For a decade and a half, Auckland's Herne Bay House has offered nursing and medical care specifically tailored to people with AIDS. Terminal, palliative, and respite care have been provided in one of the city's leafiest, plushest suburbs, surrounded by a well-tended garden and an atmosphere of support and understanding. That support and understanding was vitally important in the early days of the HIV epidemic when mainstream New Zealand and even some medical professionals, preferred to turn their back on people with ‘that' disease. But times seem to have changed, and a review of the operation of Herne Bay House is sending ripples of concern through the gay HIV care community So, what is the problem at Herne Bay House that has led to questions about its future? “There's not a problem,” says Auckland City Mission CEO Dianne Robertson. “We have operated the service for over twelve years and in that time the nature of the services we've provided, the people we're providing the service to, the nature of HIV and AIDS and treatments, everything has changed. And when we started to look at how we are using the house we decided we need to have a review and see if we are doing the service in the best way. Originally the house was set up specifically for HIV+ people, mostly gay men. But Robertson says the City Mission's objective is to cater to the needs of the most marginalised sectors of society. “There are two issues around that. One is do we actually need the same degree of care in what is effectively a hospital environment for people with HIV and AIDS. We all know that treatments have changed and that issues have changed for people. Two, are these people as marginalised as they were. People were very, very marginalised ten years ago.” But that may not be the case now she believes: “Is there another group that is more marginalised? One of the things we have found is that we are not meeting the needs of refugee people very well. So perhaps we need to look at what we are doing and how we are doing it.” The City Mission believes the environment for HIV positive people has changed considerably since the house started up. “When I arrived and did the first review of the house there were a lot of people who were extremely ill and there were a great many deaths. It was certainly a time when people found it impossible to go into hospices... a lot of doctors and nurses didn't know a great deal about AIDS. I witnessed times when doctors and nurses didn't want to go near anybody with AIDS. There was a lot of fear. So Herne Bay House provided something that was unique. It was a place where people were skilled and most of the staff had worked overseas in similar places, and it was very much focussed on the gay community and it had a real understanding of the needs of the client group so that they didn't feel excluded or marginalised.” But recently, the occupancy rate of the six-bed facility has dropped to the point where “around 48% is a fairly good month. It's not very high and that is one of our big issues.” To provide round the clock care for, currently, around three people at a time requires a significant infrastructure. “One of our issues is that we have had to register as a hospital. We are no longer a community facility, due to a change in legislation and funding.” That level of facility creates huge extra costs, according to Robertson. “Just the registration process alone costs $30,000. Then there has been the capital expenditure to make sure the facilities are up to the standard for hospitals. Audits and checks that create an ongoing cost.” The annual Herne Bay House budget is close on $1 million, according to Robertson. “We get around about $250,000 from the Health Board, plus income from a few trusts such as Heroic Gardens which gives us around $55,000, but the rest comes from the public of Auckland. And we are obligated to the Health Board about our numbers and who we are providing a service to, it doesn't just come with no strings attached. They've been remarkably kind about that and rolled over our funding for a few months while we go through this process.” There are plenty of rumours circulating in the gay community that the City Mission is determined to close the house down, but this is denied by Robertson. “We're actually looking at whether we are providing the services in the right way." The City Mission has a huge commitment to people with HIV and AIDS in the gay community, Robertson says, "and we've demonstrated that over the past 12 years. That hasn't changed... we just want to know that we're putting our money into the right place, that we are providing the service for the people who really desperately need it.” Herne Bay House seems to be about more than handing out pills and taking blood tests. Robertson has nearly completed a statistical review of how the house is being used, including why people go there and the needs that the house is meeting. “For a lot of people using the house it's not just about nursing care. It's about emotional issues, mental health, social issues, housing... and we need to look at whether we are qualified or competent or have the right skill mix, we need to look at all that. I think we have been providing services for all sorts of people, we've even used it for conferences!” Again, Robertson returns to the ‘times change' theme. “It's like a lot of residential services: when they start out they're desperately needed and they're full. But then the needs change and the nature of the client groups change and the people who're running the services try to keep the occupancy rates up and try to make the best of the facility. What we're just saying is that we need to see if we're doing it right or not. Robertson is at pains to point out that “review” isn't a euphemism for “downscale” or “close.” “When we did the review 12 years ago we went from two staff to fifteen. We went from a building that was in a really poor condition to spending hundreds of thousands of dollars to create a fantastic facility. The end of that review wasn't ‘We're not going to do this anymore.' It actually ended up as an expansion of the services and became something that we have been extremely proud of for the past ten years.” This is just time for another review," she says, “something we should be doing very, very regularly with all our services.” Robertson says the Mission is consulting as widely as it can about the future of Herne Bay House. “We've just about gone to all the community groups, and we've sent out a letter to clients and people who have used the house to come and have a meeting and we're going to meet tomorrow and next Thursday and there's an open invitation to those meetings.” What gay and lesbian groups have been consulted with so far? “The NZ AIDS Foundation, Body Positive, the Community AIDS Resource Team, Ward 68 [the infectious diseases unit at Auckland hospital]. CART and Ward 68 give us the highest number of referrals. We've met with Heroic gardens and are due to meet with the Gay Auckland Business Association. As many people as we know of, or we can contact. It's a really hard process at times to make sure that we have consulted with everybody. If we've missed anybody it's just the matter of a phone call to me really.” In the past two years New Zealand, in common with many other western nations, has seen a resurgence of new HIV infections amongst gay men. We are also in a period where some HIV positive people are coming to the end of available medications, which may lead to more people getting sick very soon... the bad old days are once again looming on the horizon. Has anyone suggested that the Mission takes that into consideration? “That's an interesting one. I've had quite a long conversation at the hospital about that and there's quite a divergence of opinion about that. And a couple of months ago I read an article which stated that people in the gay community aren't nearly as marginalised as they were ten years ago... they're much more mainstream now. We've got to take those sort of statements into consideration in terms of providing services to marginalised services. Gay might be more ok these days but has she been hearing the same thing about people with HIV and AIDS? “Yes. Yes, in terms of access to services and people making different choices about whether they want to be at home or not. But the groups that have been identified very strongly that we are not covering are women, refugees and new immigrants. So for me it's a question of ‘If those people are out there with needs and no one else is meeting those needs, what do I have to do to meet those needs.'” There are suggestions flying around the Auckland gay community that this review is an exercise in seeing if the City Mission can shut down the house and sell it. “Well... at the end of the day if it was just about selling a property, if we didn't have a service there we would probably sell the property. Probably. But I've got two or three other properties around Auckland where we have to consider if we keep them or not, use them or not... [Herne Bay House] is a very expensive piece of real estate but for the last ten years that has not been an issue, it's been about accommodation. And if we are going to provide a service we need to provide it in the best possible place and so it has never been a monetary issue for us.” Would she consider running the service at another location. “Yes, but I don't want to pre-empt anything. It would be very easy to say ‘The numbers are down, we're not providing the same service as we used to, funding is incredibly difficult to get, it provides more than any other service that the City Mission provides, it takes more out of the general donations than any other service we have...' It would be easy to say ‘This is a no brainer.' The reality is that we have been so committed to this particular group, and to Herne Bay House, that if at the end of the review it is determined that the best place to provide the service is here, that we need to get out there to the people who are not using it, then that is what we will do. If it turns out that we are not doing the right thing at the right time, at the best location, then we will have to look at our other options.” There are the two consultations, this week and next week, and Robertson may schedule another one at night. Two weeks after that, around the end of the month, with all the statistical stuff finished, Robertson will present the results of the consultations and her recommendations to the City Mission board. If the decision is taken to close the house, what might be the timeline for that? “If we did want to close it we would come back and discuss that with the key stake holders, because Herne Bay House is such an important place physically to so many people in the gay community. It's where people's partners have died, where families have grieved, where we have said farewell to friends... for so many people, including myself, that property has such a huge emotional hold on us. The public consultation meetings will be held at the Auckland City Mission offices, 150 Hobson St, 10am Thursday August 4 and again on Thursday August 11. "And if people contact me we can arrange other times as well," promises Robertson. Jay Bennie - 2nd August 2005