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GUEST BLOG: Ian Powell – Who to believe in the face of hospital safety issues?

Who is to be believed when concerns are openly expressed about the safety of New Zealand’s public hospitals? Both patient safety and the safety of hospital staff.

This issue is highlighted in a December 9 Things and Dominion Post An article by experienced local reporter Marty Sharpe about the chief nurses in the emergency department at Hawke’s Bay Hospital, which is the base hospital of the Hawke’s Bay District Health Board (one of 20 DHBs responsible for caring community and hospital). Nurses describe the emergency department as being on the “On the brink of disaster:.

But it’s not just about Hawke’s Bay as a mid-sized DHB and its base hospital. Nor is it just about emergency departments as the main entrance to hospital care. To one degree or another, the description of these experienced nurses serves as a litmus test for almost all departments and wards in all public hospitals.

Head nurses warn

The article is based on a three-page letter from the nine chief nurses of the Hawke’s Bay emergency department sent to their managers “… warning that the department is desperately unprepared for Covid-19 and that staff are leaving en masse “.

The letter is motivated by a level of desperation that has led to the need to voice serious ongoing security concerns. DE was losing experienced staff at an alarming rate. Workload and conditions were the driving force. Those who were leaving were experienced nurses; not inexperienced “newbies”.

Two months before the warning letter was sent, emergency service personnel had sent Hawke’s Bay DHB an official interim improvement notice under the Occupational Health and Safety Act. This is a written notice issued by a recognized health and safety representative seeking to resolve a health and safety problem in the workplace.

Issuing such an advisory is an unusual step to take in public hospitals. But growing clinical desperation, resulting from the worsening impact of staff shortages as well as dilapidated facilities and equipment, has recently seen it increasingly used by hospital departments.

Unfortunately, even this intensified level of action has not been sufficient to resolve the problem. With increasing pressures expected from Covid-19 on hospitals, senior nurses plead in their letter:

TDB recommends

“We’ve seen what can happen, we’ve seen what’s going on with the management of Covid, and we’re all scared, and ED, according to our senior nurse, is not ready for Covid… We’re going to be in charge of ‘a sinking ship, and a department in danger … Our voices are not heard.

“The emergency is interrupted, the flow of emergencies to services is interrupted, we are not ready for Covid and we as head nurses are warning you here and now that when sentinel events occur during this response … ED is in danger. ED needs you. Please help us. “

Not just a Hawke’s Bay crisis

This crisis is not a disaster that one DHB can solve on its own. Durable solutions do not come overnight. Invariably, the autonomy of DHB is insufficient to resolve them.

At best, the fingers can be put in dikes. Contrary to a common perception, DHBs are subject to a high degree of control below the radar of the central government reinforced by sustained underfunding.

Successive governments have largely ignored the severe shortages of healthcare professionals in DHBs and the consequent consequences of reduced accessibility and safety for patients, as well as fatigue and workforce exhaustion. ‘work. This is due to the combination of underfunding and a lack of commitment to specific workforce planning.

Although the Labor-led government inherited this situation from the National-led government it replaced in 2017, the need to address it has been overlooked. Rather, health restructuring has become his concern (made even more irresponsible during an ongoing pandemic).

Flip a coin to see where the blame lies

The Labor government has turned a blind eye to the effects of a severe shortage (around 24%) of hospital specialists, including very high burnout rates.

It only began to respond to nursing shortages in public hospitals due to a public exposure campaign asserted by the New Zealand Nurses Organization that included high-level advocacy with strong public support.

Who is responsible for this precarious state – the government responsible for causing it or the government that inherited it but ignored it? More and more, it’s about flipping a coin is my advice.

Who to believe

The government’s response to increasing pressures on public hospitals, made worse by the pandemic, has been to deny or downplay them. He confidently says intensive care units have the capacity to cope with an increase in patient admissions due to the virus. The problem is, critical care specialists and nurses strongly disagree.

So when the government plays down warnings about patient and staff safety, who should we believe? The government and those acting on its behalf or the expertise, experience and professionalism of frontline clinical health professionals, whether in an emergency department, intensive care unit, mental health, in oncology or in any other hospital or community service.

This question is obviously rhetorical especially when health professionals express their concerns collectively, as with the senior nurses of Hawke’s Bay, or through their representative bodies.

Successive governments have woefully neglected the safety of patients and healthcare professionals in our public hospitals and continue to do so while focusing on restructuring the healthcare system led by business consultants.

The greater the gap between governments and health professionals, the more the public and professional credibility of the former diminishes and that of the latter increases.

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the trade union representing senior physicians and dentists in New Zealand, for over 30 years, until December 2019. He is now a healthcare systems specialist , labor market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion