Latest news with #AssociationofSalariedMedicalSpecialists
Scoop
23-07-2025
- Health
- Scoop
Nelson Hospital Review Fails To Hold Leadership To Account
The review of Nelson Hospital released by Health New Zealand today is little more than a 'plan to make a plan' the Association of Salaried Medical Specialists says. The review just restates well-established problems with leadership and severe understaffing at Nelson Hospital which are causing delayed care for hundreds of patients. The Nelson Review was commissioned after Senior Medical Officers spoke to media in March about the poor working conditions. Doctors, fed up with inaction, described massive wait times for first specialist appointments, and repeated refusals from leadership to address staffing shortages across many departments. This prompted Health New Zealand's chief clinical officer Richard Sullivan to commission a review. He said, "I would hope we will have some answers within weeks." "Four months later and all we have is a a plan to make a plan," ASMS executive director Sarah Dalton says." Doctors, nurses and patients want solutions to these ongoing problems, not a bland description of known issues leadership should have addressed years ago. "The review lacks timeframes, holds no leaders to account for these failures. Just last month Nelson Hospital was again in the news for booking "ghost clinics" in what appears to be an attempt to game the system in regard to first specialists' appointments numbers. "There is a worrying trend of poor management and poor leadership at Nelson Hospital which the review fails to address."ASMS is disappointed there has been little engagement with hospital staff - and no consultation as to the review's findings and recommendations. "We understand regional deputy chief executive Martin Keogh and National Chief Clinical Officer Dame Helen Stokes-Lampard presented the report to just a handful of senior staff and gave other staff just 24 hours' notice to a 30-minute briefing. "This is a wasted opportunity to make positive change," Dalton says the real finding from the review is that the issues at Nelson are present in other hospitals around the motu. "The review uses comparative data that paints the dire picture of medical staffing gaps in similar sized hospitals across the country too. This aligns with our own findings. We simply need more doctors," she says. "Short staffing and increased acute patient demand, coupled with a lack of accountability from our health leaders that allow hospitals to be so poorly staffed has bred a culture of getting by instead of getting ahead." Additional information ASMS has been working with senior doctors and managers to conduct in job-sizing activities independent of the Nelson Hospital Review. The following are findings from these activities: - ASMS has completed 17 service reviews (job sizing) across the Nelson Marlborough district since are nine further services still to assess. - Our findings so far - which Nelson Hospital management has accepted - show these departments are short a total of 48.7 senior medical officers. - Only 14.7 vacant SMO roles, identified in job sizing, are currently budgeted to be replaced. - Nelson and Wairau hospital district do not provide recruitment or retention allowances, or "public-only" allowances to senior medical and dental staff. This measure would help fill vacancies. - Senior doctors are routinely working beyond their contracted FTE with large amounts of unpaid overtime being gifted to the hospital to fill staffing gaps. Leadership is aware of this. - Senior doctors are not being allocated their non-clinical time (this is non-patient facing work, including teaching, planning, audit, research, and the like) due to the acute patient load and short staffing. - Nelson district has been in breach of its obligation to have formal recovery time arrangements since 2020. This measure allows senior medical staff to safely recover after working overnight calls. The district has been in breach of this SECA clause since 2020 with most departments having no formal arrangements in place. - All reviewed services are currently understaffed Services we've reviewed to date (job-sized): Nelson anaesthesia , Child and adolescent mental health services, Cardiology Nelson general surgery, Nelson ED, Wairau ED, endocrinology, Nelson general medicine, Wairau general medicine, Nelson pediatrics, Wairau pediatrics, respiratory, Nelson O&G, Wairau O&G, older persons' health, vascular surgery, neurology
RNZ News
24-06-2025
- Health
- RNZ News
Patients increasingly diagnosed with bowel cancer in ED, Northland doctor says
Demand for colonoscopies exceeded capacity in Northland earlier this year. (File photo) Photo: 123RF Doctors in Northland are blaming a massive increase in wait times for colonoscopies over the last six months on Health NZ's decision to cut rates for locums. Health NZ data has shown the number of patients waiting longer than recommended for non-urgent colonoscopies went from fewer than 20 a month at the start of last year to 553 in April this year. Whangārei Hospital emergency department consultant Dr Eugene Fayerberg was not a cancer specialist - but said he and his colleagues were increasingly the ones to find cancer in patients coming into the emergency department (ED). "[We are] diagnosing rectal metastatic cancer all the time on CT scans that are just completely incidental, because these people have had belly pain for months waiting to get a scope. "They finally come in because they've got blood coming out of their bottom, and do a CT scan and they've got a cancer, that should have been scoped months and months ago." Dr Fayerberg, the Northland branch president for the Association of Salaried Medical Specialists, was among 240 doctors who went on strike for 24-hours last week over what they say is a crisis in healthcare, with one in five specialist positions vacant. One gastroenterologist, whom RNZ agreed not to name, said Northland was previously paying locums - and staff doing extra lists - per procedure, the same rate as Auckland, Counties Manukau and Waitematā. "The rate hadn't changed in five years, which was fine. Then Northland changed to a daily rate in November, which meant a third less pay, and locums just weren't prepared to come for that money. "We were doing 80 percent of semi-urgent scopes within six weeks, but now it's less than 20 percent." Some patients, who finally had colonoscopies after months of delays, had been found to have cancer - and for a few, it was no longer curable, the specialist said. "You have to wonder if there would have been a different outcome if they could have been scoped sooner. "We rely on locums and doing extra lists to service the population up there - it's high need, high Māori population, higher rates of bowel cancer at younger ages, higher numbers of stomach cancer. So we need to keep on top of the scoping list to diagnose early." Gastroenterologist Dr Richard Stein, 72, who held a locum clinic in Kaitaia for almost a decade until it was abruptly cancelled last year , said if Health NZ was serious about fixing regional inequities, it must recognise the cost to staff. Gastroenterologist Dr Richard Stein used to run a locum clinic in the Far North. Photo: Supplied "I'm still working, just in the public system because things are just so bad. I'm working in Invercargill, Rotorua and Hawke's Bay. They're all short-staffed." When RNZ contacted Dr Stein last week, he was reviewing patient notes and test results while recovering from back surgery. "I cover my patients 24/7." Health NZ's locum rate to do colonoscopies - about $2000 a day - looked like a lot of money, he said. "They pay transport, accommodation, maybe a rental car if you push hard. But for some remote areas, it's a day of travel each side, plus you've got all your other costs. "And if you do colonoscopies in a private clinic, you get $800 in hand and the clinic gets about as much." One of Dr Stein's former patients, Mindy, who has the inflammatory bowel condition Crohn's Disease, said even getting a form for a blood test was difficult now. "I did actually have to ring him [Dr Stein] last year because I couldn't get hold of anybody to help me with something, and he some how did manage to use his magic and make it happen for me. But I shouldn't have to do that." Mindy said her condition was currently stable, but she worried for other people who were struggling to get care, or did not have the ability to advocate for themselves. "It's unfortunate that's the way it's got to be, but you have to push and make things happen, because no-one else is going to do it for you." In a written response to RNZ, Group Director of Operations for Health NZ Northland, Alex Pimm, acknowledged demand for gastroscopies and colonoscopies exceeded capacity earlier in the year. "This was due to some workforce challenges (vacancies and difficulty securing locums to cover) and increased referral to the service. "This is now mostly resolved and we're pleased to see our waiting times reduce in recent weeks." The median wait time for non-urgent colonoscopies was now 91 days, down from 130 days in January and Health NZ was recruiting for specialists and nurse endoscopists, and doing extra lists outside when staff were available. Health NZ's target was for non-urgent colonoscopies to be done within six weeks. "We are committed to further reducing wait times for these procedures in Te Tai Tokerau." Health NZ was recruiting for gastroenterologists or nurse endoscopists, utilising extra capacity and additional sessions as kaimahi were available outside of normal working hours, and constantly reviewing waiting lists to book the most urgent patients first. Since January, it had run nine twilight and three Saturday lists, with two more planned shortly. Te Tai Tokerau was confident its reviewed locum rates - which were above the collective agreement - were "not out of step" with other districts, Pimm said. Patients in Kaitaia (who were previously under Dr Stein) were now covered by locum gastroenterologists along with permanent staff, "providing a level of resourcing that exceeds previous capacity". 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Otago Daily Times
19-06-2025
- Health
- Otago Daily Times
Private use of publicly-funded cancer drugs will widen inequities, doctors warn
By Ruth Hill of RNZ A move to allow private patients to access publicly-funded cancer drugs threatens to increase wait times for those in the public system, warn senior doctors. Under "transitional access", which comes into effect on July 1, private patients who are already receiving treatment - or about to start treatment - with a newly funded medicine will not have to shift to the public system for 12 months. Associate Health Minister David Seymour, who has championed the rule change, said it would lessen stress on private patients by enabling continuity of care, and pressure on the public system which would no longer have to deal with a sudden influx of patients. However, the move has been criticised by opposition politicians as "a subsidy for private insurers", which already cover the cost of medicines newly funded by Pharmac, and of little benefit to patients. The Association of Salaried Medical Specialists, which represents 6500 senior hospital doctors and dentists, said its members working in oncology and haematology had "significant concerns" the change would widen inequities for patients. Change will create 'two-tier' waiting list In a letter on June 13 to Pharmac's acting chief executive Brendan Boyle, the union's director of policy and research, Harriet Wild, quoted a briefing to the minister saying the policy change "would not increase volumes of cancer medicines provided in New Zealand, as only the location of treatments will change". "It will simply shift some of the existing capacity to the private system, where patients will need to fund infusion costs out-of-pocket," Wild wrote. "There will be pressure on the public system to ensure a smooth transition in treatment regime, which may mean delaying treatment for other people already waiting on the public list and unable to self-fund to start in private. "This potentially creates a two-tier waiting list and a system where those with more financial resources, will be prioritised for treatment." Furthermore, the shift of resources and inevitable increase in demand was likely to speed up the exodus of staff to the private sector, making public waiting lists even longer. Minister signals broadening access further A "back-pocket Q&A" provided to Seymour ahead of a Cabinet meeting on April 7 noted that the current eligibility criteria in the Pharmaceutical Schedule (excluding patients in private settings) was "designed to ensure public funding for medicines was prioritised for those managed in the public health system for cancer treatment, assessed by need, rather than public funding supporting those who chose to access treatment in private facilities. "Often the private treatment is funded from private health insurance that people have paid premiums into." In the same document, the minister said there was no plan to expand the policy to include other types of medicines or treatments "at this stage". "With that said, I've asked the Ministry [of Health] to do further work in this area to explore the possibility of broadening access to all publicly-funded medicines in private facilities - not just newly funded cancer medicines. "I encourage the private health providers and insurance companies to work closely with the ministry to support their understanding of how this might work in practice." Wild said opening access to publicly-funded drugs even wider would pull more staff away from the public system, reducing access for the majority who relied on it. "That would establish a system where a patient's ability to receive timely cancer care would depend on whether they could afford the out-of-pocket infusion costs." Pharmac's Budget boost needs 'back up' The government's 2024 Budget boost to Pharmac to widen access to medicines for patients had not been accompanied by extra resources for Te Whatu Ora to deliver the treatments, when public oncology services were already swamped with demand, Wild said. "Our members are increasingly needing to manage deteriorating patients, who are unable to access chemotherapy infusions in clinically acceptable timeframes. "This is unacceptable and represents a significant failure to invest in a planned and co-ordinated way to enable the public system to meet the needs of cancer patients, including those eligible for newly funded cancer medicines. "Whenever a new cancer drug is funded, it must be accompanied by an increase in the full package of care (staffing, infusion space, pharmacy) so that patients can actually receive the medicines within clinically acceptable timeframes." The Health Minister and David Seymour's office have been approached for comment.
Scoop
04-06-2025
- General
- Scoop
Postscript On Ethnic Cleansing, Genocide And New Zealand Recognition Of Palestine
My last Political Bytes post (28 May) discussed why New Zealand should officially recognise the state of Palestine: New Zealand should recognise Palestinian state. The heading I gave the post was Reasons for supporting ethnic cleansing, through genocide, in Palestine. This was my attempt at irony; by exploring the reasons that underpin the support for the genocidal ethnic cleansing in order to rebut them. Broadly speaking it appeared to work although, for some, it raised some eyebrows of initial confusion; was I actually supporting ethnic cleansing. It also generated two particularly thoughtful responses that deserve further comment. The first concerned Jews who are horrified over, and vehemently opposed to, Israel's war against Palestinians, particularly in Gaza but also the occupied West Bank. The second involved the two-state solution proposal. Both are worthy of further consideration. Jews against ethnic cleansing (and genocide) Dr David Galler is a retired intensive care specialist who spent most of his medical career in Middlemore Hospital. He was also a longstanding National Executive member of the Association of Salaried Medical Specialists (including as Vice President and President) while I was its Executive Director. Today he is actively involved in Healthcare Aotearoa with its strong focus on public (population) heath and is a health commentator. Dr David Galler outraged by genocide pursued in the name of Jews like him Coincidentally Dr Galler emailed the Israeli Embassy in New Zealand the day before my above-mentioned post. I reprint it below (with his express permission): I am Jewish My parents were Polish Jews My mother was a child in Auschwitz and survived the Death March She lost her family in the Katowice ghetto and at Auschwitz She arrived in Haifa in 1947 My father escaped Poland in 1939 but lost most of his family and married my mother in Tel Aviv My great father was the Chief Rabbi of Poland I am writing to express my utter disgust at Israel's vile and horrific genocide in Gaza Say what you will, but there's no excuse for what you are doing there – you have destroyed any good will the world had for you and the plight of my ancestors. You have brutalised your own population and actively stoked the fires of antisemitism across the world How dare your PM, a man who has done more damage to Israel than the Palestinians ever could, and your state accuse people like me of antisemitism for criticising your disregard for international law and human rights. Shame on you and shame on your government. David Galler Jews opposed to Zionism is not new Opposition among Jews to Zionism is not new. On 15 March I posted in Political Bytes about the relationship between apartheid and Zionism: When Apartheid met Zionism. Jewish immigration to South Africa from the late 19th century brought two powerful competing ideas to from Eastern Europe. One was Zionism while the other was the Bundists with a strong radical commitment to justice. It is easy to forget that historically speaking, since Palestine in the time of Jesus Christ, Zionism is a relatively new ideology. Further, Jewish opposition to Israel is as old as Zionism itself. A critical turning point in my understanding of Palestine and Israel was reading Maxime Rodinson's Israel and the Arabs first published in 1968. Rodinson was from a Jewish family (his father was a prominent Bundist leader). His central argument was that the Israel-Palestinian conflict was essentially …the struggle of an indigenous population against the occupation of its normal territory by foreigners… I was also struck by his clarifying explanation of the word 'semitic.' The common perception is that semitic refers to the Hebrew language. In fact, it also includes the Arabic language. In other words, Palestinians are as semitic as Jews, but Zionism has monopolised the use of the term to apply exclusively to the latter. Joseph Massad, of Christian Palestinian origin and from Jordan, is Professor of Modern Arab Politics at New York's Columbia University. In Middle East Eye (29 February 2024) he reports that European and American Jews have been at the forefront of opposition to Zionism since its birth as a colonial-settler movement at the end of the 19th century: Jewish opposition to Zionist Israel is as old as Zionism itself. Witness this article published in the UK Jewish News (16 April) on the critical views of some Jewish leaders to Israel's conduct in Gaza now: UK Jewish leaders oppose Israel's war in Gaza. It is noteworthy that many Jews are at the forefront of the large protests over Israel's war against Palestinians in Gaza (and oppression of Palestinians on the West Bank) throughout the world, including New Zealand. It is hardly surprising that David Galler is so frustrated and angry. Ethnic cleansing through genocide is being justified in the name of his ethnicity. The extremist Israeli government has weaponised antisemitism to apply to genocide in his and many other Jews names. Two-state solution: a delusion? The second response came from retired journalist John Trezise who publishes on his Kiwis website. He posted the following: New Zealand should recognise Palestinian statehood as an expression of solidarity with the Palestinians in their struggle for equal rights against the Zionists and their apartheid state Israel. However, I agree with Gideon Levy that the possibility of a Palestinian state becoming a reality is long gone: 'The two-state solution died a long time ago, unfortunately, and it cannot be revived in the present circumstances. We have a government that in the last 15 years did anything possible to destroy this solution; it was destroyed. There are 7,00,000 Jewish settlers in the West Bank who will never be replaced or evacuated. Without their evacuation, there is no room, no physical room for a Palestinian state, not for a viable one. Therefore, I think it's time to stop dreaming about the two-state solution. The only vision left, except for an apartheid state, is obviously a democracy between the river and the sea. I don't see any other alternative. It's a long way to go, but at least let's start talking about it. Let's start dreaming about it. Let's start realising that the only choice now is between an apartheid state between the river and the sea or a democracy between the river and the sea.' His quote from Gideon Levy is important. Levy is an Israeli journalist and author. He writes opinion pieces and a weekly column for the newspaper Haaretz that often focus on the Israeli occupation of Palestinian territories. Levy is a courageous journalist who truly practices truth to power. He has won prizes for his articles on human rights in the Israeli-occupied territories. In 2021 he won Israel's top award for journalism. In short, I agree with what he says in the above quote forwarded by John Trezise. Levy was right to advocate starting a conversation over a democratic one-state solution from the Jordanian River to the Mediterranean. That is what British Mandate Palestine was (minus the democratic bit) before 1948. Subsequently, but still decades ago, Fatah advocated a secular democratic Palestine on the same landmass as under the Mandate. I agreed with this position then and still do, despite how inconceivable this appears in this moment of historical time. Interestingly, when he was close to Fatah 'back in the day' (when this organisation was dominant among Palestinians) Palestinian intellectual Edward Said advocated a two-state solution. It was rejected by Fatah at the time. However, Said promoted it on a more robust geographic basis than what the Oslo Accords subsequently provided for. He saw his proposal as providing the basis for discussion on transitioning to the single state idea. Rightly so Said was a strong critic of the Oslo Accords because it was well short of this objective. Instead, they resembled the infamous and racist 'Bantustans' of apartheid South Africa. Recognising Palestinian Territories as a sovereign country could be the starting point for a wider conversation about the future of Israel and Palestine My support for New Zealand recognising the Palestinian Territories as the official state of Palestine, however, was in the context of a small step in the right direction towards Gideon Levy's above-mentioned conversation and the importance of solidarity with the victims of repression in one territory and genocide in the other. Final word I will leave the final word to Don Carson who has been persistently and cogently advocating for Palestinian rights since the 1970s. An email he sent me after reading my post prompted this postscript. In his words: Great piece Ian, especially the historical context and demography Only issue I would have is that sanctions on Israel should be the priority; IDF [Israel Defence Force] visitors Close the Embassy Trade and bilateral Suspend Israel from the UN I could not agree more. Ian Powell Otaihanga Second Opinion is a regular health systems blog in New Zealand. Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.
Scoop
20-05-2025
- Health
- Scoop
Budget 2025 – What Vote Health Needs Just To Stay Afloat
Press Release – Association of Salaried Medical Specialists 'Year on year specialists in our public hospitals are being asked to do more and more,' says ASMS policy director Harriet Wild. Budget 2025 will need to include $2 billion in additional operational funding this year just for the public health system to stand still. 'Year on year specialists in our public hospitals are being asked to do more and more,' says ASMS policy director Harriet Wild. 'If we do not see this level of investment as a minimum it just means the Government is choosing to dig their own hole that much deeper. Again in 12-months' time they will gamble on the future of our public health system again, knowing they have made the odds that much worse.' Two billion dollars is the increase required to meet health cost pressures (which run higher than general inflation) including changes in pricing, volumes, and inflation, as well as the increased need created by a growing and ageing population. New Zealand's population is growing by 1.3% annually. New Zealand's population is also ageing. Almost three-quarters of total life-long healthcare costs occur in the last three years of life. Census data shows 1 in 6 people were aged 65 and older in 2023, this is projected to be 1 in 5 by 2033. The need for hospital-based acute care is also increasing. Acute discharges in public hospital increased by 28% between 2014 and 2023. Almost 1.3 million people attended an Emergency Department in 2022/23, a 22.5% increase since 2013/14. Over the same period, the population increased by 16%. Two billion dollars will not remedy decades of underfunding of New Zealand's health system. New Zealand's total health expenditure (public and private) as a proportion of GDP has remained well below comparable countries for many years. Prior to Covid-19, New Zealand spent 9% of GDP on health, while countries including Australia, Canada, The Netherlands and Sweden spent an average 10.7%. The New Zealand Health Survey shows significant volume of unmet health need also remains in our community, with 1.86 million adults experiencing an unmet need for dental care due to cost. 464,000 adults have an unmet need for mental health or addiction services – an increase of 3.3% since 2023. While investing in primary care will make people healthier overall, it will also generate more cost for our hospitals as unmet need for secondary care is identified by those primary care providers. $1.43 billion was allocated to meet health sector cost pressures (demographic changes, price and wage increases) in the 2023-4 Budget. However, when appearing before health select committee during Scrutiny Week in March 2024, Te Whatu Ora officials acknowledged this fell short of what was required.
