‘Traditional’ model at Nelson Hospital outdated, review finds

Thursday, 24 July 2025

A “traditional” healthcare model used at Nelson Hospital has led to under-investment in junior staff and put too much pressure on senior doctors, a review has found.

The highly anticipated review into the state of healthcare in Nelson Marlborough by Health New Zealand Te Whatu Ora was released on Wednesday afternoon.

It came after senior doctors and nurses went public in March about a lack of staff that was leading to blown-out waiting lists at Nelson Hospital, prompting Health NZ to send a team of senior clinicians to assess the state of the hospital.

At the time, Nelson staff said the hospital was “dangerous at times” and at “rock bottom”.

But, the Association of Salaried Medical Specialists was underwhelmed by the review, labelling it a “plan to make a plan” and a “wasted opportunity”.

The Clinical Quality & Systems Review of Nelson Marlborough report released on Wednesday found Nelson Marlborough was achieving good results in a range of measures despite facing “significant challenges”.

That included a low in-hospital mortality rate compared to the national average, and having staff dedicated to providing safe, high-quality care.

But, there were “delays in accessing timely care, both acute and planned care, due to capacity (both workforce and infrastructure) not keeping pace with the increased demand for services”, the report said.

In particular, a “traditional model of care” delivered primarily by senior medical officers (SMO) was no longer sustainable, and a shift to a “contemporary, interdisciplinary model needs to be a priority”.

“The senior medical officer delivered model has led to under-investment in resident medical officers … resulting in SMOs covering a lot of duties that would be undertaken by registrars in comparable sized hospitals/districts. It has also led to underinvestment in advanced practice roles in allied health and nursing professions,” the report said.

Operational and clinical leadership structures also needed to be reformed, with more clinicians involved in decision-making.

In a statement, Health NZ’s national chief medical officer Dame Helen Stokes-Lampard said the review confirmed several long-standing challenges.

“These include persistent delays in the recruitment of both senior and junior medical staff, compounded by ageing infrastructure and increasing demand in services such as general medicine, cardiology, vascular surgery, and obstetrics and gynaecology.”

The report said both workforce and infrastructure improvements would “require significant investment and will take longer to address”.

Stokes-Lampard said Health NZ’s executive leadership team had accepted the review’s findings, and a review ‘recommendations implementation and action plan’ would be established, chaired by Health NZ deputy chief executive Martin Keogh.

It would focus on clinical quality and safety; access to care; workforce; and facilities and infrastructure.

“We are committed to keeping staff and unions informed as we implement the report’s recommendations.

“While the report focuses on Nelson Hospital, the lessons learned will inform wider improvements across New Zealand’s healthcare system.”

But the Association of Salaried Medical Specialists said the review simply restated known problems with leadership and under-staffing.

“Four months later and all we have is a plan to make a plan,” executive director Sarah Dalton said.

“Doctors, nurses and patients want solutions to these ongoing problems, not a bland description of known issues leadership should have addressed years ago.

“The review lacks timeframes, holds no leaders to account for these failures.”

It was a “wasted opportunity to make positive change”, she said.

“We simply need more doctors.”

At a media conference at Nelson Hospital after the review was released, Stokes-Lampard said the implementation team would begin work next week, and its progress would be closely monitored.

Keogh said the review’s findings needed to be worked through with Nelson clinical staff to establish their key priorities.

“We’ve now got to deliver on what the recommendations say and we will be working with them every day from here on in to deliver and meet their needs.”

Recruitment of junior doctors would be high on the list, and he expected positions would be advertised at the start of the clinical year next January. He could not yet comment on how many would be recruited, or how much the recommendations would cost to implement.

Getting a better balance between senior and junior doctors would help retain senior staff by reducing burnout, and a stronger junior model would create a pipeline for the future.

Keogh’s message to Nelson residents was that the hospital had dedicated staff providing outstanding care.

“What we have to do is address some of our delays to care,” he said.

Some of those delays were being addressed by a tripling of outsourcing cases to private providers, an additional 1000 patients.

Stokes-Lampard apologised to patients and their whanau who had suffered delays in specialist appointments or where care could have been better.

“We need to think where the various delays occurred, where the trouble occurred and how we can ensure that it doesn’t happen again.”

Labour health spokesperson Ayesha Verrall said the review’s findings were unsurprising.

“The obvious piece missing from this review is how much more funding is needed to ensure people in the top of the South Island can rely on care at their hospital.”

Solutions were needed “sooner rather than later”, she said.

NZNO delegate Marijke Cooper said Nelson Hospital needed to do more to upskill nurses and offer flexibility around part-time work.

'Te Whatu Ora needs to commit to building a sustainable and high-skilled home-grown nursing workforce by upskilling nurses and hiring graduate nurses.'

Key recommendations include:

• A robust clinical governance structure supported by a quality and safety team.

• Implement the Acute Flow Operational Standards.

• Implement the Outpatient Waiting List Management Guidelines, April 2025.

• Develop a plan and implement a sustainable medical workforce.

• Develop interdisciplinary models of care and innovative ways of working.

• Continue to build South Island regional care service models that support better local and district delivery.

• Develop and implement new operational and clinical leadership structures and implement a partnership model.

• Improve workforce experience and wellbeing.

• Progress planning for the Nelson Hospital Redevelopment.

• Progress the programme business case seeking funding for a LINAC service on the Nelson Hospital campus.

• Examine options for improving IT infrastructure, focused on improving waitlist management and booking and scheduling of patient.

• In-depth review of amputation rates and hysterectomy rates.

• Develop an action plan with a timetable and roles responsible and accountable for each action.