Violence and abuse by patients and visitors have forced staff at North Shore and Waitākere hospitals to call security or hit panic buttons thousands of times within a seven-month period.
Internal documents obtained by RNZ under the Official Information Act show clinical staff and security guards have repeatedly pleaded with management for extra security backup, and managers admitted to relying on the "good will" of guards to work overtime or come in on their days off.
RNZ has previously reported several incidents involving assaults and violence at North Shore Hospital, including a man attempting to ram his car into the packed emergency department (only prevented by concrete bollards outside the doors) and a female patient being punched to the ground after intervening when another patient started threatening the nurse overseeing people waiting in the ambulance bay.
Earlier this month, a midwifery student was attacked while walking near the Middlemore train station at the end of her shift.
According to data released to RNZ for North Shore and Waitākere hospitals between November and May, there were 529 "Code Greys", in which staff called security via the internal emergency number, with 126 calls in February alone.
Staff activated a panic button or duress alarm 308 times.
Separately, there were 363 calls for security and assistance involving violence and aggression (peaking in March at 120 calls for help), 1112 calls involving mental distress and an additional 957 calls for "other" security assistance.
Incidents involving mentally ill patients or visitors peaked in January, with security staff involved on 237 separate occasions.
Security guards needed to physically restrain people 276 times within the seven-month period.
Concerns about under-staffing in security area
Late last year staff, led by nurses, raised fears about the dangerous situation brewing in the emergency department in a formal health and safety complaint to their bosses.
Increasing numbers of patients affected by mental illness, drugs and alcohol - combined with longer wait times for all patients - were ratcheting up tension in the department, they said, but there was no increase in security.
In an email from PSA delegate Shane Weallans to security operations manager Chris Webb on 13 June 2023, he said the union remained "uneasy" about staffing levels and the "possible health and safety risk" to its members on the security team.
He noted that Te Whatu Ora Waitematā's guidelines (Management of Actual or Potential Aggression - MAP - behaviour management system) required five people to carry out "a high level restraint" but it was "pretty rare" to have five staff on duty at both sites.
"This means that this group is not adequately staffed to carry out this function if needed. This represents a safety issue for this working group and thus a risk for the organisation in respect to their obligation to have systems in place to effectively manage hazards," Weallans said.
In an earlier document (from January 2023), the PSA said shifts were "continually short in staffing, with numbers regularly falling below four".
That was not sustainable, it said.
"With no contingency or minimum levels in place, the organisation is putting guards in a position where they are set up to fail."
The union called for resourcing to be "increased urgently" with a minimum of four guards on each shift, and for management to consider "alternative" strategies for managing aggressive people.
It is apparent from emails between senior managers that they were already aware the security team was stretched thinly.
The then Waitematā District Health Board started consulting in 2017 over plans to combine security and traffic and fleet operations in order to ensure 24/7 supervision.
At that time, security and traffic supervisors only worked Monday to Friday, between 7am and 4pm, leaving security teams without supervision for the rest of the time.
More security staff needed once Tōtara Haumaru building opens
In September 2020, it was noted 24-hour supervision would require an additional six full-time security supervisor roles.
However, ahead of the opening of the new four-storey Tōtara Haumaru building on the North Shore campus in April 2024 - which will have 400 staff and 150 patients, plus up to 300 visitors and contractors on a daily basis - even more security will be needed.
It will have a purpose-built security office next to the main entrance manned 24/7.
An undated document from 2022 noted additional staff would be needed, as there was "no capacity in the current service to provide security services to the new building whilst maintaining adequate safe cover for the remainder of the hospital" and there would also be an "uplift in staff requiring escorts to and from their vehicles after dark".
In order to have two security coordinators rostered on day and night, another 10.5 full-time staff would be required.
"A decision is required to approve the increased total FTE in the security service by 10.5 FTE to allow sufficient safe coverage of the Tōtara Haumaru security office and surrounding campus areas."
A subsequent version of this document tables an alternative (cheaper) option, to place a lone security guard in the control room to manage access and admin duties, leaving guards stationed in the main tower block - 800 metres away - to respond to Code Grey incidents.
"This will cause delays in response times and, if already attending an incident, may result in not being able to attend... This option is not recommended by the security service."
However, in an email to interim lead hospital and specialist services Brad Healey on 23 December 2023, Webb - the operations manager for security - noted that under the restructure, they did not get additional staff, "rather just appointed from existing numbers".
"Any decision to remove supervisors would require them to be replaced by guards (or demote existing supervisors) which would have a detrimental impact on morale."
The cost saving from getting rid of supervisors (blanked out) had to be "weighed up against a lack of supervision [at] each site, 16 hours per day and 24 hours at weekends and public holidays with all decisions having to be made by duty managers".
On 12 May 2023, Healey requested an update from Webb, under the subject line "Security Deep Dive - Risk based assessment to help consider # of security guards needed".
"I am conscious of recent staffing gaps and the risk that flows," he wrote.
Webb quickly replied to repeat there had been "no increased provision of additional FTE [full-time security staff]".
"Our new roster has been introduced but we do not have any more numbers available and so have to reply [sic] on the good will of staff on days off to volunteer to work overtime."
Te Whatu Ora Waitematā has told RNZ its existing budget provided for 24/7 supervisors within its security team and those roles were currently in place.
"As we are a large organisation meeting the needs of a growing population, it is appropriate that we continue to review our security resourcing - this includes consultation with our union partners," a spokesman said.
"This work is ongoing and we recognise the high value of the work performed by our existing security workforce."
Tōtara Haumaru security provisions 'yet to be approved'
The Tōtara Haumaru component of the 2023/2024 budget - including any security provisions associated with the project - had "yet to be approved" and further details would be available closer to the building's scheduled opening time in April 2024.
"It is envisaged that any additional security guards at the new Tōtara Haumaru building will form part of a larger more visible security presence across the whole combined North Shore campus."
Keeping patients, staff and visitors safe was among its top priorities, he said.
Its front-line staff were highly skilled in de-escalating situations involving aggression and incidents were usually resolved "quickly and calmly".
"In most cases, people who are acting aggressively have limited or no control of their actions - this includes people who are under the influence of alcohol or other drugs and those who living with mental health conditions, such as dementia.
"It should be noted that the way in which security is provided at our Regional Forensic Psychiatry Service differs from other parts of Waitematā. Security is managed through a mix of specially built environments and specialist staff, including clinicians and security officers."
Hospitals need more security guards - NZNO
New Zealand Nurses Organisation president Anne Daniels told Morning Report there were too few security guards in hospitals to look after all departments and answer emergency calls as well.
"Panic buttons do not mean anything. If a security guard is attending to another patient and they need five of them to restrain a patient, those security guards cannot attend another call.
There should be enough guards to not only be in areas that generally have to deal with abuse or violence - the emergency department and mental health areas - but to to check the security of buildings and carparks and attend to the "myriad of calls" from nurses and doctors who need help to calm a patient down, she said.
Patients were waiting a long time in ED, sometimes for 12 to 16 hours on a busy day, and got frustrated and upset.
"I cannot remember a time in the last 10 years where I haven't gone to an ED where I work, where there are not patients lining in the corridors, or within inches of each other in the ED ambulance bay.
"That bay is generally cramped with up to 8 to 10 patients inches away from each other on beds and chairs, and that's not even thinking about the wait rooms or the corridors.
"And tensions rise, people don't want to be that close to each other, they've gone there for help."