link to page 1 Facilities Brief
•  CMDHB’s portfolio is a mix of owned and leased facilities:  CMDHB owns and manages
$663m (book value) of building and land assets that includes 7 inpatient facilities – Middlemore
856 beds, Manukau Super Clinic 78 elective surgery and outpatient beds and 84 inpatient beds
across community facilities namely Botany,  Otara Spinal Unit, Pukekohe, Papakura, Franklin
Memorial Hospital.  The theatre configuration is 10 elective theatres and two procedure rooms
at MSC and 14 theatres at Middlemore suite for acute and elective procedures.
•  The book value of building and plant assets are $426m that are located on 92 hectares of DHB
owned land with a value of $155m.  CMDHB also delivers care on leased property  across 18
sites1 at an annual expense of est $3.5m.

•  CMDHB Building Portfolio is aged:    The average age of buildings owned by CMDHB is 40
years.  The oldest buildings that support inpatient stays are Colvin built in the 1940s, currently
housing adult rehabilitation and older people services (ARHOP), and Galbraith and Bray built in
the mid-1950s/60s  from which medical, maternity, cancer and surgical services  are delivered.
Al  these buildings continue to provide acute inpatient  services.  Galbraith, in particular, was
scheduled for decommissioning of non-essential clinical services by 2021. It is unlikely this will
occur as there are limited options to increase bed capacity before 2021 as no new builds will be
commissioned or completed in time to replace.  The Consolidated Facilities Stocktake document
provided illustrates the range and risk profile of CMDHB’s buildings.

•  Immediate demand growth means we cannot decant from existing buildings that are
beyond design life as there are no options for acute or inpatient capacity: There are few
options for alternative provision  if CMDHB were to decommission these older buildings.
Regional services could not support the volume and size of demand from CMDHB residents.
Travelling out of  region places additional cost burden on patients. For example, maternity
assessment and birthing of more than 6000 births p.a. have limited options for safe delivery if
Galbraith and Bray were to be decommissioned now.
•  The Board has agreed (28 February) continued use of Galbraith in the short term  to support
meeting immediate acute demand with the aim to open additional beds in time for winter 2018.
This is despite draft findings of significantly less than 25% NBS standards for an IL4 building and
the likelihood that Galbraith will be declared ‘earthquake prone’. Although the Galbraith site is
in a zone that is highly unlikely to experience a major earthquake (SLS2), CMDHB is still required
to comply with public notifications and planning for either remediation or replacement in the
long term. Short term use includes converting Level 5 (currently office space) back to a ward (30
beds) and installation of Intervention Radiology suite.

•  The Board wil  be weighing up the costs and risks of short – medium term remediation
that do not add capacity vs. cost and timing of a potential new build/s that can add
capacity for similar investment:  Currently, a range of remediation issues are being assessed,
options costed and prioritized. This includes rolling seismic assessments (prioritizing Galbraith at
est. $60m) across all buildings, scoping the cost of removing and replacing deteriorating cladding

1 Ref LTIP Valuations as at 2015

on four buildings (est. $37.4m) Scott, Macindoe, KidzFirst and Manukau Super Clinic; asbestos
removal and its management in 3 major buildings est. $6m (Galbraith, Bray and MSC); passive
fire protection  remediation ($2m)  and  assessment of critical building infrastructure  upgrades
(est. $15m) on the Middlemore site (power, gas, water, HVAC, lifts) and Manukau Super Clinic
(power resilience).
•  Remediation cases total up to $123.4m representing an investment that will achieve compliance
and reduce health and safety risk but wil  not add additional capacity. Immediate demand
cases currently in various stages of  decision making are estimated at $56.85m representing
mostly acute capacity – a 2nd catheter laboratory, Galbraith level 1 and 5 refurbishment to add
beds, Gastroentorology Histology and Dialysis unit expansion and additional theatres at
Manukau.
•  The Board wil  be considering the trade off between some of these investments that may enable
compliance with building standards and reducing health and safety risk, against the opportunity
cost of investing in new builds that are likely to meet all those requirements AND add capacity
for same or similar levels of investment. These initiatives are not programmed in the short term
(e.g. Women’s Health Building est. $57m, new Ward Block est $57m).
•  In the immediate term, CMDHB has the following business cases in ‘flight’ at various stages of
decision making:
o  Scott Recladding (CIC has approved, waiting Ministerial sign off)  –  business case to
seek additional funding to secure Downer Construction (bought Hawkins) to reclad Scott
Building (est. $18m in total); and
o  Specialised Rehabilitation  business case (at CIC for sign off to proceed to Detailed
Business Case) –  replacement of Otara Spinal Unit with a new facility based on the
Manukau site.
Key points:
•  CMDHB wil  continue a  flow of capital investment cases that reflect immediate demand
pressures in the short term that are consistent with NRLTIP and cannot be funded from our
own capital budget: CMDHB’s annual capital budget of est $33m p.a. funds the following asset
classes that support the DHBs delivery: Facilities (major and minor works in repairs), IT/ICT (local
and regional contribution to hA) and assets (e.g. clinical equipment).   Appendix 1 outlines the
schedule of cases at various stages of development.  The Immediate demand programme cases
represent investments required to support acute growth in short term – it is CMDHB’s priority
that remediation funding is sought from the centre and funding for capital projects that expand
capacity immediately have first call on capital funding from land sales;
•  The Government should make a decision or establish a process to decide on a new hospital
site and its location in metro-Auckland as soon as possible:  The implications for the Board’s
decision making on long term investment scenarios  are significant. Decision making on new
builds either to replace or add to capacity  may offer a different investment scenario when
weighed up against the cost of remediation.
•  In the short term, we would like the Minister to support current capital bids for Scott Reclad
and also for our Specialised Rehabilitation IBC to proceed to Detailed Business Case.
Appendix 1: Schedule of Capital Requirements (Indicative)

Indicative Facilities Capital Requirements ($m) by CM Health Programme Group
Financial Year (ending 30 June) $m
Indicative
Indicative
Investment Programme & Projects
2016/17
17/18
18/19 - 21/22
22/23+
Subtotals
TOTALS
Approved Standalone Project
Acute Mental Health Inpatient Unit
14.00
27.30
16.70
58.00
Ko Awatea II
2.20
8.60
0.50
11.30
MRI Middlemore
0.30
7.77
0.00
8.07
Approved Standalone Project Total
16.50
43.67
17.20
77.37
Immediate Demand Programme
2nd Catheter Laboratory
7.70
7.70
Galbraith Level 1 Refurbishment
4.80
4.80
Galbraith Level 5 Ward Refurbishment
0.20
0.20
Gastro. Unit Expansion
4.40
4.40
Histology Expansion
1.75
1.75
Kidz First ED (2 Stages)
1.00
5.00
6.00
Manukau Theatre (Interim)
28.50
28.50
Scott Dialysis Expansion
2.70
0.80
3.50
Immediate Demand Programme Total
14.85
42.00
56.85
Remediation Programme
Asbestos Removal
1.50
2.50
2.00
6.00
CM Health Passive Fire Protection remediation
0.50
1.00
0.50
2.00
Galbraith Remediation
10.00
50.00
60.00
General Core Infrastructure Upgrades
5.00
10.00
15.00
Kidz First Building Re-Cladding
7.30
7.30
Manukau Building Re-Cladding
7.30
7.30
Manukau Power Resilience Upgrade
1.00
2.00
3.00
McIndoe Building Re-Cladding
5.20
5.20
Scott Building Recladding
5.92
11.68
17.60
Remediation Programme Total
23.92
89.68
9.80
123.40
Medium Term Demand Programme
Elective Surgery Centre
120.00
120.00
240.00
Manukau Community Dialysis
6.00
6.00
Manukau Infrastructure (New Capacity)
30.00
30.00
Manukau Radiology Hub-Phase 1
21.40
21.40
Middlemore Car Parking
20.50
20.50
New Women’s Health Building
57.00
57.00
Otago Dental School
0.00
Specialised Rehabilitation (Incl. Spinal)
115.00
115.00
Medium Term Demand Programme Total
312.90
177.00
489.90
Community Development Programme
Botany Community Hub OR Regional Sub Acute Bed Capacity
30.00
30.00
Community Central
4.70
4.70
Franklin Health Hub OR New Regional Acute Hospital
54.00
54.00
Mangere Community Hub
20.00
20.00
Manukau Community Hub
15.00
15.00
Otara Community Hub
2.50
2.50
Papakura Community Hub
20.00
20.00
Papakura Community Maternity Unit
10.00
10.00
Community Development Programme Total
52.20
104.00
156.20
Long Term Demand Programme
Harley Gray Stage 2
80.00
80.00
Manukau Outpatients (Phased fit out)
28.60
28.60
Manukau Radiology Hub-Phase 2
10.50
10.50
Manukau Support Services
31.80
31.80
Radiology Department Harley Gray
16.30
16.30
Single Wing Ward Block
57.00
57.00
Long Term Demand Programme Total
224.20
224.20
Indicative Facilities Capital Requirements Grand Totals
16.50
82.44
513.99
515.00
1127.92
Ongoing
healthAlliance
5.00
20.00
25.00
50.00
NZHPL (FPSC & NOS)
2.54
1.50
4.05
Clinical Equipment and Minor Facilities Projects
18.00
72.00
90.00
180.00
Ongoing Total
25.54
93.50
115.00
234.05
ICT Investment Programme (Regional)
Healthy Together Technology
10.30
20.00
25.00
55.30
ICT Regional (provision for Electronic Health Record solution)
28.05
79.65
72.01
179.71
ICT Total
38.35
99.65
97.01
235.01
Indicative Capital Requirements ALL CATEGORIES Grand Totals
16.50
146.33
707.14
727.01
1596.98
Note: The 2017/18 facilities capital estimates wil be further refined as we factor in project start date delays.

Consolidated Facilities Stocktake

Document Outline