Dialogue: Women draw short straw in plan for new hospital

The closure of National Women's Hospital has become the catalyst for a confusing and inconvenient fragmenting of services, writes SANDRA CONEY*.

Five years ago, Auckland women's groups were reassured that a plan to close the existing National Women's Hospital and move services into a large, new general hospital in Grafton would not result in any loss of identity or reduction in service.

They were told that it would better. But as the health services delivery plan, which mandates the shift, reaches its final stages, it is clear that an inexorable process of compromise has led to the hospital being carved up, with services located in different parts of the city.

Originally, it was planned that all of National Women's would shift to Grafton. But it seems the designers planned for too few women - hence the fragmentation.

The ninth floor of the acute services block, the huge new tertiary hospital on the Grafton site, will contain delivery suites for all births, theatres for gynaecological surgery and nurseries for sick babies. Because there is no room for assessing women with pregnancy problems or for postnatal beds, those services will be on three floors in the existing Auckland Hospital tower block.

The "Street," an airbridge, will carry all foot traffic, including staff, patients and families, over an atrium between the two buildings.

Back at Greenlane, other women's services will be located on the site of the old Green Lane Hospital. These include antenatal, outpatient, day surgery and infertility clinics. Again, they will not be in a building dedicated to women's health but in part of a general hospital building.

Women's groups have protested at this fragmentation of New Zealand's premier women's health service. It will be confusing and inconvenient for women and their families. They particularly dislike locating well women, who are giving birth, in an acute hospital that is geared around the needs of very sick people.

This will affect about 8000 Auckland women and their families every year. The plan seems designed more to meet the needs of medical students in training (across the road from the Grafton site) than the needs of women and their families.

Originally, a separate entrance for National Women's was promised, but this seems unlikely. Women in acute labour will have to negotiate which entrance to use. There are plans for transferring women who by mistake turn up at Accident and Emergency. So far there is no parking specifically for women in labour.

The separate lifts promised for transferring women in labour to the ninth floor are not secure, either. There are plans for panic buttons and intercoms between the entrance and staff five floors above. Lifts will be equipped with delivery equipment.

There is an acceptance that some women with quick labours will give birth in the lifts, which is at odds with the delivery plan argument that women need to give birth in a setting that can deal with high-risk situations.

Obstetrician critics are grimly predicting that the women who give birth in the lifts will be the lucky ones. Others will never get through the traffic logjam surrounding the Grafton site. Or they might inadvertently go to the Greenlane site only to find the "closed for the day" sign out.

Protests about women needing emergency treatment, or those fresh out of delivery, being taken along the very public "Street" led to the promise of a second "bridge" to guard those women's privacy. But, like other improvements, this depends on money that isn't there.

Already, the budget has ballooned, and the Government has yet to say it will make up the shortfall.

Money seems to be the driving force behind the shifting of National Women's. However, other arguments have been put forward.

One justification is that surveys have shown that women want to be in big hospitals because they believe it is safer. But the surveys have not been made available, so it is impossible to examine just what options women were given. The drivers of the delivery plan also claim it will cut down on transfers between hospitals. Again, despite requests, actual figures for transfers have not been provided.

However, it seems about 10 critically ill women a year are transferred between National Women's and Auckland Hospital, and we are told about five babies are transferred each week.

The new plan will not eliminate transfers, only change their nature. Complications during day surgery, or sick women presenting at antenatal clinics, will lead to transfers from Greenlane to Grafton. There will also be transfers of sick babies from the neonatal unit to Starship children's hospital.

A huge number of transfers will occur during construction, as the facilities will be completed on different dates.

Women's groups are not the only ones worried about the impact of the delivery plan on Auckland women. As the final shape of the new National Women's unfolds, Auckland obstetricians and gynaecologists also predict the scheme involves risks to Auckland women. And they believe some of their colleagues will resign rather than try to work over several sites.

The drivers of the delivery plan in Auckland Healthcare seem immovable in the face of the critics. For four years, they have said constantly that the plan was non-negotiable and it was far too late for a rethink.

Two weeks ago, Women's Health Action, supported by six other community women's organisations, took a deputation to the Auckland District Health Board asking for a review of the plan. Last week, it wrote to all Auckland MPs.

We agree that the existing National Women's is old and run-down. But the option of a new standalone hospital that would integrate all women's health services should be given urgent consideration.

Scattered services over two locations can hardly be described as a national women's hospital. The present scheme represents a step backwards for Auckland women, not a step into the future.

* Sandra Coney is the executive director of the Women's Health Action Trust.