Latest news with #RuthHill
Otago Daily Times
a day ago
- Health
- Otago Daily Times
Vaccine hesitancy growing in at-risk communities
By Ruth Hill of RNZ A growing number of families living in communities most vulnerable to infectious disease outbreaks are refusing to have their children vaccinated. Immunisation experts fear this worrying trend will make it impossible to reach the government's target of 95 percent coverage by 2030. At Ngā Mataapuna Oranga primary health organisation in Western Bay of Plenty, health workers are not passively waiting for whānau to bring their babies in for vaccination. A manager and kaiwhakahaere, Jackie Davis, said it had managed to boost immunisation rates by 10 percent in the last year through the heroic efforts of nurses, community workers and GPs. "[We've even had] community teams lurking in bushes, waiting to ambush mums coming home from shopping," she said wryly. In a league table of primary health organisations (PHOs) published by Health NZ, Ngā Mataapuna Oranga has the highest decline rate, with 25 percent of families refusing immunisation. As a small PHO, with just four general practices, it only took a handful of families to decline immunisation to drop its rates below target, Davis pointed out. However, she admitted it was up against persistent anti-vaccination propaganda, which spread like contagion via social media. "I guess their promotion is just as good as our promotions are, so they counter a lot of the work we do." Nationally, 79.3 percent of two-year-olds were fully vaccinated in the first three months of the year - marginally better than at the same time last year. In some regions however, rates were much lower: Northland had just 66.4 percent coverage, while in Tairāwhiti and Bay of Plenty, it was around 68 percent . Davis said the Covid pandemic damaged trust in the health system and it was taking time to rebuild those relationships. "I think too that we have to balance our attempts at immunisation in relation to our relationships with our families. "To put it bluntly, sometimes we're going two or three times to the same families. And at the end of the day, from their perspective, they're over us." Decline rates threaten 95 percent target - expert Infectious disease expert professor Peter McIntyre, from Otago University, said before Covid, decline rates for childhood immunisation were around 5 percent. However, for about one in three PHOs in those Health NZ figures, the decline rate was now more than 10 percent. "This substantial increase in the proportion of families declining, effectively makes that impossible." Unfortunately, vaccine distrust had got a stronger hold among Māori and Pacific communities, which already had more "delayed" immunisations, he said. "What the decline figures are telling is that these are people who are indicating they just don't intend to get their child immunised full stop, which is a development that's really worrying, because decline is a whole lot worse than delay." Full coverage remained a worthy goal, he said. "But if we really have to choose - which maybe at this stage we do - we want to focus on: How good is our protection against measles? What's that looking like? What do we have to do about it? And maybe whooping cough as well. And meningococcal B." More younger parents and caregivers vaccine sceptical Ngāti Porou Oranga in Tairāwhiti recorded the lowest coverage with just 38.5 percent of two-year-olds fully vaccinated in the first three months of the year. No-one from the PHO was available to comment. Eastern Bay Primary Health Alliance in Bay of Plenty said its figures had improved: 58.4 percent of enrolled tamariki were fully immunised as of 1 July, up from 52.5 percent in the previous quarter. Chief executive Katarina Gordon said however it was also seeing a growing number of whānau "expressing hesitancy or choosing to decline immunisation". "We're seeing a steady increase in vaccine hesitancy particularly among younger parents and caregivers. "Some are actively declining, but many are simply unsure or misinformed. Social media misinformation, past experiences of the health system, and general mistrust all contribute to this hesitancy." Many whānau were living in rural or remote areas, with limited access to transport, housing instability and economic hardship, which meant day-to-day needs often took priority over preventive healthcare like immunisations, she said. Health providers were struggling themselves with limited clinic availability, workforce shortages (especially nurses and outreach staff) and high demand, which meant some whānau faced long wait times or limited options for appointments. "Mobile outreach services help, but capacity is stretched, and funding is not always available and or sustainable." Despite these challenges, Eastern Bay Primary Health Alliance continued to work with its practice network, outreach teams, Hauora Māori partners the National Public Health Service and Te Whatu Ora Health NZ to boost immunisation rates. "We remain committed to ensuring all interactions with whānau are timely, respectful, and culturally safe."
RNZ News
5 days ago
- Health
- RNZ News
Health experts claim Regulatory Standards Bill will undermine public health system
health politics 33 minutes ago Health experts claim the ACT Party's red tape-busting Regulatory Standards Bill threatens to harm patients by undermining the public health system. Ruth Hill explains.
Scoop
7 days ago
- Health
- Scoop
‘Slash And Burn' Increases Poor Health System Decision-Making: Witness Maternity And Gynaecology
In Aotearoa New Zealand's health system there are 36 branches of vocational (specialist) medicine registered by the Medical Council. These are called 'scopes of practice' which allow doctors to work independently of supervision (doctors with general scopes of practice require some form of supervision). Overwhelmingly these specialities have one or two names such as 'dermatology', 'general practice' and 'orthopaedic surgery'. Consequently, a speciality with 'and' between two words is unusual. Obstetrics and gynaecology (usually referred to as O&G) is an 'unusual'. They are somewhat like twins or close cousins. Whereas the former is obviously about birth, the latter involves the treatment of women's diseases, especially those of female reproductive organs. 'Slash and burn' strategy Like almost all the other vocational scopes of practice, O&G suffers from a crisis of severe workforce shortages due the political neglect of successive governments. Cutting maternity beds at Wellington Hospital is part of a wider 'slash and burn' strategy led by Health New Zealand (Te Whatu Ora) Commissioner Lester Levy over the past 12 months. I have discussed this strategy previously in the context of health IT (15 December): Slash and burn health IT strategy. I have also discussed it in the context of gutting specialised health teams (22 January): Gutting specialised health teams. The maternity service crisis is national, not just local. By way of example, Hawke's Bay Today (8 July) reported that more than 900 women in Hawke's Bay are waiting to see a gynaecologist, many of them facing 'unbearable pain': 900+ Hawke's Bay women suffering unbearable pain. 'Slash and burn' leads to poor decision-making On 7 July a story by health journalist Ruth Hill on Radio New Zealand's Morning Report revealed a shocking new development: Cutting maternity and gynaecology beds in Wellington Hospital. Health New Zealand was planning to cut beds from its gynaecology and maternity wards in Wellington Hospital in a trial aimed at making more room for patients from its overcrowded emergency department. While management claimed that the maternity wards often had empty beds, those with the experience and expertise to know more (O&G specialists and midwives) disputed this. Instead, they feared there would be huge pressure to discharge mothers and newborns too quickly. The Midwives Union MERAS (Midwifery Employee Representation and Advisory Service) Co-Leader Caroline Conroy said Wellington Hospital's maternity unit was 'one of the busiest in the country'. Further: The monthly stats we get at staffing meetings show the bed utilisation is over 100%. So it's a really busy unit. She also made another interesting observation with her suspicion that the Government's health targets for emergency wait times and elective surgery were squeezing capacity elsewhere. This is one of the problems when they set targets, and we've seen this in the past – when the focus and funding goes on those targets, and other services are not given priority. O&G specialists college slates maternity bed cuts Meanwhile Royal Australian New Zealand College of Obstetrician and Gynaecologists vice president Dr Susan Fleming said, in the above-mentioned Ruth Hill piece, a further squeeze on maternity resourcing was disturbing. Demand in obstetrics is not predictable. Even 'elective' procedures like caesareans are not truly elective. You can push them back hours or even days sometimes, but you don't have a lot of flexibility. When there's a peak of demand around acute presentations in labour and a demand for inductions and caesarean sections, then there's no flex capacity, and then the only thing you have is to discharge women from the post-natal wards early. Further: …my understanding is that most maternity units across New Zealand are still struggling with midwifery resourcing, and particularly with the smaller units, with obstetric resourcing. The following day (8 July) Morning Report covered further staff distress over the maternity bed cuts: Maternity staff beg Health NZ not to cut beds. Inglorious backdown Former British Labour Prime Minister Harold Wilson is known for several 'pearls of wisdom'. One which is often repeated is that a week is a long time in politics. This is equally so with health systems; sometimes only a couple of days. By late 8 July Health New Zealand was reporting a complete backdown by reversing its decision to cut maternity beds. This was covered the following day by Morning Report: Backdown. Also see later in the programme the item by senior reporter Natalie Akoorie: Senior doctors welcome U-turn. This backdown was a huge embarrassment for the national health bureaucracy statutorily responsible for Aotearoa's planning and provision of healthcare. Rather than management on the ground, however, prime responsibility rests with the poor political leadership of the health system by the current and previous governments. This was reinforced by Commissioner Levy's destabilising 'slash and burn' strategy coupled with Health Minister Simeon Brown's simplistic soundbite advocacy. Take-home points Health New Zealand was created in 2022 by an unwanted restructuring and has been internally restructured ever since. Instability and all that consequentially follows have been the inevitable outcome. A big part of this outcome was the large loss of experienced senior and middle level health managers with operational experience. These managers often had a health professional background. It is highly likely that those managers responsible for the decision to cut the maternity beds had much less experience and insight over the risks than those employed by the former Capital & Coast District Health Board before its disestablishment on 1 July 2022. The short-lived but distressing bed-cutting decision demonstrates a failure to recognise where relevant expertise and experience resides. At the point when the idea of cutting maternity beds arose there should have been immediate engagement with O&G specialists and midwives over the implications and risks. Further, having received their advice, they should have heeded it. The final take-home point is the importance of voice in healthcare. I have previously discussed this importance in BusinessDesk (6 September 2022): Healthcare accessibility depends on health professional voice. It was the voice of the midwives and O&G specialists (and their unions, MERAS and Association of Salaried Medical Specialists, plus the O&G professional college) along with good reporting by Radio New Zealand that forced the backdown. Nothing more and nothing less! 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.
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.
RNZ News
06-06-2025
- General
- RNZ News
Flu and COVID infections rising, GPs already under pressure
ESR data shows flu and COVID infections are on the rise, with a sharp jump in hospitalisations for severe respiratory infections across Auckland in a week. As Ruth Hill reports, GPs warn they're already under pressure.
