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NZ Herald
a day ago
- NZ Herald
Health NZ apologises: Whangārei Hospital patient starved 16 hours a day for six days waiting for surgery
Emsley began to feel unwell on June 6 when she noticed her toe was very sore and felt bruised. Over the next few days, it became more painful, making walking difficult. On June 9, Emsley's GP thought she had gout and prescribed a steroid treatment. Despite the steroids, she felt very unwell and, the next morning, was so mumbled and confused when talking to her daughter on the phone, her daughter called an ambulance. Emsley was rushed to Whangārei Hospital with low blood pressure, difficulty breathing, a high temperature and confusion. It took all day for her to be stabilised with intravenous fluids, antibiotics and pain killers. 'My toe was pulsating with pain - it was like a red hot poker and I was almost screaming in pain.' Heather Emsley, 66, is still batting the infection in her toe and believes the delay for surgery prolonged her recovery. Photo / Denise Piper Once stabilised, Emsley was admitted to a ward, where doctors began trying to diagnose her illness, including her being prepared on and off for surgery. An ultrasound eventually identified a problematic pin, inserted into her toe about 25 years ago as a treatment for her rheumatoid arthritis. 'Somewhere along the line, bacteria decided to hone in on that one pin and cause a major infection, which then went through my body.' A specialist decided Emsley needed surgery to remove the pin and debridement of the wound to clear the infection. The wait for surgery meant she was unable to eat or drink anything from 2am until about 6pm, however, her operation did not proceed. This happened for six consecutive days, causing Emsley stress and emotional strain. Emsley said her situation highlighted the hospital's staff shortage, and poor communication between the theatre and her ward. Despite breaking down in tears one day, it was another day before Emsley got her surgery, about 7.45pm on June 22. She was later told she should have had surgery within 24 hours, not the 140 hours she waited. 'It wasn't the right process - it was cruel and, from my point of view, Third World. It's just not something you expect from a modern hospital.' Emsley's fight against her infection continued after her surgery, including on-going intravenous antibiotics and wound treatment. She was discharged from hospital on July 2 but still walks with a moonboot and walking stick. Health NZ Te Tai Tokerau group director of operations Alex Pimm says some patients expecting surgery need to be deferred for more urgent cases. Photo / Denise Piper Emsley and her daughter made formal complaints about her treatment, in the hope no other patient would have to go through the same torturous wait. 'I would like to see that no other patient goes through what I went through, in terms of having to wait so long and having to be starved, basically, for that length of time.' Emsley received a six-page response, with Health NZ apologising for her treatment and outlining plans for improvement. It confirmed someone in her category should have surgery within six to 24 hours. 'It sounds like, by us complaining, it helped them look into what's wrong,' she said. Alex Pimm told the Northern Advocate: 'We have empathy for Ms Emsley on her health journey and are sorry for her experience at Whangārei Hospital'. However, Pimm said the acute theatre list is prioritised based on patient need and clinical urgency. 'Unfortunately, this means that on occasion some patients who were expecting surgery are deferred to enable somebody with a more urgent condition to receive treatment.' Pimm did not answer questions about whether strike action also caused delays, instead encouraging patients to talk with the hospital directly if they have any questions or concerns. Denise Piper is a news reporter for the Northern Advocate, focusing on health and business. She has more than 20 years in journalism and is passionate about covering stories that make a difference.
NZ Herald
a day ago
- NZ Herald
Health NZ preparing to send gynaecological cancer patients to Australia, citing specialist shortage
The plan to investigate Australian options was included in a briefing in December to Health Minister at the time, Shane Reti, about New Zealand's threadbare gynaecology oncologist staffing levels, which now mean women living between Wellington and Hawke's Bay will have to travel to Christchurch for surgery. In the paper, officials warned New Zealand has about half the number of gynaecology oncologists per capita as 'international benchmarking' suggests are required. Officials told Reti the international benchmark is for about three gynaecology oncologists per million people. To meet this benchmark, New Zealand would need 15-16 subspecialists. As of mid-November last year, there were just eight staff (or 7.5 fulltime equivalent staff). The number is going backwards. In mid-November the sole subspecialist working in Wellington resigned, leaving the system with four subspecialists working in Auckland and three in Christchurch. The briefing received by Reti detailed Health NZ's plans to deal with the shortage, particularly in Wellington. Health Minister Simeon Brown said no patients from Wellington had been sent to Australia and there were no plans to do so. Photo / Mark Mitchell According to the officials, the medium-term plan, which was made public earlier this year, is to deliver complex gynae oncology surgery in Christchurch and Auckland hospitals – although mainly Christchurch. More than 100 Wellingtonians and people from central New Zealand – the Hutt Valley, Wairarapa, MidCentral, Whanganui, Taranaki and Hawke's Bay healthcare delivery areas – needing surgery will now be flown to Christchurch. Most women will not need to travel, and will instead be seen by a specialist who will fly up from Christchurch to Wellington regularly for clinics. Brown appears to have pushed back on this plan, which initially did not envisage a return of these services to Wellington in the next five years. Brown said he was 'not satisfied with the current level of access to gynaecology oncologists in New Zealand, and strengthening recruitment is essential to addressing this'. 'This is key to strengthening access to gynaecological oncology services in Wellington, which I have made clear to Health New Zealand must be a priority,' Brown said. Doctor burnout risks South Island services, leaving NZ with patchy gynaecology oncology south of Hawke's Bay Officials noted the plan to treat these patients elsewhere has 'some risk' because getting Christchurch doctors to pick up the work of Wellington was 'dependent on the goodwill and ability of the three Christchurch gynae oncologists to carry a significantly increased workload alongside travel and time away from their whānau'. They already have a full workload in Christchurch, the officials said. Both they and their clinical and managerial leadership in Christchurch are clear that if the workload and additional travel puts any of the gynae oncologists at risk of overwork or burnout, it would 'put the service for Te Wai Pounamu [South Island] at risk as well'. The Cancer Society's medical director, Kate Gregory, who works in oncology giving chemotherapy and drug treatments to women with gynaecological cancers, told the Herald the system was being held together by the 'dedication of gynae oncologists who are working in this country'. 'They're working way above what their time allows – they're seeing more patients and doing more surgeries. It's really only due to the dedication of them that things have kept going as they have for as long as they have.' Back-up plan: Australia and service rationing Officials warned that if the plan to cover Wellington's workforce shortage failed, 'the fallback position will likely include having to send patients to Australia for surgery'. Health NZ was 'investigating the practicalities and likely costs of this to ensure we are prepared for this contingency'. Officials said it might be appropriate to consider centralising the national waiting list and consider 'rationing of services' in the short term 'to ensure that scarce specialist gynaecology oncology resources are focused on high-risk cases for appropriate management within recommended timeframes'. Eight trainees went to Australia – only one returned to NZ The long-term health of these services will mean training a domestic workforce. This has been a challenge. The relatively small number of training places in New Zealand meant it was difficult to create a future workforce, officials told Reti. Currently, New Zealand-trained doctors undertake some of their training in Australia, but this was also causing problems. There is high demand for gynaecologist oncologists in Australia, causing most trainees to stay. 'Of the last eight trainees who have been New Zealand trained, only one has stayed in a fulltime role in New Zealand, with the others all accepting roles in Australia,' officials said. Gregory told the Herald that sending people overseas for training could be difficult if the trainee has a young family or a partner who is tied to New Zealand for their work. Gregory said that as conditions became more difficult for the existing workforce, it becomes harder to recruit new people. 'When you've got a service under stress, it's not that attractive for people to come and work in it. They can see people working really hard and the on-call commitments are really onerous. That makes it difficult to recruit people from outside, because they can see what it's really like,' she said. Other concerns raised by officials include that surgery performed by the subspecialists was 'physically demanding, leading to back problems for some surgeons, increasing the risks of sick leave or early retirement in this workforce'. They also said that overseas, it was becoming increasingly common to perform surgery 'using robotics'. This created a skills mismatch with New Zealand, where most surgery was still being done using more traditional techniques. 'This means that internationally trained surgeons may not have the required level of experience of surgical techniques required in the New Zealand sites which do not have access to this robotic technology,' the officials warned. Labour health spokeswoman Ayesha Verrall said patients deserved better. Photo / Mark Mitchell Labour's health spokeswoman Ayesha Verrall, a former Minister of Health, said it was a 'a huge blow for women's health that there is no gynaecological cancer specialist in Wellington'. 'New Zealand's women deserve better than this. Cervical cancer, ovarian and endometrial cancers are common cancers and women should be able to be treated in this city, just like people with other cancers can be. 'Rather than planning to send women to Australia as a fall-back option, the minister should direct officials to attract our trainee surgeons back from Australia. 'Everyone should be able to stay healthy and get care when they need it – close to home, without the cost or the wait. Unfortunately, Luxon's cuts have hurt our health system, our doctors and nurses are stressed and it's harder and more expensive to get the healthcare we all deserve," she said. Government inherited workforce shortage – Brown Brown said the Labour Government's restructuring of the health system, merging the old district health boards into Health NZ, had distracted that Government from workforce issues. 'The previous Government left the health system in a state of uncertainty, focused on bureaucratic restructuring instead of recruiting the doctors and specialists we need. 'As a result, long-standing challenges like recruiting a gynaecological oncologist in Wellington were left unaddressed,' he said. Brown said he had 'requested further advice to ensure that New Zealand does not have unnecessary barriers to entry for specialised doctors'. 'The Medical Council of New Zealand does not allow separate scopes of practice, including for gynaecological oncology. 'That means that Specialist International Medical Graduates are not recognised for their subspeciality expertise,' he said. 'Since taking office, we've taken action – investing more into the health workforce, hiring over 2100 additional nurses, 600 more doctors, and growing the number of obstetricians and gynaecologists across the country," he said.
RNZ News
a day ago
- RNZ News
New medical school at University of Waikato boasts better cost-benefit ratio, case shows
University of Waikato. Photo: Supplied / Google Maps A new medical school at the University of Waikato has been found to have a better cost-benefit ratio than other options, although only slightly. The business case for the new school has been released, which said it would have lower operating costs than other options, and would produce a higher proportion of graduates going on to become GPs. The University of Auckland has raised concerns over some of the business case's assumptions, but the health minister insists the new school was the most effective proposal at building New Zealand's "critical" health workforce. Last week, the government confirmed it would move ahead with the Waikato school, and was confident it presented the best value for money. From 2028, students will be able to start at the four-year graduate entry programme, which is intended to boost the country's rural GP workforce. National had campaigned on establishing the school at the 2023 election, but a [ full cost-benefit analysis was required as a condition of its coalition agreement with ACT. The Ministry of Health dumped a series of documents on Friday evening, including various Cabinet papers and minutes, the cost-benefit analysis conducted by Sapere, and the Ministry's detailed business case. The business case looked at three options: increasing the intake at the existing University of Auckland and University of Otago schools, a joint rural training programme run by the two schools, and the new Waikato school. The first option was estimated to cost $10.9b over the years between 2026 and 2042, and deemed the more expensive option. The joint rural training programme was estimated to cost $10.27b over the same period, while the new school - the cheapest option - was estimated to cost $9.1b. While it had the most expensive capital costs ($236.3m) the new school's operating costs ($361.6m) were deemed to be cheaper than increasing the intake at the existing schools ($513.6m) or the joint rural training programme ($508m). The lower operating costs were due to the Waikato course being shorter, the business case said. Prior degrees were also out of scope of the business case, despite the Waikato course being a graduate-entry programme. Professor Warwick Bagg, Dean of the University of Auckland's medical school, said this meant it was not a fair comparison, as it did not take into account the total cost of education. Professor Warwick Bagg. Photo: Supplied "In order to enter a graduate programme, you need to have graduated from a degree. So that's a minimum of three years, possibly longer, but at least three years which will have been funded by the government if it's been completed in New Zealand," he said. The new school also had the most favourable cost-benefit ratio, at 1.986 (meaning for every dollar invested, the benefits were worth $1.99), compared to increasing Auckland and Otago's intake (1.495) and the joint rural training programme (1.798). Waikato was also estimated to have a much higher estimated proportion of new graduates that would go on to become GPs than the other two options. The analysis estimated 38 percent of Waikato graduates would become GPs, compared to increasing the intake at Auckland and Otago (23 percent) and the joint rural training programme (33 percent). However, this is only an assumption, based on figures from the University of Wollongong's medical school, which has been used as a model for Waikato's programme. "It offers a new model, provided by a new entrant, underpinned by proven performance in an Australian context. It offers the greatest opportunity to increase GP propensity," the business case said of the Waikato option. "Option 3's propensity to provide a pathway for GPs is a consequence of a purposeful curriculum, training environments connected to communities, and a different way of selecting students. It can do this as a new entrant medical school, whereas change in an existing academic institution may be more difficult." Bagg said the modelling seemed "experimental" and "speculative," and the Australian context was different to the New Zealand context. "There are very big incentives for rural general practice in Australia that, at least to date, haven't existed in New Zealand, and certainly not historically. That's an important market force that will change behaviour. To my way of thinking, they've used the most optimistic possible outcome that could be found to make the case for the new programme." He also said the rate of graduates from the existing universities working as GPs was "quite a lot" higher than what the business case reported, saying it about 35 percent were working as GPs eight years after graduation. The health minister is standing by the figures, saying Sapere's cost-benefit analysis drew upon information about the existing Auckland and Otago graduates, as well as from Australian universities with a similar curriculum to Waikato. Health Minister Simeon Brown . Photo: RNZ/Marika Khabazi Simeon Brown said the decision was a "game-changer" for the long-term growth of New Zealand's medical workforce. "The Waikato Medical School will offer a post-graduate medical qualification based on similar successful programmes in Australia. These programmes include a year-long primary care placement and encourage students to work in primary care settings following graduation. The selection criteria of students alongside their long-term placements in primary care will both support a higher degree of these medical students to work in primary care after graduation," he said. "The Waikato Medical School will support growth of the number of general practitioners who play a critical role in keeping people healthy in the community and in managing long-term health conditions outside of hospital settings. " Labour's tertiary education spokesperson Shanan Halbert said Otago and Auckland were clear that they would be able to produce more doctors faster, if they were funded to do so. "We've got to make sure we're comparing degree with degree, apples with apples, so to speak. Because what we're seeing, as an example, is that we're comparing degrees at different lengths already." The Green Party's tertiary education spokesperson Francisco Hernandez said the dumping of the documents on a Friday evening showed the government was not confident in the business case. "The cost benefit analysis repeats the main mistake the government has made that has made this such a flawed process - rather than engaging in good faith with Otago and Auckland, and running an open process for a new graduate programme, they have deliberately stacked the deck to produce the outcome they want," he said. "The cost benefit analysis also assumes no further cost escalations - and with the minister refusing to rule out further funding - we just don't know how deep the government's blank cheque will extend to back this flawed proposal." Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
