‘Hospital still being built’ says Health Minister Clark.

“‘…the new Dunedin Hospital is rock solid.’ he said” ODT 4/4/20.
This having discovered [after buying the land without doing due diligence] that the land is a deep pug swamp requiring enormously expensive deep foundations that may not support an 8-story Hospital.

Still time to rethink what may have been the worst decision for Dunedin this century?

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From: Lee Vandervis <lee@vandervision.co.nz>
Date: Tuesday, 11 April 2017 at 8:45 PM
To: EditorODT <editor@odt.co.nz>, “Nicholas. Smith” <nicholas.smith@xtra.co.nz>
Subject: FW: Hillside Hospital? Opinion piece for ODT

Hillside Hospital?
There certainly are benefits to keeping our new Hospital rebuild in the City centre, since this physical closeness helps synergies with the Medical School. There is also the desire of some Hospital visitors to access shops and facilities found near the existing Hospital.

More generally we like what we are familiar with, with some of us fearing any change, and confusing change with loss.
Change is inevitable however, since Hospitals have become increasingly technological and new Hospital design can look quite different from our current concrete high-rise. New medical technology, better access and a need for restful ‘human spaces’ means that our new Hospital can serve Dunedin and the whole Southern region better, even if it does end up looking quite different.

The premature DCC decision to push for a central-city-only rebuild of Dunedin Hospital was unfortunately made without any staff report and without any information on modern Hospital design. The agenda item was forcibly moved by ex-Labour MP Cr. Benson Pope with an unfortunate, polarising tirade against the Government, accusing Treasury of past “lunatic suggestions”, and saying “Government makes stupid decisions based on stupid treasury advice.” Mayor Cull chimed in, accusing Treasury of always going for “what is the cheapest option”, claiming ‘saving $2 – $3 million on land costs would be soon swallowed up in extra transport costs’, and that rebuilding in the central city was a “complete no-brainer”. Only 3 Councillors voted against, but it would have been at least 4 against if we had known that a $10,000+ election-style leaflet Campaign was planned playing party politics. Cr. Benson Pope inappropriately goaded one naysayer with sarcasm about his National Party connections, and branded the three Councillors (including myself) who voted against as being ‘Tories’, even though it is public knowledge that I voted for Labour candidate David Clark at the last election.

Many modern hospital designs call for a large land area of perhaps 10 hectares allowing low-rise buildings with access to restive outdoor areas, easy close parking and a safer large all-weather helicopter landing area. These modern Hospital desirables are not possible on the current site, even with the addition of a nearby block. Mayor Cull’s $2-$3 million estimate of Central Business District land costs is beyond optimistic, since as an example much cheaper land for the Stadium outside of the CBD was budgeted at $15 million but ended up costing more than $30 million.  Prime Minister English was correct to highlight land cost as an important site consideration. As well as upsetting Government and Treasury leaders, the DCC Hospital campaign will just drive up the price of pricey central city land if there are no other agreed options.

The “SOS Save Our Services” part of the DCC Hospital campaign is misleading by its very name, since all Government and Southern Partnership Group public statements have already assured us that all current services will be retained.

As for “Saving Our Site”, it is a fantastic notion that a modern Hospital can be built on the current CBD site as well as remaining operational throughout the rebuild.  Auckland’s famous Starship Hospital is not in the CBD and neither are Shortland Street, Wellington or Christchurch Hospitals! Even if our existing Ward Block is stable enough to do up rather than rebuild, it lacks the height between floors necessary for modern services ducting alignment, and is set up for shared rooms when private rooms have real advantages such as infection control. The 2015 Harvard Business Review “Better Healing from Better Hospital Design” stated: “When one of two McGill University hospitals in the Montreal region of Canada redesigned its ICU from shared to private rooms, the rate of bacterial infection decreased by more than 50%. The new ICU design also decreased the length of stay by 10%…. When hospitals provide easy access to nature, patients, employees and family members can all enjoy the benefit it provides, including reduced stress, reduced blood pressure, reduced pain and increased pain tolerance, faster recovery times, and, simply, pleasant escape from stressful situations.”

Hopefully Council may yet moderate its narrow demand, and at least accept investigation of other sites. Two sites already owned by the Government are Wakari Hospital, and Hillside Workshops. Both sites are much larger than anything that could be available in the central city and both have good existing transportation and bus access. They both offer much better parking for patients, doctors, nursing staff and visitors, and have potential for quieter cleaner restful ‘human spaces’ in a park-like setting. Neither site is far from the suggested CBD site of Cadburys. My timed drives from Cadburys carpark took 3 minutes to get to the Medical School, 5 minutes to Hillside and 7 minutes to Wakari.

Hillside has particular advantages. It is most easily accessible, next to a major shopping area, large, level, and elevated enough to avoid flooding – even when the DCC pump screens and mud-tanks were blocked.

A new Hillside Hospital would boost South Dunedin development more than detract from central city businesses that already have the University, Polytechnic, Dental School, and Medical School, – all needing more space and parking. The Polytechnic new $60 million building program and the University $230 million building program will add to central pressures.

Building a modern Hospital is much more complex than building a modern hotel, which also takes years to design. We should celebrate our unrivaled wealth of medical specialists and teachers and provide them with the best teaching Hospital possible within achievable budgets, be that centrally located or a few minutes away. To that end it is vital to keep an open mind, especially in an election year by avoiding party-political campaigning, and aspiring to a better new Hospital, not just saving what we have. Decision-makers must wait until all the expert information is gathered to know what is the best kind of Hospital for our future, and then pull together for the best result in the best place.

Cr. Lee Vandervis

Wednesday, 9 October 2019

Ground conditions on hospital site ‘uniformly bad’

By Mike Houlahan

 

A drilling rig operates in Cumberland St outside the former Cadbury factory in August, as engineers conducted ground assessments for the new Dunedin Hospital. Photo: Gerard O’Brien

Some services may be squeezed out of the new Dunedin hospital due to budget concerns, clinicians fear.

Sources have told the Otago Daily Times they are concerned important services could be left out of the buildings due to concerns over a potential overrun in the budget of the $1billion-plus project.

Issues with the inner-city site, particularly concerning the cost of piles to build on reclaimed land, were believed to be concerning hospital planners and behind a bid to reduce the footprint of the new hospital.

Pete Hodgson

Southern Partnership Group chairman Pete Hodgson played down budget concerns and predicted the new hospital would be a similar size to the current one, with more surgical wards and larger emergency and intensive care units.

”Eighteen months ago, the hospital scale had to be reduced by a substantial amount, and we are doing that process again, but clinicians are noticing it more because planning is further advanced and they can see it taking shape,” Mr Hodgson said.

”By the end of stage two of planning, which will be this side of Christmas, we will be in a position to offer a great deal more certainty than clinicians have at the moment, and I think it is the uncertainty that is getting to them at the moment.”

The project’s Clinical Leadership Group, a committee of medical personnel assisting with hospital design, wanted the buildings to work well for patients and provide the services they envisioned, chairman John Adams said.

However, the rebuild project was faced with a ”very complex situation”, and clinical staff were involved in ongoing discussions about the function of their units in the future hospital.

”The crucial thing for us to make sure that when the final design is in, that the design meets the requirements for clinical functioning,” Dr Adams said.

”Design is ongoing, we are at the second of five stages, and it is premature to make a definitive comment on the size of the hospital because there are a number of balls in the air at the moment and it is very difficult to make a definitive comment on where things will land.”

Clinicians and the CLG would continue to raise any issues where they feel the clinical functioning of the hospital might be compromised, Mr Adams said.

”Whatever the size of the hospital, the design and functioning of the hospital needs to meet the clinicians’ view and wishes for how it will work and how the clinicians will work together.”

The new Dunedin Hospital was originally planned to include an eight or nine-storey main inpatient building with a smaller six-storey outpatient and day surgery building alongside, providing about 50 more beds than the current hospital.

Mr Hodgson expected those configurations would remain roughly the same, although final decisions were yet to be made.

Difficulties in building on the hospital site mirror issues faced by the city’s other major construction project on reclaimed land, Forsyth Barr Stadium.

For that build, piles had to be driven through a layer of soft marine silt to reach firmer ground.

The stadium’s 530 piles are at an average depth of 18m, some as shallow as 15m and others as deep as 25m.

In July, further geotechnical testing was done on the hospital site, with drilling down to 30m.

”The foundations will undoubtedly be more expensive; we have been saying that for a year now,” Mr Hodgson said.

”The only good thing about where the hospital is going is that it is uniformly bad, which I understand to be better than unevenly bad. Wherever we put the hospital in the CBD, we would run into that problem.”

The difference in price between foundations on bedrock and on less suitable ground was about 3% of total budget, Mr Hodgson said.

Ministry of Health spokeswoman Michelle Arrowsmith said it had been known for some time that considerable ground works and preparation would be needed.

”There are several ways to manage the ground conditions and we are currently working through the options.”

While the size of the new hospital was still to be finalised, it would be ”significantly bigger” than the 63,000sqm of the current hospital, but smaller than the 105,000sqm proposed in the original master plan, she said.

”The key focus is on getting the new hospital’s functionality right, not the square metres.

”Dunedin needs a hospital that makes more efficient use of space than the current hospital: it needs to be the right size hospital that is affordable in terms of building and running costs, with capacity for future growth.”

mike.houlahan@odt.co.nz

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There goes the Cruise-ship business, and like many related businesses, maybe permanently.

From today’s Economist magazine…

Holed under the waterline
The coronavirus may sink the cruise-ship business

The industry has few friends and its main customers, the elderly, may shun it for good

It seems that the Cruise-ship industry is unlikely to get any government bail-outs, even if that were possible. If the Economist is right, we may never see these elderly spenders and our related businesses in Dunedin again, certainly not this year.

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The commercial construction industry is at risk. NBR article by Russell Lund

“A House of Cards based on cashflow”

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The vertical commercial construction industry is at a precipice. In less than 6 weeks that precipice will crumble and there will be very few, if any locally based larger national main contractors not in receivership or liquidation. Even the most iconic brands are at risk. A very senior figure in construction has described the industry as nothing more than “a house of cards based on cashflow”. Today, Naylor Love CEO Rick Herd reinforced that sentiment by releasing a statement asking for government intervention saying the problem is that vertical construction is low margin and high cashflow. He claimed that many small to medium sized companies are at a high risk of collapse without Government support. However the biggest insolvency risk is to the thinly capitalized largest main contractors. The writer is aware that today startling information prepared by a senior group in the construction sector, was circulated around Government showing the devastating effect of the shutdown. In summary, a larger main contractor turning over $15 million per month would go from earning $600,000 per month margin (ie 4 % net margin which is desirable but rare) to losing $3.9 million per month. The figures allow for the wage subsidy and paying staff at 80%.  There are a number of larger main contractors whose turnover is double, triple and even quadruple this $15 million per month, and consequently will have the same proportional devastation in red ink. Naylor Love as one example are reported to have turnover in excess of $700 million nationally.

The essential problem is that the majority of larger construction firms have very little assets or balance sheet strength, often on the advice of their accountants. There is zero probability that the majority of firms turning over $15 million per month have a spare $3.9 million in cash. Resilience is non-existent, and insolvency is not far behind. To put this into perspective, larger main contractors celebrate when they can achieve 2 % EBITDA for the year, let alone 4 %.

So why is this a big problem?  Because at 2 % EBITDA ($3.6M on $180M turnover) the 4-week shutdown will consume more than the entire margin for a year. If the shutdown is 8 weeks – its 2 years of margin, ie $ almost $8 million that has gone forever: negative cashflow, insolvency and ruin beckon for many.

Adding another layer of stress to the situation, as a result of the judgement against the Mainzeal directors, directors are acutely aware of their personal liability should they allow their company to trade while insolvent, and if the company is insolvent they have no option but to call in the receivers.

Razor thin capitalization is the principal reason that margins remain low in the industry – because the only way firms can achieve an adequate return on capital invested is to minimize the capital invested and maximize the revenue. The effect of this is firms with little or no cash reserves or assets performing projects of $50 million, $100 million and more. The evidence is all around. Myopic project managers and quantity surveyors then advise clients that anyone wanting a return in excess of 3 % is price gouging.

Contractors with more assets, liquidity and balance sheet strength who consequently require a better return are – were – at a significant disadvantage. Contrary to the claims of Mr Herd, a higher proportion of the small to medium companies are better capitalized and generally more conservatively managed than the larger Tier 1 and 2 firms, and will better withstand the shutdown.

However, there is a solution to the impending devastation, and it is simple. Clients and their advisers on major projects must step up and honour their contractual obligations to pay main contractors their delay costs when contracts have been suspended due to the shutdown. This would enable a number of the contractors to at least survive. Most if not all standard forms of contract have terms similar to NZS 3910, the most widely used form of contract which at Section 6.7.1 states “ If the suspension of …the Contract Works becomes necessary, the Engineer shall instruct the Contractor … to suspend the progress.. of the Contract Works”.

It further states that all costs due to the suspension of the work are to be paid to the Contractor by the Principal, by treating the suspension as a variation. This might seem odd or even unfair to the layperson, but as a veteran of many similar disputes, I can absolutely confirm that this is the case. A future article will explore this further.

It is a sad indictment on the ethics of project managers, engineers, and even Crown departments and local bodies, including the Christchurch City Council, who have either not responded, written to contractors refusing to suspend the work or saying before they instruct the suspension of the contract works they want to “negotiate”. In the current climate it is more than sad – it is despicable. If more major contractors collapse, the effect not only on their staff but already severely stressed subcontractors and suppliers will mean financial ruin for many, and no doubt mental health problems and suicides will also result.

Major clients of the construction industry, and especially Crown and local bodies must heed this message:  now is not the time to call in the lawyers to delay, deny and defend indefensible positions.  Clients must look at the bigger picture – the entire viability of the upper end of the sector is in doubt, thousands of livelihoods are at risk, and it is far better to pay some hundreds of thousands now in legitimate delay costs than have a very high risk of contractor insolvency and consequent massive increases in cost bringing in other resources to finish the project. Recent history is littered with such examples where main contractor insolvencies during construction have caused massive increases in final project costs to clients.

There is no doubt that incompetence and mismanagement cuts a wide swathe through the industry, but now is not the time to focus on that. The commercial construction industry is at risk. Listen to Jacinda – if you can’t be kind, at least do the right thing. It’s in your own interests.

Russell Lund

russell@lunds.co.nz

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Stuff now reporting on Covid-19 Mutations

“It does not appear the strains will grow more lethal as they evolve.”

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Eight strains of the coronavirus are circling the globe. They’re giving scientists clues

Elizabeth Weise15:41, Mar 29 2020

Singapore scientists study genes to fast-track coronavirus vaccine

Scientists in Singapore believe they have developed a way to track genetic changes that accelerates testing of vaccines against a coronavirus that has killed more than 16,000 people worldwide. The team hope it can be an important step in fighting the virus.

At least eight strains of the coronavirus are making their way around the globe, creating a trail of death and disease that scientists are tracking by their genetic footprints.

While much is unknown, hidden in the virus’ unique microscopic fragments are clues to the origins of its original strain, how it behaves as it mutates and which strains are turning into conflagrations while others are dying out thanks to quarantine measures.

KATHRYN GEORGE/STUFF

Scientists are tracking eight strains of the coronavirus by their genetic footprints.

Huddled in once bustling and now almost empty labs, researchers who oversaw dozens of projects are instead focused on one goal: tracking the current strains of the SARS-CoV-2 virus that cause the illness Covid-19.

Labs around the world are turning their sequencing machines, most about the size of a desktop printer, to the task of rapidly sequencing the genomes of virus samples taken from people sick with Covid-19. The information is uploaded to a website called NextStrain.org that shows how the virus is migrating and splitting into similar but new subtypes.

Covid-19 has mutated: Should we be more fearful?

Scientists in China claim to have identified two main strains of the coronavirus that is circulating in humans, indicating that the virus is mutating.

While researchers caution they’re only seeing the tip of the iceberg, the tiny differences between the virus strains suggest shelter-in-place orders are working in some areas and that no one strain of the virus is more deadly than another. They also say it does not appear the strains will grow more lethal as they evolve.

“The virus mutates so slowly that the virus strains are fundamentally very similar to each other,” said Charles Chiu, a professor of medicine and infectious disease at the University of California, San Francisco School of Medicine.

The SARS-CoV-2 virus first began causing illness in China sometime between mid-November and mid-December. Its genome is made up of about 30,000 base pairs. Humans, by comparison, have more than 3 billion. So far even in the virus’s most divergent strains scientists have found only 11 base pair changes.

That makes it easy to spot new lineages as they evolve, said Chiu.

“The outbreaks are trackable. We have the ability to do genomic sequencing almost in real-time to see what strains or lineages are circulating,” he said.

So far, most cases on the US West Coast are linked to a strain first identified in Washington state. It may have come from a man who had been in Wuhan, China, the virus’ epicentre, and returned home on January 15. It is only three mutations away from the original Wuhan strain, according to work done early in the outbreak by Trevor Bedford, a computational biologist at Fred Hutch, a medical research centre in Seattle.

On the East Coast there are several strains, including the one from Washington and others that appear to have made their way from China to Europe and then to New York and beyond, Chiu said.

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Otago COVID-19 Welfare Helpline 0800 322 4000

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The helpline is now available to coordinate requests for assistance in relation to emergency food, household good/services and other welfare-type requests for the Otago region.

Dunedin City Council via the Customer Services Contact Centre 03-4774000 will receive calls and log details on behalf of the region.   The after-hours service will also take calls outside DCC operating hours.

The number for members of the public to use is: 0800 322 4000 and will operate daily from 7am to 7pm, from today.

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Quarantine humour for a larf :<)

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No Vaccine or anti-viral yet, but

Medical science has come a long way in the 100 years since the Spanish flu, as many have said.
In my view better hygiene, control of symptoms and understanding how to slow viral spread will ensure that relatively few will die from Covid-19 in NZ because the Arden Government have wisely followed the best Taiwanese containment model.
Not so Africa and many other countries. There is no cure or vaccine yet, and a vaccine lead-time will be long.
The price of containment in NZ is stalling our economy, which will have severe personal limiting effects, unemployment misery, and long-term economic contraction.
I apologise to those offended by the scary view of my previous post which I wrote in reaction to people claiming that Covid-19 is just another flu and that it will be business as usual after the 4 week lock-down.
I believe that we are in for years of economic contraction because major industries like Tourism have stopped, and because the printing of even more money as in the 2008 bail-out spree is unsustainable. Locally, we need to alter our spending priorities now, focusing on what is really necessary.
I am using lock-down time to reassess my personal priorities and to rethink how we might optimise social positives in a contracted economy. We now have lots of technology to build our individual social capital – to share info, skills and support.
A major world positive is the current greening of the planet, allowing much more food to be grown. Happy gardening if you have that option…
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