The CEO of an Auckland urgent care facility says the current health crisis stems from a "perfect storm" of long under-resourced health services trying to meet the demands of resurgent illnesses like flu, along with Covid-19 and normal winter pressures.
Benedict Hefford has been the CEO of Care Group - which includes general practices, specialist services and the East Care Urgent Care centre in Botany - since March this year.
The service sits in what was the Counties Manukau DHB, now Te Whatu Ora - Health New Zealand (HNZ) Counties Manukau District, and services more than 600,000 people. Funding was cut for the overnight service by the DHB in 2018.
At the time Counties Manukau DHB said "during the hours of 11pm to 7am… Middlemore can meet the demand for emergency services".
There are four overnight clinics in Auckland in addition to hospital-based emergency departments - Shorecare, based on the North Shore, White Cross in Henderson and Remuera, and historically East Care.
East Care is the only service not funded overnight by Te Whatu Ora. In 2021, then-CEO Gordon Armstrong told 1News the business was making a loss for two years before it closed.
"We were north of $400,000 a year loss just for the overnight service. And that's been painful," he said.
In December 2020 the clinic was down two GPs and not able to recruit more for the overnight shift, which made an already difficult situation untenable and the overnight service closed.
"The decision to close the overnight service at East Care in December 2020 was enormously regretful," Hefford said.
"We know there's a significant need for the service - volumes of patients coming to us overnight were only going up and up in 2020.
"We also know it was a service that was highly valued within the community. However, sustaining a 24/7 operation without any DHB funding was simply impossible.
"We have to be able to resource it so that there aren't very long wait times, otherwise the levels of stress on patients and staff becomes unacceptable. Patient safety considerations meant that the board of directors felt it had no option other than to close the service down in 2020."
Hefford said the focus since then had been to maintain the best urgent care service possible from 7am until 11pm every day, including weekends and all public holidays.
"A lot has changed since then - including population growth, ageing and of course a global pandemic. The current situation represents a perfect storm of long under-resourced health services trying to meet the demands of resurgent illnesses like flu, along with Covid and normal winter pressures."
Hefford said East Care staff remained committed and hoped the crisis facing Middlemore and other emergency departments would result in more community care investment by the new Health NZ entity, as it comes into effect over the coming months.
"There is an enormous amount of capability in the community health sector - Health NZ just needs to harness it so that the whole system can respond to the needs we see every day in our community."
Pakuranga MP Simeon Brown said last year the decision to cut overnight funding was due to policy changes in overnight care by the DHB. But, as each DHB was responsible for its own policies, it led to a "mishmash of services" across the Auckland region, he said.
In 2021, Botany MP Christopher Luxon presented a petition to reinstate the 24-year-old service, signed by more than 10,000 locals, to officials at the DHB's monthly board meeting - but it was verbally dismissed on the spot.
"The bottom line is that the board said they would not support the service due to funding pressures and their belief that Middlemore can easily accommodate the East Care urgent care customers," Luxon said.
He said at the time, he had pushed the DHB "very hard" on the issue.
"I would argue for the people of East Auckland that to have to go out of the area for an emergency issue when you are unwell or stressed is not great."
Figures from the Auckland Regional After Hours Network, a medical database, show Middlemore Hospital in 2021 saw on average 65 patients per overnight shift while East Care, when it was operating, saw 20.
Te Whatu Ora - HNZ Counties Manukau responds
A Te Whatu Ora - HNZ Counties Manukau District spokesperson told 1News there are no plans at this stage to reinstate overnight care funding for East Care.
"However, we are always reviewing our service options to make sure we are doing our best to meet the needs of our Counties Manukau community. It is important to note that overall demand is high across the system - including primary and urgent care clinics - all of which are operating at high capacity.
"In recent years, we have doubled our investment in after hours care. This consists of funding eight after hours clinics in the region, four of which are funded until 11pm, including East Care in Botany.
"This funding provides over 120,000 subsidised or free visits per annum to after hours care for children under 14, people over 65, community services card holders, high user health card holders and those living in quintile five areas."
The spokesperson said it was important for people in the community to seek "the right care for their condition early".
"That means calling or visiting your local doctor, seeking medical help at afterhours services earlier in the evening, or contacting Healthline on 0800 611 116."
Brown told 1News he hoped HNZ would re-establish the overnight service at East Care. He said he didn't believe Middlemore Hospital's ED was coping with the overflow that East Care would have historically managed.
It comes after a patient died last month after leaving the hospital due to long wait times.
"Middlemore has been struggling of late with demand far outstripping their capacity, meaning multi-hour wait times in their emergency department," said Brown.
"This is still a major issue within our community and one that constituents continue to raise with me on a regular basis. The desire and demand for a local overnight service is high, particularly when you consider that the East Auckland area has a population the size of Dunedin."