National health plan fails to meet Auditor-General's expectations
Photo:
Unsplash / RNZ
The Auditor-General says the country's nationwide health plan for the next two years is not up to his expectations.
He says it lacks important details, including the basic costs of services.
Health NZ is in charge of putting out a plan through to 2027 that shows how public health services will be delivered, and the cost.
But Auditor-General John Ryan, in a letter at the back of the
85-page plan
, said it did not do this.
"The plan developed by Health New Zealand does not meet my expectations for a costed plan," he said after auditing it.
This meant he was unable to offer an opinion on whether the plan provided a reasonable basis for delivering public services to improve health.
A bill before Parliament removes the need for future plans to go to the Auditor-General.
"I expected the plan to provide a clear explanation of how the actions have been selected and prioritised, and how the actions will contribute to the achievement of the desired improvements and targets. The plan does not do this," Ryan wrote.
"I expected the plan to be based on clear and reasonable assumptions about health needs and the expected quantity of service demand, the resources needed to provide those services, and the forecast cost of those resources. The plan does not do this."
The plan should describe how investment and service changes would achieve the right outcomes, laying out what assumptions and trade-offs were expected, but it did not.
Health NZ has an out.
In the plan, it said it had been expected to take six years - or two three-year planning cycles - to fully develop systems to ensure full costings and budgets for its core services.
The 2024-27 plan indicated its processes were not there yet.
"It is not costed to the level of traceability and integration between the financials, activities, and desired improvements expected from a fully mature New Zealand Health Plan," it said.
The plan was submitted to Ryan by the former commissioner Dr Lester Levy and deputy commissioners of health in May. Levy now chairs the new board of HNZ.
The plan is titled, "Timely access to quality health care."
Levy said in the foreword it "outlines actions to deliver better health outcomes for all New Zealanders". He does not mention it is not mature or properly costed; this is mentioned on page 44.
Levy oversaw a reset at the beleaguered agency after a financial meltdown in 2024 set it on a
path towards a $1.7 billion deficit
, following primarily a mess-up over how many nurses it had and what they would cost; spending cuts reined that back to just over a billion by mid-2025. It said it prioritised protecting frontline services while it made cuts. It aims to break even in 2026-27.
The plan said to understand what services were costing, it now had a financial procurement info system in place to track spending; plus it was bringing in a nationwide agreements
and payments system.
It had changed how it budgeted, to base budgets on what it wanted to do, rather than the other way around.
"This change of approach will place service delivery for our patients front-and-centre, allow more accurate service planning for the year ahead, and help us to identify where
cost and/or productivity improvements need to be made to meet our activity targets within budget."
The Healthy Futures (Pae Ora) Amendment Bill repeals the requirement for future such health plans to be audited by the Auditor-General.
Sign up for Ngā Pitopito Kōrero
,
a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
RNZ News
an hour ago
- RNZ News
Waikato mental health patients sleeping on floor mattresses because of bed shortage
The Henry Rongomau Bennett Centre at Waikato Hospital. Photo: Supplied A mental health nurse working at Waikato Hospital says there's a shortage of community beds to discharge patients to, while acute mental health wards are running at 140 percent capacity. Health New Zealand (HNZ) said there had been a reduction in occupancy at the hospital's Henry Rongomau Bennett Centre acute mental health inpatient unit, until recently. Earlier this month, RNZ revealed that a ward full of patients at Auckland's North Shore Hospital could not be discharged as they had nowhere to go for non-hospital care. The mental health nurse, who did not want to be named and was speaking in their capacity as a Nurses Organisation union member, said while over-capacity has been a longstanding issue, the situation was getting "increasingly worse". They said some mental health patients were sleeping on mattresses on the floor in interview rooms, seclusion rooms and sometimes in other wards due to the lack of beds. "In mental health [wards], we're struggling with getting good sleep … we're trying to deal with anxiety or manic symptoms, and not having your own bedroom or a routine area to rest all impacts that recovery process," they said. They said patients were getting agitated and were frequently violent - some had been dealing methamphetamine on the wards. Last month, a person was allegedly attacked at Waikato Hospital. Two sources told RNZ the victim was a staff member] on the mental health wards. The nurse said one of the key factors contributing to problems transitioning patients to the community was a lack of beds in mental health and addiction residential services. They said patients often did not have a supportive household to go to after leaving hospital, and needed facilities that had 24/7 care and oversight for their medications. Many facilities were already full and had a waitlist, respite services were maxed out, and there was also a lack of emergency housing options, the nurse said. RNZ asked some of the major providers of mental health and addiction residential care in Waikato about current demand and waitlists - including Pathways, Manaaki Trust and Ember Korowai Takitini - but none would comment, and one referred RNZ back to Health NZ. Labour's mental health spokesperson Ingrid Leary said what was happening in Waikato showed underfunding in both the public health and community provider systems. Labour's mental health spokesperson Ingrid Leary. Photo: RNZ / Samuel Rillstone The Public Service Association - the main union for mental health nurses - said community mental health was resource-short, with workers having their pay equity claims scrapped by the government, and a shortage of beds and purpose built facilities. "Major investment and commitment is needed by the government in community mental health, by the government," national secretary Fleur Fitzsimons said. She said there was a "culture of fear" among many community providers that they would be punished by HNZ or the government if they spoke out about the reality they were facing. Fitzsimons said she wanted HNZ and the government to be clear with providers that they could present their realities, so New Zealand could know how many beds it was short of. Mental Health Minister Matt Doocey said in a statement that he recognised the "significant pressure" on inpatient facilities, and that he had "tasked all of the Regional Executive Directors with improving the flow of patients and quality of care". He had no direct comment for RNZ's questions about the occupancy of Waikato Hospital's acute mental health wards, and the shortage of mental health beds in the community. Doocey's press secretary said the minister had not prevented anyone from speaking publicly, and Doocey said he encouraged everyone to raise any issues with him - either personally or publicly. Mental Health Minister Matt Doocey. Photo: RNZ / Mark Papalii HNZ's mental health and addictions lead for Te Manawa Taki (the central North Island) Vicki Aitken said "any decision to make comment to media is one for our community providers to make and is not for Health New Zealand to speak to". She said it had been working with community partners over the past year to improve the flow of patients to community settings, but admitted that the acute wards still experienced spikes in demand. Aitken said the demand for acute mental health services in Waikato continued to increase, due to factors including meth abuse and "wider system issues". She said occupancy at the Henry Rongomau Bennett Centre acute mental health inpatient unit was at times an issue, but added that there had been a reduction in occupancy until recently. Aitken said a new acute adult mental health facility in Waikato - with 64 beds - was on track to open next month. The facility would have four more beds than the exisiting Henry Rongomau Bennett Centre, which would be replaced. In 2019, 35-year-old Joe Carter had been sleeping on a mattress on the floor of a windowless room in the Henry Rongomau Bennett Centre at Waikato Hospital, when he went out for a walk and later committed suicide . He had been moved between wards and put into a converted interview room because the centre was at 120 percent occupancy. Meanwhile, the mental health nurse said short staffing and the shortage of senior nurses was exacerbating the situation, and they were struggling to cope with the criminal behaviour on the ward. "We have people that are admitted with being intoxicated with meth, and they've also been dealing in the community … to help pay for their habit, and they end up attempting to deal on the ward as well to other people that are meth users as well. "If they get to go on leave they'll try and bring it back, they get visitors, they'll try and bring it in whatever they're carrying when they're visiting, everything has to be checked," she said. The nurse said they had been told by management that the standard procedure when they saw such behaviour, and when they were assaulted, was to file a 105 police report - which she said was a long form they struggled to find time to fill. She said the police often dropped off people on substances, who were admitted due to risky behaviour - "Quite often police don't stick around, they're just here to transport," she added. Police have been implementing their phased withdrawal from mental health callouts , with a 60-minute limit on patient handovers at EDs, taking effect nationwide as of June. The nurse said staffing was further stretched due to an average of several staff on the acute mental health wards taking ACC leave due to injuries caused by patients - including head injuries and some unrecoverable injuries. HNZ's Vicki Aitken said any illegal drug use on premises would be reported to police immediately and police are "promptly involved" in instances where there had been assaults on staff. She said the acute mental health wards were fully staffed and HNZ was in the process of recruiting more permanent staff. "When there are roster gaps or a need for additional staffing due to demand we bring in appropriate casual staff," said Aitken. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
RNZ News
3 hours ago
- RNZ News
Nurses to strike for better nurse-to-patient ratios
Healthcare workers hold placards at a picket line in Wellington as nurses, midwives and healthcare assistants strike nationwide. Photo: RNZ/Samuel Rillstone Nurses union members want better nurse-to-patient ratios and a return to hiring every graduate, as they prepare to strike for two days in early September. Health New Zealand said it was deeply concerned by the strike plans, which it said would cause the postponement of more than 2200 planned procedures, 3600 first specialist appointments and 8000 follow-up appointments. Nurses Organisation chief executive Paul Goulter said their Te Whatu Ora members voted strongly to go on strike, after a solution could not be found through bargaining. The strike action is planned to take place from 7am to 11pm on Tuesday, 2 September and Thursday, 4 September. "I think it very clearly points to nurses being fed up with the government's inability to resource the system properly to ensure patient safety," Goulter said. Nurses were stretched and burnt out, and the union was asking the health agency to return to the bargaining table with a commitment to hire more staff when staffing models required them, to hire every nursing graduate, and "starting the work on nurse-patient ratios that are enforceable". Nurses last went on strike in late July , with similar demands. Health NZ said it was happy to return to the bargaining table, and was committed to finding a solution. It said it had not yet received a formal notice of the strike from the union, only an informal notification. Health NZ chief executive Dale Bramley said it would have a "major impact" on thousands of New Zealander - many of whom had already waited a long time for appointments or surgeries. "We want to do our very best for our nurses and we think we've put a very fair offer on the table," Bramley said. He said they were already working to improve nurse-patient ratios. The number of hospital beds across the country had gone up by 100 to 200, while the number of full-time equivalent nurse had increased by more than 3000 in the past two years. Turnover among nursing staff had dropped from 13.3 percent to 8.1 percent, and the current vacancy rate was 3.6 percent. "At any one time in our pipeline of recruitment we have up to 2000 nurses in our pipeline," Bramley said. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
RNZ News
14 hours ago
- RNZ News
Senior doctors' union worried national health plan lacks detail
Health Minister Simeon Brown blamed the delay in releasing the plan on the additional audit requirement, which was "imposed by the previous government". Photo: Calvin Samuel / RNZ The lack of detail in the national health plan for how Health NZ will meet its lofty goals, or pay for them, is especially worrying at a time when the public system is under massive pressure, warns the senior doctors' union. Auditor-General John Ryan has found Health NZ's plan - which was released last week, 18 months' overdue - had failed to show how it would deliver public health services , nor how much they would cost. Association of Salaried Medical Specialists principal policy advisor Virginia Mills said the fact there was no roadmap for delivering services, or even an estimate of "unmet need", was a damning indictment on the agency. "Essentially it means he's [the Auditor-General] been unable to vouch for the plan. And that's quite concerning because we've got a health system that's under extreme pressure at the moment, and we're not confident that this plan is going to fix those issues or deliver on better health for New Zealanders," Mills said. Of further concern was the fact that the Pae Ora (Healthy Futures) Bill, currently before Parliament, included a clause scrapping the requirement for the health plan to be scrutinised by the Auditor-General at all, she said. "That would be like if you got a school report to say your child was struggling, and instead of helping your child to do better, you called the teacher and said you didn't want the report anymore," Mills said. "It seems like the Government is saying, 'We didn't like this level of independent scrutiny. Let's get rid of that legislation'." Mills said both those things were at odds with the Government's claim that it wanted greater transparency and accountability. Health NZ blamed the delays in getting out the plan on its "immature" reporting systems, but said they were now bedding in. However, Mills said it was also possible that the focus on cost-cutting (from then Commissioner now board chair Dr Lester Levy's "Reset Plan") had made future planning more difficult. In a written response to RNZ, Health Minister Simeon Brown blamed the delay in releasing the plan on the additional audit requirement for the New Zealand Health Plan, which was "imposed by the previous government". "Removing it aligns Health New Zealand's planning processes with other crown agencies and allows the system to be more focused on delivering timely, quality healthcare care for patients," Brown said. "As part of making the system more efficient and focused on patients, we are also removing bureaucratic processes and aligning Health New Zealand's planning documents with other public sector planning documents." Health NZ would continue to have its annual financial statements and statement of performance audited by the Auditor-General, as required of all Crown entities under the Crown Entities Act. His priority was "to ensure everyone can access timely, quality healthcare whenever they need it, regardless of who they are or where they live", Brown said in a statement. "That's why, for the first time, we are putting health targets into law so every part of the system is focused on delivering faster care, shorter wait times, higher immunisation rates, and real results." Those targets would be included in the Government Policy Statement on Health, to which the New Zealand Health Plan would give effect. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
