Predicted at the time to cost more than $1 billion, the new Royal Adelaide Hospital complex would be built west of the Morphett St bridge, on the city railyards, and would be a signature project of the-then premier Mike Rann’s government.

A week or so later, in June, 2007, Mr Rann and his health minister, John Hill, announced the-then $1.7 billion Marjorie Jackson-Nelson Hospital — named in honour of the popular governor at the time.

The new hospital would replace the RAH and be built on the railyards site, at the corner of North Tce and Port Rd.

In his typically extravagant style, Mr Rann branded the new Royal Adelaide Hospital project “the greatest hospital development in Australian history”. “This is about a transformational hospital development that’s about improving health care across our state,” he enthusiastically declared.

Mr Hill prophetically said the new hospital would trigger a shake-up of the entire public health system, including the relocation of services from Woodville’s The Queen Elizabeth Hospital and the loss of Modbury Hospital’s intensive care section. The Lyell McEwin Hospital and Flinders Medical Centre would be expanded, creating a “spine” of major hospitals in the north, city and south.

“We have to make these changes because we know the demand for health services will keep growing at an astronomical rate,” Mr Hill said at the time.

In his 2016 book, On Being a Minister, Mr Hill said the new name had been needed to defuse traditional rivalry between clinicians at the RAH and QEH. Those at the latter, he had been told, would object strongly to having some key services, including kidney transplantation and intensive care, transferred to the RAH.

Western Australia had named their new hospital after leading doctor Fiona Stanley, so Mr Hill nominated the governor, an Olympic gold medallist and long-term hospital volunteer fundraiser. “Unfortunately, I didn’t foresee the reaction this would generate at the RAH and in the broader community ... Marj, as the governor was known, graciously agreed and then had to endure a couple of years of savage and personal abuse from those who objected to both the name and the changes,” Mr Hill wrote in his book.

The controversial name selection blunted Labor’s political momentum. Selling a new hospital should have been much easier. Critics argued Mr Rann, renowned for political spin, was seeking to use the governor’s good name for his monument. The Liberals, aligned with powerful and influential medical figures, called for the existing RAH to be upgraded. They promoted a new sports stadium for the railyards site. Ultimately, Mr Rann co-opted this plan and morphed it into the extraordinarily successful new $535 million Adelaide Oval.

The Liberals proposed to spend $700 million rebuilding the existing RAH. The first stage would be a new multi-level patient accommodation block, then demolishing old 1960s wards, including the stand-alone East Wing, which would be returned to parklands. “Hundreds of millions of taxpayers dollars will be wasted if the existing hospital is demolished. Instead, we can choose to rebuild those areas of the hospital which are in need of upgrade and provide better, more improved patient facilities and patient care,” said the Liberal “Building the New Royal Adelaide Hospital” policy, released in November, 2009.

Opposition to Labor’s plan for the new hospital, particularly strong among older women, became so vehement that, Mr Hill says, some within Labor wanted to abandon the project before the 2010 election.

Mr Hill argues Labor would have been rightly portrayed as gutless, shameless and panicked had the project been ditched. “History would have judged us poorly, because eventually the RAH would fail. Basic infrastructure would break down. Its inefficiencies, because of ad hoc design decisions made over several generations, would make it more and more expensive to staff and it could never be expanded because of the limited site,” he wrote.

Mr Hill predicted the new hospital would be embraced, just as the controversial tram extension of a decade ago was, and Labor would reap political credit.

But, in the 2010 election, the seeds of Labor’s eventual leadership change the next year were sown when many Labor MPs in safe seats were returned with a substantially reduced majority.

Education Minister Jane Lomax-Smith, a former Lord Mayor, lost her seat of Adelaide with a swing against her of 15 per cent, which some attributed to the RAH controversy.

But Labor pressed ahead with the hospital. Mr Rann, Mr Hill and the-then treasurer Jack Snelling (now Health Minister) announced financial close on June 6, 2011 — little more than a month before the drawn-out leadership coup that resulted in Mr Rann’s replacement by Jay Weatherill that October. “We have fought to secure the future for the Royal Adelaide and, today, we are presenting the people of South Australia with details of the plan to build, finance and then operate and maintain the new hospital for the next three decades,” Mr Rann said.

The agreed capital cost included $1.85 billion for the private partner to design and build the new hospital — a fixed price. Almost $245 million was set aside for state-funded works for upgrading and connecting utilities, key clinical equipment and project management. Labor argued the PPP (public-private partnership) model was $137.4 million, or 4.2 per cent, cheaper than traditional procurement methods.

The annual service payment would start out at $397 million a year over 30 years. This would not start until the new hospital was built and certified as fit for purpose. This was meant to be in 2016, but did not occur until mid-2017 for a, by then, $2.3 billion project. The annual repayment included construction costs, along with maintenance to an “as-new” standard over the 30 years and provision of non-clinical services.

Mr Rann and Mr Hill turned the first sod to start site works for the new RAH in late September, 2011, with less than a month remaining in his premiership. The unprecedented construction project hit some hurdles. The Government in 2015 handed over $34.3 million to the SA Health Partnership consortium building the hospital to settle disputes over contaminated soil and delays. SAHP had been seeking about $75 million.

At the time, Mr Snelling, now Health Minister, said the Government expected to get the keys to the hospital in July, 2016, but would not open it during the flu season. The transition would occur when warmer weather arrived. But relations soured between Labor and the consortium, dragging both into court over plans to fix defects and triggering allegations the Government had deliberately delayed the project because it was not ready to move in.

It is believed the Government, which last year rejected a consortium “cure plan” to finish the build, even threatened imminent plans to terminate the new RAH build contract completely.

Premier Jay Weatherill interrupted his post-Christmas leave and, with the hospital’s opening nine months overdue by January, signed off on a peace deal.

On holidays in Melbourne with his family, Mr Weatherill drove back to Adelaide for the meeting with representatives from the hospital’s six equity investors.

Some of the 15 people had flown from London and New York for the January 19 meeting, at 8.30pm in Mr Weatherill’s Victoria Square office.

They dined beforehand at Georges on Waymouth with SAHP chief Duncan Jewell, chairman James Bramley and board director Mark Balnaves, bracing for a showdown. But an agreement was reached and announced in February.

A 100-page deed provided the framework for the long-awaited completion. As part of the deal, the consortium withdrew all court action against the Government. An independent arbitration process would resolve issues in which the state believed it was entitled to compensation.

This paved the way for technical completion to be announced in March, ahead of a 90-day “facility transition” period involving dress rehearsals of clinical scenarios and other testing. In June, the Government triggered the start of $1 million a day payments for the next 29 years with commercial acceptance of the hospital. The official handover came after 90 days of testing confirmed the hospital was ready to receive patients from September 4.

The delay in commercial acceptance, blamed by the Government on the builder, saved SA taxpayers an estimated $400 million on the $2.3 billion project.

Finally, though, after years of debate and enmity, both parties were celebrating the extraordinary construction project. “This is a stunning piece of infrastructure. It embodies future-proofed design principles to ensure it is able to adapt to the health care needs of the people of South Australia for many years ahead,” said Mr Jewell, whose project consortium is now called Celsus.

Premier Jay Weatherill said the new hospital “has more beds than the current RAH and is at the top of its class when it comes to modern health care”.

The test of time

1841 The Adelaide Hospital opens near the corner of North Tce and Hackney Rd, housing 30 patients with room for an additional 10 beds.

1847 The first inhalational anaesthetic is used.

1856 The second purpose-built Adelaide Hospital opens on the RAH’s present site on North Tce.

1877 Ovariotonomy Cottage opens to remove the ovaries of women suffering “menstrual madness” and nymphomania. It was later used as a theatre and demolished in 1950.

1878 Infectious diseases ward opens.

1884 Outpatient block opens.

1889 Nurse training commences at the hospital.

1891 New operating theatre block opens, work starts on a new wing.

1894 Power struggle between the hospital and government sees a walkout by medical staff in support of nurses.

1899 SA’s first X-ray machine installed.

1901 Telephones installed.

1904 The original hospital building becomes the Consumptive and Cancer Home.

1911 Nurses’ home opens, bathrooms were added later. An indoor pool in the basement could not be drained so, after the fire brigade pumped the water out, it was never used again.

1912 Laboratory of Bacteriology and Pathology opens.

1922 Electricity replaces gas lighting.

1923 Dental hospital opens.

1925 First direct blood transfusion given.

1927 Bice Building opens.

1929 Cancer clinic established.

1937 Neurosurgical clinic established.

1938 Institute of Medical and Veterinarian Science established. Original 1840s hospital demolished.

1939 Granted “Royal” prefix.

1943 Resuscitation Unit and Transfusion Services established.

1946 McEwin Building opens.

1949 Thoracic Surgical Service established.

1951 Urological Unit opens.

1954 A second nurses’ home opens.

1956 Department of Anaesthesia established.

1957 Home wing opens.

1958 A dedicated Paraplegic Unit opens.

1960 First heart-lung bypass operation performed.

1963 Mass demolition of 47 1800s buildings starts to herald a new RAH. Male nurses employed.

1972 Renal Unit established.

1973 Emergency Retrieval Service established, the first in Australia.

1976 Haematology Unit established, CAT scanner installed.

1980 Radiology Unit established, requirement that nurses “live in” lifted.

1985 Drug and Alcohol Unit established.

1989 Australia’s first Acute Pain Centre opens, Hyperbaric Unit established, a national record of 1052 open heart surgeries are completed.

1995 Helipad opens.

1997 25,000th open heart surgery performed.

2002 RAH is a designated centre to look after Bali bombs burns victims in Australia’s best burns unit.

2003 New ED opens, the largest and most advanced in Australia, new critical care unit opens with 33-bed Intensive Care Unit.

2007 Labor Government announces it will close the Royal Adelaide Hospital, replacing it with the Marjorie Jackson-Nelson Hospital on the North Tce rail yards site.

2012 The Burns Unit in the existing RAH is the only unit in the nation to be accredited by the American Burn Association.

2017 The new Royal Adelaide Hospital opens.

Questions and answers

IN one of the most detailed and honest interviews, the heads behind the new Royal

Adelaide Hospital tell you everything you need to know about the $2.3 billion project

This is an edited transcript of a Q&A with Central Adelaide Local Health Network chief executive Jenny Richter (J), New Royal Adelaide Hospital Activation executive director Paul Lambert (P), and director of nursing/ nursing co-director surgery Su White (S), with questions from medical reporter Brad Crouch

In a nutshell, what are the best things about the nRAH (new RAH)?

Jenny Richter: To see the culmination of planning and hard work that has gone in over the last 10 years come to fruition in this beautiful facility, creating the right environment for really good contemporary patient care, with the patient at the centre of care. The best thing is the space, the light, the facilities and environment being created — it is more than a building, it is about the care provided.

Paul Lambert: It’s been about a building, but in the last three months as we’ve got access to the building, you can see the excitement of staff and see staff of the old hospital really taking ownership. There is a sense of pride that is palpable. You can see them taking great parts of existing RAH culture into this new hospital.

And the worst?

P: The thing we struggle with is — we just want to be in there now. It’s taken longer than we would have liked for a range of reasons that have been well documented. There is a sense we are ready to go, we just want to get in there.

We keep hearing about “new models of care” that will benefit patients — can you elaborate specifically on what these are?

J: It’s about the way services are provided. Some of the bigger changes in the new hospital, because of the design we can implement a more seamless experience for the patient going from admission through to discharge. In some cases, for example mental health, we are going to be able to really ramp up direct admission so they won’t need to go to ED, they can go straight to the mental health service if they are known to staff and bypass the ED altogether. That’s a much better service for the patient. For outpatients, the design is consolidated so patients coming in to see three or four different disciplines will be able to see them in the same area rather than going to different parts of the hospital.

You‘ve just mentioned some mental health patients will be able to bypass the ED on arrival. Are there any other patients arriving by ambulance who may bypass the ED?

J: Some cardiology patients will go straight to the catheter lab, known cancer patients will go straight to the cancer unit, as will renal patients.

Su White: Some surgical patients will as well. A lot of work has been done with the ambulance service which means some will be taken straight to an inpatient bed rather than coming through ED to be checked in, or through admissions to be checked in. If they are a known admission, they can be taken straight up to prevent delays.

J: We really acknowledge the partnership with the ambulance service in this. This is a change in their model of care — under normal circumstances they would not go straight to a ward.

I did notice the ED waiting room seems pretty small — is this a consequence of some patients bypassing it altogether and others being swiftly triaged and moved further on?

J: Yes, it’s a combination of factors — one is some patients won’t even go through it, another is that we expect the flow through ED to be faster so waiting times will be smaller.

So you will be seen, triaged and pushed straight through?

J: Yes. One big factor that will influence time is all inpatient rooms are single rooms — if you have an infectious disease, you have to wait in the ED until a single room is available because at the moment we don’t have many of them, but the nRAH is all single rooms so patients can go straight to a room without waiting.

S: The ED has changed their model of care with a Quick Look function as well, so people coming in will be seen by a senior team upfront, which will prevent delays further down because decisions will be made early. If someone presents at the ED, they will come into Quick Look, be seen by a very senior doctor or nursing staff and have a plan very quickly, so that will help with the throughput of the ED.

The 700 overnight rooms are all singles with ensuites, which actually feels a little like a luxury motel — but how do you monitor these patients for emergencies?

S: That’s a change in model of care that nursing has been working on, and allied health as well, looking at intentional rounding — that’s about visualising the patient very frequently and asking specific questions so the patient knows when you are coming back as well. You have very good visibility of your patient. There is a small viewing window with a direct line of sight to the patient from the corridor. It does have blinds for privacy for people who don’t need to be monitored as frequently. We can also cluster people who need high observations in one area so it is very visual, and you can monitor people that way. Every nurse will have a handheld phone and, when a patient rings a bell, that call will go to the nurse’s handheld phone and they will be able to respond from wherever they are.

The inpatient rooms have opening windows and views — was this design to have fresh air and light for medical reasons or aesthetics?

S: It goes to the healing environment, with fresh air, natural lights and also the gardens. There is a lot of research about how this contributes to people’s wellbeing and health.

So it was more than just a feel-good gut feeling, there is medical evidence behind it?

P: The hospital was consciously designed around a good patient experience. All of that research says the things the consumer wants is their loved ones close, to be able to open the window and to have good food. These were some of the principles for the design of the hospital — by having that upfront, it allowed the builder to design the air conditioning around having opening windows. Patients told us they want fresh air, so we designed the air conditioning around that.

S: There is also ready access across all inpatient areas to garden spaces on all floors, so people can go out and enjoy the greenery and fresh air.

The patient rooms have fancy electronic systems for ordering meals and for entertainment. Will pay-TV be free?

P: No — there is a daily charge, as we have at the moment. It’s important to point out a really big function of those bedside devices is clinical access, so clinical staff use the devices to access EPAS (electronic patient records), as well as meal ordering. They are both a patient entertainment system and also the clinical workspace in the room. Interstate, it’s been shown it fosters much greater collaboration between patient and clinician as they write case notes while they are talking to the patient. It ensures things are done with the patient, not to them.

Are there restrictions on visiting hours or numbers of visitors?

P: No and no — within reason.

J: In the ICU, it might be restricted to one visitor at a time.

P: We also will not be encouraging multiple people to sleep on the day bed available in each patient room; it is for single person overnight use. We are not going to have whole families camping out. We will provide bedding, and there will be a small charge for laundering of that bedding which goes to the auxiliary.

We’ve heard about the “Rahbots” (robots) carrying equipment and also transporting meals — will patients see them at all, and will a human deliver their meal?

S: The robots, or AGVs (Automated Guided Vehicles), will collect trolleys with meals and travel in corridors where the public does not travel. Once docked, they will send a message to a patient services attendant who will collect the trolley and deliver the meal. There will still be a human interface.

P: They will also transport linen and stores. It is not just meals, they have a range of delivery functions.

J: It’s a delivery system, it doesn’t do anything else.

I believe there are around 600 car parks for patients and families, is this right, and are any free?

P: There are 2300 car parks across the whole facility, mostly underground, about 600 for patients and families, at charge, except if they have an exemption. We have exemptions for certain classes of patients who might be with us regularly, for example a patient having dialysis three times a week, patients having chemotherapy or radiotherapy every day — we do that already.

When arriving at nRAH, is there any difference if you present as a public or private patient?

J: It doesn’t impact the care they get or where they sit in a queue if they are waiting.

P: We would be strongly encouraging people to use their private health insurance if they have access to that. We would always ask people if they would like to be public or private patient.

But why would I say I have private cover if I face a gap payment for getting the same treatment?

S: You don’t face a gap payment.

None at all?

S: No

So to be clear, you go to the nRAH, you say you are a private patient, and you won’t face gap payments?

S: No, and that’s all explained when you nominate to use your private health insurance. There’s an information brochure given to patients explaining that there is no gap payment.

P: And you get free telly and a newspaper. And your choice of doctor, same as always

Will the nRAH opening put an end to ambulance ramping at the hospital?

S: There is increased capacity in new ED, 70 cubicles compared to 59, with different models of care as well. People are coming in through other entrances apart from the ED — currently they all come through the ED so it is a bit of a funnel. Those other models of care working well should decrease the number of people coming in through the ED. The Quick Look (assessment by senior staff) should assist us with flow as well, and the single rooms as well.

P: Probably the last component of patient flow is the distributed imaging model. We now have a single imaging hub with our MRIs, CAT scanners and normal X-rays. At nRAH, we have five imaging hubs with a dedicated hub for the ED which should reduce queues significantly and the wait we have for access to imaging. This will mean we can get people in, seen, imaged and up to a ward or home in much quicker time. It’s all these things combined. It will take a while to settle in and for those models of care to really be established so we can’t give a guarantee (on ramping), but all these things were considered as part of the design to improve flow through the ED to make sure ambulances are on the road, not sitting in the car park waiting to drop patients off.

How many of nRAH’s 700 overnight and 100 day beds will operate when it opens?

P: We are ready to operate all of those, they are all ready to be used. We are planning to be able to run up to 800 if that’s what we need to do.

We were told not all beds would be open because this was a hospital for the future with room for expansion.

P: We will manage down whatever bed base we need to manage demand as it comes in.

J: It’s seasonal: demand does go up and down quite significantly. It is also about length of stay.

P: We have built 60 ICU beds but will only open 48 on day one, but the rest are there and commissioned and ready to use. The hospital needs to last for 70 years, we want to make sure we don’t fill it up on

day one.

OK, but come September you must have an idea how many beds will be operating?

P: We are ready to open all if needed.

You must have a target though?

P: Our preference is to work to a bed base which is about 660.

S: We have ramp down of the RAH as well so our numbers will reduce so we won’t be moving a full hospital into nRAH — it will start at a lower base and work up, then even out.

While the ED opens on September 5, I understand some outpatient services start on August 14 and some day surgery on August 21 — when specifically will nRAH get its first patient?

P: Technically, 1.30pm on Monday,

August 14, we will have a renal patient in the outpatient department: they will technically be the first real patient in the hospital. We are doing a very limited amount of renal outpatients, just to be able to step through those patient flows.

S: We have day surgery from August 21, we will run one list a day for patients with very low complexity and very low risk. It’s an opportunity to test the theatre space and the admission and recovery space for that area. We have contacted patients already and there is a lot of enthusiasm from patients. So that is all in place and planned to go.

P: We will have a dedicated ambulance crew based at nRAH as part of emergency response — we would normally have a medial emergency team which would answer a Code Blue page, but at nRAH while we are running two hospitals, we will be using SAAS to help us with that. We have had a good practice run with that with our community tours over the past few weeks, where we have had a couple of occasions where we have had to use that on-site SAAS team to help with members of the community who collapsed on those tours. It was a good opportunity to see how the system worked. We are not anticipating we will use the SAAS team during those early services but we have to have that response there ready to go. It means not pulling additional medical from the RAH to sit around on the off chance we might need them.

Are you expecting a “honey pot” effect when the ED opens which has occurred in other new Australian hospitals, with a rush of people drawn to use it and clogging things up?

J: We are prepared for that, it has been experienced in other places and we are well prepared for it.

There was much concern from researchers that there was not enough space in nRAH for even the current clinical trials at RAH, but we are now told space has been found. Where did the extra space come from?

J: The historical expectation was that clinical trials would be done at SAHMRI, for a variety of reasons that hasn’t happened, but it was left out of the planning. In discussions with staff, we have agreed to re-purpose the staff dining room into the clinical trials unit. It will be a multipurpose, purpose-built space to enable clinical trials to really grow and become a very strong part of the hospital.

Are there other places for staff to eat?

J: Yes, there are 25 or 30 staff hubs throughout the hospital. The dining space was at the front of the hospital, a long way from the inpatient area so there was a view a lot of staff would use those staff hubs anyway.

When nRAH was first announced, we were assured all services at the RAH would be at the nRAH, but this is not the case. One that springs to mind is gynaecology: I understand only cancer gynaecology will be at nRAH. What else won’t be there?

S: There is provision for patients with high complexity gynaecology issues to access the nRAH. The service has predominantly moved to QEH but they can still access the nRAH

P: As part of Transforming Health, all the health networks have gone through a process of trying to understand where services should best be run and delivered. In the past three to four years, we have shifted a number of services, for example we have shifted vascular surgery from the QEH and consolidated it at RAH. When the hospital was first planned, all the renal services were at the QEH. They are now based here so there has been some movement of services, but that is all part of the consolidation of services in a big organisation like this. Ten years ago, the service profile of this hospital looked very different to what it is today, as you would expect. So it is not a straight swap. There are some services that we will move to other locations, for example we are working with the Pain Unit at the moment to work out the best location for them, to make sure those patients have access to the right services and that looks like it will be at the QEH.

The RAH eye clinic — it was going to be at Modbury but that was dumped because of transport issues, which suggested it would be back in the city, if not at nRAH. Any suggestion where it will be?

J: Initially there will be services at nRAH, quite a comprehensive outpatient service, prior to finalising planning for where it will go eventually, which we expect will be in the city.

Will EPAS be fully operational when the nRAH opens?

P: EPAS has the potential to be fully operational but we have made the decision to only go with limited clinical functionality on day one. The issue is not EPAS, the issue is our desire to control the number of concurrent changes with staff. There will be limited clinical functionality, and we will be looking to roll it out fairly rapidly after we move, probably in March or April.

Will clinicians still need to use some paper records?

P: They will.

Where will they be stored?

P: They are stored off site at a number of locations. They will be retrieved as needed.

Will that lead to delays?

J: No, for urgent retrievals it will be within an hour. Clinicians still have access to other electronic systems which give them immediate access to information they need.

The last state budget announced major changes in the Transforming Health plans for the QEH which Health Minister Jack Snelling described as a “political decision” and a “backflip”. This included retaining a cardiac catheter lab which I understood was due to be relocated to the nRAH. What does it mean for nRAH?

J: There is a cath lab at the existing RAH which will be relocated to nRAH to make a total of three. For the QEH, we are still working through the implications of the Premier’s announcement as to what the profile of cardiac work will be at that hospital.

So were there supposed to be four cath labs, rather than three, at nRAH, before the decision on the QEH?

J: No, we are not changing that number.

P: The plan for nRAH was always to have three and that has not changed. That’s two new labs and one re-used one from the existing RAH. Plus two electrophysiology labs for a total of five cardiology labs. None of that is dependent on the QEH.

I understand 16 extra ambulances will be rostered on during the September 4-6 transfer of the final 300 or so patients from RAH to nRAH. Are you confident the overall health system is prepared for this transfer?

J: Yes, we are getting more confident as the ramp down goes ahead. The EDs have been relatively stable.

Will extra staff be rostered on at both hospitals at that time to send off patients at one end and receive them at the other?

J: Yes, there is a whole process in place at one end for sending patients and at the other for accepting patients.

Any figures on extra staff numbers at that time?

S: Not really — different areas move on different days so it is fluid, but it will be the required number to ensure safe care at both sites.

P: We are ramping down at RAH which frees up staff capacity for staffing at both sites.

Is there any concern at the Government’s decision to start tram works on Nth Tce during transfer period?

S: It is mainly night works.

J: Minister Mullighan already said they will stop work at the point of the move.

Should people still present to the RAH ED right up until 7am on Sept 5 when it closes?

S: Yes as the ED shuts at RAH, the ED opens at nRAH. When the doors shut there will still be people inside throughout that day being assessed and either being admitted or discharged, but the doors will be shut to new admissions.

SA Health has moved to privatise outpatient radiology at nRAH, and according to the Royal Australian and New Zealand College of Radiologists and the Australian Medical Association, it means our flagship teaching hospital is in danger of losing its radiology teaching credentials. Is that a smart move?

J: The structure of the radiology service needs to include the required levels of access for junior medical staff. Depending on the outcome of the consultation process and the decision the department makes, we will work with whatever the outcome is to ensure the appropriate training and access to imaging experience is provided to junior medical staff.

But you would not want the nRAH to lose its teaching credentials?

J: No we wouldn’t, but I think it needs to be recognised that at the moment the extent of outpatient imaging services here is quite small.

Have you hired a third interventional neuroradiologist yet in light of the two stroke deaths which occurred when both staff INRs were rostered on holidays at the same time?

J: Yes, they have selected an appropriately trained interventional radiologist.

You may recall The Advertiser ran a story revealing 14 RAH heads of departments wrote to SA Health saying outpatient facilities at the new hospital were “woefully inadequate and not fit for purpose”. SA Health CEO Vickie Kaminski subsequently indicated almost 40,000 outpatients now seen at RAH will have to be seen elsewhere. This will be in addition to the approximately 140,000 outpatients seen at the Repat which closes in December. Where will these 180,000 or so outpatients a year not being seen at nRAH or the Repat be seen?

J: We have opened up some additional space in nRAH to accommodate outpatient services they were concerned about, that accommodates the volume that was mentioned. Some small numbers of outpatient services are going elsewhere — Paul mentioned the Pain Unit — and some surgical clinics have gone to the QEH. So through a number of strategies we have created the space. It is a different environment for the doctors to work in, which is part of the change process. Some doctors have been working in very large rooms — at nRAH the rooms are within standards but are smaller, so it is a different way of working.

It still seems to be a lot of outpatients who once went to the RAH or the Repat to fit in elsewhere — where is elsewhere?

J: I think most of the Repat outpatients will go to FMC because that’s where their speciality services will go. We are not taking any speciality inpatient services from the Repat so I would expect most of their outpatient would go to FMC. Once we are in the hospital and have a better feel for the flow of patients, it will give us the opportunity to rejig outpatients as we need to.

Will it soak up the almost 40,000 outpatients that Ms Kaminski referred to?

J: This is 40,000 of the 400,000 we see a year. We are constantly reviewing the need-to-return ratio so, if we can reduce the number of times patients come back after their initial assessment and they can go back to their GP, we can reduce that volume. There are a number of strategies we are putting in place to enable patients to return to their GP rather than having to go back to the hospital, which creates space for new patients.

P: We will have greater access to teleconferencing in the nRAH so there are opportunities for us to develop really good models of care for country health. A big chunk of outpatients come from the country.

J: We have reduced the number of prisoners who come in for outpatient services quite significantly through teleconferencing, which is saving travel time for security guards and creating capacity for us, so there are lots of different strategies.

I understand from Auditor-General documents that the contract under the Public Private Partnership with SA Health Partnership — now Celsus — to design, finance, construct then manage non-clinical services of the facility until 2046 requires annual service payments varying from $396 million a year rising to $478 million by the final year of the contract. I make that a total of around $11.5 billion but am open to be corrected. Given it also covers all non-clinical services, is it good value?

J: It is absolutely good value — a typical PPP enables you to build the hospital all at once. FMC was built in two stages and the third stage was never built, it is where the private hospital is now. If they had used a PPP, the entire hospital could have been built at once. There are lots of advantages in a PPP so I think it is good value.

P: Some of the things to consider when you tally it all up is what Celsus is providing is not only the services but the replacement behind it — the chairs, the trolleys, the cleaning equipment, replacement of the AGVs, paint, carpet, all the stuff that otherwise the state would pay for every year as part of its upgrade budget. It is not just the building and services, it is all the components of the upkeep. At the end of the contract, they have to hand the hospital back to us in the same condition as day one. We get back a hospital which is as good, as shiny, as well maintained as it should be on day one.

Is there anything else you would like to add regarding nRAH that the public should know?

J: It’s a beautiful hospital but it is about the patient care. I think the public will be very happy with it.

S: I’ve worked here (RAH) for 30 years. You think you might grieve about leaving a place but I am so excited to be moving and the memories are in your head. Going to a facility that is so much better for the patient far outweighs anything else — it will be a different world.

P: One thing we will see is how it attracts the best and brightest. It will be a magnet: we will be co-located with SAHMRI, the universities and the Convention Centre. The whole precinct will deliver some amazing outcomes in the next 10 years and the new hospital will be the jewel in the crown of that precinct.