Fears Gisborne Hospital services on brink of collapse due to critical staff shortages

Some Gisborne Hospital services are on the brink of collapse due to critical staff shortages, with 30-40 percent of senior doctor positions unfilled.

In July, 38 senior doctors from the emergency department, obstetrics, gynaecology, paediatrics and other specialties wrote to then Health Minister Shane Reti warning "a mass exodus may occur" and the "viability" of the entire hospital was under threat.

Seven months on, they have written another desperate appeal to new Health Minister Simeon Brown and Prime Minister Christopher Luxon to say the situation remained dire, despite 14 meetings in that time to discuss the workforce crisis.

"In fact we have lost doctors to resignations but have no new SMO [senior medical officer] colleagues at our sides, except for locums plugging some of the gaps," they wrote on 21 March.

"Critical departments like radiology, psychiatry, otolaryngology (ear, nose and throat) and anaesthesia still have more than 2 in 3 posts vacant.

"Our internal vacancy rate is now 44 percent."

Doctors were "horrified" by the collapse of maternity services in Whakatāne "and fear a worse fate awaits our community, with only 3 permanent SMOs maintaining our obstetrics and gynaecology service in Tairāwhiti".

"The drive from Whakatāne to Tauranga puts mothers and babies at risk - our referral centre is only available by flight - when weather permits and a flight team is available."

Without an influx of more doctors within four weeks, the medicine service would have to close multiple days a week, "requiring transfer out of all medical admissions and depriving our surgical services of advice on our older, medically complex patients ... harm to our patients will be inevitable".

Senior doctors were also having to shoulder an increased burden of admin work after "so-called back office colleagues" were not replaced.

Internal medicine specialist Alex Raines, who signed both letters, told RNZ that patients had already been harmed as a result of the pressure on services.

"Our ophthalmologist talked about people who were losing vision because they couldn't get in to be seen.

"Those are the clear cut cases. What I always worry about is the ones we don't see - the ones who we don't know about because they didn't come in because their appointments were so delayed they gave up, or maybe even died waiting for care."

The trigger for the follow up letter was the "alarming" realisation that not only had they not made much progress, but were "actually worse off than when we started this".

"As we warned, we have services that are at risk of imminent collapse without the arrival of new doctors, so it felt like time to raise the alarm again and see if we could get any significant intervention, as we asked for the first time."

Recruitment efforts underway - Health NZ

Te Whatu Ora group director for Tai Rāwhiti, John Swiatczak, said the the region had "long-standing issues with recruiting and retaining specialist clinical staff".

"We are doing everything possible to fill vacant Senior Medical Officer (SMO) roles, which were at 37 percent in February. All requests to recruit have been approved."

Since August, the hospital had hired 8.2 FTE (full-time equivalent) senior doctors, while another 11.1 had accepted offers but were yet to begin work.

"Two other offers are with candidates for acceptance and three more are at interview stage. We are actively advertising a further 21.3 FTE SMO roles."

Meanwhile, senior doctors and management teams worked together on rosters and planned ahead to maintain patients care, he said.

"Leadership and advice from our senior doctors has improved the efficacy of the recruitment campaign and we will continue to meet weekly with the Tairāwhiti SMOs to focus on the priorities of attraction, recruitment and retention.

"We are committed to ensuring that our clinical services are maintained with locums while we recruit to permanent roles."

Health NZ was currently in discussion with the Association of Senior Medical Specialists - which represents senior doctors - over its proposal to attract and retain staff, after its initial response was rejected.

Other actions underway included providing administration support to senior doctors "to help them focus on care", fast-tracking registration applications from overseas doctors and setting up a medical recruitment unit.

Union calls for special Tairāwhiti allowance

The Association of Salaried Medical Specialists said the figures supplied to the union by Health NZ differed to those given to RNZ, with just 1.2FTE permanent doctors hired since August and seven on fixed term, a further 7.1 had accepted offers but not yet started, and two fixed-term offers were with candidates, another three interviews pending and 19.3 permanent and two fixed term roles being recruited.

Executive director Sarah Dalton said there was agreement from the employer that a 35 percent - "now more than 40 percent" - staffing vacancy rate among senior doctors was in fact a crisis.

"Our members have suggested that the Minister might want to come and host a welcome morning tea for the newly recruited staff so they can locate them because they are struggling to find out what that data means and who it refers to."

The union wanted a special Tairāwhiti allowance to attract and retain staff, but Health NZ was unwilling to commit, she said.

"We have in fact being trying to negotiate nationally for rural allowances and 'hard to staff' allowances and for 'public only' allowances for doctors who choose to work only in the public system, to try and address those issues around the country, because Tairāwhiti may be the most extreme example, but it's just one among many."

Raines said it was not enough to "paper over the cracks" with a few locums, and recruitment still seemed painfully slow, with every decision requiring sign off "from up the line".

"We need people outside Tairāwhiti to take this seriously.

"All I've been hearing so far is ways to redirect the blame back down to local management.

"From the beginning, they've tried to put the responsibility on our local management here, but have not given them any extra resources to address the problem.

"I have no doubt that local management care about our community and about the care we provide and getting the staff we need here, but they've been handcuffed from the beginning as far as the resources available to them to actually do that."

Health Minister responds

In a statement, Minister of Health Simeon Brown acknowledged he had received the letter and had asked Health NZ to engage directly with clinical leadership.

"Timely and quality access to healthcare for the people of Tairāwhiti is a priority for our government. That's why we're investing record funding into the health system and putting the focus back on frontline care for patients."

He noted his predecessor, Dr Shane Reti, met with clinical leaders last year and Health New Zealand had subsequently developed a recruitment plan. An "active national and international recruitment plan" was now underway, Brown said, "with all recruitment requests approved".

"Unfortunately, under the previous government, the number of Senior Medical Officers at Gisborne Hospital dropped significantly - from 58.9 FTE in 2022 to 51.8 FTE in 2023.

"Health NZ is now focused on reversing that decline."

Recruitment was "actively underway" for 10.8 FTE positions, Brown said.

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