Beds, budgets plague Auckland City Hospital

By MARTIN JOHNSTON, health reporter

The new Auckland City Hospital is struggling to cope with high patient numbers and the money-saving demands made on it.

The hospital and the new Greenlane Clinical Centre for outpatients and day-surgery, which together will cost $450 million when complete, have sparked a doubling of written complaints from patients.

The two facilities, which began to open in October, are meant to be contributing to savings of $40 million a year being reached by next year.

Instead, they have helped create a $9 million budget blow-out in the Auckland District Health Board's provider arm. Its July to December deficit was $16.2 million, compared with $7.2 million in the budget.

Officials say some services will continue to struggle in coming months.

The hospital has been swamped by unusually large numbers of patients for summer and has been dogged by problems in its instruments sterilisation unit.

Board chief operating officer Marek Stepniak said that after the New Year weekend, many staff wanted to close the hospital to new admissions as it was overloaded. Instead many patients were discharged, making room for 140 new ones.

"We have got enough beds," Mr Stepniak said, adding that some departments left patients in hospital too long.

The board is losing about 70 beds, but managers say this is compensated for by increases at other boards and more-efficient care of patients.

But senior doctors still say there are too few beds.

"Earlier discharge is just compounding the compromise in their care," said one, who declined to be named.

This was on top of the risks created by placing patients wherever there was a bed, rather than in the specialty ward for their particular illnesses.

Another doctor said his patients were now usually spread around six wards. "There's a real risk that patients will be missed on a ward round."

Mr Stepniak said many nurses were anxious about looking after patients outside their specialties and were not contacting the clinical nurse advisers who could help them plan patient care.

Doctors are also exasperated by the centralised sterile supply service, which sometimes delays operations for half an hour when an extra instrument is needed during surgery.

The specially stacked instrument trolleys have also been missing instruments or have contained mismatched equipment.

About 80 patients a month are sending written complaints, compared with about 40 before October. Among the complaints are having to wait four hours to see a doctor - and not seeing one at all.

Chief executive Garry Smith said the increase in complaints was to be expected because of the changes, but staff were learning from problems and fixing them.

A senior manager, Fiona Ritsma, attributed the increase to new systems.

"A lot of processes have not bedded down particularly well. There is a review of those going on."

She said staff were being encouraged to approach patients about delays and to explain the reasons, and told not to advise people simply to make a complaint if they were unhappy.