Whangārei Hospital. File photo: Edward Hyde

In the year between big Covid outbreaks $45 billion was spent from a Government Covid Recovery Fund – but not on the hospital system that is so central to the country’s response

A constant fear since the outbreak of the pandemic nearly two years ago has been of the health system being overwhelmed by the numbers of people requiring urgent and intensive hospital care.

In the early days, we were shocked by the television images from countries like Italy, Spain, and the United States of crowded hospital emergency areas, of patients (and sometimes bodies) queued in corridors, desperately waiting for attention. As the pandemic intensified, we saw similar scenes from hospitals in Britain, and more recently the most chaotic scenes of all from India, and closer to home, Fiji, of medical staff and facilities struggling to cope with the rapidly increasing numbers of cases.

The images all confirmed both the rapidity and pervasive nature of the spread of the virus around the world, and with it, the implicit expectation that New Zealand would be in no different a situation if the virus got loose in our country. That is why, in the early days prior to adopting its elimination strategy, the Government spoke in terms of “flattening the curve” of the likely spread of the virus here, to prevent our hospital system being overwhelmed as in other countries. The idea of trying to eliminate the virus in New Zealand emerged only once it was clear we were doing better at “flattening the curve” than initially expected.

Even though our hospitalisation rates have been low since then, the appearance of the Delta variant, and the still comparatively small – but now slowly rising – number of hospital cases, have raised again the spectre of the hospital system being stretched beyond its limits by Covid-19.

The move away from the elimination model to one based more on learning to live with the virus and manage its spread in the community has led to dark warnings from some quarters that the hospital system is now likely to come under pressure greater than at any point of the pandemic so far. All of which has increased the focus on our hospitals’ ability to be able to cope under such circumstances.

We already have one of the lowest numbers, in real terms, of intensive care beds available of many comparable countries, with the number reducing slightly over the past year or so, and specialists warning of staff shortages. There is emerging, but not yet loudly spoken of, doubt that our hospitals will be able to cope if we do experience an explosion in virus cases. This is despite the level of full vaccination now achieved. The experiences of countries across Europe, from Ireland to Denmark, that have seen a significant increase in case numbers in recent weeks, with fresh pressures on their hospital systems, could well be repeated here.

All of which raises an intriguing point. As part of its Covid-19 response, the government established in Budget 2020 a $50 billion Covid Recovery Fund, to be funded largely through borrowings, to cushion the impact on the country of the economic and social disruption brought about by the pandemic. Around $45 billion of the Fund has been allocated so far, and the Minister of Finance indicated a couple of months ago that the Government was not intending to borrow more at this point. He argued this was because the economy was basically stronger than many expected and showed last year that it was recovering quickly from the economic shock of the pandemic.

However, there has been criticism that the Fund has been used for many other purposes than recovery from the pandemic. For example, $515 million from the Fund has been allocated to improving the school lunches programme; $26.6 million to introduce cameras on fishing boats; and, $17.1 million for what has been described as the development of “creative spaces”. Worthy and all as these projects, and others like the replacement of Te Papa’s Spirit Collection Area, or the Housing Acceleration Fund that have been similarly funded, might be, it is hard to see how they can be described as intrinsic to the recovery from Covid-19.

Yet, at the same time, the discovery of mouldy walls recently at Middlemore Hospital or raw sewage leaking into the walls of Whangarei Hospital, as was reported last weekend, let alone the preparedness of our intensive care system for any onslaught from the virus, have been far from the forefront of Covid Recovery spending. To be fair, the Government did put another $11 million into the Middlemore situation in 2018 (before we had even heard of Covid-19), bringing to nearly $30 million the amount that successive governments have allocated over the years to try to resolve what has been a long-term problem at Middlemore.

However, that has not been the case for Whangarei. Neither this Government nor its predecessor have so far addressed a problem that has been known for about six years. After more than four years in office, and with the benefit of the Covid Recovery Fund, the present government should be doing far more than just describing the situation as “unacceptable” and, as per its penchant, blaming its predecessor.

And, despite the warnings from intensive care specialists about the inadequacy of our current system and bed numbers to deal with the potential threat Covid19 and its variants still pose, nothing has been allocated from the Covid Recovery Fund towards improvements. Indeed, the Ministry of Health has previously expressed doubts that improvements are even required at all, and the Director-General has consistently expressed his confidence that the hospital system will be able to cope in the event of more people needing to be hospitalised because of Covid-19.

This confidence seems to fly in the face of the emerging international experience. While our geographic isolation and less intense population density protect us to some extent, numbers requiring hospital or intensive care treatment are likely to increase as new variants of the virus emerge and we learn to live with Covid-19 in the wider community. Prudence alone suggests some upgrading of hospital capacity should have been planned and provided for, even if the level of demand might not become as pressing as elsewhere.

Given the nature of the virus, and its capacity for sudden and unpredictable spread, vigilance across a range of fronts remains one of our best defences. Throughout, the Government has made much of its response being driven primarily by public health concerns. Surely, the most fundamental of these is ensuring that our hospital system is fit for purpose when it comes to meeting the new demands likely to be placed upon it. The perennial excuses of blaming the previous government or there not being enough money available ceased to exist once the Covid Recovery Fund was established.

Thereafter, the issue became one of priorities – for which the present Cabinet is solely and entirely responsible. Starkly, the record shows the Government has so far found over $45 billion of other priorities that it considers rank ahead of ensuring that the hospital system can meet the public’s needs in the event the virus explodes. Even now, it seems unlikely any of the remaining $5 billion in the Covid Recovery Fund will be headed in that direction either.

The Government cannot therefore continue the charade of on the one hand encouraging grim warnings that the hospital system faces being overwhelmed if the virus takes hold, while doing nothing to forearm it on the other. Nor can it shove the issue off to someone else to address. It alone determined that funding hospitals to meet the crisis was not a priority for its Covid Recovery plan, so it alone must accept the responsibility for now leaving our hospitals so exposed.

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