An increasing number of patients are seeking treatment at Auckland hospital doors, but beds are running out and the Government purse has snapped firmly shut.
Middlemore Hospital is just emerging from the winter onslaught, where at times there was barely enough beds for patients, and the hospital is predicted to run out next year if nothing is done.
But rather than boosting budgets and pushing patients into corridors, the hospital bosses are actually aiming to cut back on 20,000 beds.
Not just that, but hospital staff are doing everything from switching toilet roll dispensers to scrapping surplus forms to rethink their approach.
It is all part of a plan from Counties Manukau District Health Board chief executive Geraint Martin.
Allowing the hospital to run beyond capacity is not an option, Martin said.
"In that situation you're moving beds quickly, you're discharging patients and making the system run too fast.
"But there's a much more profound issue than just saying the hospital is busy. How do we change it?"
Martin said what happens in the next five years will determine what happens in healthcare for the next few generations.
This is because healthcare around the world is facing a third revolution in patient care.
The first revolution was about providing clean water to stop the spread of disease, he said. The second saw the development of drugs, surgery and cancer treatment.
Martin said with people living longer and surviving with chronic diseases such as dementia, obesity and diabetes we are now entering a third revolution.
These needs to be combated with home care, community clinics and safer in-hospital treatment, he said.
"It is far better and effective to keep people well and in their homes... than creating a system that sucks them into hospital and makes them very quickly dependent."
The health care system is still geared towards to the second revolution - getting people into hospital for treatment, he said.
"What we are facing in South Auckland is a crisis of a completely different pattern of demand."
And this is where Martin's 20,000 bed reduction plan comes in.
The campaign aims at converting 20,000 hospital stays - about five per cent of the total - to the home or community.
Martin said it is not about hacking away at hospital services, but redefining how they operate.
One approach is improved infection control in intensive care units. For every patient who contracts a bacterial infection, it costs $20,000 to aid their recovery.
Another was changing the hospital toilet paper dispensers, with savings of $100,000 in annual plumbing bills.
Martin said the old dispensers were tricky to use, leading to people flushing hand towels down the toilet. This caused regular toilet blockages.
Hospital staff are also cutting back on forms where possible and better educating patients on using preventative medications, like inhalers, to reduce hospital admissions.
"We will work smarter," Martin said.
- Auckland Now
Is the cost of electricity forcing you to rethink your power consumption this winter?