Latest news with #HealthyFutures)Act
Otago Daily Times
29-06-2025
- Health
- Otago Daily Times
Faster treatment not always fairest
Anyone who has struggled to get elective surgery will not be surprised a report from the Auditor-general shows the post code lottery in healthcare is in better shape than they are. In the report, "Providing equitable access to planned care treatment", tabled in Parliament last week, John Ryan says the Pae Ora (Healthy Futures) Act requires Health New Zealand Te Whatu Ora to ensure Māori and other population health groups have equitable access to the health services they need. This means ensuring access to elective or planned treatment is based on clinical need, not background, circumstances or where they live. He concluded the way treatment is provided is often not equitable or timely. It depends on where you live. Those waiting longer are disproportionately those living in rural areas, those socially deprived, Māori, Pacific peoples, and those with disabilities. Thresholds to qualify for treatment are not consistent across the country, a throwback from the old district health board days, and although there is work under way to introduce national thresholds, this is not going to happen overnight. A national threshold has been introduced for cataract treatment. This meant about 1800 people were added to the waiting list in the Southern district. The report shows the huge variance in the orthopaedic thresholds. In Southern, for instance, your condition would need to be significantly worse to qualify for treatment than if you were in Canterbury or Auckland. The Auditor-general is far from the first to raise concerns the government's emphasis on using the private sector to provide more timely treatment could result in less equitable access to treatment. For a start, private hospitals providing outsourced treatment are not equally distributed across the country. (Health Minister Simeon Brown has downplayed this issue, citing the availability of the National Travel Assistance Scheme to help those who have to travel away from home for treatment. However, despite some improvement to the rates last year, this still leaves anybody travelling a long distance by car for treatment considerably out of pocket.) As the report notes, those selected for treatment in private would generally be non-complex patients. Patients with comorbidities making them unsuitable for treatment at the private hospitals were more likely to be Māori and Pasifika or socially deprived. Another issue raised in the report was the lack of translation services in some private clinics, so they might not accept patients with no or limited English language. Complex patients not suitable for private hospital treatment would remain on a waiting list in a public hospital while others with similar clinical needs would be treated privately. "This can complicate efforts to ensure that long-waiting routine patients are prioritised and, ultimately, that Health New Zealand provides treatment equitably for all New Zealanders." Making changes in one part of the stretched health system can often affect another part, something not always fully appreciated by policy makers. The report points out, for instance, when clinicians spend more time providing planned care, they have less time to provide first specialist assessments. Another concern of the Auditor-general is the lack of information about unmet need, and although he acknowledged this could be difficult, HNZ would benefit from a better understanding of it. "A good place to start would be to measure the level of unmet need from people who are referred for assessment but do not meet current treatment thresholds," he wrote. There have been calls for better understanding of unmet need for years, but little enthusiasm from politicians to assess this in a comprehensive way, possibly because they are fearful of what it would expose. Mr Ryan's planned care recommendations for HNZ include making a plan with clear times for introducing nationally consistent thresholds, acting to improve equity of access and ensuring faster access did not increase inequity, strengthening knowledge of unmet need, and clear public reporting on how long people wait for treatment, variations in access and how it will improve equity of access. The issues raised in the report should be taken seriously by HNZ and its political masters, but the government's almost simplistic focus on its narrow set of health targets does not convince us they will be.
Otago Daily Times
25-06-2025
- Health
- Otago Daily Times
New hospital waiting room
Now it is mid-year we are looking forward to seeing the promised action on the new Dunedin hospital inpatient building site. As the months have dragged on with little sign of life, it has been difficult not to feel uneasy about the project's progress. In April, Health Minister Simeon Brown said capping of the piles on the site would begin mid-year, followed by work on the perimeter of the basement to form the base for the substructure. The most recent move from the government, Mr Brown's announcement this month of the appointment of Evan Davies as Crown manager to oversee the delivery of the inpatient building, was bizarrely handled. The press release listed many of Mr Davies' former roles, including involvement with the Christchurch Hospital redevelopment. Curiously, it overlooked his chairmanship of the Dunedin hospital project's governance board for more than two years from 2020. Maybe acknowledging that did not fit with the government narrative the whole project has been bungled so far. Minutes from a June 2023 meeting of the hospital's Project Steering Group (PSG) Mr Davies chaired state he felt compelled to step down then because a work promotion had caused "an increase in workload". He had been promoted by gas and property company Todd to group chief executive. He still holds that position. Questions remain about his ability to give the new role the attention it needs, given that situation. It is not clear how much time the government expects him to spend as Crown manager, but he will be paid $2500 a day plus expenses for it. At his final PSG meeting in 2023, Mr Davies "wished everyone the best and good fortune" to complete the hospital build, adding that he considered it an "aspirational programme". It would be interesting to know whether, two years on, given the delays, the changes and the politicking, he would use a much stronger adjective. For those unfamiliar with the term Crown manager, it is a position specified in the Pae Ora (Healthy Futures) Act. The minister can make such an appointment if he or she believes on reasonable grounds there is a risk to the operation or long-term viability of Health New Zealand. Before making the appointment, the minister has to give HNZ written notice of their intention and allow HNZ reasonable time (depending on the urgency of the situation) to respond. That information around this has not been released, but Mr Brown has said he believed on reasonable grounds the project posed a risk to the operation or long-term viability of HNZ given the size and scale of the project, the fiscal risks arising from the cost pressures on the project and the likely impact on health services if those cost pressures are not adequately addressed and delivery is further delayed. In the New Zealand Gazette notice of the appointment, Mr Brown blames HNZ for the project woes, saying it has struggled to maintain momentum on the project and identify a path forward following consistent cost pressure and extensions to the estimated delivery time for the project. These delays have also created delays and additional costs. Not surprisingly, there is no mention of the contribution last year's scaremongering on costs and political shenanigans, which led to changes to the project's scope, made to this debacle, or of their impact on the cost, delays and uncertainty for prospective contractors. It is hard to see how the government's beatings-will-continue-until-morale-improves approach to HNZ will be effective at attracting and retaining good staff there in the long run. In that regard, the government's enthusiasm for such overarching appointments should be closely monitored and evaluated. They may begin with a hiss and a roar (think health commissioner Lester Levy) but risk ending with much whimpering. It might be rather convenient for the government to have Mr Davies as a scapegoat, albeit a well-paid one, to blame if, as has been widely suggested, the project fails to come in on budget. Among Mr Davies' functions will be negotiating the final contract for the main works package of the inpatient building, along with delivering an implementation business case to Cabinet for approval within the next three months. Action cannot come soon enough.
Scoop
16-06-2025
- Health
- Scoop
Māori Marginalised By Changes To Pae Ora Act
The Government's Cabinet-approved amendments to the Pae Ora (Healthy Futures) Act represent yet another attack on Māori aspirations for equitable health outcomes and self-determination the PSA says. The sweeping changes announced by Minister of Health Simeon Brown on 14 Pipiri (June) 2025 are regressive and undermine the intent and spirit of Te Tiriti o Waitangi and the hard-fought recognition of Māori leadership in health delivery, Te Pūkenga Here Tikanga Mahi - the Public Service Association Kaihautū Māori, Janice Panoho, says. "The Pae Ora Act was a step towards correcting decades of inequity and systemic failure in health. These amendments strip away the very mechanisms Māori advocated for and were promised, particularly the ability to shape local service design and delivery through Iwi-Māori Partnership Boards IMPBs)," says Panoho. "This is a heartless government, pushing through draconian policy under the guise of efficiency. What they call 'streamlining' is in fact the deliberate sidelining of Māori voices from decisions about Māori health. "Rather than enhancing Te Tiriti partnerships, the changes weaken Māori influence by making iwi-Māori Partnership Boards (IMPBS) mere advisors to the Hauora Māori Advisory Committee, removing their direct role in shaping services that affect their own communities. "This top-down, centralised approach reverts us to the very system that failed Māori for generations. "By repealing the Health Charter and diluting the role of IMPBs, this government is erasing the commitments to equity, kaupapa Māori, and the lived realities of whānau. It is deeply concerning," Panoho said. "We are not just stakeholders. We are tangata whenua. Health equity cannot be achieved if Māori are shut out of the rooms where decisions are made. These changes are a betrayal. Panoho says the PSA stands with Māori communities, health workers and iwi organisations in calling for the government to halt these amendments, engage in genuine consultation with Māori, and honour the promises made through Pae Ora and Te Tiriti o Waitangi. "The Government's emphasis on targets, infrastructure, and performance data ignores what Māori have said for decades, that meaningful, lasting health outcomes come from whānau-centred services designed with us, not for us. "The health system can't deliver for Māori while continuing to marginalise us. The PSA urges all political leaders, health professionals, and communities to scrutinise these changes and hold the Government accountable for actions that risk entrenching inequities even further. "He tangata akona ki te whare, tūnga ki te marae, tau ana. One who is trained at home will stand with confidence in the world. Let Māori solutions stand strong within our health system, not be cast aside once again."
The Spinoff
15-06-2025
- Health
- The Spinoff
Huge rise in surgery outsourcing prompts alarm among doctors
The government's focus on elective surgery wait times has driven thousands of outsourced operations – and fresh warnings about the risks of draining public sector expertise, writes Catherine McGregor in today's extract from The Bulletin. Health targets to be enshrined in law The government has unveiled sweeping amendments to the Pae Ora (Healthy Futures) Act, the 2022 law that dissolved district health boards in favour of a national system, RNZ reports. Health minister Simeon Brown says that 'after years of bureaucracy and confusion, the health system lost its focus', and the amendments will help anchor patient outcomes at the heart of decision-making. Under the changes, infrastructure delivery will become a core statutory function of Health New Zealand, and oversight of Hauora Māori structures will be clarified. Perhaps most importantly, the national health targets – which were scrapped by Labour in 2018 before being resurrected by the coalition – will be put into law. Outsourcing to meet surgical goals To help hit the target of 95% of elective surgeries delivered within four months by 2030, the government last week announced it had funded nearly 10,000 extra procedures since January – most of them through private hospitals. Health NZ's plan is to outsource up to 20,000 low-complexity cases such as hip replacements, cataracts and hernias. What may be good news for suffering patients is bad news for the public health system, many medical staff say. Last month RNZ reported on a Health NZ memo to the minister warning that the high level of outsourcing would hasten an exodus of medical professionals from the public system. Speaking to Morning Report, Auckland radiologist Colleen Bergin echoed that sentiment. 'This will send the workforce into private. The pay is better, the parking is better, the transport is better, everything is better.' Meanwhile anaesthetists warned that siphoning off low-complexity surgeries could dramatically slow the rate at which trainees accrue the requisite number of training hours, and there's currently no system in place to have them train in private hospitals. Who really benefits from outsourcing? While outsourcing may bring quick wins on the government's elective surgery scoreboard, critics argue it's worsening the core problems. Writing in Newsroom, Ian Powell, former head of the Association of Salaried Specialists, says the approach ignores the main pressure point – chronic workforce shortages – while pumping taxpayer funds into for-profit hospitals and incentivising top specialists to shift their hours into the private sector. In some cases, surgeons and anaesthetists are now being paid thousands per shift to take on extra weekend work through in-sourcing arrangements in their own public hospitals. 'It beggars belief how much cash is being thrown around,' one anaesthetist, told Powell, who found that some in the sector could earn up to $15,000 for a single day as a private contractor. Powell argues the result is a system in which public hospitals are left with the more difficult cases and less capacity to treat them. Primary care 'second among equals' While hospitals and wait times dominate headlines, the primary care sector remains underfunded and politically sidelined, GPs say. A recent study showed that despite years of political rhetoric about its importance, primary care has received a flat share of the health budget – just 5.4% on average over the past 15 years, far below the OECD average. Speaking to Mariné Lourens in The Press (paywalled), Christchurch GP Buzz Burrell said the visibility of hospital wins makes them more attractive to ministers. 'It looks good if they fund a raft of very expensive drugs. It looks good if they fund more surgeries.' In contrast, 'if primary care is doing its job brilliantly, it's invisible.' Asked to respond, the health minister said primary care was a 'key priority', pointing to recent announcements including new clinical placements for overseas-trained doctors to work in primary care, extra doctor training places at medical schools and a new 24-hour telehealth service.
Scoop
30-04-2025
- Health
- Scoop
Regulators Removing Health Workforce Cultural Safety Risks Clinical Safety
Te Tiratu - Latest News [Page 1] Not The Time To Retreat — It's Time To Double Down More >> Bringing The Smile Back To Taumarunui: Te Tiratū Iwi Māori Partnership Board Calls For Urgent Action On Dental Equity Monday, 14 April 2025, 3:22 pm | Te Tiratu It offered a range of on-the-spot services that included cardiac/diabetes/cancer screening, an eye clinic, immunisations, gall bladder/hernia/haemorrhoid banding specialists, to skin lesion clinics. More >> Te Tiratū Iwi Māori Partnership Board Hosts Inaugural Forum With Health Providers To Strengthen Whānau Voices In Waikato Thursday, 10 April 2025, 10:28 am | Te Tiratu The hui is a vital step in realising the aspirations of the Pae Ora (Healthy Futures) Act, which mandates IMPBs to bring the voices of whānau directly into the heart of Te Whatu Ora Health New Zealand planning and decision-making. More >> Largest Iwi Māori Partnership Board Welcomes Bowel Screening Expansion & Calls For Māori-Focused Equity In Access Friday, 7 March 2025, 9:46 am | Te Tiratu 'Screening is an essential tool for prevention and early detection, and expanding access will definitely save lives,' said Hagen Tautari, co-chair Te Tiratū Iwi Māori Partnership Board. More >>
