A patient is moved from the Covid-19 Red Zone to the Green Zone at St Vincent's Hospital Emergency Department in Sydney. Photo / Getty Images
A patient is moved from the Covid-19 Red Zone to the Green Zone at St Vincent's Hospital Emergency Department in Sydney. Photo / Getty Images
Opinion
OPINION:
We have an undeclared health workforce emergency in Aotearoa New Zealand, and it is the elephant in the room as we prepare for Omicron to explode into the community.
There has apparently been advanced planning and modelling to help hospitals cope with an expected spike in cases and staffabsences.
Unfortunately, doctors who are responsible for running clinical teams and leading patient care say information has not been well-shared on the ground, and there is a lot of anxiety about the weeks ahead.
In Victoria, there were more than 4000 healthcare workers who couldn't work because of Covid isolation requirements, with 5000 estimated absences every day on average. Health authorities took an unprecedented step of calling a system-wide "Code Brown" to manage a system buckling under severe staffing shortages and hospitalisation rates amid the Omicron outbreak.
Our system is buckling under business as usual. Due to years of underinvestment in the health workforce and a woeful lack of workforce planning, we have long-term shortages of nurses, allied health staff and hospital specialists. However, right now, doctors tell us they have never seen it so bad.
Emergency departments (EDs) are considered the safety net of a health system and will be the frontline of an acute Omicron outbreak, yet that safety net is already at breaking point.
Our EDs regularly operate at well over 120 per cent capacity and being desperately overstretched is unfortunately now the norm, not the exception. The number of code reds declared in hospitals last year, along with the issuing of health and safety PIN (provisional improvement notice) notices, are testament to that.
The situation was magnified over the holiday period with departments trying to manage exceedingly high patient volumes with even more barren rosters. Patients in some emergency rooms were left waiting up to eight hours just to be seen. Others spent hours in ambulance bays waiting to be triaged. Then there are those who didn't wait and left hospital without their health needs being met – many of whom were mental health patients. We are told seeing people sitting in ED corridors clutching their chest and looking unwell while waiting to be assessed is a common occurrence.
Congestion in emergency departments is compounded by staffing shortages on the wards and services everywhere are struggling to meet demand.
Sarah Dalton, executive director of the Association of Salaried Medical Specialists (ASMS). Photo / Supplied
Lack of adequate staffing means extremely limited or no ICU (intensive care unit) capacity in some regions. In one region with very high needs, one child psychiatrist is trying to cover the work of three. In Southland, maternity services are so precarious the hospital maternity unit almost had to be downgraded because a senior doctor was unable to get back into the country. In Canterbury late last year, ongoing staffing pressures saw cancer patients waiting up to 12 weeks just to get a first specialist appointment, while 365 patients were waiting for radiation therapy, with treatment delays of up to four months. Running a large waiting list is a direct consequence of an understaffed service operating above clinical capacity.
And good luck trying to get an appointment through the public system with a dermatologist or ear, nose and throat specialist. We simply do not have enough of these specialists and wait times are shamefully long.
We estimate that, per capita, to match Australia, New Zealand needs about 1500 more hospital specialists (private and public), 1400 GPs and 12,000 nurses. These are serious numbers.
An Omicron outbreak will underline just how unsustainable these staffing shortages are. New Zealanders will face more cancelled and delayed surgeries, resulting in an even bigger Covid backlog.
We need to declare a health workforce emergency along the lines of a civil defence emergency, to trigger official action on staff retention and recruitment and ensure it is prioritised at central government and regional hospital and community levels.
Part of that must be to look at ways to retain people through better pay and sustainable conditions of work.
A patient is moved from the Covid-19 Red Zone to the Green Zone at St Vincent's Hospital Emergency Department in Sydney. Photo / Getty Images
Against this backdrop of staffing pressure, it is beyond belief that senior doctors are being offered what amounts to a pay cut. They are expected to continue to go the extra mile and do more with less, while being offered no improvements in their working conditions or remuneration. DHBs and the Government are quick to say how much our health workers are valued, but we are seeing nothing tangible to back up that gratitude.
For too long we've made a virtue of understaffing our hospitals and made a priority of balancing inadequate budgets. Now the State Services Commission expects scarce and highly skilled hospital staff to put up and shut up – without even a CPI pay adjustment while the economy surges and inflation is pushing 5 per cent.
We are in the midst of an undeclared health workforce emergency, so looking after the people we do have must be paramount. If we don't, our valued and experienced health workers will vote with their feet.
• Sarah Dalton is executive director of the Association of Salaried Medical Specialists Toi Mata Hauora.
