The Cost of Recovery: health, mental health and its cost in the years following the Canterbury earthquakes

Alistair Humphrey Greg Hamilton Peri Renison

Canterbury District Health Board, New Zealand

Christchurch, Canterbury New Zealand17th -18th September 2015 The Great Hall Newcastle Upon Tyne

New Zealand

South Pacific nation

Population 4,409,224

Area 270,534 km2

Christchurch, Canterbury New

Zealand

Christchurch Population - 341,469 (2013)

Canterbury Population - 539,433 (2013)

Canterbury District Health Board

CDHB is the second largest DHB in the country

529,000 people

$1.4 Billion (£600m*) turnover

The largest NZ population over 75 years of age

$7m deficit in 2007 $8m surplus in 2011

Integrated Local Health

Services:Public health Primary Secondary Tertiary health

services

22nd February 2011, 12.51pm

Health infrastructure effects of earthquakes in

Canterbury

185 deaths including 11 clinicians 6,600 injuries 1 general practice destroyed with staff and patients 4 general practices lost 19 pharmacies lost Lifelines damage causing disruption 105 beds lost (of 500) in Christchurch Hospital 12,000 rooms in health board facilities damaged 700 staff displaced, dislocated 635 (14%) of aged residential care beds lost Many NGOs displaced from CBD (esp. mental health)

Extra Costs for the Health Service

Earthquake expenses by functional category, 2011 - 2014

2011/12 2012/13 2013/140

5

10

15

20

25

30Responding to damaged providers

Managing demand in the community

Replacing hospital capacity

$ million Relocation of residential

patients

Outsourcing of elective surgery

Additional community mental health services

Community programmes to manage acute demand to relieve pressure on the hospital

Health and Emergencies

Time after disaster

Initial event

Days to weeks

Weeks to Months

Years

Issues

Trauma

WASH

Mental Health Property issues Health

determinants

Community Recovery from Disasters

Seismic Activity in Christchurch

Aspirations vs Reality

Mental Health presentations since the earthquakes

A 43% increase in adult community mental health presentations

A significant increase in new presentations by women aged over 45

A 104% increase in mental health presentations to the ED (accounting in large part for an overall increase of 37%)

A 69% increase in child and youth mental health service presentations despite:– Schools’ Mental health Programme (individually focussed)– Well-Being for Success (population focussed)

A 65% increase in rural mental health presentations

Mental Health Access Rate – Adult (%)

Apr11/Mar 2012 Apr12/Mar 2013 Apr13/Mar 20142

2.5

3

3.5

4

4.5

5

5.5

6

Mental Health Access Rate - adult (%)

Canterbury DHB (CDHB)* Waikato DHBAuckland DHB Counties Manukau DHBWaitemata DHB Capital and Coast DHB

Increased acuity in mental health

Yr 09-10 Yr 10-11 Yr 11-12 Yr 12-13 Yr 13-140

1

2

3

4

5

6

Adult Community - average subscale score for admission HoNOS

Social problems BehaviouralImpairment DepressionDelusions/Hallucinations

New case starts (Canterbury) – Child & Youth community mental health

Housing and Mental Health

Chronic illness, including mental health, is managed in the community

Normally, acute mental health admissions are discharged quickly into community care

But…more than 10,000 residential properties demolished

New Houses are being built, but are expensive and supply is not expected to catch up with demand until 2018

So in 2015 this community care is difficult as housing shortages affect the most vulnerable people

Therefore - Health is working with (and funding!)other government agencies to reduce housing

shortages

The “All Right?” Campaign:A Community conversation about well being

1. We are just asking2. We’re not preaching3. Cantabrians telling their own stories4. Five ways to well being

Five ways to well being

*Resilience thinking in Health Protection

Castelden M, McKee M, Murray V, Leonardi G

Journal of Public Health (Advanced Access April 6th 2011)

Communication

Learning

Adaptation

Risk Awareness

Social Capital

The Financial Cost of the Earthquakes to Canterbury District Health Board

Canterbury DHB Financial PerformanceOver the four years-from the Quakes

Canterbury 2011 and Kobe 1995

2006/0

7

2008/0

9

2010/1

1

2012/1

3

2014/1

5

2016/1

7

2018/1

9

2020/2

1

2022/2

3

2024/2

5

480,000

500,000

520,000

540,000

560,000

580,000

600,000

2014 Series (2013 census)2013 Series (2006 census)

Over 65 population estimates and share

based on Census - Canterbury

20

06

/07

20

08

/09

20

10

/11

20

12

/13

20

14

/15

20

16

/17

20

18

/19

20

20

/21

20

22

/23

20

24

/25

60,000

70,000

80,000

90,000

100,000

110,000

120,000

130,000

Total 65+ Population Pro-jections

Dec 2013 PBFF Dec 2014 PBFFCensus2

00

6/0

7

20

08

/09

20

10

/11

20

12

/13

20

14

/15

20

16

/17

20

18

/19

20

20

/21

20

22

/23

20

24

/25

11.2%11.4%11.6%11.8%12.0%12.2%12.4%12.6%12.8%

Canterbury DHB % Share of National 65+ Population

Dec 2013 PBFF Dec 2014 PBFFCensus

The influx of rebuild workers

A Post-Disaster Policy Framework

Recognise increased costs arising from the disaster– avoid short-term service changes that compromise long-term

planning

Provide a level of revenue certainty for the period in which the Health Service faces exceptional instability in costs and demand – this enables an organisational focus on rapid recovery

Include triggers both for considering a move to an exceptional “recovery funding” approach – (such as, declaration of a state of emergency)

Include agreed triggers for reducing the level of support as operations approach stability – to avoid the problem of moral hazard

Centre on a jointly-agreed pathway to the “new normal”

– long-term objectives for local health services– agreed responsibilities for both local services and central

government– to enable timelines to be met, and processes to support this – to enable the impact of delays or other unexpected changes to

be recognised and appropriately managed

Separately identify the funding for stabilisation and recovery as a specific adjustment to Population Based Funding Formulas

Sendai Framework Priority 4:

Enhancing disaster preparedness for effective response and to “Build Back Better” in recovery, rehabilitation and reconstruction

S33To adopt public policies and actions …and funding mechanisms …for post-disaster recovery and reconstruction

Conclusions - Costs

Health service costs in Canterbury peaked two years after the earthquakes and continue to be high for a variety of reasons

Costs would have been higher still were it not for an integrated and innovative health service

Mental health costs (especially in young people) continue to rise five years after the earthquakes– Population based mental health programmes can be used

to mitigate mental health effects

Population based programmes (integrated into the health service) can reduce demand

Conclusions - Funding

“Business as usual” funding formulas are not appropriate in the aftermath of natural disasters– Exceptional funding arrangements (time limited and ring

fenced) may be a more appropriate funding model– Appropriate funding models need to be part of Disaster

Risk Planning for health (and other) services

Post disaster policy frameworks (including funding arrangements) should be prepared and are consistent with s33 of the Sendai Framework

With thanks

Carolyn Gullery – Canterbury District Health Board

Funding and Planning Manager Donovan Ryan (CDHB Communications) Mary-Ann Heal (CDHB Information Analyst) Gary Blick and Tom Love Martin Jenkins