Dunedin Hospital rebuild chief, Andrew Blair of Hawkes Bay, Chairman of the Southern Partnership Group in Dunedin. Photo: Peter McIntosh.

The "crumbling" state of Dunedin Hospital poses clinical, financial and organisational risk, and the facility could be forced to close if a "significant defect" was found, the strategic assessment for the Dunedin Hospital redevelopment says.

Released yesterday, the assessment is a crucial bureaucratic step for the $300 million project.

• University could help fund rebuild

It reiterates much of what is already known.

The assessment has been signed off by Health Minister Jonathan Coleman and Finance Minister Bill English.

The clinical services building, the children’s pavilion, the Fraser building, and the psychiatric services building are "uneconomic to repair".

The biggest problem is the clinical services building.

"The key risk is the potential for either the emergence or discovery of a significant defect in the condition of the building that necessitates part or total closure of the building for the purpose of providing clinical services.

"This would lead to significant disruption, as patients would need to be treated either in alternative locations on the Dunedin campus, or be transported to facilities in other locations."

Asbestos deposits made maintenance work difficult, and in some areas impossible.

Some services had higher-than-expected rates of infection.

"Hospital facilities in Dunedin are not just in poor shape but in some instances are crumbling.

"The current situation places Southern DHB in a position of considerable clinical, financial, and organisational risk.

"The condition and layout of infrastructure does not support features of safe care, leading to an increased likelihood of adverse events for both staff and patients."

The document warns not to expect more money to run services, and the board is encouraged to look at more privatisation.

"The DHB will need to be innovative in the way it finds capital to make things happen.

"As the DHB’s population is not projected to grow as much as other DHBs, the share of funding under the population-based funding formula is likely to reduce."

The budget is anticipated to break even in 2019-20 but "the steps to break-even are not completely clear at the moment".

"Every decision to continue using a workaround instead of improving a process, or a decision to not tackle an outdated clinical practice simply to avoid upsetting staff, is a decision that reduces the level and quality of care available for its population."

Dunedin largely did not get the patients from other DHB regions that can subsidise highly specialised services.

"While there is a significant transient and tourist population which seeks urgent care in Southern DHB, only a small trickle of patients from South Canterbury DHB routinely come to Dunedin for tertiary care."

A clinical advisory group would consider more links with other "tertiary service centres", the closest of which is Christchurch, and would look at the issue of highly specialised versus generalist medical models.

"The future of transport and retrieval will be core to service and facility design in Dunedin."

The document does not say whether a new site is favoured over building on the existing site.

The split of services between Dunedin Hospital and Wakari Hospital will be re-examined.

Shifting acute services to the Wakari Hospital building is "not an attractive" option, but Wakari has not been ruled out as the site of the main rebuild.

The most significant building on the Dunedin Hospital campus, the ward block, was viable but needed renovation.

The document was written by consulting firm Sapere Research Group for the politically appointed Southern Partnership Group.

Partnership group chairman Andrew Blair, of Hawke’s Bay, was in Dunedin and was interviewed yesterday by the Otago Daily Times about the strategic assessment.

"We have to keep disappointing people who are wanting to know where it’s going to be and what size it’s going to be.

"Next year we will have a better idea of the options, but even then it’s going to be the following year before we narrow it down," Mr Blair said.

He did not want to talk about the board’s finances, saying it was a matter for commissioner Kathy Grant, but said funding a well-planned hospital helped services to run more efficiently.

The new hospital is likely to be configured on a generalist ward model, but Mr Blair reiterated this did not mean the loss of specialist services.

Mr Blair was enjoying working with the University of Otago, and said reports the parties’ relationship was strained were inaccurate.

"The relationship with the university goes back over 100 years. There is support at the highest level for maintaining that very important relationship."

The university might contribute to the capital cost of the redevelopment (see story below).

The partnership group was looking at how the ward block could be reconfigured.

It was a structurally sound building, he said.

eileen.goodwin@odt.co.nz

Clinical services building

- Designed and built in 1960s

- Nine storeys, including basement level

- Includes radiology, day surgery, fracture clinic, physiotherapy, emergency department, laboratories, operating theatres

- Also includes plant room, water tanks and lift machine room.

- Asbestos deposits make maintenance difficult and impossible in some places.

Main points from strategic assessment

- Formal case for $300 million Dunedin Hospital redevelopment

- Warns not to accept more money to run SDHB

- Emphasises rundown state of clinical services building

- Fraser building,children's pavillion, psychiatric services building, clinical services building all uneconomic to repair

- Board encouraged to look at more privatisation

- Funding under population-based formula likely to reduce

- More links with Christchurch likely

- Better transport, telehealth and community-based services needed

- Next step is indicative business case by mid-2017.