South Australia’s new Women’s and Children’s Hospital (nWCH) has been the subject of extended debate ever since its new site was announced: the heritage-listed Thebarton Police Barracks. But what of the process – and lack of transparency – which led the current government to this controversial site?
This story began in 1801 in France with the establishment of the first children’s hospital, enabling the study of paediatric diseases, development, and nutrition. The first dedicated hospital in Britain for treatment of children, Great Ormond Street Hospital for Children, was created in 1852.
Not long after, the Adelaide Children’s Hospital opened in 1878.
Fast forward to the 1980s, and the South Australian government decided that the State would be better served by closing the Queen Victoria Hospital, which specialised in women’s, maternity, and neonatal health care, and relocating these services to the Adelaide Children’s Hospital. And so, in 1994, the Women’s and Children’s Hospital was born. It remains the only public hospital in Australia where women’s and children’s treatment are co-located.
A key benefit realised by this model was the ability to provide specialist care for newborn babies without transporting them to a different hospital. Perceived savings in administrative and operating costs from combining two hospitals were also a likely motivating factor. The price was the tempering of the environment created to care for children.
Now SA is looking to renew the facilities caring for women and children. The WCH has, like the old Royal Adelaide Hospital (RAH), become unwieldy thanks to the progressive development of buildings on the current site. And, as with any hospital, the challenges of undertaking extensive building work to achieve a holistic upgrade while the facility remains operational are significant.
This was the justification for building a new RAH and now for proposing a new WCH. What is less clear is the rationale behind the selection of a site for the nWCH.
A central location within metropolitan Adelaide is logical, as the nWCH will provide critical care for women and children across the State. A location with good access for emergency vehicles, patients, staff, visitors and contractors also makes sense. However, any benefit provided by proximity to the RAH – touted as essential by proponents of the Police Barracks site – is lost when a direct physical connection (suitable for transferring women requiring critical care) is not achievable.
The report produced by the WCH Review confirms that the initially proposed site to the west of the RAH is the only one that achieves this connection. Two options for this site were considered. Both prevent future expansion of the RAH, provide no room for future development of the nWCH, and are inefficient due to the site’s triangular shape. The site also has no connection to the surrounding green space.
The review considered four alternative locations. These include two options on the Thebarton Police Barracks site plus adjacent Park Lands and two sites in the north-west corner of the city.
All of these sites require the demolition of heritage-listed places. The two city sites involve the purchase of privately owned land and require bridges to connect to the Park Lands and RAH. Where a bridge connection to the RAH is possible, it is too far from the critical care facilities to effectively transfer patients. One of the city sites requires the closure of the western end of Hindley Street and will dramatically increase traffic through the UniSA City West campus. The Barracks site requires the rebuilding of the Port Road Bridge.
Justification for exploring only these sites for the nWHC has yet to be provided. Despite the multiple constraints that these sites present, we are being told that they are the only options for the construction of a new hospital and that if we don’t select one of these options, we are placing the care of women and children at risk. If this is the case, the current WCH, with no direct line of sight to the RAH, also places women and children at risk and has done so for decades. The alternate conclusion is that this claim is scare mongering, and that other undisclosed reasons exist that led to consideration of the identified sites at the exclusion of others.
Another factor that has played into the sites considered is their proximity to current and future research facilities in the biomedical precinct. What has not been acknowledged is that there is no further room for expansion of the biomedical precinct once SAHMRI 2 is completed without building over the rail lines or into the Park Lands. And further loss of Park Lands for privatised use was clearly rejected by the community when the Draft Riverbank Precinct Code Amendment was released for comment.
So, if the Biomedical Precinct is full and the sites already considered have multiple issues, what are the alternatives for developing a nWCH?
One option is to look at alternative sites in the city and inner suburbs that are large enough to accommodate the proposed nWCH and provide room for future expansion. The institute has already identified three possibilities. They are closer to the RAH than the existing WCH, adjacent to the Park Lands, and have no heritage impact.
Alternatives further afield include the West End Brewery and Keswick Barracks. While these sites have heritage places within them, they are large enough to enable hospital development without requiring demolition. Retained buildings could be repurposed as administrative and allied hospital facilities – for example, a Ronald McDonald House. In the case of Keswick, spaces between the buildings could be landscaped to provide green space for patients, visitors and staff. The Brewery site would enable green space along the banks of the Torrens.
These alternative sites also stimulate future development in the surrounding areas, which are predominantly populated with light industrial and service buildings that are empty or coming close to the end of their service life. Construction of the nWCH would create a need for key worker housing, allied health development and businesses to serve hospital staff and visitors. These locations would even provide opportunity for development of a secondary biomedical precinct without the constraints limiting the current North Terrace precinct.
It is true that none of these sites is currently owned by the SA Government. However, governments regularly acquire sites for major projects. If it’s okay to do this for South Road, surely it would be justifiable to secure the best site for the nWCH? It is also true that some sites are in current use. So are the Thebarton Police Barracks and the city sites considered by the WCH Review.
If the purchase of private land is not an option, an alternative pathway would be to develop an extension to the west of the RAH to provide women’s health, including maternity. This would enable connection to the critical care facilities already available in the RAH. Having accommodated women’s health at the adult hospital, the current WCH site could be progressively redeveloped to focus once again on the treatment of children and adolescents. This would allow a child-focused model of care to be the priority.
Newborns requiring critical care could be treated by neonatal specialists at the RAH, eliminating the need to transfer them and allowing them to remain close to their mothers in cases where both mother and child require hospital care post-delivery. However, any future expansion of biomedical facilities would still require an alternative site.
So, where does this leave us?
Can we say with certainty that the best site for the nWCH has been identified? No. Are there other options that merit further investigation? Yes. Will we regret rushing this decision that will result in long term critical infrastructure for the State? Yes.
Further consideration now, to future proof the long-term investment that the nWCH represents, is worthwhile. It would demonstrate real political leadership and mature decision-making on behalf of the community. It would leave a legacy that South Australians can be proud of.