The government was warned in 2015 that ageing Canberra Hospital buildings posed safety risks to patients and were in desperate need of major redevelopment.
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A business case was created by KPMG for ACT Health for a $1.2 billion redevelopment of Canberra Hospital that year, spelling out the urgent need to significantly remodel the hospital.
The report said demand for beds at the hospital was outstripping supply and the current infrastructure would not be able to deal with increased capacity needs.
It said parts of the buildings were fire hazards and at risk of failure, and suggested construction begin on the redevelopment by 2016.
The government did not proceed with the redevelopment plans, instead announcing a different project to expand the hospital in 2016.
Construction on that project - the Surgical Procedures, Interventional Radiology and Emergency (SPIRE) centre - is not expected to begin until 2020, with the site of the redevelopment only announced late last year.
Parts of the KPMG business case and a hospital audit report completed in 2014 were obtained by The Canberra Times through freedom-of-information legislation.
But only a small amount of the information in the reports can be revealed after ACT Health quoted a fee of $1715 for the two reports in their entirety.
The business case executive summary said the existing hospital structure was hampering efforts to deliver appropriate models of care, posing a risk to community access to quality, safe health services.
"The existing layout of the [Canberra Hospital] campus is the result of numerous ad hoc projects which have progressively provided additional capacity," the report read.
"As on-campus services have expanded over the past twenty years, piecemeal add-ons to various buildings has resulted in extended patient flows and is impacting on staff efficiencies."
The report used the example of patients moving from interventional suites to the inpatient unit needing two staff to get them between buildings to show the current inefficiencies.
It said unmet demand for beds was already leading to overcrowding and considerably high occupancy rates, meaning quality of care could be compromised and the hospital would continue to perform below national benchmarks.
It cited poor emergency department wait times and above-average rates of staphylococcus infections as results of the ageing infrastructure.
The report also said an increase in the ratio of single-bed rooms and improvements in emergency-department configurations provided by the redevelopment would improve safety and quality.
The report urged urgent action to expand the hospital, warning of many risks that would occur if the project was delayed.
"In addition to patient-care risks, underperformance in key performance metrics may lead to reputational damage," the report's recommendations read.
"The ability to implement new models of care, improve patient flow or embrace new innovative techniques and technologies is not possible within the hospital's existing configuration.
Staff would also likely be lost to other more contemporary hospitals in other jurisdictions.
The building condition audit report, conducted in September, found many assets within Buildings 1 and 12 were either at the end of their useful lives, not compliant with current building codes and hospital standards, or at capacity, with utilities failing.
It recommended a number of assets be urgently replaced.
Building 1 houses the inpatient wards, while the emergency department is in building 12.
"Within the next five years, ACT Health will need to invest a minimum of at least $12 million on Building 1 and Building 12 in maintenance in order to continue operating these buildings," the report said.
The hospital's ageing main switchboard caught fire in 2017, with the government aware it was at risk of failure, leading to the evacuation of about 60 patients.
A Canberra Health Services spokeswoman said there was a proactive approach to managing and maintaining the hospital buildings, as well as building new facilities.
She said the Building Health Services Program, established in 2018, progressed considerable work to plan for the long term health infrastructure needs of the ACT, including the announcement in December 2018 of the location of the SPIRE centre on the Canberra Hospital campus.
"Importantly the [program] included representatives of ACT Health, [Canberra Health Services], Calvary Public Hospital and the Capital Health Network," the spokeswoman said.
"The ACT Government is investing some $100 million in health assets and infrastructure to address identified high and extreme risks across ACT Health properties under the Upgrading and Maintaining ACT Health Assets program."
The spokeswoman said that planning and analysis undertaken after the KPMG report determined that with adequate investment in existing infrastructure and targeted expansions, the hospital campus had sufficient capacity to manage levels of demand in the short to medium term.
"Meanwhile, the government’s commitment to the $500 million Surgical Procedures, Interventional Radiology and Emergency Centre responds to longer term demand issues," she said.
"Other strategies are also used to manage demand for services in the health system, including working closely with other health services providers such as Calvary Public Hospital Bruce and private providers to utilise capacity across the system. "
