Bay of Islands Hospital in Kawakawa won’t be able to admit new patients this weekend due to a shortage of doctors, but the ED will remain open.
Photo: RNZ / Peter de Graaf

• Doctors say Bay of Islands Hospital in Kawakawa will not have enough staff this weekend or in weekends to come
• The ED will stay open but new patients will be sent to other hospitals instead of being admitted
• Doctors say a hefty pay cut for short-term staff is part of the problem
• Stressed doctors say they’ve reached their limit and can’t keep working longer hours
• Health NZ acknowledges the situation is tough, but says it’s doing what it can to recruit more doctors

Overworked doctors at beleaguered Bay of Islands Hospital say any new patients will have to be sent to other hospitals this weekend – and in weekends to come – because there won’t be enough medical staff to look after them.

The doctors said they had reached their limits and were speaking out, despite a ban on talking to the media, because they had a duty of care to the community.

In a statement sent to RNZ, the doctors said they had opted to put the few staff they had in the Emergency Department so it could keep functioning over the weekend.

That meant, however, any new patients who would normally be admitted to the hospital’s 20-bed ward would instead be sent elsewhere.

It was also likely to mean longer wait times in ED.

The doctors, who wanted to remain anonymous, said they had been forced to prioritise the emergency department because two-thirds of patients arriving at Bay of Islands ED had potentially life-threatening problems.

The crisis at Bay of Islands Hospital, in Kawakawa, follows staff shortages at Dargaville Hospital, which made headlines last month when it was unable to provide overnight doctor care, and Rāwene Hospital, which ended its after-hours doctor service in 2022.

Senior doctors in Northland have been warning for some time that Kawakawa would be “the next domino to fall”.

Bay of Islands Hospital in Kawakawa won’t be able to admit new patients this weekend due to a shortage of doctors, but the ED will remain open.
Photo: RNZ / Peter de Graaf

The Bay of Islands Hospital doctors said the number of patients turning up at their ED had almost doubled in the past five years, while senior staffing had nearly halved during the same period.

They said recruitment and retention of staff had been limited, and solutions – such as employing junior staff – had been suggested but ignored.

Bay of Islands Hospital had relied on locums, or short-term doctors, to keep staffing even at minimum levels for a number of years.

Despite that, pay rates for locums had been “substantially decreased” in May, with no planning for the resulting shortfall of staff.

RNZ has been told the pay cut was just under 50 percent in some cases.

The doctors said it appeared they were simply expected to work more hours to fill the gaps.

“The employed staff already work 40-60 hours per week, plus additional shifts. We are now at our limit,” they said.

The doctors said their direct managers had worked tirelessly for solutions, but had no power to change national directives.

“To the Whangarei ED staff who routinely help out with extra shifts, and to the Mid North GPs for always going above and beyond for your patients, you have our endless thanks,” they said.

“To our 50,000-strong community – including Waitangi, Kaikohe, Kerikeri, Paihia, Moerewa, Rāwene and Rāwhiti, we will continue to do our very best despite the circumstances. We feel you deserve better,” they said.

Alex Pimm, Health New Zealand’s group director of operations for Te Tai Tokerau/Northland, acknowledged staffing had been “very challenging” at times, especially during the past few months, and some staff were finding the situation difficult.

A number of factors had affected the hospital, including winter demand, vacancies, staff turnover and sick leave.

Recruitment was a well-documented challenge across the health sector and was often more difficult in rural areas such as the Bay of Islands.

“We are grateful for the amazing work done by our great team at Bay of Islands Hospital, who remain focused on looking after our patients, providing high quality care. The wellbeing of our staff is very important to us and we’ve been working with our teams to manage many challenges, including those in ED.”

Pimm said relying on temporary and locum staff was not uncommon, in rural areas especially, but Health NZ’s preference was to have permanent, local staff where possible.

“We have been working to reduce the reliance on locum doctors and recruit people into permanent positions, however we have not managed to do this as quickly as we would like to.”

Measures to alleviate the current challenges included recruiting for all vacancies, reviewing rosters daily, and ensuring all four hospitals in Northland worked together closely to share capacity.

Doctors fear staff shortages at rural hospitals will increase pressure on Whangārei Hospital’s overcrowded ED.
Photo: RNZ / Peter de Graaf

In the longer term, a greater focus on rural staffing in the national health workforce plan, plus a commitment to local recruitment, should see staff numbers increase over time.

Pimm disagreed, however, with the figures cited by the Bay of Islands Hospital doctors, who said ED presentations had nearly doubled in five years while senior staffing had almost halved.

He said the number of patients arriving at ED had increased by about 50 percent during that period, and the hospital currently had two-thirds of its budgeted staff.

Pimm said the general ward at Bay of Islands Hospital would stay open this weekend, with reduced beds if necessary.

“We want to assure the public that if they need hospital level care, we are here, and our Bay of Islands Hospital emergency department remains open.”

Whangārei Hospital emergency specialist Gary Payinda is among those who have tried to sound the alarm over staffing levels in Kawakawa.

When Dargaville Hospital was unable to find doctors to fill its overnight rosters last month, he warned Bay of Islands Hospital would be “the next domino to fall”.

Staff shortages at Northland’s rural hospitals had a flow-on effect for Whangārei Hospital, where the ED was regularly hitting 150 percent capacity.

A few weeks ago capacity reached 200 percent, which he described as “unprecedented”.

Taking the overflow from Dargaville and Kawakawa would make matters worse.

Payinda also pointed to a cut in locum pay rates as one of the factors.

He said the situation had been brewing for several years and affected many rural areas, not just Northland.

Asked last week about rural Northland’s staff shortages, Health Minister Shane Reti said government moves to bring back a more regionalised health system would help ease the problem by allowing more local decision making.

That included a commissioning budget and flexibility to set pay locally, instead of having to go “cap in hand” to Wellington.