GUEST BLOG: Ian Powell – The cruelty of health professional staffing shortages

In this powerful guest blog, health commentator Ian Powell argues the real human cost of New Zealand’s health staffing crisis is being measured in avoidable deaths, shattered whānau and exhausted frontline workers pushed beyond safe limits.

I suffer from an addiction – to crime dramas and novels, particularly those involving murder.

One of the themes is that as bad as murders of anyone are, it is so much more emotionally stressful for those investigating when they involve children.

But this additional distress is not confined to fiction. It is also reportedly and unsurprisingly the same for the police in real life.

In fact, distress goes beyond the police. Even though it was around four decades ago, I can still recall an experienced forensic pathologist describing the permanent emotional damage inflicted on him when investigating a horrific child murder in the Hutt Valley.

While nowhere in the same league as murders, avoidable children’s deaths (and harm) in Aotearoa New Zealand causes similarly considerable distress for our health system’s dedicated health professionals.

Avoidable baby deaths and near misses

My fiction and non-fiction recollections came back to me while reading the disturbing revelations by Stuff journalist Nicholas Jones on 29 April: Baby deaths a national tragedy.

Under the eye-catching heading Staffing shortages being linked to baby deaths in NZ hospitals a ‘national tragedy’, Jones reported the New Zealand Nurses Organisation (NZNO) concluding that maternity staffing problems linked to the deaths of babies were “a national and avoidable tragedy”.

The article followed earlier Stuff reporting (links included in article) of findings by the Coroner and Health & Disability Commissioner (HDC) for births in hospitals and maternity centres since 2016.

These findings revealed 11 cases where a baby was born stillborn or died soon after birth where subsequent investigations linked them to staffing shortages.

These shortages were also linked to five other cases in which “…the babies survived, but had to be resuscitated and suffered lifelong injury and disability, including from brain damage and stroke.”

How are staffing shortages harming patients?

Jones reports a coroner concluding in a finding on the death of a newborn girl in 2021 who was born unresponsive because of a brain injury sustained about 18 hours before her birth, possibly from a compression of the umbilical cord, and died later that day.

In the coroner’s words:

I am gravely concerned by the resourcing and systems issues highlighted during the course of this inquiry.

Further:

An acute shortage of midwives … meant there were not enough midwives available to provide care to the women who were in labour or to support the timely transfer of women from the assessment unit to the delivery unit.

The midwives on duty were short-staffed, working long hours in demanding roles, and unable to take any breaks.

Why is the health system failing frontline staff?

Jones makes the valid point that these avoidable deaths and near-misses are highly likely to be an undercount because:

…the HDC needs a complaint to be made and takes years to make findings, meaning cases from at least the past 2-3 years won’t have surfaced.

Coroner investigations can have a similar lag time, don’t cover stillbirths and they are only notified about a minority of baby deaths.

Every parents worst fear

NZNO was quick in cutting to the chase describing these cases as “utter tragedies and every parent’s worst fear”.

NZNO Kaiwhakahaere (‘one who manages or directs’) and midwife Kerri Nuku commented:

These whānau may have had different outcomes if these hospitals were safely and properly staffed.

This analysis also noted the pressure on staff, and I would like to acknowledge the mental toll these events would have had on them.

… every government makes a decision about the levels of funding they provide for the public health system.

It is time for Te Whatu Ora [Health New Zealand] to implement urgent safe midwife-to-patient, and nurse-to-patient ratios. Healthcare funding must be based on patient need not arbitrary budgets.

These deaths are utter tragedies and every parent’s worst fear. The birth of a baby should be one of the happiest times in your life. My heart and condolences are with each and every whānau that lost a baby … the grief that these mothers endure is tragically life changing.

An indictment of health system leadership

Kerri Nuku, as reported by Nicholas Jones, says it all really. These undercounted avoidable deaths and near misses are an indictment of the leadership of our health system, both politically and organisationally.

They are at the gut-wrenching heart of the most distressing impact of widespread health professional shortages on patients and their close ones across the full spectrum of healthcare.

Health professionals (including their unions such as NZNO) are doing their bit to expose the risks of harm to, and death of, patients due to in part or primarily these neglected workforce shortages.

So likewise are health journalists like Nicholas Jones to name just one of several who could be similarly identified.

Isn’t about time the Government and Health New Zealand reciprocated? A rhetorical question no doubt but one that deserves to be both asked and answered.

The medical profession is required to adhere to the Hippocratic Oath, particularly ‘first do no harm’. Isn’t it also about time for them to do likewise?