Child and adolescent mental health services in Waikato and other regions are under huge pressure. Photo / Alan Gibson
Child and adolescent mental health services in Waikato and other regions are under huge pressure. Photo / Alan Gibson
The pressure on mental health services treating children and teenagers “increases the risk of an increased number of attempted and completed suicides”, high-level hospital documents warn.
Other major risks identified by health officials across the country include vulnerable IT systems, cramped and outdated buildings, and “excessive” delays to surgeries andtreatment.
All regional health authorities (formerly DHBs) keep high-level registers that track the biggest actual or emerging risks that they, staff and patients face.
Those have been released to the Weekend Herald under the Official Information Act, and make clear the enormous strain on the health system.
Health NZ - Te Whatu Ora says “it is important to understand that an entry on our risk registers does not indicate that actual failure or harm has occurred”.
“However, the registers are tools among others we use to assist in identifying actual or emerging risks, with a view to mitigating or preventing them from occurring altogether,” the authority said.
“As working documents, our risk registers are regularly reviewed, and if risks cannot be eliminated mitigation strategies are put in place wherever possible to reduce risks so far as is reasonably practicable.”
The documents are from April. Waikato’s major risks included “delayed mental health services for children and adolescents”.
“Due to the number and complexity of referrals, the number of children and adolescents waiting for comprehensive assessment and treatment is increasing, impacting on the ability to commence, update or complete treatment,” the summary stated.
“This reduces the quality of care provided and increases the risk of an increased number of attempted and completed suicides.”
The risk rating has been reduced after actions, a spokesperson said, including more outsourcing to private providers. A paediatrician has joined the team part-time to help, and these measures had helped manage suspected ADHD cases, which make up a large number of referrals.
However, the risk remains on the register as “high” (ratings are low, medium, high, extreme), “as referrals to the service continue to increase”, the spokesperson said. Wait lists are regularly reviewed to prioritise the most urgent cases, and ongoing checks are made with families.
Asked if the delays had contributed to attempted or completed suicides, the spokesperson said “it is not possible to quantify data in the way requested”.
The risk registers for other areas of the health system include Northland, where a critical risk was a lack of investment in upgrading facilities. Like many other areas, delayed care was also rated a critical risk, with “excessive waiting times” resulting in “adverse outcomes to patients”.
Old, vulnerable IT systems were major risks in areas including Waikato, Northland, Waitematā, Counties Manukau, Lakes, Bay of Plenty and Wairarapa.
Many regions including Counties Manukau rated as major or extreme the risk of not meeting Te Tiriti o Waitangi obligations by failing to address health gaps between Māori and Pākehā.
Health Minister Ayesha Verrall and National Party health spokesman Shane Reti. Photo / NZME composite
Workforce problems including understaffing were rated as a major risk in 14 of the 16 regions for which registers were provided.
“Staff turnover rate above target and unfilled vacancies impacting on service delivery, patient care and health outcomes, and staff wellbeing,” a summary of the risk at Waitematā stated.
A shortage of midwives in Whanganui was “resulting in growing number of pregnant women unable to secure the service of a community-based LMC”.
The Government has taken steps including clearing a path for overseas health workers, and establishing a health workforce taskforce to examine the complex issue of training and retaining homegrown workers.
Earlier this year Andrew Connolly, chief medical officer at Counties Manukau, told the Weekend Herald he sees signs of hope, with more workers coming onboard.
Health Minister Dr Ayesha Verrall says efforts to bring down wait lists in the northern region show the way, and now the health reforms have the key architecture in place, more progress can be made across regions and the country.
On Thursday she announced medical schools will be funded to take an extra 50 students a year, at a cost of $23m a year over 10 years.
However, National Party health spokesman Dr Shane Reti told the Weekend Herald the health reforms are an expensive failure, and the worsening stress on the system is plain.
Over 56,000 New Zealanders were waiting longer than four months for a first specialist appointment at the end of April, Reti said, with another 34,662 similarly overdue for treatment.
“The sector is contacting me, telling me how they have low morale. They are overworked, they see no leadership and no direction.”
Te Whatu Ora’s own register has a number of “extreme” risks, including being “unable to deliver the transition, associated culture and accountability change in approach and the benefits of the health sector reforms at the scale and pace expected by key stakeholders”.
Another: “Te Whatu Ora is unable to deliver consistent high-quality services and care to the community.”
A spokesperson said managing such risks is “the nature of our work”: “The critical point is that all risks are being actively mitigated and/or managed.”
Nicholas Jones is an investigative reporter and has worked at the Herald for more than a decade. He is Auckland-based, having previously covered politics from Parliament.
