Hunter patient die without dignity in hallway and mother waits 11 hours to access John Hunter Hospital emergency department while having a miscarriage

The public submissions to NSW's impact of ambulance ramping and access block on the operation of hospital emergency departments parliamentary inquiry make for tough but important reading.

Most are anonymous, but Bridgit Akmacic wanted to tell her story.

"I am writing with a heavy heart sitting in a chair in a makeshift room in the emergency department at the John Hunter Hospital," Ms Akmacic wrote in her July submission.

"I was in pain, bleeding and visibly upset knowing I was losing my baby and waited [more than 11 hours] to be finally taken through to the emergency area. I was then not taken through to a bed but an armchair in front of the nurses station."

Ms Akmacic, who said "I never complain like this", goes on to detail being left with no bathroom or privacy as she miscarried her child.

She was surrounded by other people "standing" or "sitting on non-waiting room chairs"; all queuing to access the hospital's emergency department.

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"The nurses and doctors at the John Hunter are run off their feet with ambulances banked up, elderly patients sitting in beds or wheelchairs with no beds for admission into the hospital, people with broken bones, bleeding, it doesn't feel like Australia it feels like a Third World country," she wrote.

"The system is clearly broken, nurses and doctors are under too much pressure, it is dangerous and someone is going to die."

Ms Akmacic's is one of 35 submissions to the upper house inquiry, which the NSW government is due to respond to in March, into ambulances getting repeatedly stuck at hospitals unable to unload their patients, and how emergency departments are coping.

People waiting up to 36 hours to be admitted through emergency departments due to increased ambulance ramping and overcrowding are resulting in inadequate and unsafe care across NSW, according

to evidence before the inquiry. Health minister Brad Hazzard later labelled the 36-hour wait claim as "rubbish".

The Labor-led inquiry handed down 12 recommendations earlier this month, the key being that all public hospitals have sufficiently staffed beds to function at around 85 per cent occupancy rate so there is a "surge capacity" to allow emergency departments to transfer patients at busy times.

Inquiry chair Labor's Greg Donnelly said the biggest issue was hospital occupancy rates were too high.

"When hospitals operate constantly at 100 per cent occupancy, they cannot admit patients from EDs during 'surge' periods or times of unexpected demand," he said.

"As well, an ED operates 24 hours a day, seven days a week, while the rest of the hospital operates for considerably fewer hours. This has a flow-on effect throughout the system.

"If patients cannot be transferred from an ED to an inpatient bed at the appropriate time, EDs become overcrowded. This in turn means that ambulances cannot offload their patients, which causes ambulance ramping."

Giving evidence at the inquiry, NSW health boss Susan Pearce defended the system as one of the best in the world, detailing the impact of the COVID-19 pandemic and dismissing claims from doctors and patients that the system operated like a Third World country.

She said NSW was undertaking its largest health recruitment drive in history and consistently casting the sector in a negative light was not helpful.

"The first thing I would say is for any patient who doesn't get the care that we would like them to have, we can only ever unreservedly apologise for that. It is absolutely the last thing we want, for people not to have a good experience when they come to our hospitals," she said.

"In terms of our staff, I think we've certainly acknowledged before and I have acknowledged publicly on many occasions the pressure that the staff of the NSW health system have been under. I'm not attributing that entirely to COVID but clearly the pandemic has exacerbated those issues for our staff and, in particular, some of our very busy hospitals."

Submissions to the inquiry paint a grim picture of a system under extreme stress, struggling to cope.

A 13-page submission from the Health Services Union (HSU), following a survey of 500 members between August and September, included a Hunter-based paramedic describing an elderly patient dying "without dignity" in a "back corridor" in front of several other patients.

"Despite my raising concerns in triage, after a significant delay, the patient was still directed to the rear corridor without any further assessment and died without dignity in a busy hallway in front of multiple other patients...," the paramedic said.

"The patient had a not for resuscitation that was adhered to and was reported as a negative event, but the incident I feel is significant and avoidable, people deserve to die with dignity and privacy and other patients should not be exposed to such incidents."

According to the HSU, bed block is worsening in the public health system due to a "general state of under-resourcing in a system that has long been in decline". The staff survey revealed a "lack of available beds in wards" to be the largest contributing factor to access block, or ambulance ramping, followed by "inadequate staffing" and "lack of available beds in emergency". According to another Hunter paramedic, too many patients are using emergency departments because they are unable to get into see GPs. "More ambulances are not going to fix the problem," the paramedic said. "In the current climate we will have all the extra cars stuck in block."

A Hunter-based administrative staffer, responsible for booking patients for surgery, detailed frustration at the constant pressure. "The main issue will be that we will be unable to manage the workload for category three patients (non-urgent) that have been delayed multiple times due to the bed crisis," the staffer said in the HSU submission.

"We have been moving our lists out to private hospitals under collaborative care to try and reduce the number of patients on our wait list, but this is not a permanent solution."

A senior paramedic based in the Hunter described frustration at being stuck in access block and unable to assist junior staff calling for backup.

"As an intensive care paramedic I'm more often than not standing at hospital with a patient who doesn't need intensive care paramedic interventions, whilst a paediatric cardiac arrest is going down," the paramedic said. "Or my fellow paramedics are requesting intensive care paramedic back up."

Another area of concern detailed by HSU members in the Hunter was "pressure to discharge" patients to make beds available in hospitals. A Hunter-based occupational therapist said staff were working to "discharge priorities", rather than what was clinically best for patients.

"Relentless pressure to discharge patients who are not necessarily well enough or function enough, so beds are freed up," the therapist wrote. "No time for proactive work that will prevent patients deconditioning in hospital... Patients are discharged too early resulting in either representation to hospital or not recovering as best they could have, ultimately leading to a poorer functional outcome."

The problems extend to health and security assistance staff detailing being unable to access rooms to remove rubbish and linen due to overcrowding.

"Patients are waiting for treatment and blocking corridors and hallways," the Hunter-based staff member wrote. "Significant lack of staff across all disciplines. No room to safely move beds around the emergency department or between imaging, theatre, equipment etcetera. It stresses everybody out, staff, patients and visitors."

The Newcastle Herald reported earlier this year that ambulance ramping at the Hunter's hospitals became so extreme in May that at one point there were no paramedics available to respond to emergencies.

The NSW branch of the Australian Paramedics Association (APA) said ambulances were getting stuck at hospitals for "hours on end" as they waited to offload patients. APA NSW secretary Gary Wilson said at the time that the lack of hospital resources had a "massive" impact on paramedics who were at breaking point.

Several paramedics said while there are peaks and troughs, the problem was ongoing.

"It happens all the time and no-one wants to look at it," a paramedic said. "It's a ridiculous waste of resources for the Ambulance Service and it's even worse for people facing an emergency because there are times we aren't there or get there much later than we should."

Rural Doctors' Association of NSW president Charles Evill said his organisation had been highlighting access block as a major problem in regional and rural areas for more than 30 years.

Dr Evill said the lack of beds to transfer patients out of emergency departments was a major issue and the increase in bed numbers had not kept pace with growing emergency department presentations. "As has been remarked elsewhere it is not likely that continuing to do the same thing repeatedly will produce a different outcome," he said.

The latest Bureau of Health Information report issued earlier this month revealed just how much pressure the region's emergency departments are under. Patients at Maitland Hospital waited longer in the emergency department than anywhere else in the Hunter, and almost 70 per cent left without treatment. The report detailed a 15 per cent drop in the number of patients starting their treatment on time at the hospital's emergency department in the July to September quarter this year, compared to the same time last year.

About 45 per cent of patients who presented to Maitland Hospital started their treatment within the clinically recommended timeframe, putting Maitland at the bottom of the of a table of 15 hospitals in the Hunter New England Health District.

Four smaller hospitals had on-time figures above 80 per cent, with Calvary Mater, at 76.8 per cent, the fastest of the big facilities.

John Hunter, in 12th spot with 60.8 per cent of emergency patients treated on-time, was down 7.7 percentage points, or 11.2 per cent, on its third quarter 2021 result of 68.5 per cent.

About 78 per cent of patients were transferred from ambulance to ED staff within the 30-minute benchmark, which is above the state average.

A Hunter New England Health spokesperson said the latest report captured a "challenging period" for the hospital, as winter illnesses and ongoing furloughing of staff continued to place pressure on the health system. She said at peak times surge beds were opened and additional medical and nursing staff were rostered on.