The Nelson Hospital redevelopment has been on the table for a number of years, due to increasing demands from a growing population. Photo: RNZ / Samantha Gee
Persistent delays in recruiting medical staff for Nelson Hospital has been compounded by ageing infrastructure and increasing demand for services, a review of the hospital has found.
The review - released on Wednesday - comes after senior doctors publicly raised their longstanding concerns over staffing and patient safety which had led to waitlists blowing out and, in some cases, people waiting months for treatment at the hospital.
Health New Zealand flew senior clinicians to Nelson in April to look further into the issues that had been raised.
The report has been released publicly this afternoon and its findings have been accepted.
Health New Zealand national chief medical officer Dame Helen Stokes-Lampard said a plan would be put in place to address clinical issues, access to treatment, workforce vacancies and infrastructure constraints.
It would be overseen by Health New Zealand Te Waipounamu deputy chief executive Martin Keogh.
The Association of Salaried Medical Specialists executive director Sarah Dalton said the review failed to hold Health NZ to account, months after issues were raised and was little more than a "plan to make a plan".
"The review lacks timeframes, holds no leaders to account for these failures. Just last month Nelson Hospital was again in the news for booking "ghost clinics" in what appears to be an attempt to game the system in regard to first specialists' appointments numbers."
There was a "worrying trend of poor management and poor leadership at Nelson Hospital which the review fails to address" and it was a wasted opportunity to make positive change, Dalton said.
Health New Zealand Te Waipounamu deputy chief executive Martin Keogh and national chief medical officer Dame Helen Stokes-Lampard announce the findings. Photo: RNZ / Samantha Gee
The association was disappointed there had been little engagement with hospital staff and no consultation on the review's recommendations and findings.
The hospital, like many others around the country, simply needed more doctors, Dalton said.
"Short staffing and increased acute patient demand, coupled with a lack of accountability from our health leaders that allow hospitals to be so poorly staffed has bred a culture of getting by instead of getting ahead," she said.
Stokes-Lampard said the proposed action plan would examine high-risk specialties including vascular and obstetrics/gynaecology, improve access to first specialist appointments, reduce wait times for surgery and emergency department care, develop a plan for implementing a sustainable medical workforce and address long term vacancies and infrastructure constraints.
She said Health NZ sincerely apologised to the patients who had experienced delays in treatment and whose care could have been better.
"Where there have been avoidable delays we are truly sorry, but what we need to do is go further and look at the root causes of why those things happen."
There was a range of urgency on the issues identified in the review, but many were long-term problems that would take some time to fix.
Different models of care, more doctors needed in Nelson
While many other hospitals around the country were facing similar issues, Nelson Hospital had historically taken a consultant-led approach to providing healthcare that relied on senior doctors backed up by junior doctors.
Stokes-Lampard said that had served it well, but was difficult to maintain, especially in a region with an ageing population with increasingly complex medical requirements.
"The work that's needed requires a whole breadth of the medical workforce, not just the most senior doctors on site."
Departments of concern mentioned in the review included accident and emergency, general medicine, gynaecology and orthopaedics and Stokes-Lampard said for some, it planned to explore regional models of care to avoid reliance on a single doctor.
The review team had taken concerns over burnout raised by doctors seriously.
"The well-being of our workforce is of paramount importance we cannot serve our patients and the public if we haven't got our healthy fed workforce.
Health New Zealand Te Waipounamu deputy chief executive Martin Keogh said additional junior medical staff would be recruited at Nelson Hospital from 2026, but it was yet to determine how many and at what cost.
The additional capacity would help to address treatment delays and Keogh said Health NZ had also tripled its outsourcing volumes in Nelson Marlborough.
"We're going to treat at this stage an additional 1000 patients through those service agreements we have with our private providers and we're continuing to build on that."
He said senior medical staff hadn't seen the full report before its release on Wednesday but the initial feedback was that they " felt heard, both at the national, regional and local level".
Keogh said work had been underway to address some of the issues, before they were raised in the media, and he remained confident in the clinical leadership and management team at Nelson Hospital.
Alongside the action plan, planning was underway for a temporary inpatient ward to be built within the next 12 months, ahead of a purpose-built 128-bed inpatient unit by 2029.
There were also plans to install a radiation therapy machine at Nelson Hospital by 2029, so patients would no longer have to travel outside the region for radiation treatment.
Several other recent initiatives were cited as having improved outcomes for patients and staff, including the recently opened ophthalmology outpatient facility, paediatric outpatient facility and dialysis building.
The refurbishment of the hospital's acute mental health facility Wahi Oranga was nearing completion, and the expansion of the emergency department was on track for 2026.
Staff and unions would be kept informed as the report's recommendations were implemented, Stokes-Lampard said.
While the review was focused on Nelson Hospital, its lessons would also inform wider improvements across New Zealand's healthcare system, she said.
Labour health spokesperson Ayesha Verrall said the review highlighted that there were serious gaps in the systems that were meant to keep patients safe.
"Doctors at Nelson Hospital had already spoken out about the significant issues, so the findings of this review come as no surprise.
"Significant workforce problems are identified as a key issue. The hospital has no risk manager, isn't checking if staff have the right credentials, is not reporting adverse events and is not compliant with requirements to engage patients and their families."
Verrall said the amount of funding needed to address the issues that had been identified remained unknown.
She said the community had a right to know what the government planned to do and its timeframes to address the problems identified in the review.
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