A study earlier this year showed Christchurch Hospital's specialist trauma admitting service failed to improve patient outcomes due to staffing gaps, limited operating hours and underfunding. Photo: RNZ / Nate McKinnon
Specialists say the health postcode lottery is rampant when it comes to trauma care.
The South Island was bearing the brunt of a funding shortfall, according to a New Zealand Medical Journal editorial released on Friday.
Health NZ and the minister of health rejected the claims, and said South Island trauma patients were receiving "timely, quality care with strong outcomes".
But the authors, senior staff from Christchurch Hospital - one of the busiest emergency departments in Australasia - said the trauma team faced "considerable operational challenges" thanks to underfunding, staffing gaps and data collection issues amid increased admissions.
Injury is the leading cause of death in New Zealand for those under the age of 44, with major trauma the second most common reason for hospitalisation. The South Island's rates of traumatic incidents are higher than the national average,
However, trauma care had historically been viewed as the "poor cousin" of healthcare, and suffered from inadequate resourcing and attention, co-author of the editorial and surgeon Dr Chris Wakeman said.
In August, Auditor General John Ryan tabled a report which showed elective services in the health system were often "not equitable or timely", with the same level of clinical need qualifying for treatment in some districts, but not others.
"As a result, a person's ability to access treatment is, to a significant extent, determined by where they live," the report noted.
Auditor General John Ryan. Photo: VNP/Louis Collins
Wakeman said there was no question the same applied to traumatic injury care, and had done for some time.
"It does feel frustrating that we've published for more than 10 years about inequity between the two islands."
Christchurch Hospital took patients from across New Zealand, but the ACC model for funding emergency departments was based on census population data, he said.
"We take neurosurgical patients from Dunedin, we take spinal patients from Taupō south - if you're north of Taupō you go to Middlemore, if you're south you come to Christchurch, we also take all the transfers from Nelson, Grey, Timaru.
"It does seem unjust that we can't employ the amount of staff [we need] ... we've had to close because we have no junior doctors to run the service."
A study of almost 800 patients earlier this year showed the hospital's specialist trauma admitting service failed to improve patient outcomes due to staffing gaps, limited operating hours and underfunding.
The service, established in January 2022, was "launched without adequate funding, resulting in significant staffing shortfalls, including limited trauma surgeon involvement (fewer than four hours per week), no dedicated house officer and restricted operational hours (Monday to Friday only)," according to the University of Otago research, co-authored by Wakeman.
The team had the worst nurse-to-patient ratio in the country and no funding for administration or data management support.
Combined with "the alarming lack of medical resourcing", the service was under "critical strain".
The authors also advocated for a more uniform approach to benchmarking, and noted that while many North Island hospitals had gone or were going through the Royal Australasian College of Surgeons' Trauma Care Verification Program, no South Island hospitals had done so.
"If Health New Zealand - Te Whatu Ora is serious about ending the postcode lottery, then Christchurch should be expected to meet the same standards as Waikato."
While Christchurch Hospital "would currently fail", it would still provide "valuable, unbiased identification of service gaps and help guide the allocation of resources", he said.
"If we go through a tick box and look at what we need, we would fail, but it would highlight the issue and put in black and white exactly what we need to do and what we need to aim for, and repeat verification would hopefully prove we've achieved our goals of improving trauma care in the South Island."
Asked if the levels of underfunding was making the emergency department unsafe, Wakeman said he liked to think staff did a good job, "working hard and compensating".
"But it makes it harder, and burnout is higher over the whole hospital," he said.
Minister of Health Simeon Brown said South Island trauma patients continued to receive timely, quality care with strong outcomes at Christchurch Hospital. Photo: RNZ / Mark Papalii
At the start of the year, Health NZ urged people to avoid Christchurch Hospital's emergency department unless it was "life threatening".
On its social media page, the hospital said its emergency department was "extremely busy" with "large numbers of people coming in for care", and asked people with non-life-threatening emergencies to go elsewhere "to reduce the pressure".
Health NZ Te Wai Pounamu deputy chief executive Martin Keogh later said it was due to increased demand caused by surgical cases, and was "definitely not a staffing issue".
The following month, RNZ revealed the hospital's internal staff planning system showed the hospital had 120 fewer nurses than recommended, with the emergency department short 25 nurses.
But Health NZ spokesperson Hamish Brown said current resourcing levels "continue to meet demand".
"Trauma patients who present to Christchurch Hospital are receiving the care they need, when they need it, and with good outcomes.
"The trauma team is focused on trauma admissions and is only one part of a wider multi-disciplinary team of highly trained and experienced clinicians who regularly provide care to trauma patients," Brown said.
Minister of Health Simeon Brown said South Island trauma patients continued to receive timely, quality care with strong outcomes at Christchurch Hospital.
"To further strengthen trauma care across the South Island, Health New Zealand has reinstated its regional trauma network, working closely with the Trauma National Clinical Network to deliver a consistent, nationally standardised approach," he said.
Sign up for Ngā Pitopito Kōrero, a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
