The funding has run dry for regional Victorian hospital redevelopments as the state government faces historic debt and Melbourne projects are given priority.
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Two major hospital builds at opposite ends of the state - Warrnambool in the south-west, and Albury-Wodonga in the north-east - have been told they will receive no extra money despite strong evidence neither redevelopment will be fit for purpose at its current budget.
'Dead in the water'
The $384 million redevelopment of the Warrnambool Base Hospital is more than a year behind schedule, with the delays and higher than expected construction costs pushing the project well over budget.
ACM raised concerns in November 2023 that the original budget - announced before the COVID-19 pandemic - would still be enough to deliver everything promised in the scope.
Based on construction cost figures from the government's own valuer-general, ACM calculated the project was at least $50 million over budget, with sources saying hospital management was being pressured to cut key items from the scope.
But in March 2024 an anonymous letter from a source close to the project alleged it was more than $100 million over budget, and that the cuts to the scope would be deeper than expected.
All attempts to contact representatives from the builder or the hospital's management, South West Healthcare, were met with silence over fears of legal retribution from the government.
The source said "poor management" and "increased costs" had put the project "dead in the water", with pricing for the $65 million early works coming in at $130 million, twice the allotted budget.
The quantity surveyor for the project - the person in charge of estimating and monitoring costs - had also been fired. The source said there was now "no cost planner on the project".
A government spokesperson insisted the scope of the project had "not changed", but contracts for the project dating from 2021 showed a 120-space underground car park and one third of the new inpatient beds had already been removed from the promised scope.
Additional cuts to a proposed new paediatric unit remain unclear.
While the government has denied changes to the project, it has interrogated both the hospital and the builder in search of the source of the leaked information.
South West Coast MP Roma Britnell said the Health Minister and government were "taking us all for fools" and they needed to "come clean" about the project.
'A dud commitment'
In Albury-Wodonga there has been a series of red flags raised by local experts across the spectrum about the Albury Wodonga Health redevelopment announced in October 2022.
The $558 million project - jointly funded by the Victorian and NSW governments - will redevelop the Albury campus of the health service and transfer a range of services, including maternity, across the Murray River.
But the choice to redevelop the existing hospital flew in the face of extensive consultation and the specialist opinions of doctors, nurses and hospital executives that a new hospital on a greenfield site was the only solution that would meet the future needs of the community.
The Border Medical Association - a large group of concerned local doctors - welcomed the interstate collaboration, but said the plan risked the future health of the community and the funding was woefully inadequate.
What's needed right now is transparency. Our community deserves nothing less.
- Border Medical Association
"What has been announced is not a new hospital on a new site. It is not even a new hospital on a construction site. It is a halfway house with no further commitments to funding a whole hospital," the BMA said in late 2022.
"What is needed right now is transparency. Our community deserves nothing less."
But despite committing just $225 million to the project, the Victorian government has refused to increase the budget or answer questions about the decision making process that overturned the favoured greenfield solution.
Keeping pace with growth?
Similar questions have been raised about the $595 million redevelopment of the Ballarat Base Hospital, despite the project already having its scope and budget increased significantly.
The Ballarat build was originally a $461 million revamp, but had a further $80 million tipped in for a "central energy plant" to power the hospital, then a further $54 million for a new helipad and expanded car parking block.
But a study by Grampians Health - which runs the hospital - revealed demand was growing at twice the rate expected when the redevelopment was scoped.
The study sparked fears the hospital would immediately be back at capacity by the time the project is completed in 2027.
While Grampians Health CEO Dale Fraser said he was confident the new hospital could meet the needs of the community, he conceded it would be "an ongoing challenge" to deal with rising demand. It is uncertain whether the government would commit further funds to the project if it became clear it wasn't fit for purpose.
Where's the funding?
ACM has repeatedly asked the state government why it refuses to commit crucial extra funds to its regional hospital projects.
The government has refused to provide an explanation, but part of the answer is the $126 billion debt it has accumulated through its COVID-19 support measures and extraordinary infrastructure spending in Melbourne.
But ACM also identified a range of hospital builds - almost all in Melbourne - that have had their budgets increased substantially in the past couple of years.
The redevelopment of Frankston Hospital, currently under construction, had an extra $538 million poured into it from when it was announced in January 2021, to when the project was finalised 18 months later in June 2022.
The New Footscray Hospital also had an extra $513 million tipped into it in the 2022 State Budget, bringing the government's commitment to $2 billion.
A new ward at the Royal Children's hospital received an extra $20 million "features to combat the spread of COVID-19 and implement the best hospital design following the pandemic - such as improvements to ventilation, air conditioning systems, engineering services and heating".
ACM asked whether these innovations would be added to regional hospital projects, but the government declined to say.
An expansion to the emergency department at Monash Medical Centre in Melbourne's south-east also had its budget increased 21 per cent by the time it was completed in April 2022.
The redevelopment of the Thomas Embling Hospital has also expanded from a $350 million project to a $515 million build as the scope continues to expand.
The government also revealed a $334 million "variation" to its contract with the project's builders, John Holland, in its 2023-24 Mid Year Update.
A spokesperson said this change to the contract wasn't a "budget blowout" but wouldn't provide any further details regarding the variation.
"Thomas Embling Hospital is a forensic mental health hospital for any Victorian with a serious mental illness in the justice system - not just metropolitan Melbourne - and there is no additional funding being delivered to this redevelopment," they said.