Under-pressure EDs prove need for health reform - Minister Andrew Little

Ongoing pressures on the country's hospital emergency departments and persistent problems with access to primary health care highlight the need for major reform of the health system, Health Minister Andrew Little says.

His comments come after the College of Emergency Nurses NZ said that staffing shortages, overcrowding and poor access to primary care were to blame for this week's announcement that Middlemore Hospital's emergency department had reached near-capacity levels.

College chair Sandy Richardson said while the situation at the hospital was a major concern, it was part of a wider, nationwide problem. The group is part of the New Zealand Nurses Organisation (NZNO) union.

In a statement released on Monday the clinical director of Middlemore Hospital's emergency department (ED), Dr Vanessa Thornton, asked for the Counties Manukau community's assistance as the hospital's department was under pressure.

"We want to ensure we provide the best care for all our patients and to do this effectively we need the community to seek the right care for their condition and understand that they don't have to go to our emergency department to get the appropriate treatment," she said.

"In taking these steps people will be supporting our ED staff by enabling them to focus their time and resources on patients who have life-threatening emergencies."

Little said such capacity and access issues in the health system highlighted the need for changes.

"This government has delivered considerable increases in funding for DHBs, more nurses, more doctors and other clinical staff, record investment in new and refurbished hospitals along with cheaper doctors visits for hundreds of thousands of New Zealanders," he said.

Despite such measures, problems remained, Little said.

"The fact that we're seeing persistent difficulties for people accessing primary care and ongoing capacity issues in our hospitals' emergency departments illustrates the need for the kind of reform of our health and disability services this government is determined to progress."

He said more details on what changes were planned would be announced in the new year.

Little said last month that improving primary healthcare was a key focus of the Simpson Report, which was released in June and he's keen to see its recommendations implemented to achieve that.

"I'll be taking the opportunity to better understand the challenges providing comprehensive affordable primary care including after-hours care across the country, including in south Auckland in the coming weeks and months."

Fewer DHBs among major recommendations

The Simpson Report, or New Zealand Health and Disability System Review, recommended reducing the number of DHBs and making them more accountable for the planning and delivery of primary healthcare services. It has however been criticised for a lack of focus on disability systems.

Currently primary health organisations (PHOs) provide essential primary health care services, either directly or through contracted providers such as general practices. The PHOs are funded by district health boards (DHBs).

The Ministry of Health's briefing to Little as the incoming minister was released on Tuesday and made for stark reading. It highlighted the fact the country's health system was overstretched, underfunded and inequitable, with District Health Boards ending the financial year $874 million in the red.

Health officials have said the country's hospitals face a rising tide of illness and challenges, which funding has not kept up with since the 2008 Global Financial Crisis. But meeting the demand would need "significant trade-offs in other areas", according to the report.

Health funding was $15.280 billion in 2015/16. It increased by nearly $5bn to $20.269bn in 2020/21 and is 21 percent of all core Crown spending.

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