One doctor quit and it was (almost) all over for Porirua’s overnight health service
Monday, 29 April 2024
As the future of overnight health services in Porirua remain uncertain, official documents reveal how fragile emergency and acute doctor numbers are across the region.
An aide memoire sent to former health minister Dr Ayesha Verrall last August outlined the decision to close the overnight service at Kenepuru Accident and Medical Centre (KAMC) had to be made “from a staff, community and clinical safety perspective”.
The overnight service remains open, staffed entirely by casual doctors, but the option to replace the in-person service with a virtual one is still on the table.
Dated August 18, the documents, signed by then hospital and specialist service interim lead Jamie Duncan, reveal the overnight service fell apart after one of its four doctors resigned on the week of July 10 “with immediate effect”.
“This individual was rostered to cover 42% of the overnight shifts at KAMC over the next two months. Their resignation lead to significant gaps that cannot be filled without additional recruitment.”
At the time, a second clinician indicated they may resign “due to concerns with workload,” but Duncan told The Post that never happened and they still do overnight shifts.
The doctor who quit suddenly did so “due to personal reasons” Duncan said and declined to provide further detail when asked if they quit due to the workload.
The documents, released under the Official Information Act , stated there was “no capacity to divert ED registrars” from Wellington and even if there was, working overnight in Porirua wasn’t part of their job description.
Wellington already had “the longest waiting times, longest length of stay… will have up to five vacancies by December and averages 1 to 2 unfilled short notice gaps per day already,” it stated.
Duncan, who is now in the role permanently, told The Post the staffing situation had since improved in Wellington and now just one full-time role was vacant.
But it would still “not be appropriate” to share doctors from Wellington with Kenepuru for the same reasons, citing long patient waits, “significant pressure” at both EDs and “staffing the KAMC overnight shift is not part of ED [resident medical officers’] role description”.
“It just tells me that there is no commitment to lift or review staffing to provide improved care — or embedded permanent staffing overnight,” Sarah Dalton, executive director of the Association of Salaried Medical Specialists (ASMS) said.
“As ever, money before people. Wellington before Porirua.”
Verrall said health authorities were being inflexible when considering solutions.
“400 doctors at Wellington Hospital, and we can’t staff Kenepuru?
“It's clear to me that there is a reluctance to commit to that service by Te Whatu Ora and I think that is wrong.”
Duncan said Health NZ remained focused on finding solutions to staffing issues was utilising all avenues to fill the overnight rosters.
An email chain between Verrall’s office and health officials in September and October outlined what would happen if the service were replaced by telehealth.
A list of “potential outcomes” if a patient arrived after 10pm included: no further treatment required, or the patient might be advised to go to their GP or KAMC the next day, offered prescriptions and tests, advised to go to ED in Hutt or Wellington, possibly by ambulance that either the patient or the service requests, a Te Whatu Ora staffer wrote.
Her office replied “I cannot understate how important it is to the minister to maintain and expand after hours services, not see their decline.”
The ASMS, Ngāti Toa and Labour MP for Mana Barbara Edmonds all back a campaign to save in-person overnight health services in Porirua.
The head of Porirua iwi Ngāti Toa, Helmut Modlik, has promised to step in to ensure the in-person service is retained if Te Whatu Ora fails to find a solution.
Questions from The Post on the cost of staffing the overnight service with casual doctors are being considered under the Official Information Act.