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'House of cards': Govt extends WCH consultation amid clinician warnings

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The Marshall Government has been forced to extend its consultation on the new Women’s and Children’s Hospital, after clinicians refused to sign off on key design plans for the build, citing inadequate consultation and a lack of information about the proposed services.

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A 560-page draft ‘Functional Design Brief’ [FDB] prepared in February and distributed to stakeholders details a raft of concerns from various groups, many of whom stipulate that they cannot endorse the plan without further changes or greater clarity.

Project User Groups from Neonatal, Nephrology, the Paediatric Day Unit, Paediatric Emergency Department, Paediatric Intensive Care Unit, Neurology, Infectious Diseases, the Perioperative Unit, and one Outpatient cluster (Allergy and Immunology, Dermatology, Nephrology, Gastroenterology and Rheumatology) declined to endorse the document.

The Infectious Diseases group said it was “not prepared to agree to the FDB without seeing the final numbers of rooms, agreed size of the rooms etc” as “this data is critical to everything we do, and we understand this is available and should be presented to us before seeking an agreement to the final document”.

They added that “the caveat approach” favoured by the document – leaving key details yet to be filled in – “is totally unacceptable for many obvious reasons”, writing: “Infectious Diseases cannot endorse the document until this has been resolved.”

The Paediatric Day Unit group noted that the “proposed number of treatment spaces is less than requested”.

“After all of this consideration, the size of the new unit proposed is EXACTLY the same size as the current unit, but with the [Adult Intensive Care Unit] brought down to be co-located,” they write.

“The [group] cannot endorse this document without a full and frank discussion with the team responsible for modelling the future use of the Paediatric Day Unit.”

The Renal unit argued the proposed model “poses a risk to service delivery, as many families call in with a medically urgent question is large and removing immediate secretarial access and consultation space will put our patients at risk”.

“Renal in no way approve or sign off on this process by taking part in these meetings,” the group stated.

“The renal department alone sees patients in our four consult/workspace rooms constantly. Removing our access to these rooms will reduce our ability to see patients.

“These patients will then remain unseen, untreated, and at medical risk. “

Rheumatology stakeholders argued “room sizes and numbers will need to be increased” and pointed to concerns about the design, saying their “nurses… will have trouble walking between these areas to do all of these measurements and still book patients in efficiently”.

Salaried Medical Officers Association chief industrial officer Bernadette Mulholland said the feedback suggested the new WCH was “not fit for purpose”, citing “general unhappiness” with the Functional Design Brief.

“Currently the union is trapezing through each service to find out whether they’re happy… I haven’t come across any group that’s happy with it,” she told InDaily.

“They’re highlighting to us deficiencies within this document that they can’t support at all.”

She said there was confusion about gynaecology services, “which we’d assumed would be going to the Royal Adelaide Hospital”.

“There was no real provision made for it because everyone assumed it was going over to the RAH,” she said.

However, she said feedback from many of the gynaecologists was that “they didn’t even know that was going to be the case”.

She added that CALHN had since determined the service was more appropriately housed in the new WCH, but “none of the gynaecologists I spoke to last night even understood this was going to be moved across”.

“That [points to] the deficiencies in the document – the lack of consultation that’s occurring with the clinicians, as to what’s in the document and what it actually means to them.”

She said the design brief was “one of the foundations of how we’re going to build this hospital – and that foundation is like a house of cards that’s falling over”.

She said there were outstanding questions about whether pathology and pharmacy services were going to be on of off-site, but that the narrow consultation timeframe precluded detailed responses.

“We’re trying to put it together in a small space of time so they can make decisions about a new hospital, which we’re all saying is too small and not fit for purpose in terms of services or needs of clinicians,” she said.

“Clinicians are saying ‘this is not workable, we’ll have no part of it’.”

Opposition Health spokesman Chris Picton said the Marshall Government “must ensure these doctors are listened to and we don’t end up with a hospital with fewer beds and insufficient services”.

“Doctors across the hospital – from infectious disease, to emergency, to neonatal – are alarmed that the government’s proposals would be insufficient for patient care,” he said.

However, in a statement Health Minister Stephen Wade countered: “Labor has no credibility when it comes to planning and building a hospital [having] announced a new Women’s and Children’s Hospital in 2013, promising it would open in 2023, and then did nothing for four years.”

“Labor then abandoned the project in 2017, breaking their promise and downgrading the project to a women’s only hospital, leaving the children’s hospital stranded indefinitely at the North Adelaide site,” he said.

“In stark contrast, the Marshall Liberal Government has consulted with more than 690 clinicians and other staff, and 35 consumers during more than 1000 hours of consultation on the nWCH.”

The consultation on the Functional Design Brief is a smaller part of that consultation, which the Government says began on April 6 and ended last week – with a consultation with the union to conclude next Monday.

The union is seeking an extension claiming it has not been given time to properly consult on the 560-page document.

Wade said there were currently plans for 445 treatment spaces at the nWCH – “however, this number is not final and we are extending the consultation process as we listen to the insights of clinicians”.

However that extension is not related to the concluded consultation for the Functional Design Brief.

“There is also currently a recruitment drive open, inviting consumers to be involved in the planning and design of the new hospital,” Wade said.

He noted that the nWCH will be “complemented by an expansion of paediatric services at the state’s flagship northern suburbs hospital, the Lyell McEwin Hospital” to cater for population growth in northern Adelaide.

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