Taupō Hospital clinicians drafted an emergency closure plan amid dire staff gaps. Photo / RNZ
By Jimmy Ellingham of RNZ
Contingency measures drawn up by concerned Taupō Hospital clinicians include plans to move patients to Rotorua Hospital if staff shortages force Taupō’s clinic to close.
The hospital, which serves a population of 40,000 people in the tourist region, has struggled to attract enough senior doctors to fill its roster, which forced workers to plan for the worst.
The hospital relies on locums (temporary staff) to fill gaps, and permanent staff take on a high portion of night and weekend work.
There are 3.3 fulltime-equivalent senior doctors working there permanently, out of nine funded positions to staff the emergency department and general ward.
Overnight, one senior doctor is on duty to take care of the department and ward.
RNZ has obtained a copy of the Escalation and Closure Plan for Taupō Hospital, which outlines what could happen if the hospital were forced to shut down because of not finding enough staff.
No closures have happened, and Health New Zealand Te Whatu Ora’s top manager for the area, regional deputy chief executive Cath Cronin, has told RNZ she wouldn’t allow this and was instead focused on keeping the hospital open.
But closures aren’t unprecedented. Last year, Westport’s hospital shut its doors several times because of short staffing.
The plan’s introduction outlines the gravity of a closure: “Temporary closure of Taupō Hospital poses a potential risk to the population and, as such, Health NZ Lakes has a responsibility for managing the risk with a contingency plan, to safeguard the public to the best of its ability.”
The document said its purpose was to set out an agreed process when there weren’t enough senior doctors to staff the hospital’s emergency department.
It said authority to consent to a closure sat with the regional deputy chief executive – Cronin – and “every possible option for covering vacant roster shifts must be exhausted” before the plan was put into action.
If closure were required, contingency measures would swing into action three days before the unstaffed shift, allowing time to tell the public and other affected parties.
If the emergency department (ED) were to close, but some services continue, security would be stationed at the hospital entrance with a list of patients allowed inside.
A February memo from senior clinical staff to management outlined further details.
The senior staff cited upcoming vacancies and difficulties in getting locums.
“Consequently, we are unable to guarantee that the Taupō Hospital will be able to cover every shift in the ED or the inpatient ward. Therefore, we thought it prudent to have contingency options documented and agreed in advance, which could be employed if and when this situation arose.”
The memo described possible situations in which the plan would be enacted.
“Although none of these scenarios are considered acceptable under normal circumstances, we may be forced to implement one or more of them to ensure continuation of service provision,” it said.
Two scenarios involved using doctors from Rotorua to keep open Taupō’s general ward, or its ward and emergency department.
A third scenario suggested closing the Taupō general ward, which usually has about 15 patients.
“All inpatients requiring admission will be transferred to Rotorua, increasing the workload for Rotorua physicians and registrars/nurses.”
Option four was to use telehealth for emergency department patients.
Option five tabled closing the department, which sees an average of 50 patients a day.
This would also potentially involve telehealth, but otherwise, emergency cases would have to travel to Rotorua.
The memo said risks for this were: “No access to emergency care for Taupō-Turangi communities. No on-site clinician for ward. No on-site support for birthing unit.”
The sixth option was the status quo, with a reliance on locums. This was time-consuming to sort and expensive.
Emails released to RNZ show the hospital’s battle to find staff.
On May 15 last year, then clinical lead Jared Bayless said there were five emergency department shifts, including four overnight ones, unstaffed in the coming week.
Another email from Bayless, a month later, discussed juggling staff to cover vacancies during the week, which stretched the weekend roster thinly. There was concern that the hospital would have to operate at decreased capacity. Bayless subsequently informed emergency services about the possible staff shortfall.
In other messages, Bayless stated what would happen if staffing wasn’t found to cover all shifts, options that the Escalation and Closure Plan covered.
A draft memo to Cronin in October from Health NZ’s Lakes district group director of operations, Alan Wilson, again talked about the possibility of closure when staff couldn’t be found, and outlined the risks of this, including having to rely on an already under-pressure Rotorua Hospital.
The memo said $1.29 million was spent on locums for Taupō Hospital in 2023-24.
It recommended changing the staffing structure away from senior doctors working 24/7 and employing more doctors to allow for round-the-clock coverage.
Cronin found out about the memo from doctor unions and emailed them to say she had concerns about the issues at Taupō Hospital’s emergency department and how they’d been addressed.
“All discussions, planning or other communications regarding Taupō ED are now on hold.”
Cronin also emailed Wilson expressing her disappointment about the memo’s contents and that he let it happen.
“The proposed plan is not a direction I will endorse without further discussion, so don’t progress any further planning or discussions with the team.”
However, the Escalation and Closure Plan was circulated early this year in further emails.
Cronin told RNZ this week the Escalation and Closure Plan wasn’t an “active plan”.
“My approach is always to work on plans to keep hospitals open and EDs open,” she said.
“This wasn’t an approach that I endorsed. It got a life of its own, with the team wanting to do the right thing but not in quite the right way.
“When I found out about it, I did stop that approach to making a plan to close the ED, and instead we reconvened to work together on how we keep our ED open.”
Cronin said she’d never been asked to consider closure, as outlined in the plan, although it was challenging to fill shifts.
“But we always get there, one way or another,” she said. “We always manage to cover that. We haven’t had to close.
“We’ve got a particularly tough time in the next couple of months, not only in Taupō but across the whole country.
“We’re getting right into the middle of winter, with lots of sick leave, but everyone’s endeavouring to do what they can to maintain that access for patients.”
There were plenty of other mitigations before closure would even be considered, Cronin said.
“We take that week by week when we plan, then day by day, or shift by shift if we need to.”
Cronin said this year she met with Taupō’s medical staff weekly and would regularly check in with the lead clinician.
Asked about shifting patients to Rotorua if required, Cronin said moving patients to ensure they received the proper standard of care was something that happened nationwide.
This week, there were 4.7 fulltime-equivalent senior doctor vacancies in Taupō, which would drop to 2.7 in October when two staff members joined.
Two extra junior doctors had recently joined and one would soon start.
Another two were due by January, which left two vacancies.
Cronin said recruitment would focus on how Taupō was a great place to live and on the quality of the clinical team at the hospital.
Rural hospital medicine specialist Ralston D’Souza has just taken over as Taupō Hospital’s clinical lead.
He said the lack of permanent staffing at Taupō wasn’t new, and he and the other clinicians developed plans in response.
“It’s probably been known about for a couple of years,” D’Souza said.
“With that short staffing, there’s going to be gaps in the normal, everyday roster. So, as a group, we were trying to [say] to management: ‘Look, this is a risk to the organisation’.
“If permanent staff are unable to fill these gaps, if locums are unable to fill these shifts, we have to have a contingency plan on what we need to do.
“There’s a huge amount of people affected in the hospital and in the community if there’s no doctor in the hospital, so we wanted to get something on paper or get protocols in place if that were to occur because of the vulnerability of our workforce.”
D’Souza said additional junior doctors were welcome, although it would take some time until they were trained to fill overnight shifts, with their varied responsibilities.
But he was more hopeful than previously and he said Cronin was working closely with the hospital on staffing issues.
Clinicians, management and the community were working together to find solutions, D’Souza said.
Sarah Dalton, the executive director of the senior doctors’ union, the Association of Salaried Medical Specialists, said clinicians drawing up the Escalation and Closure Plan showed there weren’t enough doctors to staff the hospital.
“Between 40 to 50 per cent of their roster at any given time is filled either by locums or their employed staff being prevailed upon to do extra shifts, so do extra work for extra pay to keep the place open.”
She said the arrangements to fill the roster were “hand-to-mouth, subsistence stuff”.
Dalton criticised Health NZ for paying little attention to the wellbeing of permanent staff, while spending plenty on locums.
Patient Voice Aotearoa’s Malcolm Mulholland said the Escalation and Closure Plan showed how concerned clinicians were.
“It’s pretty confronting seeing that plans have been drafted to actually shut down one of our hospitals in New Zealand, and to know that it serves a community of 40,000 people or more.
“It’s extremely concerning.”
Mulholland said the advocacy group held a public meeting in Taupō earlier this year, where he heard from clinicians’ concerns about staff shortages and the prospect of patients transferring to Rotorua.
It was planning to hold a further public meeting in the town on July 30 at 6pm, at Taupō’s Hilltop School.
– RNZ