The long and winding road to a new Women & Babies Hospital
Associate Professor Paul McGurgan
AMA (WA) Obstetricians and Gynaecologists Representative
The WA Government performed a volte-face in April 2023 when they decided to change the King Edward Memorial Hospital (KEMH) relocation (aka the new Women and Babies Hospital – nWBH) from the QEII site to Murdoch due to the “significant challenges and risks, … buildability constraints, extended timeframes, and complexity for the other tertiary hospitals located within the QEII Medical Centre (Sir Charles Gairdner Hospital and Perth Children’s Hospital) affecting patients, staff and visitors to site.”
The considerable gaps for patient care in the northern suburbs left by KEMH are proposed to be filled by an expanded Osborne Park Hospital (OPH).
“ The WA Government is in an invidious position with difficult decisions to make, due to decades of poor planning for metropolitan health services, particularly with regards to obstetric and neonatal services.
The conception and early gestation for the nWBH has been fraught, with the collapse of a local co-contractor (global company WeBuild is the managing contractor) adding to the drama, and the proposal for a 10-storey, 140-bed Comprehensive Cancer Centre to be built on the QEII site causing further consternation, given the previous concerns about ‘buildability’.
As the WA Government website for the project had little specific information, it seemed timely for the AMA (WA) to ask the WA Health Department for an update on a range of questions regarding the KEMH and OPH sites.
The following is a response from a WA Health Department spokesperson:
A timeline for closing KEMH, which is governed by the North Metropolitan Health Service, will be developed during the later stages of the project.
Decisions on future governance – and on any changes to existing hospital services – are subject to rigorous planning and consideration by the Department of Health.
Clinical consultation to explore all options for the care of newborns requiring surgery within hours of birth is ongoing.
As part of the nWBH project, OPH will undergo a major expansion of its women and newborn services, which will provide capacity to deliver more than double the number of births.
Following expansion, the hospital will continue to care for women with low-to-moderate risk pregnancies and refer high-risk pregnancies to the State’s tertiary maternity hospital.
The hospital will also continue to stabilise and transfer women requiring emergency care to hospitals with the appropriate facilities and specialist staff to ensure safe, high-quality clinical care is provided.
Further north, Joondalup Health Campus (JHC) currently delivers nearly 3,000 babies each year with capacity to expand, caring for low-to-high risk pregnancies. JHC also provides comprehensive gynaecology services including acute/emergency and elective.
The challenges to date remind me of an Irish joke about a rich American coming back to discover his family’s Irish roots. He ends up getting lost driving through the depths of County Cork. Luckily, he spots an old farmer meandering by the side of the road. The American stops to explain his predicament, and then asks the farmer for directions to Cork city. The farmer looks at him quizzically, scratches his head and says, “Sure, it’s no wonder you’re lost, man… especially if you are starting from here!”
How did we get so lost?
The WA Government is in an invidious position with difficult decisions to make, due to decades of poor planning for metropolitan health services, particularly with regards to obstetric and neonatal services.
“ The vexed issue of critical care (especially surgical) for neonates who require transfer to PCH seems unlikely to be fixed unless Star Trek-style teleporters are invented.
Despite consulting with stakeholders such as clinical staff involved in women’s and newborns services, and both commissioning and being given reports detailing the problems with the proposed relocation of KEMH to Murdoch, the Government seems determined to press ahead with plans that will have long-lasting negative impacts on key aspects of women’s and newborns’ services due to the lack of ‘tri-location’, a concept the WA Health Department’s report acknowledges as international best practice.
Are we being overdramatic?
That depends on your view of the following:
- The proposed nWBH in Murdoch will be a significant boost for the patients and clinicians in the south metropolitan region. The Fiona Stanley Hospital (FSH) tower block was inevitably going to limit obstetric and neonatal capacity – and as there never was a gynaecology ward, emergency gynaecology patients were always poorly served.
- Women with complex gynaecological problems such as cancer (and the health professionals who provide care for them) will be much better served due to having care in a new purpose-built hospital with access to other medical and surgical specialties, radiology (at present KEMH still has no CT scanner!), and other state-of-the-art technology and equipment.
- The vexed issue of critical care (especially surgical) for neonates who require transfer to PCH seems unlikely to be fixed unless Star Trek-style teleporters are invented. Twenty-two kilometres can be a long way, especially on one of the most heavily congested freeways in the country. Despite its mission statement of providing ‘world-class care’, by not tri-locating with the State’s tertiary paediatric hospital, the nWBH will struggle to achieve world-class outcomes for neonates (and be an exception to the models of care provided in every other major Australian city) and other international consensus.
- One of the key reasons for moving KEMH has been the recognition that modern obstetric and gynaecology services should not be standalone. Our patients need and deserve 24/7 on-site critical medical and surgical care, ICU, and interventional radiology. Yet the proposed OPH expansion lacks any provision of 24/7 medical or surgical acute care on site, no emergency department, but will have an HDU/ICU. Regardless of the low/moderate complexity case mix planned for the expanded Osborne Park service, this lack of acute services will inevitably impact on both patient care and patient safety.
- Once KEMH closes, any woman presenting to a Perth metropolitan hospital emergency department in the CBD (i.e. SCGH/RPH) with a women’s-health related emergency such as a bleeding ectopic or miscarriage will need transfer to FSH/nWBH, SJOG Midland or JHC, as there are no plans for an Emergency Department in the expanded OPH. Similar to the travel times for the neonates, you can lose a lot of blood when actively bleeding during a 20-30 minute ambulance transfer.
- It is unclear what will happen to women in the northern suburbs requiring the services of the Sexual Assault Referral Centre.
It seems odd, and yet to be explained, why in 2023 the WA Government can decide that a nWBH cannot be built on the QEII site, yet in 2025 a new-build 10-storey comprehensive cancer centre can be considered on the same campus.
Politics is meant to be the art of the possible. But anyone viewing the WA Government’s plans should ask themselves, is this the best we can offer the women and neonates of our State in 2025 and for the next 50 years? As once built, these system-level problems will affect the care of some patient groups for many decades.