Western Australia’s hospital system is once again in the spotlight. Former WA Health director general Neale Fong has been tasked with leading a snap audit and review into the management of hospital maintenance, following growing concerns about the integrity and reliability of the state’s health infrastructure. Speaking with ABC’s Stateline, Fong described the system as being riddled with “missing pieces,” a phrase that has already stirred debate among policymakers, clinicians, and the public.
The review comes at a time when Western Australians are increasingly vocal about healthcare backlogs, emergency department pressures, and delays in elective surgery. Hospital maintenance, often overshadowed by debates about staffing and funding, is now under examination as a key structural weakness.
Why Hospital Maintenance Matters
Hospital maintenance is not merely about fresh paint or replacing broken tiles. It underpins patient safety, infection control, and the continuity of critical services. Issues such as faulty air-conditioning in operating theatres, unreliable backup generators, and outdated plumbing systems have been repeatedly raised in incident reports. In one case, an air-conditioning fault at a Perth hospital forced the cancellation of several surgeries. In another, power interruptions left staff relying on contingency protocols, straining confidence in infrastructure safeguards.
These failures are not isolated. A 2023 Auditor General’s report found that WA hospitals carried a backlog of more than $1 billion worth of maintenance needs, some of which were flagged as high-risk. According to that report, more than 40 per cent of flagged issues had been outstanding for over two years.
The Scope of Fong’s Audit
Dr Fong’s review is being conducted under tight timeframes, with interim findings expected before the end of the year. His team is expected to map not only the backlog of maintenance but also the governance structures that allowed such gaps to persist.
Three critical questions guide the review:
- Is maintenance funding being allocated appropriately? While health receives more than $13 billion annually in WA, only a fraction goes toward capital upkeep.
- Are reporting systems catching issues early enough? Current electronic incident management systems have been criticised for poor integration across hospital sites.
- How is accountability assigned? With multiple layers of contractors, subcontractors, and facility managers, responsibility often becomes blurred.
Fong has already signalled that “line of sight” from frontline staff to senior decision-makers is lacking.
Voices from the Frontline
Nurses and doctors interviewed for the review highlighted practical concerns. Leaking ceilings in wards, unreliable lifts, and slow repair times were recurring themes. One emergency nurse at Royal Perth Hospital described how an ageing oxygen supply line had caused temporary diversions of patients, calling it “a disaster waiting to happen.”
Clinical staff argue that such maintenance failures amplify pressure on an already stretched workforce. “You can roster more nurses, but if the infrastructure is failing, patients still suffer,” said a senior surgeon.
Lessons from Other States
WA is not alone. A 2024 Victorian parliamentary inquiry revealed that 25 per cent of public hospitals in Victoria reported critical maintenance risks. New South Wales has also faced questions after an audit found more than $800 million in unfunded hospital maintenance liabilities.
Fong has emphasised learning from other jurisdictions. “The challenge is not unique to WA. What matters is how quickly we build systems that are proactive, not reactive.”
Political Ramifications
The audit has become politically charged. The WA Government has promised to “act decisively” on the findings, but opposition parties argue that years of neglect cannot be solved with another review. Shadow Health spokesperson Libby Mettam has demanded immediate funding injections rather than “endless audits that highlight what we already know.”
Meanwhile, Premier Roger Cook defended the decision to appoint Fong, describing him as “uniquely placed” to identify systemic blind spots. “Dr Fong understands not just the clinical realities but also the governance challenges,” Cook said.
Public Expectations and Trust
Public trust in WA’s health system has been shaken by high-profile failures, including the tragic death of seven-year-old Aishwarya Aswath at Perth Children’s Hospital in 2021, which exposed systemic communication failures. While that case centred on clinical care, it underscored the broader perception that the health system is under strain from multiple fronts.
A survey conducted by the Australian Medical Association (WA) earlier this year found that 68 per cent of doctors believe hospital infrastructure is below acceptable safety standards. Community advocacy groups, too, have called for greater transparency, urging the government to release maintenance logs and risk assessments to the public.
What the Audit Could Deliver
Experts predict that the review may recommend:
- Ring-fenced maintenance budgets to ensure funds cannot be diverted to other operational areas.
- Mandatory reporting timelines, requiring that high-risk maintenance issues be addressed within six months.
- Centralised data platforms for real-time monitoring of infrastructure failures across all hospital sites.
- Independent oversight, possibly through a standing health infrastructure commissioner.
Such measures would represent a shift from ad-hoc repairs to a more strategic, long-term asset management approach.
The Bigger Picture: Workforce and Infrastructure Together
Health leaders caution against treating maintenance in isolation. The Australian Healthcare and Hospitals Association (AHHA) argues that infrastructure renewal must go hand in hand with workforce planning. “It’s no good fixing lifts if you don’t have enough staff to move patients,” said AHHA chief executive Kylie Woolcock.
Similarly, economists warn that the cost of neglect can outweigh proactive investment. Treasury modelling has shown that every $1 spent on preventive hospital maintenance saves up to $3 in emergency repair and service disruption costs.
Next Steps
Dr Fong’s interim report will set the tone for the government’s next health budget, due in May. With hospitals accounting for nearly 40 per cent of the state budget, any new commitments will require trade-offs elsewhere. Whether the political appetite exists for large-scale infrastructure renewal remains uncertain.
For now, hospital staff and patients are left waiting. What emerges from this audit may well shape the trajectory of WA’s health system for the next decade.
The missing pieces that Dr Fong refers to are not just technical fixes. They are about trust, governance, and the assurance that when West Australians walk into a hospital, the system around them will not only treat their illness but also keep them safe from the very walls and machines meant to support their care.
