Closing Oamaru Hospital’s Emergency Department is “an absolute last resort”, says Waitaki District Health Services chief executive Keith Marshall.

“It's not a choice we ever really want to make.”

The hospital was forced to close its Emergency Department on Saturday and Sunday (August 12 and 13) nights from 5pm to 8am, after one of the doctors rostered on for the weekend fell sick. It was the third time in less than two months the department has been forced to close.

Keith said on this occasion, the existing medical team at the hospital managed to rearrange the roster to cover some gaps, and worked with Te Whatu Ora Health New Zealand to try and find extra cover.

“In the end Te Whatu Ora came back to us and basically said there wasn't a single doctor available anywhere in the system to cover the gap, which is a pretty unbelievable situation to find ourselves in.

“We shouldn't be in a position where we have to close ED. I mean, that's the bottom line, but we just can't open an ED without a doctor.” 

Keith said Dunedin and Timaru hospitals were briefed on the situation, and Hato Hone St John were “superb”, providing an extra ambulance both nights. 

“That's one of the things that's quite hard to convey, like it might sound like you end up blaming the system for there being no doctor, and nobody's piling in, but actually, Dunedin Public Hospital, Timaru, St John's, our doctors on staff, our nursing teams, everybody really does pile in. But that doctor shortage is just, yeah, kicking us badly at the moment.” 

There is a shortage of about 2000 doctors nationwide, which comes from a combination of factors, Keith said.

“We probably weren't investing in enough doctors 10 years ago. You don't make a doctor overnight, you know, it’s five years of medical school plus two years of sections to get MD after your name, followed by three or four years worth of experience.

“So this problem goes back, and it's an under-investment in medical training, but equally - which is the other thing New Zealand doesn't like to talk about - equally, we need to make sure that the pay in terms of conditions is equivalent or similar to Australia.

“And Covid locked everybody down, the borders suddenly opened, pay rates around the world have lifted substantially . . . this has really come home to roost, really, in the last five or six months.”

The situation was not going to be a quick fix, and it was the same in general practice, he said, with North Otago medical centres unable to take on new patients.

Oamaru Hospital has always relied on locums to fill gaps in permanent staff, and in the past it has not been a problem.

“But those locums now, that we would normally rely on, we just can't find. And partly that's because Te Whatu Ora is short of doctors, so they've been hoovering up all the spare locums and they are paying more than we can pay.”

Waitaki District Health Services, which runs the hospital, is a council controlled organisation, but has a funding contract with Te Whatu Ora for provision of health services to the district. 

A new contract announced in March this year, meant an additional $3.5m for the hospital each year, on top of about $11m the hospital received annually, in order to provide pay parity to nurses and other support staff.

Trying to find the “light at the end of the tunnel” is part of the discussion with Te Whatu Ora. If the hospital can pay the locums at the same rates, that would help solve the problem, Keith said.

“Or alternatively, if Te Whatu Ora had locums, then actually one of those could come to us instead of being taken up as a second on call or a second support.”

He had been asked over the last few days by various people about whether he was confident or hopeful about being able to fix the situation.

“And I think I'm both confident and hopeful.”

Positive conversations with Te Whatu Ora make a difference, and it is a problem which can’t be solved without the organisation’s support, but that is the “cleft stick”.

“We really need their help to solve it, but actually, we could solve it on our own if we could get access to those locums . . . it's just tricky at the moment.”

The hospital is in positive talks with a husband and wife team of doctors, who are coming from the United States and due to start in the new year, which will make a big difference, he said.

There are also other “recruitments in play”.

“Things are, sort of, in place to change the situation, I guess, and I think the better that working relationship with Te Whatu Ora, the better we can look at a whole system response.”

Another positive is, since the funding boost in March, nurse recruitment has turned around and within months he expects the nursing roster will be fully staffed.

“We were horrendously short at the beginning of the year, and our nursing teams were pulling amazing shifts, doing an amazing job . . . again, it's about valuing and paying these people what they should be paid. 

“You know, the fact that up until now Oamaru Hospital hasn't done that pay parity, I think is a bit of a travesty, you know. The right thing to do here is pay these people what they would get paid somewhere else.”

As for the Emergency Department in the short-term, Keith is hesitant to predict what might happen. Filling the medical roster is an ever-evolving beast, and gaps which are present two or three weeks out, can be filled with locums as the time nears and locums confirm. 

This is a “normal course of events” for the hospital.

“You know . . . the first time we closed the ED, about six weeks ago, right up to six o'clock of that night we very nearly had a doctor to cover the gap.”

It was better to err on the side of caution and be prepared, he said.

“We try and take the precautions a couple of days before, so that we're, you know, looking at patient acuity and making sure people are stable and things like that, so that we've got the cover in place to look after patients in that way.”

Patients who required it had been transferred to Dunedin Hospital last Friday. There were still doctors rostered on during the day, and if somebody went down hill during the night, a senior doctor could be back inside the hospital in 15 minutes, he said.

“So, you know, it's about, how do you do that cover and do it sensibly . . . but by the same token, you don't want to run any risks … you don't want to spend the entire weekend living on the edge of it.”

Keith reiterates the problem is one the hospital can not solve on its own. It is important to work alongside Te Whatu Ora, which he said had “been fantastic”. Dunedin and Timaru Hospitals had also been great, but everywhere is struggling.

Timaru and Dunedin are also dealing with doctor shortages, and Timaru had been accepting patients from Ashburton, who are also short, he said.

“Nobody's in perfect condition here . . . Which is why we need to think, ‘how do we solve this problem on a bigger scale, rather than just, you know, hospital by hospital’.” 

Meanwhile, Keith himself is “exhausted”. 

The work he does is not for recognition, he is not seeking sympathy, and he doesn’t consider himself more special than a dozen other people in the hospital who are working harder than they should to keep it running.

“This is about, this hospital is really important, and I've been working six and seven days a week for nearly two years now, and I'm just worn out.”

He understands people are upset over the Emergency Department closure.

“Why wouldn't you be upset? We shouldn't be closing an ED. You know, we should not find ourselves in this situation, and that pisses me off as well. But, at the end of the day, if there are no doctors, we cannot open an ED.

“You know, I understand the frustration and the anger and the anxiety that it causes, but you know, we are all working incredibly hard and burning way too many hours, and it's not a problem we can just solve just here.”