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

 

‘Assets’ reveal Lauda Finem-[Deleted as per court order]-Slater links

On assets and teams and Lauda Finem, [Deleted as per court order] and Cameron Slater.

Lauda Finem play with words to try to deny that they are a front for a handful of (nasty) people based in New Zealand.

We will say it once more, for the last time! Lauda Finem is a foreign based blog, it is not and never has been based in New Zealand or any of it’s territories.

Everything LF publishes we do so quite legally, no different to any other foreign news source. Moreover LF is NOT a party to any legal proceeding in New Zealand whatsoever, nor is any member of team LF, again all members live outside New Zealand, always have, always will. Nor will we be the subject of defamation proceedings in the future as absolutely everything published on LF is the TRUTH, as distasteful as that may be to those who have featured on LF

In typical irony they claim “absolutely everything published on LF is the TRUTH” immediately after telling a big porky.

They may claim that ‘team LF’ is just Antony Nottingham (ok, they don’t admit that but also don’t deny it) and their  New Zealand based operators are not members but ‘assets’.

Here’s an example of Lauda Finem referring to their ‘assets'”

Funnily enough when we had one of our assets point out Fishers mistake to Slater and tweeted it during the lunch break Slater got stuck into Fisher.

From BLOMFIELD v CAMERON SLATER – POT, KETTLE, BLACK – LABOUR RAG, THE STANDARD & LYNN PRENTICE, AT IT AGAIN

Here’s another example:

LF obtained the services of probably Australasia’s greatest investigative asset over the weekend for free…well somebody paid for his services, but it was not LF!!.

Just after that they refer to “New Zealand Justice Campaigner [Precautionary delete]” and anyone who has read through [Precautionary delete] and Lauda Finem – detail will recognise that’s probably not a coincidence.

And another: Whale Oil Blogger Cameron Slaters bad dream – climbs into bed with arch nemesis Matthew Blomfield  4 September 2014

In the recorded telephone conversation, between Blomfield and [Delete as per court order] (below)…

[Deleted as per court order]

[Deleted as per court order], one of Slaters many sources, a man who was prepared to go public and stand by Slater in court…[Deleted as per court order]and others who had turned LF assets has assisted in obtaining reams of evidential material which LF has yet to publish.

Lauda Finem openly admit  [Deleted as per court order], one of Cameron Slater’s ‘sources’, as an ‘LF asset’ who has “assisted in obtaining reams of evidential material which LF has yet to publish”.

In an earlier post: TVNZ, John Hudson, Matthew Blomfield and the Ruawai Property Scam – Part One 17 December 2013

In our last post on Blomfield we evidenced that he had likely either colluded with journalists or in the alternative mislead journalists. Having had a little time to review a fraction of the material we, like Slater, received recently…

This makes it fairly clear someone (in New Zealand) has been supplying both Slater and Lauda Finem with material.

Back to the previous post:

In doing so Blomfield had knowingly laid one of those false police complaints against Mr [Deleted as per court order], in fact it was the second in two years that [Deleted as per court order]had been subjected to, both of these complaints designed to intimidate [Deleted as per court order].

As is becoming evident, Lauda Finem et al claims of being harassed can mean the opposite. This is true in my experience, and last week’s Court of Appeal judgment revealed “Mr Blomfield’s application for a restraining order against Mr [Deleted as per court order]was successful in the Auckland District Court. In delivering judgment, Judge Dawson noted that the relationship between the two was “toxic”. The Judge proceeded to find that text messages sent to Mr Blomfield by Mr [Deleted as per court order]constituted harassment under the Harassment Act 1997. A restraining order was accordingly made against Mr [Deleted as per court order] and remains in force until 9 April 2016.”

LF managed to collect additional evidence of this fact, Blomfield’s true intention, by covertly recording a telephone call that Blomfield made to [Deleted as per court order]…

How would LF, who claim none of their ‘team’ have ever lived in New Zealand, covertly record that telephone call?

At the same time Slater was communicating with Blomfield he was also chatting with one of our mutual sources, fishing for additional information on none other than Warren Powell, an action that seemed very suspicious. The source immediately contacted an LF operative and explained what had been unfolding in Slaters Skype texts…

A ‘mutual source’ again. However Slater doesn’use the term ‘asset’, he talks about ‘team’. This email is in the Lauda Finem post:

SlaterEmailtoBlomfield

It seems clear from a number of posts at Lauda Finem that Antony Nottingham doesn’t like Slater. Slater is correct in saying the lauda Finem attacks against Slater’s wife were disgusting (like many LF posts). And he has also been the target of similar, like this in the same post as the emails:

So is Cameron Slater a candidate for filthy Maggot cunt of the year? In the absence of a plausible explanation from the fat-boy himself we here at LF certainly think so. Can Cameron Slater really be trusted to keep his sources safe? We here at LF think not.

But it is also clear from this that there is no honour amongst this lot, they are all vicious, even amongst themselves. The hapless Slater almost looks good in comparison to those who have been using and abusing him.

Back to Lauda Finem’s claim:

Moreover LF is NOT a party to any legal proceeding in New Zealand whatsoever, nor is any member of team LF, again all members live outside New Zealand, always have, always will.

Lie 1 – [Deleted as per court order] still lives in Auckland as far as I know.

Lie 2 – Lauda Finem stated “[Deleted as per court order], one of Slaters many sources, a man who was prepared to go public and stand by Slater in court”. And there is also evidence that [Deleted as per court order]is a party to other legal proceedings.

Lauda Finem and Cameron Slater may use different terms but it seems clear that an LF asset is the same thing as a Slater team member.

Regardless of their semantics one could wonder whether people like [Deleted as per court order] are assets or liabilities.