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House of Assembly - Fifty-First Parliament, Third Session (51-3)
2009-03-03 Daily Xml
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Question Time

ROYAL ADELAIDE HOSPITAL

Mr HAMILTON-SMITH (Waite—Leader of the Opposition) (14:19): My question is to the Minister for Health. Is the government's five stage, 15 year model for estimating costs for the Royal Adelaide Hospital rebuild flawed and out of step with other single-stage processes used to successfully complete like hospital rebuilds in other states?

The government has produced varying costs for rebuilding work at the Royal Adelaide Hospital since 2006. One such estimate of $1.38 billion includes $533 million in supposed escalation costs over a proposed 15 year, five stage project, but the most recent project of a similar size, the Royal North Shore Hospital in New South Wales, is a single-stage project which consolidates 53 buildings, costing significantly less at $950 million, including research facilities to be built over 4½ years. A credible cost comparison between a rail yards hospital and RAH rebuild would require comparison of projects as single-stage projects.

The Hon. J.D. HILL (Kaurna—Minister for Health, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts) (14:20): It is interesting that, over recent weeks, when the government says, 'We will build the new RAH at the railway site for $1.7 billion,' the opposition says, 'No, you can't do that, that will cost you $3 billion.' On the basis of what, we don't know, but that is what they say a new hospital on a new site, a greenfield site, would cost—$3 billion. When we say, 'You can't rebuild on the existing RAH site without spending around about $2 billion,' they say, 'No, we could build one there for $300 or $400 million.' You can't have it both ways. This is real kindergarten economics coming from the Leader of the Opposition.

Let me give members full and extensive detail about the issues that are the subject of the question asked by the Leader of the Opposition. The government is continuing with work on the $1.7 billion new RAH in City West. That will combine world-class hospital care, education and research and will be opened in 2016. The decision to build a new hospital was taken after careful analysis of all the options, including an intensive investigation of the current site and the study of different locations. It has become very clear to health and infrastructure planners in the Department of Health and, indeed, staff working at the site that the current RAH is too constrained for any real development.

The majority of the site infrastructure at the current Royal Adelaide Hospital site has remained untouched since the 1960s redevelopment, when, in fact, it took over parts of the Botanic Gardens. While the infrastructure has served the hospital well for over 40 years, it has now reached the end of its working life—like some others over on the other side, I suspect. The site infrastructure is the unseen component of the building—and this is the bit that the opposition does not get. It is not a matter of plonking a new building on the Botanic Gardens or somewhere close to the hospital: it is things such as reliable plumbing, sewerage, heating, gas, treated water and power substations and generators. All this was built 40 years ago and has not been replaced or renovated, and it needs to be replaced in order to get the hospital up to scratch.

When the government considered undertaking a full redevelopment of the RAH in 2004, we were advised that the first stage would need to overhaul the worst of this site infrastructure. The proposed redevelopment, if it had started in 2006-07, would include a total of four stages, with the ultimate goal of demolishing what is known as the R wing and the residential building at the rear of the site and replacing it with a new in-patient building. The project would have been completed by about 2021. So, if we had started in 2006-07, it would have been completed about 2021 at an estimated cost of about $1.4 billion.

They ask questions. Of course, they know everything, but without any basis. There are no plans on the table from the opposition, no costings, nothing at all except pipedreams—

Members interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: Can I assure the house that serious people, smart people, from the health department have been through this every possible way. Outside people have been through it. What they have been through is their own exaggerated sense of their own intelligence and their perceptions of public opinion. They think a football stadium is more attractive to the constituents they are seeking to represent. Anyway, I digress. If the work—

The Hon. P.F. Conlon: We won, yea!

The SPEAKER: The Minister for Transport!

The Hon. J.D. HILL: I thank my friend for his performance—

The Hon. M.J. Atkinson: Where's Terry Boylan these days? What's he doing?

The SPEAKER: The Attorney-General will come to order!

The Hon. P.F. Conlon: It's the mystery of that system.

The SPEAKER: Order, the Minister for Transport!

The Hon. J.D. HILL: As I was saying before I was so amusingly interrupted by the Minister for Infrastructure, the project would have been completed by about 2021 at an estimated cost of about $1.4 billion. If that work were to start in 2010 (it is obviously three or four years later), the escalation costs would increase the total to the order of about $1.8 billion and the project would not be completed until about 2024 at the earliest. However, the project would not increase—and this is the important thing. Members of the opposition are saying that they will rebuild a new hospital on the existing site, which would be very difficult to do; possibly impossible. Nonetheless, that is what they say. Even if they were to do it, they would not be able to increase capacity of the hospital. There would be minimal extra beds and there would be no expansion of the emergency department or the intensive care unit.

What we know, from tracking the demand for emergency department numbers at the Royal Adelaide Hospital over recent years, is that there is something like, I think, a 30 per cent (I stand to be corrected) increase in demand for emergency departments. We need to increase the capacity of the hospital over the next 10 years or so. We want to get the capacity of the emergency department up to about 86,000 patients a year. It is currently designed to treat in the mid-60s. We do not have enough capacity at the hospital. Under none of the proposed redevelopments of the RAH is there any way of increasing the emergency department capacity.

Ms Chapman: Rubbish!

The Hon. J.D. HILL: Thirty per cent might be wrong. We are planning to increase it by 25 per cent. The deputy leader said 'rubbish', but I challenge her: present a plan to the public of South Australia that would demonstrate how you would increase the emergency department capacity at the Royal Adelaide Hospital. You cannot do it. You talk absolute rubbish when you say that.

Members interjecting:

The Hon. J.D. HILL: Very rarely am I called arrogant, but from you I take it as a compliment, member for Finniss. The approach would not increase capacity at the hospital. It would not increase the number of beds by very much. It would not increase the emergency department capacity, nor would it increase the number of intensive care unit beds.

Also, it would not make the current Royal Adelaide Hospital fully earthquake compliant. What we know about the current RAH is that, if there was a major earthquake in Adelaide, the RAH would stand sufficiently for the patients to leave and then it would have to be condemned. It is not up to contemporary standards: it would not pass contemporary standards in terms of disaster. A modern trauma hospital has to withstand an earthquake or other disaster because, naturally, it will be the place where victims would go if there were to be an earthquake. You cannot have your major hospital falling down and having nowhere for victims to go should such a disaster occur.

The key to this project, which really makes it impossible to proceed with what the opposition is suggesting, is that it would require up to 170 beds to be relocated elsewhere while the demolition and the rebuilding of the hospital were to take place. That is 170 beds: a hospital about the same size as Modbury would have to be constructed in the interim to take that capacity.

The original plan was that the beds could be moved to the east wing after completion of enabling works to make that possible. However, I am advised that this is no longer feasible because of the increase in demand for service at the site having now filled up the east wing. That is the problem with the hospital: it has increasing demand and we are using all the spaces to supply that demand.

The Department of Health has recently reviewed the 2004 redevelopment plan, this time including extra stages and an extra cost to allow for the relocation of the 170 beds at other locations on site. The health and infrastructure plan has looked at two possible options. Under option 1 (and this is pertinent to the question asked by the Leader of the Opposition), the hospital could be redeveloped with increased staging of the works for just over $2 billion over a period of 17 years with completion in 2027. The completed RAH would have 700 beds, still with multi-bed bays, and there would be no expansion of increasingly busy areas such as ED theatres or the ICU, as I have said before.

The second option assumed that new bed accommodation could be built in the current emergency car park (and that is a car park that is needed for emergencies). Let us say we built on that space. The plan has estimated that it would cost slightly less; $1.966 billion. Work would take a little less—15 years—once again to produce a 700 bed hospital with multi-bay beds and no other expansion. Work would finish in about 2025.

The health planners have advised me (and they have confirmed their original view) that building a new hospital on a greenfield site is clearly the best, safest and most assured plan for all South Australians. A new hospital on a new site will not need to grapple with these infrastructure issues because it will be purpose built. The Royal Adelaide Hospital on a new site will have greater capacity. There will be 800 beds, compared with the current 680. It will include 60 ICU beds compared to 43, and there will be a 25 per cent increase in emergency capacity. This is really important, because the hospital is pretty well at capacity now.

The new hospital will also have 40 operating theatres and procedure suites that will be equal in size or larger than the largest theatre currently at the Royal Adelaide Hospital. In addition, the new Royal Adelaide Hospital will have the best facilities and contain mostly single patient rooms with ensuites. A rebuilt Royal Adelaide Hospital will still have wards with multiple beds and shared toilet and bathroom facilities, remaining at greater risk for cross-infection. I will just point this out: single rooms aid the management of cross-infection.

The new hospital is the centrepiece of our Health Care Plan and will increase the capacity of the whole health system. We have been upfront about this; we have had the figures on the table for a year and a half. I am happy to provide the Leader of the Opposition and the Deputy Leader of the Opposition with a very detailed briefing of the costs that I have just gone through. I am happy, if they wish to contact my office, to make that briefing available. I made the briefing available to various members of the health profession at the Royal Adelaide Hospital during the week. I have met with a variety of journalists and gone through these briefings. So, if they want to know the facts rather than just make fictional claims in here, I am happy to provide them to the Leader of the Opposition and the Deputy Leader of the Opposition.

This is serious stuff. This is not just about political point-scoring. We have been through this deeply and thoroughly, and we are absolutely persuaded that this is the only viable option for the patients of South Australia as we head into this century. We need more capacity, and we need hospitals which are upgraded because, quite frankly, the infrastructure at the Royal Adelaide Hospital, beyond the shiny surface of the newly redeveloped parts, is falling down. The electrical, water, gas and heating systems are all falling down, and there is no realistic way that they can be upgraded without immense interruption to the running of the hospital. Even if we were to do that, build on the car park and build on other bits of buildings, it would take an enormously long time and, still, at the end of the day, it would not be big enough to meet the needs of our population as we move into the future.

I do not think the opposition has really got it. Our ageing population means there will be increased demand overall on our health system. That is why we are expanding capacity at Flinders and in the north at Lyell McEwin. We also need to expand capacity in the centre, and there is no way you can do that without essentially building a new hospital. I am happy to provide a detailed briefing to the leader and the deputy leader—and any other members of the opposition who would care to—to go through these facts with them.

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