Shane Reti: Our bulging hospitals and primary care

The waiting time to see a GP can be days or weeks away so people go to A&E. Photo / Andrew Warner

Nearly every day, people are contacting me from all over the country saying they now have family members admitted to hospital corridors because there are not enough hospital beds.

Earlier this year Otago DHB announced a black alert, which is where DHB resources are critical, and I am hearing of ambulances being redirected and long emergency department waiting times all over the country.

The overwhelming of our health system has many layers and is a very challenging situation to unpick but I want to focus on A&E as the gateway to hospitals and A&E waiting times.

One argument for why there are fewer resources for hospital beds and long waiting times is because A&E is blocked with people who should see their GP. The argument continues that one reason people go to A&E is because of cost.

I think there are multiple factors, including GP provision during business hours, outside of business hours and transport issues to name a few, but if we focus on cost the data tells an interesting story.

I recently asked the Health Minister for data over the past five years for all children under 14 who had been to A&E and were not admitted.

I asked this because, from December 2018, children under 14 are free at the GP and so the cost barrier is removed. With data, over time we can see the policy impact. That is, did fewer children under 14 still go to A&E when the cost for them to see their GP was removed?

I would add that the fact they were sent home from A&E and not admitted is a rough proxy for conditions generally suitable to be seen in general practice.

In some DHBs, a quarter of all children under 14 were seen at least once a year in A&E.

What the data also shows is that after the policy started and children under 14 were free at the GP, there was no immediate impact, with nearly the same number of children continuing to attend A&E and only a modest reduction leading up to the coronavirus lockdown.

One conclusion then, is that for children under 14, cost was not as much of a barrier as the other factors in my original arguments around the provision of primary care, namely that people take their children to A&E because they cannot be seen at their GP.

This is also what many people tell me, that the waiting time to see their GP is days or weeks away or that there was no after-hours provision, so they went to A&E.

It is clear we need more hands at the tiller and I want to thank our hard-working doctors and nurses in A&E and primary care teams who are battling away.

I do have concerns that the announced $486 million health restructuring will create uncertainty, that there will be a long transition period where things may get worse and that it is all focused on layers of bureaucracy, rather than health outcomes.

My Facebook page shows what happened when I raised this with the minister. Thank you to those at the coalface.