What’s Going On At Buller Hospital?

Chair of Patient Voice Aotearoa, Malcolm Mulholland, has launched a petition calling on the Government to urgently fix the staffing shortages at Te Rau Kawakawa/Buller Hospital. The petition reads: “That the House of Representatives urgently address the issues surrounding the unsatisfactory delivery of health services to the community of Buller by Health New Zealand West Coast due to an insufficient workforce.”

Of particular concern is the case involving a Filipino man aged in his 40’s who died on Wednesday July 17, after the hospital had been closed the previous two nights. Earlier that day the man had presented to Buller Hospital and was discharged. At 6pm firefighters and Hato Hone St John were called to a “medical event” at the hospital where it is understood the man died.

To date, Health New Zealand West Coast have refused to answer multiple questions from the community including “Was the hospital open or closed, and if closed, why was the community not notified?”, “Whether or not a doctor was available at the time?”, and “Why were the firefighters and Hato Hone St John called to the hospital?” The unsatisfactory response to date from Health New Zealand West Coast was that “Te Rau Kawakawa ASU (Acute Stabilisation Unit) was staffed and operating as per normal.” Health New Zealand have now decided to launch an investigation into the man’s death by the Serious Incident Review Committee.

Mulholland, whose family comes from Seddonville in Buller, said something urgently needed to be done by Health New Zealand before patients die because rural hospitals are understaffed. States Mulholland “I hope that the Health Select Committee undertakes an urgent investigation into the staffing operations of Te Rau Kawakawa, otherwise known by locals as Buller Hospital. The community of Buller deserve straight answers about what is happening at their hospital, including what happened on the night of July 17. The circumstances that led to this man’s death need to be fully understood. The community is deeply troubled by this situation.

“The community of Buller, just like other New Zealanders, should have faith and confidence that their local emergency health service will help them at their time of need. The people of Buller pay taxes, and they shouldn’t miss out simply because they live miles away from one of New Zealand’s major cities. Health services in New Zealand is a right, not something you might receive depending on where you live.

“It is obvious that emergency health services are unable to be offered 24/7 in Buller due to staffing shortages. Having a hospital shut an estimated total of 11 times since its opening in May 2023 for a total period of 25.5 days and 29 nights is not acceptable. The community need to be fully informed as to the state of Buller Hospital, what the plan is to get enough nurses and doctors to staff the facility, and how long it will take for those staff to arrive in Westport. Only then, with all the information, can the people of Buller make an informed decision about local health services and what they should expect if they knock on the door of their hospital. To be clear, this is not a criticism of staff who work at the hospital and who do their best with limited resources. This is about recognising a system failure and how to overcome those failures in the future.

“I hope that the Health Select Committee might be able to provide some insight and clarity moving forward, rather than the folk of Buller continuing to have no confidence in their local hospital. It could be that by focusing specifically on Buller Hospital, understandings and solutions can be found for other rural hospitals in New Zealand.”

BACKGROUND INFORMATION

Westport has had a hospital since 1868, and as recently as 2013, the hospital had 31 beds including eight for acute patients. In May 2023, the new Buller health facility titled Te Rau Kawakawa (TRK) opened its doors at a cost of $21 million. The facility offers a number of services including general practitioners and an Acute Stabilisation Unit (ASU), the latter being advertised as being available 24/7. TRK offers 12 beds, including seven overnight beds and a birthing room, to service the needs of a population of 10,000 people that has the largest percentage of people aged 80 plus for any district in New Zealand. West Coast chief medical officer Dr Brendan Marshall said recently the hunt was on for two or three more permanent doctors. He said about six doctors from Greymouth were providing support to Buller Health, mostly in the ASU.

The building, still called Buller Hospital by locals as it offers an ASU and signposts to the facility still read “Hospital”, has been shut an estimated total of 11 times since its opening for a total period of 25.5 days and 29 nights. For 11 days in June 2024, the ASU was closed for admissions but remained open for presentations. In this instance, Hato Hone St John extended care paramedics from Christchurch were contracted by Health New Zealand to help staff the unit. Extended care paramedics are trained to treat patients with non-urgent illnesses and injuries in their home and can help primary health services to provide after-hours care where there is a shortage of GPs and/or nurses.

If TRK is closed, the community must rely on the services of Hato Hone St John and PRIME (Primary Response in Medical Emergency) personnel. In June 2024, Health New Zealand West Coast revealed there had been no PRIME service in Westport for a fortnight, as their personnel had been called to staff the ASU. There is still no PRIME service in Westport, except when the ASU is closed. To travel to the closest emergency department at Te Nīkau (Grey Hospital), requires a one-and-a-half-hour drive from Westport or a three-hour commute from Buller’s most northern community of Karamea. Being transported by helicopter to either Christchurch or Nelson hospitals can take up to approximately one hour but is weather dependent. If Te Nīkau is short-staffed, staff from TRK are transferred to Greymouth.

When TRK is short-staffed, staff are sometimes transferred from the Ngakawau Health Centre. This has contributed to the centre being shut for 19.5 days since TRK opened. Often closures at Ngakawau are made on the day with no notice provided to patients who travel to the clinic for their appointments. After the centre had had intermittent closures totalling 13 days, Health New Zealand West Coast general manager, Philip Wheble, fronted a public meeting at Ngakawau in July 2023 and stated that the clinic was there to stay and should not face anymore temporary closures.

Dr Marshall has confirmed that staffing issues at Buller Hospital affect patient safety. He said: “The two major things we talk about are the two things that keep me restless first thing in the morning – it’s the continuity of care at an individual level and opening and shutting (the ASU). I know they (local people) need consistency for both of those.”

The staffing shortages have clearly caused multiple problems and fall short of best hospital practice. 40% of consultations are conducted via telehealth. Two registered nurses should be available for each shift, yet between May and mid-July 2023, 43 shifts were staffed by a nurse and a health care assistant. Upon its opening in May 2023 until August 2023, nurses worked 238 12-hour shifts to cover staff shortages. For the first year of operation, 102 patients were transferred from TRK to Greymouth’s Te Nīkau Hospital, more than the 72 patients who were transferred from Buller Hospital for the previous year.

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