‘Acute service failure’ in health units could lead to deaths
Christchurch’s Emergency Department (ED), Neonatal Intensive Care Unit (NICU), general medicine and acute mental health services are at risk of ‘‘acute service failure’’.
Chief executive David Meates warned the Canterbury District Health Board (CDHB) about the services most at risk in a report that was discussed in the publicexcluded section of the board’s monthly meeting in February last year.
The report was discussed with Ministry of Health officials afterwards. This week The Press obtained extracts of the report, including a definition of ‘‘acute service failure’’ as ‘‘when there are insufficient resources to do today what needs to be done today’’.
Despite several requests, the board and the ministry did not answer questions as to how likely service failure was to occur and what it would mean for patients, but a health system expert said it could result in loss of life.
University of Otago health policy Professor Robin Gauld said any sudden influx of patients – following a big accident or a disaster, for example – could lead to acute service failure.
This would mean the most urgent cases would be treated, but others could potentially be transferred to other DHBs, or have to wait while clinicians were flown in from other locations.
‘‘In the worst case scenario, this could result in loss of life.’’
Gauld said all DHBs faced this risk ‘‘to a degree’’ and had contingency plans in place.
However, the CDHB had been under more pressure since the February 2011 earthquake and has had to monitor the risk of service failure closely.
Health workers last week warned Christchurch’s ED could be forced to close to some patients during winter’s peak, with a recent CDHB report saying more than 56,000 patients were expected in the department this year, up
1100 on 2017. Christchurch NICU operated near or above 100 per cent occupancy for all of last year, above the international safe level standard of
85 per cent. Because of this, the CDHB sent 31 women with highrisk pregnancies to give birth in other cities – twice as many women as in 2016.
Hillmorton Hospital’s acute inpatient mental health units have been close to, or over, capacity since 2012. In December, occupancy was at 102 per cent, meaning patients had to ‘‘sleep over’’ elsewhere on 41 occasions. Occupancy was at 97 per cent in January, above the optimal level of 85 per cent.
The February 2017 report outlined post-quake issues in a ‘‘precariously-balanced’’ health system. It talked about the challenges of holding demand steady with a rapidly-rising and ageing population and limited capacity until new facilities were complete.
‘‘At this point the most at-risk service areas from a bed perspective are general medicine, neonatal intensive care, emergency and mental health inpatients but the risk of service failure is broader with demand outstripping supply in a number of key areas,’’ the report said.
The Press asked Meates what would happen if service failure occurred in the services most at risk. It also asked both Meates and the ministry what extra resources had been allocated to avoid service failure and whether other DHBs had issued similar warnings.
In response, Meates issued a written statement outlining the constraints the CDHB had been facing since the February 2011 quake and how it had responded to these pressures ‘‘to avoid service failure occurring to date’’.
‘‘The Canterbury health system is at capacity and our ability to continue to absorb the relentless pressure created by an ageing and increasing population is likely to be put to the test over winter,’’ he wrote. ‘‘We no longer have ‘winter peaks’ – our hospitals are busy and often operating at capacity throughout the year.’’
He said ED had recruited 25 new staff – including senior medical officers, doctors, and nurses – over the past six years and NICU had recruited eight new nurses in the last year.
Last year, the CDHB warned ‘‘significant service cuts of unprecedented scale’’ would be needed if the Government did not approve its planned deficit.
Documents obtained under the Official Information Act in August showed the ministry was at loggerheads with the CDHB over a $54 million deficit blowout in its draft annual plan for this financial year. It was still unknown whether the ministry had approved the deficit.