KEY POINTS:
A proposal to increase by 337 the number of beds for adult health services in Auckland City Hospital is long overdue.
When the hospital - an amalgamation of four hospitals including the famous Green Lane and National Women's - was opened with much fanfare five years ago the promise was to do more with less. The super-hospital would run with about 1000 beds, 7 per cent less than the total of the four it replaced. On top of this there was to be a strategic reserve of 60 to 80 beds which could be brought into play as the population increased.
Some aspects of the plan were grounded in good sense. For instance, it seemed a good idea to centralise the most expensive and complex surgical procedures in one place to avoid duplication of equipment and to reduce the need for patients to be transferred between hospitals. But the idea of reducing the number of hospital beds in a city with a steadily increasing population always appeared to be of questionable wisdom.
If it seemed somewhat optimistic, the ready explanation from the planners was that economies would be made by directing a greater proportion of patients to day surgery and to other hospitals, therefore the demand for beds would be lower.
Even at the time, this seemed like a dubious promise to patients and medical staff. It might well have been possible to increase the number of day-surgery procedures, but what about such factors as the ageing population, the steady development of expensive new medical techniques and the increasing demand for them?
Not surprisingly, complaints and protests accompanied the birth of the new hospital. Perhaps some of these could be put down to normal teething problems. But there was a solid core to many of the complaints which suggested that, despite the confident predictions of the planners, the super hospital was, as reason suggested, not doing more with less but rather failing to keep up with the growing demand for its services.
The most public of these complaints came from the orthopaedic department, whose head pointed out - with inescapable logic - that under the new system there were 40 to 50 beds for patients with broken bones. Under the old it had 54 but routinely needed 65 to 85, numbers that were hardly likely to decrease in a growing city.
There was real concern the department was struggling to treat patients within times regarded as appropriate by international standards and that treatment could be compromised by having orthopaedic patients spread in other wards and receiving non-specialist nursing care. Medical staff in other specialties made similar complaints.
As time has passed, these concerns have proved to be broadly justified. Within a year of opening the hospital was struggling to cope with overcrowding. Not only did the number of complaints rise sharply but the number of patients waiting more than the benchmark six months to see a specialist increased by 60 per cent. The fullest extent of the problem, however, was not so evident until this week when the Herald reported the Ministry of Health's estimate that 337 extra beds would be needed by 2015.
One hospital manager was quoted as saying population growth was the main reason. There is nothing surprising about this, other than that it should have been factored into the equation from the beginning. The extent of the planning failure can be seen by comparing the original estimate of 60 to 80 beds to cover population growth with the 337 that is now regarded as necessary.
The burning question now is whether those extra beds will be approved, funded and staffed. If not, the unfortunate experience of the past six years will be a sure guide to the next six.
