'Horizontal' infrastructure upgrades in New Zealand's hospitals comes with a hefty price tag. File photo. Photo: 123rf
New Zealanders can now see for themselves if their nearest big hospital has had old or incomplete fire detection or dodgy water, electrical or medical gas systems.
RNZ has unearthed the main report into the vital but mostly invisible systems - called "horizontal" infrastructure - that the nation's safe healthcare relies on.
But it is still not known if the issues have been fixed or not - some have, some have not - because Health New Zealand (HNZ) has not given any details.
Health NZ has known about the 82 riskiest systems for more than 18 months.
One entry said: "Palmerston North Hospital - Fire detection - end of life and incomplete coverage."
A second said: "Gisborne Hospital - Electrical essential services - end of life and not supplying some essential infrastructure." This project was listed as underway.
Thirty-five of the 82 riskiest systems identified in early 2023 have not been touched.
The other 47 have either been fixed or are being fixed. This includes the recent approval to fix Gisborne Hospital's fire detection, and sign-off of Hutt Hospital's upgraded fire systems.
The 2023 report - newly released to RNZ - is the most comprehensive risk assessment of its kind, spanning 34 hospitals that are key for surgery and emergency response.
Report into hospital infrastructure exposes those with issues
It confirms the findings of the first national asset stocktake in 2020 - hospital pipes, cables and other horizontal infrastructure are in an even worse state than Health NZ's 1300 buildings, which have an average age of 46 years.
Hospitals in Gisborne, Hawkes Bay, Palmerston North and Kenepuru were in the worst shape 18 months ago. Sixty-three percent of their major risks have either mitigation projects completed or - as with power reticulation and potable water - underway.
Health NZ said it had prioritised the most urgent fixes. The other 35 were being monitored and managed.
"The start times for these remaining projects are subject to evolving resource and capital availability."
HNZ could not give a timeline to start them all
"Health NZ continues to prioritise work to system issues on our campuses, with a higher priority given to those which may affect the health and safety of our patients, whānau and staff," it said.
Independent engineers who did the 2023 risk report wanted more investigation into an "urgent programme of works" at all 82 major risk systems.
Someone familiar with the project said they recalled that management "was shocked how bad Gisborne Hospital was - and somehow it had gone under the radar for so long - the locals had ignored it".
"I actually think that this report and approach is one of the most sensible approaches taken to dealing with the investment deficit - fix the stuff that is worst, and now that we have a national perspective, we remove parochialism and local biases," they said.
Another 599 high and medium-risk systems were found, the report said.
Aside from most major ones with the greatest consequences of failure, many hospitals had lots of other "significant issues" with things such as old pipes and wires that were unable to cope with increasing loads.
The risks presented a hazard to patients and staff.
All the official statements from HNZ to RNZ has a reassuring tone. Infrastructure asset management head Stacey Marsh said "regulatory compliance checks are undertaken annually, and regular maintenance and upgrades are ongoing at every campus", and another comment noted that even old fire systems could work
But the 2023 report - and several other reports - were less reassuring.
The 2023 risk report said that in some hospitals, only certain people had a grasp of the risks. If the person left, the knowledge went with them.
This was a "significant and growing risk", it said.
HNZ's annual report - released on Tuesday - had this to say on blindspots:
"We are aware of deferred maintenance at our sites, however, not having the systems and tools to quantify the levels of deferred maintenance means that we are unable to predict the spikes in investment required to maintain an asset's level of service."
Meanwhile, an official scorecard recently rated Health NZ in the 'red' or worst category, across eight of the 12 measures of asset management used by the Infrastructure Commission.
"No evidence of asset management systems and improvement activities," it judged.
A second HNZ report made public on Tuesday also showed its spending on maintaining hospital infrastructure might actually drop this year.
HNZ is currently trying to save $660m by next July, and fixing the hundreds of risky horizontals poses another drain on finances.
The 2023 report put the overall cost at between $140m and $370m, with construction inflation pushing that higher since.
HNZ's new annual report lays out five immediate infrastructure priorities, only one of which looks to touch on the "horizontal" deficit - through the regional hospital redevelopment programme. But this is years away from delivery at Palmerston North and Hawke's Bay hospitals with their many risks.
Plans on fixing buildings and service infrastructure have crawled along since RNZ first broke news of the Labour-led government's first-ever national health asset stocktake in 2020.
A national "baseline", promised back then, is at least three more years away.
"While this is critical... no progress has been made on this outside of a pilot (two sites) that is being finalised," said the new HNZ annual report.
A localised baseline study at Hawke's Bay hospital recently found almost 60 percent of its plant assets "beyond their engineered lifespan".
The 2023 risk reports showed eight or nine out of the 34 hospitals had only a few high and medium priority risks. But more than 20 hospitals had a whole stack.
The "very high priority risk" list comprised: Whangārei with 4, Auckland City 3, North Shore 5, Gisborne 10, Taranaki and Hutt and Wellington and Wairau 4, Hawke's Bay 6, Palmerston North 7, Kenepuru 7, Ashburton 5.
Photo: Supplied
Ten hospitals had zero "very high" priority risks.
The hospitals with the most risks in the second category - 'high priority' - were Nelson and Taranaki (19), Waitakere and Christchurch (17), and Wairarapa and Kenepuru (16).
Water upgrades were among the costliest looming: hot water costs were $10m-$34m; water supply was $12m-$40m; and wastewater was $13m-$31m. Power upgrades were even higher, at between $31m and $70m. Mechanical plant renewal was put at $15m-$34m.
At four regional hospitals - Gisborne, Hawke's Bay, Palmerston North and Kenepuru - overall upgrades might cost $47m-$124m.
The work is complex. Wellington hospital has three working generators, but its four multi-million dollar new ones are still not linked up or working, and are waiting on 2025 for parts. This comes nine years after a "catastrophic failure" took an old generator out in 2015.
"Detailed assessments needed to be undertaken (including structural & geotechnical), which take time," Health NZ told RNZ on Tuesday.
The agency's new reports stated that, amid its ongoing restructure, it aimed to "streamline" infrastructure and investment.
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