Length of patient stay, overstretched staff and mental health resourcing are some of the biggest challenges facing the Northland District Health Board, according to its chief medical officer.
Dr Mike Roberts, who has been in the role since 2012, says these issues are key inhibitors to improving quality of care and notes a lack of funding has held the NDHB back from solving them.
His comments came after last week's DHB board meeting when two reports were discussed from the Health Round Table, a non-profit collaborative organisation of health services across Australia, New Zealand and Abu Dhabi.
The reports, released quarterly, compared the performance of similar-sized hospitals through a series of factors and statistics, and were two of the NDHB's primary data sets which informed the development of its healthcare strategies.
The Australian National Standards (ANS) report analysed data from across Northland's hospitals in the last year, relating to seven standards including clinical governance, comprehensive care and communicating for safety.
The Hospital-Acquired Complications report (HAC) evaluated the rate of 16 complications per 10,000 episodes at Whangārei Hospital in 2019, such as the rate of cardiac, surgical and respiratory complications.
Speaking to the Northern Advocate , Roberts went through both reports and explained what they showed worked well and what worked poorly in Northland's healthcare system.
In the HAC report, the rates of cardiac surgical and respiratory complications per 10,000 episodes in Whangārei Hospital for 2019 were all lower than for similar-sized hospitals.
The rate of respiratory complications (chest infections) was almost half for Whangārei Hospital (10.3 per 10,000 people) compared with similar hospitals (20.1 per 10,000 people).
Roberts said this was a good marker for quality of healthcare, particularly in a region like Northland.
"It's especially good because one of the challenges for Northland is that the population here is, on average, a lot sicker than most populations in New Zealand."
Roberts also highlighted the rate of venous thromboembolism (blood clots), which occurred at a rate of 3.6 per 10,000 people versus 6.1 per 10,000 in similar hospitals.
Roberts said the DHB had prioritised this issue in a campaign a few years ago which focused on better risk assessment and treatment of patients with blood clots - something he saw reflected in the data.
"That [campaign] has worked and I think we are all quite proud of that."
While he noted the HAC report made for fairly encouraging reading, Roberts accepted the ANS report pointed to a number of pertinent issues for the NDHB.
Under the standard "Partnering with Consumers", both the proportion of formal complaints acknowledged in five days and formal complaints closed within 35 days was less across Northland hospitals when compared to similar-sized hospitals.
Another concerning conclusion from the report saw the NDHB's mental health 28-day readmission rate - the rate at which patients with mental health issues were readmitted into hospital within 28 days - at 34 per cent, over 20 per cent higher than similar-sized DHBs (13 per cent).
Roberts said mental health problems were very common in Northland and while the NDHB's readmission rate was impacted by a variety of factors, it pointed to a wider issue regarding funding.
"If you ask me about things that I'm not happy about at the hospital, the investment that we have available to us for our mental health services is not enough."
However, Roberts said his primary concern from the report referenced the Acute Relative Stay Index (RSI) - the length of time a patient stayed in hospital - which was seven per cent longer for Northland's hospitals when compared with those of a similar size.
While this figure had decreased by six per cent in the last six months, Roberts said this indicated an inefficient flow of patients through the NDHB's hospitals, which could have a range of serious health implications - particularly for older people.
"Obviously they are exposed to other infections. For older people, they get 'deconditioned', lying in bed not doing anything," he said.
"Even an extra two or three days can make a difference, a big difference, to how an elderly, frail person manages when they get home."
Roberts said the NDHB's ability to accelerate the rate of patient discharge was severely hindered by not having a Medical Assessment Unit in Northland.
A Medical Assessment Unit (MAU) was a facility inside a hospital where patients were seen in a more intensive and efficient fashion than on the wards.
According to Roberts, every similar-sized New Zealand hospital, compared with Whangārei, had a MAU and the NDHB had been petitioning for one to be built since 2012.
Given a patient in the MAU would be seen sooner and more often by clinical staff - and therefore more likely to be discharged within 24 hours of arrival, Roberts was confident this resource would improve RSI rates.
"When I see these lengths of stay, I know that if we had a MAU, they would be better, there's just no two ways about it."
After multiple promises of MAU funding in the past, Roberts said such a unit would likely come in the next two to three years as part of the new hospital set to replace Whangārei Hospital in about seven years.
However, Roberts emphasised the necessity of other methods to shorten RSI, which included simple measures such as telling a patient when they were likely to be discharged.
"If you say to somebody, 'You can go home at 10am today', and they weren't expecting it, quite often, especially if they live far away from the hospital, they won't have anyone to come and get them," he said.
"If we'd told them three days beforehand that, 'You're going to be going home on Friday', then they might have organised that."
While he said there was no reason why these measures couldn't be implemented, Roberts said issues concerning efficiency would always be hard to resolve without key resources like a MAU.
"There's no question, the hospital is stretched," he said.
"We haven't been as well-funded as we should have been, so we have a hospital which is stretched in terms of capacity for people who are sick and in terms of staff having to work bloody hard."
Roberts said the problem, which worsened during winter, was a crucial one to solve for the sake of future patients and staff members.
"If you went down to the emergency department today and asked them, 'How many of you have had a lunch break today', you probably wouldn't find anybody.
"That's not right, that's not good for staff and that's not good for patients."