Editorial: Hospital funding not fair

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The sight of sick and often elderly people lying in trolleys parked in hospital corridors is all too common at the onset of winter. Herald reporter Carroll Du Chateau found five such patients in a corridor of North Shore Hospital one day recently, and 30 more parked in cubicles. One of those in the corridor was still there the following day, too ill to eat and still waiting for a place to be found for her in the wards.

North Shore is possibly the last part of the country where you would expect to find a failing health service, which may be its problem. Since it has the highest average income of any hospital district and scores well on other social and life expectancy measures, the Waitemata District Health Board receives the least amount of public funding proportionate to its population.

Former chief executive Dwayne Crombie spent much of his time trying to convince the Ministry of Health that the 20 per cent social variation in the funding system was excessive and unfair. "It wasn't clear to me," he says, "that shifting health resources will solve unemployment, illiteracy and some of those basic health behaviours they are trying to address."

He estimates that the weighting against the Waitemata board (which covers Waitakere City and Rodney District as well as the North Shore) is costing it nearly $100 million a year. The consequences are felt most visibly at North Shore's emergency care centre where patients are sent for assessment after admission.

Urgent cases such as heart attacks, strokes and haemorrhaging wounds are treated quickly but the rest have to wait until time and space can be found for them.

Those left in corridors and cubicles suffer not just a lack of privacy, anxiety and discomfort, according to Dr Tim Parke, an emergency department clinician at Auckland City Hospital. Writing on the page opposite last week, Dr Parke said waiting in such conditions could reduce a patient's chances of survival.

The solution, he said, was for hospitals to keep their occupancy level no higher than 85 per cent so that surges in illness, such as caused by a cold snap, could be accommodated. North Shore's general manager of adult services, Rachel Heggarty, has told Du Chateau the hospital falls low in efficiency measures, with usually more than 90 per cent of its beds occupied.

Perhaps North Shore is too gentle in the discharging of patients, or perhaps patients and their families in higher-income deciles are harder to convince that the patients can complete their recovery at home. Either way, it is unsatisfactory that those who have just been taken ill must wait so long and in such unsatisfactory conditions for proper treatment and care. The hospital needs to rethink its priorities.

All departments of all hospitals, at times like this, need to be strict about bed occupancy. The load that emergency departments are carrying needs to be spread, as Dr Parke's article suggested, with the side-rooms, day-rooms and treatment rooms of any ward turned over to accommodate a winter rush of respiratory illnesses and the like.

Hospital emergency units are not favoured in public health priorities at present. Primary care is receiving extra funds for the purpose of keeping people out of hospital, and in emergencies people are encouraged to seek help from primary care providers, which are liable to charge a fee. But in areas with a rapidly growing and ageing population such as North Shore, the pressure on public hospitals warrants a fairer share of the health budget.

Social statistics such as income and employment levels are the roughest of guides to health needs. Winter viruses and infections do not respect health district boundaries. North Shore seems to be getting a poor deal.

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