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Scoop
11-06-2025
- Health
- Scoop
The Disgrace Of The Hospice Care Funding Scandal
Ian Powell discusses the tipping point of the funding crisis facing hospice care in New Zealand. In the referendum on assisted dying in which it was voted in by a decisive majority (65%) in 2020, I voted against it. This was primarily because much of the argument in support seemed to me to centre on difficulties in accessing palliative care, including in hospices. My view was that the priority was to improve accessibility to palliative care. I would have felt better if palliative care access had been improved but sadly it has further deteriorated to the point of crisis and tipping point. Understanding palliative care and hospices Palliative care is a branch of medicine regulated by the Medical Council. It improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening, including terminal, illness. When a person receives a terminal diagnosis, they can choose to receive hospice care. Annually hospice services in New Zealand provide palliative and holistic wrap around care to over 10,000 people who die, as well as another 9,000 living with terminal illness, and their whānau. Although hospices are not statutory health authorities, everything they provide is free of charge. Roughly there is a 50:50 split between government funding and hospice fundraising. Hospice New Zealand is the national representative organisation of these 32 hospices. Hospice health professionals include doctors, nurses, therapists (physical, occupational and speech) and social workers. Consequently, even more so than hospitals, they are labour intensive. Hospices provide medical care designed for the end of a person's life. The purpose of this care is to improve the quality of the life that these patients have left. It includes pain and other symptom relief, along with emotional, psychosocial, and spiritual help for both patients and their families. Hospice care operates at four levels depending on circumstances – routine home care, continuous home care, general inpatient care, and respite care. Most patients under hospice care are able to stay in their own homes, with brief admissions to hospice for respite or to adjust pain medication. Hospice funding crisis reaches tipping point Unfortunately, despite the invaluable work for the terminally ill that only they as institutions can provide, the funding crisis that hospices face has reached a tipping point. This was brought to the fore by Kathryn Ryan's Radio New Zealand Nine to Noon programme (6 June): Hospice funding crisis. The focus was on one of the largest hospices, Tōtara Hospice, which services the communities of South and South-East Auckland. It has had to formally advise Health Minister Simeon Brown that it is planning to reduce services next month. This action comes after years of warnings from hospices that their funding was unsustainable. This was reinforced by a recent report by the MartinJenkins consultancy which concluded that for the first time the hospice sector won't be able to raise enough money to break even. Expanding the tipping point Radio New Zealand's coverage of the funding tipping point continued three days later on Morning Report in a thorough piece by health journalist Ruth Hill: Collapse of hospices could cost taxpayers millions. Hill reported the hospices warning that funding shortfalls were putting their critical services at risk. Already they were only available to one out of three New Zealanders who were dying. She provided individual examples of this sorry state of affairs. The Government's scuttling of the pay equity claim for hospice nurses also had a negative impact. Hospice New Zealand chief executive Wayne Naylor noted that hospice nurses were currently paid up to 35% less than Health New Zealand nurses. He said: That was a real out-of-the-blue sideswipe for hospices and hospice nurses in particular, to have our pay equity claim, which was almost completed, just stop. Hospices were being forced to consider two unpalatable alternatives. Naylor described it this way: That then falls back on community to provide more money to support their local hospice. The alternative is that hospices have to make some staff redundant so that they can increase the salaries of other staff, and that leads to a reduction in services. Minister Brown has said that Health New Zealand had enough funding for hospice care. However, Naylor reported that the organisation had told Hospice New Zealand something quite opposite to the Minister: They told us they had no more funding, that they have no contingency that they can call upon, and the people with whom we met said they had no authority to allocate funding from anywhere else. So essentially it's a no to funding from Health NZ right now. Ruth Hill also tellingly cites the MartinJenkins report which that the 28 partially publicly-funded hospices are returning at least $1.59 in health benefits for every dollar of taxpayer money received, including fewer emergency departments and hospital admissions or rest home stays. What is to be done Simeon Brown maintains that he and his government value the services hospices provide. What they provide is as core to the public health system as the services provided in our general practices and public hospitals. Further, many (probably most) of the terminally ill are people who have invested in the public health system for much longer than those who sit around the cabinet table. They have done their bit to ensure their health system has been funded for the benefit not just for themselves and their families. It has also for hugely many more others that are unknown to them. It is only reasonable that hospice care should be available for them in their final weeks or months. It is not just a question of the hospice service being sufficiently funded. It should not have to be financially dependent on charity to survive, let alone function. This is fundamentally wrong. Being dependent on charity only makes sense if governments are so cynical to factor into their calculations that the terminally ill don't amount to many votes and not for very long! It also makes sense if governments are so short-sighted that they can't see the financial return of investing in hospice care! If hospice care being dependent on charity does make sense, then the words 'disgrace' and 'scandal' have no meaning.
Scoop
11-06-2025
- Health
- Scoop
The Disgrace Of The Hospice Care Funding Scandal
In the referendum on assisted dying in which it was voted in by a decisive majority (65%) in 2020, I voted against it. This was primarily because much of the argument in support seemed to me to centre on difficulties in accessing palliative care, including in hospices. My view was that the priority was to improve accessibility to palliative care. I would have felt better if palliative care access had been improved but sadly it has further deteriorated to the point of crisis and tipping point. Understanding palliative care and hospices Palliative care is a branch of medicine regulated by the Medical Council. It improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening, including terminal, illness. When a person receives a terminal diagnosis, they can choose to receive hospice care. Annually hospice services in New Zealand provide palliative and holistic wrap around care to over 10,000 people who die, as well as another 9,000 living with terminal illness, and their whānau. Although hospices are not statutory health authorities, everything they provide is free of charge. Roughly there is a 50:50 split between government funding and hospice fundraising. Hospice New Zealand is the national representative organisation of these 32 hospices. Hospice health professionals include doctors, nurses, therapists (physical, occupational and speech) and social workers. Consequently, even more so than hospitals, they are labour intensive. Hospices provide medical care designed for the end of a person's life. The purpose of this care is to improve the quality of the life that these patients have left. It includes pain and other symptom relief, along with emotional, psychosocial, and spiritual help for both patients and their families. Hospice care operates at four levels depending on circumstances – routine home care, continuous home care, general inpatient care, and respite care. Most patients under hospice care are able to stay in their own homes, with brief admissions to hospice for respite or to adjust pain medication. Hospice funding crisis reaches tipping point Unfortunately, despite the invaluable work for the terminally ill that only they as institutions can provide, the funding crisis that hospices face has reached a tipping point. This was brought to the fore by Kathryn Ryan's Radio New Zealand Nine to Noon programme (6 June): Hospice funding crisis. The focus was on one of the largest hospices, Tōtara Hospice, which services the communities of South and South-East Auckland. It has had to formally advise Health Minister Simeon Brown that it is planning to reduce services next month. This action comes after years of warnings from hospices that their funding was unsustainable. This was reinforced by a recent report by the MartinJenkins consultancy which concluded that for the first time the hospice sector won't be able to raise enough money to break even. Expanding the tipping point Radio New Zealand's coverage of the funding tipping point continued three days later on Morning Report in a thorough piece by health journalist Ruth Hill: Collapse of hospices could cost taxpayers millions. Hill reported the hospices warning that funding shortfalls were putting their critical services at risk. Already they were only available to one out of three New Zealanders who were dying. She provided individual examples of this sorry state of affairs. The Government's scuttling of the pay equity claim for hospice nurses also had a negative impact. Hospice New Zealand chief executive Wayne Naylor noted that hospice nurses were currently paid up to 35% less than Health New Zealand nurses. He said: That was a real out-of-the-blue sideswipe for hospices and hospice nurses in particular, to have our pay equity claim, which was almost completed, just stop. Hospices were being forced to consider two unpalatable alternatives. Naylor described it this way: That then falls back on community to provide more money to support their local hospice. The alternative is that hospices have to make some staff redundant so that they can increase the salaries of other staff, and that leads to a reduction in services. Minister Brown has said that Health New Zealand had enough funding for hospice care. However, Naylor reported that the organisation had told Hospice New Zealand something quite opposite to the Minister: They told us they had no more funding, that they have no contingency that they can call upon, and the people with whom we met said they had no authority to allocate funding from anywhere else. So essentially it's a no to funding from Health NZ right now. Ruth Hill also tellingly cites the MartinJenkins report which that the 28 partially publicly-funded hospices are returning at least $1.59 in health benefits for every dollar of taxpayer money received, including fewer emergency departments and hospital admissions or rest home stays. What is to be done Simeon Brown maintains that he and his government value the services hospices provide. What they provide is as core to the public health system as the services provided in our general practices and public hospitals. Further, many (probably most) of the terminally ill are people who have invested in the public health system for much longer than those who sit around the cabinet table. They have done their bit to ensure their health system has been funded for the benefit not just for themselves and their families. It has also for hugely many more others that are unknown to them. It is only reasonable that hospice care should be available for them in their final weeks or months. It is not just a question of the hospice service being sufficiently funded. It should not have to be financially dependent on charity to survive, let alone function. This is fundamentally wrong. Being dependent on charity only makes sense if governments are so cynical to factor into their calculations that the terminally ill don't amount to many votes and not for very long! It also makes sense if governments are so short-sighted that they can't see the financial return of investing in hospice care! If hospice care being dependent on charity does make sense, then the words 'disgrace' and 'scandal' have no meaning. 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.
The Spinoff
11-06-2025
- Entertainment
- The Spinoff
A Beautiful Family: a haunting summer holiday novel, reviewed
Claire Mabey reviews the novel about a New Zealand summer that caught the attention of one of the world's most famous agents and is being released in multiple countries, with a film adaptation attached already. Jennifer Trevelyan's pathway from unknown author to international name is a particularly compelling one. Media attention has been hot and close this past week as A Beautiful Family is released in Aotearoa, Australia, the US and UK. On RNZ's Nine to Noon, Trevelyan told Kathryn Ryan how she'd been writing away for a decade before she finally felt she had a manuscript worthy of sending out to an agent. Felicity Blunt – renowned literary agent – responded (for the uninitiated, this is notable in itself: it is extremely hard to get an agent, especially such a huge one) and the fairytale trajectory from hopeful scribbler to signed-up writer was set into motion. Blunt sold the book into multiple territories, secured Trevelyan a two-book deal, and sold the rights to the film, which already has Niki Caro down to direct. Trevelyan told Ryan that her one wish is that it is filmed in New Zealand. Without knowing anything about the novel, this is an extraordinary story. It is notoriously hard for New Zealand writers to crack the international market: not many manage to do it and certainly not via the pull power of Felicity Blunt, who represents Meg Mason, Jilly Cooper, Claire Keegan and Bonnie Garmus among others. It's the kind of dream-come-true that gives hopefuls just enough to plough on with. Though the chances of such a sequence of events happening again is so slim it's hard to imagine it repeating anytime soon. I received a limited edition advance proof of A Beautiful Family a few months ago with the number 137/150 handwritten on the promotional cover, which read 'if you only read one book in 2025 make it this one'. I have to admit that at this point in the game I'm skeptical of such commands. I get a lot of advance copies with grand promises and I don't read them all: that would be more than a full time job. I put the book in my pile and frankly forgot about it until a week ago when I was looking through my to-be-read piles trying to find something that I'd be able to read quickly, and that might hold my attention over a gloomy, frigid day in which I was stuck inside with a head cold. Enter, the child. Trevelyan's narrator is 10 years old. She's unnamed until the very end of the book (I won't reveal it here: best to find out for yourself). It's this naive perspective that makes A Beautiful Family both easy to read and impossible to put down. The narrator's innocence is pitted against several disturbing factors, all orbiting her summer in various shapes and shades, and it's that persistent dance of disturbances that creates the sustained and unrelenting tension in the novel. Child narrators aren't uncommon in adult literature but the decision to use them is fascinating to me. Catherine Chidgey's The Book of Guilt uses the perspective of three siblings to tell that sinister story; John Boyne's The Boy in the Striped Pyjamas is a famously affecting use of the child's perspective to tell a holocaust story – the adult reader immediately understanding what the child characters do not. This distance between the child narrator and the adult reader is where sickening suspense lies: as adults we know more than they do and all we have left is to hope that, in this story, we're wrong. A Beautiful Family is set on the Kāpiti Coast in the 1980s. We know this because Trevelyan is meticulous with her references to the time period: the child's prized possession is a Walkman through which she plays Split Enz; The Exorcist has aired on TV; there are Seventeen magazines with sealed sections; the child and her sister Vanessa get terrifically sunburned and only after getting blisters does their mother buy some SPF15. There is also casual racism at play in varying degrees of intensity. A Chinese family is talked about in grotesque terms; a Māori character is described as having 'skin the colour of burnt caramel'. It makes you grind your molars until you remember that this is the 80s and such clangers were horrifyingly commonplace. The question that came to haunt me as I read A Beautiful Family was from what distance is this child narrator telling her story? The voice is in first person, past tense, which indicates that there is space between the events and the telling of them. But it's never made clear how much space: only a couple of moments where the narrator says directly that she doesn't remember a certain detail. For some reason this struck me and niggled at me. I suspect that not many other readers will be at all concerned with this but I wished for those intimations of distance to be either removed or embellished because, for this reader at least, it made me question memory, naivety and the precise impact of the story on its teller. Trevelyan has revealed herself to be a perfectionist and a very careful writer so I doubt that this ambiguity is erroneous, but rather a deliberate nod towards the way core childhood memories stay, and replay. Because this is a summer that lingers: it's the kind of childhood scenario that would lodge itself in the brain and return to the mind's eye with changing lenses as you aged. It is immediately clear that the child's parents are unhappy and that Vanessa (the sister) has struck a particularly unpleasant and caustic stage of her teenage years. The child is left largely to her own devices until she meets Kahu, a young boy, and he tells her about Charlotte who disappeared from the beach one summer when she was nine years old. The book is haunted by Charlotte in several ways. As an unsolved mystery it gives the two lonely children something to investigate; and it adds an extra element of suspicion to the dead-eyed neighbour that trains his gaze over the child and her family. Trevelyan carefully places her threats: there's the simmering unhappiness between the parents; clear signs of an affair; a very creepy neighbour; and the sea. Children are frequently left alone at the beach in this story. While the descriptions of diving in and out of the waves like dolphins are charming, nostalgic, you're left to worry about drowning. New Zealand has horrendous child drowning rates. Our losses make it very hard to read a local novel where the sea laps and waits for unsupervised children. You're left to shout into the pages for the adults to focus on their kids for once; to shout 'remember Charlotte?!' The mother character is one of the most intriguing figures in this novel where the adults are so absent they're almost abstract. She's having an affair (this is made obvious early on), and she's trying to write a book. At least, her child thinks that's what she's doing. Whatever it is she's scribbling, it lets her take her eye off the ball: helps her escape her family, escape parenting, her miserable marriage, her surroundings. Early on we learn that the mother usually demands they holiday in remote places. So her family finds it unusual that this summer she wants to go 'where there are people'. It becomes clear that the affair has a lot to do with this change of heart; but what I found most interesting was the depiction of the writer as selfish, self-isolating and self-destructive. I suspect that many women of a certain age will empathise strongly with her, particularly in contrast to the man she married. Through his child's eyes we get glimpses of a father who thinks it's not his job to chaperone the children on the beach; who is friendly enough but who is quietly fuming about his marital situation; who is racist; and who enacts a violence that will severely scar any of Trevelyan's readers who are writers. A Beautiful Family reminded me, to some degree, of the film Little Children (2006). Ostensibly a movie about an affair, it becomes, in dramatic fashion, a story about the selfishness of adults: the damage they can cause to the children they like to think are unknowing and unseeing. Trevelyan's story plays a similar trick in that its mystery centres on a missing girl, a creepy man, and the terror that experimenting teenagers can inflict upon themselves and others. But this is really a novel about parents: about what they don't see, what they distract themselves with (cricket, BBQs, projects, affairs, discontents) and what they miss. But what of that bold claim on the proof copy? A Beautiful Family is well written, it's immersive, and it is haunting. It's a novel that will prompt you to look back over your own childhood and assess the threats; the fast friendships; the collisions with siblings and strangers. A Beautiful Family has an atmosphere and an eye for place that means it has the potential to make a good Aotearoa noir film and one hopefully filmed on the Kāpiti Coast. I can see why Felicity Blunt was so confident about this novel: there is a universality to the way the child observes danger, weathers the storm of family, is plagued by what she remembers. There's a cinematic quality to the writing. But I hope you read more than one book in 2025. New Zealand is producing so much compelling fiction: more of it deserves to be read, discovered, and helped to go big. Hopefully Trevelyan's success will help kick that door open a little wider. A Beautiful Family by Jennifer Trevelyan ($37, Allen & Unwin) is available to purchase from Unity Books. The Spinoff Books section is proudly brought to you by Unity Books and Creative New Zealand. Visit Unity Books online today.
Scoop
28-05-2025
- Business
- Scoop
First-ever Global Shipping Emissions Levy Approved, But Pacific Push For Stronger Deal Fails
But a Pacific push for stronger deal failed at the International Maritime Organisation meeting in Londom last companies will soon have to pay for carbon emissions produced by its vessels for the first time, but the new deal agreed by the global maritime watchdog is still significantly lower than what was demanded by Pacific Island nations. The shipping emissions framework was finalised by the International Maritime Organisation (IMO) at its meeting last month in London. While it is yet to be ratified, a formal vote in October on its adoption is expected to be successful. The IMO is the UN agency responsible for the safety and security of shipping and the prevention of marine and atmospheric pollution by ships in international waters. Once implemented, the proposed global emissions scheme would subject ships to a charge on their greenhouse gas emissions. After a certain threshold, that charge is increased, as set out by the finalised framework. Ships would also have the ability to trade carbon credits under the scheme. Overall, the scheme is expected to generate about US$10 billion a year – a fraction of the $60b a year Pacific and Caribbean nations wanted in their own carbon levy pitch for the framework. UCL Energy Institute's Dr Tristan Smith, a professor of energy and transport, told RNZ Nine to Noon that, while agreement on a global emissions scheme is significant and likely a world-first, it could have been more robust. 'In climate terms, and as a scientist, it's always frustrating because you know what needs to be done in order to keep us on the temperature goals that we've talked about in the Paris agreement,' he said. However, achieving that in practice, he said, 'is always incredibly difficult because of the politics of climate negotiations'. 'We also had a particularly difficult time this year with the geopolitical situation, referring to the fact that the Trump administration has taken a strong anti-climate stance, which put the US in a very different position to how they were in previous administrations, and changed the dynamics of the IMO a bit.' Membership of the IMO includes 176 states and more than 150 intergovernmental and non-governmental organisations. Dr Smith said the end result of negotiations between various member parties on the proposed scheme resulted in a significantly lower carbon price for shipping emissions than what he believed was needed. 'In the final package, we've got about a $15 per ton of greenhouse gas emitted price that's coming in, and we thought that we needed somewhere between 100 and $150. 'It's a significant reduction, but it still exists and it's still a global agreement, which I believe makes it the first global carbon price.' As recently as February, Pacific nations had proposed a more ambitious global shipping emissions scheme. Not only had the agreed IMO framework failed to meet that, it had also failed in achieving the IMO's own greenhouse gas strategy which it revised in 2023. Smith said Pacific nations wanted a much tougher scheme to effectively drive the transition of the shipping sector to a low carbon model by charging higher costs for greenhouse gas emitters. 'Their vision was to have this transition of the shipping sector driven by a carbon levy – a universal price on greenhouse gas emissions that charged for every ton of greenhouse gas emissions about $150. 'Then coupling that with a mandate that reinforced the fact that this was going to be driven by stringent regulation [like] a hard fine or a penalty if you weren't reducing your emissions and driving a very steep reduction in greenhouse gas emissions, reaching nearly full decarbonisation by 2040.' Dr Smith said that 'steepness' in the reduction of greenhouse gas emissions and 'power' through a heavy levy was missing. He said that in turn had effectively hampered the rate at which decarbonisation of the shipping industry would likely occur. 'Because we could really subsidise some of the very expensive, or currently very expensive solutions…at the early stage of decarbonisation and really enable companies to have the confidence to invest in scale. 'But also use significant amounts of revenue to help low income countries, not just [small island developing states and least developed countries] like the Pacific island states, but also middle income countries, low income countries, which will need support as we go through the transition.' He said these countries would need assistance to modernise and shift their their own shipping industries to a low-carbon model. The cost of doing that, as well as the economic impacts of increasing transport prices, must be factored in, he added. The finalised framework, which needs two-thirds of the IMO membership vote in October to be ratified, would cover all ships bigger than 5000 gross tons, such as largo cargo ships, in international waters if implemented. Dr Smith believes that eventually it would also cover ships smaller than 5000 gross tons. At that point, all vessels that trade internationally would be captured by the shipping emissions scheme. 'It doesn't drive or change what national governments do with domestically operated ships. So coastal vessels servicing the coast of New Zealand, or ferries within New Zealand wouldn't be affected by this regulation. That's down to the national government to decide what to do,' he said. 'In some ways though, that exactly illustrates why it's such a significant agreement, because it's the missing emissions in international waters that no one was counting that are now, at least in a framework here.' Dr Smith expectes the October vote on the final framework to be successful, despite previous opposition from several larger nations like Saudi Arabia, China, and Brazil. Following that, the scheme was set to be fully implemented in 2027. The UN said that timeframe would give 'the industry time to adapt to new requirements and invest in alternative fuels and technologies'.
Scoop
23-05-2025
- Health
- Scoop
'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.
