Stretched to the limit
Fears for already burdened hospitals as deadly flu looms
Emergency departments had their busiest month ever in normally quiet January, raising fears that hospitals may not cope with the lethal strain of flu set to hit our shores this winter.
Population growth is being blamed for the flood of patients, with more sick people, more injured and more elderly all adding to the numbers. Staff say they are stressed, exhausted and overworked, with some feeling they are propping up the DHBs at the expense of their health.
Updating the Counties Manukau District Health Board on Wednesday, chief executive Dr Gloria Johnson said South Auckland’s Middlemore Hospital had its highest-ever number of patient presentations in emergency in January and “that’s been mirrored across metropolitan Auckland”.
After an extremely busy 2017 winter for the Auckland, Counties Manukau and Waitemata DHBs, emergency presentations kept trending upward till summer, Johnson said.
“Really early, exceptionally high and exceptionally sustained” numbers to the emergency department left all three DHBs clogged.
With several strains of influenza, including the lethal “Aussie flu” due to hit New Zealand, 2018 winter admissions are expected to be higher still. Flu season has overloaded the system in the UK and US, with hospitalisation rates worse than during the swine flu epidemic.
“If we have that then we’re not only going to have an exceptionally busy winter — we’re going to have very, very sick people in our hospitals,” Johnson said. “That’s going to put pressure on our entire system.”
Counties Manukau had been exceeding the Government health target of 95 per cent of patients staying less than six hours in the emergency department, but in recent months had only hit 92 per cent. The hospital was too full to move patients to the appropriate department, Johnson said.
“This is not a measure of efficiency of our emergency department. It’s a measure of the
efficiency of the whole hospital.”
Pharmac announced on Wednesday a beefed-up flu vaccine would be available in April, designed to protect against four strains of the flu circulating in the UK. DHB chiefs are crossing their fingers it will work.
Johnson said fears about being overwhelmed in flu season were part of what drove the bosses of the three DHBs to give an unusually frank presentation to Parliament’s health select committee last week.
They were in Parliament to plead their case for a share of the $8 billion of extra health spending Labour has pledged over the next four years.
Lester Levy, the DHBs’ outgoing chairman, painted a picture of a system at breaking point, saying there was “very little resilience, if any, in the system”.
He questioned whether the public health system had the resources to deal with a pandemic.
Primary care providers said they had warned for a decade there was a “perfect storm” coming for hospitals, especially in the upper North Island.
A 2009 report from the Pinnacle Midlands Health Network — a nonprofit network of central North Island GPs — predicted shrinking GP numbers would collide with a growing and ageing population to swamp secondary care services.
John Macaskill-Smith, Pinnacle’s chief executive at the time, said it was frustrating to see DHBs “acting like this is a big surprise”.
He accused DHBs of “overfunding hospitals and underfunding primary healthcare”.
“Once people are in hospital it’s too late . . . We said it would happen 10 years ago and they’ve done nothing.”
Minister of Health Dr David Clark reiterated that there would be another $8b for health over the next four years, but details would not be revealed until the Budget was announced in May.
But Clark confirmed it would include measures to make GP visits cheaper. Last year’s New Zealand Health Survey found 500,000 people could not afford the GP visits they needed.
Every new government faces a demand for more health spending, particularly a Labour government. This one is no exception. Last week Auckland’s three district health boards told a select committee of Parliament the city’s health services could not cope with any more demand. Lester Levy, chairman of all three boards, said the demand for services was growing more rapidly than the population and had reached the limit. “Last year Auckland grew by the population of Nelson and there is very little resilience, if any, in the system,” he said. “The last year has taken us to the limit.”
The pressure was being felt across the board, not just in hospitals but in community care and primary health services. The head of the Counties Manukau board, Gloria Johnson, said, “Our staff were working unexpectedly long hours and became increasingly stressed about not just how hard they were having to work but about the extremely unwell people they were having to look after.”
Waitemata’s chief executive, Dale Bramley, said hospital emergency departments in all three districts had seen peaks of attendance that would normally occur in winter. Johnson said they noticed the increased demand for acute surgery last summer. It failed to tail off and left services already overstretched before winter illnesses arrived. She said the load this summer has been even greater.
Labour came to office with a promise to spend an extra $8 billion on health over the next four years. That might go no further than meeting the deficits district health boards have been reporting in recent years. A free health service is a voracious monster of public spending, capable of consuming a healthy Budget surplus all on its own. Every government needs to be able to make the system live within reasonable rations.
That means limiting free services to those most in need or genuinely unable to pay for them. Those with minor or non-urgent illnesses should not be seen in emergency rooms. If they are children they can be treated by GPs or private emergency clinics at no charge. If they are elderly and can afford to pay, they should expect to pay. If this message is too harsh for the Government’s comfort, it needs to suggest another way for health boards to live within their budgets.
One other way is to lift the standards of rental housing and nutrition for low-income families. New regulations and subsidies should improve the ventilation and heating of those homes if tenants can afford to run the appliances. Hopefully increases in benefits and family support payments, last year and in this year’s Budget, will be used for both home heating and better nutrition.
Cold and damp houses put demand on the Auckland boards in winter, but they can hardly be blamed for the summer demands the board leaders have described. They are in line for Budget boosts but they should also be expected to constantly find savings in their operations. If they cannot, the Government ought to review their worth. Auckland does not need three boards, New Zealand does not need 20. Savings on district administration could meet some of that fearful increase in demand.