A study into the Hawke's Bay health system has highlighted numerous pressures and challenges in coming years, both in primary care and for District Health Board services.

The information prepared by Sapere Research Group was commissioned to provide a background into the current state of health services to help inform the DHB's Clinical Services Plan (CSP).

The plan was currently being developed to determine what the health system in Hawke's Bay will look like into the future – what services will be delivered, how they will be delivered and where from.

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In a baseline document Sapere researchers noted that primary care in Hawke's Bay was under pressure from patient ageing and poverty, and that demand would continue to increase.

"The system is increasingly seeing the effects of poverty, adequate/timely access to services and significant unmet need."

This included increasing rates of mental health and addiction issues, family violence and transitory living, and child and adult obesity.

The report noted that feedback from patients and whanau indicated wait times could be long, whether that be for ED, a bed, or specialist services, and there was confusion and frustration for patients with a lack of referral co-ordination and clear communication.

Services reported being stretched too thin across the district and within the hospital, the report said.

"Hospital wards consistently operate with occupancy at or close to 100 per cent .... theatres are full ... nursing staff shortages are reportedly common."

In primary care, increasingly complex healthcare needs required GPs to work long hours exacerbated by increasing administration demands.

"The net result is that it is becoming increasingly difficult for people to enrol with a general practice.

"The practice nurse workforce, essential to the functioning of most practices, is also ageing and feeling equally under pressure."

In the hospital, average length of stay and acute readmissions were higher than for other DHBs, in part due to elderly age and frailty increasing and issues with poverty in the region, and that general medicine struggled to offer a general medical outpatient service.

"Medical wards find themselves bed-locked in the face of winter surges combined with increasingly frail patients."

In terms of the health workforce, the report said staff were ageing with no proactive workforce planning and succession planning in place.

"Staff in some instances face, or are incresingly at risk of, burn out."

In the face of these pressures, however, the report said the DHB was performing well and strived to improve.

"Compared to other DHBs, this DHB makes a good show of service development, service delivery in a sustainable manner, in a field of DHBs which generally are under strain and out of money."

The report noted the Hawke's Bay DHB remained in surplus despite increasing service demands.

Adding to these challenges were the physical environment, with the hospital facilities said to be a patchwork of buildings.

"We suspect nurse rosters are larger than they need to be because of the physical dimensions of wards and patient experience and recovery is much less than what a modern hospital could deliver."

An update on the CSP was included in the agenda for a DHB meeting tomorrow, and report author Ken Foote said although a draft of the plan had been due this month, workload pressures had meant this had to be delayed until June this year.

The draft CSP would then go out for public consultation in August/September, with the final plan going to the DHB for approval in October this year.

When completed, he said the CSP would describe the challenges and opportunities, with high-level options to address those, would give an indication of the strategic direction and important areas for investment, and provide the health sector with a new five-year strategic plan.