Hospitals have hit "a level of panic" with 71 patients waiting for beds at Middlemore's emergency department in one night and warnings from doctors that delays will lead to deaths.
Top emergency doctor John Bonning told the Herald hospitals across the country were seeing "record-level delays and record-numbers of patients".
"Middlemore Hospital saw its biggest day ever" on Tuesday night, he said.
Emails leaked to the Herald from a different doctor showed the South Auckland ED saw more than 420 patients for the second night in a row this week, normally they see 300, shifting the hospital to code red, which the doctor said basically meant "a level of panic".
Bonning said it was time for Health Minister Andrew Little to show leadership and he had advised him to reintroduce hospital wait time targets.
"A patient that arrives in an emergency department with a 10 per cent access block, which means if you have 100 patients and 10 have been there for longer than eight hours, then they have a 10 per cent greater chance of dying over the next seven days," Bonning said.
"There is a very real impact for people waiting."
The unnamed doctor said the minister needed to acknowledge the country was in a hospital crisis and staff needed to be paid better so they aren't forced to leave the profession they love.
Little told the Herald while hospitals were under pressure, "as they were every winter", they were coping.
"A few months ago hospitals were preparing for a flu season that was expected to be bigger than the last two years and for that reason they expected to get planned care right down, most hospitals have been able to do that," he said.
The Minister said he had not seen any data showing hospitals were reaching record levels of delays and patient presentations.
"It would be interesting if he (Bonning) did provide it, because he is known to say things like that without backing it up with data."
He said he would not reintroduce ED wait time targets as previously it meant DHBs manipulated the system which meant lots of patients had a negative experience because they weren't allowed into the ED if they had already met the threshold.
"Previously hospitals were punished if they didn't meet targets and all that did was deprive them of resources, now we use those measures to understand what is happening and then intervene with management resources, for example [...] more resources to stop bed block."
The doctors' warnings came after the Herald was leaked an email that was sent by Counties Manukau District Health Board management to staff on Wednesday morning saying "the hospital remained at red with a full hospital, ED and 71 patients awaiting a bed".
"Staffing for the afternoon and night is looking critical [...] overnight the hospital was on bypass to North Shore Hospital for a few hours which was very helpful. Both Waitakere and ADHB were under similar pressure to us," the email said.
The doctor who leaked the email asked not to be identified as staff were sent a "stern email from the chief medical officer" after a previous Herald story about a woman with typhoid fever being forced to sleep in her vehicle at Middlemore Hospital's car park due to bed shortages. But the doctor said pressure on hospitals was "extremely concerning".
"I think red is like the level of panic basically [...] every time you deviate from optimal timely care, you increase risk of complications occurring from delays, and that includes patient death," he said.
The doctor said hospitals operating above full capacity also meant doctors seeing patients had to rush and may miss things, "everything about their care slows down".
"You might not get started on treatment in time, tests or scans might not be done on time, you might stay longer in hospital put you at risk of infections or other complications, the doctors don't have time to explain anything to the patient or their families," the doctor said.
"Doctors are ward rounding until 7-8pm (from 8am) which is terrifying. Ward rounds should be over before lunch."
Bonning echoed the unnamed doctor's comments, adding "the problem is not just patients who should see their GP, it's the really sick patients who need to be admitted."
He said the massive influx was caused by a combination of factors.
"Each year demand is going up 3 to 4 per cent based on population growth (without more hospital resource), winter illness is worse this year because we have not been exposed to influenza virus for two years so people are sicker, Covid is not the cause but it's adding to the stress, departments are having to be rearranging and workforce is the top issue ... we've had sways of nursing resignations across the system and staff illnesses," Bonning said.
"It's (the problem) manifested in emergency departments but it's right across the whole system."
Bonning said those numbers at Middlemore Hospital were repeated across the country.
"I'm aware of smaller hospitals struggling, Wellington, Palmerston North, Dunedin, Southern has gone into code black, which generally means hospitals have hit crisis point."
Bonning said: "It's the worst winter ever and we are only a few days in, and it's a pretty mild winter to be honest."
"People are waiting six, seven, eight hours just to be seen by a doctor in ED. We pick out the sickest one and we triage people, people go into resuscitation rooms etc etc but people are waiting in corridors."
Counties Manukau Health Acting CEO Dr Pete Watson said Middlemore Hospital was under "abnormally high" pressure for this time of year with both high occupancy and high patient presentations to ED.
"Middlemore's Emergency Department presentations last week were 17 per cent higher than last year, and we have seen a significant increase in flu and respiratory illnesses," Watson said.
He said they were expecting a challenging winter season and were underway with recruiting additional workforce and the coordination of patients across the region would help them manage the increase in demand for their services.
"We are at capacity and we expect this to continue over the winter months [...] Anyone in our community who needs emergency medical care in the Counties Manukau Health region will receive it," Watson said.
Auckland DHB director of patient management services Alex Pimm said their hospitals were very busy with many people presenting with acute respiratory illnesses.
"While this is not unexpected coming into winter, we've started seeing the impact of winter respiratory illnesses earlier than usual."
Pimm said presentations to the adult ED each day on average in May compared to April increased by 7 per cent.
"Overall, we're also seeing more complex cases presenting to our emergency departments. We acknowledge that at times there can be longer waits than we would like to see and are conscious of the impact this has on patients and their whānau."
Auckland DHB was planning for challenging winter which included postponing planned procedures when hospitals were very busy to ensure we have sufficient capacity for acutely unwell patients.
"We never take the decision to postpone planned procedures or surgeries lightly," Pimm said.
DHBs wanted to encourage everyone to get their flu vaccine this year to help protect against four different strains of the virus and reduce the need for hospitalisation.
Flu vaccines are free for Māori and Pacific aged 55 and over, everyone 65 and over, pregnant women and those with certain underlying health conditions.
Waitematā DHB sent the Herald a statement saying Waitakere Hospital was busy but it was expected at this time of year and they had good systems in place to manage surges.
"Sometimes we have large groups of people presenting at our Emergency Departments however, the safety of our patients and all staff is paramount. The public can be confident that people requiring hospital-level care or other health services will always receive the right level of support," the statement said.