Middlemore Hospital report: Hospital wait time issues are systemic, say healthcare specialists

Emergency care specialists are warning that the issues identified in a damning report into Middlemore Hospital’s ED are symptomatic of the entire health system.

The review found only half of all patients at the emergency department were seen within six hours, describing it as “dysfunctional, overcrowded and unsafe”.

It followed the June death of a woman who left the department because of delays in being seen.

Australasian College for Emergency Medicine (ACEM) spokesperson Dr John Bonning told Morning Report the ED at Middlemore was the busiest in the country, but the problems seen there were mirrored in other hospitals across both New Zealand and Australia.

“This is absolutely mirrored right across the board - not with quite the numbers that Middlemore sees, but full waiting rooms, full beds, patients in corridors, ramped ambulances, patients that can’t even get out of the ambulance because of no physical space, full hospitals; this is right across the entire motu.”

Bonning said the wait-time crisis was the worst he’d seen in his career.

“The graphs and the pictures of the amount of time people wait in emergency departments is quite stark. [In] 2015 we were performing really, really well, and it’s just gone absolutely to pot, one could say, since then.”

He said the “horrible tragedy” of the woman’s death after she left Middlemore’s ED occurred on a day that wasn’t out of the ordinary with regard to the number of people waiting to be seen.

Australasian College for Emergency Medicine spokesperson Dr John Bonning says the hospital wait-time crisis is the worst he's seen in his career. Photo / Supplied

“The number of people that turn up to emergency departments has been going up consistently year-on-year for decades.

“The crowding that we’re experiencing is entirely predictable, it’s not some sort of post-pandemic blip.”

The issues hospitals were facing were not isolated and would require “system-wide solutions” to address, Bonning said.

“It’s multi-factorial, it’s across the health system from primary care, through hospital, back out into the community as well.”

Royal College of Urgent Care co-founder, and White Cross director of urgent care Dr Alistair Sullivan agreed, telling Morning Report the overcrowding in EDs was also being seen in other parts of the health sector.

“It comes as no surprise to me and many doctors working in the community, both in general practice and in primary care, that our ED colleagues are struggling with volume, because we’ve got exactly the same situation in the community,” he said.

“We’re seeing enormous workforce shortages both in doctors and nurses; we’re still seeing the effects of our infection control processes slowing staff down in terms of efficiency - that’s leading to long waits both in-hours and after-hours.”

Sullivan said more needed to be done to address workforce shortages, both by training additional doctors and nurses in the country and by making it easier for overseas-trained healthcare professionals to work in New Zealand.

Pay rates for healthcare workers also needed to increase, he said.

“It’s no wonder they don’t want to work in challenging situations with major pressure after hours and overnight, in the current conditions.”

Bonning said reducing hospital occupancy rates and investing in the health workforce and in health infrastructure was also critical.

“There does need to be more money given to health; we’re very, very low on the OECD average in terms of health spend.”

While the most visible problem was in EDs, solutions lay across the rest of the system, he said.

“We need some increase in size in EDs but it’s the hospital that needs to have more beds, more staff, so we can move patients through; it’s the patients that are the sickest ones, the ones that need admission, they’re the ones we need to move through.”

Bonning said the college would be in favour of targets being reintroduced to ensure patients were seen within a particular timeframe.

“We think that they would be part of a good solution in terms of having the whole system think about how to deal with acute emergency patients.”

‘There have been major problems’ - Minister of Health

Health Minister Andrew Little acknowledged the health system was under “extraordinary pressure” but told Morning Report it was also providing people with the care they needed.

“We have a system that, every day, is providing the healthcare needs of literally thousands and thousands of people.”

Resourcing for the sector had increased by about 45 per cent under this government, he said, and a $7 billion building programme was now underway.

“We know that there have been major problems with the health system, that’s why we’ve had to add resources.”

Addressing the Middlemore report, Little said a target to have patients treated, discharged or admitted within six hours of arriving at an ED hadn’t been met there “for some time” but wasn’t able to say whether any other hospitals were meeting those targets.

“It’s a performance measure that has been deteriorating over time.”

Tackling the sector’s ongoing workforce shortage - both in the public and the private system - was the “critical issue”, he said.

“We are in a world health market that is about two million short of what it needs to be according to the World Health Organisation; those are the circumstances in which we are trying to recruit to fill the vacancies that we’ve got.”

He said Te Whatu Ora would be engaging with the healthcare workforce to do all it could to help increase staff numbers.

“Any idea, that will give us the ability to fill the roles that we’re funding at the moment but are sitting vacant, that’s going to be the critical thing that we have to do.”