20 Jul 2021

Government schedule to fix critical health assets 'at risk'

7:29 am on 20 July 2021

The government's first-ever plan for upgrading hundreds of unfit - and sometimes unsafe - hospital facilities is encountering a lot of delays.

Iv Drip in hospital corridor

Photo: 123rf

Almost half of the 27 projects at the new Health Infrastructure Unit that's doing the plan are marked as "schedule at risk", in an OIA response from the Ministry of Health.

Even what was meant to be the "urgent" identification of "critical" health assets has been held up, and this is meant to set out a pipeline of nationally significant health investments for the next four years.

"Limited progress made. Resource being prioritised on to task in June," the OIA said.

The proposed national asset management plan - or NAMP - is an unprecedented attempt to properly coordinate repairs and rebuilds across $24 billion of often rundown health assets.

It is meant to be ready next year.

But an Official Information Act (OIA) response shows 13 out of 27 work streams are off track.

In many cases, that is due to a lack of resources, according to the latest schedule from the Health Infrastructure Unit (HIU), set up to deliver the plan.

The ministry said the document showed the timeframes "may be at risk", and what actions were being taken about that.

"It would not be accurate to describe either the NAMP or the HIU work programme as 'mired in delay'," the ministry told RNZ in a statement.

Health Minister Andrew Little says he and Finance Minister Grant Robertson "view health infrastructure as a key priority" and are on the verge of tapping millions of dollars for the work on preparing the NAMP.

The government last year trumpeted how it was beginning on the plan, starting with an inaugural nationwide stocktake of thousands of hospital assets, released 13 months ago, that revealed structural, earthquake, leak and asbestos risks at hundreds of facilities.

The stocktake, sparked by Middlemore Hospital's infrastructure woes revealed by RNZ, was grim. Half of the 20 DHBs each had more than 50 buildings in poor or very poor condition, not even counting critical facilities like emergency departments and intensive care, which awaited more checks.

"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," then Health Minister David Clark said last June.

But 13 months on, the HIU schedule for where things are at, repeatedly says: "Schedule at risk."

Again and again, across the 27 workstreams, it says resources have just been found to restart work, or are still being sought.

For example: "Awaiting dedicated resourcing to finalise, expected to be in place in June" regards coming up with a way to help district health boards (DHBs) prepare better business cases for rebuilds, which is meant to be finished by October.

The work on figuring out a streamlined way of getting people to do the actual work - such as architects, engineers and project managers - was still to start, held up by recruitment.

Middlemore Hospital

Middlemore Hospital in South Auckland has several rotting buildings. Photo: RNZ / Claire Eastham-Farrelly

The pandemic has placed immense pressure on health sector staff, spending and schedules - as well as exposing the paucity of backup and planning for emergencies.

The NAMP is also caught up in the overhaul of public health administration that will disband most DHBs.

Any delays in delivering the overarching plan will complicate the long-term planning done by health boards, such as at Hawke's Bay, which has long been struggling with old buildings so hot in summer the DHB is forced to spend thousands of dollars on iceblocks.

The Budget has a $8 million contingency for the plan.

Health Minister Andrew Little told RNZ: "We are currently considering advice from officials on the first drawdown from this contingency to advance the work programme."

The total contingency over the next four years is $17m.

Among the funding, $750,000 has been carried over from last year's Budget; this appears to have gone unspent at a time when the OIA shows the HIU reported experiencing resource constraints.

As part of the OIA request, RNZ asked for the latest briefing to Little about NAMP; the one that came back was from almost six months ago.

Little said he has had many briefings and updates about health infrastructure.

The ministry's January briefing to him does not talk about delays, instead saying:

"There has been good progress on the National Asset Management Programme (NAMP), but it highlights the poor state of our health facilities.

"Further support for the NAMP will be sought through Budget 21 to ensure that it is better integrated with DHB risk management and investment planning."

Large parts of the ministerial briefing are blanked out.

Whatever national asset plan eventually emerges, it must address a huge range of problems, from cramped operating theatres to a $2 billion gap in IT infrastructure - a gap cruelly exploited in the ransomware attack on Waikato DHB in May.

The OIA states that the Health Ministry has "little central visibility" about IT underinvestment.

This was "despite the significant operational risk associated with the use of equipment beyond vendor support, and poorly maintained and fragmented information technology creating create complex and time-consuming environments for health professionals to navigate".

The HIU is meant to fix that, with a nationwide IT assessment it began in September last year.

RNZ has asked to see that assessment.

The ministry in the OIA listed six priorities it had already finished or that are underway.

This includes setting up an investment programme for mental health facilities. It has recently been revealed that very little of the $400m-plus allocated for 15 new inpatient mental health facilities and upgrades has been allocated.

The NAMP is meant to deliver:

  • A national framework with service design standards
  • Maintenance and renewal strategies
  • Capital planning guidance

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