small.... Which makes for little confidence in their ability to plan and future proof services. It’s amazing that these facilities are referenced as the reason to stay on this site, but they are either replacing them or have to grow them further.
There is much to be learnt from the 2021 masterplan released through a freedom of information request (FOI), and from the forensic interrogation the impressive Amanda Cohn gave the NSW Health Minister at budget estimates. The section that confirms the outcome of the planning was that a greenfield was identified as the best approach and was to be the option taken for further planning was buried deep in the document. The brownfield option required to achieve a single site hospital, replace the infrastructure that was identified as parlous and grow the capacity beyond what we need right now, would be a complex staged approach that would drag on- if there was money available. At least that option contained the capacity we need, unlike what we are being served up. It also confirmed the costs of both approaches were largely similar, even accounting for current infrastructure at AWH. The impact on service delivery and the length of time taken were compelling reasons to push for a greenfield.
The other interesting elements that have come out of the FOI are the correspondence from NSW Health, that seemed hell bent on a brownfield development, only two weeks after the end of the planning. Clinicians have long been concerned that there was an invisible hand in the process pushing for a brownfield. Clinicians were told to trust the process but could tell that something was awry. These documents bell the cat. Briefings to the NSW treasurer that recognise the outcome, but that NSW would not build a greenfield hospital in Albury as it would not have “operational control”. Ahem. Surely the author of that brief knew that NSW does not run AWH now, nor will it operate a brownfield hospital. A dopey excuse used to hoodwink the then NSW Treasurer. Pseudo-business cases calling for a brownfield in 2021..... all whilst the Masterplan were being undertaken, as if itwere a foregone conclusion. BMA members were told by AWH in May that there was a business case that led to funding. Surely there was a subsequent business case in 2022 for a greenfield, given the Masterplan result? If not, why would AWH not ask for a greenfield, as its Board preferred? Did NSW
Health act according to political masters, or was the government not briefed in a transparent manner? Even former NSW Premier Gladys Berejiklian had told members of Executive and the then Chair of the Board she was in support of a new hospital prior to the Masterplan being concluded.
The disappointing response from the NSW Health Minister, Mr Ryan Park, when questioned by Dr Cohn indicated he knows there are major issues with the redevelopment. The cry was that he was delivering better services, not a new single site hospital. More pressure is required though to force him to act appropriately.
And what of Albury City Council? The Albury Mayor was a no show at the meeting of regional councils on Wednesday. We would hope that there was a significant engagement that prevented her from attending. If not, it is a fundamental failure of leadership on her behalf. It is a continuation of Albury City’s dismissal of valid concerns, spitting in the faces of those who are calling for help, whilst not seeking answers to the questions many of the local ratepayers are asking.
Clinicians are increasingly fed up. They are tired of the gas-lighting, the patronising way legitimate concerns are dismissed, and they are tired of the duplicitous nature at which this entire process has been handled. What is being developed is not covering off our core issues.
Our health service is stretched beyond capacity, and frequently in crisis. We have not enough beds, theatres and outpatient services to cover off a rapidly growing community. We have seen this crisis coming for well over five years.
The health service needs a single site hospital, given the risks of separating services that creates risks to patient safety and the inefficiencies of running duplicated hospitals.
That the facilities at AWH are dilapidated and not fit for purpose. The recent news regarding the questionable structure is not limited to one ward. There are multiple issues with the building, and from a patient care perspective it is severely limited. However, it needs to be pointed out that the foundations of the entire site were not designed for a long- standing hospital. It was these elements that meant irrespective of site it was agreed- as you heard from the NSW and Victorian Premier in 2022- we needed an entirely new hospital.
To cover off these risks we needed a new single site hospital. And that is what was promised. But here are the concerns with what we are being lumped with:
The community may be being told that the details of the building have not been finalised, but there is enough evidence that the 450 million is only going to deliver enough capacity to cover the massive deficits we have now. Fail point one.
That it is clear that there is a retreat on the promise of a single site hospital. Failed on point two
That the capacity created does not decant the current wards. This means patients are still cared for in antiquated wards. It also limits future opportunities to build on that site. Failed point three.
Those key points mean that there are major concerns that this project will not fulfil our needs and will leave us at the back of the pack when needing more government support. That’s even before we look at the disruption of services as clinical areas are cleared out before the bulldozers come in....
So where to from here? We need:
To plan for a new single site hospital. Except we already have. Let’s get back to the service planning documented in 2021- as in how many beds and theatres etc and have both NSW and Victoria commit to the planning they were involved in.
To get us urgent relief now. We cannot safely care for admitted patients in overflow areas or in an emergency department waiting room. We cannot continue to risk patient care or overwhelm already exhausted staff. We cannot continue to cancel surgery, or cope with only doing the bare minimum elective surgery. Our elective waitlist for category 3 surgeries (joints etc) number higher than the Alfred hospital- one of the biggest hospitals in the nation.
Then Stop and think. For the same relative cost.... Do you build in complicated stages that derail patient journeys over a longer period of time with a constant fight for more money, or do you do it once, do it right, build it on a new site?
As Bill Tilley has previously said, both governments can do the heavy lifting on this- it will be the cheapest hospital they ever build. It is never too late. It was community outrage that saw the governments belatedly act in October last year. Time to let them know that what the dish they have served up has a bitter and sour taste.
Dr Lachie McKeeman
Border Medical Association
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