Waitemata Health
The Herald reports on the woman who had to wait for 30 hours in A&E at Waitemata before getting a bed.
She spent 13 hours on a drip in the waiting room, and then 17 hours on a trolley before getting a bed and then surgery the next day.
The Government claims it has increased doctor numbers at the hospital by 78%. But the problem wasn’t doctors, but beds. How can health funding almost double and there not be enough beds in A&E? Or at least capacity elsewhere.
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August 22nd, 2007 at 8:06 am
Lots of reasons for A+E (ECC these days) problems. People using the hospital rather than their own GP, weather conditions, bed blocking in the wards due to inadequate home services and, of course, staff shortages.
August 22nd, 2007 at 8:20 am
North Shore Hospital emergency dept is a cot case. A few weeks ago it was so bad they had couldn’t empty ambulances and had to park 5 of them outside to use as emergency rooms as it was so crowded in there.
Of course, that meant the North Shore had no ambulances available to attend other emergencies. This, so far, was a one-off, but still a bloody disgrace.
The ageing population of the North Shore is also an issue. The ECC dept is always full of them and it breaks your heart to see them lying there for hours upon hours.
No sign if the extra health spending at North Shore hospital, or at least not enough to keep up with demand.
Still, I bet the admin dept runs like a dream.
August 22nd, 2007 at 8:23 am
But Sonic, hasn’t the Government thrown an extra $5bil at health to sort all this stuff out? Isn’t increased spending the answer? So how come hospitals now are way, way worse than in 1999? And how come people wait longer for a smaller range of surgery in the public system? I mean $5bil – that’s a heck of a lot of money with not a heck of a lot to show for it, wouldn’t you agree Sonic?
August 22nd, 2007 at 8:30 am
Its always a hard one inventory when you get the winter spike in demand. You cannot have a ward full of empty beds on standbye (or the staff to run it) that would cost a hell of a lot of money I’m afraid.
Also not enough doctors is a biggie, perhaps we need to have a long hard look at how many medical students we train and the debt they end up with.
August 22nd, 2007 at 8:42 am
Also not enough doctors is a biggie, perhaps we need to have a long hard look at how many medical students we train and the debt they end up with.
Really Sonic? Then why was Hodgson trumpeting in questiontime yesterday that the number of doctors in Waitemata Health had risen by 78% under Labour?
Why are resources not getting where they are needed? Why is the ratio of bureaucrats to beds in public health greater than 1:1? Why is the ratio of bureaucrats to front line nurses greater than 3:1? Where is this extra 5 billion dollars being spent?
If we assume that these 12000 “crats” are being paid $50000 each per annum (and that is conservative) That is $600 million per annum being spent just on salaries, Factor in office space, operating costs etc and we start to see just where a lot of wastage could be.
Just think of the hospital that could be built on the north shore with that money and ask if the priorities of health spending could be improved.
August 22nd, 2007 at 8:43 am
The A&E services at major hospitals are a critical core activity that should never be neglected. This strikes at the very heart of universal and equal access to vital services at your time of need.
Poor employee relations caused by aggressive administrators have caused a lack of morale in key staff such as doctors and nurses which adds to the difficulty of recruiting and retaining professionals with the skills we need. We must target investment into retaining highly trained experienced staff and making them feel like vital members of the team along with developing state of the art facilities in these core activities. This is a top priority while administrative overheads should be kept the minimum required for efficient management.
This new environment and attitude will encourage top medical and nursing staff to stay here.
Kevin Hicks
k.o.hicks@xtra.co.nz
August 22nd, 2007 at 8:46 am
Having worked a good part of my life in the hospital system, I am well aware of the “balancing act” the hospitals have to perform. Successive governments have taken capacity out of the public hospital system in a drive for efficiency – starting when Helen Clark was Health Minister in the late 1980’s, and continuing under Upton’s reforms in the early 1990’s.
This government however seems to have the view (simplistic IMHO) that throwing large sums of money at the problem will bring the solution. However, I question the spending priorities of a lot of DHB’s, and the quality of advice they are receiving. In addition, student debt is cited as the reason for the doctor shortage – the fact of the matter is than any doctor wanting to train in a particular specialty has a manadtory overseas component of their specialist training, any most will avail themselves of the opportunity to add to their experience whilst overseas.
Health will continue to be the single most difficult area for any government – there’s no easy solution the the problems currently faced by our hospital services in particular. However, in investing the huge sums of money that this government has spent, they (and we!) must also demand accountability from DHB’s, and results.
August 22nd, 2007 at 9:01 am
“they (and we!) must also demand accountability from DHB’s, and results.”
No disagreement there.
August 22nd, 2007 at 9:01 am
Putting all the excuses aside, the current government has had 3 terms to fix the problem but instead has made things worse.
Basically Labour’s incompetence is killing people.
August 22nd, 2007 at 9:04 am
If you are in Auckland (or otherwise) inventory2 (and anyone else) we would welcome your input and comments. Cooperation is the key.
One member of our team (Ian Ward) was on the management of the ADHB for a long time and has vast experience in dealing with these issues.
We stand for good efficient governance and administration and improved staff relations as key to improving the health sector. We want to capture more of that funding for core activities and capital investment to keep pace with modern medicine.
August 22nd, 2007 at 9:16 am
Hi Kevan
I think poor administration has played a critical role in the failure of our Health System. A few years back, I was involved with a multi million dollar tender with ADHB and was shocked at the incompetence of the people and processes. We pointed out the risk of their approach but an Australian vendor had a really nice boat for entertainment. We didn’t win, the project failed and $30 million of taxpayers money down the shitter. We could have delivered success for a third of this, blindfolded with our hands tied behind our back.
August 22nd, 2007 at 9:19 am
One problem that i think North Shore still has is that Waitakere Hospital still does not have EC cover 24/7 ie at night.
This problem will be to some degree affecting the EC dept at Nrth Shore.
August 22nd, 2007 at 9:33 am
It seems to me to an issue of “allocation of funding” issue as much as “inadequate funding”. With socioeconomic & ethnic demographics as principle determinants of funding there is much disparity in what DHB’s receive. If you are wealthy and live in Karaka you may get you hip replacement in a couple of months, but if you are financially poor and live in Beachhaven you ae likely to be languishing on a ‘waiting list’ for years. Clinical staff shortages are also a significant factor and certainly the oppressed environment that is hospital medicine is a huge factor in recruitment & retention of doctors & nurses. Nurses are currently in the process of negotiating pay claims currently and are set to remain the only state sector employees that don’t receive Govt. superannuation, additionally the DHB’s have reduced annual leave entitlements that had previously been negotiated because of the legislative changes that meant they had to now pay 4 weeks annual leave to all employees! And with such demand for doctors and nurses, many simply choose to work in roles where their contributions are valued and are much less stressful than tending to unwell people and their concerned family & friends in an inadequately resourced environment with not even enough beds. We should however be heartened to learn that in response to a family members concern about her mother having been left on a trolly at NSH ECC department for an inordinate period of time without even a pillow…. the GM adult services stated that this problem would be resolved soon because they were going to have a “pillow amnesty”………. Paid big bucks to come up with such innovative strategies she is!
August 22nd, 2007 at 9:35 am
Right, let’s sort this out.
First, purge the beaurocrats. Eliminate unrequired duplication, aim for a ratio of one admin person for every 10 hospital beds. Plough the savings back in to the front line staff.
Second, rationalise the real estate. How many health department buildings are now taken up by admin staff. The New Auckland hospital is a prime example!
Third, Tax concessions for those who take out private health insurance, reducing the demand on our public system.
August 22nd, 2007 at 10:00 am
“they were going to have a “pillow amnesty”………. ”
my Lord, you would have to laugh if it wasn’t just so sad. I had the same issue with my daughter a while back….I lasted 2 hours of her not having a pillow while lying on a cot in the emergency dept until I went up to a ward and stole one off a bed.
I like RWWR’s comments. I mean how hard could it be to at least start addressing this issue.
Of course, they would have to employ a dozen consultants at 3k a day to manage the project for them.
August 22nd, 2007 at 10:02 am
I note the woman in question had a shin infection. She spent 30 hours in emergnecy.
In 2000, I had a shin infection. I was taken to the local Emergency Department, examined after an hour, sent to x-ray to ensure the infection had not spread to the bone, and from the x-ray department, I was admitted within about 45 minutes. That’s from front door to admitted, on an IV antibiotic drip within 2 hours.
Where was this wonderful service. Makati Medical Centre, Manila, the Phillipines!
August 22nd, 2007 at 10:04 am
CraigM said “Of course, they would have to employ a dozen consultants at 3k a day to manage the project for them.”
Flippin heck – is that the going rate now? We used to budget on around $1200 a day in the good old CHE days – so that’s a 250% increase since 1999! No wonder $5bil in extra spending doesn’t make anyone healthier!!!
August 22nd, 2007 at 10:11 am
Kevin Hicks said “If you are in Auckland (or otherwise) inventory2 (and anyone else) we would welcome your input and comments. Cooperation is the key.”
Sorry Kev – I’m out in the provinces – Lawsville, to be precise. The only way to get on council or DHB here seems to be to join the Vision Eyeliner Wearers party, and I ain’t gonna go there!! (Apologies for the grammar).
PS – Condolences to the whanau of Chas Poynter – I didn’t always agree with the little bloke, and maybe he stayed as mayor one term too long, but you couldn’t fault his energy, passion and commitment for the job. He will be fondly remembered by many. Which begs the question – toupee or eyeliner – which is the greater fashion crime? Chas would have seen the humour in that! RIP Chas.
August 22nd, 2007 at 10:11 am
No wonder $5bil in extra spending doesn’t make anyone healthier!!!
Dunno about that, the consultants look quite happy.
August 22nd, 2007 at 10:14 am
And healthy – on that dosh, they “go private”!!!
August 22nd, 2007 at 10:19 am
Excellent, I would like to offer my services to Kevin Hicks as a consultant!
August 22nd, 2007 at 10:42 am
Me too! but I’l consult for the princely some of $1K a week!
August 22nd, 2007 at 10:46 am
Thanks Fedup, I always appreciate a heads up. As a team we are absolutely committed to reintroducing meticulous conflict of interest disclosure and routing this type of behaviour so the money can be spent on the front line.
Lisa, I appreciate your comments, and I have read many of your previous posts also. I’m not sure whether you are at ADHB but for Auckland District health Board we feel after the elections we can start afresh on staff and patient relations, and put the agro and conflict behind us. Front line staff and facilities equally and universally available to all patients we see as our top priority and can’t understand why that had not been the case. i hope other hospital boards will follow suit. I would be very interested in hearing further from you and any other doctors and nurses.
August 22nd, 2007 at 10:57 am
Unbelivable story about the Philipines. We need to have first world hospital services.
The other thing we should all get behind is supporting the dotors get PET in NZ for cancer patients. It is long overdue.
http://aucklandhealth.wordpress.com/2007/08/21/lets-get-pet-for-auckland/
August 22nd, 2007 at 11:16 am
IMHO the problems with the Health Service can be summarised as follows
1. Poor governance. Ill equiped Boards. Lack governance financial and legal understanding to make good decisions.
2.Too many Managers Administrators Consultants all trying to defend their patch.
3. The Straining at Gnats and Swallowing Camels Syndrome.
Hightlighted above .Overly complex procedures to obtain a safety pin whilst aprovn multi million dollar expenditure in a flash.
4. Government interference in the wrong areas frustrating the efforts of good people.
5. Lack of consultation with the rock face to find out whats needed.
All easily solved by a committee of 2 persons with one bastard permanently absent.
August 22nd, 2007 at 11:19 am
Too many ‘crats telling doctors and nurses what they need to do their job methinks.
August 22nd, 2007 at 11:29 am
Once we had an Auckland wide HB, so they could make economies of scale .
But someone decided to have 3 separate organisations and the put cash registers in wards and A&E to manage demand that way.
The name of the health minister escapes me , but it could have been Jenny Shipley
[DPF: Why only go back 15 years. Let's blame that Seddon character from 100 years ago]
August 22nd, 2007 at 11:44 am
Numerous cuts to health services were undertaken in the 1980’s, and many small rural hospitals were closed or downgraded. Amalagamation of Hospital Boards was effected by the government in power at the time, and a number of provincial regions lost their autonomy. The name of the Health Minister does NOT escape me – it was Helen Elizabeth Clark, Cabinet Minister in the Rogernomics Labour government.
August 22nd, 2007 at 11:57 am
Kevin Hicks is on the right track. Thank goodness we have some common sense strategies and back to the basics of fundamental respect and professionalism in his thinking. Be interested in what Mr Brown thinks of these ideas which seem to be a big departure from his own thinking and management style.
August 22nd, 2007 at 11:58 am
When I opened this post to read the comments I was mentally telling myself: “Selma will be in there blaming it on a National government of the past”.
Lo and behold, she is. The current Labour government has had nigh on 9 years in power to fix any issues that might have cropped up. And if not fix, at least get the ship steered in the right direction. They have not managed this in the case of health, or so it seems. Continuing to blame this on the past simply shows an inability to accept responsibility for your own failures.
And as Inventory2 pointed out – Helen Elizabeth Clark? Too funny!
August 22nd, 2007 at 12:07 pm
As an aside, we went to our local ER (White Cross) with a 11 month old baby that appeared very ill. The doctor there immediately referred us to Starship, because she believed we were looking at a case of Meningicocal disease. She declared it an emergency and at around 10:00pm we rushed out of there to get our daughter to the hospital.
Despite having had a telephone call, a fax and advanced notice of this it was not until 4am the next morning that the staff at Starship was able to attend to us. In that time we had migrated from a waiting room to an ER. Ranging from polite inquiries towards a full blown explosion around 3am, they kept on informing me we were on the list and would be seen as soon as a doctor was available.
Now ask yourself. Meningicoccal disease. Emergency declared by first level of medical staff seen. Would it not make sense to actually prioritize or perform basic Triage on these types of things?
The second case that comes to mind is that of my father. He had heart surgery which required something called “stints” put into his heart. My understanding of this is limited, but I believe it is a small device intended to enlarge the veins. On his return from a business trip in Germany he had a full blown heart attack on the plane, got diverted to Bangkok and admitted to hospital there. Where after a week in their cardio deparment he learned that when putting these stints in, you are required to stay on a certain type of medication for a 3 month (?) period to assist with their acceptance / (?) of the body. The local doctors had only, according to guidelines, prescribed a 3 week course of this medication.
He knows of two people who had the same operation. Both of them died within two years of having this operation done. Neither of them were told they needed to carry on with this medication for 3 months.
Nobody from the hospital / medical area got in touch with patients to warn them of this. We, as a family, are currently researching and gathering as much information about this as we can in the hope that it will actually reach some other people who have had the same operation.
Because while people are on strike for higher pay, while the number of administrators and managers keep on climbing, there are people dying because of substandard care.
August 22nd, 2007 at 12:16 pm
Thanks Lisa. We need the help and cooperation of the staff on the frontline to run a good health system. They are the ones that know best how to look after people’s health. It will be a battle for the new board to win their respect and trust. Luckily we have Ian Ward who is highly respected by the clincal staff. Also Brown and possibly other government appointees who have been less than concilliatory are leaving. That will give us a chance to start over and build the type of teamwork we need in a modern health system.
Send any health profesional our way to give their perspective. We are willing to listen and certainly don’t think the bean counters have delivered the promised results. The answer is to try to get the dog wagging the tail again, with the help of the bean counters, not the other way round.
August 22nd, 2007 at 12:17 pm
Throwing more and more money will never catch up to the increases of disease and illness. Until our experts realise the dangers that are being put into our foods, the necessities to protect corporations profits above peoples lives and health and having garbage foods available 24/7 we will continue to slide into deep hole of obesity and the diseases associated with it. Ofcourse people should be allowed to eat what they want, but reasonable education for all and REAL facts of the dangers additives etc pose.
Prevention will always be better than treating, yet it seems less profitable to the Big Corps and the leeches that unhindered them, under the guise of protecting us.
Look at the US, number one in the world for excellence in medicine and funding yet have horrific rates of iatrogenic deaths, and disease. Populations there live upon a drug culture believing there is a pill for every ill. That mentality along with garbage food culture is what driving the disease rates in the US and we are no further behind.
Unless all our people in power and our “experts” get off their fat asses and work for the health of us, rather than the pockets of their corporations, we will continue to slide.
Anyone would wonder why in the US there is a great public awareness now about how the Bush administration stands more for profits and very little for human health.
Our health derives mostly from what we eat, in other words eat crap, end up like it, eat artificial food, the body will struggle on and one day something will break. The disease rates prove it, the experts studies prove it. We have not evolved to eat and survive normally on drugs or non-foods. We could do better here.
August 22nd, 2007 at 12:37 pm
Pascal, that is very surprising about your baby with meningococcal disease. I would have assumed the fax would have alerted them to the severity of the situation. This looks like a really bad breakdown in communication on the face of it.
On the whole we do have a very good public health system in new Zealand, mainly thanks to the hard working nurses and doctors who ignore the politicians and get no with their hard jobs often under difficult circumstances. My opinion is there is quite a lot of wastage in some feel good vote catching areas that could be diverted back to the core activities. Until the core activities are running like a well oiled machine our major focus should be on them.
We have the basic structure in place for the best health system in the world. That structure is:
1. A publicly funded health system where there is universal and equal access.
2. A no fault ACC system where rehabilitation can be achieved AND we can all learn from errors and breakdowns in communication in order to improve long term outcomes.
These two systems guarantee the cooperation and goodwill of the health professions. For example imagine being a dedicated health professional and saying you can’t come here because you can’t afford it!
We need to work with that framework to improve the obvious glaring deficiencies we have now – such as the highly politicised nature of the system, self interest and lack of transparency, difficulty in recruiting and retaining the best health professionals and lack of capital expenditure in modern technological medicine.