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Heather Roy's Diary: Winter Ills, Ailing Hospital

Heather Roy's Diary

Winter illness and our ailing health system

Winter came early this year, and with it, the usual winter flus and illnesses. Hospitals around the country have struggled to cope with an influx of patients requiring hospital beds, and patients booked for elective surgery have been the casualty, with some being prepared for surgery and sent home at the last minute.

I had the following story relayed to me this week:

At one New Zealand hospital recently there was a deadlock as the number of admissions exceeded the hospital's ability to absorb new cases. The short stay Accident and Emergency facility had turned into a medium stay facility and five new cases lay in Accident and Emergency waiting a spare bed in a medical ward. To ease the pressure, patients with medical conditions were "boarded" in surgical wards, but the flow of new admissions didn't stop and the surgical beds were filling up. Reluctantly the management decided to stop elective (non-urgent) surgery.

News reached a surgeon as he was about to enter the operating theatre that there were no beds. The patient was prepped and the anaesthetist was standing by.

"What do you mean there are no beds" he demanded. "The patient had a bed this morning and came up in a bed. Why can't he go back to the same bed?"

The ward was full of patients with non-surgical complaints he was told.

"But I can't cancel this man, he has been put off twice already."

So the surgeon did the operation in defiance of instructions.

This might explain why one manager famously remarked that managing doctors is like trying to herd cats - and why this is a good thing.

Medical staff are bound to do the best thing for their patients, and have worked hard to battle the winter bulge. When patients are sent home untreated, it is their doctor who has to tell them and bear the brunt of disappointment, rather than the people who count heads on pillows.

Hospitals in Hawke's Bay, the central North Island and Auckland have been on "red alert" - an indicator that they are overfull - with Wellington, Hutt Hospital and Wairarapa also reported as having no available beds. In the last few weeks, winter ills have caused Palmerston North and Christchurch hospitals to postpone some elective surgery, but they aren't the only ones. In Hawke's Bay, two operations were cancelled, and six delayed. Hutt Hospital has cancelled at least one operation, Waikato deferred six and Wellington cancelled 16 - at one point cancelling all elective surgery requiring an overnight stay.

I recently read a press release that aptly described the struggle to cope with acute admissions in the face of winter flus and illnesses.

"Winter should not be a crisis. It happens every year and its associated ailments can be life threatening, especially for the elderly and very young. These crises could be avoided if we had a health policy flexible enough to allow for a surge in demand in the winter. It is unacceptable that people are missing out on planned surgery because of bad planning."

This press release was dated 11 August 1997, and was released by Labour's then health spokeswoman, Annette King. She was - of course - criticizing the policy of a National government, but nothing much has changed.

Present Health Minister Pete Hodgson is now facing exactly the same problems, as did Annette King when she was Minister of Health from 1999 until the 2005 election. Minister King's chickens of the last six years are finally coming home to roost. She had incredible luck in avoiding the results of her decision-making years, and got out just in time. I have to admit to feeling just a little sorry for Pete Hodgson, who has inherited a screaming baby, and he must feel at least a little resentment at being left to pick up the pieces of a public health system in critical condition.

In her press release, Annette King went on to say...

"When one considers that most average households budget for the extra costs that come with winter, it is sheer irresponsibility that this Governmnet should allow for this in its annual plan"

No doubt Mrs King would now claim that this budgeting is the responsibility of the District Health Boards. Instead of dealing with problems, Labour has put great effort into reassigning accountability to officials and bureaucrats, avoiding both tough decisions and blame. There are several possible solutions to this problem. Allocating more elective cases to private hospitals, who don't have to juggle them with acute hospital admissions, would be a great start. Another is the concept of separating acute work from elective surgery altogether. Public hospitals will always be responsible for dealing with acute problems like admission for winter ailments, car accidents, heart attacks and the like. Elective surgery is very different, in that it can and should be planned well in advance, with patients receiving certainty about dates. What is truly unacceptable is canceling patients - frequently more than once - because their hospital bed has been taken by someone with a sudden need.

Mrs King talked tough in opposition, but her legacy to New Zealand has been no better than the situation she criticized so vocally. If anything, her legacy is worse.


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