Debate on Crown Entities, Public Organisations, and State Enterprises — MidCentral District Health Board

I congratulate the MidCentral District Health Board on its review of the quality of aged care, through a special audit it undertook last year when the board was worried about the number of complaints it was receiving about the quality of care in MidCentral Health. The board was worried that the issues that were being raised could be endemic, so it decided to conduct a special audit of eight facilities operated by the MidCentral District Health Board. It found instances of abuse and numerous, wide-ranging, and systemic problems that it said had caused significant risk to the safety of residents and had resulted in an unsafe environment for residents. The board said that many of the issues and problems that it found were breaches of the district health board contract and of the legislation. There were things such as medication errors, untrained staff dispensing medicines, acute shortages of staff, people who had had falls and so forth not being attended to, and people who had illnesses that had not been detected. I could go on and on.

The picture that emerges from reading the MidCentral District Health Board special report is the same picture that is emerging from an investigation that Luamanuvao Winnie Laban and I are conducting around New Zealand. We have now held about 12 public meetings, and we have also met with aged-care nurses and aged-care workers privately, because, of course, many of them are not able to speak publicly about the situation for fear that they would immediately lose their jobs.

The same picture is emerging of institutional neglect and, in some cases, even abuse. To give members an example, last night I met with 20 aged-care workers who said that there are widespread acute shortages of staff in the sector, particularly at weekends where it is commonplace for only half of the number of staff who are meant to work in an aged-care facility to be on duty. One of the reasons is that they are paid, if they are lucky, only 50c an hour extra to work at weekends, so there will mostly be casuals, students, and untrained people working in the weekends and in the evenings.

One nurse I met last night was in charge of 64 residents, and another nurse was in charge of 70 residents. I asked them what happens when there are no staff in the evenings and the weekends, and they said that, basically, they leave residents in bed all weekend. The only thing they can do is literally just leave them in bed all through the weekends and through the evenings. They said that they are simply unable to attend them, and they gave me examples. We have had many reports of people who have had a fall who were left for an hour or so before someone discovered them, and of people being unattended for hours on end, because there literally were no staff. From my own experience, when I visited an aged-care facility over a 6-week period, I found a complete absence of staff. There was no one to be seen, and residents were just lying in their beds day after day after day.

The aged-care workers also talked about showers. Apparently, most residents are being showered only twice a week, and, if they are lucky, three times a week. They are not even being toileted enough. Aged-care workers will tell residents that they are sorry that they do not have enough staff, and that the residents will have to wait for an hour or so. Residents are not being walked properly and not being fed properly, because meals are just being left with them and they cannot feed themselves. They also get dehydrated, and so on and so forth. The other concern is that apparently it is becoming routine for aged-care workers to dispense medication, even though, as the Minister pointed out in the House, that is technically illegal.

I am pleased to have the opportunity to speak in this debate on the MidCentral District Health Board entity. Mrs Kedgley is correct in pointing out that the MidCentral District Health Board has undertaken some of its own work to look at the status of rest home auditing and monitoring in its own region. It is done within the context of a quite serious situation that this Government inherited. It is set out in the report that informed the work of the MidCentral District Health Board, which is the quite damning report of the Auditor-General. Mrs Kedgley acknowledges that report, even though she is travelling around the country with the people who are damned in it. That report sets out very clearly the failure during the period 2002-08 to correctly monitor performance in our nation’s rest homes. This is very much the theme picked up in the MidCentral District Health Board report.

The Auditor-General said that despite knowing about a number of shortfalls in the monitoring of rest homes in New Zealand as early as 2004, the previous Government failed to act on the issue of rest home monitoring and auditing.

💬 Hon Steve Chadwick: Who turned down the aged-care inquiry?

We do not want inquiries; we want action. That member was an Associate Minister of Health whose governance was panned in the Auditor-General’s report. The Auditor-General’s report was highly critical of the Ministers of Health under the previous Government—and it had three in 3 years—who failed to act on the poor state of monitoring in rest homes.

As the MidCentral District Health Board report says, a number of changes are needed and this Government has acted. The first thing we were very concerned about—and it was a feature of the MidCentral District Health Board report because it talked about the importance of clinical engagement and leadership in a lot of these rest homes—was to deal with the quality of nursing supervision in our nation’s rest homes. One of the first things we did in last year’s Budget was put an extra $18 million into subsidies for aged care, specifically to improve nursing supervision and numbers in rest homes. That is a very important investment. We followed that up this year with an additional $16 million increase in subsidies for aged residential care. So there was a 5 percent increase last year and an additional increase of $16 million this year, with a real push on nursing quality and supervision in our rest homes. That was something that was picked up by the Auditor-General and by this MidCentral District Health Board work that Mrs Kedgley talked about.

We have followed that up even further by introducing a spot auditing regime. Many members would be surprised to know that when it came to the mid-year audit, the auditors used to ring up the rest home and say: “We’ll be arriving on this date.” Well, hello! Does that mean that the auditors would get a true look at what is happening? They might, but they might not. We have introduced spot auditing. We do not tell the rest home the date on which the auditors will turn up, and that is very important.

What is more, we have said that the people in rest homes, their families, and those considering going into rest homes need more information about the performance of rest homes. That is why, for the first time, despite the previous Government being asked to do it, this Government has put those audit results online. We have provided an easy colour-coding in order to look at how rest homes are performing against the key quality criteria.

💬 Craig Foss: What does red mean?

It starts with blue, which means a very good performance, through to red, which means a poor performance. When a rest home has a poor performance, there is a requirement on that rest home to address those concerns.

As is pointed out in the MidCentral District Health Board report, much of this hinges on the designated auditing agency, the third party, that comes in and audits the rest homes. The Government has been concerned about the auditing process because, as Mrs Goodhew pointed out in her discussion paper on aged-care policy in 2007, a lot of these rest home audits were contradictory. They could be done within weeks of each other, yet they were contradictory. We have been looking at this audit process, with particular scrutiny on the auditing agencies. One of the initiatives of this Government, which is in line with the Auditor-General’s report, is to bring in third-party accreditation of the auditing agencies. This means that the auditors themselves now have to meet an accredited standard in order to audit rest homes. This action was announced a week or two ago by myself as Minister of Health. It follows a programme of auditing the auditors. Last year we sent the Ministry of Health in to audit—

💬 Hon Steve Chadwick: More bureaucracy.

Well, do we want to care for the old people in rest homes, or not? It is not more bureaucracy, because it is actually dealing with the problem where we can have duplicate audits saying completely contradictory things. We are auditing the auditors, we have brought in third-party accreditation for the auditing agencies, and we are reviewing the auditing process—so much so that the Ministry of Health is now briefing the auditors directly on how they do some of their work.

All of us have visited rest homes from time to time to visit some of our most vulnerable New Zealanders there. Earlier this year I went with my children Maisie and Llewellyn to visit a rest home in Te Puke. I can tell members that it was very clear that most older New Zealanders in rest homes are receiving very good-quality service. They are being looked after by people who care for them, love them, and are doing their level best for them. Those front-line workers deserve our support and admiration for what they do. But there is no doubt that there are a number of cases of people not receiving the quality service that they need, and that is why this Government has invested in nursing quality and supervision in rest homes. We have brought in accrediting of the auditing agencies, we are smoothing the audit process so we do not get these contradictory audits, we are reporting the results online, and we are engaging with district health boards on how we make sure we get a better service there. The key thing is we can have all the auditing we like, but we still have to make sure we get good-quality care for the residents.

Anybody who has visited a rest home recently would be able to tell us that we have done a pretty good job of staffing our rest homes in the last 18 months. Work has been difficult for many people and turnover has dropped dramatically in the health sector. Last year I visited a rest home on the Kapiti coast, and for the first time in years it had had a number of people apply for nursing positions. Previously, it had struggled to get even one person to apply, but others have now applied as well. We have been able to get good staffing in many of our rest homes around New Zealand.

However, it is very easy to beat up scaremongering stories. We heard one today in the House in question time, where it was alleged that the Government had taken away Meals on Wheels in Helensville. The truth of that is that eight people will now be covered by the general service for Meals on Wheels and home support in the Waitemata District Health Board. Those people will still get their Meals on Wheels. They will be getting the same, if not better, service as a result of that. It is very easy to put out a press statement that says, as that one did, that starvation was inevitable as a result of those changes, but it is very important to know the details.

In their work on rest homes, the good people at MidCentral District Health Board have identified the importance of a number of factors. One is that there are some risks around smaller, owner-operated rest homes. They have indicated that there were some risks when there is a large turnover of staff or management, in particular. They have identified that when there are complaints, that is also a red flag showing further investigation is needed. That is all being adopted into the changes that we are making in rest home supervision. The Government did not inherit a good situation. The Auditor-General, not the National Government, tabled a report before Christmas that damned the governance of the previous Government. It said that the previous Government knew the state of rest home monitoring was appalling and it did nothing about it. It took this Government, led by John Key, to start dealing with the issues. From that party opposite, we see that it is trying to rewrite the history of its neglect of rest home monitoring and supervision in New Zealand.

As I travel around the country, I can tell members that more and more people have wised-up to the political games that are going around the country on this select committee dealing with rest homes. They know the members whom they are talking to were Ministers in a Government that neglected rest home nursing and supervision, neglected monitoring, and neglected dealing with the auditing agencies. They are all issues that this Government is dealing with, and they are all issues that the MidCentral District Health Board is strongly supportive of.

Thank you for the opportunity to speak in this debate on the performance and current operations of Crown entities, public organisations, and State enterprises, and it is with great pleasure that I speak on the MidCentral District Health Board and the health service in general. Undoubtedly, National has reignited life in New Zealand’s health service, and the MidCentral District Health Board is one of the classic examples.

Let us look at the board’s performance against the basic performance criteria over the last three quarters. Firstly, diabetes and cardiovascular health services came up from fourth in the country to third in the country. That has to be pretty good. Then we get to the “better help for smokers to quit” health target, and in that area the board came up from twelfth in the country to fifth in the country. That is very, very good progress indeed. Increased immunisation is, of course, absolutely vital for the children of New Zealand, and the board came from sixteenth in the country up to ninth in the country, which is a great result. On the issue of shorter waits for cancer treatment radiotherapy, the board has come up from nineteenth in the country to first equal. So the MidCentral District Health Board deserves to be congratulated on the clear, evidence-based progress it has made over this period of time.

There is absolutely no doubt that under National we have seen, as I said earlier, a reignition of life in New Zealand’s health system, in stark contrast with the previous 9 years, when we saw increased bureaucracy and wastage, a dismal productivity result, which was basically zero, as was clearly identified by successive Treasury reports, and very, very poor value for money.

What is extremely important for the MidCentral District Health Board, as for district health boards around the country, is workforce. In 2010 we have just realised that our nursing workforce, for instance, is now 46,000, which means a total of 1,000 more nurses than the previous year. That is a very good result, given the difficult times. Let us just think about what happened under the previous Labour Government. All it could do was strategise about workforces. There was committee after committee, strategy after strategy, and nothing whatsoever happened.

Under this very good National Government we have seen immediately the creation of Health Workforce New Zealand, under Professor Des Gorman, and there are some very innovative things going on there, but also the voluntary bonding scheme, which has worked extremely well. It includes graduate doctors, midwives, and nurses, and it has been oversubscribed for a second year in a row, with 501 new health graduates just joining the scheme. It was salutary to learn this afternoon that we now have 1,400 doctors, nurses, and midwives accepted into the scheme, which offers a student loan debt write-off or cash incentives to stay in New Zealand. Labour had plenty of time to do a creative initiative like that, but it failed to do so. It is vitally important for district health boards like MidCentral District Health Board. This year’s intake includes 45 midwives, 392 nurses, and 64 doctors. In fact, almost half of new midwifery graduates have joined the scheme. Of course it takes time for those improvements to work through.

What we have today is the legacy of Labour’s dismal performance, but fortunately we also have the reignition of New Zealand’s health service, through the National Government.

Report noted.

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