The closing of Napier’s hospital in 1998 and relocation of hospital services to Hastings was one of the most contentious events in Napier’s history. Over strong objections from Napier residents, the hospital on the hill closed.
The plan was to provide a broad range of ‘sub-acute’ services through a new health centre in Napier.
Think of a hospital and its services: patients in beds, victims of nasty accidents, heart attacks, strokes, CAT scans, etc. Then subtract the people who use the ED as a clinic, and you have acute care. Subacute care is anything less. Primary health care is what you get from your GP.
The central hospital would provide intensive medical treatment, surgeries, inpatient care and expensive high-level diagnostic equipment.
Are the healthcare needs of all Napier’s residents being met, as promised, by the combination of the Napier Health Centre, a broad network of general medical services and the Hawke’s Bay Regional Hospital?
Health Centre rises to the occasion
“When the Napier Health Centre was developed, possibly 100% of people in Napier thought the mix of a centre here and a hospital in Hastings would not meet their needs, but now the centre meets the needs of 90% of the people who present there,” said Barbara Arnott, Napier’s mayor and a member of both the Napier Health Services Advocacy Forum and the District Health Board (DHB).
Last year approximately more than 33,000 people went to the Napier Health Centre for health care … not far off the estimated 36,000 people who went for services to the Hawke’s Bay Regional Hospital in Hastings.
A 2010 review, or ‘stocktake’, of the Centre’s services runs to considerable length, listing everything from 24-hour emergency and general practitioner (GP) services through physiotherapy (which has its own pool), dental care at the centre and in the community, a maternity unit (yes, they deliver babies), outpatient and specialist clinics, district nurses, social work, regional public health protection and screening, immunisations, mental health and addiction treatment, and minor surgical procedures.
The Centre has a laboratory and a radiology (X-ray) facility and performs blood tests and electrocardiograms. It is ACC accredited. It even has a café and a bus stop with free bus rides between the Centre and the hospital.
The DHB contracts with the Centre’s City Medical service for delivery of a 24/7 Level 2 emergency service. This requires the Centre to provide 24-hour availability of accident and medical services. The City Medical unit has 38 general practitioners who provide acute surgical, medical and orthopaedic management. People who
come to the Centre but require inpatient services are transferred to the Hastings hospital, by ambulance if necessary.
Should disaster strike the city, such as a major earthquake, the Centre will become an emergency medical unit providing triage, initial assessment, management and referral or discharge for casualties.
Napier Health Centre recently renewed its lease of the Wellesley Road facility for another ten years. A service expansion and renovation project is underway, with $700,000 of structural improvements to be funded by the landlord, Vital Healthcare Properties, Auckland.
Centre improvements
“The desire is to grow the number of services we can provide and improve integration with primary care services,” said Andrew Lesperance, general manager of planning and performance with the DHB.
The first project is nearing completion, with about half a million dollars spent on state-of-the-art digital radiology equipment from the US. The new facility opened 1 August 2011. In 2010, radiology performed 10,047 procedures, with a larger number anticipated this year due to the new equipment.
New periodic clinics staffed by medical specialists are also targeted. Among them are a pain clinic, which has begun with a specialist coming from Wellington, and a nurse specialist urology clinic. A local GP with a special interest in orthopaedics staffs a clinic at the Centre once a week.
Napier residents and medical practitioners identified the need for these clinics in a series of meetings last year. “We had many focus groups last October and November,” said Wietske Cloo, project manager for
Napier Health Services and manager of public health nursing and smokefree programmes. Young people, consumers, a multidisciplinary team, Mãori and nurses took part in the various groups.
With the clinics “we’re looking at providing better care for people with long-term or chronic conditions,” Cloo said.
What are the costs of the new programmes? With some exceptions, “we think we can do it with existing resources,” Cloo said. This will be a mix of funds ‘redirected’ from other services to cover travel costs and professional charges, and the deployment of existing personnel. Lesperance cited the example of the rheumatology clinic: a rheumatologist and a nurse from the Hastings hospital come to Napier to staff the clinic. The only additional cost is their mileage. However, the new pain clinic is hiring staff and is funded by the DHB.
The Centre itself will be reconfigured. Walking into the Centre’s vast lobby and glassed reception area, you would not know that the treatment rooms include a warren of cramped, neon-lit, windowless boxes. Even the brightest décor could not mitigate the impact of a depressing diagnosis, but it would be nice for all
the members of even a small family to be seated comfortably while it’s being delivered. The remodelled rooms also will provide better working conditions for specialists.
But the horse before the cart: “We’re first determining what we can bring in before we reconfigure the rooms,” Lesperance said.
“We want to remove any disincentives for specialists to work in Napier,” said Kevin Atkinson, chair of the HBDHB. “We want the Centre’s clinics to be as good as those in Hastings. This review (of the Centre’s services) is to ensure we’re providing services to Napier the best way
we can. We can’t duplicate expensive equipment, but we want the services to be as close as possible.”
Community health delivery
“Most general procedures can be done in the community and, when we get to that stage, it will be a happy thing. The more work you can do in the community and the more services people can access in their neighbourhood, the better,” Barbara Arnott said.
The community health-care network is sizeable and comprises physicians in private practice, public health nurses, freestanding laboratories and clinics, health centres, and facilities with a focus on Mãori and Pacific Islanders.
Many of the services have signed on with the Hawke’s Bay Primary Health Organisation (PHO). The organisation’s website describes it as “a not-for-profit, charitable organisation that brings together health professionals and the community to coordinate and deliver health services for the population of
Napier, Hastings and Central Hawkes Bay.” Central government funds the PHO to subsidise a range of health services, focusing on four goals: population health, reducing health inequalities, workforce development and service sustainability.
In Napier, 62,528 people were enrolled in the PHO through their GPs last year. This compares favourably with the government’s estimated population of the Napier urban area: 58,600 people in 2010. Of those enrolled, 10,434 people identified themselves as Mãori and 1,228 as Pacific Islanders. Even allowing for residents of other areas, it would seem the preponderance of Napier area residents are getting health care.
Special attention came to focus on primary health services to Mãori in Napier with the settlement in 2008 of a Waitangi Tribunal claim. Local Mãori lodged the claim, Wai692, when the hospital closed. The settlement provided a building in Maraenui for what has become a well-used surgery and some $300,000 for health services. According to Des Ratima, who is on the DHB’s Mãori Relationship Board, the funds sit in a dedicated trust while plans for their use are being developed. Related to the settlement are contracts for oral health, traditional Mãori medicine and Whanau Ora or family wellness, all of them popular, Ratima said.
Nevertheless, access to service, waiting for service, travelling to the hospital for service and the time required, and the need for more follow-up care are still issues raised by Napier residents. Part of this results from a general shortage of GPs in New Zealand. Part is inherent in the need to balance availability of services with available funding. Some bad experiences are intrinsic to this very human endeavour.
If you’re not at death’s door, you might have to wait for care. Compared to the general availability of health care in, say, the US and South Africa, New Zealand is doing very well. Your best bet is to check in with your GP for whatever ails you and take it from there.
As reported the layout is poorly optimized. The large unused lobby area contrasts with the consulting rooms which are cramped and poorly laid out. On occasion patients need to sit on the examination plinths due to a lack of room for chairs. And specialists do musical chairs sometimes to find a spare room. Yet there seems to be room for about 30 patients to wait while there only 7 examination rooms. And to get to the last examination room, one has to do a horseshoe type circuit around the centre of the complex; a little tricky if you have poor mobility from arthritis. It would make ergonomic sense to move to a star type typology with reception/waiting room in the middle, and the examination rooms on the arms. But that's the outcome from using a building not purpose built for outpatient health delivery.
Oh, Mr. Lesperance has it wrong. The rheumatologist and nurse have chosen to base themselves in the NHC, and travel to Hawkes Bay Hospital once a week, and not the other way round. This has led to the provision of 4 rheumatology clinics per week in the NHC compared with 1 as reported in the 2005/6 annual report.