Are our hospitals ready for coronavirus?

Health Minister David Clark is responding to the coronavirus threat well by basing his approach on advice from health experts and delivering it in a calm, measured manner. He has the added benefit of a Director-General of Health who is also a public health specialist. Much hard planning work is under way centrally and in our public hospitals. But what it also shows is a failure to learn from the past and to recognise that the best way to prepare for an anticipated crisis is when there is no crisis, not when the crisis happens. This should have been learnt at the very least from the Sars virus around 10 years ago. Sars, from the same family of viruses as coronavirus, was a timely reminder that there would be more viruses to come that would spread more quickly, be more contagious, and be ‘‘smarter’’. The takehome message from the hospital planning for Sars was that hospitals would be under much greater pressure when the next virus arrived and, therefore, they should be prepared.

It is an indictment of successive governments that the state of our public hospitals has deteriorated rather than improved and, despite employing highly dedicated and skilled health professionals, are not fit to cope with the anticipated onslaught of coronavirus should, as expected, it become widespread. This is a disgrace especially as we have one of the most integrated overall health systems in the world. It is a leadership rather than systems failure.

To begin with, there is a hospital specialist workforce crisis. The best estimate is that we have shortages of nearly 25 per cent – give or take around 1000 more specialists are needed. And yet official advertised vacancies are between one-third to half of this because of underfunding and short-sighted leadership in our district health boards. Inevitably we have a burnout rate of specialists (50 per cent is the best estimate).

Best estimates are also that it is only going to get worse: nearly a quarter of specialists intend to leave hospital employment within a five-year period. Increasing the peril is a more than 60 per cent specialist pay gap the wrong way between Australia and New Zealand.

As well as a highly vulnerable workforce, our hospitals have been under increasing pressure for several years. The pressures on our hospitals when coronavirus further impacts will not just be from winter flu. We have a growing population, which increases patient demand, but more challenging is the effect of our ageing population. We have added pressure with the link between serious illness and entrenched poverty (social deprivation to express it more gently). Increased pressure on hospitals is an inevitable cost of our disgraceful number of children and families living in poverty.

The result of these pressures forcing more and more New Zealanders to require urgent treatment is that the rate of acute hospital admissions has been increasing at an alarmingly higher rate

The state of our public hospitals has deteriorated rather than improved.

than the rate of population growth. This is why hospital bed occupancy rates are so high (and help explain high health board deficits, too).

The pressures of coronavirus on hospitals is likely to be most felt on emergency departments and intensive care units. I’m confident health professionals will go to enormous efforts to find ways of caring for patients. I’m also confident the health of these professionals will suffer consequently.

Coronavirus is bringing the chickens of failed leadership home to roost. When I think of the quality of health leadership in the stewardship of public hospitals, the words of Blackadder come to mind – clucking bell. When I think of how coronavirus might further impact this, much more explicit words come to mind.

Ian Powell is a health commentator and the former spokesman for the Association of Salaried Medical Specialists.