Healthcare Services for Auckland City’s most underserved

Fifty-six – is the average age of death at the Auckland City Mission’s Calder Health Centre. ‘Homelessness affects people’s bodies, and it means we die early’ were the words shared by Manutaki – Auckland City Missioner, Helen Robinson, during last year’s Aotearoa NZ Anaesthesia ASM Gala Dinner.

The Auckland City Mission – Te Tāpui Atawhai was the official 2024 Aotearoa NZ Anaesthesia ASM charity partner. Their HomeGround building in Auckland City serves as a central community hub offering a wide range of support services in one location including: permanent homes for 80 people; Haeata, a communal dining room providing over 300 people with one hot meal a day; withdrawal services with 15 social detox beds, alongside 10 medical detox beds that are run by Te Whatu Ora; a hub where people can get an assessment of their needs, access to housing support and MSD; and access to a variety of activities grounded in Te Ao Māori including weekly Waiata and Kapa Haka.

It’s also the home to the Calder Health Centre, a general practice clinic that provides a range of low-cost health and social services.

The Mission’s GM Health Services, Brendan Short, spoke with the NZ Anaesthesia to provide more insight into the unique health challenges and the approach taken by the Calder Health Centre and the Mission’s health services to support those in need.

The Calder Health Centre isn’t your usual general practice clinic

The people we see often have highly complex needs, impacted by poverty and circumstances that make it difficult to maintain physical or mental health. Many have been excluded from specialist and primary care services for numerous reasons, leading to both latent and acute health issues when they reach us. In addition to physical and or mental health concerns, they often face significant social challenges.

The Calder Health Centre is a VLCA (Very Low Cost Access) clinic and one of the lowest copayment clinics in the country. However, copayment is not a barrier to accessing our health services; we see everyone, regardless of their ability to pay.

Our team includes a doctor four days a week, a nurse practitioner five days a week, a nurse prescriber, practice nurses, and a full-time outreach nurse. We also have a part-time mental health nurse and full-time health and social services coordinator.

As a nurse-led practice, the Calder Health Centre offers both booked and walk-in appointments. Around half of our roll of 2,300 are Māori. Standard consultations last 30 minutes, and most patients attend around 7-9 appointments annually – significantly more often than in a typical general practice clinic.

Our services include a lot of what you would expect to see at a general practice, such as bowel screening, vaccines, and sexual health services as well as wound care, which can be difficult for people to manage in unsterile environments. We also offer a podiatry clinic and a minor surgery clinic.

We are able to approach healthcare a little differently from your typical general practice clinic, thanks to the support we receive. This enables us to better meet the needs of the people we see and engage them in healthcare that they might otherwise miss out on.

Navigating the healthcare system can be challenging for anyone, but it’s even more challenging for those who are experiencing homelessness, living in poverty, or who carry a mistrust of health and other statutory services due to negative experiences in the past.

Our entire team use a trauma-informed approach. We may not always know the personal histories or triggers people come with. What might seem like a routine conversation to us could be deeply triggering for someone who has experienced significant trauma and had no support to process it. This awareness is integral to how we engage with people to support them to continue receiving clinical care.

It’s highly relational work

Two positions less commonly seen in a general practice clinic are our Health and Social Services Coordinator and our Outreach Nurse. Both are highly relational positions.

The Health and Social Services Coordinator supports people to align their health needs and their housing, benefits, and legal issues. This non-clinical role focuses on those with the most complex presentations and ensures they can access outpatient appointments. The role also involves providing a lot of palliative care support.

The Outreach Nurse’s primary focus is engaging with our marginalised populations who would not otherwise access support and often end up in the emergency room. By going out to people in the places where they are, whether at pop-up clinics for high-risk groups at the needle exchange, the Auckland City Library, Mission-run housing services, or rough sleeping spaces, the Outreach Nurse encourages people to engage with the healthcare system. While some of these engagements may take place at the Calder Health Centre, the Outreach Nurse will support people to engage wherever they’re going to feel most comfortable.

These roles help develop long-term relationships with the people we serve, leveraging those relationships to provide ongoing health support. For example, last year a person came into the clinic with concerning presentations that we felt required specialist support. They were referred to the hospital but went alone, and the appointment did not go well. They left partway through the consultation.

We continued to engage with them through the Calder Health Centre, and the hospital later contacted us to inform us that the person had a significant head injury. The Health and Social Services Coordinator, through the relationship they had built with this person, was able to say, ‘I think we need to give this another go, I think we need to get you up there. There’s something serious going on. How can I support you to do this?’ This is just one example of many similar cases we see.

The Mission provides additional services beyond HomeGround, including transitional housing services. While people accessing these services are not expected to visit Calder, many often do because of the trust and relationships we have built with them. This is especially important for those who have had negative healthcare experiences in the past, and helps us to ensure people continue to engage with the healthcare system.

Dental services are coming!

This initiative addresses a critical gap in healthcare services for New Zealand’s most marginalised populations. Many New Zealanders struggle to meet their dental needs, and providing dental services has been a long-held dream for the Mission – to address that gap and engage the people we see in that care.

HomeGround was built with a designated space for dental care, and since mid-last year, we’ve been working on a project to bring this vision to life. Our business plan has been approved, and we’re currently in the process of purchasing and arranging the installation of equipment. We hope to be operational by July 1st!

The health services we currently provide (including the social withdrawal services) require an additional $1.2 million to operate on top of existing contracts. In the current financial year, the Calder Health Centre is running at a deficit of nearly $630,000, and the social withdrawal services are running at a deficit of just over $530,000. We are able to deliver the services we do and meet these costs, thanks to the generosity of those who donate to the Auckland City Mission.

I include this context to demonstrate why our dental service has been designed using a model that will not add to that financial burden. Financial sustainability is key, and we believe we can achieve this, again thanks again to the generosity of our donors. We have a few dentists who have kindly donated their time, expertise and knowledge. Our scope and services will be based on Work and Income’s Immediate and Essential Dental Treatment Grant, which enables a limited range of dental interventions.

We will initially open three days a week and don’t anticipate having any difficulty filling our chair. To begin with, we will prioritise those who are already engaged with other services the Mission provides. We are mindful that this small-scale response can’t meet the widespread need for accessible dental care in this country, and that’s tricky. But we also know that many of the people who will engage with this service are unlikely to have visited a dentist in many years, perhaps since they were at school. Often their issues are exacerbated by their complex circumstances, and they end up in the ED or hospital, which ultimately costs the public system more.

For those who have significant histories of trauma, the thought of engaging in dental care for the first time in decades comes with a lot of apprehension. It will be crucial for us to leverage our relationships to support people into the dentist’s chair and provide care that we know will help them feel better about themselves, both physically and mentally.

We see the need daily and understand how difficult it is for people to engage in what is publicly available. When we think about what better looks like, for us, it comes back to getting people engaged in healthcare.

Our goal is to contribute to the continuum of care by planning and delivering services that meet their needs. We know this isn’t the be-all and end-all of what’s required. But we can get it started, make it successful, and then think about what’s next.

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