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SERVICE DEVELOPMENT PLAN 1984 - 1988
WESTCCOAST HOSPITAL BOARD
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MOH Library LI J H328
New Zealand Department of Health LIBRARY Box 5013 Wellington Accession No...... [t Classification:...WA .. 541 KN4 Location: ...... 24480G-1,000/1O/84MK WEST COAST HOSPITAL BOARD
SERVICE DEVELOPMENT PLAN 1984-1988
Prepared and Published by:-
West Coast Hospital Board Box 387 Greymouth
April 19814
LIBRARY DEPARTMENT OF HEALTH WELLINGTON PREFACE
This West Coast Hospital Board Service Development Plan 1984-1988 was produced by the Board s Executive Officers and adopted by the Hospital Board at a special meeting on 3 April 1984.
The Plan outlines the proposed development of Hospital Board services in the contexts of reduced government funding and of identified needs for future services.
It should be noted that the Plan does not apply to the public and private health services provided on the West Coast by government departments, private health practitioners and voluntary agencies.
Currently West Coast Service Development Groups representing all the major health service agencies are working towards the preparation of Service Plans for different services. The most advanced of these Groups is that reviewing elderly health care services on the West Coast, and it is expected that its first Elderly Health Care Service Plan will be ready by the end of 1984.
The Hospital Board s Service Development Plan has been produced to assist the work of SDGs, and in response to the Department of Health s population based funding requirements for the West Coast Hospital Board. In 1982/83 the Hospital
Board was 16.9 over-funded in relation to the Department s preferred allocation of funds ($3.2 M out of a total budget of $19.1 M).
It is hoped that this Plan will demonstrate the careful and reasoned use of its resources by the Hospital Board, and will facilitate some reduction to current expenditure while also providing for the maintenance and development of essential services. WEST COAST MAJOR COMMUNITIES
Karamea
Mokihinui
4 Waimangaro. WESTPORTY .• Pnangahua Junction
Reofton.
Barrytown • Ahaura • Ngahere GREYMOUTH •Dobson Paroa •Moafl • Rotomanu Ru4Kumara.
110 KITtKA/
t^ -ra ^; 1 • RossR
Hard.
Whataroa r. / . FnzGlacier Fox Glacier
H OSPITAL BOARD AREAS - SOUTH ISLAND
Administrative Centres Shown NELSON Psychiatric Hospitals Shown Nelson MARLBORO U( GOLDEN BlenI SAY
-- l3racm(r
WAIMIA "-Ngawhatu
WEST COAST NANGAHUA Greymouth KA
G K I Y A 11 U K I -Queen Mary Seaview/\ 1 NORTH WAIF CANTERBUR MALVERN ASHLEY Christchurch 0 Ox.oO Sun nvside In,
ASUKUATON - Al 08 Templeton MACK(N ASHBURTON z shburton ¼ WAIMAT( SOUTH CANTERBURY -VINCENT- Timaru Clyde WAITAKI MANIOTOIO Oamaru 7 VINCy 3 KanturlyMANIOTOTO b
WA OUAITI FIORD ( Cherry Farm 1 WALLACE TUAPKKA rth Canterbury SOUTHLAND OTAGO ORUCE ncdi n [0 UTH LAN CLUTUA J\ SOUTH-- - OTAGO Invercargill " Balciutha
STIWART ISLAND
C At
-_.4 J - I Is I - I KU I-If NORTH ISLAND with West Coast Region
+ superimposed
Miles. 20 0 20 tO 60 80 100 Palrnors:cn N I I F. C 40 80 120 Le vi Ki.orne;res Well ttigton.4 Scale 1:4 000 000
POPLLIatiCn Of West Coast: Population within this area:
347( $981) I , 169,000(est) CONTENTS
INTRODUCTION
MEDICINE ...... --.-...... -..--...... -...... 8
- .... - ...... - ...... SURGERY 13
OBSTETRICS - 18
PAEDIATRICS -.---"- 21
...... GERIATRICS -.....-..-....-....--.--....-....- 24
MENTAL HEALTH CARE ...... - ... --"---- ...... - 30
PRIMARY HEALTH CARE...... 39
NON-CLINICAL SUPPORT SERVICES ..... 42
HOSPITAL BED AND BUDGET SUMMARY 43
LIST OF APPENDICES 47 1
INTRODUCTION
The West Coast Hospital Board was established in 1968 following the dissolition of the former Buller, Inangahua, Grey and Westland Hospital Boards.
In 1972 it assumed control of the Seaview psychiatric hospital in Hokitika.
The thirteen member Board represents a district some 645 km in length from
Karainea in the North to Jacksons Bay in the South, which incorporates the counties of Buller, Inangahua, Grey and Westland and the boroughs of Westport,
Greymouth, Runanga and Hokitika.
POPULATION
The population of the West Coast has been falling for many years, recently at about .4% per annum. At the 1981 census there were 34,178 people on the
West Coast (1.08% of New Zealand) , (tables 1 and 2). Short term projections from the Department of Statistics are for a continuing decline, mainly because of emigration. The medium fertility, medium migration model used by the Department of Health for projected bed numbers in November 1983 shows a population increase for the West Coast and therefore has doubtful relevance. 3,858 people (11.3% of the population) were aged 65 and over and this number will increase to 4,398 over the next 20 years, but the 80 years and over group will increase from 561 at present to :.975. There were 8,772 children 14 years of age and below at the census and this is projected to drop to 6,142 (low fertility) or 7,431 (medium fertility) in the next 20 years. 97.3% of the West Coast population is classed as European. There is an influx, estimated to be around 2,000, of people to
South Westland in the whitebait season (September to November). At any one time in the summer there may be up to 1,000 tourists on the Coast.
GEOGRAPHY
This small population is dispersed over a wide area (6% of the land area of
New Zealand). From Karamea (regional population 647) to Haast (regional 2
population 491) is 522 km and eight hours travel by road. (Karainea is three hours from the base hospital and Haast five hours). It takes 11 hours to get to Greymouth from Westport, one hour from Reefton and half an hour from. Hokitika
The nearest regional centre is Christchurch which is 31 hours travel over an alpine road from the base hospital in Greymouth. Although 19,295 people live within 50 km of Greymouth by road, 14,784 people (43% of the population) do not have immediate access to the base hospitai 3,617 live between 51 and 100 km away, 8,850 between 101 and 150 km and 2,317 over 150 km from Greymouth. This dispersal of population increases the costs to the community of travel to reach hospital services, but it also increases the cost to the Hospital Board of providing these services. These increased costs come about in the following wa
1. Transport - large distances are covered by road ambulance in bringing emergency cases to hospital and in transferring people between the Board s hospitals. Air ambulance and helicoptersfrequently have to be used to transfe patients with severe injuries or serious illness to avoid a long road ambulance trip.
2. Emergency services - ambulances and resuscitation facilities are required at multiple sites rather than only in one central location.
3. Outpatient and diagnostic facilities - these must be provided in several locations and the Board s specialist medical staff have to spend a considerable time travelling to provide these services.
4. Domiciliary services - these are expensive because of the large travelled and more staff are required because each must have a smaller than normal caseload, 3
5. Inpatients - investigation and anaesthetic preassessment often requires an extra day in hospital if the patient lives a considerable distance away.
Discharge is likely to be postponed to ensure that medical staff are certain the patient is fit enough to go to an isolated area.
6. Day patients - geriatric day patient treatment is not feasible where people live beyond a relatively short distance from hospital. Day case surgery is curtailed for similar reasons.
7. Geriatric services - old people should be hospitalised in their own community. Long hospital stay, loss of independence and institutionalisation is encouraged by having elderly people in hospital away from their homes and their relatives.
This need for decentralisation of emergency services, outpatient and diagnostic facilities, bases for domiciliary services and particularly decentralised geriatric services means that several hospitals are required on the West Coast, not just one. Also for the reasons expressed in paragraphs 5 and 6, utilisation rates of hospital beds should be expected to be above the national average.
Isolation from larger boards combined with the low population also adds to the costs of providing services in the following ways:
1. Staff - because of the low level of staffing in some specialties, an extra staff member is often required to provide cover for weekends and holidays. Because of the lack of private medical specialist practice, part- time appointments are often difficult to make and a full-time appointment may be necessary where only a part-time appointment is really required. 4
Transport of patients to larger centres - cost of road and air ambulances and overtime payments to ambulance drivers and nurse escorts are not insignificant.
3. Lack of private x-ray and laboratory facilities - the Board is requi to provide these services in the absence of the private sector and this is nc recognised in the population based funding model.
SOCIAL AND ECONOMIC FACTORS Population based funding if implemented fully would have disastrous effE
for the West Coast Hospital Board. The resultant necessary centralisation ol
services would mean the closure of Westland and Reefton Hospitals and
considerable reductions in services at Buller Hospital. The loss of earning
in the communities of Hokitika, Reefton and Westport would be considerable a
would seriously conromise the viability of Hokitika and Reefton. Even with
maximum possible centralisation further economies would have to be made at t
base hospital and there would definitely be no finance available for a redev,
ment of services and for the provision of desperately needed domiciliary ser
The Ministry-of Works is conducting an independent study of the effects on
Hokitika of various levels of reduction in the staffing of Seaview and Westi
Hospitals over the next 20 years. The future of Hokiti.ka and Reefton is
considered to be brighter when exotic timber production in those areas reach 7 significant proportions in the early 1990 s.provided that they can-keep soci
services relatively intact until then. Regional development on the West Co
retarded because resources are either exhausted or cannot be developed becat
of economic or environmental pressures. The average socio-economic status c
the West Coast when measured by income, education or occupation is lower th
the national level. (Table 3) HEALTH STATUS
Only indirect measurements of health status are available for West Coasters.
Mortality is higher than the national level and SMR s published in Run 9 show that males on the West Coast have a 9.5% higher mortality than nationally and females 2.2% higher. Consequently morbidity is presumed to be higher also.
Socio-economic status is a strong indicator of health status. Hospital utilisation data on the West Coast cannot be considered to be a true indicator of morbidity because of the high rate of hospital bed provision. However, making allowance for this in analysing hospital morbidity data, it seems likely that there is a higher rate on the West Coast of respiratory disease, cardiac disease, diabetes mellitus, and accidental injury. (Tables 4 and 6). Known figures for alcohol consumption are higher than the national average and therefore alcohol related disorders must be more common.
UTILISATION RATES
Information from the Department of Health (MSRU, Utilisation Rates in
Hospital Boards 1981) indicates that in 1981 17% more days in hospital were spent by West Coast residents aged up to 64 years than would have been expected for this population. In addition 21% more days stay in hospital were recorded by the age group 65 and over. These figures take into account stays in private hospitals as well as public hospitals. There are several reasons for this apparent excess utilisation of hospital beds.
1. The dispersal of population requires more use of hospital beds as explained earlier.
2. There is an excess of hospital beds over and above the guidelines suggested by the Department of Health and where these beds are provided they tend to be used. 6
3. Because of the easy availability of hospital beds there has been no pressux
to provide domiciliary services and to develop alternatives to hospital admissic
It is suggested thatthe West Coast Hospital Board should aim to reduce its bed
utilisation to 1.05 and to this end hospital beds should be reduced to guide-
lines and policies of encouraging alternatives to hospital admission be
developed.
BED GUIDELINES
Attached are tables of the Health Departments bed guidelines and their
interpretation for the West Coast population (table 11). Also attached is a
table showing the average occupancy of the hospital beds provided on the West
Coast (table 18). It should be noted that there are 157 short stay paediatric, medical and surgical beds on the West Coast (tables 9 and 10). There are 100
at Grey, 39 atBuller, 10 at Westland, 6 at Reefton and 2 at Whataroa. These beds had an average occupancy of 100.0 in 1982/83. The Departxnent:of Health s bed guidelines for the West Coast would allow 99 short stay beds in these categc
SUMMARY
The West Coast Hospital Board is "over funded" because it has six hospital with associated overhead costs, where .a similar population in one area would nee
only one hospital and also because it has an excess of hospital beds and under
developed domiciliary services. 1.4% of the Board s expenditure in 1981/82
was for domiciliary services compared with a national average of 3.2%. $6.55 per capita was spent compared with $9.58 for the country as a whole (Hospital
Management Data 1982). Domiciliary services need to be increased to a level
above the national rate and this must be done before any attempt at decreasing
utilisation rates is made. Beds that are not being used (or staffed) can be 7
closed immediately but this will not save much money. The savings that can
be made from reducing bed utilisation will take a year or more to begin to be
seen and are not easy to quantify. At least $200,000 is required this financial
year to make appointments in the domiciliary area and immediate savings are not
available to enable the Board to do this within its existing allocation. Cuts
totaling $677,000 have been absorbed in the last six years. Bridging finance
will be required for 1984/85. The proper allocation of finance for the West
Coast Hospital Board is not determinable by the population based funding model
in its present form but should be determined by the amount of money required by
this Board to provide services when its bed utilisation rate is 1.05.
There is no other hospital board in the country that has problems with distance
from larger centres, dispersed and declining population, lack of regional
development opportunities, low average socio-economic status, financial restraint
and difficulties with professional staff recruitment all in combination as we do.
If special concessions are not made, or if some alteration in the population based
funding model is not possible to take into account these special circumstances,
then the centralisation required to achieve economies of scale, and the lack
of resources for development of much needed new services will condemn West Coasters
to having an increasingly obsolete and inappropriate hospital and health service.
The Hospitals Act 1957 places the responsibility for adequate hospital services
squarely on the Minister of Health s shoulders. Section 3A reads
"It shall be the duty of the Minister on behalf of the Crown to ensure
the provision and maintenance by hospital boards to such extent as he considers
necessary to meet all reasonable requirements throughout New Zealandof:hospitals,
hospital accommodation and medical, dental, obstetrical, nursing and other
services at or in connection with hospitals." 8
MEDICINE
SITUATION
The Board provides medical beds at Grey, Buller, .Westland and Reefton
Hospitals as described in the introduction. These include specialised coronary
care beds at Buller (1) and Grey (3) hospitals. X-ray facilities are available
at all four hospitals and there is a laboratory at Grey and Buller. Lab specimE
are sent to Grey Hospital from Westland and Reefton. There is no pathologist.
Post-mortems are done by the surgical and medical staff and histology and
cytology specimens are sent to Christchurch. There is a sector scan ultrasound
facility at the base hospital. Medical outpatient clinics are held regularly at
all four hospitals and ECG and respiratory function testing is available.
Consultants in the medical sub-.specialties of neurology, rheumatology, nephroloç
haematology and cardiology regularly visit the base hospital to provide .outpatiE
clinics. There are no .specialised oncology services and patients are required t
travel to Christchurch for consultation and for treatment. The Board has an
establishment for 2.4 specialist physicians (this includes duties in paediatric
and geriatrics) and nursing staffing.ievels are adjusted regularly according to bed occupancy. A 30 bed medical ward is staffed by a charge nurse, three staff
nurses and four other nurses on morning shift, the same except for a charge nur
on afternoon and two staff nurses at night. This..totals 28.5 FTh s per annum.
Physiotherapy,bcupational and speech therapy, dietetics and social work are a] providedat-the base hospital by. staff who are responsible for other acute
services. All these services are made available to all four hospitals and
Buller and Westland have their own physiotherapist and social worker. Domici1i
services are available in all areas (Reefton is covered from Greymouth for physiotherapy and occupational therapy and social work - district nursing duties
are carried out by the public health nurse). Out of 64 available medical beds
the average occupancy was 47.2 in 1982/83. Medical beds at Buller and Grey 9
are frequently occupied by patients who are undergoing rehabilitation or are
waiting for long stay placement or who require social admission to relieve
relatives or allow resolution of a family problem. Of 100 recent consecutive
admissions to Morice Ward, up until 18 March 1984, 50% were over the age of
65 and 18% over the age of 80. General practitioners are free to admit patients to medical wards as they require and this is seldom refused. The medical outpatient consulting rate for West Coasters is 14% compared with a
national average of 11%. There is no specialist physician providing private
consultation on the West Coast.
ANALYSIS
Traditionally on the West Coast, geriatric and acute medical services have been combined and the real picture of utilisation of medical beds obscured by admissions more properly designated as geriatric. Bed occupancy is never- theless only 74%. Beds at Westland, Whataroa and Reefton are mostly used for relatively minor conditions, for geriatric assessment or social purposes.
Diagnostic services are adequate. Oncology outpatient clinics are now not available even at the base hospital and there is no sub-specialty diabetic outpatients oreven a. diabetes nurse educator. Outpatient numbers are relatively high and follow ups are still frequent (although down from 88% of total visits
in 1981/82 to about 70% in 1983). Future needs are not likely to be different
from present needs in that although total population is falling, dependent elderly population is increasing. Because SMR s for West Coast residents are
slightly above 1 presumably this indicates an increase in morbidity and a less
satisfactory health status than other New Zealanders. It is probable that the
increased admission rate of West Coasters for cardiovascular, respiratory and
metabolic conditions is not only a reflection of the ready availability of
beds but also indicates a true increase in prevalence. High alcohol consumption 10
on the West Coast means that there must also inevitably be a high rate of
alcohol related disease.
AIMS
The stated aims of the West Coast Hospital Board are:
"The Board supports the principle of maintaining a high standard of community
health care and consequently reduced dependence by the community on
institutional and inaptient hospital care • The Board intends to strengthen the I
provision of specialist medical and surgical services at Grey base hospital
in a manner which will meet the needs of all West Coasters as evenly as pos
The Board acknowledges the need to implement gradually and responsibly the
population based hospital bed guidelines of the Health Department and notes
a reduction in beds implies an expansion of community health care services.
Guidelines for medical and surgical short stay beds should be met within six
years. The Board commits itself to the continuation-of specialist clinids at
the peripheral hospitals." (See Appendix I) F
STRATEGY
Development of a full geriatric service is the key to the future of
internal medicine on the West Coast. With this development . a reduction in
medical bed numbers should be possible immediately and further reductions
possible within five years. Westland Hospital does not require general medical
beds if there are geriatric facilities, although Reefton and Whataroa should
continue to have several short stay beds but these should be redesignated
primary care beds and not be included in the medical and surgical quota.
Outpatient clinics must be continued at all four hospitals and domiciliary
services improved (details of this programme will be considered with geriatric
services). General practitioners should be encouraged to look for alternative4 11
to hospitalisation in some cases (for instance elderly patients with myocardial infarction) and methods should be devised by the hospital to provide more assistance to the general practitioners to enable them to look after their patients at home.
OBJECTIVES
(These are in rough order of priority and have a date for implementation and an estimate of annual cost or savings.)
1) Buller Hospital s Foote Ward be used for all acute admissions and be established at 20 beds. Bed occupancy figures and bed establishment should be reviewed annually.
April 1984 cost Nil
2) All medical and surgical short stay beds at Westland, Reefton and Whataroa hospitals be disestablished.
April 1984 seegeriatric service plan
3) General medical outpatient clinics continue at Grey, Buller,
Westland and Reefton hospitals and negotiations be started with. Canterbury Hospital Board to re-establish oncology clinics at Grey and Buller hospitals and to begin a visiting specialist diabetes outpatients clinic at Grey Hospital.
End of 1984 cost $3,000
4) Establish within existing nursing budgets a part-time diabetes nurse educator at Grey and Buller Hospitals.
June 1984 cost Nil 12
5) To monitor utilisation of beds in Morice Ward at Grey
Hospital with a view to reducing medical short stay beds in that ward. 1984-86 definite future saving
6) Reduce outpatient follow-up for general medical clinics to 60% of total visits. end of 1985 cost Nil 13
SURGERY
SITUATION Although there are acute beds in all five general hospitals, only Buller
/ and Grey have designated surgical beds, 24 at Buller and 59 (including 4 ICU)
at Grey. There are operating theatre suites and central sterile departments
at both hospitals. Anaesthetic and surgical equipment at Buller Hospital is
adequate for major abdominal surgery and full facilities are maintained in a
suite of 4 theatres at the base hospital for major surgery, including urological
and vascular surgery, orthopaedics, gynaecology and emergency thoracic and
neurosurgery. There is no anaesthetist or surgeon at Buller Hospital and
operations are rarely performed there now. The base hospital is staffed by
two specialist general surgeons who perform some genito-urinary and vascular
surgery, two gynaecologists and an orthopaedic surgeon. The orthopaedic
position while established as full-time, is filled in a 7/10th s capacity by
retired orthopaedic surgeon. There are 2.4 FTE anaesthetists and a further
full-time position is vacant. Outpatient clinics are held at Westland, Reefton,
Buller and Grey. visiting specialists from Canterbury provide an ophthalmologY
and ear, nose and throat consulting service at the base hospital only. Patients
requiring operation must go to Christchurch (except for some tonsillectomies
done by general surgeons at Grey). A senior urologist, a plastic surgeon and
the professor of surgery provide regular consulting clinics at Grey Hospital.
The orthopaedic services at present are assisted by visits from a Christchurch
surgeon who does outpatient sessions at Grey and Buller and operates on some
West Coast patients at Christchurch Hospital. Diagnostic and paramedical
services are as outlined for medicine. In addition there is an orthotic
department at Grey Hospital whose staff visit Westport regularly. Blood
transfusion services on the West Coast are generally self-sufficient. Adequate
donors are available to fill all normal requirements for whole blood, plasma and 14
cryoprecipitate. Ward nursing staff are provided at the same level as for medicine and are also adjusted to keep pace with bed occupancy. In addition there are 12.2 FTE nurses working at Grey Hospital theatre. Bed occupancy is
low (35% in Buller and 66% in Grey - 57% overall) and the waiting list for operation fluctuates between 100 and 200 (202 on 31 December 1983). The lower
figure usually coincides with a period of full staffing. At present there is about 3-4 months wait for non-urgent general surgery and orthopaedics and
only 2-4 weeks for gynaecology. Operation numbers have averaged about 140 per month for the last two years. Day case surgery is only occasionally perfori
The outpatient surgical consulting rate is 25% (20% nationally). There is no
specialist surgical private practice on the West Coast.
ANALYSIS
Surgery is historically a "strong specialty" on the West Coast and is
well financed and this is reflected in the low bed occupancy and low day case
rate. Barclay ward is better utilised thanCouston ward at Grey Hospital.
Average monthly patient days in Barclay in 1983 were around 600 compared with
500 for Couston.. A relatively high accident rate (especially in working age
males) has necessitated a strong orthopaedic service. Outpatient numbers are
higher than nationally, probably only reflecting the lack of private services.
Cross boundary-flows are significant. (tables 19 and 20). 15% of West Coasters
admitted to hospital do so outside the West Coast and 17% of days spent in
hospital are away from home. Most of this time is spent in Canterbury
Hospital Board beds and some flow (presumably from the Buller region) is to
Nelson. Very few patients go to other Boards. It is not possible to say how
much of this outflow occurs as a result of illness or inj.iry while West Coast
residents are outside the region. How much is self referral and how much is
referral for diagnosis or treatment not available on the West Coast. There is 15
surprisingly little use of private hospitals even allowing for the absence
of such beds on the West Coast. Only a few patients are transferred as
inpatients - most of the admissions to Christchurch Hospital seem to be from
outpatient referrals particularly for eye conditions, ear, nose and throat
conditions and for oncology therapy. Outflows as measured by days stay (Run
8 and 9) are increasing and have more than doubled in four years. Staffing
problems in anaesthesia and recently orthopaedics have been a problem in
providing adequate services. A surgical service in the Buller district existed
until the late 1970ts. When the surgeon left a replacement was considered
inadvisable and except for occasional locums and sporadic lists done by
Greymouth surgeons this service has lapsed. To reinstate it would require
an appointment of a further full-time surgeon at the base hospital (5/10th s would be ideal but probably impossible) who would visit Westport with an
anaesthetist for two full days each week to undertake an outpatient clinic
and an operating session. Four further beds and corresponding nursing staff would be required at Buller Hospital and Grey would need to be reduced by the
same amount.
AIMS
These are as stated for medicine. (see page 10)
STRATEGY
It should be possible to provide some of the services that patients have
to travel to Christchurch for at present. This would partially finance itself
from reduction in cross boundary flows. Bed occupancy should be improved by
reducing bed numbers and introducing day case surgery at Greymouth for the
57% of the population living within 50 km of the base hospital. A limited
surgical service for Buller could be provided if financial pressures allow. 16
Outpatient clinics should be continued at all four hospitals and more visiting
specialists encouraged to visit Westport.
OBJECTIVES
(In rough order of priority and with time for implementation and estimate of cost or savings.)
1) All acute beds at Westland and Reefton be disestablished and short stay medical and surgical beds combined in Foote Ward at Buller Hospital as outlined in the medical service plan.
April 1984 savings See geriatric service
2) Reduce surgical beds in Couston ward to 26. Convert the
1st 4 bed room into a day case unit, requiring 1.0 additional
FTh nursing staff.
June 1984 cost $18,000
3) Appoint part-time - (4/10th s) visiting ophthalmologist and visiting ear, nose and throat surgeons to provide outpatient clinics at Buller Hospital and operating lists at Grey Hospital.
End of 1985 cost $40,000 probably 50-70% offset by reduc cross boundary flows
4) Appoint third full-time surgeon at Grey Hospital to provide a surgical service for Buller Hospital.
By the end of 1985 salary $40,000 added cost $20, total $60,000 17
5) Monitor bed utilisation statistics with a view to further reductions in beds before the end of 1988. definite future savings 18
OBSTETRICS
SITUATION
The West Coast population is decreasing slowly but this is not due to a low birth rate, but rather to emigration. Standard fertility ratio as quoted in Run 9 data for the average of the years 1977-81 is 1.009 and there were 463 births in West Coast hospitals in 1983, 371 at Grey Hospital and 92 at Buller Hospital. Of the 371 at Grey . Hospital, around 90 would be births to mothers from the Westlánd area. There are 22 beds in the newly built McBreart
Ward at Grey Hospital and 12 beds in the Kawatiri Annexe of Buller Hospital.
There are three beds at Whataroa Hospital that are used for post-natal patient
Until August 1982 there was an obstetric unit at Westland Hospital in Ellis
Ward but this was closed because of low utilisation. More complicated deliver are undertaken at Grey Hospital and all caesarean sections with the exception of a very rare emergency procedure, are undertaken at Grey Hospital, • There w
46 in 1983 giving a caesarean rate of 10%. Due to the lack of neonatal dia.
services women in premature labour, or babies with the slightest problem partum are sent to Christchurch. There are two specialist obstetricians at
Greymoüth and enough mid-wives to cover all nursing shifts at Buller and Grey
McBrearty Ward has both open and closed beds and :the Board has an Obstetric
Advisory Committee which monitors standards-of G.P. obstetrics. Equipment at
the base hospital is excellent with ultrasound and neonatal intensive care
equipment being available. Antenatal facilities and parenthood education are
provided at Grey, Westland and Buller. Perinata], mortality fluctuates widely
from year to year because of low numbers, but the average over the last few
years is close to the national rate. (table 5)
ANALYSIS
Because of the spread out population on the West Coast there is a need
at least two maternity units. Westport is 11 hours by road from Greymouth. 19
Hokitika is 30 minutes by road and the population of Westland is close to
that of Buller and the expected birthrate if all women from the Westland area
were delivered at Hokitika would be about 90 per annum for that hospital.
However, most women from South Westland prefer to go all the way to Greymouth
and chose not to book in at Westland Hospital when Ellis Ward was still
operating. The need for two obstetricians at Grey Hospital exists because
there is no general practitioner with the necessary time or experience available
to provide cover for one obstetrician. National bed guidelines for obstetrics would indicate that 17 beds were required on the West Coast. This is clearly not relevant to special circumstances thatrevail here. The average occupancy of the 22 beds in McBrearty Ward was only 11.8 in the 1982/83 year but .fluctuations were such that the full 22. beds were required on several occasions during that time. The desire for home delivery services on the West Coast does not appear to be great and the difficulties of providing such would be enormous in the face of dispersed population and large distances to travel. Facilities are available at Reefton and Whataroa hospitals for discharge from Grey to post- natal beds at those hospitals. Post-natal domiciliary services are the responsibility of Public Health Nurses.
AIMS
The aim of a modern obstetric service should be the provision of safe, accessible, acceptable and relevant facilities for mothers to have their babies in the hospital.
STRATEGY
The West Coast Hospital Board should continue to operate two maternity units at Grey and Buller and to continue the already established policy of providing an indivualised service without the trappings of high technology 20
unless there are complications. For mothers who want it, accelerated discharge and post-natal visits from a domiciliary midwife should be available and paediatric services should be upgraded so that neonatal resuscitation and intensive care is available at least until transfer to Christchurch can be arranged for the more severe cases.
OBJECTIVES
1) Reduce the nominal obstetric bed establishment at Buller Hospital to eight.
April 1984 no saving
2) To continue to provide post-natal beds at Reefton and Whataroa
Hospitals. 21
PAEDIATRICS
SITUATION
There are 8,772 children under 15 years on the West Coast and this
number is projected to drop to 6,142 by the year 2001 ( . ow fertility . At
Grey Hospital ten paediatric beds are provided in Hannan Ward (combined with
geriatric beds). Their average occupancy was 5.4 in 1982/83. Most sick
children in the Buller region are treated at Buller Hospital. There is no
specialist paediatrician at the base hospital and the general physicians cope.
with acute admissions in this age group. Regular visits are made from Christchurch
by specialist paediatricians to take outpatient clinics. In recent years the
Board s physicians have been experienced in treating childrens diseases and
have provided consulting clinics, but this has not been so since the end of
1982. Consequently newborn babies with problems must be sent after stabilsation
as far as possible, to Christchürch for further treatment. There is excellent
equipment available in the neonatal intensive care unit at McBrearty Ward, Grey
Hospital. Eye and ear, nose and throat surgeons visit Grey Hospital every six weeks (see surgical services). TheDepartinent of Health has a medical officer, public health nurses and a vision and hearing tester who visits schools in the area.
Physiotherapy, audiology and orthotic services are available at Buller and Grey hospitals and an orthoptist visits . Grey Hospital every three months. There are no particular health problems in children on the West Coast.
ANALYSIS
Provision of adequate services for children in this region is bedevilled by the fact that just under 9,000 children do not provide an adequate workload
for a specialist paediatrician (despite the advice of the recently published paediatric service guidelines to the contrary). The West Coast really needs
two full time physicians with paediatric experience so that adequate cover is
available all times. 22
A guideline level of 12 beds is insufficient to justify a ward on its own and nursing staff ratios must be determined by local needs. No child or adolescent psychiatry is available (except for a limited private service in Westport)
There is no visiting therapist for handicapped children and the Grey Hospital paediatric unit is too small to have a teacher or play therapist. Facilities
and personnel must be available to ensure adequate neonatal resuscitation and
treatment of less severe conditions in Greymouth.
AIMS
The Board of Health report on child health services in New Zealand 1982
suggests that most people would probably agree
1) That children are entitled to grow and develop normally.
This--requires a favourable start in life, a good social, emotional, educational
and physical environment and good preventive services, including immunisation
and developmental checks.
2) If children become ill or injured we would wish them to be cared for
in.their home environment if that is safe.
3) If the child has a handicap, we would wish the child to live as
normally as possible.
4) For the problems that need hospital care we would. want the best care
in an environment where the other needs df the child are recognised properly."
STRATEGY
It is necessary to improve neonatal services on the West Coast, to
provide more frequent and accessible specialist consultation;, to develop
further services for handicapped children and to continue to provide adequate
hospital care for sick and injured children that cannot be treated at home.
The facilities for parents that exist in Hannan Ward at Grey Hospital are an
essential part of this hospital service and paediatric beds must be kept in
that one ward.
23
OBJECTIVES
1) To recruit and retain two specialist physicians with experience
in paediatrics including neonatal paediatrics.
end of 1985 cost Nil (covered by existing staff establishment)
2) To negotiate with Canterbury Hospital Board for visits from a
child psychiatrist and for visits of a paediatrician to Buller
Hospital.
by the end of 1984 cost $2,000
3) To encourage an existing staff member (physiotherapist or
occupational therapist) to train as a visiting therapist for handicapped
children.
by the end of 1984 minimal cost 24
GERIATRICS
SITUATION
The elderly (65 years of age and over) make up 11.3% of the West Coast population, compared with 9.9 % nationally. There are quite marked variations
of this figure within the region and considerable concentrations of the elderly population are away from rural areas. The proportion of the population supportin
the elderly (those aged 15 - 64) is the same on the West Coast as for the rest
of New Zealand (63%). Projections for the future indicate a 14% growth in
the total elderly population but a 74% growth in the 80 years old and over
group. No detailed information is available about the health status of the
elderly. Admission data reflects the availability of beds as well as health
status but does show a much greater than national average utilisation for
endocrine disorders (mostly diabetes mellitus), circulatory disorders (mostly
ischaemic heart disease) and particularly respiratory disorders (chronic airwa
disease in males). Geriatric beds are available at Grey, Buller, Westland,
Reefton and Seaview hospitals and there is accommodation for the frail elderly
provided-by the Board in each of the four main centres. Psychogeriatrics is
discussed in the context of mental health. There are no specific facilities
for assessment and rehabilitation or day care. The distribution of long stay
beds is skewed away from the base hospital. Short .stay admissions for relativ
relief are possible but there are no specific , beds set aside for this purpose.
Medical staff attend .--to the geriatric service in addition to their normal
duties and the only specific appointment for geriatrics is 1/19th at the base
hospital. A visiting geriatrician comes from Nelson twice a year. Nursing
staff are allocated according to need. The basic staffing pattern for a 20
bed and a 30 bed ward is shown in the attached table. Para-medical staff are
available at all hospitals but have other duties besides geriatrics.
Domiciliary services are reasonably well developed, but cannot cope with any
further workload without increasing staff. Long stay bed occupancy is not hig 25
but a proportion of medical beds are used by the geriatric age group, especially
at peripheral hospitals. Frail elderly accommodation is at a premium in
Westport and Hokitika and difficulty is often experienced in placing women
in Greymouth.
ANALYSIS
The geriatric hospital service on the West Coast owes much to dedicated
nursing and para-medical staff. There has been no geriatrician since 1976
and then only in Greymouth. Each hospital has developed in isolation and there
is at present no clear assessment and rehabilitation philosophy. In the future
there will be more dependent elderly and greater need for services but at
present it would seem that guidelines are more than adequate. Average long
stay bed occupancy in 1982/83 was 64.8. The guidelines are for 70 beds.
Assessment and rehabilitation beds will make a reduction in medical beds
possible. Although there is a tendency for young people to leave the region,
the proportion of population available to support the elderly is the same as
in the rest of the country. There is a generally held view that West Coast . - family structure is strong and supportive and although this accepted value is
still present, the reality is probably no longer generally true. In some areas
there are still multi-generation families but there are many: elderly West
Coasters who no longer have any close relations living nearby. Accordingly
there is a need for well developed domiciliary services. These will be
increasingly required in future. The care of the frail elderly has traditionally
been the responsibility of the Hospital Board, although there are two homes for
the elderly run by community agencies on the West Coast, one in Buller and one
in Greymouth. The Board provides 99 places and the average occupancy is 84.8.
A study of the costs of providing this accommodation and the financial return
from recovery of fees from these non-hospital patients indicates that the Board 26
is subsidising this service at the rate of at least $500,000 a year without an
recognition for this service being available under the population based funding
mode]:.
AIMS
The aim of the geriatric service should be to provide hospital beds and
related services for the West Coast elderly population In a manner which
both best utilises resources and reflects the interests of the people concerned
The service should help to maintain physical, mental and social independence,
prevent chronic ill health and maintain the elderly in the community rather
than in institutions.
STRATEGY
These aims are best realised on the West Coast by keeping geriatric
services decentralised where possible and by developing a general climate of
I - •1 rehabilitation. A full range of alternatives to long term hospitalisation ne to be. developed and the whole service provided with leadership and coordinati
Long stay geriatric beds should be redistributed so that each hospital has
adequate beds for its own local population. In addition these beds should be .... supplemented - by convalescent and rehabilitation beds, day care (or night care) I beds and short stay (relative relief) beds in accordance with guidelines.
These changes would need to be made gradually as patient numbers permit.
Patients suffering from terminal illness while not always in a geriatric age
group use services usually developed for geriatrics and although population oni
the West Coast does not permit the establishment of hospices, domiciliary
services should be developed to allow terminally ill patients to be nursed at
home and cared for by their general practitioner if the family and patient
wishes for this. If information is not available before mid 1984 that a 27
satisfactory level of extra funding is available then negotiations with private• and community interests should be started with a view to turning over to them the responsibility for the care of the frail elderly by the end of 1988.
OBJECTIVES
(In rough order of priority with an indication of a date for implementation and an estimate of cost or savings.)
1) To establish an assessment and rehabilitation team at the base hospitalto provide specialised care in a unit at the base hospital and to provide consultation, advice and assessment services for rehabilitation facilities at the peripheral hospitals.
This will require:-
a) appointment of a regional geriatrician and director
of extra-mural services cost $40,000
b) appointment of a domiciliary occupational therapist for the Grey / Reéfton area, who wilihavean advisory
role for the whole Boards region cost $18,000
c) designation of geriatric beds in Hannan Ward, Grey
Hospithl . aS assessment and rehabilitation beds. cost Nil. all to be iinplemeñted at .the end of 1984..
2) To reallocate geriatric beds to obtain the following schedule by the end . of 1985, with the exception of Reefton Hospital which may take a longer period: 28
long stay bed type (including day rehabilitation total hospital relative care relief)
Buller 17 5 3 25
Reef ton 5 (included in stay) 5
Grey 30 10 6 46
Westland 18 5 3 26
Total 79 20 12 f 102
Guidelines 70 19 j 8-12 .1 97-10
To provide 30 long stay geriatric beds at Grey Hospital will necessitate
re-opening O Brien Ward andeventually to have long stay patients
probably in Couston and / or Morice Wards. The total number of long-
stay geriatric patients will not change. Some medical patients will
move from Morice to assessment and rehabilitation beds and some medical
patients from Reefton and Westland will behospitalised in Grey.
Considering nursing staffing only:
Reefton nursing budget reduced 2 FTE saving $36, 900
Westland nursing budget reduced . saving $400,000
coot-- U-5Q,-C
Saving by end of 1985 $861900
3) Increase domiciliary services in all areas by additional appointments.
a) district nurse Reefton half time initially $8,000
b) district nursing Grey Valley and Westland Hokitika
as required and monitored by the Chief Nurse. Probably 1 FTE $16,000 29
c) domiciliary physiotherapist Buller, Reefton $16,000
d) occupational therapist Westland (separate from Seaview) $16,000
e) Buller social work field worker half time $6,000 by the end of 1984 total cost $62,000
The .cost of $120,000 for additional appointments cannot be met by savings in geriatrics until at least the end of 1985. 30
MENTAL HEALTH
PRESENT SITUATION:
Mental Health services on the West Coast have developed around Seaview
Hospital at Hokitika (40km from the base hospital) which was established in
the nineteenth century along the asylum model brought out from Britain. This
hospital was used extensively in the 1940 s and 50 s for block transfer of
institutionalised patients from all over southern New Zealand. These old
long stay patients have formed the majority of Seaview s in-patient population
since then and, until recently, have determined the underlying philosophy
of the service offered by that institution.
There is very little direct statistical information about mental health status
of West Coasters. There have been 32 deaths from suicide in the years 1977-83
(analysis of Coroner s post-mortems) which givesa rate of 0.13%/100
This is slightly above national rates (0.11%.1000 in 1980). Prevalence of
alcohol related disorders is said to be proportional to alcohol consumption.
The only figures available for alcohol consumption are those supplied to ALAC
p by Lion Breweries for beer. West Coasters consumed 272 litres per capita in
1981 compared with 115 litres per capita for New Zealand as : a whole. Social
and economic factors are strong determinants of mental health status and the
West Coast with its pattern of lower than national average income and lower
rate of tertiary education must have a higher than national average service
need. Admission data both for Seaview Hospital and for West Coast residents
as a whole show a higher than national rate for admissions and re-admissions,
especially for alcohol related conditions, for senile and presenile organic:
psychotic disorders, and for depression and other neurotic disorders. More
West Coast women than men are admitted to mental hospitals (a reversal of
the national situation). 3].
Seaview Hospital consumes more than 30% of the financial allocation for the
West Coast Hospital Board ($19,077,000 in 1983/84). 82% of the hospital s
budgetis for salaries and wages for 278 FTE positions (table 17) which include
three medical officers, 160 FTE nursing staff (61% either students or unqualified),
an occupational therapist, social worker, six other professional and technical
staff (occupational therapy aides and industrial therapy instructors) and 107
FTE non-clinical staff. A psychiatric nursing three year training programme
takes in 10 students annually. Few comprehensive nurses are employed at Seaview.
There is one domiciliary psychiatric nurse.
There is now a policy of appointing only trained nursing staff and of offering
Enrolled Nurse training to unqualified staff. The PSA and the WCHB have reached
an agreement about desirable staff/patient ratios that is based on an Interboard
Liaison Group Working Party report. Annual review of patient depending status
is to be undertaken and staff levels determined accordingly. At present it is
accepted that there is a shortfall of nursing staff of around 20 FTE.
There are 320 beds in eleven villas and all these buildings, have a life
expectancy of more than 20 years (with a projected average maintenance cost for
each of around $50,000 to ensure this). None of the villas is designed for patients requiring any major degree of nursing care. Sewerage and .stormwater
drains are combined and in poor condition. Considerable expenditure will be
required-to separate the two types of effluent to meet local body standards.
A laundry, kitchen, chapel, recreation centre and occupational and industrial
therapy centre are part of the hospital complex and there is a half-way
house in the town. 32
Bed occupancy at Seaview Iospi.ta], has decreased in recent yeaxs and was 286
the end of Feburary 1984 (table 21). At the end of 1982 there were 175 old
long stay patients and a projection of their numbers based on life expectan
and no prospect of discharge from, hospital shows that 38% will still be a],iy in 20 years. The projected decrease is around 6-7 per year which is less th
the rate of reduction in Seavjew in-patient numbers as a whole in the last
five years (11/year). A recent review of patients at Seaview has suggested
that up to 21 further patients could qualify for inclusion in the OLS regist
Non-OLS patients at Seaview have a median age between 65 and 69 years and 0L
patients have a median age of between 60 and 64 years. There are 84 OLS pat
and 57 non-OLS patients aged 65 years or over. For the next 20 years there
will be over 20 OLS patients over 75 (there are 42 currently) and at present there are 27 non-OLS patients in Seaview with a diagnosis of senile or prese organic psychotic condition. Approval has been given by the Department of H
to prepare working drawings for alterations to Huia. and Ruru Villas to pro vi Proper accommodation for nursing care of elderly patients. Patients with men handicap are not .now admitted to hospital in the number they were 15 or mOre
years ago and the few admissions with this diagnosis are normally transfers
from Braemar or Templeton of adolescents or young adults whose families
are resident on the West Coast but who are not suitable for discharge.
Outpatient consultatns are available at Seaview, Grey and Buller hospitals
but referral rates are low (first attendances 2.5/1000 popülation compared wi a national rate of 10/1000) (Hospital management data 1982). Patients are
admitted to hospital most often at their own request or that of their family rather than from GP referral or outpatient follow-up.
Cross boundary flows are not insignificant and account for 3.6% of all bed days used by West Coast residents. Most of this seems to be for treatment of 33
alcohol related disorders. There is also a limited outflow of young severely mentally handicapped to Braemar and Templeton hospitals.
West Coast residents used mental hospital beds at 86% above the national rate in 1981 (MSRU, Utilisation Rates in Hospital Boards, 1981) and this remained high at 84% in 1982. Besides more frequent admission there is a pattern of longer stays making considerable excess bed utilisation.
Domiciliary care is provided by a social worker and a domiciliary psychiatric nurse both of whomtravel all over the West Coast. The social worker travelled
18,500 km in 12 months in 1982/83 and make 1788 visits. The nurse made 1186 visits and travelled proportionally less distance.
ANALYSIS
Mental health services on the West Coast are dominated by one institution and by the history of that institution as.a national resource providing now outdated institutional and custodial care.
There is a pattern of utilisation of resources that indicates only one basic therapeutic endeavour - admission to hospital. There is no specialist psychiatrist, and communication between Seaview staff and the general hospitals and general praótitioners is poor. The range of outpatient services is very limited and does not include any specialised alcohol dependency assistance, and child or adolescent psychiatry, or crisis intervention facilities. There are at least 40 inpatients requiring nursing care in villas which are not designed for this purpose. There is no physiotherapy available for inpatients and no psychologist. The occupational therapist is responsible for general and domiciliary services for the Hokitika community in addition to her Seaview duties. Community services are fragmented and unco-ordinated. Domiciliary 34
services are stretched and the social worker and nurse can provide only a
drop-in service.
Guidelines indicate that the West Coast population requires 17 short stay
beds, 17 long stay beds and 51 psychopaedic beds. In addition 20 psycho-
geriatric beds are suggested. It is generally considered that the psychopaedic bed guideline is now much too high and should be about 50% of the currently
accepted level (i.e. about 26 beds for the West Coast). Hence the total psychiatric and psychopaedic beds for this region should not exceed 80.
At the present time no specialist psychopaedic facilities are available and
therefore the bed provision should be between 60 and 70.
AIMS AND GOALS
The stated aim of the West Coast Hospital Board for mental health is -
"The Board commits itself to the redevelopment of mental health
services with increasing emphasis on alternatives to custodial
and institutional care."
An appropriate addition to this could be adapted from the Otago Hospital Board
document "Community Mental Health in Otago".:
"The goal of modern treatmént : of persons .with major mental illness is
to enable the patient to lead as normal a life as possible One o
the means toward this end is to allow the patient to live in the
community wherever this can be achieved, since usually a richer and
more normal life is possible outside: hospital. If admissions are
necessary they shOuld be as brief as possible to save the :patient
from the debilitating effects of institutionalisation. Rehabilitation and
aftercare are essential and should be a continuation of the multi-
disciplinary approach to care used in the hospital." 35
STRATEGY
It is essential that the mental health service be decentralised and that
the management and coordination of services be improved. Greater communication
is necessary with general practitioners and other community workers and
organisations. A new emphasis must be placed on keeping patients out of
hospital if possible and discharging more rapidly those requiring admission.
Guidelines for non OLS beds should be met within 5 years.
The essential directions for change required are clear. The choices to be made
are only those of priorities and speed of implementation and depend on
availability of resources.
OBJECTIVES
(These are stated with a date for their implementation and an estimate of
cost or savings are in rough order of priority.)
1) The appointment of a specialist psychiatrist as Director of Mental Health Services, to be superintendent of Seaview Hospital and to provide overall direction and coordination of services on the West Coast
August 1984 cost Nil
2) The reorganisation of social work services to use local
social workers for psychiatric work in their own region.
April 1984 Nil
3) The formation of community mental health care groups (in
the four main centres initially) to improve liaison and communication 36
between local health care workers.
June 1984 Nil
4) To review the dependency status of patients in Seaview
Hospital by May 1984 - to repeat this annually and to reach a
nursing staff / patient ratio agreed by the WCHB and PSA by
a process of attrition of patient numbers initially.
1986 Nil
5) To increase the outpatient consultation rate to a
national level and to reduce the admission rate and length
of stay of patients at Seaview Hospitalso that non-OLS
patients are reduced to 65.
end of 1988 ) saving $550,000 by
.1 6) To close three villas and to reduce non-clinical staff end of 1988 by 15
end of 1988
7) To close one of the Boards laundries and to centralise
laundry services at one site.
November 1984 saving $300,000
8) To expedite the programme to redesign and upgrade Huia and
Ruru villas to provide proper units for the nursing care of
dependent elderly OLS patients and psychogeriatric patients.
mid 1986 capital expenditure
37
9) To establish a psychogeriatric assessment unit in one
of the redesigned villas.
mid 1986 Nil
10) To make the following appointments:
- alcohol dependency services coordinator $25,000
- physiotherapist at Seaview Hospital $18,000
- a second domiciliary psychiatric nurse $18,000
- a clinical psychologist $25,000
before March 1985 cost $86,000
11) To open in conjunction with community interests in
premises not physically associated with the hospitals in
Hokitika, Westport and Greymouth, community health centres to act as drop-in centres, crisis centres and bases for the I provision of outpatient alcoholism services - using community workers and existing Board staff. . 1985 Nil
12) To make a feasibility •study of the possibility of transfer
of some longer stay patients at Seaview Hospital to other types
of care or to discharge them.
end of 1986 Nil
13) To investigate the possibility of establishing a psychopaedic
unit at Seaview Hospital.
end of 1986 Nil 38
14) To evaluate the need for continuing psychiatric nursing
training at Seaview.
end of 1988 Nil
15) To install new sewer lines from Seaview Hospital to allow
discharge of effluent to the Hokitika Borough oxidation ponds.
end of 1988 capital expenditure 39
PRIMARY HEALTH CARE
SITUATION
Primary health care in New Zealand is largely the responsibility of the private sector and hospitals have a limited, but not insignificant role to play. The West Coast Hospital Board is responsible for a . system of patient transport from community to hospital, between hospitals within the Boards area and for travel if necessary to other Boards for treatment not available on the West Coast. There are 17 ambulances based at 12 locations from
Karamea to Haast. The Board operates 11 of these and the St. John Ambulance
Assocation provides the balance. With a population of only 34,000 the ratio of 1 ambulance to every 2,000 people is the highest in the country. A city of similar size would be considered covered with 4 ambulances. The Board s general vehicles fleet throughout its hospitals and services numbers 50 and in order to maintain a reasonable standard of medical services, transport by way of Board car has been made available to the specialist staff and doctors based at Grey Hospital so that they can hold regular clinics at the outlying hospitals. Provision of domiciliary and other paramedical services to peripheral hospitals is also dependent on these vehicles. District nurses,
,social workers, occupational therapists, physiotherapists, psychiatric nurses, laboratory, pharmacy, orthotic staff, dietitians, radiology, laundry, engineers, nursing education and speech therapy all require transport in order to extend their particular services and expertise to the three outlying hospitals.
Air ambulance either by light aeroplane or helicopter is available at short notice from private contractors. It is heavily dependent on weather conditions and can be considered only a complementary service to an adequate road service which must be available 24 hours a day, seven days a week. There is an accident and emergency department at Grey Hospital and G.P. s provide A & E services in the other centres. Emergency equipment and facilities for resuscitation are 40
required at outlying areas, especially South Westland, Otira and Karamea.
In some of these areas there is no doctor immediately available and district and public health nurses must be the primary care agency. The Board provides
laboratory and x-ray diagnostic facilities and a physiotherapy service for general practitioners in all four main centres. This diagnostic service costs t
Hospital Board $200,000 annually. Beds at Whataroa and Reef ton hospitals which have been included in the acute medical and surgical quota are used as observati or convalescent beds to provide a further option between remaining at home in an isolated area far from a doctor and being admitted to an expensive hospital bed at the base hospital. The primary care facilities provided by the Board are adequate and have evolved to meet the special needs of the West Coast community. Domiciliary services are only barely adequate for the types of care provided at present and are not capable of handling any extra work-load.
AIMS AND STRATEGY
A fully functioning primary care service in the community is essential to the successful running of a hospitlsystem. The possibility of treating
illness and managing disability at home should be first priority, , because not only is the patient not exposed to the known risks of loss of independence of institutionalisation but the country pays less for care delivered in this way. General medical-practitioners need the back up of hospital extra mural
services to enable them bdequately to assess and manage more people at home.
In addition they need to be adequately reimbursed for the extra time they
need to spend in providing this service. Communication between community and
hospital must be maintained and improved to make the health service operate
as an integrated whole. The administration of such a service needs to be
unified and the concept of area health boards will provide a path towards such
a goal. Primary care beds that are separate from short stay medical and 41
surgical quotas should be provided at Whataroa and Reefton. The hospital should provide those primary care services that the private sector cannot provide because of geographic or economic factors.
OBJECTIVES
1) To increase domiciliary services as outlined in the geriatric service plan.
2) To establish two primary care beds at Whataroa Hospital and three at Reefton Hospital.
3) To establish better communication between primary health care workers and the hospital and to institute a planning process for primary care by establishing with the district office of the Department of Health and the West Coast United Council, a Primary Health Care
Service Development Group. This would require the Board to find 1/3rd of the cost of a primary health care planning coordinator.
$8,000 42
NON CLINICAL SUPPORT SERVICES
The need for planning is now readily apparent and adequate resources and information must be available for this purpose. Accordingly .the following objectives should be set for the next five years:
1) Establish funding for a permanent position of service planning coordinator (change of name from research and planning officer).
January 1985 cost $20,000
2) Investigate methods of computerising statistical data for planning and management.
1988 Nil
3) Investigate methods of computerising patients clinical, data.
1988 Nil
4) Considerable savings can be made at Buller Hospital by
converting steam services there to low pressure hot water. Some
capital expenditure will be required.
end of 1985 saving $100,000
r
43 SUMMARY
BED ALLOCATION (excluding frail elderly accommodation)
PROJECTIONS FOR EACH HOSPITAL 1984-1988
Projected Beds Present Hospital Beds end of 1985 end of 1988
Bul ler 66 53 48 Reef ton 25 10 10 Grey 138 156 152 Westland 45 26 26 Seaview 320 320 230 Whataroa 5 5 5
Total 599 570 471
1988 PROJECTION FOR EACH HOSPITAL BY SERVICE
- Service Hospital . ______Total Primary Medicine Surgery Paediatrics Obstetrics Geriatric! Psychiatry Care
Buller 10 5 8 25 48 Reefton : - . 2 .5 . 3 10 Grey 31 43 10 22 46 152 Westland . 26 26 Seav I ew 230 230 Whataroa 3 2 5
Total 41 I 48 I 10 35 102 230 5 471 44 SCHEDULE OF FINANCIAL EFFECTS OF IMPLEMENTING THE SERVICE DEVELOPMENT PLAN
IEffects on Budget/Allocation Service Proposal 1981+/85 1988/89
$ $ Medicine and Surgery oncology clinics 3,000 + 3,000 + day bed unit 18,000 + 18,000 + visiting eye and ENT surgeons 40,000 + 40,000 + reduced cross boundary flows 20,000 - third full-time surgeon 60,000 + 60,000 + 2 decreased utilisation rate 166,000 -
Paediatrics visiting paediatrician and child psychiàtrist 2,000 + 2,000 +
Geriatrics - assessment and rehabilitation team 58,000 + 58,000 + increase domiciliary services 62,000 + 62,000 + bed reductions Westland / Reefton 86,000 - frail elderly - extra funding or relinquishment of responsibility 500,000 -
Mental Health I additional appointments 86,000 + 86,000 + adjustment in staffing levels - Seaview 550,000
Primary Care plannin coordinator 8,000 + 8,000 •+ diagnostic services - extra funding or relinquishment of responsibility 200,000 -.
Non-clinical planning coordinator, 20,000 + 20,000 + closure laundry 300,000 - Buller hospital steam / hot water conversion 100,000 -
Total 357,000 + 1,565,000 45
Notes
Ii The details of each service proposal are given fully in the relevant service section of the plan.
2 Decrease of utilisation rate from 1.17 to 1.05 for general (non-geriatric, non-obstetric, non-psychiatric) patients at Grey Hospital was calculated from 1983/84 expenditure as follows:
(a) general treatment nursing expenditure $2,320,000 general treatment supplies and expenses 666,000 food 236.000
$3,232,000
(b) allow 50 of this total for fixed costs 1,616,000
(c) reduction factor for reduced utilisation rate 1.17 - 1.05 - 10 X 0.103 1.17
estimated saving $ 166,000
3 Even if attempts are made immediately to recruit staff and reorganise services, a maximum of $200,000 will be in fact spent in the current financial year.
4 This figure is an estimate of possible savings at the end of the 5-year period. Some of these savings will be apparent as early as 1985 and the total will develop incrementally. I
LIST OF APPENDICES
I West Coast Hospital Board: Planning Guidelines
II Population
III Health Status
IV Resources
V Resource Utilization APPENDIX 1
WEST COAST HOSPITAL BOARD:
PLANNING GUIDELINES
(Adopted by the Board at a Special Meeting held 23rd March 1983)
(1) The Board commits itself to the development of a comprehensive and unified Health Care Plan for the West Coast, with the deployment of resources for the benefit of all West Coasters.
(2) The Board supports the principle of maintaining a high standard of community health care and, consequently, reduced dependence by the community on institutional and inpatient hospital care.
(3) The Board advocates the expansion of Primary Health Care services in all four West Coast districts (Buller, Inangahua, Grey and Westland), including District Nursing, Rehabilitation Services, Social Work and other support for general practitioners.
(4) The Board acknowledges the need to implement, gradually and responsibly, the population-based hospital bed guidelines of the Health Department, and notes that a reduction in beds implies an expansion of Community Health Care services. Guidelines for medical and surgical short-stay beds should be met within six years.
(5) The Board intends to strengthen the provision of specialist medical and surgical services at Grey Base Hospital in a manner which will meet the needs of all West Coasters as evenly as possible.
(6) The Board commits itself to the redevelopment of Mental Health Services with increasing emphasis on alternatives to custodial and institutional care.
(7) The Board supports the need for upgraded regional transport services to provide West Coasters beyond the Greymouth urban area with improved access to the Specialist Services at the base hospital, and commits itself to action designed to achieve this and also commits Itself. to the continuation of Specialist Clinics at the peripheral hospitals.
(8) The Board agrees to re-examine the structure and operation of hospital non-clinical support services with a view to effecting significant and immediate financial savings.
(9) The Board confirms its strong commitment to Service Planning, especially in its priority areas of Specialist Medical & Surgical Services; Elderly Health Care; Maternal & Child Health; Mental Health Care; and Primary Health care. APPENDIX Ii : POPULATION
Table 1 West Coast Population: Actual and Projected
Table 2 West Coast Population,1981: Age Structure by Local Authority Areas
Table 3 Comparative Socio-economic Indicators, 1981 Tab1r I
WEST COAST POPULATION ACTUAL AND PROJECTED
AGE GROUP 1981 1 19912 20012
o - 14 years 8772 (26%) 6542 (l9%) 6142 (18%)
IS - 39 years 13044 (38%) 13816 (40%) 11835 (35%)
40 - 64 years 8505 (25%) 9116 (27%) 11038 (33%)
65 - 79 years Women 1725 (5%) 1987 (6%) 1782 (54%)
Men 1572 (4%) 1735 (5%) 1641 (5%)
80 years & over Women 372 (1%) 519 (1%) 643 (2%)
Men 189 (%) 259 (%) 332 (1%)
ALL AGES 34178 (100%) 33972 (100%) 33413 (100%)
1 Actual population figures are from the 1981 Census.
Population projections are provided by the Demographic Specialist Studies Section of the Department of-Statistics In Christchurch. In 1983 the Section provided three different sets of projections for-the West Coast: the first, used here, is a low projection based on low fertility and some outwards migration (120pa); the second, is based on medium fertility with no migration, and projects a small population increase (1991, 35600; 2001, 36,800); and the third, based on high fertility with some inwards migration (120pa), projects a bigger Increase (1991, 37,200; 2001, 40,300). The low projection has been used In this table for the sole reason that it is closest to the actual post-1981 Census trend: Departmental estimates for 1982 & 1983 show a continuing decline in the West Coast s population during those years - to 34,000 in 1982, and 33,900 In 1983 (an average decline of 150pa). (These estimates are based on actual births and deaths, and on other data provided by government departments and local authorities, such as building activity, dwelling occupancy rates, primary school rolls, motor vehicle licensing and Institutional records, as well as taking into account the actual historical pattern of the preceding inter-censal period.) NOTE: The adoption of the "low projection" for the West Coast s population will require instant revision in the event of a major change to existing economic and employment patterns (e.g. the InitIation of new Industrial development). - -
Because of the "random rounding" procedures used by the Department of Statistics, totals vary slightly from the sum of the component parts.
Sources: N.Z. Census of Population and Dwellings, 1981: Volume 2: Ages, Marital Status and Fertility. Wellington: Department of Statistics.
N.A., 1983: "Population Projections: West Coast Hospital Board, 1986-2006." Data provided by the Management Services and Research Unit, Department of Health, Wellington, November 1983.
Demographic Specialist Studies Section, Department of Statistics, 1984: "West Coast Hospital Board Population" Letter and appendices provided to Research and Planning Office, 4.C.H.B. Table 2
WEST COAST POPULATION, 1981: AGE STRUCTURE BY LOCAL AUTHORITY AREAS
AGE GROUPS
(In Percent) TOTAL POPULATION LOCAL AUTHORITY AREA 65 Years & 0-14 Years 15-39 Years 40-64 Years Over
3788 (11.1%) Buller County 29.3 35.5 25.1 10.1 4686 (13.7%) Westport Borough 25.3 36.4 24.8 13.5
Reefton Township 25.4 35.0 26.0 13.6 1200 ( 3.5%)
Inangahua Rural Area 30.2 41.0 21.9 6.9 1018 ( 3.0%)
Grey Rural Area 27.6 39.3 23.5 9.6 2718 ( 8.0%)
Greymouth Urban Area 25.1 39.3 24.4 11.2 11604 (34.0%)
Westland County 26.0 39.9 24.4 9.7 5750 (16.8%)
Hokitika Borough 26.7 38.3 22.6 12.4 3414 (10.0%)
ALL WEST COAST 26.3 38.3 24.3 11.1 34178 (100%)
ALL NEW ZEALAND 26.9 39.7 23.6 9.9 3175737 (100%)
There are eight local authorities on the West Coast; in addition to the boroughs and counties listed here, the others are the Runanga and Greymouth Boroughs, and the Inangahua and Grey Counties. The boroughs, township and urban areas are all urban (61.2% of the total population), and the counties and rural areas are rural (38.9%). [The national GA-an : rural population ratio is 83 : 16k.]
2 The figures for age groups exclude those persons whose usual residence is overseas (of whom there were 1084 on the West Coast at the time of the 1981 Census).
3 Total population figures are those for all persons on the West Coast at the time of the 1981 Census.
4 Reefton township is anon-administrative area within the Inangahua County Council, defined by the Dept of Statistics as a self-contained community."
5 The Inangahua rural area is that part of Inangahua County outside Reefton Township.
6 The Grey County Council has a population of 4955 of whom 2237 (45%) reside within the Greymouth urban area; the Grey rural area comprises the non-urban part of the county.
7 Greyinouth is one of New Zealand s 14 secondary urban areas and comprises all of the Runanga and Greymouth boroughs and part of the Grey County Council.
Sources: NZ Census of Population & Dwellings, 1981: Volume 1: Location and Increase of Population, Part A. Wellington: Dept of Statistics (1982). NZ Census of Population & Dwellings. 1981: Volume 2: Ages, Marital Status and Fertility. Wellington: Dept of Statistics. NZ Census of Population & Dwellings, 1981: Regional Statistics Series: Bulletin No. 7. Wellington: Dept of Statistics (1982). Table 3
COMPARATIVE SOCIO-ECONOMIC INDICATORS. 1981
WEST COAST NEW ZEALAND
Highest Educational Attendance:
% Having Tertiary Education 27.5 36.7 (15 year olds & over)
Occupational Structure (Full time workforce): % Professional & Technical work 11.7 14.3 % Administration & Management 2.2 3.6 % Clerical and related work 12.2 16.8 % Sales workers. . 8.1 9.9 % Service workers 9,5 8.3 % Agriculture Forestry 17.1 11.4 Fishing % Production Transport 393 35.7 Labouring
ANNUAL INCOME:, Average Earnings (15 year olds &. over) $6480 $7215
Source: Town & Country Planning Division, Ministry of Works & Development, 1983: 1981 Census Statistics: Local Government Regions. Christchurch: MWD. APPENDIX III : HEALTH STATUS
Table L West Coast General Morbidity Data, 1982
Table 5 West Coast Perinatal Mortality Data, 1976-81
Table 6 West Coast Geriatric Morbidity Data, 1982
Table 7 West Coast Data: First Admissions - for Psychiatric Disorders, 1981
Table 8 West Coast Data: Readmissions for Psychiatric Disorders, 1981
Table 4
WEST COAST GENERAL MORBIDITY DATA, 19821
NEW ZEALAND 2 WEST COAST3 DISEASE GROUP
MALE FEMALE MALE FEMALE
NUMBERS RATE NUMBERS RATE NUMBERS - RATE NUMBERS RATE
Infectious and parasitic diseases 4 596 2.9 4 423 2.8 58 3.3 73 4.4 Neoplasms 13 259 8.4 15177 9.5 151 8.6 137 Endocrine, nutritional, immunity & metabolic diseases 8.2 2 461 1.6 3 173 2.0 52 3.0 66 4.0 Diseases of blood and blood forming organs 1 153 0.7 1 107 0.7 23 1.3 Mental disorders 18 0.9 3 858 2.5 5 102 3.2 41 2.3 50 3.0 Diseases of the nervous system and sense organs 9013 5.7 9 289 5.8 37 2.1 43 2.6 Diseases of the circulatory system 22 801 14.5 17 402 10.9 342 1.5 326 19.6 Diseases of the respiratory system 18 354 11.6 14 837 9.3 293 16.7 207 12.4 Diseases of the digestive system 16 741 10.6 13 755 8.6 251 14.3 203 12.2 Diseases of the genitourinary system 7 807 4.9 19 907 12.5 110 6.3 328 19.7 Complications of pregnancy, childbirth & puerperium - - 68 111 42.7 - - 611 36.7 Diseases of the skin and subcutaneous tissue 3 115 2.0, 2 769 1.7 58 3.3 49 2.9 Diseases of the musculoskeletal sys. & conn. tissue 8 676 5.5 9 276 5.8 105 5.6 116 7.0 Congenital anomalies 4 044 2.6 2 544 1.6 23 1.3 21 1.3 Certain conditions originating in the perinatal period 3 971 2.5 3 269 2.0 71 4.0 56 3.4 Symptoms, signs and ill-defined conditions 10 182 6.5 11 764 7.4 200 11.4 Injury and poisoning 228 13.7 34 543 21.9 20 122 12.6 454 25.9 Other •252 15.1 5 535 3.5 21 964 13.8 75 4.3 265 16.0
1 The data In this table refers to the numbers of patients discharged ordying in public hospitals. .. -. 2 Sources: National Health Statistics Centre (NHSC), 1983: Hospital and Selected Morbidity Data, 1982. Wellington: Dept of Health and NZ Census of Population and Dwellings, 1981: Regional Statistics Series: Bulletin No. 10. Wellington: Dept of Statistics (1982). 3 Sources: NHSC, Job Request PUS 212, ND: Morbidity Data 1982: West Coast Hospital Board; and NZ Census of Population and Dwellings, 1981: Regional Statistics Series: Bulletin No. 7. Wellington: Dept of Statistics (1982). 4 All rates per 1000 population of respective sex. Table 5
WEST COAST PERINATAL MORTALITY DATA, 1976_81
PERINATAL MORTALITY RATE PER 1000 LIVE BIRTHS YEAR
WEST COAST NEW ZEALAND
1976 21.2 14.4 1977 18.2 14.4 1978 7.5 13.0 1979 15.9 12.2 1980 12.2 12.2 1981 17.9 10.5
Perinatal mortality is the combined mortality in the late foetal (28-40 weeks gestation) and the early neonatal (birth to 7 days) periods.
Sources: National Health Statistics Centre, 1976-81: Fetal and Infant Deaths, Wellington: Dept of Health. eo
WEST COAST GERIATRIC MORBIDITY DATA, 19821
MALE FEMALE TOTAL DISEASE GROUP
NATIONAl? NUMBERS NATIONAL NATIONAL NUMBERS RATE 2 RATE NUMBERS RATE RATE RAT RATE
Infectious and parasitic diseases 4 1.0 1.1 14 Neoplasms 3.6 1.6 18 4.6 2.7 90 23.2 19.7 52 13.4 16.0 142 36.6 Endocrine, nutritional, immunity 6 metabolic diseases 35.7 p 24 6.2- 2.2 36 9.3 - 3.2- Diseases of blood and blood forming organs 60 15.5 5.4 - 7 1.8 1.0 6 1.5 Mental disorders . 1.5 13 3.3 2.5 . 5. 1.3 2.7 18 4.6 4.5 23 5.9 7.3 Diseases of the nervous syste and sense organs 8 . 2.0 5.9 16 4.1 7.5 24 6.1 Diseases of the circulatory system 13.4 178 46.0 33.0 197 51.0 30.8 375 97.0 Diseases of the respiratory system 63.8 102 26.4 12.0 40 10.3 7.3 142 Diseases of the digestive system 36.7 19.3 67 17.3 12.4 59 15.2 11.3 126 32.5 Diseases of the genitourinary system 49 23.7 12.7 9.0 22 5.7 5.2 71 18.4 14.2 Complications of pregnancy, childbirth & puerperium - Diseases of the musculoskeletal syst. &conn. tissue 12 3.1 1.3 8-- 2.0 Congenital abnormalities - - - 1.9 20 5.1 3.2 - .09 1 0.2 0.1 1 0.2 .19 Certain conditions originating in the perinatal period ------Symptoms signs and ill defined conditions 62 16.0 6.8 68 17.6 7.2 130 33.6 14.0 Injury and poisoning 17 4.4 7.3 61 15.8 15.2 78 20.2 22.5 Supplementary classifications 13 3.4 5.1 12 3.1 4.2 25 6.5 9.3
1 The data in this table refers to the numbers of people discharged or dying in public hospitals.
2 Rates per 1000 people over 65, regionally.
3 Rates per 1000 people over 65, nationally.
Sources: See Table 4
Table 7
WEST COAST DATA:
FIRST ADMISSIONS FOR PSYCHIATRIC DISORDERS, 1981
DIAGNOSES
C) —4 -0 710 0 (1) 0. 0 -0 C ) C) 0- Sw C) 0 C+ C) O O(D CD U)C) c-f - .CD. CD c-f - -(Drf CDCD (0 -0 0-0 0. < U) 0. 0, - U) - c-f —4 CD 0 (0(0 Cl)- CD 0 -0CD0V1CD CD CD 0, 00 O5 - . 0. •.. CD 0. - 0 Cr0. 00 O r+ c-f (A 0. c+ C) PATIENTS - • C) CD C) - CD (n U) CD -a. - - 0 CD 0) 0) Qo 0 - . CD U) - CD C) 5 — CD c-f - C) o U) 0 CD C) U) 5 U) 5 U) U) —a. LOCATION AND CD 0 U)U) CDO CD C) 0. 0). c+1 C) 0.. 0 0 CD 0. Qo c< o -< -- La. C) CD -a. U) CD U) -a. 0 CD rf GENDER U) a -i. OCD 01 C) C)U) CD 5(D Cl) C) CD U) CD(fl c-f 0 •U)V) U) U) U)- CD CD CD CD 0. -a-O U) c-P
124 100 2276 145 M 133 736 44 110 301 285 365 NEW ZEALAND 64 91 2166 136 F 169 204 31 184 401 527 495
8 1 - 29 165 M 3 9 - 4 1 3 WEST COAST RESIDENTS 1 - 37 221 F 8 5 - 1 7 12 3
- 16 91 M 3 1 - . 2 0 2 8 - SEAVIEW HOSPITAL 1 - 35 209 F 8 2 - 1 8 12 3
Source: National Health Statistics Centre, ND: Mental Health Data, 1980-81. Wellington: Dept of Health.
WEST COAST DATA:
READMISSIONS FOR PSYCHIATRIC DISORDERS, 1981
DIAGNOSES
0 (l) 0 Cu> 0 Q. -a (I) C) 0.. J - ) 0-D C) C) —I 0CD cf -•CD CDhCDc-f (D(D c-f (0 0 C) C C < (I) 0 C 0.. C/) - C) OQ) -i. Q, 0 c. (0(0 c-f —1 - c-f PATIENTS J. —a C) - • CD 0 5 0 0 1/ CD ø c-f CD C CD Qj N 5 0 0 c-f Cu 0 5 c-f -- CD C —s 0 C 0.. 00 -s I— - h () U) 0.. c-f c-f -. 0.. 0.. 0. - C) - (A (DCD C U) _ CD -. 0 La. CD Q LOCATION AND 0 ) CD c-f C) 0 CDD< CD U) - (DC) C--—CD- c-f (DC) /) U) U)V)(flhC Cl) 0. .0 . Q CD C) 0. GENDER - c-f c-f 5 0 C) - Q. rD 3 ) < C) 0 0. -J. 0 C) (A CD (I) 0 CD 0 CD c-f CD -< CD C) Cl) C) 0 00 0(1) 0. - . c-f(./) CD CD c-f Cl) CD CD U) CDV) Cl) U)Cn c-f 0 0.C/) Cn. - -• CDCD 0. — -0 CD 0. - V) U) CD C) CD CI, - CD
M 105 1847 72 1397 728 303 504 1 564 138 5658 358 NEW ZEALAND
F 94 424 57 1204 1381 650 715 289 73 4887 305
M ) WEST COAST - NOT AVAILABLE 135 395
F )
M 3 12 — 11 4 1 7 3 2 43 245 SEAVIEW- ______
F 2 5 — 9 14 12 6 3 2 53 317
N.
Source: National Health Statistics Centre, ND: Mental Health Data. 1980-81. Wellington: Dept of Health.
APPENDIX IV : RESOURCES
Table 9 West Coast Hospital Board: Local Hospital Beds
Table 10 West Coast Hospital Board: Hospital Beds & Guidelines
Table 11 Health Department s Planning Guidelines for Hospital Beds & Services
Table 12 West Coast Hospital Board Medical Staff
Table 13 West Coast Hospital Board Nursing Staff
Table 14 West Coast Hospital Board Paramedical Staff
Table 15 West Coast Hospital Board Domiciliary Staff
Table 16 West Coast Hospital Board: Nursing Requirements for Geriatric Wards
Table 17 Seaview Hospital Staff WEST COAST HOSPITAL BOARD:
LOCAL HOSPITAL BEDS
INSTITUTION SERVICE CATEGORY - ALL HOSPITALS BULLER INANGAHLJA GEY WESTLAND SEAVIEW WHATAROA
SHORT STAY: - - Acute Medical & Surgical:
Paediatric (0-12 years) - - 10 - - - 10 Adult (13-64 years) Geriatric (65 years & ) 39 6 90 10 - 2 147 over) )
Other Short Stay:
Psychiatric - - - - 29 - 29 Maternity 12 - 22 - - 3 37
223
LONG STAY: Adult (13-64 years) ------Geriatric (65 years & over) 15 19 16 35 - - 85 Psychiatric ) 291 Psychopaedic ) - - - - - 376
ALL SERVICES 66 25 138 45 320 5 599
Source: WCHB Medical Superintendent-in-Chief, April 1984
Table 10
WEST COAST HOSPITAL BOARD: HOSPITAL BEDS AND GUIDELINES
BED NUMBERS SERVICE CATEGORY 1 PRESCRIBED ACTUAL VARIATION
133 223 +90 SHORT STAY:
Acute Medical & Surgical: Paediatric (0-12 years) 12 10 - 2 Adult (13-64 years) 68 ) 147 +60 Geriatric (65 years & over) 19
99 157 +58 Other Short Stay: Psychiatric 17 29 +12 Maternity 17 37 +20
34 66 +32
REHABILITATION & LONG STAY: 164 180 + 6
Paediatric (0-12 years) 0 0 0 Adult (13-64 years) 7 0 - 7 Geriatric (65 years & over) • Assessment & Rehabilitation 19 0 -19 • Long Stay Care 70 85 +15 17 Psychiatric ) 952 +27 Psychopaedic 51
ALL SERVICES 297 403 +106 C
1 See Table 11. 2 The total number of long stay psychiatric and psychopaedic beds is 291; however, as at 29/2/84 196 of these beds were occupied by patients classified as "Old Long Stay Patients", and eligible for supplementary funding from the Health Department.. In order to provide a realistic comparison with the Department s guidelines for these long-stay beds, the beds eligible for supplementary funding have been subtracted from this table.
Source: See Tables 9 and 11.
Table 11.
HEALTH DEPARTMENT S PLANNING GUIDELINES FOR HOSPITAL BEDS AND SERVICES
SERVICE CATEGORY GUIDELINE FORMULA ACTUAL BED (No. of beds/population) POPULATION GUIDELINES
SHORT STAY 133.8 ACUTE MEDICAL & SURGICAL: Paediatric (0-12 yrs) 1.6/1000 7605 Adult (13-64 yrs) 12.2 3.0/1000 22713 Geriatric (65 yrs & over) 68.1 5.0/1000 3861 19.3
99.6 OTHER SHORT STAY: Psychiatric 0.5/1000 (max) 34178 17.1 Maternity 0.5/1000 (approx) 34178 - 17.1
34.2
:EHABILITATION & LONG STAY 164 Paediatric (0-12 yrs) 7605 Adult (13-64 yrs) 0.3/1000 22713 6.8 Geriatric (65 yrs & over) Assessment & rehabilitation 5.0/1000 3861 19.3 Long Stay Care 18.0/1000 3861 Psychiatric 69.5 0.5/1000 (Min ) 3 34178 17.1 Psychopaedic 1.5/1000 34178 51.3
ALL SERVICES 349178 297.8
1 Guidelines are provided for the use of all Hospital Boards by the Dept of Health (see below). 2 The 1981 population figures in this table , are slightly different to those in Table 1 due to similarly small variations between different reports from the Dept of Statistics and to their use of "random rounding" procedures. See below (source). Combined short- and long-stay psychiatric bed guidelines are 1.0/1,000 maximum. Sources:
Health Department, 1977: Planning Guidelines for Hospital Beds and Services. Wellington: Dept of Health.
NZ Census of Population & Dwellings, 1981: Regional Statistics Series: Bulletin No. 10 Wellington: Dept of Statistics (1982). Table 12
WEST COAST HOSPITAL BOARD MEDICAL STAFF
Position ETE
Medical Superintendent-in-Chief 1.0
Grey Hospital - Physicians 2.4 - General Surgeons 2.0 - Orthopaedic Surgeon 0.7 - Obstetricians 2.0 - Radiologist 1.0 -:Anaesthetists 2.4 - House Surgeons 4.0 - Visiting Specialists 0.3
Buller Hospital - Superintendent 1.0 - Medical Officers 1.0
Westland Hospital - Superintendent 0.6 - Medical Officers 0.4
Reefton Hospital - Superintendent 0.6
Seaview Hospital - Superintendent 1.0 - Medical Officers 2.0
Total 22.4
Employed as at 31 March 1984.
Source: WCHB Medical Superintendent-in-Chief, April 1984. Table 13
WEST COAST HOSPITAL BOARD NURSING STAFF
Hospital I Category of Total 1. Nurse I Westland Grey Buller Reefton Seaview District
Chief Nurse 1 Principal Nurse 1 2 1 1 5 Ass. Principal Nurse 1 1 2 Supervisors 5 1 6 12 Charge Nurses 9 7 1 4.75 15 36.75 Staff Nurses 44.34 13 5.2 8.95 36.25 10.3 118.04 Enrolled Nurses 25.62 22 6.8 13.5 7 0.4 75.32 Other Qualified 2.4 2.4
Hospital Aides 15.37 2.4 4 13.21 34.98 Psychiatric
Assistants 57, 57
Total 103.73 46.4 17 42.41 123.25 11.7 344.49
1 As at 31 March 1984 (NB: Does not include 9 tutors and 86 students ).
2 Position Vacant.
Source: W.C.H.B. Chief Nurse, April 1984.
Table 14
WEST COAST HOSPITAL BOARD PARAMEDICAL STAFF
HOSPITAL
PROFESSIONAL GROUP BULLER REEFTON TOTAL GREY L J
Dietitians 2 2
Medical Technologists 2 2
Laboratory Technologists 5 1 6
Occupational Therapists 2 1 1 4
Orthotists 2 2
Pharmacists 2 2
Physiotherapists 5 1 1 7
Radiographers 3 3
Social Workers 3 1 2 6
Speech Therapist 0.5 0.5
4.
ALL GROUPS 26.5 4 4 - 34.5
Qualified staff only (excluding aides, field workers, laboratory assistants and unqualified radiographers).
Source: WCHB Medical Superintendent-in-Chief, April 1984.
Table 15
WEST COAST HOSPITAL BOARD DOMICILIARY STAFF1
______PROFESSIONAL ______- ______HOSPITAL GROUPSEAVIEW GREY BULLER REEFTON WESTLAND TOTAL
District Nurses 4 2.27 4.23 10.50
Domiciliary 2 Physiotherapist 1 1.00
Home Helpers 4.75 1.77 .48 .90 7.90
Occupati onal 2 Therapists 2 1 1 4.00
Psychiatric Nurse 1 1.00
Social Workers 2 3 1 2 6.00
ALL GROUPS 14.75 6.04 8.71 .90 30.40
1 Projected FTEs for 1983/84.
2 Staff in these categories are included in the table of paramedical staff. Social workers and occupational therapists also have inpatient responsibilities.
Source: WCHB Medical Superintendent-in-Chief, April 1984 Table 16
WEST COAST HOSPITAL BOARD;
NURSING REQUIREMENTS FOR GERIATRIC WARDS
A. 20 BED WARD
SHIFT NURSING TOTAL FT1 per annur GROUPS MORNING AFTERNOON NIGHT
Charge Nurse 1 - 1.66
Staff Nurses 1 1 - 3.32
Enrolled Nurses 4 5 and Students 2 18.59
All Groups 6 6 2 23.57
B. 30 BED WARD
SHIFT TOTAL FT NURSING per annu GROUPS MORNING AFTERNOON NIGHT
Charge Nurse 1 - 1.66
Staff Nurses 1 1 - 3.32
Enrolled Nurses 6 5 2 21.97 and Students
All Groups 8 6 2 26.95
Source: WCHB Chief Nurse, April 1984 Table 17
SEAVIEW HOSPITAL STAFF
CATEGORY STATUS FTE
Medical Senior 3.0
Nursing Qualified 62.39 Students 32.31 Unqualified 65.22
Other professional Occupational Therapy 1.02 and technical Social Worker 1.00 Other 6.06
K. Administration and 17.08 clerical
Other non-clinical 90.03 services
ALL STAFF 278.11
Source: WCHB Medical Superintendent-in-Chief, April 1984 APPENDIX V : RESOURCE UTILIZATION
Table 18 West Coast Hospital Board: Bed Utilization, 1982/83
Table 19 Numbers of West Coast Residents in Public Hospitals, 1981
Table 20 Diagnoses of West Coast Residents-in Canterbury Hospital Board Hospitals, 1981
Table 21 Seaview Hospital Inpatient Numbers, 1977-1983
Table 22 Seaview Hospital Inpatients: Numbers, Ages and Gender Structure
Table 23 Seaview Hospital: Population Projection of 1101d Long Stay Patients"
Table 24 Seaview Hospital: Source of Referral of - Patients Admitted in 1981
Table 25 West Coast Residents Hospitalised for Psychiatric Disorders, 1981
WEST COAST HOSPITAL BOARD
BED UTILIZATION, 1982/83
BED CATEGORY
GERIATRIC FRAIL MEDICAL PAEDIATRIC PSYCHIATRIC OBSTETRIC ALL BEDS HOSPITAL SURGICAL AND GENERAL ELDERLY
EST AV.00C, EST AV.00C, EST AV.00C. EST AV.00C. EST AV.00C. EST AV.00C. EST AV.00C. EST AV.00C.
126.7 GREY 59 38.9 31 22.1 10 5.4 22 11.8 16 13.1 42 35.4 180 (70.4Z)
57.2 BULLER 24 8.5 15 13.7 12 2.4 15 8.5 27 24.1 93 (615%)
• 53.1 WESTLAND 10 7.1 34 27.5 20 18.5 64 (839)
26.7 REEFTON 6 4.2 19.. 15.7 10 6.8 35 (76.3)
0.4 WHATAROA 2 0.1 3 0.3 5 ( 8%)
289.0 SEAVIEW 320 289.0 320 (90.3%)
ALL 83 47.4 64 47.2 10 5.4 320 289.0 37 14.5 84 64.8 99 84.8 697 553.1
HOSPITAL< (57.1%) (73.8%) 54%) (90 3%) (39.2%) 77 1%) (85.7%) 1 (79.4%)
Source: WCHB Medical Superintendent-in-Chief, October 1983
- \.___• Table 19
NUMBERS OF WEST COAST RESIDENTS IN PUBLIC HOSPITALS, 1981
Hospital Boards Nos of Days Stay Prov,iding Treatment Patients
.Ashburton 2 20 Auckland 15 187 Hawkes Bay 2 13 Marlborough 7 37 Nelson 65 583 North Canterbury 675 7215 Northland 2 57 Otago 26 382 Palmerston North 2 4 South Canterbury 8 41 Southland 7 51 South Otago 1 1 Vincent 4 5 Waikato 6 238 Wairarapa 2 1282 Waitaki 1 3 44 4. Wanganui 1 Wellington 11 185
All Other Boards 837 10348 West Coast Hospital Board 4641 60368
TOTAL WEST COAST RESIDENTS 5478 70716 TREATED IN ALL HOSPITALS
Source: National Health Statistics •Centre, Job Request PUS 169, ND: Morbidity Data 1981: West Coast Hospital Board Residents by Board of Admission, Diagnosis, Age and Length of Stay." Table 20
DIAGNOSES. OF WEST COAST RESIDENTS IN CANTERBURY HOSPITAL BOARD HOSPITALS 1981
Diagnostic Category Admissions Days Stay
Cancer 128 2201
Heart & Circulatory Disorders 76 840
Genitourinary Disorders 42 293
Respiratory Disorders 39 175
Digestive Disorders 21 .175
Eye Disorders 61 400
Ear, Nose & Throat 58 125
Injury & Poisoning 73 867
Complications of Pregnancy & Childbirth
Miscarriage 51 90
Others 13 113
. Other Conditions .113 1936
ALL DIAGNOSES 675 7215
Source: See Table 19 Table 21
SEAVIEW HOSPITAL INPATIENT NUMBERS, 1977-1983
Source: WCHB Medical Superi ntendent-i n:Chi ef.
Table 22
SEAVIEW HOSPITAL INPATIENTS:
NUMBERS, AGES AND GENDER STRUCTURE
OLD LONG1 STAY PATIENTS NEW PATIENTS ALL PATIENTS PATIENTS AGE M F M F M F M & F
Under 20 - - 1 1 1 1 2 20-29 4 1 5 2 9 3 12 .30 - 39 8 12 3 .1 11 13 24 40 - 49 18 8 4 3 22 11 33 50 - 59 18 18 6 6 24 24 48 60 - 64 14 9 3 2 17 11 28 65 - 69 10 9 10 6 20 15 35 70 - 79 18 24 9 11 27 35 62 80 - 89 7 9 4 13 11 22 33 90-99 1 6 1 3 2 9 11
TOTAL 98 96 46 48 144 144 288
1 "Old Long Stay Patients" are those who had been in hospital for at least one year on 1 April 1976. (Costs of their care are provided by "q Supplementary Grant" to the Board from the Department of Health.) -
2 "New" patients are those in residence at the time of the survey, admitted since 1 April 1975.
Source: J Allan, 1984: "Seaview Hospital Patients Survey, February 1984." Greymouth: WCHB, Research & Planning Report No. XIV.
Table 23
SEAVIEW HOSPITAL: POPULATION PROJECTIONS OF "OLD LONG STAY" PATIENTS
Number of Old Long Projected Hospital Patients at 31 December2 Stay Patients 1 2002 Age 31 December 1982 1987 1992 1997
Males Females Total Males Females Total Males Females Total Males Females Total Males Females Total
25-29 1 - 1 ------30-34 3 1 4 35-39 4 5 9 3 1 4 1 - 1 ------40-44 9 5 14 4 5 9 3 1 4 1 - 1 45-49 7 4 11 9 5 14 4 5 9 3 1 4 1 50-54 10 9 19 7 4 11 9 5 14 4 5 9 3 1 4 55-59 5 6 11 9 9 18 6 4 10 8 5 13 4 5 9 60-64 11 9 20 5 6 11 9 8 17 6 4 10 7 4 11 65-69 8 10 18 9 8 17 4 5 9 8. 8 16 5 3 8 70-74 10 16 26 6 9 15 8 7 15 3 5 8 6 7 13 75-79 8 7 15 7 13 20 4 7 11 5 6 11 2 4 6 80 + 6 21 27 7 14 21 7 16 23 5 13 18 5 10 15 Total 82 93 175 67 74 141 55 58 113 43 47 90 33 34 67
1 This listing of Seaview Hospital s "Old Long Stay Patients" is from the Dept of Health s Mental Health Register. Cf. T Crombie et al., 1983: "Equitable Allocations: Run 9 Data." Wellington: Dept of Health, Management Services & Research Unit.
2 Projections were derived by application of age-sex specific survivorship rates assumed for West Coast Hospital Board District population projections (1981 base) to patients alive at the beginning of each period. Because of the size of the population exposed-to-risk these projections should be regarded as approximate only.
Source: Demographic Specialist Studies Section, Department of Statistics, Christchurch, 11 January 1984. Table 24
SEAVIEW HOSPITAL: SOURCE OF REFERRAL OF PATIENTS ADMITTED IN 1981 1
Seaview , Hospital All NZ Hospitals2 Source of referral
No. % No,
Self and/or relatives 61 47 2444 19
Private psychiatrist - 155 1
Other medical practitioner 16 12 3867 30
General hospital (non psychiatric unit) 19 15 1295 10
Psychiatric unit (general hosp) . - - 535 4
Geriatric unit (.excl, general hospital) 2 2 123 1
Law enforcement agency 6 5 1251 10
Non-medical - agency 1 1 908 7
Domiciliary nursing 9 7 230 2
Outpatient & day patient psychiatric 1 1 1536 12 unit Inpatient psychiatric care unit . 1 1 143 1
Unknown. 14 11 560 4
All Referrals 130 100% . 13047 10O
1 Excludes replacements - patients returning from leave. 2 Includes all public psychiatric services (general and psychiatric hospitals), four Salvation Army institutions and Ashburn Hall.
Source: National Health Statistics Centre, ND: Mental Health Data 1980-81. Wellington: Dept of Health. Table 25
WEST --_COAST RESIDENTS HOSPITALISED FOR PSYCHIATRIC DISORDERS, 1981
.-.-.-..-. ...,.-. First Re- Hospital Admissions Admissions
Braemar - 3 Ngawhatu 1 4 Queen Mary Seaview (76/a) 91 (67°! Princess Margaret 1 3 7 (11%) Sunnyside 21 (16%) Templeton 1 1 Cherry Farm 1 Ashburn Hall 1 The Bridge (Chch) 1 7 Rotorua SanitOriUm - 1 ------66 135 All Hospitals -
Source: See:Table 24 H342 WA 75427 541 STACK KN4 [Q] WES V \ i&
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