The Health Minister has been warned of a "service failure" risk at the Mason Clinic and told it will eventually need to double in size - despite thousands of KiwiBuilds going up next door.
Waitemata DHB has repeatedly warned the Government about risks stemming from a stalled rebuild programme at the forensic psychiatry unit, while also addressing the long-term future of the Point Chevalier campus.
The 111-bed clinic covers Auckland and Northland and holds people with mental illness or intellectual disability, some of whom are dangerous and have been detained as patients.
Eight years ago weather tightness problems were discovered. Four buildings were repaired, and five more marked for total rebuild. Work last year extended the lifespan of the to-be-replaced buildings by up to five years, but ongoing delays could make that timeframe too tight.
The shrink-wrapped Tanekaha building is first on the replacement list. When that happens, patients from the "next worst affected" Rata building will move in, and so on.
Waitemata DHB chair Kylie Clegg wrote to Health Minister David Clark in March and stressed the situation's urgency, "as the longer its construction is delayed, the longer the Mason Clinic carries the risk of patients and staff in the next worst affected area being put at risk from an unhealthy and unsafe living and working environment".
"Because of the incremental way in which the DHB has been asked to replace the failing buildings, Tanekaha's completion is also holding up the replacement programme as a whole, thus prolonging the health and safety risk," stated Clegg's letter, released under the Official Information Act.
A new building "will allow the repatriation of patients who are currently being housed elsewhere in New Zealand".
The "unacceptable health and safety risk" at the Mason Clinic was also raised by then DHB chair Lester Levy in a letter to former Health Minister Jonathan Coleman in September 2017, and again in a handover letter to Clark in January.
"A number of facilities pose a significant health and safety risk (as a result of significant leaky building problems) that is not tolerable and we urgently need to remediate and redevelop the service. Ongoing delays increase the risk of service failure," Levy wrote to Clark on January 17.
Replacing the Tanekaha Unit was "urgent and pressing", Levy wrote, but satisfying ministry officials on conditions for the release of funding "is further delaying the matter and exacerbating a health and safety risk".
"I would appreciate you looking into this matter with a view to directing officials to streamline and speed up the remaining process for the release of funding."
Unitec had previously asked for the Mason Clinic to move. The DHB rejected that, and has been careful to underline the importance to Clark of the clinic staying put.
Reasons listed in a May 8 briefing included the clinic being accepted by locals. Mental health facilities have been in Point Chevalier since 1867, the DHB noted.
Demand beyond 25 years may require multi-storey buildings on the existing 3.9ha campus, which the DHB said was undesirable for the type of care needed.
"We believe we need to plan for 217 beds for the long-term, nearly double the current number," the briefing notes state.
The DHB told Clark an expanded 6ha campus would cope with growing demand and have other benefits like providing youth forensic inpatient facilities - none currently exist outside of Wellington.
Dr Andrew Brant, chief medical officer and deputy chief executive at Waitemata DHB, said the health and safety risk identified in the documents didn't relate to current conditions at the clinic, but rather what might happen if the rebuild was delayed too long.
"Owing to the need to replace these buildings incrementally and decant patients into new units one at a time, there is a health and safety risk in delays to the process for approving the construction of these replacement units."
There are visual inspections of the buildings at least once a month, and air testing every six months. A new unit, Te Aka, opened in August last year and the DHB hopes to begin construction on the Tanekaha replacement in early 2019.
Housing Minister Phil Twyford in March announced the land at Unitec's Mt Albert campus - 9km from Auckland's CBD - would be transferred to the Crown with the intention of building a community of between 3000 to 4000 homes.
After National's housing spokeswoman Judith Collins asked why the project is beside the clinic, Twyford said "at this time" there are no plans to move the clinic.