Health Minister will step in if cuts go too far, as doctors become ‘corridor specialists’

Saturday, 3 August 2024

Health Minister Dr Shane Reti is promising to step in if his commissioner cuts too far, but a doctor treating patients in corridors says we are already way past that point. Rachel Thomas reports.

Northland emergency doctor Gary Payinda picks up the phone, says it’s mayhem, and coins a new term: the corridor specialist.

“We stack [patients] down the back hallway and of course, we don't have nursing assigned to those areas. We don't have doctors that are corridor specialists. But that’s what we are facing now.

“This is unprecedented.”

When an emergency department is running at 100% capacity, there is zero room to deal with the unexpected, he said.

“Lately, we've been operating at 130%, 150% and even 200% capacity. We're managing an ED crammed full, and an equal number of ED patients we're trying to manage out in the waiting room, which is not safe.”

It is not difficult to find shortages: Health NZ told The Post it has a total of 3079 full-time roles vacant for nurses, midwives and doctors.

“Oh my god,” Payinda said, “and those are just budgeted roles”.

It comes as Health Minister Dr Shane Reti said he expected Health NZ to continue hiring staff where they were critically needed.

“You've heard the [Health NZ] chief executive say at the end of last year, they over recruited on nurses, but here's the problem … it's not in the areas and in the locations we actually need them.

“We need nurses in maternity. We need nurses in critical care. We need nurses in mental health. We need nurses in some of the regions… That's part of our dilemma.”

“I will hold him to that promise,” health opposition spokesperson and former health minister Dr Ayesha Verrall said.

“It is well known that levels of staffing and hospitals does impact patient safety and you can have deaths as a result.“

President of the NZ Nurses’ Organisation, Paul Goulter, said the union and the health authorities disagreed over where critical areas were, and that nurses were experiencing a freeze, whether or not it was official.

“They aren't being recruited immediately to fill vacancies. The whole thing is slowed down, and that's just as effective as having a freeze … and for a nurse or a patient, the net effect is the same.”

Goulter said New Zealand was still ”desperately short“ of locally trained nurses, but said there had been a surge in international recruits seeking jobs here.

Nursing Council figures show more than 4600 international nurses joined the nursing register in the three months to June 2024 alone, the highest number in a year and almost double that of the previous quarter.

“But they need a lot of support. We really question whether or not that additional resource … is actually being provided and being counted,” Goulter said.

While Health NZ Commissioner Lester Levy may be in charge of making savings, Reti promised to step in if the commissioner, tasked with making $1.4 billion in spending cuts, sliced too deep.

“Health workforce is critical … the front line must not be adversely affected,” Reti said in an exclusive sit-down interview with The Post.

“I can build this and build that but if I can't staff it, it kind of doesn't matter.”

Payinda did not buy it. “He is living in a fantasy land if he thinks front line services are not being negatively impacted, grievously impacted by the Government's decisions.

“They really need to stop saying we are over recruited, overstaffed and have more budget than we need. That is simply a lie.”

Verrall said clinicians were telling her roles for booking clerks or schedulers were no longer being filled “and that means that our doctors and nurses are tied up in paperwork rather than delivering care”.

Reti said Health NZ, the Ministry of Health and the Health Quality Safety Commission were under instructions to raise the alarm if they considered cuts were too severe. Reti was also speaking with Levy every 48 hours.

“I've made it very clear to the commissioner what concerns me … I don't want to see substantial changes to the relatively good progress we're making on some of the [health] targets … There's also things clearly like patient safety, staff safety.”

Levy has said between 2500 and 3000 non-clinical jobs could go in cost-cutting efforts. Health NZ was unable to say how many of these ‘back office’ roles, as the Government and Levy have described it, were already vacant.

Former health boss, Sir Ashley Bloomfield, perhaps New Zealand’s most famous ‘back office’ health worker, said those who don’t work on the front line were still essential.

“Very often there's this tendency to blame bureaucracy or ‘back office’ people. I hope, rather than blaming them, that we can move on … to really being clear about what the problems are and what needs to happen next to resolve them.

“They are not new issues and they're not going to go away just through a cost cutting exercise.

“It will require great people, trained well, led well, innovation and investment in the right places. Those things need to be the focus, regardless of what the structural arrangements are.”

When Reti was asked if his commitment to workforce extended to non-clinical roles, he said there were “some enabling functions like payroll that you just can't mess with”.

“What the commissioner is finding is duplications that we can't account for. Those are roles that we want to reprioritise back to the front line.”

Paul Goulter said nurses were always impacted by other cuts in the health ecosystem.

“You can't just extract one piece out of the system without damaging the other parts of the system. By cutting out these other roles, you're just exacerbating the problem.”

Payinda said his non-clinical staff were the only reason he could do his job.

“What mythical back office? The thing he’s calling back office are the PAs that call around every day trying to beg doctors to work extra to staff these vacancies.

“They keep the department running and they do so on low salaries in a thankless job under a government that thinks they’re superfluous.

“If you are cutting down the ‘bloated’ administration … that will have direct impacts on patients lives. The work they do matters.”

The Post asked to speak to Levy and sent questions around recruitment, whether any areas were ring-fended from job cuts and how often Levy was meeting with Reti but was told he was unavailable and questions would be put to him “later next week”.