Hospital’s building woes
News that no major repairs to earthquake damage at Christchurch Hospital have started seven years on reveals the extent of infrastructure poverty in Canterbury’s health system. Cate Broughton reports.
Mouldy walls in Auckland’s Middlemore Hospital drew a collective gasp and a flurry of finger pointing in April, but Canterbury District Health Board (CDHB) members say Christchurch Hospital has far greater problems.
At a monthly board meeting earlier this year, members listened to a sobering presentation about the expected Alpine Fault rupture, likely to cause a magnitude-8 earthquake and widespread damage throughout the South Island.
CDHB member and hospital advisory committee chairman Andy Dickerson said he had trouble sleeping that night.
The presentation underlined long-held concerns by the board about the state of Christchurch Hospital’s buildings – especially the Riverside building, which was recently assessed as ‘‘earthquakeprone’’.
‘‘It is my personal view that Christchurch should be a much greater priority than Middlemore Hospital,’’ Dickerson said.
‘‘Middlemore has done a good job of publicising their problems, but they are probably no greater than any other major hospital in New Zealand and certainly no greater than Christchurch Hospital.’’
Fellow board member Jo Kane said the rest of the country might think Canterbury had ‘‘had it’s fair share’’, but that was ‘‘BS’’.
CDHB chief executive David Meates agreed, saying the the level of capital investment around the South Island had been significantly lower than the North Island over the last 10 years.
A Treasury investment statement in April reported more than 19 per cent of hospital assets were rated ‘‘poor’’ or ‘‘very poor’’. In the Southern region, more than 16 per cent of assets were in ‘‘very poor’’ condition.
Christchurch has had three new buildings commissioned since 2011 – the new Burwood Hospital, which opened in 2016; the Outpatients Clinic, due to open in November; and the acute services building, expected to open in September 2019 – but Meates said the shiny new facilities needed to be seen in context.
The acute services and Burwood Hospital buildings were planned before the quakes to replace the Riverside block at Christchurch Hospital and Princess Margaret Hospital.
The February 2011 earthquake may have sped up the process, but it also created a massive programme of repair work that had to be done, Meates said.
‘‘There is this sense around the country of ‘well, Canterbury has got it’s fair share’ – well there is no other part of the country that has had to deal with the impacts of New Zealand’s largest natural disaster.’’
CDHB member Aaron Keown said it was important to understand the board had not been gifted the buildings by the Government.
‘‘You have to be able to pay it back – health has a capital charge of about 8 per cent.’’
Canterbury’s huge budget deficit – $60 million forecast this year – was testament to the effects of the flurry of building projects. The expected deficit will be upgraded to $74.5m for 2018-19 and climb further to $81.5m for 2019-20.
Worst among Christchurch Hospital’s facilities is the 1960s Riverside building, deemed earthquake-prone in an updated seismic assessment in December.
The assessment, commissioned by the Ministry of Health, showed Riverside Central was earthquakeprone and had an overall rating of less than 34 per cent of the new building standard.
Under the New Zealand Building Act, a building is ‘‘earthquake prone’’ if its ultimate strength would fail in a ‘‘moderate earthquake’’ and it was likely to collapse causing injury, death or damage to other property.
The Riverside building houses eight medical wards and a large range of clinical services, including paediatric units.
The Riverside West block was originally supposed to be demolished after the acute services building was finished, Meates said.
Most medical services would then be moved to the Parkside building next door, but only after repairs on that building were completed, which could take up to two years. The acute services building will not be finished until September next year.
Riverside Central and East will now be repaired for non-clinical services to remain in those buildings, and Meates has assured staff they are safe to occupy, as advised by engineers.
‘‘In terms of a building being occupied and used, the risks are no different today than what they were yesterday,’’ he said.
Many staff members still feel anxious about the building though and are struggling to reconcile Meates’ assurances with the detailed seismic assessment.
Board members too remain uncomfortable about Riverside staying in use for another three years.
Keown said the whole building should have been demolished years ago.
‘‘If we are unfortunate enough to get a big [earthquake] event between now and when that hospital is finished and Riverside collapses – it’s going to make Pike River really, really pale in comparison.’’
Kane said the state of the Riverside building was deeply concerning and extremely frustrating.
‘‘That’s why the delays are unacceptable because we know we are carrying this risk and we know we have to get out of that building.’’
The situation was a result of the Ministry of Health’s lack of understanding about the gravity of building problems in Canterbury, she said.
A lack of specialist labour and complex design changes are responsible for the delays to the acute services building.
To make matters worse, the new building will not provide much additional space, as Canterbury’s population has growing faster than expected.
Meates said the new facility would provide an extra 32 hospital beds. Canterbury’s population has grown by 50,000 more people than planned for.
Board members said they have repeatedly raised concerns about the looming space shortage and the condition of the Riverside building with the Ministry of Health.
‘‘As a board we’ve lost huge chunks of time and the ministry has been quite content in dragging out decisions and put us in an invidious position. It has left us grappling with how we will meet our health and safety requirements,’’ Kane said.
A solution may be revealed in a masterplan under development by the ministry and Hospital Redevelopment Partnership Group – construction of a third tower on the acute services building.
Ministry critical projects director Michael Hundleby said an indicative business case for the masterplan was under way. Board members said it included a third tower on the acute services building.
Hundleby declined to release a draft of the plan to Stuff, saying keeping official advice confidential outweighed the public interest "at this stage’’.
Meates said building a third tower to give the hospital more space was part of a plan made in 2012, but the board realised it would be needed sooner than first thought.
It was clear to the board that rapid population growth and revised projections showed the tower would be needed by 2019, but the ministry did not accept the data underpinning this proposal.
A dispute over population estimates, funding and building requirements intensified between the board and the ministry, reaching a bitter low in 2017.
‘‘I have no idea where the ministry formed the view that we were experiencing depopulation when all the evidence was that our population was increasing rapidly and had been for many years,’’ Dickerson said.
The ministry also held onto the idea that Riverside could be remediated until December 2017, delaying the development of a business case for a masterplan with a third tower, Meates said.
‘‘A lot of time and energy that should have gone into development of tower three went into looking at options around Riverside and hence that’s why the [December] report was done by the ministry to look at a set of engineering solutions they thought they could do.’’
CDHB chairman John Wood said all parties now agreed Riverside was not ‘‘an acceptable building for inpatient care and supported the demolition of Riverside West’’ as soon as possible.
Hundleby said the number of beds included in the acute services building was ‘‘based on the best projections at the time’’.
‘‘Once construction of the building was under way it was not practicable to increase the number of beds. However, the building was built with an ability to add a third tower in the future.’’
New bed modelling had been commissioned and would be based on the most recent population projections available, he said.
‘‘Any capacity issues will be addressed as part of this business case, which is nearing finalisation.’’
The Christchurch business case would be considered ‘‘alongside other business cases by the national capital investment committee, with recommendations made to the ministers of finance and health’’.