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00:00:05
Speaker 1: Yeah, No, I'm Chelsea Daniels and this is the Front Page, a daily podcast presented by The New Zealand Herald. It'll come as no surprise when I say our emergency departments are suffering. It's a tale that's haunted consecutive governments and one that has those at the front line crying out for support. Winter is one of the busiest periods for hospitals in the entire year, and many are already reportedly at capacity. But what do we do with this broken record and how do we fix a sector that's been chronically underfunded for generations. Today on the Front Page, Herald's senior investigative reporter, Michael Morra joins us to discuss what he's heard from those at the coal face of this crisis. You've done some digging around emergency department waiting times and it's no surprise that it's pretty bad.
00:01:06
Speaker 2: Hey, yeah, I think that what this report reveals that I've got into the Official Information Act reveals precisely how bad. And I think, to be fair, a lot of this sort of information is in fact hidden from the public or is not really prevalent in the public domain. A few of the key points that were raised in this report. From last winter Winter twenty twenty four, more than fifteen hundred patients treated in corridors over a thirty six day period at Middlemore Hospitals ed. Essentially, this was because of severe overcrowding and a lack of staff for ron dirty. But more importantly, over this same thirty six day period, there were forty three separate patient harm incidents. Now, when I say patient harm, what I mean by that is that several of these would have been what's classified as category one or category two adverse events. So essentially it could be a patient who dies or suffers some other major medical event due to delays in care or poor care. Now, the physicians who are working very hard out at Middlemore, I mean they're skilled operators, right, but if you are overwhelmed with too many patients, people are falling through the cracks. And this is essentially what this report is talking about. So it is fairly concerning, and there's even some comments from staff themselves, And I'm just going to quote you a couple of points here because I think this is really salient to the whole discussion. One staff member says the lack of resourcing and support for the emergency department at Middlemore is having a quote significant effect on the morbidity and mortality of the population that we are meant to be serving. It reported ED overcrowding does not show the old ladies who wet themselves in the corridor because there is nowhere else to go. Another staff member says, our patients are being done an injustice and we're not talking about it. It's certainly not visible to our politicians to say that the ship is sinking and no one is coming to help as an understatement. So really really strong language there and a pretty concerning report. And the points I've made just now with the patients being treated in corridors, I mean there's other elements. Two hundred and thirty excess bed days, so that is patients who are in the ED languishing there, remaining in a bed, but they're not being admitted to the ward. So that's the time. That's the extra time they're spending in a place that they should not be because they need to be admitted, but there is bed block in the hospital so they can't get in. There were also issues around meeting certain KPIs for people who are walking into the ED with a heart attack, for example, not getting the interventions they should within the ninety minute KPI. So yeah, some pretty serious points that have been raised in this and certainly a real insight into what has occurred at Middlemore Hospitals ed last winter. Now you might say, well that was last winter, Mike, But the point is is that the clinicians wrote this report so it could be reviewed escalated up the chain to Health New Zealand and to the Minister. Now, what they ultimately wanted was three point six million dollars of additional funding to boost their staff numbers and boost resourcing and make it safer for this winter twenty twenty five. Have they received that money? No, they have not. Did the report get escalated up the chain to the national clinical Leadership? It did. I've worked out that it did go up there. However, Health New Zealand has told me that there were quote delays in acknowledging it. So that's pretty worrying, right. You've got clinicians who essentially write this very detailed report, it's a cry for help, goes to the top and doesn't appear like much happened.
00:04:56
Speaker 1: No, so who did the report? The clinicians who are seeing this every day.
00:05:01
Speaker 2: Correct. There was several emergency department doctors and nurses who were involved in compiling this report.
00:05:08
Speaker 1: It must be so frustrating if you're seeing people like that from the grand extremes. And what got me there is the older ladies urinating in hallways because there's nowhere else to go. I mean that gives you a real vesceral on how bad this is. It must be so frustrating for them.
00:05:25
Speaker 2: Yeah, it is. And I interviewed doctor Vannessa Thornton, who's one of the regional managers at County's Monaco, also an expert emergency department physician and has been an edy doctor for you probably about twenty or thirty years. I think she's certainly been doing the job and knows the craft pretty well. But she said and admitted, yes, it is extremely frustrating. But on some days they will have not enough staff. There might be three or four staff who call them sick and they just cannot replace those people. And I said to her, well, what about this money? Will you get that money ahead of this one? And she said, look, we're hoping to get some resourcing. But she certainly sympathized with her colleagues. Comments about the ship is sinking as in the ed is thinking, because she agreed that on certain days it felt like staff were not being heard and were
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overwhelmed.
00:06:19
Speaker 3: As Minister of Health, ensuring that all New Zealanders can access timely quality healthcare is my top priority. Reducing weight lists so that patients have shorter weight times for appointments and surgery is a key part of this and this hospital will play a critical role in delivering these targets. While there is significant progress needed to meet these targets, I'm pleased at patients in this region and further Afield are benefiting from the state of the art facility. This number will only grow as theater capacity and resourcing continues to scale up over time.
00:06:51
Speaker 1: So this isn't unique to Middlemore Hospital. Hey, how widespread is this issue?
00:06:57
Speaker 2: Yes, I've spoken to doctor Kate Clark, who is the chair for the Australasian College of Emergency Medicine. This is essentially the group that oversees eds all around the country and absolutely she says, Look, this is not an issue that is unique to Middlemore. And interestingly she told me and you can read this in the Herald, that many of our bigds are actually right now at capacity and we have not yet hit winter. I'll give you a little bit of insight into this. Health New Zealand has provided me with some data which relates to just how busy our eds are right now. And remember every winter there are stories about ED overloading and we are not quite there yet. But look at this the seven day average from May fourteen to May twenty. Every day christ Church Hospital has been seeing three hundred and thirteen patients. That's a day. Middlemore Hospital, which we've been speaking about, three hundred and twenty nine patients per day now. To give you some context around them. The last time Health New Zealand put out a public health alert about extremely busy eds was last year with christ Church's ED and at that point they were seeing four hundred and thirty patients a day and Health New Zealand put out basically a plea to the public that if you don't need to turn up there, police don't because they are extremely busy. Same goes for Middlemore three hundred and twenty nine patients they're seeing on a daily basis. I've just had an email come in a concerned ED worker. I won't be saying who that is but they tell me Middlemore's ED was built to receive two hundred and seventy patients a day. Right now they're seeing three hundred and twenty nine.
00:08:42
Speaker 4: And we haven't even hear winter yet.
00:08:44
Speaker 2: No, and that's official data from Health New Zealand, so you can kind of get a picture. And the other point to make is that every year, year on year, these numbers are going up, So the number of people presenting is going up by you know, two to three percent a year.
00:09:07
Speaker 1: Now, this is an issue that successive governments have had to deal with and I mean, what is the solution here, bar getting more staff in, bar more funding, do we really need to go grassroots?
00:09:18
Speaker 4: So looking at general practices, do
people rock up to the.
00:09:22
Speaker 1: You know, the old outage people are just going to the ED because it's the you know, they've got a sniffer and they just go there.
00:09:27
Speaker 4: They're clunging it up. I mean that's not really the case though, is it.
00:09:30
Speaker 1: No?
00:09:30
Speaker 2: And look, yeah, that's a really really important point that you've raised. And a lot of people will say and sometimes say, oh, well, you know, please don't turn up to your ED. But actually, if you look at the facts, more than fifty percent of patients who are turning up to middlemore ZD, for example, are high acuity patients. That means that they are severely unwell or they're having some sort of medical condition, and over fifty percent of those patients require admission to the hospital. They're not turning up with a sniffly nose, And in fact, there's been research done about that which rebuts that idea that a lot of people are just turning up without needing to be there.
00:10:09
Speaker 4: Where does that come from? Do you reckon? I mean, that's spread over years and years and years.
00:10:13
Speaker 2: Hey, I think so, and certainly maybe some EDS that that might be the case, where a lot of people are turning up to get coughs and colds locked out or something like that when it's not an emergency. But I think it's actually a bit of a myth at the moment to suggest that, you know, everyone in New Zealand who's turning up at EDS don't actually need to be there, because the facts just don't support that.
00:10:36
Speaker 4: So looking at mental health patients and emergency departments, I remember reading something in the New Zealand Medical Journal last year about this time last year, and it's said almost one in five ED presentations are by mental health clients.
00:10:49
Speaker 1: They crunched the numbers over a five year period and these presentations were often younger female Maori required more urgent care and waited longer. This would come as no surprise to UA.
00:11:02
Speaker 2: Yeah, and in fact, this report that I've got much delves into the situation at Middle of the hospital. It's one of the key points they might make right up the top of the report that over this thirty six day period that was under review, five patients who are under the Mental Health Act absconded from the ED while there, one of whom attempted suicide as soon as they got outside the ED doors. Now, I've spoken to Vanessa Thornton about this at Middlemoor ED and also doctor Kate Allen. Both of them say, look, this is happening, and it is actually happening daily. You know, it's happening pretty regularly. And again though one of the key concerns they raise is staff. You know, they don't have enough staff, so that is one of the key concerns here. I guess it also goes back to the point you raised earlier about sort of the community care right we know in New Zealand, to have a well functioning health system and an emergency which operates in a hospital that operates without being overwhelmed. You need to have a good, healthy, functioning primary care system in the community because if patients are coming to see their GPS, and they can see the same GPS over a long period of time, they are less likely to have to go to ED because they don't suddenly get sick. That's what gps are all about, preventative medicine. This has been a long concern of GPS for many years now, and I saw multiple press releases from the likes of gen Pro the GP Owners Association after the announcement of this budget just saying this is woful and we're not happy again. The concern is under investment in a core part of our health system in New Zealand.
00:12:50
Speaker 1: They're just crying out, aren't they. I remember I spoke to New Zealand Initiative Research fellow and GP doctor Prabarni Wood earlier this year about the country's primary healthcare system.
00:13:02
Speaker 5: I'd love to get stuck in and look in more detail into alternative funding models. I have to do that in the future, but it makes logical sense to me that any money that's saved by general practice from patients not having to attend the emergency department. That saving could then be fed back into primary care. So we're not asking for new money, but we're asking for the money that we're saving to come back to us. And that would absolutely make sense to look at things like that in that way.
00:13:35
Speaker 1: So what is the solution here. It's obviously not an easy one. There's going to be no silver bullet. But what are some of the ways that we can alleviate this pain on EDS?
00:13:45
Speaker 2: Well, certainly there has been general support for the Health Minister same and Brown's announcement about the expansion of urgent care services. So for example, it's just just remember that this announcement from the government is not about building new urgent care clinics, it's just extending the hours for which they are open. So that would be probably useful in the sense that perhaps some of those patients who may have gone to the ED at Middlemore might be able to go at midnight to their urgent care clinic instead, so that will alleviate some of it. And also there's been various other initiatives, but what GPS and what emergency Medicine physicians are saying, is it's about priorities, right, and health is important and there just hasn't been enough funding injected into that and it hasn't been prioritized like it should in New Zealand. And even when I actually asked Health Minister Simeon Brown direct questions about the report at Middlemore, you know, direct questions about the concerns from staff about the number of people in corridors, about whether he had seen the report as clinicians wanted him to. He did not respond to those questions, which is pretty concerning, and he talked more about the government's health targets and how that is improving Edie wait times. But again we come back to the key thing. It's funding and it's staff numbers.
00:15:11
Speaker 4: Thanks for joining us, Michael Pleasure.
00:15:16
Speaker 1: That's it for this episode of The Front Page. You can read more about today's stories and extensive news coverage at enzdherld, dot co, dot MZ. The Front Page is produced by Ethan Seals and Richard Martin, who is also our sound engineer. I'm Chelsea Daniels. Subscribe to the Front Page on iHeartRadio or wherever you get your podcasts and tune in tomorrow for another look behind the headlines.