The head of intensive care at Christchurch Hospital is warning some surgery for children and adults will have to be put off because of funding woes.
Fit-outs at the emergency ward at Christchurch Hospital (file picture). Photo: RNZ / Simon Rogers
The Canterbury District Health Board says it is not reducing any services.
However, it has run out of money to fully operate three units at its brand new Hagley block.
One of the three services being curtailed is Canterbury's first-ever dedicated children's intensive care unit (ICU) (in addition, a specialised children's unit in the Emergency Department, and an Emergency Observation unit for all ages also face unexpected constraints).
The clinical director of intensive care, Dr Seton Henderson, learned about two weeks ago that he will not get the extra ICU staff he needs to cover the children's high-care unit.
This was due to "not enough money", he said.
This means the unit will only have paediatric staff - not ICU staff - and only be able to care for less-acutely sick children, instead of more serious cases as well.
The sicker children will, as now, occupy ICU beds alongside adults.
"Our staff are terribly disappointed, they were waiting for this," Henderson said.
The new Hagley block was meant to be the culmination of seven years of planning for "enhanced" services that kept children separate from adults.
Benefits were to include greater efficiency and safety from having all the equipment all the time being calibrated for children.
"Now that's been put on the back-burner yet again."
Mixing children with adults was not an appropriate model of care "because that's a vulnerable group, they're at greater risk", Henderson said.
Wider impacts
ICU doctors and nurses had been sent for specialised paediatric training for up to a year in Australia and Auckland in anticipation of working in the dedicated children's unit, Henderson said.
"It'd be fair to say that the entire intensive care team is incredibly disappointed that it's not going to work the way we'd planned for."
The unit's diminished usefulness would have wider impacts, he said.
Hagley would not now deliver all the extra adult ICU beds expected, limiting the capacity to cope with surges in demand - which in turn would impinge on elective surgery for children and adults.
"We're going from a very constrained ICU to a slightly less constrained ICU.
"Our paediatric surgical colleagues had planned to be able to undertake more paediatric surgery. Some surgeries will have to be put off, I'm sure," Henderson said.
"I know the paediatric ENT [ear, nose, throat] and plastics have concerns."
Another impact: A new risk for paediatric staff working in the new children's ICU because they would now be several floors away from the paediatric ward, he said.
"They haven't got staff immediately available to call on if they need them urgently.
"ICU will still, along with paediatric anaesthesia, provide emergency cover.
"But that's as opposed to urgent call."
Unit 'will still operate'
The DHB in a series of statements, began by saying the children's high dependency unit "will still operate within the ICU space" at Hagley.
However, it did not say if the unit would run as planned for all along.
When RNZ questioned this, the DHB changed tack.
It would operate, "with the eight beds we have always planned for as soon as the new facility becomes operational. More seriously unwell children requiring intensive care will be cared for in the adult ICU pods", it said in another statement.
This curtailed service would be reviewed before next winter.
Dr Henderson detailed how instead of ending up with 36 ICU beds in the $500 million Hagley block, they would have 32. Currently they had 29.
- Currently ICU has 23 beds for adults and children, in two pods
- Currently the paediatric ward has an adjacent six-bed unit for less acute child ICU cases
- That six-bed unit will close when the shift to Hagley is made around November
- Hagley has four 12-bed ICU pods built
- One pod is spare for future expansion
- Of the other three pods - 36 beds - one pod is for children
- It has eight beds exclusively for children, and another four beds that adults can go into
- Those four beds cannot now be used, as the ICU has no extra staff to cover them
- Between six and eight children's beds will be used, but only for less-acute cases covered by paediatric staff only.
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The DHB chief executive David Meates, who resigned and left last Friday, earlier said in a statement to RNZ that "I would like to stress children will continue to get the care they need".
His resignation, and those of six other hospital executives since July, have been blamed by unions, and some of the executives themselves, on clashes with board members and the Health Ministry over efforts to find at least $60m of cost savings.
No standalone Emergency Observation
The DHB defended how another of the three units - the Emergency Department Observation unit - now will not open at Hagley for lack of staff.
"It won't be in a standalone area as it is now" but the observation "function" would still be done, spread through the department, it said.
The head of ED Dr Mark Gilbert earlier told RNZ this was not ideal, and had flow-on impacts on inpatients.
The DHB said it has one of the lowest uses of ED in Australasia, thanks to the use it made of urgent-care clinics.
"I want to stress that we are not reducing staff, nor are we reducing services and we are not anticipating a sudden increase in the number of people coming to our ED," Meates told RNZ.
"The new facility was designed to ensure that we do not need to resort to using beds in corridors and we will move from a significantly constrained environment in the current ED to a more spacious modern environment."