Matthew Littlewood cuts through the confusion.
The National-led government’s plans for the inpatient building have been hard to decipher, with carefully worded statements that never fully commit to its pre-election promises to reverse cuts.
But that all changed on Tuesday when Dunedin Mayor Jules Radich emerged from a meeting with the health minister, smiling and brandishing good news.
There would be no clinical cuts.
But the good news lasted all of two hours, when a hastily re-written statement from the mayor removed one crucial line: "The minister has said there will be no clinical cuts to this hospital project, and our campaign puts him on notice that we expect nothing less."
Then, only hours after meeting the mayor, Health Minister Dr Shane Reti appeared to blow up the project completely, saying the solution was to abandon one large building and instead build the hospital in "phases".
Dr Reti walked his comments back almost as quickly as Mr Radich and by the next morning he was saying his comments to Parliament were not about the Dunedin hospital but the health sector generally.
Hidden from view, behind all the public arm-waving, serious negotiations are close to concluding between Health New Zealand and the preferred contractor CPB.
This prompted an 11th-hour scramble to find savings, which the ODT learned includes the option of cutting emergency department beds and downgrading operating theatres.
In the coming months the government will likely face the choice of accepting a final offer from CPB, or putting the project on hold to find another construction company to build it more cheaply.
In the meantime, politicians from the South this week revived a campaign in the hopes marching on the streets will stop the government from taking a knife to the hospital it promised.
Malice or incompetence?
"I think the government will need to speak up in the coming week or they will face a backlash across the southern region," he told the ODT yesterday.
"The public hates a vacuum and we've heard nothing but confusion from Dr Reti over the past week, and nothing from Health New Zealand Te Whatu Ora. They need to speak up."
Are there more sinister factors at play, the ODT asked Mr Hodgson.
"I don't think the confusion is deliberate; you're dealing with an under-prepared minister during the week and an uncommunicative HNZ," he replied.
"I think it’s more to do with incompetence than anything else."
Dr Reti declined to respond to Mr Hodgson’s barbs and once again kept his cards close to his chest, with a spokeswoman for his office saying: "The minister reiterates that the Dunedin project remains under active consideration, and he recognises the deep interest of the people of the city and in the southern regions."
A new ‘sheriff’
Concerns about looming cuts to the new Dunedin hospital have been almost constant, but reached fever pitch in July when it became clear the man appointed to fix the health system had the project in his sights.
The budget for the whole project is about $1.59 billion, but the Otago Daily Times understands costs have ballooned to close to $2b.
Dr Levy has made this comment in regards to his work on the entire health system, but when pressed by Taieri MP Ingrid Leary at a health select committee this week, would not confirm or deny a vertical build was still the only option for the new Dunedin hospital.
"Right at the moment, there are issues about affordability," he said.
"Just as soon as that work is done, we will have a go-forward position."
HNZ declined the ODT a request for an interview with Dr Levy.
In the background to this is the fact that HNZ has acknowledged it is still negotiating with the lead contractor , CPB, on the inpatients building, , on the pricing of the build.
This is happening as the last of the piles go up on the inpatients building site; it is expected the piling work will be completed in late October.
When asked whether the protracted negotiations could delay the next stage of the inpatients building, HNZ declined to comment.
Reading the files
The documents obtained by the ODT show last-minute efforts from HNZ and contractors to find savings has moved beyond just finding more efficient ways to build — such as using cheaper materials — to cuts that would affect the level of care provided to patients.
The cuts being looked at by HNZ include the "shelling" of an 11-bed "short stay" pod in the emergency department and instead incorporating these beds in acute wards.
The organisation is also looking at downgrading operating theatres, by having only one with specialist-grade ventilation instead of two, removing wall-mounted medical gas in some theatres and having only one high-spec "hybrid theatre" on opening, instead of two.
HNZ believed downgrading the level of ventilation in one theatre could lead to significant space and maintenance cost savings, but was considering the impact it could have on the hospital’s capacity to carry out high-risk procedures.
The documents caused much consternation in the clinical community. Dr John Chambers, who retired last year after 30 years working in ED, said the proposed changes were crazy and with the proposed cuts, the ED would be overloaded within a week of opening.
Dr Chambers believed much of the change had been influenced by a recent Infrastructure Commission report, which warned of massive overspends and signalled that that there has to be some sort of rethink or change in the way health infrastructure is planned.
"It uses terms like ‘Trilemma’ and ‘right-sizing’, but it’s mostly full of nonsense and without understanding about how the health system works.
"The impression I have is that all of this work in the report has resulted in hesitancy in committing to any expenditure on health infrastructure — already evidenced by the reversal of plans for a new Nelson hospital."
"HNZ remains committed to delivering an important health facility that represents value for money and provides the health services needed for the local community and wider region."
The final cut
Mr Hodgson was worried any changes would be irreversible.
"Even some of the things that seem harmless, such as removing air conditioning in the stairwells, I would have to be certain that these changes would not render the new hospital incapable of responding to a Covid-like event in the future.
"Frankly, I don't give a toss about the colour of the curtains — I do care very deeply about the clinical integrity of the building.
"The facility needs to be able to offer the quality and quantity of clinical service that the region would be needing."
Mr Hodgson was also wary of delays to the inpatients building.
"Leaving aside the bewilderment the health minister found himself in, the main thing that is happening is that prices are going up.
"You have a new sheriff [Lester Levy] in town and every time one of these new bosses charges in, they think they can somehow make the projects more affordable and they take a while to realise that there was nothing wrong with the original design.
All of this has caused much chaos and confusion, and one would have expected the Dunedin City Council to immediately put up a united front against the proposed cuts.
For a brief time, there appeared to be division in the council how best to approach it.
But the council has now banded together, and the march for the new Dunedin hospital will take place on September 28.
A lot can happen in a week.
