A leak-prone roof, bad heating system and features similar to those developed for prisons are among the reasons Rotorua Hospital's mental health unit is not up to scratch.
That's according to a recent report into the state of district health board infrastructure nationwide.
The Lakes District Health Board says the unit has been a point of concern for several years and has submitted a $30.7 million business case to fix it.
But this is yet to be approved.
Whare Whakaue is a 12-bed acute inpatient unit providing assessment, treatment, stabilisation and crisis care for adults and older persons with mental illness.
The issues with the unit are highlighted in The Current State Assessment, a report released last month about the state of district health board infrastructure across the country - the first of its kind to be done.
Part of the Ministry of Health's National Asset Management Programme, the report was a measure of a Government focus to improve capital funding decisions, investment plans and asset management.
The Rotorua Hospital main campus was built more than 40 years ago and the average building condition is considered good, with some average to poor aspects.
The report rated the mental health unit as "very poor", identifying a roof prone to leaks. The unit's central and local heating ventilation and air conditioning systems and building management system were rated average to poor.
While the building was generally in an average condition, the report also identified a lack of privacy for recovery and inadequate support for staff and patient communication.
The outdoor area was deemed low-quality, as was the natural light inside the facility, and there was no ability to separate patient cohorts.
The floor-plans were found to be "compromised", as the shared bathrooms took away patient privacy, rooms were undersized and there was a lack of appropriate spaces and access between some rooms.
More than half of the mental health units around the country which were assessed in the report had "features common to designs first developed for prisons".
These features included a lack of privacy, shared bathrooms which created a lack of privacy, a low-quality outdoor area, undersized rooms and lack of appropriate spaces.
A central glass-enclosed staff base gave those in care a sense of being watched as well as no privacy for staff, the report stated.
Dead-end corridors created a risk staff could become trapped with an agitated person.
In response to the report, a Lakes DHB spokeswoman said they were "well aware" the current mental health inpatient unit, Whare Whakaue, was in poor condition.
The spokeswoman said the DHB had been known for years the facility was "suboptimal", which sparked the business case.
The board had spent several years developing a new model of care for mental health across the district, she said.
This informed the design of a new mental health facility pitched in the business case.
"The facility was adequate for its day, but 40 years later is not suitable for delivering contemporary, therapeutic care."
The single-stage business case for the new mental health facility was submitted to the Capital Investment Committee in December 2019 but has not yet been approved.
The improvements would take at least two years to complete once funding was approved.
According to a Mauri Ora newsletter, a Lakes mental health and addictions facility development governance group has been established to oversee the project, led by chief
executive Nick Saville-Wood.
The DHB executive and mental health service staff, consumers, and Ngāti Whakaue, as mana whenua of the Rotorua Hospital site, are represented on the group.
"All clinicians within the Mental Health and Addictions Service recognise that suboptimal facility affects recovery," the spokeswoman said.
She said the design "limits our clinical staff's ability to deliver contemporary therapeutic care in a way that maximises clients' recovery".
She said the facility's ability to accommodate families was limited, which impacted the ability to reintegrate patients into the community.
It had poorly established outdoor areas for patients, limited ability to separate genders or different cohorts of patients and little flexibility to support a range of treatment options.
"Our staff do an excellent job, with immense clinical leadership, to adapt to the needs of clients and the family and whānau in a challenging environment."
Health Minister David Clark said the Government had known for some time many DHB buildings had serious faults but it now had a comprehensive picture of the state of the vital infrastructure.
"The Government has already made a start on fixing the most pressing problems, committing a record $3.5 billion for DHB capital projects in our first three Budgets."
However, the 86-page stocktake of hospital infrastructure puts the fix-it bill at $14b over the next decade.
Both the Rotorua and Taupō hospitals have been redeveloped in the past decade. The Rotorua Emergency Department was redeveloped and expanded from 15 cubicles to 32 in 2012.
New clinics, patient rooms and staff areas, were constructed in the current Elderly Services Centre in 2012.
Work to redevelop Taupō Hospital was done early in 2015. It included a new maternity unit, new radiology area, new outpatient area and main entrance, redeveloped inpatient ward and occupational therapy and refurbished physiotherapy department and day-stay unit.
Existing buildings were also upgraded to meet new seismic requirements.
Clinical buildings are upgraded as clinical needs required and the DHB's financial position allows.
The Current State Assessment said building refurbishments were expected after 25 years and major refurbishment or renewal was expected after 50 years.
About the report
The report looked at three of the hospital's clinical facilities and assessed buildings on patient, staff and visitor safety.
It looked at structural integrity, seismic restraints, the presence and condition of the asbestos and the passive fire separation.
Lakes DHB's facilities gradings
• Mean score on nine design principles for mental health units: Very poor.
• $36 million Ngāti Whakaue building, opened in 2011: heating distribution was poor.
• Ngāti Whakaue building water distribution, some electrical systems: average to poor.
• Geothermal Exchange Plant House building management system, boiler house and computer room: Average to poor.
• Mean score on nine design principles for operating theatre suites: Average.
• Financial management systems: Average.
• Patient administration systems: Average.
• Mechanical infrastructure and mechanical assets condition: Average.
• Clinical portals: Average.
• Operating theatre: Average.
• Mean score on nine design principles for emergency departments: Good.
• Emergency department: Good.
• Electrical infrastructure condition: Good.
• Pharmacy management system: Very good.
• Pharmacy management systems: Very good.