End to medical centre under the microscope: Our letter writers have their say

Several months ago, I wrote to the Western Advocate suggesting the best site for the new hospital was near the airport. It still is!

Orange has a very impressive centre near their airport and medical specialists fly themselves in and out daily.

It seems to make good sense for Bathurst to have a similar arrangement considering most of our specialists already travel here from Sydney or elsewhere.

There's plenty of room for a massive parking area near Raglan!

DESPITE the disappointment of some, the decision not to proceed with the Bathurst Integrated Medical Centre (BIMC) provides an opportunity to establish a health precinct that accommodates a collocated public and private hospital complex.

A 'deliberative democracy' process that brings together community members, health workforce, health care organisations and local and state government should be implemented with the aim of exploring all the options and agreeing on a preferred model.

The agreed model should be put out to tender.

The collocation of public and private hospitals will facilitate local and affordable access to health care services, with the critical mass and synergies required to attract and retain the multidisciplinary health workforce needed to serve the current and future needs of the rapidly growing population of the Bathurst region.

A better understanding of the benefits of collocated public and private health services will help to address the limitations of the current public hospital redevelopment by a health department that 'knows best' and that is reliant on a Clinical Services Plan devoid of broader planning considerations.

The current hospital site is difficult to access. Many find the location extremely steep and this, together with insufficient parking, makes access difficult for the aged, disabled and parents with young children.

The unexpected rise in building costs also means that any improvements will fail to keep pace with our growing and ageing population's demand for readily accessible health services.

RE: Loss of BIMC opens the door for works depot site talks, mayor says (July 1).

I note with some concern the mayor's reported comments about siting an integrated medical centre on the site of the current council works depot.

This site is no more suitable for that use than was the Clancy site, and for the same, and even more, reasons.

Firstly, it is possible that with more severe storms and extreme weather resulting from climate change, the site could become flood prone again, levee banks notwithstanding, as other people have noted.

But worse than that, we immediately see that any doctor, whether specialist or other, any patient, staff member or any other person, especially the sick and the aged, would be forced to use a car or an ambulance to move between the two.

That is not co-location, which is the stated government policy, and apparently the same for both major parties.

So why would any government help with any funding for anything which flies in the face of their policy?

The community needs to be aware of why many people feel so strongly about these issues, and why I have chosen to speak out about them.

Over the past 50 years, my wife and I have spent more time in many hospitals than some of the doctors we have met, and various complications have led to many contacts with some of Sydney and Canberra's leading specialists from time to time; sadly too often.

A specialist friend of mine, away from any hospital, once took the trouble to explain to me, many years ago, why this policy of co-location exists.

It is so that the community - and the doctors - get the very best use of their available time.

He explained that a specialist, after more years of study and training than most doctors, needs to use his/her time as effectively as possible, both to provide the most efficient service to patients, but also to make the money needed to justify the costs s/he has had to pay, and still pays, to maintain that role.

Where hospitals are co-located, as with RPA and Chris O'Brien Lifehouse, Westmead Public and Private, Royal North Shore Public and North Shore Private, even Coffs Harbour Public and the specialists' centre across the driveway, and many others, specialists can move between the hospitals and patients and consulting rooms with the least loss of time (and thus money).

(Yes, we have lived experience with all those hospitals. And with Macquarie and its adjoining specialist rooms. And a few others.)

My friend also explained that specialists make their "bread and butter" income in the public system, but they make the "cream on the cake", which they also need to survive, in the private system.

I will come back to why they may need that extra income.

So, imagine that a specialist surgeon has to fill in just 20 or 30 minutes between procedures in a theatre of a public hospital, perhaps while cleaning takes place.

It is ideal if s/he can use that time to just walk for maybe five to seven minutes to the adjoining private hospital, or their consulting rooms, spend 10 minutes with, or checking on, a private patient, then walk back to the public hospital to carry out the next procedure.

S/he can charge that visit, and the contact, at the rate to which s/he is entitled, and s/he is making effective use of their time, and patient care is improved.

Imagine if that situation arises perhaps five times during a day's surgery work. Where would a doctor, one at the top of the tree, choose to work?

At a co-located hospital complex where they can maximise the use of their time and their earning capacity, or one where they had to go to a car, drive between the facilities, with all the problems of parking at each end, perhaps even having to change clothes?

If Bathurst goes down that path of medical centres a block apart, in our climate, the specialists we need will simply vote with their feet.

They will choose not to come here.

There have been many times when various doctors have visited my wife, in both public and private hospitals, during the day, still in their theatre gear, because that is how those (successful) hospitals are set up.

And before someone objects to the concept of specialists making lots of money, I think we should consider what another friend said to me almost 25 years ago, so at about age 50.

He is a leading orthopaedic surgeon at one of Sydney's largest hospitals, and he said to me then that he would never be able to afford to retire.

He was just finishing raising four children and helping them with their start in life, and he could see the lessening of his clinical skills would come at some stage.

But he said that he had to continue to pay the premium for his Professional Indemnity insurance every year for seven years after ceasing to work, and even at that time, it was $40,000 per year! I have no idea what it might be now.

He knew he simply would not have the capacity to generate that extra amount of money in retirement, over and above his own needs.

The premiums for anaesthetists and obstetricians are apparently even higher.

So we need to help those doctors by providing the types of facilities which they might choose to work in to generate the income they may need.

Thus, many of us feel that our medical centre needs to be located close enough to the public hospital that everyone, not just specialists, can move between the two, in an enclosed walkway in any weather, at any time of the day or night.

And the associated multi-level parking needs to be available to both hospitals, so that people leaving either hospital at the end of shifts do not have to walk on hilly, dark and unsafe streets in all weather conditions.

I say multi-level car parking for two reasons - firstly, the degree of slope that exists all over the adjoining area, and secondly, because we need to avoid the problems now evident at Orange Public Hospital, where many people have to walk literally hundreds of metres in the open before they even get to the hospital.

If their parking were to be in a multi-storey tower, like ours will need to be, then they would only have to walk to the nearest lift, and move up or down to the level to which they need to gain access.

We need it also because of site area restrictions, and it will improve conditions for users in poor weather if properly designed.

But I have another suggestion for the community to consider and it arises from speculation about re-siting the council depot and then seeking expressions of interest from developers.

I suggest that the community form a committee of councillors and interested citizens, to contact private hospital operators, like Ramsay Health, and others, but not developers, and find out from them what it would take for our community to make Bathurst attractive enough for them to develop a private "integrated" medical centre and private hospital in Bathurst.

What do they see as the ideal site? How should all the aspects be configured? And so on.

There needs to be a clear idea of what an operator would need, not what a developer needs, for one of them to establish the service we are seeking.

For example, the ideas I have written about above may be completely at odds with what the operators see that they need at present, or for the future.

I think the whole Zauner fiasco has been a matter of the cart before the horse, and now we have a chance to do differently and better.

FOUR years ago, Bathurst was offered a state-of-the-art multi-disciplinary medical centre by private investors. This centre, the Bathurst Integrated Medical Centre (BIMC) will not proceed as it currently stands.

As prospective tenants of the facility, we feel that this is a huge loss to our town.

It is important for the community to know that in the years we have interacted with the developers, we have found them to be honest and forthcoming in their intentions.

Yes, they are private investors, but they have always demonstrated to us a genuine desire at the heart of their project to provide a much needed health service for our community.

With the support of local health care providers, and Bathurst Regional Council (BRC), an enormous amount of money and time has been invested into an agreed plan that was forwarded to the State Government for approval.

It should be noted that all prospective tenants were satisfied with the CBD location of the development.

BRC then tabled a late request for an additional level of car parking. BIMC were prepared to include this in the development if BRC could contribute an additional $5 million towards this extra parking.

Sadly, BRC is not able to fund this.

If BRC was able to change their position, or if the Local or Federal Members were able to get the State or Federal Governments to make funds available for the extra floor, perhaps the investor would proceed with the Development Application.

This would increase the 330 existing car parks behind the RSL to 740 and Bathurst benefits from more parking in the CBD.

As we understand it, the proposed multi-storey 740 parking facility would have included the following components:

Bathurst deserves a multi-disciplinary medical precinct in the CBD.

BIMC was set to house the private hospital, a general practice, and other critical healthcare services including medical imaging, a pathology service and potentially a pharmacy.

In addition to BIMC's location being well placed for all Bathurst residents in terms of public transport and taxi services, co-locating various healthcare facilities within the BIMC would have fostered collaboration among medical professionals.

Locating hospital services, general practice, specialist clinics, diagnostic services and pharmacy all under one roof enables streamlined patient referrals, interdisciplinary consultations, and comprehensive care.

When doctors, nurses, and allied health professionals work closely together, patient outcomes improve significantly.

A thriving medical precinct attracts investment, stimulates local businesses, and creates jobs. Bathurst faces a shortage of GPs, specialists, and other healthcare professionals.

The BIMC would offer a powerful solution to the challenges of workforce shortages. Providing state-of-the-art facilities attracts new clinicians to the region, and supports them to establish roots in our community to stay long term.

The current private hospital premises are in need of refurbishment, and this project would have allowed them to relocate and reinstate themselves in a modern, fit for purpose private hospital, and expand the already amazing service it provides our community.

As our population grows, having a robust medical centre becomes more and more critical.

We feel very fortunate to be part of a team of health professionals across our town who work hard to provide excellent care to our community, within the constraints under which we work.

The demise of the BIMC development plan has dealt a significant blow, and is a major setback for the town in adequately preparing for the inevitable population growth we face.

Future-proofing medical care in Bathurst is a crucial component of ensuring Bathurst continues to be the thriving, caring community that we know and love.

BIMC represents more than just a building with additional car parking. It's an investment in our health, economy and future.