Hospitals warned of bed shortage a year before dire winter

Senior North Shore Hospital staff told Government officials failure to add more beds quickly would have dire consequences - a year before a flood of winter patients overwhelmed the hospital.

But the warning in June 2006 by Auckland's three district health boards did not produce the recommended immediate increase and the hospital entered the winter of 2007 ill-prepared and short-staffed.

The hospitals' report, obtained by the Weekend Herald, said: "Investment decisions need to be made within the 2005/06 year in order to address the forecasted requirement in 2008/09."

Failure to act would lead to reduced elective surgery because acute patients would be given priority, productivity would shrink and, in a prediction proved right the next winter, patients would spend long periods in emergency departments which "may generate poorer-quality care with higher levels of patient dissatisfaction".

The report indicated the Waitemata board, which operates the North Shore and Waitakere hospitals, had 717 beds in 2006 and needed to add 14 within a year.

Since 2007 it has added more than 60 and has plans for another 55 by 2011.

Dwayne Crombie, who resigned in 2006 as the board's chief executive, has defended himself and former chairwoman Kay McKelvie against criticisms in Health and Disability Commissioner Ron Paterson's inquiry into the hospital's 2007 failings.

Mr Paterson's report last week accepted the Health Ministry's assertion that Waitemata might not have done enough to develop the services needed by its growing population.

But Dr Crombie dismissed this. "To pretend we didn't listen to their directions is just a hypocritical attitude," he told the Weekend Herald.

He said the 2006 report produced by the region's three boards and given to ministry and Treasury officials was clear evidence of the extra beds the district health boards thought they needed.

"Their response was, 'Well that's all very interesting; unless you can pay for it in your annual funding, we're not interested'."

Boards have to pay the capital charges and staff costs of extra beds.

Dr Crombie, now chief executive of Guardian Health Care, said that after capital spending of $170 million between 2000 and 2006, Waitemata's annual operating grant was insufficient to enable more beds to be provided because the grant was unfairly low.

Waitemata missed out on $135 million a year when compared with average funding per-head for the rest of the country, mainly because it had one of the wealthiest populations.

The ministry bases a board's funding mainly on the age, gender, degree of deprivation and ethnicity of people in its area - factors it says determine a population's health needs.

Dr Crombie said health and Treasury officials had forced down bed numbers in Auckland since the late 1990s on grounds this could be compensated by expanding primary-care access and shortening hospital stays.

He cited the Auckland board's reduction of about 100 beds in the construction of the new Auckland City Hospital.

A ministry deputy director-general, Anthony Hill, said yesterday that the 2006 report was not a formal business case making a bid for capital spending.

Any such case must ensure the board could afford the operational costs of the extra beds.

"The ministry notes that no business cases were received from the Waitemata DHB relating to additional acute beds until November 2008.

"Waitemata DHB's funding per person is less than the New Zealand average because their population is younger than average, has fewer people living in areas of high need and has smaller Maori and Pacific populations."

It was statistically healthier than the national average and was expected to have lower costs at a given age.

THE NUMBERS
* In 2002, the average number of acute care beds in developed nations was 4 per 1000 population.
* In New Zealand, there were 1.68 per 1000 in 2005.
* Auckland, the rate was 1.61 in the same year.
* Figures exclude mental health beds, emergency departments and disability support.
* Sources: Auckland health boards' report and Organisation for Economic Co-operation and Development