Hospitals at ‘tipping point’

The Association of Salaried Medical Specialists is never backward about airing its members’ concerns. In a report released this month, it suggests hospital services are at a ‘‘dangerous tipping point’’.

‘‘Hospitals on the Edge’’ paints a depressing picture of hospitals where desperate specialists struggle to cope with increasing numbers of acute admissions, unsafe rates of bed occupancy and too many people being readmitted as emergency cases within a month after being discharged.

It estimates the shortfall in senior doctor workforce across most of the country’s 20 district health boards averages 24% (27% for Southern DHB).

And, although hospital doctors are rushed off their feet, the association estimates there may be about 430,000 children and adults missing out on hospital care. These people would include those rejected by hospitals because of a lack of capacity, those who did not meet a threshold for treatment despite their symptoms, and many poor, Maori or Pasifika who did not get as far as seeing a GP.

The association wants some proper measurement of such unmet need, something which appears to have been resisted by successive governments, possibly because the numbers are likely to alarm. Without knowing the truth of the situation, however, it is impossible for proper planning of services.

It is hard to argue with the report’s view that the gross neglect of hospital buildings illustrates how the health system has suffered from short-sighted policies. It cites the example of Dunedin Hospital, quoting from a Sapere report which found the deteriorating physical environment was eroding quality of care, creating safety risks and causing distress to patients and staff.

The association estimates $14billion is needed over the next 10 years to correct this neglect.

It also points out that health expenditure as a percentage of GDP has been decreasing.

The actions it wants from the Government include an extensive recruitment campaign for overseas specialists and trainees, restoring funding to at least previous levels, integration of services and more action on child poverty.

It says the health system does not need restructuring, policies with a three-year focus and ideas from overseas which do not fit.

The timing of the ASMS report is no accident, stating the association’s position just before election year, and before the final report from the $9.5million review of the health and disability system, led by Heather Simpson, due in March.

The association’s report does not spell out what it means by restructuring, and it is hard to tell from the review panel’s interim report if it is likely to propose anything bold in this area.

The panel says it recognises the system will always be complex but the objective should be to make it less complicated with fewer, not more, agencies.

The interim report said the way people work in the system is not leading to the most productive results. Healthcare organisations did not co-operate well, many professionals resisted collaborating across disciplines, there was a lack of flexibility in employment arrangements, and a general resistance to change at many levels.

It has said that before deciding the solution is to have fewer DHBs, it is worth considering whether the system should provide more analytical or back-office functions to smaller DHBs. There is a deja vu sound about that.

The panel says it has not formed a definite view on whether DHB elections are an effective or essential way of getting community input into health service planning.

If the Simpson review proposes any dramatic changes to the system, it seems unlikely the Government would be keen to promote them in an election year.

In the meantime, the Government will insist it is doing its best, given what it inherited. There will be limits, however, to how far down the road politicians can kick the can on the issues raised by the senior doctors. ‘‘Hospitals on the Edge’’ will not be the doctors’ last word.


As with anything the government tries to fix, the ratio of front line workers (doctors, nurses) is being reduced as the the number of highly paid administrators increases. The back-office crowd are laughing whilst we wait for our operations and check ups. Increasing the whole budget pie is not the answer but shrinking admin staff, in hospitals, schools, universities, councils etc.

Our health care system was - and is - paid for by taxpaying citizens, for themselves and their families.

Is it too much of a stretch to suggest that if you're not a taxpaying citizen, or member of their family, you go to the back of the line?

My whole family - all of whom have always worked and contributed to the system - have now had to take out private health insurance, because the public system is overcrowded with people who haven't contributed a cent to it.

So we're paying twice over. What's fair about that?

There's a growing number of kiwis who have paid and paid, and are getting sick and tired of hearing about "the poor" who do nothing to help themselves, except help themselves to everything we've done for them.

We've had enough. If people can't support themselves they can go to the back of the line.






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