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Fears, frustrations and critical risks highlighted in report on Hawke’s Bay hospital

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Doctors have been grappling with mistrust around information entered into the IT systems at Hawke’s Bay hospital, including what it tells them about patients and critical scan results.

A newly released report has revealed 15 critical risks that assessors found in late June, before suspending the radiology department’s international accreditation in July.

It described reporting gaps which critical results about patient health had slipped through.

“The uncertainty of the delivery of [scan] reports was of particular concern for the radiologists, adding to their stress.”

“Mistrust” and frustration are mentioned five times in the short report by International Accreditation, or IANZ, released to RNZ.

Read the report: IANZ – Hawke’s Bay Surveillance Assessment, June 2023 (964K)
“There was an inherent mistrust of the system” among senior doctors, it said.

Staff “were overworked, tired and frustrated, and they have become fearful not of ‘if’, but ‘when’, a major incident of patient harm will occur”, it said – and indeed, there were documented cases of harm, it added.

One failing was that the radiology IT system and the clinical IT were not able to share critical results.

They were “not integrated” and “therefore reports are not automatically sent out”.

“Critical results are sent out via a manual process or a phone call if the referrer can be identified.”

But the system often failed to show which doctor had made a referral.

“There is no way to easily identify the referrer and unnecessary time is spent doing so.”

Referrals by GPs for a scan were having to be typed into the system.

The system was stabilised in May but problems persisted, it said.

Doctors were being forced to work after-hours to get scan reporting done.

Te Whatu Ora: two reviews into patient records
Te Whatu Ora was now randomly going through patient records in Hawke’s Bay to find any harm that had gone unreported.

The agency said a review of a risk register “did not find a significant number of harm events logged, and those which had been are all being investigated”.

But this was during a period of low reporting, it said, so it had begun a second review, this one of random patient records, to find unreported events of harm, or potential harm

Cases would be managed as they were found.

And once it had looked through a large enough sample, it would be in a better position to assess the rate of harm.

It said the concerns of the local community and radiology staff had been heard.

“Substantial work has been in place for some time to stabilise and enhance the reporting system, and this work will continue under a governance group,” it said in a statement.

Latest IANZ report adds to issues raised in earlier review and report
But poor reporting had harmed patients, IANZ said. At least four events were being investigated in August; RNZ has asked Te Whatu Ora for an update.

The IANZ report comes on top of a scathing external review in April of the district’s radiology, which Te Whatu Ora had kept under wraps for months.

Once it was forced to release the report in August, the agency then told the public all the risks were being dealt with.

The Minister of Health echoed this, saying the “immediate safety risks” at Hastings hospital (Hawke’s Bay hospital) had been addressed. She added the way IT was set up there, “is not present in other hospitals”.

However, an internal agency report last September about radiology reporting problems across the whole central region – from Hastings to Wellington to Whanganui – stated:

“The risks are alarming to read considering the serious nature and length of time they have been present.

“… these risks have been present for a long time in many districts in the region … The risks are present and we must address them.”

It listed failings that echoed Hawke’s Bay’s, including:

A “missing clinical result” from a scan; “delayed or missed communication of clinical result”; “reduced capacity/clinical capability due to lack of integration”; and “unavailability/poor performance of system”.

Hastings’ radiology system was upgraded in May 2023 and had been “stabilised” – and new rooms were being built for it – but the problems remained “unresolved” as of late June.

Similarly, Hutt Hospital’s radiology IT had just been upgraded, but was rated as “high risk” just last month by IANZ. Counties Manukau’s system was, too.

The mid-2023 IANZ assessment at Hastings said problems with its clinical IT portal “were common across other hospital services including Medical Laboratory and Cardiology”.

“Discussion with key staff indicated they were frustrated by the system and the lack of perceived engagement from IT to resolve the issues.”

On top of that, Hawke’s Bay was short of doctors and medical technicians, with vacancies worst for radiologists, the assessment said.

Cyclone Gabrielle’s impacts had made trying to recruit harder, the hospital told IANZ, when it pleaded in May 2023 for the assessment to be postponed. “We … cannot stress enough the impact that Cyclone Gabrielle has had,” it said.

IANZ went ahead anyway, finding that the staff shortages and IT woes had combined to present “several recognised and documented critical risk of patient harm issues … which remain critical even after controls were applied”.

The problems have added to the long wait lists for scans.

Routine scans have a six-week target to get done, but at Hastings this had blown out by midyear to:

2-6 months to get a CT scan
MR 2 months
Nuclear medicine 3-4 months
Community-referred ultrasound 3-4 months
Steroid injections up to a year
Fine-needle aspirations up to 5 months
The hospital continues to deliver radiology services.

Te Whatu Ora has repeatedly told the public that the “tireless work of our clinical staff” ensured the services were safe.

But the assessors in June reported back that “discussion with key staff identified low morale, staff were overworked and frustrated with inefficient workflow”.

The health agency did not mention frustration or mistrust in its media release about Hawke’s Bay’s suspension in July, though these featured in IANZ’s findings.

Te Whatu Ora was due to report back to IANZ last week on what safeguards it had put in place. RNZ asked for an update.

If it does not fix things properly within a year, Hastings will have its accreditation formally withdrawn, as happened recently to Palmerston North Hospital.

 

VIA RNZ

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Police guarding scene after Massey house fire overnight

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Seven fire trucks were required to put out a blaze in an abandoned house in Massey overnight.

The fire on Don Buck Rd was first reported around 10pm, with multiple calls coming in from the public, said Fire and Emergency NZ northern shift manager Carren Larking.

Nz herald

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Mother of missing Marokopa children posts letter she says is from their fugitive dad

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The mother of the missing Marokopa children has published a letter which she says was written to her by the children’s fugitive father, Tom Phillips.

Police have been searching for Ember, eight, Maverick, nine, and Jayda, 10, since December 2021, when they were taken by Phillips to an unknown location – though police believe it was in Western Waikato within Marokopa or the surrounding areas.

Tom Phillips does not have legal custody of the children and there is a warrant out for his arrest.

A picture posted by Cat on social media which she says is the last birthday we got to celebrate with Jayda as a family.

A picture posted by Cat on social media which she says is “the last birthday we got to celebrate with Jayda as a family”. Photo: Supplied

Posting on Facebook, their mother, known as Cat, said she was “well aware of the hateful rumours being spread around” and asked that people knew her before judging her.

She said she was sharing the letter to show that all was not as it seemed and to assure people that the children would be coming home to a loving and stable family.

Cat said she along with their two sisters, grandparents, aunties and cousins would be waiting for them.

The handwritten letter – which is not dated or signed and which RNZ has not been able to verify – describes the writer’s love for Cat, apologises to her and says he has a good heart and means well.

“I know if I ever give up trying to make things right I will regret it forever,” the letter says.

“Im sorry for everything I have ever said or done to hurt you,” it says.

The letter goes on to say that “although I make multiple f*** ups I have a good heart and I mean well”.

“We have an awesome family and thats worth fighting for,” is the last line of the letter.

Cat said she had not spoken out earlier because she did not believe it would bring her children home, but the fact that police were now offering a substantial reward had given her the courage to break her silence.

On Tuesday Cat broke her silence to make a video appeal provided by police for people’s help in returning the children to her.

Police have offered an $80,000 reward for information that would help discover the whereabouts of three children and lead to their safe return.

RNZ has contacted the police to verify whether they knew about the letter and whether they can confirm it is from Tom Phillips.

 

rnz

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Nicola Willis challenged over climate change, cancer drugs

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Finance Minister Nicola Willis has revealed new details about the timeline for cancer drug funding, and faced a barrage of questions over climate under questioning from MPs.

Willis appeared before the Finance and Expenditure Committee on Wednesday as part of Parliament’s first Scrutiny Week, a new initiative which allows for extended questioning of ministers over the government’s spending.

She quickly came under fire from Labour’s Finance and Climate spokespeople Barbara Edmonds and Megan Woods, and the Greens’ co-leader and Finance spokesperson Chlöe Swarbrick.

Cancer drugs

The election policy of funding 13 specific cancer drugs had been a glaring broken promise from this year’s Budget.

Willis told the committee MPs that as the Budget for this year was formulated, the cancer drugs policy “did require more work”, and she outlined how the government intended to pay for the drugs using money from next year’s Budget while still working to supply the promised drugs.

“It was not resolved in time for Budget 2024, so we agreed it would be a priority for funding set aside in Budget 2025,” she said. “So we are now working diligently on the policy delivery ahead of Budget 2025, with a view to making a decision on it shortly.”

However, she soon clarified that “we will be funding those drugs this year”, and the reason the policy was not funded in this year’s Budget was “we still had significant policy choices to make as we worked through the problem. And so it wasn’t appropriate to set aside a contingency until those fundamental policy decisions had been made”.

She later explained under questioning from Woods that people would be able to access at least some of the drugs before 2025.

“We will be making an announcement that will ensure that some of those medicines are funded this year,” she said.

Woods questioned if that would mean funding for the drugs this year, and Willis agreed.

Under questioning from Edmonds she said expressed confidence that the government would find the money, noting the government had already approved health funding from the 2025 and 2026 Budgets.

“As the member says, budgets are about priorities – and we are confident that, because this policy is a priority, we can and will fund it.”

She later told reporters at Parliament the word “some” was “just a use of a word, we will be funding the 13 medicines, we’ve made that commitment, we’ll be making announcements on it shortly”.

When pressed, however, she would not confirm whether that meant all 13 specific drugs listed in National’s policy would be funded and available before 2025.

“We’ll make a full announcement with the details of how drugs will be accessed and what dates in due course. I’m not making that announcement today.”

She also refused to shed light on how exactly the drugs would be funded.

Climate change

Swarbrick focused in on the Budget and its effect on climate change, asking how Williis could account for the $700m her Budget assumed would be coming from Emissions Trading Scheme revenue when today’s unit auction appeared likely to fail.

Swarbrick highlighted that at an expected $58 price point they would fall short of the $60 lower limit at which the units would be permitted to sell, and asked what would happen if the units failed to sell, but Willis said she was “not going to go into a hypothetical”.

“We have a requirement for approximately $2.9b in terms of your numbers stacking up here for revenue from the emissions trading scheme,” Swarbrick said, “but you’ve also have presented a Budget which cuts approximately $15m from market governance and integrity of the emissions trading scheme, so I’m wondering if you could help us reconcile those things”.

“It is very important … that I not in any way influence auction behaviour,” she said. “We want it to be a functional, effective, reliable market.”

When Swarbrick pushed her on why the funding had been cut from the efficacy and market governance, Willis said the government did not consider that funding necessary to improving the market’s operations, and rejected Swarbrick’s characterisation there was “next to no meaningful regulation of the ETS market, for example insider trading is technically legal”.

“We do not have concerns about the current way in which the ETS is regulated,” Willis said. She noted the government was yet to release the second Emissions Reduction Plan, due in December. That plan would set out how the government intends to achieve the emisssions reductions set out in the Emissions Budget, in line with international obligations.

“The government is doing its own work on the emissions reduction plan and we envisage the ETS will play a critical role,” Willis said. She also pointed to some initiatives the government had not scrapped in this year’s Budget including the rollout of electric vehicle chargers and the purchase of electric buses for local councils to buy.

Swarbrick earlier asked whether the decisions in this year’s Budget would increase or decrease emissions. Willis acknowledged climate impact policy assessments had showed they “won’t make a significant material difference to emission period 1. Over the second two emission periods, they will have an impact of potentially increasing emissions”.

However, she questioned whether those reports were “as good as they could be”, and pointed to the emissions impact report having included policies like more police on the roads, and upgrades to Defence Force equipment and infrastructure, as examples of where the reports were questionable.

“My point is it is not always appropriate to narrowly look at a policy based simply on its emission impact, because I don’t think there is a New Zealander who would say ‘I don’t want you hiring more police because it might add to emissions’.”

She later told reporters the assessment only looked at a subset of 40 initiatives.

Swarbrick also asked about the $3 billion to $24b the government is estimated to need to fork out in “offshore liability” – buying foreign climate credits to make up for the lack of domestic emissions reductions, and whether Willis had budgeted for those expected costs this year.

“No, I have not,” Willis said. “That has not been a priority in this Budget.”

VIA RNZ

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