Reti ShaneDr SHANE RETI (National): On June 15 at 1 a.m. be in no doubt Minister Little that Middlemore emergency department (ED) was in crisis. The health sector is in crisis. I have said for some time that there are two parts of the sector that particularly worry me—aged residential care and emergency departments—and here it is. The chickens have come home to roost. This independent report is a damning indictment of Andrew Little's failure to address health workforce shortages to heed ED warning signs and to maintain health targets. What happened here? Well the first thing that happened was there was overcapacity in ED. On the night involved there were 46 patients for a room that sits 30 people. There were 94 people waiting for bed placement—a whole ward presumably in corridors waiting to get up to a hospital that was 98.2 percent full at capacity. The report tells us there was understaffing. There were three nursing vacancies including the critical waiting room nurse: the nurse who triages patients the nurse who says what the waiting time is the nurse who coordinates those who are the most urgent—that was a vacancy. A critical vacancy and do you think the reviewer had the privilege of a job description for that nurse? Not at all. Look at the report—not at all. There were warning signs. The weekly census report the week before the independent reviewer said showed the worst ED wait times to target—a week before June 15.The fourth point I'll make is the outcomes. I will come and contest the point that the Minister has made that it was unavoidable and raise some challenges to that conclusion. How did we get here? We got here because the Minister refused to address the health workforce shortage that has been blazingly obvious for years. We got here because the Minister ignored warning signs. He was warned there was a health workforce crisis. Keriana Brooking on behalf of all of the DHBs when she was chief executive wrote a letter in July last year saying Minister we have a health workforce shortage and if we do not address immigration settings several things will happen" and in the appendix she even put graphs. She said "First of all ED wait times are ballooning out. They will get worse." She said "Planned care our elective surgical lists are ballooning out and they will affect New Zealanders for generations to come." and then almost her final sentence in that letter was that if immigration settings are not attended to we will not avert a health crisis.Keriana Brooking on behalf of every single DHB warned the Minister in July last year there was a health crisis that we needed to attend to the health workforce and that we needed to use immigration settings to do that and the Minister pretends he didn't even receive the letter. I don't think so. Ashley Bloomfield did senior people and deputy director-generals did—of course the Minister did. I asked him parliamentary questions on it and he replied—of course he saw it. No one believes that.The Minister today disputed the fact that he had retired ED targets. That is not tenable. As I quoted in the written question where he states that he has retired the ED targets—in fact I'll go on for the whole sentence. What he says is and this is written question No. 14016: "The previous Health Targets were retired in June 2021"—and here's the next part that I didn't say in my supplementary—"and public reporting of results was discontinued". He took down the public reporting of ED wait times. It wasn't until May or June with consistent pestering by myself and colleagues on the health team that he decided to put them back in public domain. He removed them from visibility because they were so bad he wanted no one to see them. In his own words "The previous Health Targets were retired in June 2021 and public reporting of results was discontinued".He makes the claim that health indicators have taken them over the 12 health indicators named in December last year. Do you see ED wait times in those health indicators? No. Most other sophisticated health systems recognise that ED wait times are a good snapshot of how the system is doing. It represents a primary care that is struggling so they make ED their home. It represents a hospital system where the wards are full and you can't move them out of ED. It's an important measure and the Minister refused to make it a health indicator or indeed to support the health targets that National set.To everyone in the health sector and at the ED interface here is what the Minister told me in oral questions in the week of June when this tragedy happened. To John Bonning from the Australasian College of Emergency Medicine who said the wait time crisis was the worst in his career this is what Minister Little said; to Dr Kate Allan the chair of the Australasian College for Emergency Medicine here is what Minister Little said; and to every single person working in the ED sector here is what Minister Little said the week that this tragedy happened at Middlemore. What he said in parliamentary questions was—and the primary was around emergency department wait times—"but as a whole the system is coping".At the same time in the same week that this independent report is making statements like "ED overcapacity and an incredible 94 patients in ED awaiting bed placement" the Minister says the system was coping. An overcrowded ED a hospital well over acceptable capacity and subsequent system dysfunction and the Minister says the system was coping. The reviewer says it was a desperate situation; that same week the Minister said the system was coping. The independent reviewer said this is an unsafe environment for both patients and staff and is not sustainable and that very same week the Minister said to this House the system is coping. No it has not been coping Minister Little. No one believes that.Let's look at the time frames. If we look at ED wait times let's see what we've got. The target is to wait less than six hours—95 percent of people to wait less than six hours in an ED. Six hours is a long time with a child with a burst eardrum with an inflamed knee that may be septic or with a spinal disc that's protruding on your sciatic nerve. Six hours is a long time but it was an international target that we all accepted. What we know is that when we handed over target times in October 2017 that figure was around 91 percent. Today it's around 78 percent which is what the Minister is telling us. It has got worse every single year that the Labour Government has had responsibility.If you think six hours is worse what about 24 hours? Surely people can't be waiting 24 hours! Yes they can. Minister Little wrote in parliamentary questions that hundreds of people are waiting 24 hours but surely that's not the worst! Oh yes if you ask Minister Little how many people are waiting in emergency departments for more than 48 hours—two days—would you believe there are dozens who wait more than 48 hours? You had the 12 ED specialists from MidCentral and I commend their bravery for putting this out in an open letter to the Minister a few months ago saying that we have people with urgent critical conditions waiting in wheelchairs for more than eight hours. That was a brave statement from those 12 ED doctors.What we also know is that just like this unfortunate woman people leave when the waiting time is too great and what we know is every single month in New Zealand—and I know this because the Minister has written it to me and I can tell you exactly which hospitals are involved—5000 people leave. They leave before they're seen and they don't sign the indemnity form because they cannot wait any longer.The Minister said "Oh well the report came up saying it was unavoidable." There are things we need to think about there Minister actually. What happened was that this person was hypertensive and they hadn't been taking their Losartan for about two years. When you have a brain bleed maybe if you check blood pressure maybe if it's high you would restart their hypertensive medication and maybe the outcome could have been different. The neurologist raised this point as well.The Minister blames COVID; we've just heard a respected ED person saying this is no COVID blip. Oh and by the way I'm tired of that being a sad excuse for every bad behaviour from this Government. Go back before COVID even arrived. Look at the ED wait times from October 2017 when we handed over to before COVID even arrived and they were getting worse.The Minister's new excuse is flu. That does not stand up and he's had to change his tone from it being the worst ever in memory because it turns out the Institute of Environmental Science and Research can't back that statement. This has not been the worse season ever actually when you look at the data and when I inquire of him in ministerial questions how does he substantiate that fact he says "Oh of the people I've spoken to they tell me it's the worst flu season in memory." Unbelievable. How can that be statistically significant or any sort of science whatsoever?Come up with another excuse Minister because they're tired and worn. New Zealanders don't believe you. You are responsible for this crisis. You are responsible for the health workforce shortage. You are responsible for removing targets. It's a sad indictment—it's a sad indictment. Be very clear Minister: this is a crisis. Call it what it is and show the sector you understand them."