Epidemiologist on teen who died from flu complications
A 15-year-old died from complications of influenza B on Saturday. Otago University epidemiologist, Professor Michael Baker spoke to Ingrid Hipkiss.
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Anti-red tape bill a health risk, doctors say
Bill architect David Seymour insists it is about ensuring rules are actually justified and calls critics are "woefully misinformed". Photo: RNZ / Mark Papalii Deputy Prime Minister David Seymour insists his bill - the party's fourth attempt to get similar legislation passed - is about ensuring rules are actually justified and calls critics are "woefully misinformed". Hokianga farmer Tokowhati Piripi finally had his long-awaited heart surgery two weeks ago at Auckland City Hospital. He actually needed a second operation within 24 hours after a sudden life-threatening bleed, but is now recovering well. Teina Piripi, who once feared her husband would die on the waiting list, said the care he had received had been "incredible" - but the outcome for the vast majority of Māori was not so good. "There is no way of explaining why Māori receiving cardiac care survive 50 percent less than non Māori." Teina Piripi - who works as a Kaiāwhina (Māori health support worker) in Northland - said the problem with the Regulatory Standards Bill was that it claimed everyone was "equal under the law", but that was not supported by the facts. "All those laws were used to dispossess us and disenfranchise us from our land, from our ways of life, from our language. "They know this. So it is not equitable, and we don't receive equal care for our health and well-being, otherwise we wouldn't die seven years earlier than everyone else." The 2023 coalition agreement between ACT, National and New Zealand First included a pledge to pass a Regulatory Standards Act "as soon as practical" - but when passed, the bill will not be binding. It lays out a set of principles which law-makers, ministries and agencies must consider when looking at changes to regulation: people's freedom of choice and private property rights should not be unduly affected and there should be fair compensation. The Association of Salaried Medical Specialists - which represents the 6500 senior doctors and dentists working in public hospitals - was one of scores of health organisations, which made submissions against the bill. Senior policy and research advisor Virginia Mills said the RSB was about upholding individual rights - but that would not lead to equitable outcomes, especially in health and particularly for Māori. "It includes this formal principle that 'everyone is equal under the law', which on the surface sounds okay, but is actually quite a loaded principle because when it comes to health. "People have got different needs and require different treatments, and we know that treating everyone the same won't lead to the same outcomes." The RSB also saw regulation as "a negative hindrance" - red tape that needed cutting, she said. "But if you were to deregulate the health workforce for example, that could mean lowering the standard of education or experience or skills to do the job, which could lead directly to patient harm." Seymour - who is also associate health minister - said the RSB's aim was not deregulation. "These comments are woefully misinformed. "The bill does not have an emphasis on deregulation, so that is a false assumption from the get go. "The bill does have an emphasis on transparency and justification when rules are made." The proposed new law would have a Regulatory Standards Board to consider how legislation measures up to its principles, with members appointed by the Minister for Regulation - currently Seymour. Psychiatrist Giles Newton-Howes said he and his colleagues had major concerns about what such transparency meant for health services. "Who makes the decisions about what regulations are appropriate or not and how that is measured? "And if that is done in economic terms, we're fundamentally missing the point. "You're trying to monetise health, and you can't do that." In its submission on the RSB, the Royal Australian and New Zealand College of Psychiatrists said it was dangerous to allow two people (the Regulatory Standards Minister and the Attorney-General) to decide whether wider consultation was needed. "Without legislative expectation to consult with those who hold the most experience in particular spaces, such as psychiatry, we expose ourselves to the mercy of ministerial appointments and ideological frameworks that may not reflect evidence based best practice in health." The submission also noted a "one size fits all model" did not work in complex spaces, such as health and addiction, especially for those who were "persistently harmed by unconscious bias, systemic racism, and social drivers of intergenerational trauma". Newton-Howes said if New Zealanders were truly "equal under the law" in terms of health outcomes, some groups should be receiving more resources than they were. "You can pretty much name any objective you like and we're not [equal under the law], because we're under-serving people in poverty, people in rural areas, Māori and Pacific people, and particularly for mental health." Nurses Organisation chief executive Paul Goulter feared the bill would open the door to further privatisation of healthcare because it favoured business interests. "You get a tension between that collective right to a quality public health system and the private property owning rights. "And this bill takes you into the private property owning rights having dominance over the collective right to a quality public health system." Public health and legal experts have also warned of a potential "chilling effect" on public health measures . They point out that under the bill's "takings or impairment principle", it would allow commercial interests (such as the tobacco and alcohol industries or big polluters), to seek compensation from taxpayers if future legislation caused them to lose money. Seymour has denied the legislation could be weaponised by business interests. "The bill does not anywhere mention, preserving the right to make a profit, so such an objection could never be raised. I would be very happy to sit down with these people and address their concerns, because it appears to me that they have not properly understood the bill before criticising it." The RSB made it clear it created no new legal rights or obligations enforceable through the courts. Furthermore, there was provision under the bill to "constrain" someone's liberties in order to secure the same liberty for others, Seymour said. "That is how you would justify a restriction on polluting the air or water that other people breathe or swim, for example. "If people feel their proposals will not withstand scrutiny, the answer is not to oppose scrutiny but come up with better proposals." However, leading medical oncologist Associate Professor George Laking, Māori Clinical Director at Auckland University's Centre for Cancer Research, remained sceptical. "If you look at the history of environmental catastrophes around the world, they're all carried by people who don't have power to affect the political process, and those are the ones who end up with trash and pollution and the knock on health effects of that. "So sure, there may be provision to deal with pollution under the RSB, but it's much more likely to be dealt with if it irritates someone who's wealthy." There was a risk the "broad brush" legislation with its narrow focus on economic measures could be used - for instance - to change Pharmac's current remit of focusing on patient outcomes, he said. "Of course efficiency is important but what I object to is this elevation of efficiency as the 'be all and end all'. It's not as simple as that." He was disturbed by Seymour's tongue-in-cheek remarks following a speech to the Adam Smith Institute in London last month, in which he credited smokers with saving governmental balance sheets by paying lots of excise tax and not claiming a pension. "This Minister's clearly not interested in health outcomes if he's going to jokingly refer to people who smoke as so-called 'fiscal heroes'. He's much more interested in fiscal outcomes than health outcomes." Parliament's Finance and Expenditure Select Committee is meeting all this week to hear submissions and is due to report back in November. Meanwhile, Teina Piripi was looking forward to taking her husband home to Northland ahead of the birth of their new mokopuna next month. Several times a day, while visiting him at Auckland City Hospital, she has walked past a plaque commemorating the fact the land for it was donated by Ngāti Whātua chief Āpihai Te Kawau in 1847. "Most of our hospitals in this country are built on Māori land - and why? "It's because Māori care about people. It's innate to our understanding. "This bill denies history and the present and the breaches and inequities that come from denying that racism exists." Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
