WEBVTT - Emergency department wait times hit critical mass: Is there an easy solution?

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<v Speaker 1>Yeah, No, I'm Chelsea Daniels and this is the Front Page,

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<v Speaker 1>a daily podcast presented by The New Zealand Herald. It'll

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<v Speaker 1>come as no surprise when I say our emergency departments

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<v Speaker 1>are suffering. It's a tale that's haunted consecutive governments and

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<v Speaker 1>one that has those at the front line crying out

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<v Speaker 1>for support. Winter is one of the busiest periods for

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<v Speaker 1>hospitals in the entire year, and many are already reportedly

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<v Speaker 1>at capacity. But what do we do with this broken

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<v Speaker 1>record and how do we fix a sector that's been

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<v Speaker 1>chronically underfunded for generations. Today on the Front Page, Herald's

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<v Speaker 1>senior investigative reporter, Michael Morra joins us to discuss what

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<v Speaker 1>he's heard from those at the coal face of this crisis.

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<v Speaker 1>You've done some digging around emergency department waiting times and

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<v Speaker 1>it's no surprise that it's pretty bad.

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<v Speaker 2>Hey, yeah, I think that what this report reveals that

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<v Speaker 2>I've got into the Official Information Act reveals precisely how bad.

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<v Speaker 2>And I think, to be fair, a lot of this

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<v Speaker 2>sort of information is in fact hidden from the public

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<v Speaker 2>or is not really prevalent in the public domain. A

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<v Speaker 2>few of the key points that were raised in this report.

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<v Speaker 2>From last winter Winter twenty twenty four, more than fifteen

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<v Speaker 2>hundred patients treated in corridors over a thirty six day

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<v Speaker 2>period at Middlemore Hospitals ed. Essentially, this was because of

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<v Speaker 2>severe overcrowding and a lack of staff for ron dirty.

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<v Speaker 2>But more importantly, over this same thirty six day period,

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<v Speaker 2>there were forty three separate patient harm incidents. Now, when

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<v Speaker 2>I say patient harm, what I mean by that is

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<v Speaker 2>that several of these would have been what's classified as

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<v Speaker 2>category one or category two adverse events. So essentially it

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<v Speaker 2>could be a patient who dies or suffers some other

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<v Speaker 2>major medical event due to delays in care or poor care. Now,

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<v Speaker 2>the physicians who are working very hard out at Middlemore,

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<v Speaker 2>I mean they're skilled operators, right, but if you are

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<v Speaker 2>overwhelmed with too many patients, people are falling through the cracks.

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<v Speaker 2>And this is essentially what this report is talking about.

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<v Speaker 2>So it is fairly concerning, and there's even some comments

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<v Speaker 2>from staff themselves, And I'm just going to quote you

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<v Speaker 2>a couple of points here because I think this is

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<v Speaker 2>really salient to the whole discussion. One staff member says

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<v Speaker 2>the lack of resourcing and support for the emergency department

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<v Speaker 2>at Middlemore is having a quote significant effect on the

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<v Speaker 2>morbidity and mortality of the population that we are meant

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<v Speaker 2>to be serving. It reported ED overcrowding does not show

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<v Speaker 2>the old ladies who wet themselves in the corridor because

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<v Speaker 2>there is nowhere else to go. Another staff member says,

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<v Speaker 2>our patients are being done an injustice and we're not

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<v Speaker 2>talking about it. It's certainly not visible to our politicians

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<v Speaker 2>to say that the ship is sinking and no one

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<v Speaker 2>is coming to help as an understatement. So really really

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<v Speaker 2>strong language there and a pretty concerning report. And the

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<v Speaker 2>points I've made just now with the patients being treated

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<v Speaker 2>in corridors, I mean there's other elements. Two hundred and

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<v Speaker 2>thirty excess bed days, so that is patients who are

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<v Speaker 2>in the ED languishing there, remaining in a bed, but

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<v Speaker 2>they're not being admitted to the ward. So that's the time.

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<v Speaker 2>That's the extra time they're spending in a place that

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<v Speaker 2>they should not be because they need to be admitted,

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<v Speaker 2>but there is bed block in the hospital so they

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<v Speaker 2>can't get in. There were also issues around meeting certain

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<v Speaker 2>KPIs for people who are walking into the ED with

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<v Speaker 2>a heart attack, for example, not getting the interventions they

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<v Speaker 2>should within the ninety minute KPI. So yeah, some pretty

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<v Speaker 2>serious points that have been raised in this and certainly

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<v Speaker 2>a real insight into what has occurred at Middlemore Hospitals

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<v Speaker 2>ed last winter. Now you might say, well that was

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<v Speaker 2>last winter, Mike, But the point is is that the

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<v Speaker 2>clinicians wrote this report so it could be reviewed escalated

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<v Speaker 2>up the chain to Health New Zealand and to the Minister. Now,

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<v Speaker 2>what they ultimately wanted was three point six million dollars

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<v Speaker 2>of additional funding to boost their staff numbers and boost

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<v Speaker 2>resourcing and make it safer for this winter twenty twenty five.

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<v Speaker 2>Have they received that money? No, they have not. Did

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<v Speaker 2>the report get escalated up the chain to the national

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<v Speaker 2>clinical Leadership? It did. I've worked out that it did

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<v Speaker 2>go up there. However, Health New Zealand has told me

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<v Speaker 2>that there were quote delays in acknowledging it. So that's

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<v Speaker 2>pretty worrying, right. You've got clinicians who essentially write this

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<v Speaker 2>very detailed report, it's a cry for help, goes to

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<v Speaker 2>the top and doesn't appear like much happened.

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<v Speaker 1>No, so who did the report? The clinicians who are

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<v Speaker 1>seeing this every day.

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<v Speaker 2>Correct. There was several emergency department doctors and nurses who

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<v Speaker 2>were involved in compiling this report.

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<v Speaker 1>It must be so frustrating if you're seeing people like

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<v Speaker 1>that from the grand extremes. And what got me there

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<v Speaker 1>is the older ladies urinating in hallways because there's nowhere

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<v Speaker 1>else to go. I mean that gives you a real

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<v Speaker 1>vesceral on how bad this is. It must be so

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<v Speaker 1>frustrating for them.

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<v Speaker 2>Yeah, it is. And I interviewed doctor Vannessa Thornton, who's

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<v Speaker 2>one of the regional managers at County's Monaco, also an

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<v Speaker 2>expert emergency department physician and has been an edy doctor

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<v Speaker 2>for you probably about twenty or thirty years. I think

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<v Speaker 2>she's certainly been doing the job and knows the craft

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<v Speaker 2>pretty well. But she said and admitted, yes, it is

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<v Speaker 2>extremely frustrating. But on some days they will have not

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<v Speaker 2>enough staff. There might be three or four staff who

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<v Speaker 2>call them sick and they just cannot replace those people.

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<v Speaker 2>And I said to her, well, what about this money?

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<v Speaker 2>Will you get that money ahead of this one? And

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<v Speaker 2>she said, look, we're hoping to get some resourcing. But

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<v Speaker 2>she certainly sympathized with her colleagues. Comments about the ship

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<v Speaker 2>is sinking as in the ed is thinking, because she

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<v Speaker 2>agreed that on certain days it felt like staff were

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<v Speaker 2>not being heard and were overwhelmed.

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<v Speaker 3>As Minister of Health, ensuring that all New Zealanders can

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<v Speaker 3>access timely quality healthcare is my top priority. Reducing weight

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<v Speaker 3>lists so that patients have shorter weight times for appointments

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<v Speaker 3>and surgery is a key part of this and this

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<v Speaker 3>hospital will play a critical role in delivering these targets.

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<v Speaker 3>While there is significant progress needed to meet these targets,

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<v Speaker 3>I'm pleased at patients in this region and further Afield

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<v Speaker 3>are benefiting from the state of the art facility. This

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<v Speaker 3>number will only grow as theater capacity and resourcing continues

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<v Speaker 3>to scale up over time.

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<v Speaker 1>So this isn't unique to Middlemore Hospital. Hey, how widespread

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<v Speaker 1>is this issue?

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<v Speaker 2>Yes, I've spoken to doctor Kate Clark, who is the

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<v Speaker 2>chair for the Australasian College of Emergency Medicine. This is

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<v Speaker 2>essentially the group that oversees eds all around the country

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<v Speaker 2>and absolutely she says, Look, this is not an issue

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<v Speaker 2>that is unique to Middlemore. And interestingly she told me

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<v Speaker 2>and you can read this in the Herald, that many

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<v Speaker 2>of our bigds are actually right now at capacity and

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<v Speaker 2>we have not yet hit winter. I'll give you a

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<v Speaker 2>little bit of insight into this. Health New Zealand has

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<v Speaker 2>provided me with some data which relates to just how

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<v Speaker 2>busy our eds are right now. And remember every winter

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<v Speaker 2>there are stories about ED overloading and we are not

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<v Speaker 2>quite there yet. But look at this the seven day

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<v Speaker 2>average from May fourteen to May twenty. Every day christ

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<v Speaker 2>Church Hospital has been seeing three hundred and thirteen patients.

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<v Speaker 2>That's a day. Middlemore Hospital, which we've been speaking about,

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<v Speaker 2>three hundred and twenty nine patients per day now. To

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<v Speaker 2>give you some context around them. The last time Health

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<v Speaker 2>New Zealand put out a public health alert about extremely

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<v Speaker 2>busy eds was last year with christ Church's ED and

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<v Speaker 2>at that point they were seeing four hundred and thirty

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<v Speaker 2>patients a day and Health New Zealand put out basically

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<v Speaker 2>a plea to the public that if you don't need

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<v Speaker 2>to turn up there, police don't because they are extremely busy.

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<v Speaker 2>Same goes for Middlemore three hundred and twenty nine patients

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<v Speaker 2>they're seeing on a daily basis. I've just had an

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<v Speaker 2>email come in a concerned ED worker. I won't be

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<v Speaker 2>saying who that is but they tell me Middlemore's ED

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<v Speaker 2>was built to receive two hundred and seventy patients a day.

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<v Speaker 2>Right now they're seeing three hundred and twenty nine.

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<v Speaker 4>And we haven't even hear winter yet.

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<v Speaker 2>No, and that's official data from Health New Zealand, so

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<v Speaker 2>you can kind of get a picture. And the other

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<v Speaker 2>point to make is that every year, year on year,

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<v Speaker 2>these numbers are going up, So the number of people

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<v Speaker 2>presenting is going up by you know, two to three

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<v Speaker 2>percent a year.

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<v Speaker 1>Now, this is an issue that successive governments have had

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<v Speaker 1>to deal with and I mean, what is the solution here,

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<v Speaker 1>bar getting more staff in, bar more funding, do we

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<v Speaker 1>really need to go grassroots?

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<v Speaker 4>So looking at general practices, do people rock up to the.

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<v Speaker 1>You know, the old outage people are just going to

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<v Speaker 1>the ED because it's the you know, they've got a

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<v Speaker 1>sniffer and they just go there.

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<v Speaker 4>They're clunging it up. I mean that's not really the

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<v Speaker 4>case though, is it.

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<v Speaker 1>No?

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<v Speaker 2>And look, yeah, that's a really really important point that

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<v Speaker 2>you've raised. And a lot of people will say and

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<v Speaker 2>sometimes say, oh, well, you know, please don't turn up

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<v Speaker 2>to your ED. But actually, if you look at the facts,

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<v Speaker 2>more than fifty percent of patients who are turning up

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<v Speaker 2>to middlemore ZD, for example, are high acuity patients. That

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<v Speaker 2>means that they are severely unwell or they're having some

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<v Speaker 2>sort of medical condition, and over fifty percent of those

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<v Speaker 2>patients require admission to the hospital. They're not turning up

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<v Speaker 2>with a sniffly nose, And in fact, there's been research

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<v Speaker 2>done about that which rebuts that idea that a lot

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<v Speaker 2>of people are just turning up without needing to be there.

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<v Speaker 4>Where does that come from? Do you reckon? I mean,

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<v Speaker 4>that's spread over years and years and years.

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<v Speaker 2>Hey, I think so, and certainly maybe some EDS that

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<v Speaker 2>that might be the case, where a lot of people

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<v Speaker 2>are turning up to get coughs and colds locked out

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<v Speaker 2>or something like that when it's not an emergency. But

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<v Speaker 2>I think it's actually a bit of a myth at

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<v Speaker 2>the moment to suggest that, you know, everyone in New

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<v Speaker 2>Zealand who's turning up at EDS don't actually need to

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<v Speaker 2>be there, because the facts just don't support that.

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<v Speaker 4>So looking at mental health patients and emergency departments, I

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<v Speaker 4>remember reading something in the New Zealand Medical Journal last

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<v Speaker 4>year about this time last year, and it's said almost

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<v Speaker 4>one in five ED presentations are by mental health clients.

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<v Speaker 1>They crunched the numbers over a five year period and

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<v Speaker 1>these presentations were often younger female Maori required more urgent

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<v Speaker 1>care and waited longer. This would come as no surprise

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<v Speaker 1>to UA.

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<v Speaker 2>Yeah, and in fact, this report that I've got much

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<v Speaker 2>delves into the situation at Middle of the hospital. It's

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<v Speaker 2>one of the key points they might make right up

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<v Speaker 2>the top of the report that over this thirty six

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<v Speaker 2>day period that was under review, five patients who are

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<v Speaker 2>under the Mental Health Act absconded from the ED while there,

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<v Speaker 2>one of whom attempted suicide as soon as they got

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<v Speaker 2>outside the ED doors. Now, I've spoken to Vanessa Thornton

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<v Speaker 2>about this at Middlemoor ED and also doctor Kate Allen.

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<v Speaker 2>Both of them say, look, this is happening, and it

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<v Speaker 2>is actually happening daily. You know, it's happening pretty regularly.

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<v Speaker 2>And again though one of the key concerns they raise

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<v Speaker 2>is staff. You know, they don't have enough staff, so

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<v Speaker 2>that is one of the key concerns here. I guess

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<v Speaker 2>it also goes back to the point you raised earlier

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<v Speaker 2>about sort of the community care right we know in

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<v Speaker 2>New Zealand, to have a well functioning health system and

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<v Speaker 2>an emergency which operates in a hospital that operates without

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<v Speaker 2>being overwhelmed. You need to have a good, healthy, functioning

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<v Speaker 2>primary care system in the community because if patients are

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<v Speaker 2>coming to see their GPS, and they can see the

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<v Speaker 2>same GPS over a long period of time, they are

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<v Speaker 2>less likely to have to go to ED because they

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<v Speaker 2>don't suddenly get sick. That's what gps are all about,

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<v Speaker 2>preventative medicine. This has been a long concern of GPS

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<v Speaker 2>for many years now, and I saw multiple press releases

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<v Speaker 2>from the likes of gen Pro the GP Owners Association

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<v Speaker 2>after the announcement of this budget just saying this is

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<v Speaker 2>woful and we're not happy again. The concern is under

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<v Speaker 2>investment in a core part of our health system in

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<v Speaker 2>New Zealand.

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<v Speaker 1>They're just crying out, aren't they. I remember I spoke

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<v Speaker 1>to New Zealand Initiative Research fellow and GP doctor Prabarni

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<v Speaker 1>Wood earlier this year about the country's primary healthcare system.

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<v Speaker 5>I'd love to get stuck in and look in more

0:13:05.360 --> 0:13:08.360
<v Speaker 5>detail into alternative funding models. I have to do that

0:13:08.400 --> 0:13:11.240
<v Speaker 5>in the future, but it makes logical sense to me

0:13:11.440 --> 0:13:17.199
<v Speaker 5>that any money that's saved by general practice from patients

0:13:17.360 --> 0:13:21.920
<v Speaker 5>not having to attend the emergency department. That saving could

0:13:21.920 --> 0:13:25.400
<v Speaker 5>then be fed back into primary care. So we're not

0:13:25.480 --> 0:13:27.880
<v Speaker 5>asking for new money, but we're asking for the money

0:13:27.880 --> 0:13:29.839
<v Speaker 5>that we're saving to come back to us. And that

0:13:30.320 --> 0:13:33.120
<v Speaker 5>would absolutely make sense to look at things like that

0:13:33.240 --> 0:13:33.720
<v Speaker 5>in that way.

0:13:35.679 --> 0:13:38.520
<v Speaker 1>So what is the solution here. It's obviously not an

0:13:38.520 --> 0:13:40.920
<v Speaker 1>easy one. There's going to be no silver bullet. But

0:13:41.040 --> 0:13:43.199
<v Speaker 1>what are some of the ways that we can alleviate

0:13:43.280 --> 0:13:44.960
<v Speaker 1>this pain on EDS?

0:13:45.240 --> 0:13:48.800
<v Speaker 2>Well, certainly there has been general support for the Health

0:13:48.840 --> 0:13:52.760
<v Speaker 2>Minister same and Brown's announcement about the expansion of urgent

0:13:52.920 --> 0:13:56.559
<v Speaker 2>care services. So for example, it's just just remember that

0:13:56.920 --> 0:13:59.840
<v Speaker 2>this announcement from the government is not about building new

0:14:00.200 --> 0:14:04.000
<v Speaker 2>urgent care clinics, it's just extending the hours for which

0:14:04.080 --> 0:14:07.680
<v Speaker 2>they are open. So that would be probably useful in

0:14:07.720 --> 0:14:10.880
<v Speaker 2>the sense that perhaps some of those patients who may

0:14:10.920 --> 0:14:13.120
<v Speaker 2>have gone to the ED at Middlemore might be able

0:14:13.120 --> 0:14:16.360
<v Speaker 2>to go at midnight to their urgent care clinic instead,

0:14:16.440 --> 0:14:19.720
<v Speaker 2>so that will alleviate some of it. And also there's

0:14:20.360 --> 0:14:25.840
<v Speaker 2>been various other initiatives, but what GPS and what emergency

0:14:26.560 --> 0:14:30.080
<v Speaker 2>Medicine physicians are saying, is it's about priorities, right, and

0:14:30.160 --> 0:14:34.040
<v Speaker 2>health is important and there just hasn't been enough funding

0:14:34.520 --> 0:14:38.000
<v Speaker 2>injected into that and it hasn't been prioritized like it

0:14:38.080 --> 0:14:40.840
<v Speaker 2>should in New Zealand. And even when I actually asked

0:14:41.040 --> 0:14:44.920
<v Speaker 2>Health Minister Simeon Brown direct questions about the report at Middlemore,

0:14:45.000 --> 0:14:48.400
<v Speaker 2>you know, direct questions about the concerns from staff about

0:14:48.400 --> 0:14:51.320
<v Speaker 2>the number of people in corridors, about whether he had

0:14:51.440 --> 0:14:54.920
<v Speaker 2>seen the report as clinicians wanted him to. He did

0:14:54.960 --> 0:14:58.760
<v Speaker 2>not respond to those questions, which is pretty concerning, and

0:14:58.800 --> 0:15:03.160
<v Speaker 2>he talked more about the government's health targets and how

0:15:03.200 --> 0:15:07.600
<v Speaker 2>that is improving Edie wait times. But again we come

0:15:07.680 --> 0:15:11.000
<v Speaker 2>back to the key thing. It's funding and it's staff numbers.

0:15:11.200 --> 0:15:13.040
<v Speaker 4>Thanks for joining us, Michael Pleasure.

0:15:16.200 --> 0:15:19.280
<v Speaker 1>That's it for this episode of The Front Page. You

0:15:19.320 --> 0:15:23.120
<v Speaker 1>can read more about today's stories and extensive news coverage

0:15:23.160 --> 0:15:27.200
<v Speaker 1>at enzdherld, dot co, dot MZ. The Front Page is

0:15:27.240 --> 0:15:30.960
<v Speaker 1>produced by Ethan Seals and Richard Martin, who is also

0:15:31.120 --> 0:15:35.800
<v Speaker 1>our sound engineer. I'm Chelsea Daniels. Subscribe to the Front

0:15:35.800 --> 0:15:39.400
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0:15:39.520 --> 0:15:43.120
<v Speaker 1>tune in tomorrow for another look behind the headlines.