In one of six outcome areas of a new report on children in sate care, Oranga Tamariki could not answer 18 questions about healthcare or disability. File photo Photo: RNZ / Alexander Robertson
Almost 3000 of the most vulnerable children are not enrolled with a doctor, and GPs say Oranga Tamariki has never asked them for help fixing that.
They say inmates released from prison and refugees can get help finding a doctor, so why not children in state care.
The latest report from the Independent Children's Monitor (ICM) shows about 2970, or 47 percent, of children in care are not enrolled with a GP or medical centre.
Only 53 percent are.
Royal New Zealand College of GPs (RNZCGP) president Dr Samantha Murton said this had not been flagged to them by anyone, though they see a lot of statements.
Dr Samantha Murton. Photo: Royal New Zealand College of GPs
"GPs would be distressed if they found that the most vulnerable children were not getting access to the health care that they need," she said.
RNZCGP had not been alerted to the first full ICM report two years ago, when the non-enrolment figure was 40 percent.
In the second, for 2021-22, it had dropped still further.
This latest report also shows Oranga Tamariki (OT) could not say if 6300 children in its care were getting any health or dental checks.
It was "unable to tell us if tamariki and rangatahi had received an annual health check within the reporting period. It is still unable to provide us with this information".
In one of the six outcome areas, OT could not answer 20 questions and 18 of those were about healthcare or disability.
A newly published study shows people who do not have a GP are 39 percent more likely to die early.
OT did not dispute the monitor's report but said its files showed 88 percent of the children had their health needs assessed and a health plan.
'Critical factor'
Oranga Tamariki says addressing the health needs is "a foremost priority". Photo: RNZ / Angus Dreaver
Dr Murton checked back and found no record of GPs being contacted about this by either OT since it was set up six years ago, or by the Ministry of Health which monitors primary healthcare delivery.
"I have not been involved in any conversation," Murton said.
"OT has not come to the College of GPs to say, 'can you assist us with this because we are struggling'."
Even if children in care moved around frequently, this did not lift the onus off the Children's Ministry as de facto parent to ensure they had all their vaccinations and checks, as well as that their mental health was okay, she said.
"It's a really critical factor in the safety of that child.
"We can't actually reach out to children we don't know about. So as GPs on the ground, if we don't know some child has moved into our area who needs health care, we will never know."
Independent Children's Monitor executive director Arran Jones said he raised, with the Health Ministry late last year, the gaps in what OT knew about mental health care for children - but not the GP gap.
He would raise the GP gap this year, though he stressed ICM's own mandate was only to assess OT against national care standards.
"I'd expect that Ministry of Health will be focusing in on that to make sure that they've got strategies in place to ensure that these kids are registered, but, look, the answers to why they're not, I will assume will be a multitude."
Jones on Friday told Nine to Noon they were in the midst of evaluations for next year's report, and his sense was things would not have moved a lot, though he hoped some of the data might improve.
Listen to the full interview with Independent Children's Monitor executive director Arran Jones on Nine to Noon
'Absolute travesty'
The College of GPs says it wants to meet with Oranga Tamariki to improve the situation. (file image) Photo:
One thing ICM was working on was understanding why children were not enrolled, Jones said.
Ngāti Awa Social and Health Services in Whakatāne has no such gap.
Chief executive Enid Ratahi-Pryor contrasted what they did versus a state system, which she said was broken.
"All of our children are enrolled with a GP, all of our children receive dental care, and that's because our focus isn't purely on care and protection, which tends to be what Oranga Tamariki is focused on," Ratahi-Pryor said.
The responsibility had to be put on the direct caregiver, including foster carers, to ensure children got healthcare, but that required the whole structure changing so that OT only looked after the 'sharp' end of acute immediate needs.
"The fact that we continue to put resources and money into a system that, quite frankly, our children aren't getting general practice care, that's an absolute travesty," Ratahi-Pryor said.
The College of GPs said now it knew of the problem, it would act.
"What we're going to do is gonna reach out to Oranga Tamariki and say, 'can we meet? What can we do to make this better?'," Murton said.
Oranga Tamariki did not agree to an interview but in a statement said addressing the health needs was "a foremost priority".
"We acknowledge that our figures around registration with a GP need to improve," said OT quality practice and experiences deputy chief executive Nicolette Dickson.
It was partly a data capture problem, she said.
GP enrolment was "only one measure" and while most tamariki got primary health care from a GP, "we take an approach to match tamariki with the health service to best meet their specific needs".
Dickson referred to the benefits of a 'Gateway Assessment' all children in care were entitled to get.
But ICM said such assessments did not mean the needs were actually being met. "This is quite different from a regular check-up with a doctor who may identify medical needs that can then be met."
Both OT and the Health Ministry told RNZ they were working on an 'Action Plan' to help more agencies to cooperate to deliver the healthcare.
A third key agency, Te Whatu Ora, was developing tailored, local resources under that plan, said the Health Ministry.
"Manatū Hauora would welcome the opportunity to meet with the ... Independent Children's Monitor to discuss progress and opportunities to improve health outcomes of these children and young people," it said.
Recent research shows primary health enrolments are highest in the general population for 5-14 year olds, at 100 percent; versus 59 percent for children of that age in care.
Primary healthcare enrolments for New Zealand population, based on age groups. Photo: International Journal for Equity in Health
Ratahi-Pryor said the low 13 percent enrolment of the youngest (0-4 years) children in care could be because they were eligible for government-funded health checks with Well Child Tamariki, such as via Whānau Āwhina Plunket. However, these do not cover child vaccinations, which GPs do.
The complication for 15-20 year olds (28 percent enrolled) was they were "often absconding and of an age where they are making decisions for themselves", Ratahi-Pryor said.