'I Can Confirm They Are Hypotheticals Drawn Largely From Anecdotes And Issues The Minister Has Heard About.'
Ian Powell discusses when health professions regulatory authorities policy is shaped by second hand anecdotes and issues.
Before reading further hold on to the words in my heading above. Then consider who said, 'I can confirm they are hypotheticals drawn largely from anecdotes and issues the minister has heard about'.
Further, who did the comment refer to, what was its context and meaning, and what is the significance of this meaning?
The context is a review of the regulatory health professions presently being undertaken by the Ministry of Health for Health Minister Simeon Brown.
However, the ideological origin of the review is the coalition Government agreement between the National and Act parties.
Regulation of health professions is covered by the Health Practitioners Competence Assurance Act 2003. Its overriding purpose was to provide a framework for the regulation of health practitioners to protect the public where there is a risk of harm from professional practice.
The Act included the requirement for scopes of practice for each of the regulated occupations. Eighteen regulatory authorities cover 26 professions. The authorities that cover the largest professions are the Medical and Nursing Councils.
Health Ministry discussion document
As part of the review the health ministry published a discussion document under the misleading 'milk and honey' title of 'Putting Patients First: Modernising health regulation'.
But drill down further and a more sinister picture emerges. My drilling down was recently published by Newsroom (24 April): Threatening political meddling in health regulatory authorities.
My main points about this discussion document were:
It is based on a false construct that too much regulatory 'red tape' was making it more difficult to ensuring that New Zealanders 'have access to timely, quality healthcare'.
There was a complete absence of evidence to justify its contentions. In fact, contentions were contradicted by evidence.
It is ideologically loaded and weak arguing by insinuations and with an obviously pre-determined outcome in mind.
It raised several questionable scenarios to justify regulatory change that could, in fact, be resolved within the existing system (discussed further below).
The biggest threat implicit in the document was political interference in the functioning of the regulatory authorities thereby weaking their responsibility to protect the public from harm.
The risks for patients being diagnosed and treated by the medical profession was succinctly outlined by the Chair of the Medical Council, Dr Rachelle Love (a Christchurch head and neck surgeon) on Radio New Zealand's Nine to Noon programme (8 May): Increased political control risk.
In rebutting the claims of the Ministry's discussion document, Dr Love said that what it proposed risked leading to increased political control. Instead, the real issue was the retention of doctors which was ignored by the Ministry.
General practitioners don't pull their punches
Steve Forbes in a paywalled article published by NZ Doctor (17 April) reported Dr Angus Chambers, general practitioner and Chair of the General Practices Owners Association (GenPro) concerns. The latter was at his forthright best.
He described the consultation practice for the Health Ministry's discussion document as poorly designed and amounted to a consultation process with a preordained outcome. If implemented, it would lower both standards of care and clinical safety guidelines.
Dr Chambers assessed the process as being 'completely cynical' adding, as reported by Forbes, that:
There are good reasons for the different specialised regulatory authorities to oversee various health professionals, he says. But he is concerned the consultation paper is designed to get a 'quick-fix response from the public'.
Further:
Opening the floodgates to new, less-qualified health professionals, such as physician associates, to plug workforce gaps isn't the solution, Dr Chambers says.
'If we had enough GPs, we wouldn't need these additional professions.'
General practitioner and Chair of Women in Medicine Dr Orna McGinn also questioned the credibility of the process in her LinkedIn page:
The document presents a case to further politicise the health landscape via deregulation and undermining of commitments to uphold Te Tiriti o Waitangi and thereby address inequities in health access and outcomes.
We note that two government statements concerning practitioner scope and regulation were published before closure of the consultation period. This raises doubts as to the validity and legality of the process.
Scenarios scam
The dubious use of the above-mentioned scenarios in the Ministry of Health's discussion document to justify the 'preordained outcome' highlighted by Dr Chambers unsurprisingly attracted strong and angry responses.
No wonder than NZ Nurses Organisation Chief Executive Paul Goulter called it poor quality and that it should be withdrawn.
The scenarios led to the Association of Salaried Medical Specialists (ASMS) formally complain to both the Public Services Commissioner and Director-General of Health over their use.
Two of the scenarios claimed that podiatrists being unable to prescribe some feet medicines and approval for new occupational groups, such as physician associates, were being obstructed by the existing regulatory system.
Soon after the Health Ministry released its discussion document, approval for both issues occurred.
The former made sense while the latter (which was a ministerial decision) did not. But both demonstrated that working through the existing regulatory system led to the sought outcomes.
ASMS meanwhile also pursued the scenarios controversy with the Health Ministry under the Official Information Act. The response from a Ministry official to ASMS, as reported in another paywalled Forbes article (6 May) was:
I can confirm they are hypotheticals drawn largely from anecdotes and issues the minister has heard about.
The answers to my opening questions
The official's response reinforces what many suspected. The Ministry's discussion document was largely written from within Health Minister's office.
A feature of his office is the absence of health system experience understanding, including about the intent of the Health Practitioners Competence Assurance Act discussed above, is poor.
Returning to my above opening questions, the Health Ministry made the comment, and it was referring to their health minister Simeon Brown.
The context was a false construct that the health professions regulatory authorities were contributing to the health workforce crisis.
The meaning was that political involvement was required even though this poses serious risks to the authorities prime legislative responsibility to protect the public from harm.
As for the significance of its meaning it highlights the serious risks of harm to the health and wellbeing of the public (and to health professionals) when decision-making is ideologically driven and designed by those with at best minimal health system experience.
No wonder, as I observed in my above-mentioned Newsroom article, the failure of the discussion document's authors was not being able to make a silk purse out of a sow's ear. They should have listened to Jonathan Swift.
Given the ideological origin and consequential high level of predetermination they never had even a dog's chance.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Otago Daily Times
4 hours ago
- Otago Daily Times
Arrest after woman found dead in Tūrangi
Labour has overtaken National as the party New Zealanders consider most able to handle the cost of living, according to the latest Ipsos Issues Monitor survey.
Otago Daily Times
9 hours ago
- Otago Daily Times
Counting on the census
One of the great pillars on which modern New Zealand society is based has been scrapped by the government in a move which has shocked many. The five-yearly, or thereabouts, census has seemingly had its day, Statistics Minister Shane Reti reckons. He announced on Wednesday that New Zealanders had, for the last time, needed to scurry about looking for a pen to fill out the forms or pray that the more recently online documents would work as intended. Citing the need to save time and money, Dr Reti signalled the census will be replaced with "a smaller annual survey and targeted data collection". This will, according to the somewhat breathless Beehive media release, provide better quality economic data to underpin the government's "growth agenda". In line with this thinking, there will be no census in 2028, with the new approach starting in 2030. The new method of collecting nationwide statistics will sharpen the focus on delivering "more timely insights into New Zealand's population", the minister reckons. Good luck with that. While we should not automatically kibosh something before it has had a chance to prove its worth, it is difficult to see how what may effectively be a scattergun approach will be superior to the system which has developed over more than 170 years. The census has, of course, never been perfect. There were well-publicised issues with the 2018 and 2023 counts, and the five-yearly spacing has been interrupted several times, due to such events as the Depression, World War 2 and the Christchurch earthquake in February 2011. There were also concerns about the robustness of responses when the 2023 census was held the month after Cyclone Gabrielle. Dr Reti also has some justification for being concerned about the cost of the census, which has ballooned during the past decade. According to government figures, the 2013 census cost $104 million, but outlay for the 2023 one was $325m, and the now-ditched 2028 one was expected to cost around $400m. The huge leap in price is certainly concerning. Based on those government numbers, there can be no doubt running a census is a very expensive business. However, we need to remember, and perhaps remind the government, that the policies which are meant to benefit everyone across the country in healthcare, education, housing, transport and so on, actually cost many billions of dollars. The price-tag for a census which informs those policies is definitely not chicken feed, but money generally well-spent. Reaction to this week's announcement has largely been negative and expressing surprise at the move. There is particular concern about how cherry-picking data and using smaller sample sets will affect the rigour of information about Māori and Pasifika communities, and also people with disabilities, rainbow communities, and smaller ethnic groups. Dr Reti's promised land of a "sharpened focus on quality" when it comes to statistics will be extremely difficult to achieve. There are crucial questions to answer around how people's existing data within government agencies will be appropriately and sensitively used, who decides what to use and when, and who will oversee the process to make sure it is as comprehensive and fair as such a potentially fraught new system can be. We are uneasy that this move appears to be another example of this government not being especially interested in the science or data necessary for good decision-making and for making policy which is evidence-based, instead careening ever-more wildly across the political landscape in pursuit of zealotry-driven outcomes. We unapologetically support the census system we had, and believe in the provision of proper statistical data sets for modern-day needs and as a source of valuable information for the historians of the future Beware the old saying: "Garbage in, garbage out."
1News
18 hours ago
- 1News
Matariki celebrated across NZ with ceremony and reflection
New Zealanders right around the country have been celebrating Matariki, with many of them up well before dawn to watch the rising of the star cluster which heralds the start of the Māori New Year. It became an official public holiday only in 2022, but it's already become one of our most meaningful days and the first holiday to recognise Te Ao Māori. It was the first new public holiday since Waitangi Day became a public holiday in 1974. The date of Matariki changes from year to year, but it will always fall in June or July. A public holiday is held for Matariki on June 20, 2025. (Source: Ngāti Rangi hosted this year's national Matariki ceremony at Tirorangi Marae at the base of Mount Ruapehu. ADVERTISEMENT Iwi spokesperson Che Wilson told 1News it was a "huge honour" to be the first marae to host the national holiday ceremony. "It's truly a privilege to welcome everyone here," he said. "It means a great deal to us." Wilson explained that the Matariki celebrations would include offering karakia to specific stars in alignment with their Puanga traditions. "In our Puanga narrative, we'll offer them to four atua – Tāne, Rongo, Tangaroa, and Maru [the gods of forest, cultivated food, the sea, and war]." The Māori Queen, politicians, and dignitaries attended the national ceremony. Māori Development Minister Tama Potaka said having events across the country was a "real kotahitanga moment". "To bring it to national presence and international presence is something that connects us to the universe, and that's really important for us, that we see our tikanga as a way of life, as a daily platform for kotahitanga. And for me, it also connects to many, many other people from throughout the world." ADVERTISEMENT It was also a poignant moment for European Union ambassador to New Zealand Lawrence Meredith, who lost his father when he was young. "This whole transition for the ancestors is a really powerful message, the idea that ancestors become stars," he said. Hautapu ceremony at Auckland's Bastion Point this morning. (Source: 1News) Hundreds gathered at Auckland's Bastion Point to ring in the Māori New Year this morning with a hautapu ceremony. Food and steam were offered to the stars of Matariki as an offering of thanks from the umu or hāngī. The kai that is prepared for the hautapu connects to four different whetū (stars) in the Matariki cluster: Seafood with the star Waitā; freshwater kai with the star Waitī; kai from above the ground with the star Tupuārangi; and kai from the earth with the star Tupuānuku. Many were up well before dawn to watch the rising of the star cluster. (Source: 1News) ADVERTISEMENT Kingi Makoare (Ngāti Whātua Ōrākei) said it was awesome to see the eagerness from people to learn about Māori culture. "It's heartwarming to see people really interested in us." Fiona Smith (Ngāti Whātua Ōrākei) added that it was a "great reflection of what New Zealand really should be". "Together, collaborative right from the beginning, standing shoulder to shoulder, doing things together, holding hands together." A maumaharatanga ceremony on Mauao/Mount Maunganui. (Source: 1News) In Tauranga, people of all ages summitted Mauao / Mount Maunganui before dawn for a remembrance of loved ones who had died in the past year. Te Puna I Rangiriri trust chairman Jack Thatcher led the maumaharatanga ceremony and said it was a "very emotional" morning. ADVERTISEMENT Maumaharatanga translates to memorial, memory or recollection. Grieving families and friends were invited to place their hands on the monument Te Tapuātea o Mauao and call out the names of their loved ones. "We have people bringing a lot of hurt. To call out the names of the loved ones that they're missing gives them a chance to heal and carry on," Thatcher said.
