Purpose
In determining the topic of this review, we considered themes uncovered through our earlier monitoring work, including our two published Experiences of Care in Aotearoa reports on compliance with the NCS Regulations. Our 2021/2022 report referred to data from Oranga Tamariki showing that only 53 percent of tamariki and rangatahi in its care were enrolled through a Primary Health Organisation with General Practice services. For both of our previous Experiences of Care in Aotearoa reports, Oranga Tamariki was unable to tell us whether the tamariki and rangatahi in its care were able to access annual health and dental checks as set out in the NCS Regulations. ...
We were concerned as broader research findings suggest a prevalence in long-term negative health outcomes experienced by tamariki and rangatahi who have been in care. Tamariki and rangatahi in care are less likely than the general population to report having good health or wellbeing and are almost twice as likely to report having a disabling
condition – this includes long-term disabilities, chronic conditions, and pain that impacts their daily functioning. ...
Research also shows poorer health and dental outcomes for Māori and Pacific tamariki and rangatahi regardless of care status. Māori of all ages have the lowest PHO enrolment rates in Aotearoa and are more likely to have unmet health needs than non-Māori. Four-year-old Pacific tamariki, followed closely by tamariki Māori of the same age, have the highest average number of decayed teeth compared to other tamariki10. This is important because Māori and Pacific tamariki and rangatahi make up most of the care population in Aotearoa. ...
Annual health checks, as set out in the NCS Regulations, are important for tamariki and rangatahi in care because they provide opportunities for further health needs to be identified. They also allow for health assessments and plans to be updated. These are important tools to ensure that tamariki and rangatahi in care are getting their needs met.
Key Results
This review focused on the National Care Standards (NCS) Regulations relevant to enrolment and access to primary health services and dental care for rangatahi and tamariki in care. We are aware of wider concerns with accessing secondary health services such as mental health, and some of these are covered in our Experiences of Care in Aotearoa report.
We found that the health-related NCS Regulations have not been implemented well. The experiences of tamariki and rangatahi were mixed. However, several clear themes emerged.
There is a lack of clarity regarding what the NCS Regulations require, what an annual health check is, and when parental/whānau consent is required. We heard in our monitoring visits that policies and guidance are not clear for Oranga Tamariki social workers, which means that caregivers are sometimes made responsible for arranging health care, and that sometimes they do not have important health-related information on the tamariki and rangatahi they look after. We did not hear from staff or caregivers about training, although Oranga Tamariki has since told us that training and information are available for both social workers and caregivers. While Oranga Tamariki has pointed to its practice guidance as evidence of clear expectations being set, we also heard from Oranga Tamariki national office that practice guidance is not embedded across the organisation. Our monitoring visits suggest that clear expectations have not been set from Oranga Tamariki national office to ensure tamariki and rangatahi have access to primary health services and dental care. ...
While we found pockets of good practice and heard from Oranga Tamariki that tamariki and rangatahi can generally access health care when they need to, better implementation and oversight across Oranga Tamariki is needed. Access to primary health care is vital because tamariki and rangatahi in care have poorer health outcomes than those who aren’t in care. It is through primary health that further health needs can be identified and met, resulting in better health outcomes for this group. ...