GUEST BLOG: Ian Powell – A microscopic view that highlights worsening crisis in public hospitals

There are occasions when a crisis in a particular hospital department provides a microscopic insight into the wider crisis across all of Aotearoa New Zealand’s acute public hospitals.

One such occasion was an article by experienced Stuff journalist Janine Rankin published in the Manawatu Standard on 18 July: Orthopaedic department nears breaking point.

Journalist Janine Rankin focuses on orthopaedic department about to crumble

The focus of her article is centres on recently retired and respected orthopaedic surgeon (and head of department) Dr Geoff Anderson at Palmerston North Hospital concerns that the department “nears breaking point” and “about to crumble”.

This follows the recently reported collapse of the hospital’s gastroenterology department.

A department in crisis

Janine Rankin reports that:

Anderson said he was speaking up on behalf of colleagues remaining in the department who were worried about being ignored or harassed if they complained.

Anderson said three current surgeons were working limited hours, did not do acute or on-call surgeries, and would be retiring in the next six months. Another four were also part-time.

There were four recently-appointed overseas trained surgeons still settling in to New Zealand. Two of them were resigning. Another surgeon was suspected to be job hunting.

Anderson said job satisfaction was low, as surgeons and other staff did not have the capacity to treat everyone needing their help.

Further:

People waiting for elective surgeries such as hip and knee replacements were often being “bumped off” theatre lists several times.

In response to Health New Zealand claims that more than 90% of people on the list were receiving care within 120 days, the average wait was 65 days, and the longest wait was 266 days, Anderson observed that:

…those figures masked the real problem – the people who would benefit from surgery but could not get on the list at all.

Instead he said the orthopaedic department had received more than 5,000 referrals in the past 12 months and that:

Well less than half even get an outpatient appointment let alone get onto a surgical waiting list.

And:

Before he retired he said he spent a discouraging amount of his time reading GP referral letters, and having to turn people away.

In Anderson’s own words:

I was spending one day a week telling people I could not treat them.

Geoff Anderson was also critical of the conditions his former department had to work in:

It is fragmented and not user-friendly. The plaster room is tiny. There is no privacy for dictating medical notes. There are not enough hand basins. Patients are getting lost going to x-ray or are not waiting and have gone home…the cramped conditions were having a dreadful effect on morale.

Orthopaedic surgeon Geoff Anderson: no longer a dedicated orthopaedic ward

It gets even worse. According to Anderson:

Another issue worrying surgeons was that the hospital no longer provided a dedicated orthopaedic ward.

That meant people fresh out of surgery on their bones were put at higher risk of post-surgical infection as they were sharing space with medical and other surgical patients.

Sad reality

The sad reality is that with a little give-and-take and allowing for some nuances and differences in circumstances, the situation confronting Palmerston North’s orthopaedic department can be more or less found in almost all departments in all acute public hospitals in New Zealand.

This conclusion is reinforced in the article by Newsroom journalist Amanda Gillies (31 July): Public hospitals descending into crisis.

All public hospitals in further descending crisis (Stuff)

Her article focuses on headlines in public hospitals during the month of July as a lead into a Radio New Zealand The Detail podcast on this subject. Gillies includes:

• a patient dies after collapsing in a hospital waiting room toilet;
• a patient slips in the shower while trying to squash cockroaches, and with fleas reported nearby:
• critical IT systems fail forcing staff back to pen and paper;
• hospital buildings fall into disrepair with leaking roofs, mould, failing lights, and wet, crackling electrical sockets;
• a hospital left with no permanent gastroenterology specialists after the last one departed;
• plans to pitch a tent outside an emergency department as corridors fill up with patients in beds;
• long waiting lists;
• chronic understaffing; and
• exhausted frontline workers.

My only disagreement with the article is that our public hospitals are not descending into crisis. They have been in a state of crisis for some years. Rather they are descending further into crisis.

Health system leadership on different page

What makes the situation more difficult is that the leaders of the health system, political and managerial, are in a state of denial.

Message to Simeon Brown: Patients need a health minister who is on the same page as those at the clinical frontline

They are at odds with fatigued and burnt-out health professionals for whom this continuing descent is their daily grind. Public hospitals will not get out of this crisis until this leadership gets on the same page as its health professional workforce.

Geoff Anderson has not only lifted the rock off an appalling situation in his own department that he played such an important role in making a previous success story.

He has lifted the rock off the wider continuing descent into further crisis throughout all public hospitals. Learning the lesson that flows from this is long overdue.