The business case included a service profile for the redeveloped RWH. This profile was determined by a service planning review undertaken in 2001-2002 and formed the basis of a facility configuration for the new hospital. The service profile was modeled for 20 years, with the new hospital configuration based on a mid-point of projected activity in 2011.
The service review incorporated service demand modelling and a review of environmental factors including:
• RWH service delivery levels
• service demand projections
• Australian Bureau of Statistics data
• projected RWH market share after the relocation of the Mercy Hospital for Women from East Melbourne to Heidelberg in 2006.
The service review was informed by the following key documents:
• Strategic Service Plan and Model of Care for the Royal Women's Hospital-Final Report 2001
• Strategic Functional Brief Version 6-17 December 2002
• RWH Model of Care-2002-2006.
Consistent with the RWH model of care, service planning allowed for a reduction in the average length of stay for inpatients as it was anticipated that there would be a decrease in overnight stays by non-maternity patients.
The estimated 2011 service profile is shown in Figure 3D.
Figure 3D Estimated service profile for the new hospital in 2011
RWH project service profile | Annual volume |
Maternity separations (i.e., patients treated) | 2 250 |
Deliveries | 5 250 |
Non-delivery separations | 1 000 |
Total multi-day separations | 8 500 |
Same-day separations | 11 100 |
Pregnancy day care centre | 2 700 |
Total adult multi-day and same-day separations | 22 300 |
Source: RWH redevelopment business case, September 2003, p. 73
Care for complex maternity patients, who would have otherwise been admitted as inpatients, was increasingly expected to be provided as 'same day' services through the pregnancy day care centre and other ambulatory areas.
At time of service planning, birth activity at the existing RWH had declined from a peak of 6 657 births in 1996-97 to a six year low point of 4 660 in 2001-02, in large part reflecting national (declining) birth trends at that time.
Since the business case was approved (five years ago) there has been a 20 per cent increase in demand for maternity services at the RWH: from 4 660 women giving birth in the 2001-02 financial year to 6 363 women giving birth in the 2006-07 financial year (albeit still below the 1996-97 peak of 6 657).4
The increase in activity levels from the 2001-02 low point was particularly evident from 2003-04 (5 118 births)-an increase of 8.4 per cent from the previous year (4 721 in 2002-03). We note that this coincided with implementation by the Commonwealth Government of a 'baby bonus' payment from July 2004.
In response to increases in birth activity at RWH and other Victorian public maternity hospitals from 2004 and later periods, DHS developed the Maternity Demand Action Plan (December 2006) to manage maternity demand on a state-wide rather than site specific basis.
The RWH project brief included the requirement for the building design to provide flexibility for the potential future addition of two extra floors on the new hospital. Figure 3E discusses the future flexibility issue and the impact of an unforeseen increase in maternity demand.
Figure 3E Future flexibility in design to facilitate increase in demand
During the past five years, RWH has seen a 20 per cent increase in demand for maternity services. The increase followed a six year low point in birth numbers at the RWH, in large part reflecting national birth rate trends at that time. It has been DHS policy for a number of years to include flexibility in a project brief to design the building with the ability to accommodate future expansion. The new RWH building design incorporated an adjustable roof as well as other design features, which would allow the addition of two extra floors. In light of the increased maternity demand, which became more obvious during It has been DHS policy for a number of years to include flexibility in a project brief to design the building with the ability to accommodate future expansion. The new RWH building design incorporated an adjustable roof as well as other design features, which would allow the addition of two extra floors. However, we saw no evidence of any consideration by DHS during the construction period to exercise the design option to add extra floors. Instead, the increase in maternity demand is planned to be managed using the existing metropolitan health network, and targeted investment in hospitals located in Melbourne's growth corridors. Building the additional floors during the initial construction would have been far more cost effective and less intrusive to the hospital’s operations than expanding in the future. Any short-term savings made by avoiding expansion now, will likely be invalidated by much higher costs in the future, if a decision is made to expand the new RWH. |
Source: Victorian Auditor-General's Office analysis of DHS information.
4 The Royal Women's Hospital Clinical Report 2007, page 9, figure 2, 'Number of women giving birth'.