Stage 3 Of Major Auckland Hospital Upgrade Funded
Minister of Health
Health Minister Simeon Brown has today announced a major investment to strengthen critical infrastructure at Auckland City Hospital and Greenlane Clinical Centre, as part of the third tranche of the Facilities Infrastructure Remediation Programme.
'This Government is committed to investing in and upgrading critical infrastructure that supports our health system – and that includes ensuring the hospitals we rely on every day are safe, modern, and fit for purpose,' Mr Brown says.
'Over the next three years, tranche three of the Facilities Infrastructure Remediation Programme in Auckland will fund critical upgrades and replacements to the power, heating, building management, and safety systems that support clinical services at Auckland City Hospital and Greenlane Clinical Centre.
'These upgrades are about ensuring Auckland Hospital is able to deliver reliable care for patients and has increased resilience through upgraded systems.'
This third investment tranche is part of the Government's $1 billion Budget 2025 hospital infrastructure investment includes:
Upgrades to the high voltage power supply to improve power security at Auckland City Hospital.
Replacement of the ageing steam heating system to boost reliability and reduce utility costs.
Improvements to electrical monitoring and building management systems at both sites.
Design work for the next stage of the Auckland hot water pipes replacement project, with construction on the first stage already underway.
'Replacing the hot water pipe system in the main building of Auckland City Hospital is a priority within the Health Infrastructure Plan, and this investment will help speed up delivery by funding the design work for the next stage of this project. Getting ahead on the design work now will mean we can fast-track the next stage by eight months.'
This tranche builds on the first two stages of the remediation programme, which addressed the most urgent infrastructure issues at these sites and are scheduled for completion by the end of 2025.
Health New Zealand is carefully managing this work to minimise any disruption to clinical services, and ensure patients and staff are not impacted as this vital infrastructure is upgraded.
'This is about investing in the future of Auckland's health services – getting the basics right so frontline teams can keep delivering high-quality care to New Zealanders.
'As we continue to invest in hospitals across the country, projects like this are key to ensuring our infrastructure can keep pace with growing demand and support better health outcomes over the long term,' Mr Brown says.
Note:
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Scoop
6 hours ago
- Scoop
Simeon Brown Places Target On Patients' Heads
Wilhelm Tell had an expert understanding of targets and outcomes. A 14th century folk hero in Switzerland, Tell was an expert marksman with the crossbow – most known for successfully shooting an arrow through an apple on his young son's head. According to legend, this incident launched the struggle for Swiss independence against the Austrian Hapsburgs. Tell came to be widely considered to be the symbolic father of the Swiss Confederacy. The only point of similarity between Tell and Simeon Brown is their focus on targets. But they are widely apart on their approach to them. For Tell, mythically at least, targets involve precision (arrow through the apple) and systems improvement (Swiss independence). Contrast this with the Minister of Health's approach: imprecision and an absence of health system improvement. Brown, health targets and legislative inclusion Last month Minister Brown initiated the first reading of his Healthy Futures (Pae Ora) Amendment Bill. The original Pae Ora Act had come into effect three years earlier in July 2022. The amendment bill is now with Parliament's health committee. Brown's speech included the following: 'This Government is firmly focused on delivery. That's why we're legislating health targets – not just talking about outcomes but making them law – because what gets measured gets managed. 'Let's be clear about what those targets are: shorter wait-times in emergency departments; faster access to elective surgeries like hips, knees, and cataracts; on-time immunisations for our children; faster access to cancer treatment; shorter delays for first specialist appointments.' Later in his speech he added: 'Mandating the health targets in legislation provides clarity and certainty for the entire health sector going forward.' There are two defining pieces in his speech. First, 'what gets measured gets managed' and second, the legislative mandating of this 'provides clarity and certainty' for the entire health sector into the future. Potted history of health targets There are two essential ingredients to health targets if they are to be effective. First, they need to make good clinical sense. Second, they need to lead to systems improvement in some way. Health targets were first introduced in 2007 by Labour health minister Pete Hodgson. After the 2008 general election National health minister Tony Ryall kept half of Labour's targets – elective surgery, cancer treatment, immunisation, smoking, and heart and diabetes checks. He also added a sixth new target of cutting emergency department waiting times. Some targets contributed to better outcomes but not necessarily to systems improvement because it was difficult to distinguish between them and other measures (particularly heart and diabetes checks and smoking). Increased immunisations was successful as an illness prevention measure although it is now struggling due to the small but strident anti-vaccination movement that arose out of the Covid-19 response. It was the other three targets, however, that attracted the most prominence and controversy. One was improved access to planned (elective) treatment, mainly surgery. This involved timeframes between general practitioner referrals for first hospital specialist assessments and, following this assessment, for patients to be treated. The second was the time for diagnosing and treating (where necessary) patients graded with a high suspicion of cancer. The third and most significant target in terms of systems improvement was shorter stays in emergency departments; specifically, 95 percent of patients should be either discharged or admitted into the main hospital within six hours. There was a high level of emergency medicine clinical leadership in its design. Further, it was not just about what happened in emergency departments; they are a barometer of how well hospitals performs. The target required a hospital-wide response because the key challenge was not patients who could be discharged from the department without being admitted into a hospital ward as an inpatient requiring further investigation or treatment. Instead the key challenge was those patients who required hospital admission. This meant that there had to be available inpatient beds for them to be admitted. When hospital bed occupancy is 100 percent (or close to it) it is called 'bed-blocking'. Unfortunately, the then-National-led government erred in hyping up the targets by incorrectly asserting that they were a measure of productivity improvement. This monitoring narrative was judgemental and punitive. Consequently it incentivised various forms of 'gaming' within district health boards (managerially rather than clinically driven) in order to appear to meet the target. From targets to indicators The subsequent Labour led government, first elected in 2017, was incorrectly accused of abandoning the health targets. Instead, in response to their misleading productivity narrative, they continued but with a much lower profile. While the thinking was sound, the messaging was poor. It should have continued to publicly report the results but been explicit that this was not a barometer of productivity. Labour did, however, work towards developing 12 health indicators that were designed to be neither carrot nor stick. They covered a bigger range of clinical activities such as the rate of hospital admissions for children under five years that might have been prevented or better managed in the community and the percentage of under-25-year-olds able to access specialist mental health services within three weeks of referral. In general they were both more mature than and a big improvement on the preceding targets with a wider scope and less focussed on what could be more easily counted. However, there are glaring omissions – addressing workforce shortages and enhancing health professional engagement (where most expertise for systems improvement resides). Accessing cancer treatment was inexplicably omitted. Returning to targets In March 2024 then health minister Shane Reti announced the return to health targets for: faster access to cancer treatment, improved childhood immunisation rates, shorter stays in emergency departments, and shorter wait times for first specialist assessments and elective treatment. Subsequently five mental health targets were announced. Reti asserted that these targets would 'drive better outcomes for all New Zealanders'. Although overhyped, his media release at least recognised that addressing workforce shortages was critical to achieving the targets. Although less comprehensive and more prone to 'gaming' than Labour's health indicators, there were two useful specified target enablers – workforce and infrastructure. From policy to legislation Under successive governments from health ministers Pete Hodgson to Shane Reti, health targets (and indicators) were policy-based. Now, under Minister Simeon Brown they are to become legislatively-based. As part of a wider amending bill specified health targets would be included in the Government Policy Statement. These specified targets are: cancer management care; immunisation of children; admission to, and discharge and transfer of patients from, emergency departments; specialist assessments; elective treatment; and access to primary care. The upside of these legislative targets is that although narrow in scope (at least in respect of hospitals) they are not prescriptive. Excluding 'access to primary care', their operational details have already been spelt out and can be revised by policy rather than further legislative amendment. However, this is as good as it gets. In his first reading address, Brown was belligerent. He assertively alleged that under Labour's stewardship of the health system, from 2018 to 2023, emergency department, first specialist assessments and elective treatment waiting times had skyrocketed. Meanwhile child immunisation rates had 'plummeted'. Health system truth speaking to political power This 'analysis' is both politically disingenuous and wildly inaccurate. Broadly speaking hospital care falls into three broad categories – acutes (treatment that can't be deferred), chronic illnesses (illnesses requiring ongoing continuing treatment such as dialysis), and electives (can be deferred and planned). The hospital targets only apply to what can be counted, largely in the third category. Much of what happens in hospital care falls outside this scope. Significantly acute hospital discharges can be counted but National led governments have deliberately excluded this as a target. Brown's 'analysis' also ignores what is really behind the dropping off of target achievement since 2018; in fact, since 2013/14. As a starting point, it is estimated that around one-third of our adult population has an unmet need for healthcare. This is significantly higher than reported in 37 European countries. People with unmet healthcare are at higher risk of presenting at an emergency department and, even worse, being admitted to the hospital as an acute patient. From 2013/14 to 2022/23 the number of people presenting to emergency departments increased by 22.5 percent (nearly 1.3 million people in 2022/23). Further, the number of immediately or potentially life-threatening presentations is growing at a much higher rate (51 percent) than less serious presentations. The above-mentioned data helps explain the following highly relevant information involving acute hospital admissions. Acute discharges increased by 24 percent between 2014 and 2023 (28 percent when adjusted for complexity/case mix). Over the same period of time population growth only increased by 16 percent. Combined with widespread severe workforce shortages, this rise of acute (unplanned and able to be deferred) cases displaced non-acute (planned and able to be deferred) inpatient discharges. The 24 percent increase in acute hospital discharges (28 percent for complexity cases) contrasts with the -1 percent decrease for non-acute hospital discharges (-3 percent for complexity cases). Tipping point When the rate of acute hospital discharges is greater than the rate of New Zealand's population growth a tipping point is reached. It leads to' bed blocking' which means insufficient inpatient beds for both non-acute patients referred by emergency departments and for planned treatment patients. Targets become superfluous. This raises the obvious question, why did this tipping point arise? Relative underfunding for much of the 2010s and political neglect of workforce planning contributed. So did population growth. The aging of the population certainly impacted with a greater number of people with serious health conditions, including chronic illness. These are largely outside the influence of the health system. They are driven by either demography or government (in)action. But the dominant factor was worsening external social determinants of health which are the biggest drivers of health demand (including acute) and health cost. These determinants include low incomes (the most important), unhealthy housing and educational opportunities. If I had to sum the impact of these determinants in two words, it would be 'increasing impoverishment'. While our health system can, with the right leadership culture, mitigate the impact of these determinants (the former Canterbury District Health Board is a case in point), it can't control them. Only government actions can. These determinants, as reflected in rising acute hospital demand, decide more than anything else whether targets can be achieved. The above-mentioned two defining pieces of Simeon Brown's first reading speech need to be considered. The first was 'what gets measured gets managed'. However, much of what happens in healthcare does not lend itself to measurement. Further, the Government is selective in what chooses to measure. Acute hospital discharges can be measured. But to include them as a target would require the Government to address the external social determinants of health along with severe workforce shortages and underfunding. The second was that legislatively mandated health targets would provide 'clarity and certainty for the entire health sector going forward'. While the Government continues to describe health targets as measurements of health system performance and productivity and blame public hospitals for non-achievement, the opposite is true. Legislatively mandating a flawed and overhyped policy framework will compound health system inflexibility and accelerate the system's tipping point.
Otago Daily Times
17 hours ago
- Otago Daily Times
Health plan doubts
Anyone ploughing through the 85-page New Zealand Health Plan document might wonder if the wait was worth it. The lack of detail and some of the disconnection between it and planned amendments to existing health law, and other actions already taken or signalled by the government, are among the issues. There is also the thorny question of whether it can do what it says it will. According to Health Minister Simeon Brown, the plan, covering financial years from 2024 to 2027, outlines how Health New Zealand Te Whatu Ora will deliver on the government's health priorities. But Auditor-general (AG) John Ryan, who, under existing law, must audit the costed plan before it goes to the minister, could not give it a green light. He was unable to form an opinion on whether the plan provided a reasonable basis for delivering publicly funded health services to achieve desired improvements in health or gave reasonable effect to the Government Policy Statement on Health. Mr Ryan said the plan did not provide a clear explanation of how the actions intended to improve aspects of the health system had been selected and prioritised, and how they would contribute to the achievement of the desired improvements and targets. Health New Zealand said the plan was indicative of the level of maturity of the organisation and not costed to the level of traceability and integration between the financials, activities and desired improvements from a fully mature plan. The government plans to do away with the requirement for the AG to audit the plan, and its delivery. This move is included in the wide-ranging Healthy Futures (Pae Ora) Amendment Bill, submissions on which close today. Mr Brown says removing requirements for auditing the plan pre- and post-delivery aligns HNZ with other crown entities. The organisation would still have its annual financial statements and statement of performance audited by the AG. While we understand there might be concern such an audit before the plan becomes public may be time-consuming, it is hard not to see this removal of specific scrutiny of the plan altogether is more about avoiding criticism rather than ensuring greater transparency and accountability. It is not the only time recently the Auditor-general's office has been critical of health plans. We have already written of the AG's concerns about whether the government's push for more planned surgery to the private sector may result in patients with complex issues, not suited for such referral, waiting longer than they otherwise might have. As the office pointed out at the health select committee last week, faster care did not necessarily mean more equitable care. It is still not clear how HNZ plans to ensure its plans do not exacerbate inequity, which should include looking at unmet need. The health plan has some clangers in it which do not align with the current government position. In the section on improving timely access to primary and community care, it says "we are resolving pay equity claims and improving nursing recruitment and retention by ensuring there is consistency in nurses' pay". That would have been a surprise to those in the sector who still do not have pay parity with their colleagues in HNZ and whose pay equity claims were scuppered after the government's ambush law changes earlier this year. Public health advocates may have been buoyed by the statement "we aim to reduce the availability and social acceptance of alcohol" in the section on modifiable risk factors, along with reference to strengthening compliance and regulatory approaches in this area. However, recent RNZ reporting showed initial plans to reduce off-licence sale hours now appear to be off the table nationally, and there will be an emphasis on reducing red tape for alcohol retailers to make life easier for them. Hard on the heels of the release of the health plan came another damning report about the health post-code lottery, this time for the treatment of heart disease, the biggest single cause of death in New Zealand. It was another illustration of how much work the government has to do to convince the public it has a cohesive plan for an equitable health system.
Scoop
17 hours ago
- Scoop
Faster, More Accurate Brain Tumour Diagnoses For Kiwis
Minister of Health More than 100 New Zealanders have already benefited from a groundbreaking diagnostic tool that is delivering faster, more accurate brain tumour diagnoses, Health Minister Simeon Brown says. DNA methylation profiling, the international gold standard for diagnosing brain tumours, has been rolled out at Auckland City Hospital over the past year. 'This technology is a game-changer for brain tumour diagnosis in New Zealand. It enables doctors to pinpoint the exact tumour type with greater precision and in less time, meaning patients can start the right treatment sooner,' Mr Brown says. 'Until now, diagnosis was typically made by microscopic examination. In some complex cases, samples were sent overseas for methylation profiling, but that could take up to six weeks. 'Having this cutting-edge capability in New Zealand means more Kiwi patients can access this advanced diagnostic technology locally. Turnaround times are faster, around four weeks, and quicker for urgent cases. 'It also means we can prioritise urgent cases, deliver answers sooner, and give patients and their families greater certainty.' In some recent cases done locally, methylation profiling has significantly altered the initial diagnosis. In others, it has identified rare or unexpected tumour types that may have been missed using traditional methods. The Auckland-based service is one of only three in Australasia, with samples from hospitals around the country also being sent to Auckland for analysis. Along with improving access and outcomes for patients, it is also significantly cheaper than sending samples offshore. 'Delivering faster access to cancer treatment is a key focus for the Government, which is why it is one of our five national health targets. Faster, more accurate diagnosis for brain tumours that may be cancerous is a vital part of that. 'By providing local access to the world's best diagnostic tools, we are improving outcomes for New Zealanders,' Mr Brown says.
