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Southland Hospital struggling with 'too small' ED

Southland Hospital struggling with 'too small' ED

Problems with Southland Hospital's "too small" emergency department are outlined in information prepared for former Health Minister Shane Reti in December 2024, released to Local Democracy Reporting under the LGOIMA.
The three-page document discussed the hospital's struggling emergency department and operating theatres which have been waiting on upgrades since 2021 when funding was allocated.
'Southland Hospital is experiencing significant capacity constraints in ED (emergency department),' the report stated.
'The ED is too small to allow for the efficient flow of patients, this leads to extended times for patients to be placed in a clinical space to be assessed.'
A lack of specialised treatment spaces in the department meant it was not complying with relevant standards of 'safe, effective and dignified care', the document said.
'The ED is not equipped to sustainably and safely treat infectious patients.'
Meanwhile, demand was only increasing.
In 2024, the department was tracking at 2015 patients per bed compared to recommended targets of between 1000 - 1500
A shortfall in theatres was also hitting the hospital hard, with Southland now home to a 'stringent' eligibility criteria and some of the highest thresholds for surgery in the country.
At the time the information was prepared in December, there were 1071 patients waiting more than four months for surgical procedures.
High demand for acute and trauma care — especially from Queenstown — was straining resources, it said.
Surgeons were not being fully utilised, and a further 90 surgeries could be completed each month if more theatres were created.
The initial business case from 2021 estimated a need for two more operating theatres.
Health New Zealand Te Whatu Ora would not give the current budget for upgrades to the hospital, but said $3 million had previously been allocated for theatre capacity and $5 million for emergency department expansion.
The combined $8 million is deemed insufficient without significant compromises, the document said.
A more accurate figure is expected as part of an updated concept design and business case, but it is expected to take a further two years to deliver the upgrades once the case is approved.
Issues with sleeping facilities were also noted, as the current arrangement did not satisfy the multi-employer collective agreement.
The report said the hospital was built with the expectation the region's population would decrease, but it had done the opposite.
It also highlighted pressure resulting from the closure of Invercargill's urgent doctors in March 2024 and a struggle to recruit new GPs.
Local Democracy Reporting asked for notes and minutes from a February meeting between Southland District Council and Te Whatu Ora, but none were taken.
A spokesperson for Te Whatu Ora said they understood the two parties met regularly.
LDR is local body journalism co-funded by RNZ and NZ On Air

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Prominent medical bodies call for release of delayed gender affirming healthcare guidelines
Prominent medical bodies call for release of delayed gender affirming healthcare guidelines

RNZ News

time2 days ago

  • RNZ News

Prominent medical bodies call for release of delayed gender affirming healthcare guidelines

Te Whatu Ora was due to release the guidelines in March. Photo: RNZ / Angus Dreaver Prominent medical bodies are calling on the government to allow the release of updated gender affirming healthcare guidelines after a small section on puberty blockers caused it to be delayed. The guidelines were due to be released at the end of March but it's is now unclear when they will be. The Professional Association for Transgender Health Aotearoa, who was asked by Te Whatu Ora to update the guidelines, believes the delay is "due to unprecedented and inappropriate political interference". Te Whatu Ora says it'll publish the guidelines "once decisions are made by the government following the ministry's consultation process". Public submissions on the matter closed 20 January. But PATHA says the advice on puberty blockers in the guidelines was updated in November to reflect the Ministry of Health's new position and this was approved by Te Whatu Ora's National Clinical Governance Group. It says this advice makes up only six pages out of the total 182 pages of the document. The guidelines cover all aspects of gender-affirming care to support trans and non-binary people and their families to navigate healthcare. This includes whānau support, creating inclusive clinical environments, non-medical and non-surgical gender affirmation, speech and language therapy, fertility and sexual health, mental wellbeing, gender-affirming hormone therapy, and detransition, as well as specific guidance for Māori, Pasifika, and refugee and asylum seeker trans people, PATHA said. More than 300 medical bodies, community organisations, and individual healthcare professionals have signed an open letter calling for the government to allow Te Whatu Ora to release the guidelines. These include General Practice New Zealand (GPNZ), Royal New Zealand College of General Practitioners, The Paediatric Society of NZ, New Zealand College of Clinical Psychologists, New Zealand College of Primary Health Care Nurses, College of Child and Youth Nurses and New Zealand Nurses Organisation. PATHA president Jennifer Shields said delaying the release impacts on the ability to improve healthcare delivery and health outcomes for the transgender and non-binary population. "Less than 24 hours before the date of publication, there was an unnecessary, indefinite and unexplained delay in the publication of these clinical guidelines, we believe due to unprecedented and inappropriate political interference." In November, the government released its evidence brief on puberty blockers and a position statement which sets out its expectations for their use. It signalled its intention to consider regulating them in gender affirming care and tasked the ministry with consultation, opening up public submissions. Regulatory measures could include restricting prescribing puberty blockers in the context of gender affirming care for young people but not its use in other contexts, the ministry said. Further measures being considered by the ministry included updating clinical guidance and increasing monitoring of prescriptions. The Green Party has denounced the signalled change of approach. Medical practitioners are currently working with guidelines published in 2018. PATHA said Te Whatu Ora contacted it in 2023 to update these. "It is standard practice for guidelines to be periodically updated to ensure their content is kept up to date. PATHA submitted the updated guidelines in October 2024 and they followed the standard process for publication of a clinical guideline, and were approved by Te Whatu Ora's National Clinical Governance Group." Vice president Dr Rona Carroll said clinicians are asking for up-to-date guidance to provide appropriate and safe healthcare. "The need for this updated guidance is clear and something I hear from health professionals on a daily basis. We just want to be able to publish these guidelines so the clinicians who need them can use them." Health NZ Te Whatu Ora national clinical director primary and community care Dr Sarah Clarke said it acknowledges the guidelines currently being used are from 2018 and that the evidence base in this area continues to evolve. "In the interim, and ahead of the updated guidelines being published, our advice is that health professionals continue to provide effective care based on the best available evidence and consult and take advice from colleagues more experienced in this care when appropriate." Puberty blockers can be used as part of gender affirming care to delay the onset of puberty by suppressing oestrogen and testosterone. They are also used for precocious puberty in children, and the ministry says the same medications can be used in adults to treat endometriosis, breast and prostate cancer, and polycystic ovary syndrome. The evidence brief released in November and subsequent public consultation only looked at the use of blockers specifically as they related to gender affirming care. The ministry says overall, the evidence brief found "significant limitations in the quality of evidence for either the benefits or risks (or lack thereof) of the use of puberty blockers". Following the release of the evidence brief, the ministry directed clinicians to exercise caution in prescribing puberty blockers. At the time Shields said this was already in line with New Zealand best practice and it was reassuring to see the ministry recognise this.

GP honoured, warns of health funding
GP honoured, warns of health funding

Otago Daily Times

time4 days ago

  • Otago Daily Times

GP honoured, warns of health funding

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Health Professionals Concerned At Further Delays To Gender Affirming Healthcare Guidelines
Health Professionals Concerned At Further Delays To Gender Affirming Healthcare Guidelines

Scoop

time30-05-2025

  • Scoop

Health Professionals Concerned At Further Delays To Gender Affirming Healthcare Guidelines

The Professional Association for Transgender Health Aotearoa (PATHA) is deeply concerned at further delays to the publication of updated Guidelines for Gender Affirming Healthcare in Aotearoa New Zealand. PATHA has been informed by Te Whatu Ora | Health New Zealand that the updated Guidelines will not be published until the Minister of Health decides on whether to introduce regulations on the ability of medical professionals to prescribe puberty blockers as part of gender affirming healthcare. The guideline's advice on prescribing puberty blockers was updated in November 2024 to reflect the Ministry of Health's position statement on the use of these medications. This advice spans just 6 of the total 182 pages of information contained in the guidelines. The guidance is evidence-based, aligns with international best practice and guidelines, and supports a holistic approach to gender affirming medical care for young people who need it. 'Medical professionals working in this area are constantly being asked by colleagues for clinical guidance on gender-affirming healthcare,' says Dr Rona Carroll, a Specialist General Practitioner and Vice-President of PATHA. 'By not publishing the updated guidelines, the government is stopping healthcare providers from being guided by evidence-based, up-to-date New Zealand specific information. We have been given no timeframe for when to expect a decision about the puberty blocker consultation or the updated guidelines. Considering how many other areas of health these guidelines include, and that the advice on prescribing puberty blockers is in line with the Ministry's position statement, the updated guidelines should be published immediately. I think clinicians would be providing safer care if they had access to these guidelines today.' On Wednesday, 28 May, PATHA published an open letter calling on the Minister of Health, Simeon Brown and the Associate Minister for Health, Matt Doocey, to release the updated guidance. This letter was signed by over 500 medical bodies, clinicians and community organisations. Signatories include the Royal New Zealand College of General Practitioners, the New Zealand Society of Endocrinology, the College of Child and Youth Nurses, and the Paediatric Society of New Zealand. The evidence-based guidelines, which have been peer reviewed by clinicians with expertise in this care from within New Zealand and internationally, provide detailed information on a wide range of topics relevant to healthcare for transgender and non-binary people. This includes several revised chapters from the 2018 edition in line with emerging medical research. 'I'm proud of the amount of work the authors have put into these guidelines, bringing their extensive collective expertise into creating guidance that is broad and has a holistic view of transgender health,' says Jennifer Shields, PATHA President. 'These guidelines cover so much more than puberty blocker medication, and this information is important for all healthcare workers to have.' 'It is clear that there is no evidence-based justification for considering restrictions on prescribing puberty blockers to transgender young people,' Shields says. 'These medications continue to be prescribed to children for other indications, and limitations in the quality of the academic evidence are not unique to this care. Healthcare professionals are now left wondering if this government is being pulled into alarming 'culture war' trends away from best practice medical care, and into anti-transgender policies that lead to a reduction in patients' rights and freedoms, and set precedent for making clinical decisions based on political beliefs rather than what's best for patients.' 'This is clear evidence of ideological interference in an operational, professional frontline medical resource that is being requested by the health sector,' Carroll said. 'We reiterate our call for the Government to allow Te Whatu Ora Health New Zealand to publish these updated guidelines immediately.' Background information Statement on puberty blockers On 21st November 2024, the Ministry of Health published a position statement on the use of puberty blockers in gender affirming care, emphasising that puberty blockers could continue to be prescribed when needed as part of interdisciplinary teams. The Government expressed an intention to explore further restrictions on access to this care, and opened public consultation on possible restrictions. This consultation closed on 20th January 2025. A memo sent to then Minister of Health Shane Reti on 30 April 2024 was released to PATHA under the Official Information Act. In this memo, the Ministry of Health clarified that: 'There is currently no evidence that individual clinicians are prescribing [puberty blockers] outside of an interprofessional team.' This shows that concerns about individual professionals prescribing puberty blockers inappropriately are unfounded, and current prescribing practices are already in line with the Ministry's position statement. PATHA previously published a collective statement opposing the restrictions the Government is considering on the prescription of puberty blockers to transgender young people. This statement also received broad support from medical bodies, including the New Zealand Paediatrics Society and the New Zealand Society of Endocrinology. The statement reads [in part]: 'The Ministry of Health Evidence Brief identified that any evidence of harm associated with providing puberty-blocking medication is limited and inconclusive, and withholding this care may exacerbate gender dysphoria and negatively impact mental health. Equitable and non-discriminatory access to this care should be provided and maintained throughout the country. Decisions about prescribing puberty blockers should continue to be made collaboratively between young people, their families or support people, and the health professionals involved in their care. These decisions are individualised, based on informed consent, and guided by professional training, clinical experience, and the best available evidence. Any move to restrict access to puberty blockers would be a political decision and not one based on clinical guidance from health experts in New Zealand and international best practice. Medical decisions should remain free from political interference.' Background on puberty blockers Puberty blockers are a medication called gonadotrophic releasing hormone (GnRH) agonists. They were developed in the 1980s for use in much younger children with precocious (early) puberty, and have been used in gender affirming care for over 20 years. They halt the development of secondary sexual characteristics, such as breast growth or voice deepening, and can relieve distress associated with these bodily changes for transgender young people. Puberty blockers have the benefit of allowing the young person time before making any decisions regarding starting on gender affirming hormone therapy. The effect puberty blockers have on pausing pubertal changes is reversible. Once the puberty blocker medication has been stopped, puberty will resume as it would have done without medication. All medications have known or potential risks, but evidence and experience to date does not raise significant concerns about the safety of puberty blockers. As is the case in all medical prescribing, risks, side effects and benefits of medications are discussed with patients as part of the informed consent process before prescribing. There are also risks to not prescribing medications when they are indicated. Puberty results in irreversible physical changes, which can result in lifelong distress and gender dysphoria for some transgender people. In every area of healthcare, decisions about treatment and medication prescribing take all of these aspects into account, and health professionals support patients and their families to weigh up the pros and cons for their individual situation. Gender affirming healthcare is no different. Decisions about whether to start puberty blockers are made between health professionals, young people and their whānau. These are healthcare decisions which should remain free from ideological political interference. Clinicians who initiate puberty blockers should be experienced in providing gender affirming healthcare and working within an interdisciplinary team. It is essential that access to this care and to puberty blocker medication is maintained. Topics covered by the updated Guidelines Advice on the prescription of puberty blockers is a small portion of the content covered by the updated guidelines. The updated guidance also includes detailed information on a broad number of other areas of transgender health, including whānau support, creating inclusive clinical environments, non-medical and non-surgical gender affirmation, speech and language therapy, fertility and sexual health, mental wellbeing, gender-affirming hormone therapy, and detransition, as well as specific guidance for Māori, Pasifika, and refugee and asylum seeker trans people.

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