Heroic efforts in understaffed norm: How many full-time equivalents do we need, exactly?

Published: November 23, 2022

This column by ASMS Executive Director Sarah Dalton previously appeared in NZ Doctor magazine.

Like so many of our hospitals around the motu, Middlemore in south Auckland is too small to meet the needs of the population it serves. It is also critically understaffed.

October’s headlines highlighted, once again, the effects of underfunding and understaffing of healthcare services.

The death of a patient who had left the Middlemore Hospital waiting rooms without being seen highlights how these deficits can create pitfalls with tragic outcomes.

The subsequent report showed the emergency department was 30 per cent over capacity with staff scrambling to keep up.

This is fast becoming the norm. When interviewed by RNZ, I found it all too easy to rattle off half a dozen hospitals around the country with maxed-out EDs.

I also noted the Northern Region Long Term Investment Plan of 2018 pointed out the need for another hospital somewhere in south Auckland.

These infrastructure and staffing issues are not new nor are they limited to public hospitals. We all know the workforce is too small, too unevenly distributed, too reliant on heroic efforts to fill the shortfall and staffing gaps.

Unmet need

Each year thousands of people aren’t being treated or seen in community settings when they need to be, due to this pressure. But, while we can and do measure the unmet need in primary care, we simply do not know the true extent of unmet need in hospitals.

We don’t know because we don’t measure it. Equally, we haven’t bothered to properly map, track or plan for our health workforce.

How many full-time equivalents do we need, exactly? We are not sure.

What is the headcount? Who knows?

Where do they work and with whom? Err, uncertain.

Te Whatu Ora has created the Workforce Taskforce to address this issue. It is tempting to decry, “Oh my God! Another taskforce!” But let’s keep our glass half full just for a moment and consider its brief. “The taskforce provides an enabling function for a whole-of-system workforce view recommending options for the removal of barriers to our desired future workforce state – an agile, responsive, inclusive workforce that is underpinned by Te Tiriti, pae ora [healthy futures] and equitable outcomes.”

But, like so many other health initiatives, this group is fettered by New Zealand’s insufficient health budget.

This Government has put more money in the pot but, if we’re serious about rebuilding a system that provides equitable access, timely care, training and improved outcomes, and ensures public hospitals can function, we must invest a lot more.

Give change a chance

Positive system change needs to be front-loaded and given some “oomph” to get us under way. Alas, we’re already hearing the familiar lines echoing those of the DHB era about the need for savings. Or whether to invest in option A or option B, when we need both plus C, D and E as well.

By the time this column lands, the Association of Salaried Medical Specialists will have launched two discussion papers about health reform and the need for greater investment in health.

The first is Workforce: the make or break of the health reform. It is a cracking piece of work from our prodigiously hard-working and talented policy and research team. It’s one to share with your boss, the local MP and health ministers. I’m confident it will make its way to the boards of Te Whatu Ora and Te Aka Whai Ora and will be read with care.

However, feel free to point them in the direction of your favourite of the 13 key recommendations within the report.

It’s hard to pick favourites, and possibly counterproductive when it comes to reports, but two recommendations urgently need adoption.

These are: “Undertake a regular health workforce census to support strategic planning across all health professional groups” and “Approach health service design and delivery collectively, harnessing the clinical experience within health workforce and engaging with communities.”

Like all the recommendations, these two link to the Interim Government Policy Statement on Health 2022– 2024. Both are eminently doable.

The second paper has been prepared for our annual conference and has been written by Max Rashbrooke. Entitled A fully free public healthcare system, this paper is a compelling reminder that we could improve our economic wellbeing by investing more directly into people’s health and into our health sector. It also reminds us that public healthcare is part of the public good and part of the shared interests we all have as citizens.

I particularly like the line, “Leaving individuals to pay for so much of their own healthcare represents a collective failure to adequately invest in that public good.” It’s a good talking point to those who think smart economic policy is a tax cut.