Ian Powell – Public hospitals were already overflowing before winter flu outbreak

With all the extensive media coverage one could not be blamed for attributing the current winter flu outbreak, which started to peak in late August, to the disastrous situation facing our overstretched and overflowing public hospitals.

There is no doubt that this year’s winter flu outbreak has led to a big increase in severe respiratory illness rates which, in turn, has impacted on hospital overflowing.

It is unfortunate that there was not an earlier higher profile public campaign vigorously promoting the importance of influenza vaccinations and warning of the severe risks for those not vaccinated, especially children.

It is good that the Government has recently made vaccines free for all children under five years. This should be acknowledged.

Nevertheless it is unfortunate, especially given the level of economic distress many families now find themselves in, that this decision was not made much earlier and extended for older children.

It is also unfortunate that the Government has not learnt from the Covid-19 pandemic experience and developed an alert system specific to influenza.

Good investigative journalism

However, despite the understandable above-mentioned attribution, thanks to good investigative journalism by Radio New Zealand, it is clear that winter flu is not the driver of overflowing public hospitals.

Hospitals were already severely overcrowded before the outbreak peaked. Winter flu is simply an accelerator.

RNZ journalist Rowan Quinn gets to the truth of overflowing public hospitals

Rowan Quinn is a senior journalist for Radio New Zealand who has covered many health stories for some years.

On 9 September Morning Report covered her investigation into hospital overflowing data: Hospitals overflowing well before flu cases peaked.

Quinn had successfully requested data on hospital occupancy from Health New Zealand/Te Whatu Ora although this was delayed because the organisation required her to use the Official Information Act; a longer process.

The data itself was in the form of a snapshot of the occupancy rates over eight days (excluding weekends) from early to mid-August in eight specified hospitals.

It showed that most had more patients than staffed beds. This would have been no surprise to those doctors and nurses who worked in these hospitals.

What the data analysis revealed

Christchurch Hospital was the worst hit by overflowing (RNZ)

Rowan Quinn’s key points from her data analysis were:

1. Christchurch Hospital was worst hit  with nearly a fifth more patients than beds most days.
2. Whangārei Hospital was usually at about 110% capacity.
3. Waikato Hospital was just under 110%.
4. Auckland and Wellington Hospitals were regularly over 100%.
5. North Shore and Waitākere Hospitals were between 103 and 93%.
6. Dunedin Hospital was the only one of the eight hospitals that never hit 100 percent.

Over the period covered by the snapshot flu hospitalisations were increasing but, since then, grew to record numbers forcing many hospitals to cut planned (non-acute; elective) surgical operations and set up dedicated flu wards.

The reality of hospital overflowing

The reality is that our public hospitals have been hit by overflowing at least since 2011. That was when a tipping point was reached; the rate of acute hospital discharges was greater than the rate of population growth.

More and more hospitals were increasingly both reporting 100% or more occupancy and more often.

Compounding this problem were the continuing widespread severe workforce shortages affecting almost all health professional occupations in public hospitals.

‘Bed-blocking’ is less to do with the number of beds and much more to do with the number of doctors and nurses to staff them.

‘Bed-blocking’ crisis caused by hospital overflowing

This above-mentioned tipping point of increasing acute demand meant that emergency departments started to become overwhelmed and ‘bed-blocking’ in hospital wards began with acute patients having to take priority over non-acute patients requiring planned procedures.

An additional casualty was the hospital-based health targets of the time, such as the six hour emergency department target (in reality a hospital-wide target); ‘bed-blocking’ prevented patients from being transferred into hospital wards.

What can be done about rising acute demand

Increasing acute demand has plagued public hospitals for over a decade and a half

So what drives increasing acute patient demand. In the past I have identified three key factors:

1. Population growth.
2. Population ageing.
3. Increased and entrenched impoverishment of people.

To this could be added a fourth factor (or alternatively a subset of the second above) – people are living longer.

Prime Minister Christopher Luxon’s coalition government is not providing the political leadership to address overflowing hospitals

The health system in general and public hospitals in particular can do nothing about the first two above factors; nor the fourth! But something practical could and should be done about how to cope with these pressures better and more safely.

This begins with the need for both recognition of the severe workforce shortages crisis and the development of occupational specific tangible strategies to address these shortages.

What this requires is political leadership and political will which, so far, are sadly lacking and there is no sign of either under the current coalition government.

Social determinants of health are external to the health system but drive health demand

Political leadership can address the third above factor, however. Addressing poverty requires addressing the external social determinants of health, such as low incomes, educational opportunities and housing, which are the biggest driver of health demand and cost.

But this requires legislative and government policy measures. Only empathetic and competent political leadership can do this.

Failure to provide this leadership simply dumps the harmful consequences on patients (personal harm, even death) and health professionals (fatigue and burnout) struggling with their overflowing hospitals.