When no doctors were available after hours, Dargaville Hospital was making use of telehealth service and transferring the sickest patients to Whangārei. Photo: RNZ / Peter de Graaf
Dargaville Hospital has become a "political football" with patients caught between what's best for them, party politics, and the public health system's budget crunch, a doctors unions says.
The Association of Salaried Medical Specialists, the union representing employed senior doctors and dentists, said the situation in Dargaville was an example of the rationing of health resources in rural New Zealand.
A leaked email last week revealed clinical staff initially wanted the hospital closed when Health NZ was no longer able to find doctors to staff the ward overnight.
That was over-ruled at a national level, with Health Minister Shane Reti's office telling RNZ any speculation the hospital could close was "utterly wrong".
ASMS executive director Sarah Dalton said her organisation knew of debates between local managers, doctors and national leadership about whether it was possible to keep the hospital open.
"While our members would like to see the hospital remain open at night, they don't believe it is being done safely at present … We're really concerned that it is to some extent a political football between what's best for patients and access to care, and some of the financial drivers Te Whatu Ora [Health NZ] is grappling with at the moment," she said.
Their key concern was that if a Dargaville Hospital patient's condition deteriorated overnight, they would not necessarily have access to a doctor.
Instead, nurses would have to take advice via telehealth, or the patient would be transported to Whangārei Hospital.
"What's going on in Dargaville is, I think, an example of rationing of resources for people who live in rural areas all over New Zealand … what I would call a refusal to staff hospitals in ways that are sustainable."
Dalton said telehealth - a commercial service in which a doctor at another location provided medical advice via phone or video calling - was a "fantastic advance" which had made follow-up and specialist care available to more people.
However, it was a back-up that was less safe than having a doctor physically present, especially when a diagnosis or urgent care was required.
"I don't think we should pretend that provision of telehealth makes care safe, and I know that the nurses have already expressed concerns about that. I think we need to have some better conversations about how telehealth is being used, and we need to be really clear that you're always better off if you're in the room with a doctor," she said.
"We'd all like to see Dargaville Hospital maintain its inpatient beds but they need to be supported to do so safely, and clinical advice is that that can't be done on current staffing arrangements."
Dalton said the medical workforce shortage was a worldwide problem, but ASMS believed Health NZ was not doing enough to recruit, retain and support staff in rural areas.
One of the factors affecting staffing at Dargaville, and other rural hospitals, was a cut in pay rates for locums, or temporary doctors.
Dalton said locums should not be a "first port of call" for staffing hospitals, but a drop in pay meant a previously available workforce was no longer willing to fill gaps in the roster.
Senior doctors have told RNZ the pay cut was in some cases more than 40 percent.
Another problem was unrealistic budgets, Dalton said.
"Most hospitals have agreed budget allocations for medical staffing that are smaller than the number of staff needed. At the end of the day, if we want our hospitals to be appropriately staffed, we have to be prepared to fund and resource that. And that is not currently the case."
Health NZ northern deputy chief executive Mark Shepherd said patients at Dargaville Hospital were safe and well-looked after.
"All patients admitted to Dargaville Hospital are assessed as appropriate for the care currently available at the hospital, with ambulance services transporting all high-risk patients directly to Whangārei Hospital."
Shepherd said efforts to recruit doctors for Dargaville Hospital were continuing, and contingency plans would remain in place to ensure patient and staff safety in the meantime.
He thanked staff for their hard work and ongoing dedication to their patients and community.
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