Hospital cuts


Bed cuts, emergency department (ED) closures – even hospital doctors ditched.

These proposals are revealed in a dire “discussion paper” doing the rounds at Queenstown’s Lakes District Hospital – and leaked to Mountain Scene by an out-of-town health source.

The author isn’t identified but appears to be a senior administrator at Invercargill’s Southland District Health Board.

The potential cuts come to light just weeks after lobby group the Wakatipu Health Trust – pushing for a health services shakeup – revealed Queenstown’s hospital is already underfunded by SDHB.

The bombshell document says hospital medical staff claim spiralling ED numbers “create clinical risk for the patients and potential health and safety risks for staff”.

SDHB’s author acknowledges “the current demand at LDH with the current configuration of healthcare…is at about the limit that can be reasonably expected…”

Despite this, the discussion paper mostly centres on cost-cutting.

LDH’s 6000 ED patients per year are blamed – two-thirds, it’s claimed, turn up for free treatment with non-urgent or minor ailments instead of going to GPs.

Those GPs are also blamed – their high fees and unwillingness to do callouts outside medical centre hours are driving people to LDH, the document claims.

SDHB could “stop the walk-in patient presentations” by closing LDH between 8pm-8am to all patients except those delivered by ambulance or admitted by GPs.

LDH could then ditch one or two doctors, the document says, at the risk of patient backlogs each morning.
Queenstown’s hospital is currently believed to have seven doctors.

Two other options canvassed for cutting hospital doctors have both been tried unsuccessfully in the past.

First, LDH could ditch its own doctors and “contract the full provision of [hospital] medical cover to local GPs”.
“[GPs] would assume responsibility for seeing all patients and could choose whether to do this [at medical centres] or as an [ED] patient at the hospital,” the document says.

There are risks, the author admits: “Some GPs may not be experienced [enough] to manage [serious] patients.”
But: “[SDHB could] provide training [for inexperienced GPs] through Southland Hospital.”

Another way of cutting hospital staff would be for GPs to run private clinics at LDH for low-priority ED patients.
This idea was also tried and scrapped in 2004 – for the very reason the paper’s author then outlines:

“Patients may be reluctant to pay a GP consultation fee when they present to a general practice based on the hospital grounds.”

Another possible cost-cutter is slashing LDH inpatient beds – by half – to just five.

Last month’s indictment by the Wakatipu Health Trust claimed bed numbers are already below par – based on population, LDH should have 13 beds.

Halving beds would save an entire nursing shift, says the leaked document, but there’s “a potential increase in the number of transfers to Southland Hospital”.

St John may not cope with such an ambulance shuttle service and hospital “bed block” could result at both Invercargill and Queenstown. Nurse cover in LDH’s maternity ward could also be jeopardised.

Still, muses the author, “closing beds [at LDH] will force a change in bed usage and may decrease soft admissions”.

“Soft admissions” is thought to mean patients hospitalised unnecessarily.

The paper also briefly discusses a possible boost of LDH medical staff to cope with growing patient numbers.

Yet this conflicts with the money-saving theme throughout the entire leaked document, whose author says:

“It is quite clear the DHB has no financial capacity to sustain increased or even current costs.”

Wakatipu Health Trust spokesperson Maria Cole tells Mountain Scene she’s “dismayed by the apparent possibility of a further reduction of staff at LDH”.

She contrasts SDHB’s treatment of Queenstown with the Ministry of Education, which is building a new Frankton primary and planning a new secondary school.

“The [SDHB] document confirms the issues the trust has raised over the past 12 months.”

Elderly bed shuffle

Whatever cuts occur at Lakes District Hospital, six elderly-care beds appear likely to go.

The beds pop up in this week’s announcement by Presbyterian Support Services of its sale of the 28-bed Wakatipu Home for the Elderly (left).

North Island resthome operators John and Heather Rogers are buying the resthome, which adjoins LDH.

The Rogers want to move LDH’s “hospital-level beds” into their resthome, PSS says, a move foreshadowed in February by SDHB boss Brian Rousseau.

SDHB’s long wanted to get rid of LDH elderly-care beds, and the PSS-Rogers deal is conditional on DHB approval.

In February, Rousseau pledged the six beds would be converted to extra hospital beds to boost LDH’s patient capacity but that now looks doubtful.