GUEST BLOG: Ian Powell – New hospital building trumps ‘Yes Minister’ hospital without patients

Yes Minister is arguably the funniest British political satire sitcom. There were three series between 1980-84. It was followed by a sequel Yes Prime Minister (1986-88).

The comedy centred largely around the relationship between the fictional Minister of Administrative Affairs Jim Hacker and his Permanent Secretary Sir Humphrey Appleby played by Paul Eddington and Nigel Hawthorne respectively.

The Minister’s private secretary Bernard (Derek Fowlds) was invariably caught in the middle.

One of the most famous episodes involved a newly built hospital. Although it was fully staffed administratively. a government imposed reduction in the recruitment of medical staff meant that there were no patients.

The following brief video clip sums up the hilarious episode: Hospital without patients.

Non-fiction version of Yes Minister: the vertically centralised New Zealand health system way

RNZ Health Correspondent Rowan Quinn: Wow, what a scoop!

Of course, Yes Minister was fictional. Now Radio New Zealand Health Correspondent Rowan Quinn has revealed a believably unbelievable non-fictional similar situation in Auckland (8 April): New hospital building without staff (and patients).

Tōtara Haumaru building (North Shore Hospital): no staff, therefore no patients. How would Sir Humphrey Appleby explain this?       

The new four storey building is part of the Health New Zealand (Te Whatu Ora) owned North Shore Hospital and is dedicated for surgery. Around the same size of Taranaki and Southland public hospitals, it was approved in 2018.

The $300 million facility, with eight operating theatres and accompanying wards providing 150 beds, was always intended to be opened in stages.

The first stage – the ground and first floor – was initially supposed to open last December, then this month and now a vague “mid-year”.

Implementation is supposed to be achieved in stages but, so far, there is not even a “rough date for when the entire facility will be operational.”

I’ve also been advised that there are many design deficiencies through squeezed spaces including no breakout rooms. Not even a tearoom!

The good news is that the lights are on, it is the cleanest hospital building in Aotearoa New Zealand, and the patient mortality rate is zero.

Two huge blunders – workforce and operating budget

There are two interconnected huge blunders that stand out in this non-fictional Yes Minister hospital with no patients.

First, there are no staff. This is not just surgeons, anaesthetists and nurses. Absent staff also includes a range of other critical support staff such as anaesthetic technicians and cleaners.

Sitting behind this is the severe workforce shortages  that have increasingly plagued public hospitals for well over a decade. Responsibility for this rests with the past neglectful political leaderships of National and Labour-led governments.

This has been inherited by the current National-led coalition government. To his credit Dr Shane Reti is the first health minister to recognise, both openly and explicitly, that these shortages have been (and continue to be) a crisis and the biggest threat to public hospitals.

Health Minister Shane Reti: no visible signs of action over workforce crisis

Unfortunately, there is no obvious sign of him focussing on taking the necessary steps to start addressing the crisis. I have discussed this recently in Otaihanga Second Opinion (2 April): Time for health minister to step up.

The second huge blunder in this embarrassing fiasco is that there is not even a hint of an operational budget to run the new hospital building.

The amount of money allocated to run it for the next financial year (1 July 2024-30 June 2025) has yet to be decided.

To the best of my knowledge this is the first time this has happened in major hospital rebuilds, at least not in the last over three decades.

It makes the vague “mid-year” timeframe for the opening of even the first stage of the building ‘pie in the sky’.

The double-blunder debacle also features in a Newsroom published podcast (15 April) by journalist Sharon Brettkelly: The empty surgical hospital that should be slashing waiting lists—not. The journalist who broke the story Rowan Quinn is also interviewed in the podcast.

Defending the indefensible with a “crock of…”

On 15 April Te Whatu Ora’s local leadership based at the former Waitemata District Health Board forwarded its staff a circular which included the defence of the double-blunder. In its words:

An update on Tōtara Haumaru

Many of you are keenly anticipating the opening of Tōtara Haumaru and would have seen it covered in the media this week.

Tōtara Haumaru was originally planned to open to the public in April. This is now expected to be mid-year.

The go-ahead for the build was announced in October 2018 under the then-Waitemata DHB. In the more than five years since, we have moved to a national healthcare system, navigated the demands of a global pandemic and evolved healthcare services to meet the needs of a rapidly growing and ageing population.

The operation of the facility is being reviewed by Health New Zealand in today’s healthcare delivery environment and with a broader, national lens on how we utilise our facilities.

Work is underway on an operational business case to ensure the most cost-effective approach to opening.  The business case will determine the operating budget for Tōtara Haumaru and the initial configuration of staff and services.

As the business case is progressed, we continue to prepare Tōtara Haumaru for its first patients.

The plan is for the building to open in stages with theatres and beds to open progressively as it is scaled-up to full capacity over time. Once we have the right level of work lined up for the facility, staff will come from other areas where planned care work is currently being delivered in addition to recruitment.

We are now well into the commissioning phase with our operational teams focused on getting the facility ‘clinically ready’.  Project and operational staff are working hard to ensure that patient, staff and equipment flows work as planned. Construction continues in some areas; primarily on the third floor.

Delivering a project of this scale is a huge achievement and I am keen that we do not lose sight of that. This will be a fantastic asset for our community and in the provision of healthcare regionally.  I would like to thank our project management, construction, commissioning and clinical teams for their commitment and collaboration as we work through these final stages.

This long ‘explanation’ is best summarised by a description sent to me by a hospital specialist: “What a crock of crap!!”

Where the responsibility should lie

A white elephant? Time will tell

In an earlier email the above-mentioned specialist described the new building as a “white elephant”.

Despite the above-quoted toe-cringing rationalisation it would be wrong to point the finger at Te Whatu Ora’s local leadership.

Flawed decision-making culture incentivised by former health minister Andrew Little’s health restructuring

The more a health system is vertically centralised, as was done by the former Labour government when Andrew Little was health minister, the more decision-making is concentrated in a small, isolated bubble removed from the operational reality of healthcare delivery.

The command and control leadership culture that this fosters guarantees that the quality of that decision-making will decline and the risk of blunders and debacles increases.

Further, when increasing workforce shortages are neglected to the point of crisis, as they were by previous both National and Labour governments, then the greater the likelihood of hospital buildings without staff (and patients).

In other words, the greater the likelihood that Yes Minister transitions from fiction to non-fiction.