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House of Assembly - Fifty-First Parliament, Second Session (51-2)
2008-04-09 Daily Xml
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Parliamentary Committees

PUBLIC WORKS COMMITTEE: FLINDERS MEDICAL CENTRE REDEVELOPMENT

Ms CICCARELLO (Norwood) (11:02): I move:

That the 279th report of the committee, entitled Flinders Medical Centre Redevelopment, be noted.

The Flinders Medical Centre is a tertiary hospital for southern Adelaide and will provide a full range of major complex medical, surgical, diagnostic and support services across the continuum of care for adults. It will also provide a range of surgical and medical services for children and mothers. Built in 1974, the hospital requires redevelopment of critical clinical functions and site engineering infrastructure. The project comprises:

a new multi-level building to the southern side;

operating theatre expansion from eight to 12;

integrated day-of-surgery admission facilities and day surgery unit;

expanding the emergency department from 31 to 50 treatment cubicles;

relocating and expanding the emergency extended care unit and the cardiac intensive care unit into refurbished spaces;

expanding the intensive care unit from 24 to 32 beds and the acute assessment unit from 19 to 36 beds;

upgrading the central sterile supply department; and

essential major plant and infrastructure upgrade.

The total capital cost budgeted for the project is $153.68 million on completion, due in September 2011.

The new south wing is envisaged as a multilevel building linked to the south of the existing A, B and C ward wings. It will principally be framed from concrete elements. This is due to the need to marry with the existing floor levels in the adjacent building whilst providing adequate space for the reticulation of the necessary services. It is planned with a slab at level 5 to enable future development of a further two floors. The expansion and redevelopment of the emergency department will occur within the existing building after the emergency extended care unit and the emergency department offices are relocated.

The new south wing at level 3 accommodates women's assessment and birthing suites—a combined labour and delivery and birthing unit. The link to the new wing has been located for direct and discreet access to theatres (for emergency caesarean births and presentations) and to have minimal impact on clinical areas in the neo-natal unit. The new emergency department facility will provide:

an overall increase in emergency department cubicles;

adult assessment and treatment facilities;

a separate paediatric facility;

mental health facilities;

two new resuscitation rooms;

a new isolation room with en suite;

a dedicated cubicle zoned to coordinate the time-critical and chest pain assessment patients; and

reorganisation of the five treatment 'streams' to best respond to functional adjacency requirements.

A major initiative incorporated into the project involves construction of a new, purpose-built day procedure unit and day of surgery admission unit for patients requiring day-only or day-of-surgery services. This will be established within the operating theatre suite.

The existing Central Sterile Supply Department at Flinders Medical Centre requires redevelopment and provision of additional equipment in order to meet the demands of the redeveloped Operating Theatre Suite. There will be a major upgrade of the central engineering plant and the systems infrastructure which includes mechanical, electrical, fire, hydraulics and lift infrastructure, and data and communication systems.

The project has significant ESD requirements factored into the brief. A water reduction target of 30 per cent has been established. Energy and greenhouse reduction targets of 13 to 15 per cent have also been established. The design of the new facilities is intended to achieve a five-star rating in the Greenstar rating tool for hospitals.

Extensive consultation has occurred with clinical and non-clinical staff, and the committee is assured that consultation has also occurred with the Bedford Park Residents Association about its concerns regarding transport, traffic issues, and parking in particular. The redevelopment is intended to provide Southern Adelaide Health Service with a facility that will meet the future needs of patients and staff and enable service synergies and enhanced collaboration between functions within the hospital and across the region.

The Flinders Medical Centre redevelopment must align to the vision for health service reform in South Australia, achieve national benchmark standards for service provision and service planning, contribute to optimising financial performance and achieving a balanced budget outcome, and provide a facility which will meet the needs of patients and staff for at least the next 20 years.

A key aim is to provide high quality and efficient health care services which directly align to patient needs by maintaining the existing range of health care services and redesigning them to meet current and future needs of local population. Services will be streamlined to reduce unnecessary delays, overlaps and duplication. The functionality between service areas within the hospital will be improved.

It is hoped that the amalgamation of services will achieve economies of scale without compromising service delivery within a facility that meets environmental objectives. The expanded operational capacity and profile of the hospital will lead to increased recurrent expenditure, and preliminary modelling suggests this will be in the order of $19 million. Part of this increase will be met in the first instance by redirecting funding related to services transferred. Additional operating requirements generated by the expanded operational capacity will be met from within approved funding allocated as part of the 2006-07 budget process.

The option of not redeveloping the hospital would fail to address the required service expansions and changes to functionality. It would also fail to improve access to health services, patient safety and clinical outcomes, or address all currently identified occupational health and safety risks. In contrast, the redevelopment provides a modern, safe and secure facility that enables the effective delivery of services to consumers in the southern region.

This project also improves functionality and enhances work flow and opportunities for better support systems and information sharing. It also avoids the problems of the 'do nothing' option by improving access to health services, optimising patient safety and clinical outcomes, and also responding to occupational health and safety concerns.

The committee closely examined agency witnesses about the impact upon local residents arising from car parking around the hospital. This will be addressed by several factors and future steps. A GP Plus centre at Marion in the next couple of years will reduce the demand on the hospital Emergency Department. About 5 per cent of the work at Flinders will be transferred to the proposed Marjorie Jackson-Nelson Hospital. A new 588-car car park has alleviated the problem triggered by the Flinders Private Hospital. The current car park levels can be added to and further parking analysis will ascertain any changes to the long-term demand. Temporary arrangements allow access to space for 280 cars to park at the Science Park location. Much of the all-day parking in the area is used by Flinders University students, and the council is reviewing the arrangements with a view to limiting all-day parking. Finally, a traffic consultant has been engaged for the project to study this issue and provide recommendations.

The committee was also concerned to ascertain that the residential component available for the families of country patients was appropriate. We were told that the use of the flats behind the hospital campus has been reviewed, and consideration is being given to removing the student component of users to allow more access for country clients. Based upon the evidence presented to it, and pursuant to section 12C of the Parliamentary Committees Act 1991, the Public Works Committee reports to parliament that it recommends the proposed public work.

Mr PENGILLY (Finniss) (11:10): I clearly support the report that the member for Norwood has just read out in some detail. It is, indeed, pleasing to see that some $150-odd million is being spent at Flinders Medical Centre. However, it is not all beer and skittles. The fact of the matter is that, during the course of the investigation, through the local member (the member for Davenport), we discovered that the Bedford Park Residents Group had not been consulted, and it was only as a result of a push by the Public Works Committee that the committee was able to get representatives from the Flinders Medical Centre to go out and talk to those people and discuss their concerns. So, I think that was something important that we raised.

The issue of the Flinders Medical Centre is certainly dear to the hearts of people in the south, the Fleurieu Peninsula and my electorate. It is a critical hospital for the people down south who need to come to the city for urgent medical attention. There are frequent helicopter transfers to Flinders and, indeed, if someone down south is critically ill, that is the first place to which they are taken. So, I am very much aware of just how important the Flinders Medical Centre is, and I am pleased that the facility will be upgraded in due course.

However, I think it is probably worth noting and putting on the record that this Rann government, to all intents and purposes, has forgotten about the south. It is all very well to do something with the hospital—that was a terrific outcome—but the rest of it can fall apart at the seams and the Rann government could not give a tinker's, in my view; it does not care. It sees other places in the metropolitan area—the north and what-not—as being far more important than those tens of thousands of people who live down south. However, clearly, we will be supporting this measure.

Another concern that I wish to raise is that it seems slowly and inextricably linked that the independence of the Repatriation General Hospital will disappear and the Flinders people will take over and destroy that institution. That is something about which I know the member for Bragg has concerns, which she has raised in many places. That matter will take its course, and I would suggest that we will see the outcome in time to come. A lot is being done at Flinders. However, a lot more probably needs to be done, and we will be following this issue with great interest and great attention. It is very important to the south, and I have great pleasure in supporting the report read by the member for Norwood.

The Hon. R.B. SUCH (Fisher) (11:13): I welcome this rather large upgrade of the Flinders Medical Centre. It is very close to my electorate; it is literally within a few metres. It used to be in the electorate of Fisher. I commend the government for spending this money. One could spend all of the state budget on health and it still would not be enough. We have other priorities as well. However, as someone who spent time in Flinders many years ago (and I do not seek to go back there—and that is no reflection on the hospital, because it is a fantastic hospital), I see this as a very positive move and a welcome upgrade and, as the member for Finniss said, it serves the people in the south, in particular. It has a great reputation.

I hear very few complaints about the hospital. You get the odd one or two, but that is inevitable when you are dealing with tens of thousands of clients each year. I welcome this move. I congratulate the government on committing to this upgrade and the Minister for Health for his input, and I commend the staff who work at Flinders Medical Centre because they are fantastic.

Mr PISONI (Unley) (11:15): Like my colleagues, the member for Finniss and the member for Norwood, I, too, support the expenditure of $153 million on health in the southern suburbs. I point out to the parliament that that was achieved without any land sell off; that is, the capital expenditure of $153 million has been achieved without any land sell off at the Flinders hospital. As a matter of fact, it was the reverse of a land sell off, because the Public Works Committee was told that more land was acquired for car parking across the road. So, we saw an expansion of the landholding of the Flinders Medical Centre for this new development.

It is in complete contrast to what is happening at Glenside, of course, where the very same minister is telling us that we must sell this land to fund the redevelopment of the Glenside Hospital. I can see a number of inconsistencies in this government. As a matter of fact, when I asked the officers of the department and the hospital who gave evidence to the committee: was any thought given to selling off the land to fund the extension of the emergency ward at Flinders Medical Centre, their response was shock and horror—why on earth would there be? You could see from their faces that they thought it was a ridiculous question, but that is the exact scenario that is happening at Glenside.

The government and the very same minister have told us that that development can only be funded through the sell off of public open space in a part of Adelaide which has very little public open space and which is also being squeezed out by urban consolidation. I know that is also of serious concern to people living in the electorate of the member for Norwood, but I never hear her speak up about urban consolidation in her electorate.

Something else that needs to be noted about this particular project is that this work is being done while the hospital is in use. They are not closing the hospital; they are not building a new hospital to put on this ward: it is being done while the hospital is in use. Again in complete contrast to what the Premier and the health minister are telling us about the new Marjorie Jackson-Nelson Hospital. That must be built at a brand new location because you cannot revamp a hospital; you cannot rebuild a hospital while you are using it. Perhaps the minister needs to see how it is being done at Flinders, because the Public Works Committee saw how it was being done when we held our hearing about this matter.

The facts are that we are seeing a revamp of the Flinders Medical Centre while the Flinders Medical Centre is being used but, for the Royal Adelaide Hospital, we have to throw away 150 years of tradition, a good name that is recognised throughout the world, move shop down the road, and consequently build a brand new hospital, because the same minister who has authorised the refurbishment of the Flinders hospital while in use tells us that we cannot refurbish the Royal Adelaide Hospital while it is in use. Again no consistency.

I was a little surprised to learn that, when I inquired about the emergency backup power and the cogeneration project that came with this revamp and extension of the emergency services, it was diesel powered. There was no direction from the minister or cabinet to look at green sources for this emergency power or the cogeneration. Diesel-powered generators will be used to generate the additional electricity that this project needs outside the grid. I think it was disappointing that there was no interest whatsoever in cabinet at looking at a green alternative. With those closing comments, I support the project.

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (11:20): I rise to applaud the Public Works Committee for completing its charter in relation to the $154 million redevelopment at the Flinders Medical Centre, and I appreciate the work it has undertaken to secure the progress of this project. Page 4 of the report identifies the background to this redevelopment, which was announced during the 2006 election campaign by Premier Rann.

Page 5 of the report outlines some details of the proposal, and I wish to refer to just three: first, the expansion of the theatre operation (that is, the surgical theatres) from eight to 12; secondly, the expansion of the emergency department from 31 to 50 clinical treatment cubicles; and, thirdly, the expansion from 19 to 36 beds in the acute assessment unit. There are corresponding expansions of the intensive care unit, as well as other areas, in addition to the new building on the south side which will accommodate the relocation of a number of wards and services existing in the hospital.

This is a major project; it is quite an exercise to be undertaken. As the member for Unley pointed out, it is a redevelopment on a current hospital site, which is consistent with hospital redevelopments around the country. Melbourne is about to launch the opening of its new children's hospital and a new women's hospital on-site with multistorey buildings within the existing hospitals, which confirms, as does this project, the importance of and the capacity for major hospital rebuilds to occur in situ and not require greenfield developments.

There is another matter to which I particularly draw the attention of the parliament today. Page 4 of the report outlines a number of reforms under South Australia's Health Care Plan 2007-16 which was launched by the government. That report, which refers particularly to reforms in relation to the Flinders Medical Centre, states:

Some surgical services from the Repatriation General Hospital (RGH) will gradually transfer to FMC [referring to the Flinders Medical Centre], and some high volume/low complexity work will transfer to Noarlunga Hospital. RGH will provide a designated elective orthopaedic surgical service to relieve demand and pressure and improve waiting times for elective surgery.

That is very important, because I do not doubt for one moment that the Public Works Committee would not have had before it the secret Paxton consulting report, which was finally released to the parliament last week—a report which we had been calling on for some two months.

The report, which is dated 25 February 2008 and which was provided to the parliament on 1 April 2008, contains an assessment summary of recommendations in respect of the Repatriation General Hospital. So, whilst we see in the report tabled by the Public Works Committee an expansion of services at the Flinders Medical Centre, members should understand that it is not exclusively for the purposes of providing for increased demand for health services; it is to provide for the fact that services will be cut elsewhere.

The Paxton consultancy report makes it absolutely clear because it contains a number of recommendations, including the closure of what is the equivalent of its emergency department. The Paxton report states:

...implement alternative admission processes to manage the existing ARU patients and cease the operations of the ARU...

The report then goes on to identify the cost savings. The ARU is the Acute Referral Unit at the Repatriation General Hospital (otherwise known as its emergency department), which receives an enormous number of referrals from general practitioners and other doctors who send patients to the repat hospital for assessment and often processes which are, of course, not available at a GP clinic.

Also, from time to time it has received the overflow from the Flinders Medical Centre when its emergency department has been under some crisis. This is an important recommendation in a report which was secret until last week and which I guarantee was not before the Public Works Committee. So, when the Public Works Committee was considering the demand and the need for the expansion of medical services, rather than just the generic, it would have been honest of this government if it had allowed the committee access to this document.

The health minister said that document, which cost nearly $1 million of taxpayers' money to prepare, was not available to the Public Works Committee so it could take into account the very important demand. It will be picking up the services as they slash them from the Repatriation General Hospital. There are eight recommendations, most of which involve the slashing of services, reducing access to facilities and, importantly, the removal altogether of the acute facility. It has not had the decency to put this document before the Public Works Committee. Clearly, the slashing of services in other hospitals will increase the demand under the government's plan, and that is why it is necessary to expand the services in Flinders Medical Centre, which is a major tertiary hospital.

When this issue is being reconsidered I would ask, when the Public Works Committee is being asked to consider public works, viability, demand, and all the things which are within its charter and on which the parliament requires it to make an assessment in relation to these projects, that the government comes clean with reports on other services which will be removed or significantly undermined, so the Public Works Committee has all the material before it. It may even recommend a further advance on the projects that it is considering. Nevertheless, I acknowledge the Public Works Committee's consideration of this matter and support the motion that the committee's report be noted.

Ms CICCARELLO (Norwood) (11:26): I thank members for their support for the redevelopment of Flinders Medical Centre. I point out that the Public Works Committee considered this project in November last year, and it is because of the way in which this parliament operates that we are debating it now. The Flinders Medical Centre will bring a lot of benefits to the people in the south. This matter was considered so important that, instead of taking 10 years to redevelop the Flinders Medical Centre, it has been brought forward so that it happens within four years. I say to the member for Finniss that my heart bleeds when I see the money that is spent in the southern part of Adelaide; I only wish I could have some of it to spend on the eastern part of Adelaide. I commend the report to the house.

Members interjecting:

The SPEAKER: Order!

Motion carried.

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