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Hospital employees in New Zealand filed more than 23,000 formal reports warning of unsafe levels of staffing in the past three years, a Weekend Herald investigation has found.

Figures obtained under the Official Information Act (OIA) reveal that some wards and departments racked up hundreds of unsafe staffing reports as workers repeatedly alerted their bosses to critical shortages. One service in Porirua for people with severe intellectual disabilities recorded more than 1,000 incidents in a single year.

The number of these reports recorded by district health boards (DHBs) more than doubled in the three financial years before the boards were merged, which health officials say is partly a result of better reporting. But it also starkly illustrates how the Covid-19 pandemic has pushed already-strained hospital services to breaking point.

The investigation also found that hospitals recorded 22,870 incidents of violence, aggression, or harassment against staff in the same period - a rate of more than 20 such incidents per day nationally.

Anne Daniels, president of the New Zealand Nurses Organisation (NZNO), said these figures likely understate the frontline pressures because staff are often too busy and stressed to complete the paperwork required to report incidents, or do not bother to do so because they think their concerns will be ignored.

“The staff are so tired and exhausted and demoralised, and have lost faith in anything changing,” said Daniels, who is an emergency nurse in a large hospital in addition to her position at the nurses’ union.

Sarah Dalton, executive director of the Association of Salaried Medical Specialists (ASMS), the senior doctors’ union, said the strain on hospital employees is “definitely worse” now than when the figures were recorded, based on what she is hearing from members around the country. “People are very tired indeed.”

The health sector was in the spotlight again this week after Prime Minister Chris Hipkins, announcing a review of Covid-19 restrictions, said the system is better now than before the pandemic. National leader Christopher Luxon told the AM Show Hipkins was “gaslighting the New Zealand people, saying everything’s fine in health care and it’s frankly not”.

In recent months, a cascade of media reports portrayed a health system sinking deeper into crisis, with emergency departments overflowing, patients experiencing long delays for treatment, and nurses leaving in droves for Australia. Our investigation indicates that the staffing pressures may be more widespread than the media coverage suggests.

Emergency departments rank highly among the services with the most incidents, but cardiac, cancer, maternity, mental health, general surgery, and many other services also feature. Among the specific problems we identified:

• One specialist team run by Capital & Coast for people with severe intellectual disabilities had 1,204 unsafe staffing reports in 2020-21, up from 44 the previous year and by far the highest number recorded by any of the services for which we obtained data. A spokesperson blamed increasing demand from patients with “very complex and challenging needs” at the same time as workforce shortages due to illness and departures.
• At Wellington Regional Hospital’s cardiology ward, Ward 6 South, unsafe staffing reports jumped from 17 to 472 in three years. There was also a sharp increase in reports at Ward 7 North, which cares for general surgery patients. Last June, staff representatives served a formal notice on hospital bosses calling for all but life-saving surgeries in those wards to be suspended until the staffing situation improved.
• Reports by staff in Auckland DHB’s maternity service leapt from 14 to 355 in three years. Auckland’s child health division, which includes general and specialist paediatric services at Starship Children’s Hospital, had a ten-fold increase in the period, to 393 unsafe staffing reports last year.
• Southern DHB’s specialist mental health unit, which includes secure facilities for people with severe mental illness, dementia, and intellectual disabilities, recorded 714 incidents of violence or aggression against staff last year, up 205 per cent in three years.

NZNO’s Daniels said the problems in these services are “the tip of the iceberg” and the nursing situation nationally is “going downhill rapidly”.

“We’re not able to do our jobs safely,” Daniels said. “We’re not able to provide timely, safe care. We’ve gone beyond desperation.”

�ճ����Weekend Herald used the OIA to request data from all 20 former DHBs on reports received from employees concerned that staffing levels in their services were putting them or patients at risk.

Historically, there has not been a standardised system and process for collecting and monitoring this information. Instead, data was fragmented across different regions which had their own systems and safety cultures.

Te Whatu Ora - Health New Zealand, the new national body created by the merger of the DHBs in July, repeatedly delayed supplying the data. Eventually, it provided figures for 18 DHBs. Waitemata and South Canterbury said they did not hold data on unsafe staffing in a way that was readily retrievable.

Taken together, the data points to a significant increase in unsafe staffing in the past three years.

In 2019-20, hospital staff filed 4,283 reports flagging unsafe staffing levels. A year later, that climbed to 9,713. Reports dropped slightly in 2021-22 to 9,461, but this was still more than double the number filed two years earlier.

Capital & Coast had a 130 per cent increase in reports in three years. In Auckland, they rose by 222 per cent. Canterbury’s rose by 282 per cent.

Reports also more than doubled over three years in Bay of Plenty, Hutt Valley, MidCentral, Nelson-Marlborough, Wairarapa, and West Coast.

Te Whatu Ora said there are several reasons for the upward trend, including a greater emphasis by regional authorities and staff unions on reporting incidents, so that gaps can be detected earlier and resources allocated more efficiently.

Hospitals are also dealing with more patients with pressing, complex problems that require specialised treatment.

But officials also acknowledged there are grave shortages in the medical workforce that have been years in the making.

“We know our workforce in Aotearoa is under pressure and has been throughout our response to Covid-19 over the past few years,” said Jim Green, chief people officer at Te Whatu Ora.

Te Whatu Ora said it is now tracking unsafe staffing incidents centrally.

In October, the first month for which that data was available, it recorded 876 incidents of inadequate resourcing across the system, a rate of 28 per day. These dropped over the summer, when there is typically less demand for hospital services, to 665 in January, the authority said.

�ճ����Weekend Herald also obtained figures showing the number of reports of violence, aggression, and harassment against hospital staff. These incidents rose by 9 per cent nationally in three years, with several DHBs recording double-digit increases. In the Southern region, the number more than doubled.

Te Whatu Ora’s Green said there is a global shortage of skilled, experienced clinical workers, and “Aotearoa is no exception to these trends”.

Shortages were compounded by the coronavirus pandemic, which caused more people to need acute care, disrupted hospital operations and thwarted recruitment plans taking many frontline staff out of action because of illness.

Green said Te Whatu Ora has several initiatives in place to plug staffing gaps and grow the health workforce. These include an international recruitment campaign to entice foreign-qualified clinical workers to New Zealand, funding for more domestic training places, and incentives to encourage nurses who have left the workforce to return.

Te Whatu Ora has also implemented measures to reduce violence and aggression against staff in hospital services, including training staff in “de-escalation procedures”.

This week, the Government announced changes to immigration policy that will make it easier for foreign workers in 32 health sector roles to get residency. Hipkins said the Government recognised more needed to be done to attract skilled workers from overseas.

Dalton, from ASMS, said the measures to bolster the workforce have so far amounted to “little bits and pieces around the edges”, but have not relieved the pressure. And there are growing concerns about how hospitals will cope in winter when demand for acute care typically increases.

“We are not well positioned,” Dalton said. “We’ve got really, really sick people that need to spend time in hospital, and we have a system that is bulging at the seams.”

HELP US INVESTIGATE

�ճ����Weekend Herald will continue reporting on the crisis in New Zealand’s health workforce and we need your help. Do you have information on this topic? Have you or someone you know missed out on treatment because of capacity problems? Are you a hospital employee working under difficult conditions? Do you have documents that can help us shed light on these issues?

We want to speak to as many people as possible who have experience in the system, to ensure our reporting is thorough and accurate. You can reach the Investigations Editor Alex Spence by email ([email protected]), secure Signal messaging (0272358834), or post (The New Zealand Herald, Private Bag 92198, Victoria St West, Auckland CBD 1142.) We can’t reply to all submissions because of the volume we receive. We will not publish your name or identify you as a source unless you want us to.