Hospital patients are being held in overflow rooms while they wait for treatment and ambulances are being diverted as under-pressure emergency departments in Auckland - one apparently at 195 per cent capacity - struggle to cope.
Doctors and nurses have raised concerns about the winter ahead given this is usually a quieter season for patient numbers.
At Auckland City Hospital, ambulance workers stepped in to care for patients on Sunday and Monday because emergency department (ED) beds were not available. Visitors said several dozen patients had been placed in a cafe on the same floor as the ED while they waited for treatment.
Te Whatu Ora New Zealand said the space was not a cafe but was sometimes used as a lunch room or a backup space in case of mass injuries - such as after a natural disaster or plane crash.
A frontline staff member at another hospital, who did not want to be identified, claimed ambulances were diverted from Auckland and Middlemore hospitals on Monday because the EDs were full, and patients went to North Shore Hospital instead.
Te Whatu Ora Health New Zealand confirmed that six ambulances were diverted to other hospitals on Monday, saying it was a “rare occurrence” for Auckland City Hospital. Patients who required specialist care were still seen at the hospital and no one was turned away, the health agency said.
Other patients brought by ambulance faced delays in being seen, and had to be cared for by St John staff until ED beds became available.
Peter Knight, from Auckland, took his wife to Auckland City Hospital on Monday because she had severe abdominal pains.
Staff were coping admirably, he said, but the department was clearly understaffed and overworked. One nurse said the ED was at 195 per cent capacity. St John workers were looking after patients in the corridors, he said.
“It was like a war zone and it was Monday afternoon in the off-season,” he said.
Te Whatu Ora interim lead for Te Toka Tumai Auckland, Dr Mike Shepherd, said that the ED had been particularly busy on Sunday and this had a flow-on effect on Monday in terms of capacity. Numbers had since settled, he said.
All metropolitan Auckland hospitals were co-ordinating to ensure resources were deployed and shared where needed, he said.
“We are also working together to improve our services and develop robust responses to increased demand as we head towards winter.”
Auckland and Middlemore hospitals have been identified by Te Whatu Ora as two of eight “hotspots”, which are expected to bear the most pressure during winter.
Emergency department doctor Dr Kate Allan, however, said these pressures were occurring across the whole country at all hospital EDs, and before winter had arrived.
“My sense is that the pressures within emergency departments are getting worse,” said Dr Allan, who is Aotearoa New Zealand chair of the Australasian College for Emergency Medicine.
“And it is not necessarily because our presentation numbers are getting worse. It’s more that the pressures within departments are much higher.
“Our patients are staying longer in the emergency department, meaning there is blockage happening there. It feels busier and it is busier for our teams on the floor, and patients are getting delayed care because of that.”
The most recent available data, from the first quarter of 2021/22, showed that 80 per cent of patients were being admitted, discharged or transferred from EDs nationwide within six hours. That was down from 90 per cent from a year earlier. At Auckland, the rate was 84 per cent and at Middlemore, 76 per cent. The national target is 95 per cent. More recent data is not available, but rates are believed to have deteriorated further since those figures were released.
Dr Allan said the problems being observed in EDs reflected pressures across the whole sector.
“If there is any bursting at the seams, it happens at our emergency departments. That is through backlogs from the hospital, and also backlogs from community into the hospital. It is an overwhelmed system.”
Te Whatu Ora’s identification of ED hotspots is part of a process to provide more resources to prepare hospitals for the winter period. These hospitals - which also include Whangārei, Tauranga, Palmerston North, Wellington, Christchurch and Invercargill - would get more resources and have systems to divert pressure into primary care.
New Zealand Nurses Organisation president Anne Daniels said the pressures on EDs in the warmer months meant members were extremely concerned about the winter season ahead.
“We’re in trouble right now,” she said. “It is not just a few hotspots that need dampening down, the entire nation is on fire. We’re in summer, apparently, and winter is coming.”
The health sector is moving from the district health board (DHB) model to a centralised system under Te Whatu Ora.
One of the aims of the reforms is to reduce duplication of roles across regions to allow more resources for frontline workers.
Representatives for GPs, hospital doctors, nurses and surgeons told the Herald that they were yet to notice a material difference since Te Whatu Ora was established in July.
The Government has stressed that the reforms would take time to bed in.
But there was concern about the urgency being shown in addressing chronic workplace shortages under the new system, and the level of resourcing for some sectors.
The reforms include a more collaborative model in which GPs, hospitals, and community services work more closely together to meet patients’ needs. That would allow, for example, a patient in hospital to be discharged into the community in the knowledge they would get good appropriate, ongoing care - and reduce hospital and ED backlogs.
General Practice NZ chairman Dr Bryan Betty said his sector was strongly in support of this approach, but was yet to notice any difference as a result of the reforms.
“There is an absolute will among GPs and practices to work collaboratively, but that needs to be funded and resourced,” Betty said.
“We’ve got a number of quite urgent problems in terms of workforce, funding, access and there’s a degree of uncertainty that still needs urgent attention.”