An aerial view of the new Royal Adelaide Hospital. Source: SA Health.
An aerial view of the new Royal Adelaide Hospital. Source: SA Health.

Australia’s most expensive building, puts ‘lives at risk’

AS YOU'D expect from walking into what is the most expensive building ever constructed in Australia, the new Royal Adelaide Hospital looks impressive.

Sunlight streams in through huge windows, jagged metal work creating a dappled pattern on the concrete floors, reminiscent of a wooded glade.

For its $2.4 billion price tag, patients and medical staff were promised Australia's most modern medical facility; a paperless building brimming with robots where patients were fast-tracked not on to wards but to private rooms with ensuite amenities.

It was more hotel than hospital.

The fancy entrance foyer of the new Royal Adelaide Hospital (nRAH). Picture: Bianca De Marchi
The fancy entrance foyer of the new Royal Adelaide Hospital (nRAH). Picture: Bianca De Marchi

What they got was a multi-billion dollar debacle which had such a calamitous opening that next month it could be stripped of the accreditation it needs to keep operating, according to the Advertiser.

Eight months after the first patient entered the new facility in Adelaide's CBD, serious problems persist, say people at the coalface.

The new State Government, which took office in March, said bungles at the hospital were "staggering" while parts of the building were "not fit for purpose" and would have to be rebuilt.

Talking to news.com.au, Professor William Tam, head of the South Australian branch of the Australian Medial Association, the peak body for medical practitioners said: "No hospital is an easy project but we need to acknowledge that the nRAH (new Royal Adelaide Hospital) has had a troubled birth."

Others have been less diplomatic. Phil Palmer, General Secretary of the SA Ambulance Employees Association, told news.com.au staff morale was low, the move to the new hospital had been a "recipe for disaster" and lives were being put at risk.

The new hospital is the most expensive building ever constructed in Australia. Picture: Russell Millard/ AAP
The new hospital is the most expensive building ever constructed in Australia. Picture: Russell Millard/ AAP

MORE EXPENSIVE THAN A CASINO

New hospitals are always expensive, due to their hi-tech equipment and specialised areas, but the nRAH is a doozy. Built on old railway sidings, the hospital complex cost almost a billion more than the Australian Parliament and is more expensive than London's Wembley Stadium, Taiwan's landmark Taipei 101 skyscraper or the Bellagio Casino in Las Vegas.

It is the major trauma referral centre for all of SA and Alice Springs as well as regularly fulfilling the same role for western parts of NSW, Victoria and the entire Northern Territory.

Adelaide’s new hospital cost more to build than the Bellagio casino in Las Vegas.
Adelaide’s new hospital cost more to build than the Bellagio casino in Las Vegas.

FUNDAMENTAL PROBLEMS

Since it opened in September, problems have stacked up as fast as ambulances trying to enter the tiny new emergency department (ED).

Two workers were killed during construction. When the doors finally slid open, 18 months late, the lights went out in the middle of operations due to a software failure; duress alarms didn't work and the substandard food was criticised. Some of these were teething issues, for sure, but some were more fundamental difficulties.

Resuscitation rooms in the nRAH, one of the most frantic spaces in any hospital, are too small to be practical, said Prof Tam.

A new way of managing patients promised to speed them through the building rather than having them languish in waiting rooms or in the new, and significantly smaller, emergency department. But the spiffy plan simply didn't work, and the ED soon became cramped with the ill and unwell.

 

The standard of food was one of the first things to get criticised at the new Royal Adelaide Hospital.
The standard of food was one of the first things to get criticised at the new Royal Adelaide Hospital.

ALMOST A 'DISASTER'
Regularly, ambulances became "ramped" up outside as they had nowhere to put their patients. SA Health has had to install industrial fans to blow the exhaust fumes away from patients, the Advertiser reported.

On March 19, things got critical. Bernadette Mulholland, of the Salaried Medical Officers Association, said despite that day being relatively routine, the amount of ramped ambulances was akin to what you might have expected with a plane crash.

"They backed away from implementing a disaster (strategy) right at the last moment," she told The Australian.

Mr Palmer said the problems at emergency stemmed from another dumb decision, the absence of a discharge lounge.

These are rooms where patients ready to leave get officially signed out and wait for relatives. Instead, at the nRAH, otherwise well patients linger in beds that could be used by people in need.

"It's a domino effect. Because the hospital is full, there's nowhere for patients to go from the ED," he said.

"We expressed alarm about a couple of deaths due to long response times because no ambulances have been available because they were either on a job or stuck on a ramp (prior to the opening of the nRAH) and we think it will happen again.

 

The Australian Medical Association’Professor William Tam said all new hospitals are expensive but the nRAH has had ongoing issues since it was opened. Picture: Tom Huntley
The Australian Medical Association’Professor William Tam said all new hospitals are expensive but the nRAH has had ongoing issues since it was opened. Picture: Tom Huntley

"We're at the pointy end where people's lives depend on us and it's frustrating the system has broken which means lives are at risk, it's as simple as that."

SA Health has not responded to news.com.au's questions. But the state government last week hastily opened a discharge lounge, located in a previous meeting room, as an "interim option" to reduce the hospital's bed block. A rebuild of the ED has also been flagged.

Mr Palmer said he had pleaded with ministers to delay the nRAH's opening as it was attempting too much, too soon.

"The government of the day made a mistake of building a new hospital with a new geography, new models of care and a new electronic patient system, and it all happened at once and it was a recipe for disaster."

Ambulances have been “ramping” at the new Royal Adelaide Hospital as there have been times with no beds to move patients to. Picture: AAP Image/David Mariuz.
Ambulances have been “ramping” at the new Royal Adelaide Hospital as there have been times with no beds to move patients to. Picture: AAP Image/David Mariuz.

TOO EXPENSIVE, TOO LATE, TOO SMALL

Prof Tam told news.com.au medical staff were never properly consulted about the building's design: "There were lots of issues raised by clinical staff, but were they listened to?"

He said that because a $400m paperless patient records system hadn't been fully implemented, furniture and trolleys had to be shipped in to house patient notes cluttering up the already small space.

"We want technology and tools to assist our clinicians to do our work, not the other way round. We shouldn't have to cope with a clunky system."

Nurses have said they will ramp up a campaign highlighting the hospital's failings unless the new Liberal government of Premier Steven Marshall comes up with a plan for the nRAH.

Mr Palmer said changes were now urgent: "The current government was highly critical of the way the Labor Party managed the hospital; now the onus is on them to fix it. But it's going to cost quite a bit of money."

Health Minister Stephen Wade, who took up his position in March with the incoming Liberal administration, said minor structural modifications were essential for the resuscitation rooms as they weren't "fit for purpose" and patients were at risk. But, long term, entirely new rooms would have to be built.

"It is staggering that a hospital costing $2.3 billion, that was 17 months overdue and $600 million over budget has resuscitation and trauma rooms that are too small," he said. Labor said he was "playing politics" and should get on with the job.

 

Aerial images of new Royal Adelaide Hospital with the CBD behind. Picture: Ethan Rohloff
Aerial images of new Royal Adelaide Hospital with the CBD behind. Picture: Ethan Rohloff

TRAGEDY

Prof Tam said the tragedy of the nRAH was that, on some levels, it was a great step forward in medical care.

"All the negatives have overshadowed the positives. The hospital is the only one in Australia where every patient has their own room and en suite bathroom and they like that. We have operating theatres that are big multifunctional spaces and it's a delightful new building where clinical doctors and nurses can work together.

"The hospital may not be delivering very well now, but in time it will."

Mr Palmer was less optimistic.

"We're very alarmed at the prospect of this winter. Already the system can't cope and were nowhere near the (ill health) peak," he said.

"We could say 'we told you so' but we'd rather they'd just get it right."

There are no wards at the new hospital. Every in patient has their own room. Picture: Bianca De Marchi
There are no wards at the new hospital. Every in patient has their own room. Picture: Bianca De Marchi
The Emergency Department has been criticised for being too small. Picture: AAP Image/David Mariu.
The Emergency Department has been criticised for being too small. Picture: AAP Image/David Mariu.
Nurses say they will take action unless the hospital’s problems are solved. Picture: Mike Burton
Nurses say they will take action unless the hospital’s problems are solved. Picture: Mike Burton


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