A review by Health New Zealand has outlined “significant” staffing issues at Nelson Hospital but stops short of outlining how this will be addressed.
Senior doctors spoke out to 1News earlier this year, saying patients’ lives were being put at risk due to staffing levels at Nelson Hospital.
The subsequent review by HNZ’s top clinicians has found that Nelson Hospital has specific shortfalls in some services compared to the rest of New Zealand.
Senior doctors say patients’ lives are being put at risk. (Source: 1News)
It found there was a shortage of senior doctors, especially in general medicine, geriatrics, obstetrics and gynaecology, paediatrics and vascular. Nelson Hospital also had a model that relied too heavily on senior doctors, rather than employing junior doctors to assist with the workload.
The review looked at nine cases and found avoidable delays in five of them. There was also concern raised about the number of amputation and hysterectomies, but that data required further analysis which was now underway.
In one of the cases, the gynaecology department had capacity issues which led to a patient not being seen within the correct time frame, leading to requiring an emergency operation. The review found they weren’t prioritised correctly, and the patient could have been seen earlier.
What senior doctors said about Nelson Hospital
The review came after senior doctors spoke out earlier this year detailing how they said patients lives were being put at risk due to staffing levels at Nelson Hospital. That sparked a public protest in April with hundreds turning up.
In total, 1News interviewed nine current or former senior doctors at Nelson Hospital who all raised similar concerns.
Nelson Hospital cardiologist Dr Tammy Pegg is the ninth doctor to speak to 1News about concerns staffing levels are having on patients in the region. (Source: 1News)
In March, there were more than 1000 people on the waiting list for Nelson’s obstetrics and gynaecology department. The head of the department, Dr Claudia Hays said: “I’ve never seen that number of patients waiting to be seen.”
Hays and fellow consultant Dr Adelle Hanna said some patients were requiring emergency hysterectomies because they were left waiting too long.
Senior urologist Dr Suzanne Beuker said patients weren’t making it onto her departments waiting list unless they had a cancer or life threatening condition.
She said the urology department has regularly been understaffed for the past two years. “Certainly I have seen patients that I believe their disease has gone from curable to incurable during that waiting time.”
Doctors from other departments at Nelson Hospital including the ED, cardiology and ICU have spoken to 1News about the impact low staffing had on their patients.
Leadership, culture under the spotlight
The review found the leadership structure at Nelson Hospital wasn’t fit for purpose and there was a lack of understanding of how to escalate problems.
“There was a clearly expressed and repeated view, particularly from medical staff, that there is a ‘lack of confidence’ in leadership.”
The group manager of operations, Lexie O’Shea, used to be the chief executive of the Nelson Marlborough DHB when it existed. The review noted that under the current structure she had 42 direct reports.
Health NZ denied the accusation, instead calling it a temporary administrative move. (Source: 1News)
“The clinical leadership model has not evolved over time as Nelson Hospital and the population it serves has expanded substantially.”
Culture at the hospital was also an issue with the review finding: “Culture issues that have not been addressed evidenced by a lack of hope, and frustration with perceived inequalities relating to historic funding issues and staff arrangements”
Health NZ review recommendations
The review has instructed that a “recommendations implementation and action plan” be established, chaired by Health New Zealand Te Waipounamu deputy chief executive, Martin Keogh — focused on four key areas.
- Clinical quality and safety: Reviewing clinical governance to ensure it aligned with national guidelines, improves communication and visibility for clinicians and services, and is effectively used to escalate issues when needed. Also examining high-risk specialties, including vascular and obstetrics/gynaecology.
- Access to care: Improving access to first specialist appointments and reducing wait times for surgery and Emergency Department care.
- Workforce: Develop and then implement plan for a sustainable medical workforce at Nelson Hospital; address long-term vacancies in senior and junior medical roles; and manage demand and capacity challenges across key services.
- Facilities and infrastructure: Address infrastructure constraints across inpatient beds, outpatient clinics, and Emergency Department; and progress the hospital redevelopment project.
Senior doctors’ union reacts
The Association of Salaried Medical Specialists, the union for senior doctors, said it had been privately raising concerns with Nelson Hospital management for months if not years.
Emails shown to 1News earlier this year documented concerns about staffing levels going back to 2013.
One wrote of a “crisis in the Department of Medicine” as far back as 2013. (Source: 1News)
ASMS executive director Sarah Dalton today described the review as a “plan to make a plan”.
“Doctors, nurses and patients want solutions to these ongoing problems, not a bland description of known issues leadership should have addressed years ago.”
She said the review lacked timelines and failed to hold leadership accountable.
If you have information about the issues at Nelson Hospital please email [email protected]
