My three weeks in hospital: Why our health system can’t cope

Opinion: Exhausted staff, outdated facilities, disjointed communications - Gill Higgins reflects on her stay in an overcrowded Auckland hospital.

Recently, out of the blue, a life-threatening autoimmune condition racked my body.

For three weeks, the doctors and nurses went above and beyond to make sure I lived to see another day.

But it was plain to see they were up against it: understaffing, patchy IT systems and planning infrastructure that couldn't keep up. Add to that facilities in North Shore Hospital’s old wing that left a lot to be desired for patients like me, facing a lengthy stay.

I came away genuinely surprised at the state of New Zealand's hospital care. Not about the exhausted staff who battle through day after day. It’s the system itself that is seriously ill.

Hospitals should help you get better, feel better. Mine did neither.

I was in a mixed ward, in the old part of the building - the kind of shared sleeping and bathroom arrangement the UK banned back in 2010, on the grounds that it stripped patients of dignity and privacy and slowed recovery.

Here, it's still the norm. You learn to keep your curtain drawn around what is already a tiny space - mine had stains on it, which wasn't much of a view for three weeks.

Further to that, once on high-dose steroids, I was extremely immunocompromised, but across from me was a drawn curtain saying the patient was infectious. How does that make sense?

The bathrooms are shared too. Some patients are very old and infirm. They don’t always lock the doors. The toilets are sometimes out of action waiting on cleaning staff to clear up “accidents”. There are signs asking you to clean the toilet seat yourself before sitting down.

Then came the nights - meant to be the time for healing sleep. Instead: a patient trying to "escape", calmed down night after night by a security guard; an hour-long alarm from a leaking roof; the ordinary chorus of snoring, coughing, and calls for nurses. Small things, individually. Together, they wear you down.

I kept reminding myself how lucky I was to have brilliant specialists fighting for me. But it's hard not to be affected by what's happening around you - and the exhaustion of the nursing staff was impossible to ignore.

While taking my bloods or handing over medication, nurses would tell me about their workload, and what they were most looking forward to on their next day off. Nine times out of 10, the answer was simple: sleep. Climb into bed, draw the curtains, and let their bodies recover before the next shift.

Many said they loved the job - and many said they were leaving it, because they couldn't cope any more. Others wanted to leave but stayed because they needed the income.

That exhaustion has now boiled over.

With winter flu in full swing, the New Zealand Nurses Organisation has declared a state of emergency over unsafe staffing levels in North Shore Hospital's Emergency Department, which has been short by 25 full-time nurses.

Health NZ's response so far: nine new staff for the ED. The shortage isn't confined to emergency, either - an extra 14 nurses and 10 healthcare assistants are now being recruited for a team shared between North Shore and Waitakere Hospitals.

But staffing alone can’t explain everything I saw.

The bigger problem, through no fault of the frontline staff, was communication - between nurses and doctors, doctors and specialists. Notes weren't always updated. Medication changes went unrecorded. It wasn't always clear what tests I needed or when.

I appreciate mine is a complicated case. Several specialists have been involved in my care, with tweaks to treatment often occurring on a daily basis.

But one morning sums it up. I knew I had a liver ultrasound scheduled. My nurse didn't know the time and went to check. Before I'd heard back, an orderly arrived with a wheelchair - first he needed to confirm I'd fasted for four hours. I'd literally just finished my bowl of cornflakes for breakfast. Nobody had passed that information on.

The scan was cancelled, and a 45-minute radiology slot went to waste.

It's a small example, but it points to something larger: every gap in communication sends nurses back to doctors, and doctors back to specialists, chasing information that should already be there if the IT system was working effectively.

I don't blame any individual for this - I blame a system where information isn't updated in real-time. Again, workload pressures won't help if staff have to prioritise patient care over data input. But the New Zealand Nurses Organisation points to another pressure: Health New Zealand's restructuring of its IT services.

The agency originally proposed cutting its filled IT workforce by about a third. Unions warned that would increase the risk of outages and delays. And Health New Zealand's own internal analysis subsequently identified increased risks to patient care from having fewer digital staff, less institutional knowledge and ageing IT systems.

I was fortunate: I could advocate for myself, and my husband stepped in on the days brain fog made that hard. But many patients - especially those who are elderly or frail - don't have that safety net.

After discharge, I was moved to Hospital in the Home, an excellent phone-based service where a nurse checks in daily. The staff were, again, wonderful - but, again, working from information that wasn't always accurate.

Possibly because the specialists are working so hard. On a few occasions, I was phoned by mine as late as 9pm as he drove home from work. We’d discuss changes. He’d reassure me he’d jump back on his laptop at home to put in necessary requests for specific bloods or infusions or medication changes. But these wouldn’t always get passed on.

I had to be readmitted to hospital a couple of times. On one visit last week, I was in the waiting room till late at night and saw the trolleys lined up in the corridor outside ED. I now learn that some patients had to spend 50 hours there - two nights running - while waiting for a bed.

It makes me realise how lucky I was a week earlier, with no ward space free, when my bed was wheeled into a visitors' lounge, which is where I spent two nights.

Even leaving had its own small chaos. On one occasion, told I could go home, we packed up and waited for our discharge notes. One hour, then two, then three. We eventually called the nurse again who apologised and said we could just go and get the notes by email. This is while patients queued in corridors for the beds we were sitting in.

Fix enough of these small things, and they add up to a very different hospital experience.

I don’t want to sound ungrateful. Quite the opposite. I am indebted to the staff at North Shore Hospital and in awe of their dedication to give the best possible care.

But they deserve better - as do the patients who need their help.

Healthcare isn't a nice-to-have. It’s not a new motorway that will shave 10 minutes off a commute, as appealing as that may be.

For patients, it's often life versus death, or pain versus comfort. For staff, it's the difference between doing their job well and burning out entirely.