District Health Board leaders have warmly welcomed new Government funding for Northland and Auckland as they set out a 20-year vision for healthcare in Northland and Auckland DHBs’ first joint Long Term Investment Plan (LTIP).
Today’s announcements include more than $200 million for a new surgical hospital for the North Shore Hospital campus, which will create significant additional elective capacity for the people of the Waitematā DHB district and the wider region.
Northland DHB was allocated $24 million for a Whangarei Hospital Theatre extension, a new Endoscopy Suite, and a new Cardiac Catheter Laboratory, to meet medium-term demand for acute medical and surgical services.
Earlier this year, $275 million of Crown funding was allocated to remediate and upgrade critical infrastructure at Auckland City Hospital, Starship Hospital and Greenlane Clinical Centre. Other business cases for the region, including plans to remediate and upgrade Middlemore Hospital, are at different stages in the capital investment process.
The Northern Region LTIP was developed by the Northland, Waitematā, Auckland and Counties Manukau DHBs, with input from the Ministry of Health, Treasury, and other partner agencies. Released publicly today, it will provide important regional context for future investment decisions.
Dr Dale Bramley, Chief Executive of Waitematā DHB and regional Chief Executive lead for the LTIP project, says this is the first time such a comprehensive investment plan has been developed to meet the needs of the people of Northland and Auckland.
“This is an important and exciting plan that provides a new perspective on the challenges and opportunities that face the Northern Region healthcare system,” says Dr Bramley.
“The new LTIP-related investments announced by the Government today at North Shore Hospital, and earlier this year at Auckland City Hospital, will make a tangible, positive difference to the health outcomes of all the people living in our Region.
“The LTIP paints a picture of the substantial population growth and demographic shifts that will occur over the next two decades. It provides regional context for the investment of our existing budgets, and identifies the priorities that will require additional funding to meet the needs of our uniquely diverse population.
“Health equity is an important theme of the LTIP. We are ambitious to reduce the inequities that currently exist in our system, and to work across DHB boundaries, integrating and sharing resources, assets and services to ensure every dollar is spent in a way that optimises health gain for all our communities.”
The northern DHBs receive more than a third of the nation’s public healthcare funding (over $5 billion in annual revenue) and use it to provide and fund healthcare services for both regional and national populations. National services provided by the Northern Region DHBs include Starship Children’s Hospital and the National Transplant Unit.
The Northern Region itself has a population of 1.8 million people, predicted to grow to 2.3 million by 2036/2037. The population aged over 75 years within the region is anticipated to more than double during this time.
Counties Manukau Chief Medical Officer, Dr Gloria Johnson is the regional CMO lead for the LTIP. Dr Johnson says while this first phase of the LTIP is focused on the condition and capacity requirements for the region’s hospital services, the second phase has a community centric approach.
“The longer lead times necessary to plan and fund increased hospital capacity mean we have prioritised hospital services the first iteration of the NRLTIP,” says Dr Johnson.
“Phase one of the NRLTIP details the remediation work required to ensure our current building stock is fit for purpose and to address the current maintenance backlog.
“The NRLTIP also identifies the Northern Region will need approximately 1,600 extra hospital beds in the next 20 years and outlines options for increasing hospital capacity, These include the development of current hospital sites and the potential for building additional hospitals in the region.
“However it is equally important to invest in changing our models of care, in early intervention and prevention work, and community and primary care. We are working with our primary care partners to further develop this aspect of our long term investment planning.
The Northern Region LTIP is the result of more than 18 months of work by the four northern DHBs in collaboration with other stakeholders, including primary care, the Ministry of Health, Treasury and the Northland and Auckland Councils.
“On behalf of the four DHBs, I want to thank everyone who has contributed to the first Northern Region LTIP or is contributing to the next phase of this work,” says Dr Johnson.
The full NRLTIP is available on the Northern Regional Alliance website at www.nra.health.nz/our-services/regional-planning-and-service-delivery(external link).
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Population growth: The Northern Region is experiencing unprecedented growth in demand, unique within New Zealand. Over the next 20 years, approximately 57% of New Zealand's growth will be in the Northern Region. The NRLTIP identifies that we can expect 562,000 additional people in the next 20 years using medium growth forecasts. We have an aging population; the number of people aged over 75 years within the region is anticipated to more than double during this time.
Health Outcomes: Although health outcomes in our region are generally better than the New Zealand average, these are variable across our Region. Waitematā DHB has the highest life expectancy at 84.1 years, whilst Northland DHB life expectancy is currently 79.6 years. Some variation is seen in amenable mortality, cancer and CVD mortality, as well as cancer survival rates.
Key: Dark blue = Greatest opportunity for improvement, Light blue = Lesser opportunity for improvement.
Equity is a major theme of the NRLTIP. The Northern Region is the country’s most diverse region, but there are significant inequities for some population groups and geographic areas. The NRLTIP identifies options for reducing the inequities that currently exist in our system, by working across DHB boundaries, integrating and sharing resources, assets and services so that our investment path optimises health gain for all our communities.
Our diverse Region has:
A high Māori population in Northland DHB and Counties Manukau Health
A high Pacific population in Counties Manukau Health
A high Asian population across the region, particularly in Auckland DHB
A high rural population particularly in Northland
High levels of deprivation in Counties Manukau Health and Northland DHB
We are comparatively young but have a rapidly growing 65+ population
Capacity and demand: We anticipate that the demand for healthcare associated with our growing, ageing and changing population will quickly outstrip our ability to deliver healthcare under our current models of care and require significant investment. The NRLTIP quantifies the significant increase in capacity that is required to meet future growth, particularly in our hospitals where there are already capacity constraints. Many of our community based services are also reaching the limits of their ability to meet demand.
If we simply multiply current activity by expected population growth, in 20 years the Region will need to support:
1.1 million additional outpatient attendances
2.2 million additional GP consults
2.055 additional hospital beds
41 additional hospital theatres
Hospital capacity is a focus of the Phase One NRLTIP. The plan identifies that we will need approximately 1,600 extra hospital beds in Northland and Auckland in the next 20 years and outlines options for increasing hospital capacity. These include investing in further development of our current hospital sites, building a new 400-bed hospital south of central Auckland, and planning for a new hospital site to the north of Auckland. The need for a further 450 beds has been avoided in this plan through investment in prevention, early intervention, and community-based alternative models of care. These new models of care will see people who currently need to come to hospital able to be treated in their homes directly, or in community settings.
Fixing critical infrastructure: Alongside the long term investment planning required to increase hospital capacity in our region, the NRLTIP outlines the more immediate investment required to remediate our current facilities. Patient safety is protected through active maintenance programmes, but across our four DHBs, 18.5% of the facilities are in poor or very poor condition, including critical infrastructure such as water and power supply. Around one fifth of our clinical services are in not fit for purpose facilities. Counties Manukau DHB and Auckland DHB recently received additional capital investment to upgrade and repair critical infrastructure. Other business cases for the region are at different stages in the capital investment process.
Patient and whānau centred care: The NRLTIP also recognises that health services in our region are not sufficiently centred around the patient and their whānau. The NRLTIP describes a vision for the future where care is delivered through a more integrated, patient centred health system, including patient self-care, private and NGO services as well as services funded and provided by our DHBs. Increased collaboration across the whole system and a fresh look at which services should be centralised and which localised will improve the overall health of our population, increase access to care and reduce inequities.
Prevention and early intervention: Investing in the acceleration of changes to our models of care is essential to improving health outcomes and managing healthcare demand. The NRLTIP outlines the role of investment in population health and prevention efforts to improve health outcomes across our region, and to reduce the demand for hospital services. Examples of focus areas are improving health literacy, empowering patients to lead healthier lifestyles, and increasing the uptake of screening programmes so we can help people before they become sick.
Deep dives: Each phase of the NRLTIP involves deep dives into specific areas of our regional healthcare system. The Phase One NRLTIP looks at our future models of care for Cancer services, Elective surgery, Radiology, and services for our Frail Elderly patients. As part of Phase Two, we are developing detailed plans for these areas, as well as conducting deep dives into our Community, Primary Care, Population Health, Mental Health, and Laboratory Services.
A planned investment path: The NRLTIP identifies a need for substantial investment over the next 20 years to meet our regional challenges, including operating costs and capital investment. Investments required in workforce and information systems to support and enable the desired changes are an on-going focus. The Northern Region DHBs are working together to decide how best to develop and sequence the investment path outlined in the NRLTIP, and to identify the priorities for additional funding. We are committed to ensuring every dollar of health funding we receive is spent in a way that optimises health gain for all our communities.
Long term collaboration: On-going collaboration with local and national Government over the 20 year period of the NRLTIP is essential if we are to meet the health needs of people living in the Northern Region. The Government has welcomed the NRLTIP as a document that will assist in the co-ordination and sequencing of capital projects to ensure DHBs continue to deliver the services people deserve while at the same time addressing long term issues, and has made capital allocations aligned to the NRLTIP. Other business cases for the region are at different stages in the capital investment process.
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