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