Middlemore Hospital continues with emergency department vouchers and app testing

By Stephen Forbes, Local Democracy Reporter

The Middlemore Hospital emergency department is giving non-urgent patients up to 500 free vouchers a month to encourage them to go to private accident and emergency (A&E) clinics for treatment.

The vouchers and use of the Emergency Q app were adopted as a result of work started two years ago on a plan to improve patient care and flow in and out of the hospital.

The Manukau County Board of Health typically issues 2 to 300 coupons per month and up to 500 during peak hours.

The app, which is being used as part of a trial that was recently extended for another year, allows emergency department staff to inform patients about wait times at local urgent care centers.

It also informs patients about whether they need to go to the hospital or go to an accident and emergency clinic.

A Counties Manukau Health spokesperson said the system ensures that the emergency department is available for acute emergencies, while allowing non-acute patients to be treated at other healthcare facilities without having to pay for the visit.

But the DHB is unwilling to say how much the coupons cost each month, citing commercial sensitivity.

According to a report by the DHB Hospital Advisory Committee, implementing an improved version of the app could cost “several million dollars.”

The Executive Director of the Association of Salaried Medical Specialists (ASMS), Sarah Dalton, said there are benefits to using the coupon system.

“It’s better than not being seen at all, and for some people who are unwell, but who don’t meet the strict definition of needing emergency care, it’s a good option.”

He said that many people go to hospital emergency departments for primary medical care because they cannot afford the cost of visiting their GP or because they cannot take time off from work.

“For emergency departments like Middlemore Hospital, vouchers are a good option and for the patient it means less waiting time in the event of an accident and emergency,” Dalton said.

“With Covid-19 and the need for social distancing, it’s probably not a bad idea.”

But he said the problem highlights the need for free primary health care after hours in public hospitals. This would allow non-emergency patients to access treatment without increasing the workload of the emergency department staff.

However, not everyone is so impressed with the plan. John Tamihere is the Executive Director of the Whānau Ora Commissioning Agency, which deals with Maori health and social service providers in South Auckland.

He has been openly opposed to the voucher scheme, saying that after-hours private health clinics are already subsidized by DHB and ACC for many of his patients.

Emergency Q vouchers are just another recharge, he said.

“It’s because no one wants the headache of running services after hours,” Tamihere said.

“That is a misfortune.”

He said that these primary health care services should not be a profitable exercise for private health clinics.

“They should make the services 100% publicly owned, rather than leaving them to private commercial interests.”

A review of the New Zealand health system, published in June, called for DHBs to be responsible for planning and organizing primary health care services.

The Disability and Health System Review said DHBs should also have the flexibility to order primary health care services that are tailored to the needs of an area.

“Services should be located where they best fit the community and more services should be open longer. As part of the planning and contracting process, the hours of operation for services within the network would be agreed with the DHB.

“This could mean, for example, some or all services being open earlier or later in the day, providing clinics on the weekend, or participating in outreach activities. It could mean aligning the opening hours of services and the workforce in similar places and times, so that one person or whānau can conveniently meet all their needs at the same time. “