Hospitals under pressure

Health Minister Andrew Little
Health Minister Andrew Little
As we hold our breath wondering about the reach of Covid-19 into southern parts of the country this summer, it is not encouraging to hear of the short-staffing of Dunedin Hospital’s intensive care unit (ICU) and the ongoing issues with patient flow.

This week we learned some beds at the ICU and the high dependency unit (HDU) are going unused because there are not enough nurses to staff them. Also, some elective surgery has had to be cancelled to leave ICU and HDU beds available for any acute patients who might turn up.

Then, a fortnight ago , the hospital almost struck gridlock, what is known as "Code Black" when the hospital is full and patients need to be discharged so new patients can enter.

For years there have been a steady stream of projects and initiatives to address the issue of patient flow, but none of them appear to have made much impact. The increasing complexity of presenting patients’ conditions and short-staffing are ongoing issues which contribute to the problem, and neither can be magically changed.

It is understandable board chairman Pete Hodgson expressed some frustration with the recent near Code Black event given the situation, as he said, that there was no Covid-19 in the city, no seasonal flu, no bad weather, no long weekend and no crashes, any of which might put the hospital under pressure.

Southern District Health Board is not alone in having ICU staffing problems, and the Covid-19 pandemic has highlighted the general shortage of nurses.

Last month, the New Zealand Nurses Organisation pointed out that each of the three Auckland DHBs had 300 to 400 vacancies and staff were so stretched patient care was at risk.

Staffing shortages in Southern are not confined to Dunedin Hospital either. Some beds in Southland Hospital’s medical ward had to be closed most days in October because of nursing shortages. Midwifery vacancies were described by SDHB chief executive Chris Fleming as "an extreme risk" in his latest report to the board, with only about half of the positions filled in Dunedin and 17.3% in Southland and registered nurses being required to lend support.

Since the pandemic began there has been concern about the limited number of ICU beds in the country, with our ICU staffed beds per capita considerably lower than those in Australia.

But this was an issue before the pandemic too, something which successive governments have not adequately addressed. It has been reported that in 2018, 17% of planned surgery was cancelled because there were no ICU beds available.

Trying to make sense of the numbers of beds available for seriously ill patients is difficult, and Health Minister Andrew Little’s claims the 289 ICU and HDU beds could be ramped up to 550 under the "surge" scenario and that 1400 surge nurses are being trained, have been challenged.

Mr Little recently announced funding for some new ICU beds at several hospitals, but it will be at least six months before they are ready and there are already questions around staffing them. (In Dunedin, the long-awaited and much-delayed stage 2 of the ICU upgrade is still not open because of issues with the ventilation system.)

The adequacy of plans for surge capacity, where surge nurses with limited extra training, are brought in to help under supervision from an ICU-experienced nurse and patients might be housed in spaces not normally used for intensive care, has been questioned.

Of course, if those surge nurses are required, they will have to come from elsewhere in hospitals.

Everyone will be hoping that high vaccination rates will mean the worst-case Covid-19 scenario for 9000 cases a week in the Southern area, with 40 people in hospital, does not become a reality.

There does not seem to be much stretch left in the SDHB rubber band.

Comments

Little seems to be living in cloud cuckoo land. We have known of a staff shortage for years. We also know there are thousands of doctors and nurses wanting to come and work here. So what do we do? Keep them out of course and, to rub salt into the wound, deny those who are here on work visas the opportunity to apply for residency.
We have also known for years that our hospitals are under resourced, especially for ICU beds. Labour's response, provide funding very late in the day and then expect to find qualified staff, presumably from the same magical trees that money comes from. Take away all the spin and it is plain to see what a complete failure this government is.

How can this be !!!
It's always easy to say it's the fault of government, implying elected representative that come and then go, but the wheels, cogs and gears that run our government funded institutions don't change every election cycle
There is something rotten inside the system !
Sure, we rely on our representatives to identify and fix faults within the system but they in turn rely on those same wheels, cogs and gears, as well as public complaints and whistle blowers to inform them of what's going down
We have education in Medical, Dental, Nursing, Physiotherapy, Pharmaceutical and Radiology, to name a few but staffing is an issue in the same city
To top that off, we are told the staffing shortage is because we can't get qualified people, many of which are recruited from developing nations in greater need than our own, across the border
None of it make sense !!!
After meeting our own needs, we should be providing medical expertise to these nations, not the other way around !!!
Something is very rotten in the system !!!

A lot of the qualified health professionals wanting to come here are not from developing countries, many are from the UK, USA, Europe yet still we keep them out. Sadly we cannot produce enough staff ourselves, mainly due to the lack of supervised clinical experience during their training. Certainly there are issues about conditions of service, we simply don't pay as well as Aus for example and pensions are pathetic but the MoH and minister seem oblivious to all this.

David, you seem to have some insight as to what is going on.
My comments come from what I observe, read and hear about.
With nurses, it's obvious an increasing proportion come from overseas. As to whether they are trained in NZ once hear is not so clear but I have read that recruitment is taking place in Asia, namely the Philippines who also have a large need.
The treatment of the South African family (that lost their three girls) by the system as they immigrated to NZ to join our medical workforce needs a serious look at.
The Canadian doctor, that returned to Canada only to take his own life, also needs reviewing as to pastoral support and work load placed on new arrivals.
I would be surprised if professionals considering a move to NZ didn't know about these events.
Dunedin public health services are all teaching facilities, as far as I know, so why is there a disconnect between the availability of "supervised clinical experience" and the schools ?
We have spent B$ to protect our health system, done immense harm to our society but the underlying issues remain in the dark.
If you or others know more, please speak up !!!
Something is very rotten in the system !!!

There are 1000's of health professionals waiting in the wings to immigrate to New Zealand and I cannot understand why the system cannot fast track these individuals into the country? Every Government for the last 20 yrs has eroded our National Health system seemingly wanting to privatise health. We have people in the Ministry Of Health who are not competent to run our Hospitals - this is the same Ministry that operates no matter who the government is. People not being seen because maybe the hospitals will be full of covid - there is no Covid in Dunedin so the schedules of operations and treatments should not be stopped under the guise that covid could interrupt - it hasn't interrupted anything down here so why should our hospital take a "do nothing approach" to people who need X-rays and subsequently treatment. this is just an excuse not to continue seeing patients - to what end? i am exhausted by bureaucracy ......

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