On 9 February TVNZ’s 1News reported massive public hospital occupancy; 100% more than 600 times in 2022. At this level no person in their right mind could dispute the fact that Aotearoa New Zealand has a health system crisis even before this year’s winter is upon us: Hospitals hit 100% occupancy over 600 times last year.
The figures were released to 1News under the Official Information Act. Translated it meant that on average each day roughly two public hospitals around the country were running at an occupancy higher than they were resourced for.
A 100% occupancy rate is heaven for hotels. But it is hell for public hospitals providing emergency, acute and planned (elective) services.
It is due to what is described as ‘bed blocking’; that is, patients can’t be admitted to hospital beds in the wards from the emergency department or directly because they are already fully occupied.
Dr Kate Allan: scary data; when there aren’t enough hospital beds, patients queue in hallways
Middlemore Hospital emergency medicine specialist Dr Kate Allan described what this meant for emergency departments:
I think that’s quite scary data to know that hospitals are so full. We definitely can feel that on the floor in the emergency department.
When there’s not enough beds our patients queue. They queue in our hallways, they queue in our ambulance bays, they queue in ambulances and they don’t get seen in a timely manner.
Dr Allan noted that when hospital wards are at very high occupancy levels, emergency departments often become overcrowded with standing room only.
But it isn’t just emergency departments that are affected. With this level of pressure on the hospital system, diagnoses can be delayed and planned surgery cancelled. It also delays treatment for the terminally ill as 1News coverage of a cancer patient revealed.
However, 2022 was not an isolated one-off year. Further, 1News correctly reported that this parlous situation is expected to continue in 2023 with continued high hospital demand.
The high occupancy is due to severe staffing shortages (specialists, nurses and allied health professionals). There is no ‘quick fix’ for these shortages.
I have previously discussed these shortages in a wider context and the need to have a focussed approach recognising the different labour market drivers of the numerous health professional occupational groups in a BusinessDesk published article (1 March): We have a healthcare worker crisis and were not fixing it.
Pre-winter consequences of workforce shortages
Since the 1News story there have been many prominent media stories on the consequences of these shortages in the lead up to an anticipated harsh winter for public hospitals.
On 7 March the Otago Daily Times reported that because Dunedin Hospital was “very busy” operations were having to be postponed: Very busy hospital leads to postponed operations in Dunedin.
This situation was attributed to a deadly mix of severe health professional shortages, large numbers of very unwell people coming into the emergency department, and staff illness (hardly surprising given the pressure on staff).
It was also noted that Dunedin Hospital was not an isolated case; “many hospitals around the country are very busy.”.
The following day the NZ Herald reported that hospital patients were being held in “overflow rooms” while they wait for treatment and ambulances were being diverted as under-pressure emergency departments in Auckland’s public hospitals struggled to cope: Hospital patients put in “overflow rooms”; ambulances diverted.
On 27 March the NZ Herald reported the impact of ‘bed-blocking’ on patients needing cardiac surgery at Waikato Hospital: Overdue Waikato cardiac patients sent to Auckland.
Waikato Hospital was sending patients to Auckland because nearly 80 people on its cardiac surgery wait lists were overdue. They should have had surgery within 90 days, but had been waiting 115 days.
The consequences of these and many other reported experiences were revealed in a feature article on 25 March in Stuff. Investigative journalist Rachel Thomas analysed a ‘state of healthcare access’ under the graphic heading ‘Not a good time to get sick’.
Based on official data for key performance markers her analysis concluded that they “went south” in 2022: Not a good time to get sick.
Rachel Thomas: good investigative writing
Thomas’ revelations included a parlous lack of access to planned surgery, denied investigative diagnosis, delayed discharges from emergency departments, and restricted access to general practitioners.
With much justification she described it as “extreme rationing”; only two words but they say so much. Again this was the situation pre-winter.
Hospital doctors denied annual leave
Another revealing (deservedly front page) feature article by Thomas was published by The Post (Stuff) on 1 May. She captured one of the consequences of this extreme rationing: Hospital doctors being denied annual leave.
The information was provided to Stuff by the Association of Salaried Medical Specialists who, in turn, obtained it from Health New Zealand (Te Whatu Ora) under the Official Information Act.
In summary, senior hospital doctors (mainly medical specialists and including dentists) have unclaimed annual leave of 1.72 million hours or, to put it another way, a total of 1,024 years. For resident medical officers (junior doctors) the total unclaimed leave equates to 408 years.
Some of these doctors received cash payouts in lieu of leave. For senior doctors the number receiving these payouts in 2021-22 was 311 (compared with 199 in 2017-18). For junior doctors it was 128 (over double the number in 2017-18).
Being denied taking annual leave does not been that leave applications have been rejected by senior management. This would have raised serious issues of non-compliance with employee rights under the Holidays Act.
Leave is being denied because of hospital doctors concerns that their severe shortages put patients at risk. Doctors are caught in the tightening vice of government failure to address shortages and professionalism pushed to the extreme by the conseqincreasing denial of patients’ healthcare access.
Leave is critical for well-being and good health, especially for those in stressful occupations. In other words, doctors are paying for this tightening vice with their own health.
When is a winter plan not a winter plan
New health minister Dr Ayesha Verrall has been promising a plan to help public hospitals to cope with the coming winter. She announced the ‘plan’ developed by Te Whatu Ora in a media release on 4 May: Health Minister’s media release on ‘winter plan’.
The ‘plan’ comprises 24 points as reported by Radio New Zealand that same day: ‘Winter plan’ summarised in 24 points.
The ‘plan’ includes, in selected health districts, more telehealth, expanded primary care referral to community radiology, a doubling of the volume of primary care (largely general practice) options for acute care, and extension of the scheme for management of minor ailments in pharmacies.
Health Minister Ayesha Verrall: a plan that isn’t a plan and disappointing erroneous claim
Dr Verrall in her media release disappointingly made the erroneous claim that this was only now able to be done under her government’s new ‘reformed’ health system.
Few things could be further from the truth. Not only could they have been done under the previous health system dismantled in July 2022; many were already well underway under the previous system.
All of the 24 points are laudable, all by their very nature are inevitably continually works in progress, and largely they are not new. More important, none will make a discernible difference in helping hospitals cope with the pressures of winter.
Will there be a winter from hell?
To address these pressures there needed to be a practical recruitment strategy to boost medical, nursing and allied health professional workforces that was being actioned months, if not years, ago.
Not only is there any action on a strategy; there is no strategy in the first place. Not even a Baldrick ‘cunning plan’!
Baldrick: Sorry Blackadder, I don’t have a ‘cunning plan’ to get out of this mess
Achieving a plan that would prevented a horrendous winter pressure on hospitals could not never have been achieved in these circumstances.
The workforce at the clinical frontline is unimpressed with the non-plan. This is well discussed by Local Democracy Reporting’s investigative reporter Steve Forbes (5May): Winter health plan fails to address shortages and burnout. It never could!
What we now have is doctors, nurses and other health professionals facing a horrendous winter with high unmet patient need and high hospital occupancy. And this is without the yet to arrive flu! There have been plenty of warning red flags raised over recent years but they have been ignored.
Will this winter be a winter from hell for our public hospitals? Maybe but more likely yes than no. The cause is the failure of political and health system leaders to provide leadership; nothing more and nothing less.
Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion