Waiting for 10 hours in a crowded emergency department (ED) is no one’s idea of fun, but for many patients, it seems to be an increasingly regular occurrence.
When the ODT asked people to share their ED stories, they flowed thick and fast, with dozens of emails and hundreds of comments online.
Most talked about time delays, some talked about the conditions of the ward and the struggle to get assistance, others blamed understaffing and the complexity of presentations, a lack of beds in the department or the fact that many people should have waited until a GP was available.
Whatever the reasons, something needs to happen.
Dr John Chambers was the head of the ED for more than a decade.
Now retired, he is aware of the department’s reputation.
‘‘There’s always unconscious bias that the ED’s actually a hell hole.
‘‘And it’s not true. None of it’s true.’’
‘‘It was the 2010s, and you had Tony Ryall as Health Minister. Slowly but steadily, we all started to get better because, you know, they were told, you’ve got to meet this six-hour target.
‘‘So, they threw some resources at the EDs, particularly in Middlemore, but all over the country ... We eventually got there to 95% in 2013 for a whole week.
‘‘It was really good. But it wasn’t sustainable because the patients were getting more complicated all the time. They were older.’’
For a while, the ‘‘six-hour target’’ became so much of a standard that it was printed on the noticeboards, and even in the Otago Daily Times.
The lack of attendant funding meant it was never going to last, Dr Chambers says.
But the de-emphasising of the targets by Labour Health Minister Dr David Clark, followed by the Covid-19 pandemic, did not help processing times.
‘‘When Covid-19 came along, we had all this madness of setting up a red zone and a green zone and the masks and the screening and everything.
‘‘Everything slowed up, and we haven’t recovered.
‘‘Now, because it hasn’t been a priority, the management haven’t been throwing resources at anything.’’
Targets were re-introduced by the government, but Dr Chambers said they’re spaced out so far - EDs have to process 95% of patients under six hours by 2030 - that they could simply not be met, or forgotten.
Health New Zealand Te Whatu Ora’s ‘‘top down’’ and ‘‘distant’’ management also means there was a lack of local governance, he says.
‘‘Health New Zealand may say centrally that things are getting better somehow, but they’re certainly not getting better down here indeed.
‘‘If there were local governance, the local governance would not be happy.
‘‘They’d be seriously asking questions of local management. I think that’s the message - if there were local governance and local managers were accountable, then the pressure would be on.’’
Health systems specialist Prof Robin Gauld, who also has a position at the Otago Medical School as an honorary professor, said the government’s present ‘‘incoherence’’ is also to blame.
‘‘I don’t think you could describe it as anything but chaotic.
‘‘We might hear [Health Minister] Simeon Brown saying, well, we’re seeking to fix things. But it’s chaotic because between governments and within government cycles, there’s just ongoing change within the health system.
‘‘Then there is the starving of funding, which has been systematic across governments over a very, very long time.’’
Under-funding emergency services leads to all sorts issues in the greater hospital chain, Prof Gauld says.
‘‘The emergency department is the frontline of services - so that affects workforce.
‘‘It affects facilities. It ultimately affects morale as well, which all the evidence and research suggests does have an impact on the productivity of the workforce and teamwork.’’
‘‘They had separate kinds of flows of people going in for triage initially, and then they would put the less urgent people in one queue and the more urgent in another.
‘‘So they had a really robust system for organising all of this. And I believe they were in the best situation in the country at the time in terms of the work that they had done.’’
Yet Dr Kerruish eventually stepped back from ED roles because of increasing frustration about the lack of resources, Prof Gauld says.
‘‘What Tim very controversially said in the mid-2010s - it was reported on the front page of the ODT at the time - was that they couldn’t improve things any more until the rest of the hospital changed how it works.
‘‘That’s about how the rest of the hospital actually focuses itself on the ED and what it takes to keep patients moving through the ED, because many of the patients will be discharged and some of them would be admitted. Many are reliant on tests and x-rays and so forth. So you need the rest of the hospital to work in tandem.’’
This can be done on a long-term basis, but it needs long-term planning from governments and hospital management, he says.
‘‘So there’s a whole cultural shift that needs to take place within the hospital itself - but the key thing holding us back, I think, is just the starving of the funding and the chaotic policy.’’
‘‘The problems that culminate in long wait times are systemic within the whole health system, and the biggest challenge for the nurses and their colleagues is being able to provide timely care when the patient care demand is higher than the numbers of nurses available to care for them.
‘‘NZNO has gone on strike and protested against the increasingly unsafe, understaffed wards for some time now. Once again our calls for safe staffing have fallen on deaf ears, with many public rebuttals of Health New Zealand.
‘‘Yet the Ombudsman saw differently when HNZ’s own data, denied to NZNO for nearly a year, showed the appalling level of understaffing that nurses are forced to work with. Going to work knowing that, despite your best efforts, your patients will wait, is not something any nurse wants to do.’’
She is not optimistic about any positive change in the short term.
‘‘... unless there is a political change of heart and action that has beneficial outcomes for patients, families, communities and improves the social determinants of health.
‘‘We need out-of-politics, cross-union policies that will stop health being a political football, and have long-term solutions that we all agree to adhere to.’’
Ms Daniels’ message to HNZ is blunt: what is being done now is not working.
‘‘People who need healthcare and cannot access [it] go to the nearest emergency department instead.
‘‘We have an ageing population. Older people tend to have complex health challenges, meaning they need higher levels of care and more nurses and doctors to care for them. Aged-care facilities are also less accessible than they once were, leaving patients needing ongoing care once discharged from hospital, with nowhere to go, so they stay in hospital. This leads to ED overcrowding, as there are not enough ‘resourced’ hospital beds to admit patients to.’’
July, August and September’s figures had not been compiled yet, but Dr Chambers did not expect there to be much change, given those months take in the city’s winter.
When Mr Brown was asked about the Dunedin ED’s performance, he stressed the majority of patients across the country, including at Dunedin Hospital, were admitted, discharged or transferred from emergency departments within the government’s six-hour target.
‘‘While progress has been made, there is more work to do to reach the goal of 95% of patients meeting the target by 2030, and strengthening our workforce is a key part of that effort.
‘‘To support this, I recently announced that Health New Zealand is funding an additional $20 million for ED staffing across the country. This investment will enable faster care for patients and relieve pressure on hospitals such as Dunedin.’’
Mr Brown also pointed to the performance statistics for the Southern region, where 73.5% of patients were processed on time.
‘‘Emergency department staff are working incredibly hard, and we are grateful for the care they continue to provide every day. This funding will help ease some of that pressure and enable them to continue delivering the best possible care.’’
Labour argues doctors’ fees increases, freezing of funds and failing to hire enough doctors and nurses have all lead to the situation we have now.
Dunedin Labour MP Rachel Brooking said they would make it cheaper and easier to see a doctor or nurse, which would help keep people well and ease pressures on hospitals.
There are no easy answers or solutions.
In the meantime, we keep waiting.
