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Former health chief criticises ICU bed reduction at new Dunedin Hospital

Former health chief criticises ICU bed reduction at new Dunedin Hospital

NZ Herald29-04-2025
Health Minister Simeon Brown said the total number of ICU beds had not changed and the Government was committed to getting a new Dunedin Hospital built.
After months of uncertainty and delays, it was welcome news when Brown confirmed the fate of the new Dunedin Hospital, albeit a scaled-back version, in January.
Now, months later, he has been facing flak for not revealing the new build would not have as many ICU beds when doors open.
The former head of Dunedin Hospital's emergency department, Dr John Chambers, said the public was in the dark about the ICU beds, which were critical to how a modern hospital functions.
Fewer beds could impact patients, he said.
'There's nothing worse for a patient than to have their complex surgery cancelled because of a lack of intensive care beds for post operative care, and similarly in the emergency department, there's nothing worse having to keep a very ill patient in the emergency department for prolonged periods of time because there's no bed in intensive care,' Chambers said.
He was also a former Southern District Health Board member and said the current hospital had struggled with its intensive care unit, which had partly prompted the call for a new build.
Chambers said it had taken years to refit the current unit, causing many surgery delays or cancellations, so it was not enough to simply leave space for more beds.
'What you don't want to do is open a hospital and then be depending on it failing to open up more beds,' he said.
'This whole business of using a shell-type model to plan for the future means that at any point in the future, the argument will have to be made that we need more intensive care beds because we're not coping.'
In January, Health New Zealand advised the then-Health Minister Dr Shane Reti about proposed new bed modelling that would reduce ICU bed numbers while increasing the number of other bed types, particularly medical surgical or ambulatory beds.
Officials found the proposal met forecast demand on opening and followed a consistent nationwide approach to demand modelling.
But Chambers wants to see the original plan go ahead.
'If anything, you should plan in some spare capacity to cope with surges, to cope with unexpected increases in population,' he said.
'To try and cut it so fine is just taking too much chances with the healthcare of a population.'
Changes guided by more up-to-date modelling, says Health NZ
Labour Party leader Chris Hipkins said the entire lower South Island depended on the hospital so it needed to be built as promised.
'The National Party lied to New Zealanders about the Dunedin Hospital rebuild before the election when they said they were going to do the full-scale Dunedin Hospital rebuild. They have backtracked on that several times,' Hipkins said.
'This is just the latest broken promise when it comes to Dunedin Hospital.'
In response, Brown said the Labour Party had failed to deliver on the new Dunedin Hospital while in office and now the Government was getting on with it.
'The new Dunedin Hospital will future-proof the provision of timely, quality healthcare for the people of Dunedin and the surrounding Otago and Southland regions,' he said.
The total number of ICU and high dependency unit beds had not changed from the detailed business case, Brown said.
Health New Zealand head of infrastructure delivery Blake Lepper said the changes to bed numbers and types had been guided by more up-to-date national modelling and a recent assessment on expected demand.
The current proposal had the same number of beds overall and part of the shell space would be used as an interim workspace, he said.
'The additional spaces earmarked for future fit out have been informed by the updated modelling and current thinking about models of care,' Lepper said.
'We will continue to work with our staff, our regional colleagues, and our wider stakeholders in planning how best to provide the health services our community needs now and into the future.'
Work on the new Dunedin Hospital's inpatient building was expected to resume from mid-year.
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The rise of DIY funerals, water cremations and death doulas in NZ
The rise of DIY funerals, water cremations and death doulas in NZ

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  • NZ Herald

The rise of DIY funerals, water cremations and death doulas in NZ

A death or end-of-life doula is a relatively new experience to New Zealand, with the doula movement first emerging in the early 2000s in the United States. Death doulas care for terminally ill or dying people in the final stages of their life and help to organise their funeral after their death. 'Doulas are a new thing in New Zealand, there's not that many of us around the country yet but we are growing ... we've seen the success of this role overseas and we know we can make a difference for families,' Gallogly said. The choices are growing for how people might want to honour their death, but it's also linked to financial pressure. Funeral celebrant Kelly Townsend, who also does volunteer work for Death without Debt – an advocacy group working to make funerals more affordable – said families could now conduct their own services. Kelly Townsend says 47% of New Zealanders are unable to access $5000 for a funeral. Photo / Corey Fleming. In some cases, families would be going through too much grief to perform a DIY funeral but for those who did, it was often a restorative experience. 'It's the old-fashioned Irish wake, it's the tangi, you know, it's the way our ancestors did it and it's really quite healing to be hands-on – washing the body, building a casket, decorating or transporting a casket – in that whole process the kinaesthetic is healing,' Townsend said. Townsend said 47% of New Zealanders were unable to access $5000 in savings but the average cost of a funeral was $13,000. 'Automatically 50% of people in this country are going into debt to pay for an average funeral,' Townsend said. 'If people can't pay that funeral debt they will be paying interest on it.' Propel NZ Auckland group general manager Wade Downey, who has been a funeral director for almost 40 years, said he thought DIY funerals were getting more attention, but that the trend wasn't growing massively. 'There's some conversation that funeral companies or the industry blocks people's ability to do it themselves – we don't,' Downey said. Downey says people don't want to spend money on funerals because of the grief and sadness associated with them. Photo / Carson Bluck. Downey said the emotional burden was often too much for people trying to carry out aspects of the service themselves, and families had come to them midway through the process for help. Gateway Funeral Services managing director Bradley Shaw, who is based in Whakatāne, has been a funeral director for 14 years. He said he had noticed more and more families were struggling with funeral debt. 'I think over the years they [funerals] have gotten more expensive as our operating costs have gone up along with everything else. 'In Whakatāne, which is a lower-socioeconomic area, we probably would have 90% of our families applying for the Winz [Work and Income NZ] funeral grant. 'That's extremely high compared to other places around the country.' New Zealand Cemeteries and Crematoria Collective chairman Daniel Chrisp said more people were exploring DIY funerals and natural burials, but it was still nothing like the numbers for traditional funerals and burials. 'I think it's one of those things where there's always going to be a popular option, but families just appreciate having choices, what they don't like is just having to pick between two options,' Chrisp said. Shaw said the majority of people seemed to be sticking with the traditional direction of hiring a funeral director. Downey said the perception of funerals as being 'so expensive' or costing too much was his biggest concern about the current industry, however, he felt it was a difficult mindset to shift. 'One of the challenges is it's a cost we don't want to spend money on, we don't want to spend money on grief ... we want to buy a trip or spend money on weddings.' Shaw had made the decision to sell all coffins at his funeral home for the same price to avoid the difficult choice for families of having to choose a cheaper casket. 'We've been doing that since last year and we've had wonderful success with it ... they still get multiple options.' Gallogly had worked with families who built their own coffins using harvested wood or natural timber and decorated them with messages from friends. She said there were alternatives to cremations and normal burials, such as being buried in a shroud or a natural burial – that involved a person being buried in a shallower grave in nutrient-rich soil. A person could choose not to have a headstone and instead the family could plant a native tree or be given the GPS co-ordinates of the grave. Waikumete Cemetery was currently the only site in Auckland that offered a natural burial area. Townsend said planning was crucial to save costs for a funeral but often families did not want to think about a death before it happened. She hoped this would change. 'The trouble is if you don't plan and someone dies, you're grieving and you're not in a good place to make decisions and are more likely just to take the first option,' Townsend said. For instance, the average price of embalming was between $500-$1000 but there were other ways to carry out the process to avoid this cost, Townsend said. Car crash victims or people who had died from trauma wounds would need to be embalmed, but in other cases there were natural ways of keeping the body cool or intact. 'You don't always need to be embalmed ... people don't realise it, so it's just about education and preparing in advance.' There was also now the option for water cremation in New Zealand which offered an environmentally friendly alternative for cremation. A water cremation - also called bio-cremation or alkaline hydrolysis - involves a body being dissolved in an alkaline solution inside a stainless-steel machine. It usually takes from three to four hours and unlike the traditional cremation process, it creates zero emissions. After the dissolving, the bones could be given back to the family as ashes. Chrisp said he had noticed conversations were happening about alternatives to traditional cremations at funeral homes and cemeteries. 'I think at the moment most New Zealand families seem to be happy with burials and cremations as the predominant options, and typical flame cremation is still the most popular,' Chrisp said. 'In America, they've even got human composting now. 'So, I think there are conversations and there is a bit of publicity about newer options for what to do with your body when you don't need it anymore, but in terms of families committing that's possibly further down the line.' Gallogly said she would like to see the funeral industry change to have 'a greater willingness to unbundle services' for families. 'I think it's important when people are working with a family that they understand the financial position they might be in and are willing to share with that family other ways of doing things rather than going to the default tick-box situation,' she said. Downey said he did not think funeral homes were maximising profits and that all the businesses he knew were in the industry for the right reasons – to care for families. However, it was also a reality for funeral directors that they could not offer their services to families if their businesses went under. 'We're in business, we need to make money ... a funeral home has to be profitable to stay in operation,' Downey said. He said funeral directors could assist people with cost-saving measures, such as bringing their own flowers or reducing the catering size of a funeral. Gallogly said she had observed that New Zealand was a country where denial of death was common, and it was often a subject that was avoided in conversations. 'I'd like to see a society where death is much more accepted and talked about more openly to take away the fear around it,' Gallogly said. New figures released by the Funeral Directors Association of New Zealand earlier this week showed significant jumps in burial and cremation fees in cities around New Zealand. Shaw was concerned about the hike in council cremation fees, as he had observed a higher number of cremations happening for Māori families. 'We noticed an increase in cremation for Māori families after Covid, it went up about 150% in the first year,' Shaw said. 'That was due to funeral restrictions but now it's still around that and it's probably increasing every year.' The most expensive cremation fee was $1300 in Invercargill, compared to the cheapest council cremation service of $630 in Rotorua. Auckland's Manukau Memorial Gardens and Waikumete Cemetery charged the highest fees for ash burials, each costing $3080. Mākara Cemetery in Wellington was the cheapest cemetery for an ash burial, with a price of $365. Funeral Directors Association chief executive Gillian Boyes said rising cemetery and cremation fees were placing an unsustainable financial burden on low-income families. 'The sad reality is that at a time when a very low-income family is hurting and grieving and just wants to remember their loved one, they are going to be faced with the added pain of a big bill with fixed basic costs that just keep going up,' Boyes said. In 2025, the highest council costs for a burial were in New Plymouth at $7207. Marlborough's burial fees had risen to $6611 in 2025, which was a 19% increase on last year's amount. Shaw said the Winz funeral grant, which offers up to $2616, needs to be raised to reflect the council cost increases. The hike in burial and cremation fees was putting additional pressure on funeral directors as they had to adjust their own costs and pricing for families. Townsend said there were many families living with death poverty in New Zealand, who were currently paying back debt from a funeral. Gallogly had seen, first-hand, families struggling to afford to pay for a funeral. 'There is a lot of poverty in our communities, I think people really struggle to survive these days never mind pay for someone's funeral, especially if it's not expected,' she said. She had also witnessed ceremonies where communities had banded together to help with flowers, bringing meals or running the ceremony to cut down on costs. 'I think it's about building a village around the family,' she said. Eva de Jong is a New Zealand Herald reporter covering general news for the daily newspaper, Weekend Herald and Herald on Sunday. She was previously a multimedia journalist for the Whanganui Chronicle, covering health stories and general news. Sign up to The Daily H, a free newsletter curated by our editors and delivered straight to your inbox every weekday.

Experts Urge Fix As Government Expands Failing Lunch Scheme To Primary Schools
Experts Urge Fix As Government Expands Failing Lunch Scheme To Primary Schools

Scoop

time2 days ago

  • Scoop

Experts Urge Fix As Government Expands Failing Lunch Scheme To Primary Schools

Underprivileged primary school children are about to suffer the same poor service as their intermediate and secondary school peers, with the Government's announcement today that primary schools are transitioning to the cut price, revised Ka Ora Ka Ako - Healthy School Lunches programme. The revised version of the school lunch programme, rolled out to secondary and full primary schools in January 2025, saw the Government partner with national consortium the School Lunch Collective to achieve drastic reductions in the programme cost. The new version of the programme is being plagued by a multitude of problems, including delivery of unsafe and unpalatable food, massive wastage of uneaten meals and packaging, and the nutritional quality of the lunches plummeting. Nutrition experts found the government-funded school lunches are failing nutrition standards. The new lunches now provide only about half the energy recommended for a school lunch. Despite all providers being contractually obliged to meet the Ministry of Education's Nutrition Standards, none of the 13 meals provided by School Lunch Collective that were examined by nutrition experts met them. This means the lunches are no longer healthy - despite the programme being named the Healthy School Lunches programme. This is hardly surprising, given the School Lunch Collective members, Libelle and Compass, were failing to consistently deliver good quality lunches under the previous funding model, when they were receiving nearly three times the funding per lunch. "It's not a cost saving if it's not delivering the nutrition our most disadvantaged children need to succeed at school. Under the previous model, schools could choose how they provided lunches to their tamariki, with many walking away from Compass and Libelle to either do it themselves or work with local community businesses. Tamariki got better food for less cost. Our growing teenagers are now getting less to eat and being told to be grateful for it", says Professor Lisa Te Morenga, Health Coalition co-chair and Massey University researcher. "This Government has prioritised productivity, but hungry, undernourished children cannot learn effectively nor be productive. More than a quarter of children in Aotearoa face poverty and food insecurity - this programme is designed to help those kids. These children are our future workforce; we need to invest in them", says Professor Te Morenga. "I'm extremely angry and disappointed this government continues to ignore our voices and our evidence of the success of locally provided lunches. Instead, they want to remove what's working to save a few dollars - at the expense of our tamariki. We need to be investing in our tamariki and their future, says Seletute Mila, Tumuaki/Principal of Arakura School. "The changes to Ka Ora, Ka Ako have set back the progress schools were making in helping New Zealand's disadvantaged children. The programme must be fixed now- by being appropriately valued for the potential it has to lift our most disadvantaged children out of poverty and to lead healthy, productive lives. This benefits us all. We are calling for this current mean and draconian model to be abandoned. Raise the funding and give communities the flexibility to provide the best nutritious food they can for their tamariki," says Professor Te Morenga. More information Reports from schools across Aotearoa reveal serious failures in the revised programme, including: Unsafe food: The NZ Food Safety Authority is investigating concerns, as reported by BusinessDesk. Lack of allergy-friendly meals: Students with allergies are left without safe options, as reported by BusinessDesk. Waste and inefficiency: Unappealing meals are going uneaten, and previous systems to redistribute food to students or charities are no longer happening. Excess rubbish: The new system generates more landfill waste than before. Poor nutrition: The lack of fruit likely means lower fibre intake. Lack of transparency: Schools and families don't know the actual nutritional value of meals. Halal concerns: No clear process ensures meals meet halal dietary needs. Late or missing deliveries: Many schools report meals not arriving on time. Repetitive and insufficient portions: Meals lack variety and are often too small. No direct communication: Schools can no longer work directly with suppliers. No student feedback: Tamariki have no way to voice concerns about their meals.

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