Health system now “beyond a crisis”

Perhaps Minister of Health Andrew Little is right to deny the existence of a crisis in Aotearoa New Zealand’s health system. However, to the extent that he is right, it is accidental. It is not because there was never a crisis or it has been mitigated enough to no longer warrant this descriptor.

Instead, it is because the health system now finds itself in an even more precarious position, beyond a crisis. Before going further it is useful to appreciate what the word ‘crisis’ means in the context of a universal health system like New Zealand’s.

Health system crisis

Crisis is when there is an internal experience within a health system of confusion and anxiety to the degree that formerly successful coping mechanisms fail those working in it and ineffective decisions and behaviors take their place.

The dominant emotions within the system include confusion, vulnerability, anxiousness, fear, anger, hopelessness and helplessness. Words like contingency, emergency, exigency and juncture are common synonyms of crisis.

A crisis is when a health system is at a crucial juncture whose outcome will make a decisive difference for better or worse. A health system crisis is when there is a workforce crisis due to prolonged and extensive severe shortages.

This is because of the centrality of workforce to highly labour intensive, integrated and inter-connected universal health systems, such as in New Zealand.

This BBC photograph is about Sri Lanka’s health system verging on collapse; is Aotearoa’s health system unlikely to be in a much better space?

For me a health system crisis is when the juncture at a particular point of time and circumstance is at a tipping point into collapse. It can either tip over into collapse or, through good leadership or sheer good luck, pull back from the precipice.  

Beyond a crisis

On 25 June Stuff journalist Benn Bathgate published an article under the heading ‘Dire warning from health frontline’: Beyond a crisis – whistleblower’s dire warning from the hospital frontline.

It is a sorry indicator of the difficult and top-down control of the health system that a staff member who spoke to Bathgate would only do so as a whistleblower for fear of loss of job. But it is the substance of the comments that is important.

The article focussed on the former Waikato District Health Board but the experience outlined is applicable to all public hospitals in Aotearoa. Hospitals are described as “not coping at all.” Further: “Actually we are beyond a crisis, we are broken. The minister, the prime minister are not acknowledging it.” [emphasis added] Hospital care is being provided by “just a lot of exhausted, disillusioned staff.”

Bathgate reports staff as identifying the causes of this ‘beyond crisis’ state of affairs as being inadequate staffing numbers and underfunding from successive governments. This precariousness is made worse by the impact of the Omicron variant of Covid-19 and winter flu exacerbating staff shortages.

Not an isolated experience

This is not an isolated experience. To one degree or another all public hospitals are experiencing something similar.

Today (8 July) Otago Daily Times journalist Mike Houlahan reports a worse than crisis situation in the Otago and Southland hospitals: Hospitals struggling to treat patients. In his words:

Southern hospitals were in desperate straits last night, as staff from all disciplines were reassigned from their usual duties to treat sick patients.

Dunedin Hospital was over capacity and its intensive care and Covid-19 wards were at capacity, while several rural hospitals were battling to find staff to fill medical and nursing rosters.

Staff were yesterday advised all training and education work was to be deferred, and all “available and appropriately qualified” staff were being asked to do clinical duties rather than their usual roles.

…all hospitals in Otago and Southland are struggling to manage with a high number of patients, while also coping with staff absent either through seasonal ailments or due to Covid-19 requirements.

“Staff are really under the pump and it’s all hands on deck…”

“People are working incredibly hard but it’s a nearly insurmountable strain that they are under.”

Meanwhile, on the same day, Stuff journalist Cate Macintosh reports the grim news of surgical waiting lists soaring leaving desperate patients to languish in pain and feel “like the living dead”: Languishing surgical patients in pain feel like the living dead.

Getting to ‘beyond crisis’

The crisis that has been allowed to deteriorate to ‘beyond crisis’ is well illustrated by Jeff Bell’s cartoon published by Stuff (7 August).

The opposite universes of Health Minister Andrew Little and New Zealand’s health system

The opposite universes of Health Minister Andrew Little and New Zealand’s health system

In late October 2017 the Labour led government, with Jacinda Ardern as prime minister and David Clark as health minister, inherited a workforce (ie, health system) crisis as an unwanted legacy of the previous National led government.

In 2017 severe workforce shortages were the greatest pressure on the health system. But the most generous description of Labour’s response has been neglect thereby allowing the situation to get worse. There was not even the development of strategies to address these shortages.

If there had been a proactive genuine endeavour to address these shortages soon after taking office in 2017, we would not have fixed all of them but we would have been well down the path towards this outcome.

The health system would still have struggled under the pandemic pressures, now reinforced by harsh winter flu. But it would have been much better placed to handle them, including a higher level of patient access to diagnosis and treatment and a much less stressed health workforce.

Prime Minister Ardern’s government focussed on repositioning and centralising bureaucracy

Instead the Ardern government focussed on restructuring the system essentially by repositioning and centralising bureaucratic decision-making. And what has been the unsurprising outcome?

The health system has gone from being in crisis to being beyond crisis – collapsing under the weight of poor political leadership.

This collapsing can be turned around but not until we have a qualitative turnaround in the standard of political leadership. New Zealanders deserve this turnaround now. They should not have to wait and hope until next year’s election.