TV1’s ‘Close Up’ programme on 26 November featured a visiting emergency health expert, Dr David Mountain from Western Australia. He is both a senior lecturer, and a hands-on emergency specialist.
His well-researched message was sobering. We have a national problem with too few public hospital beds. The lack of ward beds is costing the country as many deaths a year as we suffer through the road toll.
In response, Geraint Martin, CEO of the Counties Manakau District Health Board, agreed on the programme that bed numbers hadn’t kept up with the population increase. Indeed they haven’t. As successive governments have sought to save money, the number of public hospital beds across New Zealand has been slashed from 2.48 per thousand people in 1988, to 1.56 per thousand people in 2006.
Australia now has twice as many hospital beds per thousand population as New Zealand.
And, not surprisingly, patients are not kicked out as fast in Australia as here, so they can recuperate better. The average length of stay in New Zealand is 3.9 days as against 6.1 days in Australia.
The Australasian College for Emergency Medicine says a 15% increase in ward beds is now needed in this country.
Hawke’s Bay – Special problems
Here in Hawke’s Bay the problem runs deeper than the national average. It goes back to the 1990s. At the start of the ’90s, there were 762 public hospital beds for Hawke’s Bay. It had previously been planned there would be over a thousand by 2001.
But by 1999, after ‘restructuring’ under the previous National government, the number of beds had been slashed to 400. And the cuts still did not stop. My understanding is that the number has since been reduced by a quarter, to about 300. So in our region, the number of beds has been far more than halved over the past fifteen years.
Specialists always knew there weren’t enough beds planned when the regional hospital proposal was put forward. They warned at the time that the number planned was unacceptable and would not provide better services. How right they were!
As the number of beds plummeted, so the waiting lists exploded. In the three years from 1993 to 1996, the number of people awaiting surgery at Napier and Hastings Hospitals blew out from 1,871 to 5,766. Eventually the authorities reacted in two ways. Both just massaged unacceptable figures so they looked better. Neither of them treated people or attacked the real problem.
First, in 1998, the authorities created a waiting list to go on the waiting list. Then, over the next five years to 2003, they dumped nearly five thousand people off the waiting lists that remained. Yet, because patients had not been treated, just re-defined under new categories, their ailments had not gone away. So our waiting lists as well as our bed numbers continue to be unacceptable.
Mark Sainsbury, the Close Up interviewer, said the figure about the number of deaths resulting from too few beds was so appalling, ‘why aren’t people up in arms?’
Well, here in Hawke’s Bay, we have been for years. A scan of Hawke’s Bay Today headlines across just three months of 2003 produced headlines like “Hospital-bed shortage ‘a scandal’” … “Bed shortage under review” … “No beds, so urgent cancer surgery must wait” … “Surgery cancelled – for the second time”. As we all know, they have continued since.
I addressed the DHB giving chapter and verse on the problem in 2004. It is exasperating when common sense and clearly stated facts have yet again to be proved right by a visiting expert – and deeply saddening, when lives have meanwhile been lost.
When are we actually going to get some action? Labour failed us on this over the past 9 years. Will the new National government now act to put right what it did wrong in the 90s?
Initial signs are not encouraging. New Health Minister Tony Ryall says he will set a maximum patient waiting time of six hours in hospital emergency service waiting rooms. Six hours, for emergencies? Contrast the situation in the United Kingdom, where the target is four hours – and it is met.
Nationwide, we desperately need a new approach and better emergency department staffing. And here in Hawke’s Bay in particular, we need more ward beds.
PUBLIC HOSPITAL BEDS IN HAWKE’S BAY
| 1989: | 762 |
| 1999: | 400 |
| 2003: | 346 |
| 2007: | 300 |
It`s not just the waiting list to go on the waiting list. Did you know that all referals from Specialists are set aside for 1 month before they are looked at by the Hospital. That coupled with the 3-6 months to see a Specialist and one`s treatment (sometimes urgent) recedes into the distance.
The stats are pretty bad for Hawkes Bay all round, with our DHB having some of the worst health statistics in the whole country. As you know, Robin – they formed part of an interesting presentation you did at the EIT recently.
Yes, beds are important, but we should be focusing also on preventative measures. Poverty is linked closely with obesity, poor nutrition, cigarette smoking, asthma, learning difficulties, a shorter life expectancy…the list goes on and on. What are we doing about it?
Alcohol-fuelled accidents and injuries fill our women's refuges, police stations and operating theatres every weekend, pushing elective surgery further back. We need to do something about it – urgently! Australia is trying out making alcopops much dearer and using the taxation generated for alcohol education programmes. Alcohol abuse has become an accepted part of our culture – at considerable cost to the well-being of our society.
Our aging population (I'm one of them!) deserves to have the backup of a robust, affordable health system. The Labour government lowered the price of prescriptions and doctors visits – a good move to keep us out of hospitals.
Tony Ryall faces many challenges and it will be interesting to see what he does.
The standard of healthcare in Hawkes Bay is apalling and can be compared to a third world country (I have worked in numerous countries and HB takes the cake). The reasons are numerous and not just due to low bed numbers – poor management with lack of consultation with senior clinicians, an ineffective board, lack of resources and a willingness to improve resources, poorly motivated senior clinicians with private practice conflict of interests a very serious issue to name but a few. It is disillusioning to work in a hospital in which there is a lack of motivation to improve these issues. Many motivated senior clinicians have left the hospital in the past few years for these very reasons. Trying to change the prevalent attitude in management is like hitting your head against a brick wall – fruitless and a waste of time. Its the reason I left after dedicating 5 yrs of my life to that hospital. The people of of HB need to wake up and smell the roses and start being more vocal instead of allowing politicians and mayors speak on their behalf – the latter don't have a clue as to the seriousness of the issues in that hospital – I know as I tried to raise these issues with them before I left but they typically follow the party line and have blinkers on!! As for Tony Ryall his decision to reinstate the board without serious review was a mistake and does not bode well for healthcare in HB in the future.