Patients are set to be discharged from hospitals more quickly this winter to recover safely at home in a bid to relieve pressure on emergency departments.
The New Zealand Nurses Organisation (NZNO) and the Association of Salaried Medical Specialists (ASMS) have cited serious concerns with the $25 million Health New Zealand Winter Plan released yesterday.
“When you’re running a winter plan based on doing things more quickly or doing less of something as opposed to providing more of something, that sends alarm bells to me in an already under-resourced, rationed system,” ASMS executive director Sarah Dalton said.
This plan comes after a record number of emergency patients were treated across the country’s hospitals last winter, with some treating twice the number of people they had beds for.
Figures covering a two-week period at the height of winter showed Wellington Hospital’s ED was at 223% capacity on one day, and most city EDs were regularly over capacity.
This winter, Health NZ Te Whatu Ora said it was working to strengthen and maintain safe, efficient hospital care, so more people could get the right healthcare when and where they need it.
Health NZ’s Winter Plan focused on four priority areas: preventing illness, strengthening primary and community care, improving patient flow within hospitals, and supporting safe patient transition home after discharge.
Steps being taken across the country include:
Health NZ clinical executive national director Dr Richard Sullivan said a key focus in the plan was preventing patients from becoming unwell.
He said this can be done through flu vaccinations and making early use of primary care.
“New Zealanders will see other ways to get help without going to the ED, including urgent care, telehealth and pharmacy services.
“There will also be more care options close to home or in the community,” he said.
Sullivan said if people do need hospital care, this will mean quicker movement through EDs, with staff available to assess patients sooner, and faster hospital testing and treatment due to increased staffing.
“Additional nursing and clinical staff will also be in place across the country, and there will be an increase in the number of beds available over winter,” he said.
NZNO told the Herald the plan was great in theory but not practical, with many district nurses already having “unsafe workloads”.
NZNO president Anne Daniels said the plan included “some helpful initiatives” but failed to address existing staffing issues that are “seriously undermining the standard of care in our hospitals”.
She said pushing services out into the community through the Hospital‑in‑the‑Home service in the Northern Region to alleviate hospital overcrowding was good in theory, but it could only work if sufficient resources were available.
“The greatest problem we have right now is chronic understaffing, and NZNO’s fear is that this will only intensify the problem we have where the quality of health services you receive depends on your postcode,” Daniels said.
She said discharging patients earlier who may require specialised hospital services and preventing hospital stays altogether could be risky for patients.
ASMS executive director Sarah Dalton questioned the plans to increase the number of senior doctors at ED entrances.
“I don’t know where they’re coming from ... in none of our meetings in the districts, like at the grassroots, are we getting any information to suggest that staffing levels are increasing,” she said.
Sullivan said Health NZ acknowledged the concerns and recognised the ongoing pressure on both patients and the health workforce.
He said the Winter Plan has been clinically endorsed, with funding deliberately directed to the most affected regions.
Each district’s group director of operations has also been involved in the development of their district’s respective plans.
“The plan includes an additional 378 FTE [fulltime equivalent] frontline health workers nationwide, including nurses, doctors, allied health professionals and support staff,” Sullivan said.
He said some roles are new and are being recruited for, and some are extensions of current FTE hours where capacity allows.
He said regions were asked to ensure all initiatives could be recruited for and operational in time to support the additional pressures winter brings.
“Progress will be closely monitored on a weekly basis, so any emerging issues can be identified early and responded to quickly.”