Hundreds of documents briefing new Government ministers on key policies have been released. Herald journalists have been analysing the Briefings to Incoming Ministers (Bims). Here we look at the Health Ministry.
Healthcare waiting lists have recently become one of the most prominent complaints made about district health boards, the Health and Disability Commissioner has told the new Health Minister.
The issue is one of a number highlighted by the office of the Health and Disability Commissioner in its briefing to new Health Minister David Clark.
Based on complaints received by the commissioner, there were also issues which needed addressing within the midwifery care, aged care, disability support services, primary care, mental health, workplace culture and leadership and seamless service delivery, the report said.
When it came to wait times, prioritisation schemes had become vital to make sure those patients at greatest risk received timely treatment, the commissioner said in the report.
"Our investigations into waiting list management and prioritisation, although focused on specific service areas within individual DHBs, are likely to provide broader lessons for the sector."
The briefing identified mental health services as the second most commonly complained about service type for district health boards. Mental health service issues made up 11 per cent of complaints to the Health and Disability Commissioner.
Common issues were inadequate risk assessments, discharge planning, service co-ordination, communication with family and the adequacy of services available to consumers with co-existing conditions, the briefing stated.
It also said a number of recent investigations identified issues around midwives' adherence to guidelines about consultation with other medical specialists so the commissioner was engaging with the Midwifery Council on the issue.
Other common issues included fetal monitoring and the interpretation of it, a lack of situational awareness and failure to identify fetal distress, failure to escalate care to senior staff and inadequate communication between lead maternity carers and specialist care, the report said.
Within aged care, common complaints included the recognition and management of deteriorating conditions, communication between providers, provision of dementia care, provision of end of life care and fall management.
The report also identified that complaints about community-based disability support services were rising. Issues included support staff not turning up at the right time, difficult contacting the service and the skill level of support staff.
"These issues are of particular concern for these vulnerable consumers who are reliant on the care provided to them by support staff," the briefing said.
There were also issues within the care provided by GPs which included delayed diagnosis, the follow-up of test results, referral management, use of locums and continuity of care for patients seeing multiple GPs.
Workplace culture and leadership often played a part in services that the commissioner received complaints about, the report said.
Those issues included the impact of hierarchy on junior staff speaking up; the accessibility and support of senior staff; supervision of junior doctors, enrolled nurses and health care assistants; relationships between clinicians and management; and the tolerance and normalisation of sub-optimal practices.
The report noted that transitions of care were particularly prone to error because of inadequate communication, co-ordination and integration during transitions between departments and services. Inadequate documentation during transitions was also an issue which a universal electronic patient record would significantly improve, the commissioner said.
The commissioner welcomed recent announcements signalling an increased emphasis on mental health and addiction issues and said he looked forward to contributing to a review of mental health services and providing input into plans to reinstate the Mental Health Commissioner.
The commission would be writing to the Health Minister shortly to address the issues in more detail, the briefing document noted.