GUEST BLOG: Ian Powell – Who should one believe over hospital safety concerns?

Who should one believe when concerns are raised openly about safety in New Zealand’s public hospitals? Both the safety of patients and the safety of hospital staff.

This question is highlighted in a 9 December Stuff and Dominion Post article by experienced locally based journalist Marty Sharpe on emergency department (ED) senior nurses at Hawke’s Bay Hospital which is the base hospital of the Hawke’s Bay District Health Board (one of 20 DHBs responsible for community and hospital care). The nurses describe the ED as being on the “verge of disaster:.

But this is not just about Hawke’s Bay as a medium-size DHB and its base hospital. Neither is it just about EDs as the front entrance of hospital care. To one degree or another the description of these experienced nurses serves as a litmus test for almost all departments and services in all public hospitals.

The senior nurses warning

The article is based on a three-page letter from all nine senior nurses at Hawke’s Bay’s emergency department sent to their managers “…warning that the department is hopelessly unprepared for Covid-19 and staff are leaving in droves”.

The letter is prompted by a level of desperation that led to the need to voice ongoing serious safety issues. The ED was losing experienced staff at an alarming rate. Workload and conditions were the driving force. Those leaving were experienced nurses; not inexperienced ‘newbies’.

Two months before sending the warning letter ED staff had issued Hawke’s Bay DHB with an official Provisional Improvement Notice under the Health and Safety at Work Act. This is a written notice issued by a recognised health and safety representative seeking the addressing of a health and safety concern in the workplace.

Issuing such a Notice is an unusual action to be taken in public hospitals. But increasing clinical desperation, arising out of the worsening impact of staff shortages along with facilities and equipment rundown, has seen it recently being used more by hospital services.

Unfortunately even this level of escalated action was not sufficient to resolve the plight. With the anticipated increasing pressures from Covid-19 on hospitals the senior nurses plead in their letter:

“We have seen what can happen, we have seen what is coming with dealing with Covid, and we are all scared, and ED, in our senior nurse opinion, is not Covid ready … We are going to be in charge of a sinking ship, and a department at risk … Our voices aren’t being heard.

“ED is broken, the flow from ED to wards is broken, we are not ready for Covid and we as senior nurses are warning you here and now that when sentinel events occur during this response … ED is in danger. ED needs you. Please help us.”

Not just a Hawke’s Bay crisis

This crisis is not a disaster that a single DHB can resolve on its own. Enduring solutions are not overnight ones. Invariably there is insufficient DHB autonomy to resolve them.

At best fingers can be put in dykes. Contrary to a common perception, DHBs are under a high degree of below-the radar central government control strengthened by sustained underfunding.

Successive governments have largely ignored the severe health professional shortages in DHBs and the consequential consequences of reduced accessibility and safety for patients along with workforce fatigue and burnout. This has been through the combination of underfunding and lack of commitment to specific workforce planning.

Although the Labour led government inherited this situation from the National led government it replaced in 2017, the need to turn it around has been neglectfully disregarded. Health restructuring has instead become its preoccupation (made even more irresponsible during an ongoing pandemic).

Toss a coin for where responsibility rests

The Labour government has turned a blind eye to the effects of severe shortages (around 24%) of hospital specialists, including very high burnout rates.

It has only started to respond to addressing nursing shortages in public hospitals because of an assertive public exposure campaign by the New Zealand Nurses Organisation which included high profile industrial action strongly supported by the public.

Who is responsible for this parlous state – the government responsible for causing it or the government that inherited but ignored it? Increasingly it comes down to tossing a coin is my advice.

Who to believe

The Government’s response to the increasing pressures on public hospitals, made worse by the pandemic, has been to deny or downplay them. It confidently claims that intensive care units have the capacity to cope with a virus driven patient admissions surge. The problem is that intensive care specialists and nurses strongly disagree.

So when Government downplays warnings about patient and staff safety who should we believe?.  The government and those acting on its behalf or the expertise, experience and professionalism of health professionals at the clinical front line, whether it be in an emergency department, intensive care unit, mental health, cancer treatment or any other hospital or community service.

This question is obviously rhetorical especially when the health professionals are voicing their concern collectively, as with the Hawke’s Bay senior nurses, or through their representative bodies.

Successive governments have woefully neglected patient and health professional safety in our public hospitals and continue to do so while focussing on business consultant-led health system restructuring.

The wider this discrepancy between governments and health professionals the more the public and professional credibility of the former decreases and the latter increases.

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion