A report released by the Ministry of Health, highlighting the poor state of some of Whangārei Hospital's assets, doesn't nearly reveal the full truth, Northland District Health Board (NDHB) says.
The report, called National Asset Management Programme (NAMP) commissioned by Minister of Health David Clark in 2018, evaluates older DHB buildings across New Zealand and shows "many acute care facilities and mental health facilities are below modern design standards", Clark said.
Whangārei Hospital overall scores "good" looking at the mean building condition and the mental health units, indicating that while some assets are maintained well, others are in poor condition.
However, NDHB's chief executive Dr Nick Chamberlain paints a much darker picture: "Northland DHB's independent assessments show that Whangārei Hospital is in worse condition than indicated in the NAMP report.
"The mean building condition score in the NAMP report also does not reflect that the worst-condition parts of the main block at Whangārei Hospital that accommodate the most vulnerable patients, including the emergency department and ICU."
The report lists Whangārei Surgical and the Child Health units as well as Te Roopu Kimiora – the mental health and addictions service for youth – among the 24 clinical facilities country-wide and are no longer deemed fit for purpose.
The Whangārei emergency department is among nine EDs across New Zealand assessed, scoring "average".
NDHB adds their laboratory, radiology, the special care baby unit, as well as outpatient areas for ophthalmology, ear nose and throat, dental and audiology to the list of facilities that are no longer fit for purpose.
"Addressing issues with our child mental health facility is a priority," Chamberlain said.
"Community mental health services are currently delivered from four sites around the city, and some are in poor-quality prefab accommodation. Our recommended solution is to co-locate and better integrate these services in a central hub, and we need capital support to achieve this."
NDHB has sought Crown funding to establish a community mental health hub in central Whangārei.
"We are continuing discussions with the Ministry of Health about Crown funding availability for this project, and are expecting an update on this shortly."
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The report further mentions Whangārei's ED as particularly small.
Major problems manifest themselves through infection control issues, lack of privacy for people being treated, and poorly sized and shaped spaces for key clinical work.
The cramped working space imposes safety issues for staff and patients, NAMP says.
"The capacity and configuration of the ED restricts our ability to meet the target of limiting emergency department stays to less than six hours," Chamberlain explained
But while facilities may score poorly, "staff apply best clinical practice to ensure patients are safe and well cared for".
NAMP raises major issues around the children's ward, which fulfils multiple purposes: medical and surgical care, inpatient and outpatient care, along with child protection and mental health cases. Chamberlain confirmed extensive problems with the children's ward.
Both Whangārei's patient administration and pharmacy management score "good" or "very good".
Chamberlain said older clinical facilities weren't expected to score well in the NAMP as guidelines for the sizes of rooms and facilities, layout and available therapeutic space have changed over the past 25 years.
"Northland DHB has been doing a lot of work to address these issues. We have been working with the Ministry of Health and regional DHBs on a master plan for redeveloping the hospital since 2015."
In 2018, NDHB submitted a business case for a full redevelopment of Whangārei Hospital at the cost of over $1 billion. This work was paused because funding was unavailable.
However, after recognising the age and condition of Whangārei Hospital – a significant amount of the hospital is well over 60 years old – the ministry indicated that planning a full redevelopment should resume if steps were taken to address affordability issues.
"In May this year we resubmitted the business case, and the ministry is currently considering it," Chamberlain said.
According to Clark, DHB infrastructure is expected to need $14b in funding over the next decade – the same estimate from two years ago. An extra $2.3b is earmarked for IT upgrades.
In the meantime, NDHB continues to mitigate the issues through smaller projects and other minor property works to ensure the safety and wellbeing of patients and staff.
"Over the last five years, we have also sought smaller capital allocations to address urgent capacity and condition issues at Whangārei Hospital. In October 2018 ministers approved $24 million to enable us to expand theatre capacity, to build a cardiac catheter laboratory and an endoscopy unit.
"There is also funding prioritised in Budget 2019, which will allow us to address issues with paediatrics, the special care baby unit and our laboratory over the next two-three years."