Westmead Hospital
Westmead Hospital is a major 975 bed tertiary hospital in Sydney, Australia, opened on 10 November 1978 by the then Premier, Neville Wran, and guest of honour was former Prime Minister Gough Whitlam. It is the major hospital in western Sydney, managed by Sydney West Area Health Service. Effective from 1 January 2011, Westmead Hospital will form part of the Western Sydney Local Health Network. The hospital serves a population of 1.85m people (43% of the population of Sydney) and is located on one of the largest health and hospital campuses in Australia. In 2008/09, Westmead Hospital provided more than 1.3m occasions of care to outpatients, in addition to 86,392 inpatients. Annually, there are around 14,000 medical operations, in excess of 4,600 births, more than 55,000 presentations to emergency department of which nearly one-third are admitted to hospital. Westmead Hospital is located on the junction of Darcy and Hawkesbury Roads in Westmead, and provides a full range of tertiary medical and dental services except for paediatrics which is serviced by the adjacent Children's Hospital at Westmead, relocated from Camperdown to Westmead in 1995. The Hospital includes a large Dental Clinical School and extensive clinical pathology and medical research facilities. Located nearby are the Cumberland Hospital (providing outpatient and inpatient psychiatric care), a branch of the NSW Coroner's Court, and Westmead Private Hospital, a division of Ramsay Health Care.

History
The history of health service in western Sydney began with a tent hospital established in Parramatta to meet the medical needs of convicts, military personnel, and early settlers in 1789. The hospital at Parramatta saw many changes over the years, firstly in 1818, it was known as the Colonial Hospital and later, in 1897, the hospital was expanded and became known as the Parramatta District Hospital. As population expanded in Sydney's west, the services provided at Parramatta became inadequate to meet demand. The hospital was the first major tertiary referral health centre in outer Sydney. Prior to its exiistence, referral health services were provided in inner-city centres such as the Royal Prince Alfred Hospital, the Prince of Wales Hospital, Sydney Hospital, Royal North Shore Hospital and St Vincent's Hospital. In a speech delivered at the Blacktown Civic Centre, on 29 April 1974, Whitlam stated: In the last Budget we set aside $4 million to proceed with the building of a teaching hospital at Westmead. Though this project has been planned by the ( Askin) NSW State (Liberal) government for six years, that government has informed us that they are unable to spend the money we have provided. Our offer still stands. The money is there. It is up to the NSW State government to use it. Askin eventually accepted Whitlam's offer of funds, however he was no longer Premier at the time of its completion. The final cost was about $175 million. With the establishment of Westmead Hospital on 10 November 1978 (initially known as the Westmead Centre), the role of Parramatta Hospital changed. Acute services were relocated to Westmead Hospital with the Parramatta building continuing to function as the rehabilitation arm of Westmead Hospital. In 1991, all services moved out of the old Parramatta Hospital and in 1995 the building was decommissioned. Westmead Hospital, together with the Parramatta Hospital, was initially governed by a local hospital Board. When local boards were restructured into Area Health Services by the New South Wales state government, Westmead Hospital became part of the Western Sydney Area Health Service, together with Westmead Dental Hospital, Cumberland Hospital (mental health services), district hospitals at Blacktown, Auburn and Mount Druitt. In 2005, the boundaries of the Area Health Services were changed, and Westmead Hospital is now one of two tertiary teaching hospitals (together with Nepean Hospital in Penrith), of the Sydney West Area Health Service. In 2004, a contract worth in excess of $130 million for refurbishment and development of new facilities at Westmead Hospital was awarded to Theiss Pty Limited, a subsidiary of Leighton Holdings Limited. As works were nearly completion in July 2007, NSW Minister for Health, Reba Meagher together with NSW Member for Parramatta Tanya Gadiel inspected the new Women's Health and Newborn Care Centre that provides a new birthing unit, special care nursery and neonatal intensive care unit, 41-bed maternity ward, antenatal and gynaecology inpatient wards and ambulatory care clinics in the one location. It is expected that by 2011, more than 5,000 babies will be born at Westmead Hospital each year. Refurbishment of cancer wards at Westmead Hospital occurred at around the same time. The Westmead Cancer Care Centre is based on the US-style comprehensive cancer centre model which combines cutting-edge services with a patient-friendly approach. Inspeciting the facilities during 2007, Ms Meagher stated: This means that patient care at every level will be organised to ensure smooth transition between hospital inpatient services, community treatment or palliative care as people's care needs change. The co-location of a range of speciality cancer services means patients will be able to receive diagnoses and a range of treatments and rehabilitation without the need to make separate trips. Other facilities to be refurbished under the Theiss contract included facilities for intensive care and renal treatments.

Services
As well as General Wards, there are a range of high dependency wards at Westmead Hospital including a Coronary Care Unit, an Intensive Care Unit, a Special Care Nursery, High Dependency Wards, and a Neonatal Intensive Care Unit. For a full list of service, refer to the table in links below. Westmead Emergency Department is one of the busiest in Australia seeing over 52,000 adult patients annually. It is supported by tertiary specialist services including 24 hour/7 days per week interventional cardiology, trauma services, cardiothoracic surgery, neurosurgery and toxicology. Westmead Medical Research Foundation provides fundraising support and community advocacy for medical research and patient care at Westmead. Westmead Hospital is the base for the New South Wales helicopter operations of CareFlight air ambulance service. Its aircraft and trained medical and operational crews respond to emergencies threatening the life, health and safety of people caused through medical emergency, illness, natural disaster, accidents or mishap. Within Westmead Hospital exists the Trauma Service, which provides research and education of injury prevention, and death statistics.

Waiting lists and controversy
Tensions between Sydney West Area Health Service NSW Health officials and medical staff at Westmead Hospital had been brewing since late 2008 when Westmead's doctors passed a no-confidence motion in Professor Steven Boyages, Chief Executive of Sydney West Area Health Service. Media reports claimed that NSW Health Minister John Della Bosca would intervene in an attempt to resolve a breakdown in relations between doctors at Westmead Hospital and Boyages. Doctors were told the hospital is at least $70 million over its budget allocation and that savage bed and staffing cuts were put into place at Westmead Hospital. During early 2010, it was reported that Westmead Hospital was cancelling surgery at four times the rate the Health Department considers acceptable, and waiting times are so long some surgeons are refusing to add new patients to their operating lists. Contributing factors incllude population growth, a jump in the proportion of emergency admissions from 41 to 45 per cent (between 2009”“2010) of all surgery, the designation of Westmead as a major trauma treatment centre, and the rigid enforcement of unrealistic bed budgets were behind the worsening shortage of beds for non-emergency surgery. In a further glitch, a massive administrative error caused hundreds of cancer patients to be excluded from a waiting list for surgery. According to media reports, staff at Westmead Hospital claim the problem began when the Sydney West Area Health Service NSW Health moved to centralise the hospital's admission bookings. Surgeons working at western Sydney hospitals were told to submit bookings for operations at a central office in Blacktown. But the administration staff were overloaded, couldn't cope and failed to process all the bookings. Amid mounting pressure, Steven Boyages resigned suddenly on 27 April 2010 to take up a new posting as Director of the NSW Clinical Education and Training Institute. Media reports claim that Boyages' tenure at Sydney West Area Health Service was dogged by controversy over debts to suppliers and by dissent among senior doctors and nurses over his management style.

Teaching and research
Since its establishment in 1978, the Westmead Clinical School of Sydney University at Westmead Hospital has been a place of innovation and growth. The Faculty of Medicine is Australia's oldest and largest medical faculty (established as Sydney Medical School in 1856) undertaking teaching and research in health and medicine of international standing. As part of the Western Clinical School, teaching facilities at Westmead form an integral part of education as the largest of the University’s four centres of clinical care in Sydney. The University supported the establishment of research clinicians in all key staff specialist postings at the Hospital in 1978. The Hospital accepted its first dental patients in 1980. The Westmead Hospital Dental Clinical School (now the Westmead Centre for Oral Health) has become a major facility for the Faculty of Dentistry for both undergraduate and postgraduate education and training. Medical research has been taking place at Westmead Hospital since the early 1980s. In 1996, medical research facilities were consolidated through the establishment of the Westmead Millennium Institute for Medical Research (WMI). Initially with just 60 scientists and doctors, the Institute now has over 450 medical research scientists.

Acute Intervention Medicine Aged Care, Neurology and Rehabilitation Allied Health Anaesthetics Brain Injury Rehabilitation Unit Cardiac Services Chronic and Continuing Care Community Education Community Health Services Diabetes and Endocrinology Division of Imaging Emergency Services Endocrinology General Surgery Intensive Care Unit Library, Westmead Hospital Mental Health Neurology Nuclear Medicine & Ultrasound Nursing Ophthalmology Oral Health, Dentistry Pathology Services Patient Education Plastic Surgery Primary Care Public Health and Community Medicine Radiology Rehabilitation Medicine Renal and Transplant Surgery Resident Support Unit Respiratory Medicine Rheumatology Sexual Health Women's Health