A. and E. Under Threat

 Nurses and emergency doctor alarmed by DHB’s plans to ditch after-hours service

 By KI reporters and Wellington Scoop

The NZ Nurses Organisation (NZNO)says its shocked that the Capital and Coast District Health Board is considering removing the last after-hours health service in the Porirua area.

Its remarks echo a call from an emergency doctor to keep the clinic open.

Under the plan, the accident and medical clinic at Kenepuru Hospital would close from 10pm to 8am, seven days a week.

The NZNO says the Board made the decision to investigate the possibility of replacing after-hours services with a roving paramedic service for over 100,000 people at a secret Board meeting and are not considering any other options.

The NZNO is the union and professional voice for nurses throughout the country. Organiser Laura Thomas says:

OK to disadvantage low socio-economic group?

“We can’t help but wonder what would happen if the DHB decided to do the same in Wellington. Even thinking about that is laughable. The DHB seems to think that it’s OK to disadvantage a low socio-economic population with high health needs though.

“Residents in the region north of Wellington suffer some of the highest rates of preventable illness in New Zealand and yet their current after-hours health service is not free and now the DHB is trying to take it away altogether.

Emergency doctor worried too

And the possible closure of the accident and medical clinic has been labelled ‘dangerous’ by emergency doctor Rob Kieboom.

“If it goes ahead, people would have to wait in their homes for medical treatment or drive to Wellington Hospital – something many low-income families could not afford,” Dr Kieboom has told the Dompost.

Dr Kieboom has worked at the clinic as a contracted doctor for five years and works one overnight shift each week, alongside two emergency trained nurses.

He questions whether paramedics, who are not medically trained, have the skills and equipment necessary to assess and treat acute patients in their homes.

“Maori and Pacific Island children have high rates of meningitis, rheumatic fever, acute respiratory distress and sepsis [blood poisoning]. Older patients have a high incidence of strokes, heart attacks and acute abdominal pain,” he says.

“These sort of patients present to the centre overnight. These patients cannot wait for . . . a paramedic to come to their house.”

 Nurses’ union outlines case for DHB

In its detailed statemen, the Nurses Union also  urges the DHB to ensure “everyone in their catchment can access the health care they need when and where they need it, not downgrade it.”

Organiser Laura Thomas says: “Demand on the current service is increasing and the DHB should be facilitating easier access to it.

“We are also sceptical of the reasons for the change put forward by the DHB. It is our understanding that the current after-hours service is entirely cost-effective and that cutting it would only increase pressure on an already stretched emergency department at Wellington Hospital.

“NZNO will be continuing to urge the DHB to consider proposals that would prioritise the health of the residents of Kapiti and Porirua. We will not let 100 000 people become the victims of short-sighted ‘cost-cutting’ measures.”

New Zealand Nurses Organisation
The New Zealand Nurses Organisation (NZNO) is the leading professional body of nurses and nursing union in Aotearoa New Zealand, representing more than 45 000 nurses and health workers. Te Runanga o Aotearoa is the arm through which our Te Tiriti o Waitangi partnership is articulated.

Its members include nurses, midwives, students, kaimahi hauora, health care workers and allied health professionals. The NZNO vision is “Freed to care, Proud to nurse”. Our members enhance the health and well-being of all people of Aotearoa New Zealand and are united in their professional and industrial aspirations.

Plan to close after-hours clinic overnight 

Comment by Kris Faafoi:-

“I realise there may be concern but I think there could be some real benefit for our communities in the new proposed model.

“I am waiting to see more detail but I know that the overnight service is a serious threat of financial viability and the alternative being proposed could see families who require urgent medical care get it in their own homes rather than having to travel to After Hours.

“In the end the level of service is the key factor. I have been told the trial of the service in the Kapiti Coast has been successful and I can see some benefit to having medical support going to patients, especially those families who may not have transport.

“Whatever service is offered it has to be at the same level as going into Kenepuru A&M. I look forward to seeing more detail. Patient service is the priority.”

Good job IMO ! it never gets used for kapiti people, we always have to go to wellington ED and sit in the hallways for hours and hours.
Didn’t you know this Alison ?
Its the Doctors and specialists that are failing to take a stand IMO, they have the strongest lobby with the Govt.
The hospital, staff and environment is 100 times more pleasant than wellington but we on the coast never get to go there ! so why wouldnt they c;lose it ?
Everybody needs to wake up to the fact that you CANNOT rely on the current public health system, its been getting steadily worse and more costly every year for the past 20 years IMO, the same as the schools, railways, roading etc.
Believe it or not there is a Hospital facility in Kapiti ! lol, I dont know what its used for ! the iwi health service works from there and is the best practice I have experienced in 50 years.
Seems like health workers are not liking shift work ?

I don’t know what pilot is going on in Kapiti, but as a family doctor who has worked in the UK and Kapiti and currently working in an area akin to Cannons Creek, let me tell you, if you close your A&M the ED in Welly with be swamped with ‘minor illness’ (so called) – as Laura Thomas of the NZNO states. Then those who really are in need of ED care will languish in the corridors waiting.

One of our targets as GPs here is to reduce the number of our patients attending the ED. Despite having an excellent 24h A&M here, my patients still attend the ED for stuff that does not need to go there, where they are over investigated and treated, by grumpy staff who (understandably) resent their presence and do not have the skills to manage their complex health needs. (And neither do – or should – paramedics!) We GPs are at a loss as to how to get people to ‘go to the right place’ despite free helplines, 100% taxpayer funded medical care and leaflets / websites / etc. Will Kiwis be any different – my experience is that NZ and the UK are very similar as far as health is concerned.

Kris Faafoi needs to understand that what is ‘urgent’ to a patient is not what is urgent to a doctor – and what is urgent to someone from Cannons Creek is different from what is urgent to a person from Khandallah. Urgent does not necessarily mean life threatening and the ED is for emergencies, hence its name – which is not the same as urgent which can be purely for many different social reasons….

Closing the Porirua A&M would be a huge step back and the incidence of third world illness in NZ such as rheumatic fever and meningitis would increase. Meanwhile the standard of care for those who really need it at Welly ED would decline rapidly. Don’t do it!