Hawke's Bay hospital. Photo: RNZ / Tom Kitchin
What do you do when you get the promise of a shiny new hospital, when your existing hospital is on very shaky legs?
Hawke's Bay is finding out, with a bandaid called Project Domino to buy time for an ED that is overcrowded, an ICU that is not fit for purpose, and a scanning department that just lost its international accreditation.
Contractors have begun shifting walls around inside the main hospital in Hastings under a $50 million-plus reshuffle, just days after the Bay learned it had, at last, made it on to the government's list for redeveloping regional hospitals.
In fact, it is less a bandaid than construction's equivalent of open heart surgery.
It involves "priority tactical investment projects" for "urgent improvements" to intensive care and the emergency department, earthquake-proof steel inserts, and relief for a radiology department from years of being cramped - if not, however, from the worsening shortages of senior doctors, down to six when it could do with 15 radiologists.
Most of this is still years from delivery - 2027 for a radiology overhaul talked about as urgent since 2018 - though the newly expanded operating theatres are set to open late this year.
It has not come in time to stop IANZ suspending the scanning department's accreditation - the leading objective assurance of safety and quality - in mid-July for five factors, around staffing, wait times, space and IT problems.
The chop had hovered over it for five years, but an inside source told RNZ, "it's better than a year ago so I'm surprised it has been suspended".
Separately, Te Whatu Ora Hospital and Specialist Services interim lead, Chris Ash, told RNZ, "the department has been working so hard, and with some degree of success, on its known challenges".
The install of a new CT scanner by early October "will resolve the most critical equipment risk", he said.
The upgrades across the range of projects cannot come soon enough: An external audit last September obtained by RNZ found the ED, ICU and renal services suffered from "over-crowding, congestion and ED patients receiving treatment in waiting room".
They "remain unsuitable for contemporary clinical care and pose an infection control risk", the audit said.
Cubicles were so cramped "staff were observed raising their arms to allow space for others to attend to the patient".
There were also "patients in beds being cared for in front of the staff desks".
A whistleblower inside the hospital recently raised an alarm. Te Whatu Ora refused to release that to RNZ, saying it would breach the Protection of Whistleblowers Act 2022 as it "might identify" the source.
A lot of the actual care was very good, the audit found, but was compromised by the spaces, or staff stresses.
Away from the coalface, the audit found inadequate quality and risk management systems, and gaps in clinical governance processes.
It came down to "long-term underinvestment in clinical facilities and the needs of a changing population", Ash said in a statement.
ACC, which funds at least half a million dollars of scans at Hawke's Bay, is sticking by the radiologists, though technically it should also pull its funding.
ACC said it had discretion to stick with it while Hawke's Bay tried to get over the bar again, which it aims to with new CT and MRI machines on hand, waiting for the Domino work to allow their install.
The IT system, so vital to getting the reading of patients' scans correct, was gradually on the improve, the source said - though still with significant problems, including around integrating with other central region hospitals.
Domino was "a range of capital projects ... to mitigate the most pressing challenges", Ash said.
However, it does not get around the age old problem of excruciating waits for capital project sign-off - Hawke's Bay also needed better cardiology and cancer services, but the business cases for those developments "are awaiting government consideration", it said.
Centralised handling of multi-million-dollar signoffs for big projects is aimed to speed this up, however, Te Whatu Ora is far off proving that.
The inside source expressed scepticism the new build would make it through at all, saying they had heard it all before.
Weighed against that, others that previously made the regional cut - Nelson and Northland hospitals - have embarked on half-billion-dollar rebuilds recently.
In the Bay, the clinical services survey alone was a "huge piece of work" that took about a year, even before a business case for a rebuild was done, local hospital leaders said. The elevation into the ranks of regional redevelopment provided new money for this.
Local mayors confirmed to RNZ they wrote in April to the health minister, asking about a new hospital.
Central Hawke's Bay mayor Alex Walker said it was good to know now that planning had not proceeded too far along without them.
Hastings' Sandra Hazlehurst said regional leaders had not had a sit-down with Te Whatu Ora yet and needed to.
Big promises are nothing new, from governments or oppositions of all stripes.
In the 2020 election campaign, National promised a half-billion-dollar rebuild for Hawke's Bay. A policy paper at that time said the average age of the hospital's facilities was 50 years, and it was "cramped, ageing and outdated, causing significant issues for patients and staff".
Among the smaller 'dominoes' in the short-term fix that have so far fallen are three Digital Radiography rooms refurbished and new diagnostic equipment installed, the fluroscopy unit replaced, and major software upgrade and minor hardware upgrades to existing MRI machine; a new MRI is on hand to put in once seismic fixes are made.