East Care Accident and Medical is ending the overnight service it has been running in Counties Manukau for more than 20 years.
East Care Group chief executive Gordon Armstrong made the announcement today.
“This is a move we have taken with enormous regret,” Armstrong said.
“We know better than most that there is a significant need for the service we have been offering and that it’s highly prized within the community. But we have found ourselves increasingly caught between a rock and a hard place, to the point where we can no longer provide a safe and high-quality overnight operation.”
East Care initiated its overnight (after 11pm) service 24 years ago because it could see that rapid population growth and an aging demographic were only going to increase the urgency of the need for overnight care within the local community.
Although the service got off the ground without DHB or any other external funding, in 2014 Counties Manukau Health agreed to step up with funding to help support the service as part of a regional initiative to provide access to overnight care and to maintain financially viability in the face of increasing healthcare costs.
In 2018, however, the DHB reversed course. Instead of delivering to their stated intention of having two funded overnight services in Counties Manukau, it elected that none would be DHB funded, Armstrong said.
This meant that while East Care could produce independent research showing its clinic was the highest volume provider of overnight primary care in Auckland (33 per cent of all overnight urgent presentations in the last quarter), it found itself the only Auckland clinic running a 24/7 service without any DHB subsidy.
Armstrong said that even with the loss of the funding, East Care determined that it had a responsibility to continue the overnight clinic for as long as it reasonably could, in the interests of patient wellbeing. In the interim, although it was no longer funding the service, Counties Manukau Health relied heavily on East Care both as a provider of 24/7 primary care services and to provide community Covid-19 swabbing.
“We took the attitude that our patients need us, so we had to keep sucking it up,” Armstrong said.
“From the beginning, this was a loss-making service. With the advent of DHB funding five or six years ago, we found we could manage.
“But the situation we’re in now is not just unfair, it’s unsustainable. To expect a loss-making service, however strong the need for it may be, to stay open just because we feel it’s the right thing to do, even as the losses keep mounting, is an argument that has stopped making sense. And, frankly, as a GP-owned organisation, we don’t have the economies of scale of a larger, funded provider. We do however maintain the ongoing ability to service patients from 7am to 11pm, just not overnight.”
In November 2020, patient volumes began to increase significantly at East Care and all other primary care clinics across the region. This led to major operational pressure, staff burn-out, long wait times and a spike in patient cancellations.
The worsening outlook was exacerbated earlier in December when a doctor employed at East Care was effectively ‘poached’ by a funded overnight provider, who were able to offer higher hourly rates as a result of their being subsidised for their overnight service. Here was a situation where a subsidised entity was able to outbid an unsubsidised clinic for precious – and scarce – resource.
“The writing seemed to be on the wall,” said Armstrong.
“Then, on Monday of last week (December 7), the clinical director and I met with our doctors. They graphically described to us the burn-out they were experiencing, the high volumes of patients they were seeing and they talked to us about what we could all identify as a spiralling clinical risk,” Armstrong said.
“That night, in fact, our (contractor) overnight doctor experienced just such very high volumes, long wait times, an unacceptable level of stress and understandably frustrated patients. At 10.30am the next morning, she advised East Care’s Clinical Director that she wasn’t prepared to work overnight again in those conditions.
“The clinical director took the view that increasing resource pressure would lead inevitably to more staff being unable to cope, putting further pressure on the clinic and its staff.
“At this point, we were no longer simply considering a commercial equation. We were confronting a major ethical issue. Given the now clear resourcing issues and high risk to clinical and patient safety, the Board of Directors felt it had no option other than to close the service down from December 18.
“The imminent closure of the East Care overnight service brings to an end over 20 years of 24-hour, 365 days a year care for our community. It’s not a decision we’d ever have made voluntarily. We feel coerced by the clinical safety issues we are facing and a highly inequitable funding environment.
“Since we can no longer provide a high quality and clinically safe overnight service, we have no option but to close between 11pm and 7am every day. East Care remains committed to the East Auckland community and is still the first choice for high quality urgent care.
“We will still be open from 7am until 11pm every day, including weekends and all public holidays. We remain committed to providing the highest quality care to the east and south Auckland communities in the long term.”
Meanwhile Counties Manukau Health said in a statement it will continue to provide the community the right care.
“People needing emergency medical care in the eastern part of Counties Manukau will continue to get the care they need, when they need it,” CM Health said.
Dr Vanessa Thornton, Clinical Director of Middlemore Hospital’s Emergency Department, said that since 2017/18, CM Health had doubled its investment in afterhours care.
“This consists of funding eight afterhours clinics in the region, four of which are funded until 11pm, including East Care in Botany,” said Thornton.
“This funding enables these clinics to provide free or low-cost care for children under 14 years old, adults over 65, and Community Service Card or High User Health Card holders.”
Thornton said that while CM Health was disappointed to hear of the cessation of East Care’s overnight service in Botany, the decision would not impact Middlemore’s ability to provide services for patients who require emergency care.
“Those who need emergency medical care after 11pm should either ring for an ambulance or come to the Emergency Department at Middlemore Hospital.
“Even at our busiest, ED staff will ensure anyone presenting at the hospital gets the right care as soon as possible.
“Our message remains consistent – we need the community to seek the right care for their condition early. That means calling or visiting your local doctor, seeking medical help at afterhours services earlier in the evening, or contacting Healthline on 0800 611 116.”
