Emergency departments are the symptom, not the problem.
By Dr David Galler
This situation described at Wellington Regional Hospital’s Emergency Department is not new, so do not think this is unusual. It is a common occurrence in many areas of the country especially those where demand, driven by social and commercial determinants of health, is greatest. It does not need to be that way.
My former institution Middlemore Hospital, once and potentially still, the busiest Emergency Department in Australasia, was commonly in this position. Ironically, tucked away in South Auckland, it seldom received press coverage like this. Because of its location, Wellington Regional Hospital is a crucible, so what happens there is noticed and reported, so much more likely to provoke a response from a health minister.
Emergency Departments are hugely important places for local communities. They have traditionally been the last resort for many seeking help after being referred there by general practitioners, but now they have become for many, their only choice to alleviate pain, seek a diagnosis and receive treatment.
These are situations when people are most vulnerable so to not get the help they need or forced to wait for extended periods of time in corridors on uncomfortable gurneys to get that help, is crushing and erodes their trust in our health system.
These situations are also awful for the hard-working staff doing their best to help their patients, often knowing they have insufficient support to do that. As a result, those health workers are too often on the receiving end of the public’s frustration by way of threats and abuse.
This report from Wellington also points to a change in the circumstances of that place, some relating to staffing and capacity at the hospital itself, potentially partially remediable with extra funding from Te Whatu Ora. The promised new beds due 2029 will alleviate some of this pressure for the short term, but there are also broader societal changes at play in the city and region, worsened now by tough times. Those of you who live there will know much more about that than me!
Broadly speaking, Emergency Departments are by nature pinch points, or a bell weather in a system where unmet demand in the community overwhelms supply – both at the hospital’s entry point, the ED; in its over crowded wards, and again at its exit point, back into community care, where so many aged care and other facilities are similarly overwhelmed or inaccessible because of other reasons.
This is a problem of flow created by a fundamental lack of vision, system design, capacity, and resourcing, underpinned by our serial unwillingness to address those social and commercial drivers of demand that account for over one third of our nation’s overall preventable health loss.
The Health Minister recognizes the situation is not good enough for patients and staff, but simply saying it is unacceptable and expecting Te Whatu Ora to be able to fix this, especially in the current environment, is disappointingly simplistic.
If the government is seriously interested in addressing this, community-based care and must be improved with co-ordinated, reliable, and affordable access to social and primary care services, community-based diagnostics, and advice from specialist services to avoid hospital admissions and better manage people in the community.
That boost in funding should be accompanied by medium- and longer-term plans to address demand, notably the commercial and social drivers of ill health and the design of the health system to better meet the needs of our people more generally.
If the Health Minister and this government are genuinely interested in dealing with this pressing issue and in securing the future of publicly funded and publicly provided healthcare in Aotearoa New Zealand, they need to be more thoughtful and invest more broadly to support this goal.