Cancer care delayed by nursing cuts

By MARTIN JOHNSTON health reporter

Auckland Hospital has cut the capacity of its intensive care unit to save money, forcing delays in cancer surgery.

Several months ago - and against clinical advice - the Auckland District Health Board management required the unit to cut $300,000 off its annual bill for nurses' pay.

The unit cut its establishment number of fulltime-equivalent nurses to 64, from 69.

The unit's clinical director, Dr Colin McArthur, said yesterday that the actual number had fallen to about 60 because of the board's hardening its recruitment freeze in May and June in response to a "blow out", and the worldwide shortage of intensive-care nurses.

This meant it could care for only 10 to 11 patients on a one-to-one nursing ratio, compared with 14 to 15 previously, although several more patients could usually be accommodated because some were less sick and needed less attention.

The senior doctors' union exposed the cut while objecting to board chairman Wayne Brown's assertion that the board had chopped its 2002-2003 deficit to $49.7 million, from $74.2 million, "without cutting services".

Ian Powell, executive director of the Association of Salaried Medical Specialists, said this was a misleading claim made to satisfy the Government.

Mr Brown could not be contacted but board spokeswoman Brenda Saunders said yesterday that his statement was correct.

"The issue is their interpretation of cutting services.

"A service as a whole has not been cut in the sense of cut out."

Dr McArthur said that in the past two months the cut had forced delays of up to one week for 15 to 20 patients waiting for major elective surgery, including cancer treatment.

Also, some patients who would normally have been discharged to the intensive care unit after surgery had instead been sent to a standard ward. Others had been discharged earlier than usual from the unit to a ward and one or two of them had to be readmitted to the unit because their condition deteriorated.

The cut had not caused any deaths or other bad outcomes for patients, he said.

"We made it clear [to managers] what the effects would be, that we were going to take the risks I have described: deferral of elective surgery, early transfer out with the risk of readmission.

"The risk was noted and accepted as being what we had to do to deal with the financial reality."