ED wait a ‘parent’s worst nightmare’
It is a parent’s worst nightmare. Their pre-schooler is sick and upset. Healthline advises them to take her to the emergency department, because the welts and swelling on her face could be an allergic reaction to the general anaesthetic she had earlier that day.
They spend more than seven hours in ED, bouncing their tired 3-year-old on their leg, finally seeing a doctor just before 6am.
Anna, not her real name, had this experience with her partner and daughter at Hutt Hospital’s emergency department on Friday night, where she developed a varicose vein on her leg from rocking her upset child. Stuff has decided not to name her because she works in a governmental role and didn’t want to affect her employment prospects.
She has been left open-mouthed at the pressure and dysfunction she witnessed. After spending hours watching others leave the waiting room, she wonders how desperate you have to be to get prompt care. Did their child need to stop breathing before she could be seen?
‘‘The pressure the health system is under is just too scary,’’ Anna said.
It is a scenario unfolding across the nation’s emergency departments, sparked by ballooning wait times and huge staff shortages. But it has also raised broader questions about the level of care people expect from the health system and how this measures up to what it can realistically deliver without drastic uplift in investment.
Emergency departments are regarded as a bellwether of a hospital, because backlogs develop when there are no beds available in the wards. Pressure has been building for years and clinicians now say staff illness and absences as a result of the pandemic have pushed the issue to levels not seen before.
Many of the fears Dr John Bonning, an ED specialist and immediate past president of the Australasian College of Emergency Medicine, raised more than a year ago have been borne out, such as ambulance ramping when there is nowhere to offload patients.
But he was at pains to emphasise the pressure in EDs was not a result of people needing to go to their GP. There was a level of unmet need, which meant some illnesses were treated later than they should have been. However, it was a shortage of beds and staff across the hospital which was creating delays.
More investment across the entire health system was the solution, including in primary care as well as EDs, he said. ‘‘More beds, nurses, aged residential care facilities. We are under significant stress at the moment.’’
He was among dozens of senior doctors who met in Wellington last week for the Association of Salaried Medical Specialists annual conference, where delegates heard an extra $6.7 billion boost to the health system – every year – would be needed to bring it in line with the spending seen in 15 other comparable wealthy nations across western and northern Europe.
The astronomical figure was calculated looking at the Government’s 2020 health spend and totals 1.8% of New Zealand’s GDP. In May this year, Finance Minister Grant Robertson poured a massive $13.2b into the health system but this was spread over four years. The Labour Government
has increased health spending by nearly 45% while it has been in office and redesigned the governance and bureaucracy behind the health system.
Free GP visits were also touted as another potential solution to the health crisis, as part of a shift towards what would be a free public healthcare system. Max Rashbrooke, an economic commentator who researched and wrote a paper on this for the medical specialists’ association, said free GP visits for everyone would seriously reduce impacts on the health system. The healthcare training intake would need to grow by 20% as well. Cutting fees would cost up to $1b a year.
The idea had even more merit as a way to cushion the impact of high costs as a result of inflation, higher interest rates and next year’s predicted recession on lower-income families, he said.
However, Health Minister Andrew Little said it was $1b he did not have ‘‘having already boosted health spending by nearly 45% to a record $24b a year’’ – although more of the health budget would go towards primary care in time.
Dr Samantha Murton, the president of the Royal New Zealand College of General Practitioners, said free visits would do little to solve the crux of the problem – chronic and growing workforce shortages as about half of all GPs were due to retire within the next decade.
GPs deliver 14 million consultations a year, a figure anticipated to grow with the ageing and sicker population, where mental health issues are increasing and where young Māori and Pacific people are disproportionately affected by complex health conditions.
Making GP visits free would add even more pressure overall, she said, because people would use it unnecessarily.
Te Whatu Ora Capital Coast & Hutt Valley director of Provider Services Joy Farley said the ED was very busy when Anna visited and was experiencing high volumes of presentations for people with complex conditions. ‘‘We understand that it can be difficult and frustrating waiting in hospital emergency departments and we sympathise with anyone who has experienced distress.’’