'Impossible task': DHBs warn underfunding means care could be unethical

DHBs say alcohol and drug treatment has been chronically underfunded. New Zealand Herald Photograph by Glenn Jeffrey.

A new regime for treating addicts is so underfunded it risks unethical "revolving door" treatment that could lead to chronic homelessness, seizures and death, DHBs have warned the Government.

In an extraordinary letter to Health Minister David Clark, Auckland's health boards slammed a lack of funding for a law change to give compulsory treatment to the worst drug and alcohol addicts.

Dr Lester Levy, then chair of Auckland, Counties Manukau and Waitemata, wrote of big gaps in alcohol and drug treatment, including respite services – and said the support that is already in place is overburdened.

Clark declined to comment on the letter yesterday, telling the Herald the matter was subject to a budget process.

Levy wrote to Clark in January, just weeks ahead of the substance addiction law starting on February 21.

"Without additional resource those discharged from the legislation are likely to be lost to follow-up, return to homelessness, relapse to chronic substance misuse, become critically unwell or injured, re-present at emergency departments and be readmitted to medical wards or medical detox facilities," Levy wrote.

Cycles of detox and relapse would worsen symptoms of withdrawal, and could have serious medical consequences including convulsions, seizures, hallucinations, extreme anxiety and death.

"To summarise we believe it would be potentially unethical to place people experiencing a chronic relapsing condition and impaired cognitive functioning and/or brain injury under compulsory treatment legislation in the absence of appropriate funded detoxification treatment and aftercare services."

Former Auckland District Health Board chairman Lester Levy. NZ Herald photo Mark Mitchell.

The new substance addiction law allows a third party such as a family member to apply for a person to get compulsory treatment, if it is signed off by a specialist.

It passed under the previous National-led Government and replaced a 1966 law, setting a higher threshold for care and adding greater protections for patients' rights.

Levy told Clark concerns were raised with the previous government at every opportunity.

The claims will add to the debate over health spending. Prime Minister Jacinda Ardern this week responded to mould and asbestos issues at Middlemore Hospital by saying health underspending "is worse than we thought".

National says the Labour Government doesn't have the funds to invest in health infrastructure, after big campaign promises like free tertiary study.

In his letter to Clark, Levy said there was a lack of funded specialist roles needed under the new regime. Before addicts could be sent to the Nova Star national service in Christchurch a comprehensive detoxification in their home DHB was needed.

That process would put more strain on near-full facilities, he said, and significant delays in getting treatment at Nova Star were likely. There could also be reduced availability of treatment services for voluntary patients.

Levy – whose resignation as chair of the DHBs took effect in January – told Clark DHBs faced an "impossible task", leaving them and the Government in "the unenviable position of substantial clinical, organizational and reputational risks".

"It is important to note that this is all in the context of an already overburdened and in our view, chronically under-funded alcohol and drugs sector."

The DHBs called for an immediate funding of specialist roles, and for consideration for "flexibility" to be given around the requirements of the law change in the first 12 months.

Levy also advised Clark a potential solution was to partner with the Auckland City Mission to co-locate detox facilities in its new multi-million dollar redevelopment of its central Auckland premises – a step that would increase regional alcohol and drug treatment capacity by 50 per cent.

Health Minister David Clark. New Zealand Herald Photograph by Mark Mitchell.

The Mission wants a commitment from DHBs to add another floor to the proposed building, Levy wrote, and this would need an early indication of Government support.

Asked what his response to the letter had been, Clark said he had assured New Zealanders that the Government will "fund health better than the previous Government".

"This is subject to a budget process so I'm not in a position to comment further at this stage."

A mental health inquiry announced in January will include addiction services, including the Substance Abuse (Compulsory Assessment and Treatment) Act. The Ministry of Health's director of mental health services, John Crawshaw, has said the ministry will work with the sector to ensure capacity meets demand.

National's health spokesman Michael Woodhouse said, "if Dr Clark agrees with Dr Levy he has it in his power to fix with some of the $8 billion he intends to invest into health."

A spokeswoman for the Waitemata, Auckland and Counties Manukau DHBs said they remained very supportive of the purpose of the new regime.

"We continue to discuss the implementation challenges outlined in Dr Levy's letter with the Ministry of Health and do not have any updates at this time."

Substance addiction law change

• Allows compulsory assessment and treatment of people who have a severe substance addiction and can't reasonably make decisions for themselves. Passed under the previous National Government, the law came into effect on February 21.

• Auckland health boards wrote to Health Minister David Clark to say a lack of funding meant new responsibilities – including specialist roles – would put extra strain on already "overburdened and chronically underfunded" alcohol and drug treatment.

• DHBs warned of delays in treatment for both voluntary and compulsory patients, and people being lost to follow-up and enduring a damaging "revolving door" of detox and relapse.