Seeing the things I do on a daily basis, it’s dismaying to be told New Zealand isn’t experiencing a healthcare crisis, writes emergency medicine specialist Dr Scott Orman.
I know I’m not the only frontline health worker to be utterly baffled and disheartened by the denials from officials, including the director general of health, that there is a crisis in our healthcare system.
The fact is, we are in the middle of an utterly unprecedented healthcare workforce crisis in New Zealand, and while the current government focus is mainly on Covid, the emergency situation we are facing predates the pandemic by some years.
Covid-19 is simply the latest boot in the ribs.
For many years demand on the healthcare system has been increasing. The population is getting larger, living longer, and has greater complexity of illness. Demand on acute systems is increasing out of proportion to population growth. Many medical treatments are becoming better, but they are also becoming more expensive. Meanwhile, healthcare funding has increased with time – but it has not been adequate to keep up with increasing demand. These issues have been occurring for years, and cannot be attributed to a single political party or government.
On the clinical frontline, long-term deficiencies in funding, investment and planning have led to ever-increasing deficits in necessary staffing levels, and healthcare being delivered in facilities that are frequently no longer fit for purpose.
In my practice setting in emergency medicine the crisis takes many forms, and I’m aware that the problems are the same nationwide. Patients marooned in ambulances for hours because they are unable to access a staffed clinical space in the hospital. Patients lying on beds in corridors with untreated pain and no staff available to assist them. Delays in assessment by medical staff and nursing staff that grossly exceed expected standards. Patients stuck in the emergency department because there are no staffed beds available on the hospital wards. Mental health patients waiting up to three days in the emergency department for staffed inpatient beds to become available.
The risk to patients is extreme.
I am sure every other acute service in the healthcare system has its own equivalent markers of chronic system failure. Many team members in the healthcare sector feel burnt out, mistrustful, disillusioned, undervalued, and are struggling to deal with the moral injury of being unable to deliver safe care to their patients. This is clearly shown in the rolling wave of healthcare strikes that have occurred in recent years.
The problems described above are not new. They developed well before Covid-19 arrived in New Zealand.
The pandemic has placed further strain on an already struggling system. Delivering healthcare with Covid-19 has become even harder, more stressful, and more complex. Many staff have decided enough is enough and have resigned, with the result being further stress on those who remain. Nursing staffing shortfalls in particular are extreme. New Zealand has traditionally had a huge reliance on overseas-trained healthcare workers, and the inexplicable and inexcusable failure to prioritise and maintain the inflow of overseas healthcare workers when the borders closed in 2020 has hit the health sector hard.
The system is currently staying afloat through the desperate triage manoeuvre of cancelling a huge amount of planned care. This is absolutely necessary, but is not sustainable. Even with reductions in planned care the healthcare workforce is currently struggling to manage the combination of Covid-19 and “business as usual”.
While there will no doubt be a lot of well-deserved congratulatory back-patting when the omicron surge passes, the hardest times may yet be still to come. Covid-19 is not going to go away. We will have to live with it, and find ways to deliver healthcare with the threat of further surges still lurking around every corner. It is hard to see how the system will be able to safely reinstate the cancelled elements of healthcare with the current workforce limitations. Frontline staff are acutely aware of this, and there is a widespread perception that there is not a lot of light at the end of the tunnel.
Contrary to Ministry of Health messaging that suggests ICU beds are the only measure of capacity that matters, disruption to general healthcare is likely to be where the biggest risk to the New Zealand public lies going forward. For every person who dies of Covid-19 because they can’t access an ICU bed how many more will die (from non-Covid causes) a preventable death in the back of an ambulance, or in a corridor, because they can’t access normal care in an appropriate timeframe? How many people will die a preventable death due to delays in cancer diagnosis and treatment? How many will quietly deteriorate unnoticed in a corner of a hospital ward because nurse staffing numbers are inadequate to safely monitor them?
While access to staffed ICU beds is critically important – and very concerning given our ICU bed numbers per head of population are among the lowest in the OECD – problems in this area are dwarfed by the deficiencies across the rest of New Zealand’s healthcare system, and for two years now this has been largely ignored in the Ministry of Health’s daily information releases.
To have the director general of health and at least one government minister now declare the healthcare system is not in crisis raises extreme concerns about the accuracy of the government’s information, and its situational awareness. The current workforce deficiencies in our healthcare system represent a unprecedented crisis. It will take us years to recover from this, if we recover at all. There is a huge risk of “normalisation of deviance”, where we simply grow to accept that a decompensated, unsafe, understaffed healthcare system is normal and acceptable.
As always in healthcare, the next step is to recognise and declare an emergency. We can’t fix problems unless we acknowledge them for what they are, and this requires our leaders to tell it like it is.