Hospital assessment report highlights dire problems

A report of an assessment of the condition of hospitals and health systems has been released today.

The National Asset Management Programme for district health boards: Report 1: The current-state assessment

The current state assessment of DHB assets is the first consistent nationwide report on the condition and clinical fitness for purpose of DHB facilities and buildings, with a focus on main hospital campuses and acute care facilities.

The findings are not unexpected given the accumulated under-investment in this area. Over the next decade, DHB infrastructure is expected to require $14 billion in funding.

The more money is needed for growing health needs is not a surprise.

Minister of Health David Clark:  Stocktake of hospital buildings to guide investment

The Government now has the first ever clear and comprehensive picture of the state of New Zealand’s hospital buildings and other assets to help ensure future investment decisions deliver the best health outcomes for New Zealanders.

“Although Governments have known for some time that many of these buildings have serious faults including seismic weakness and weathertightness issues, until now no Government has ever had a comprehensive picture of the state of this vital infrastructure,” says Dr David Clark.

The report, which focuses on older DHB buildings, provides a good foundation for understanding the pressure points.

“It shows site-wide infrastructure is in poorer condition compared to hospital campuses, and many acute care facilities and mental health facilities are below modern design standards.

This was already known. Clark and Labour promised to start building a new hospital in Dunedin in their first term. While demolition has begun on the new hospital site it will be some time before any building begins. The actual new hospital currently isn’t planned to be started for several years (they decided to start on an outpatient block) and the design keeps being downgraded.

Knowing hospital conditions are poor is one thing, dealing with them is another.

Clark’s media release is loaded with self promotion and political point scoring.

RNZ – The state of our hospital facilities: New stocktake paints dire picture

The closest ever look at the country’s hospitals reveals many intensive care units, operating theatres and emergency departments are in “poor or very poor” shape.

“Audits of DHBs found that poor asset management has compromised the quality of long-term plans… The Covid-19 pandemic response also highlighted weaknesses in health sector asset management, notably around the capacity of facilities, sitewide infrastructure, clinical equipment and IT,” the stocktake said.

The Ministry of Health (MOH) admission covers problems with sourcing vital equipment such as ventilators, problems with older negative pressure rooms so poorly designed they compromise infection control, and problems with data systems so old and mismatched they have hampered development of a gold-standard contact tracing system.

‘Poor or very poor’

The stocktake assessed nearly half of the country’s critical care units, focusing on those in 75 older buildings at 31 hospitals, and comparing them to units in five newer blocks.

“As expected, the older units scored from very poor to average, with a poorer range of scores for mental health and intensive care units,” it said.

Out of 32 ICUs, emergency departments and operating theatres, 17 rated as “poor” against nine key measurements of how they were designed.

The South Island’s key operating theatre suites at Christchurch Hospital rated as “very poor”.

Less than a third got an average score, and only 15 percent rated good or very good.

Ward blocks fell far short, too – of 19 looked at, 16 were in poor or very poor shape.

The same went for 15 out of the 24 mental health units assessed – poor or very poor.

To sum up the problems, many of the facilities are too cramped, too dirty – the surface materials such as wood are hard to clean, but also separation of clean and dirty (such as soiled linen) workflows is poor – and too cluttered to keep a safe eye on patients.

At Starship Children Hospital, for instance, its operating theatres are too small and cross infection is a risk.

Six out of 10 intensive care units assessed did not have proper negative pressure rooms – some lacked adequate door seals.

“There appears to be a poor understanding of the [Australasian Guidelines] for negative-pressure rooms, a problem also observed in the intensive care units,” the stocktake said.

Whangārei’s emergency department was only 40 percent as big as it should be.

An upside

The stocktake said the buildings themselves – such as their walls, windows and doors – were mostly in average to good condition.

These ratings, however, were based on self-assessments by the DHBs, which appeared optimistic compared to the independent engineers’ assessments of 166 other buildings, and around which there was greater uncertainty, it said.

However, it showed a long-running lack of asset management by successive health boards, the MOH and governments.

For instance, DHB asset management plans were only introduced in 2009, and long-term plans only from three years ago.

The stocktake showed the 20 DHBs competed on unclear terms for scarce funds, at the same time shelling out money to patch up old gear.

There was a stark example in IT, where a DHBs’ self-assessment was that 90 percent of spending went on trying to keep outdated systems going, like Windows 7.

Fixing it

A 2019 Cabinet office circular demanded DHBs now adhere to better asset management plans.

The stocktake said authorities now had to look at options to improve:

  • Seven mental health units
  • Three emergency departments
  • Five operating theatres suites
  • Five intensive care units
  • Eight inpatient wards

The report said another $2.3b was needed to upgrade hospitals’ “ageing” and “slow” IT systems that frequently failed.

There was danger in rushing the upgrades, with research showing hurried planning of new health facilities “risks poorer long-term outcome”, the stocktake said.

Here is the Executive Summary from report:


As noted in the Health and Disability System Review interim report (2019, p 263), ‘The current state of DHB assets is not good and there is little in the way of long-term planning which can give any confidence that the problem is under control.’ Resources have tended to be directed to managing short-term operational pressures, rather than to plan for and invest in longer-term sustainable solutions, including infrastructure.

And it is not just a matter of remediating the accumulated investment deficit; we need to build the capability to support system transformation, especially as models of care evolve, including the advances in clinical equipment and technology that enable shorter hospital stays and more community-based care. In addition, a growing and ageing population will continue to see increased demand for both hospital and community services.

What did the work find?

The results of the current-state assessment (the review) carried out as part of the NAMP are outlined below in respect of buildings and infrastructure, older clinical facilities and IT. Several factors contributed to the results, including:

  • health sector weakness in asset management
  • the prioritisation of expenditure on operational rather than capital requirements, which has led to a significant backlog of deferred maintenance
  • the demands of rapidly changing health technologies
  • the inability of DHBs to adapt quickly enough to changing demands

Full report:

Click to access national-asset-management-programme-district-health-boards-report-current-state-assessment9june2020.pdf

 

Leave a comment

6 Comments

  1. Alan Wilkinson

     /  10th June 2020

    Mrs Al is scathing of NZ public hospital standards compared with what she was used to in SA’s private systems in the days before the ANC governments there wrecked everything.

    Reply
    • Duker

       /  10th June 2020

      White privilege does that to people

      The way new build hospitals in NZ cant be completed by private contractors close to the schedule , often years late while ‘problems fixed’ means we have lost the ability to build complex stuff.
      Christchurch new main blocks still not open for patients , Greymouth the same.
      Yet 10 years or more ago we could do this.

      Reply
  2. Pink David

     /  10th June 2020

    What a shame we just spent $20 billion locking people in their homes to improve people’s health and protect the hospitals.

    Reply
    • The 306 over 80s who died at this time (306 more than usual for the time) may well have died as a result of the hospitals being closed down, or as the result of the lockdown; stress-related illnesses. It certainly seems possible; that’s a lot of people dying.

      Reply
      • Duker

         /  11th June 2020

        No its not more than usual . Theres around 38,000 deaths per in NZ or 3200 per month.
        Most of course are ‘elderly.’-Four in every five deaths are to people aged 65 years and older. or 2500 per month
        I hear births all babies too.
        Your claims come from death obsessed fantasy land you live in

        Reply
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