Health experts claim Regulatory Standards Bill will undermine public health system
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.
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RNZ News
5 hours ago
- RNZ News
Nurses to start local industrial action before strikes
Healthcare workers hold placards at a picket line in Wellington as nurses, midwives and healthcare assistants strike nationwide. Photo: RNZ/Samuel Rillstone Nurses begin the next round of their industrial action from Monday as they push for better staffing levels . Local action will include district nurses on Auckland's North Shore wearing T-shirts saying 'Not Enough Nurses' instead of uniforms. Nurses who work in the cardiothoracic and Vascular Intensive Care Units at Auckland City and Whangārei Hospital will refuse to shift to other wards to cover staff shortages. "The North Shore District Nursing Service is short of six staff," NZNO delegate and district nurse Lesley Pook said. "That leaves 26 nurses to provide crucial community-based nursing, such as complex wound care, intravenous medication management, cancer treatment support and palliative care. "Being short-staffed means we have to ration care. We can't see everyone when we need to and have to rush the appointments of those we can get to." The New Zealand Nurses Organisation (NZNO) says it follows the 24-hour nationwide strike by 36,000 Te What Ora nurses, midwives and healthcare workers at the end of last month . Last week, Health New Zealand was deeply concerned by the plans, which it said would cause the postponement of more than 2200 planned procedures, 3600 first specialist appointments and 8000 follow-up appointments. NZNO chief executive Paul Goulter said Te Whatu Ora members voted strongly to go on strike, after a solution could not be found through bargaining. A full strike is planned from 7am-11pm on Tuesday, 2 September and Thursday, 4 September. "I think it very clearly points to nurses being fed up with the government's inability to resource the system properly to ensure patient safety," Goulter said. Health NZ said it was happy to return to the bargaining table and was committed to finding a solution. "We want to do our very best for our nurses and we think we've put a very fair offer on the table," Health NZ chief executive Dale Bramley said. Sign up for Ngā Pitopito Kōrero, a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
Newsroom
11 hours ago
- Newsroom
Assisted dying: Thoughts from the front line
Comment: When the End of Life Choice Act 2019 came into effect in November 2021, it marked a profound shift in how we approach death and dying in New Zealand. As researchers and clinicians our team felt a deep responsibility to understand how this new law was unfolding, not from the top down, but from the ground up. That meant listening to the very people who were making it happen: assisted dying practitioners. These are the doctors and nurse practitioners who sit with patients in their final moments, who navigate complex eligibility criteria, and who carry the emotional weight of helping someone die on their own terms. They are the ones who bring the service to life. And yet, before this research, we knew very little about their experiences. Why we did this study The motivation behind this research was simple: to capture what was actually happening in practice. Assisted dying is a new health service in New Zealand, and many practitioners entered it with no roadmap. They were learning as they went, often alone, often unsure, and often deeply moved by the experience. We wanted to understand their journey, not just to document it, but to help improve the service. If there were challenges, we needed to know. If there were moments of beauty and meaning, we needed to honour those too. Ultimately, this study was about making assisted dying safer and more sustainable for everyone involved, including patients, their families, and providers. We used a 'memorable case' approach, inviting 22 assisted dying practitioners to reflect on their experiences during the first 12 months of the Act's implementation. These weren't just clinical accounts, they were deeply personal stories that revealed the emotional, ethical, and logistical complexities of assisted dying. Through thematic analysis, we identified three major themes: 'Knowing', reflecting on practitioners' prior personal and professional experience; 'doing', reflecting on their early assisted dying experiences of delivering this service; and 'being', reflecting on their personal/professional accounts of being an assisted dying provider. These themes helped us understand not just what practitioners did, but how they felt, what they struggled with, and what they learned. What assisted dying practitioners said Let's start with the positives because there were many. Practitioners consistently described the experience as a privilege. Despite the anxiety and emotional intensity, particularly during the first couple of service provision, they felt honoured to be part of something so meaningful. For many, the last words they heard from patients were 'Thank you'. That simple phrase carried immense weight. It affirmed that they were helping to end suffering, honour final wishes, help fulfil autonomy and choice, and offer peace. But there were challenges too, some of which persist today. One major issue is the eligibility criteria, particularly the requirement that a person must be likely to die within six months. This can exclude people who are suffering profoundly but don't meet the strict timeline. Assisted dying practitioners sometimes found themselves in situations where they were challenged to give an exact or accurate prognosis because of the unpredictable nature of many medical conditions. Another challenge is the regulatory prohibition on raising the topic of assisted dying with patients. Practitioners can't initiate the conversation; it must come from the patient. While this protects against coercion, it also means that many people don't even know the option exists. Some practitioners felt torn: they felt ethically challenged by withholding information about the full range of end-of-life care options, but they couldn't say so. Some others accepted the restriction, fearing that even a well-intentioned suggestion could be misinterpreted. Assessing suffering was another complex area. There's no standard guideline or measurement tool, and suffering is deeply subjective, which could confuse patients in the evaluation process. Practitioners had to dig deeper, asking about daily activities, joy, and quality of life to understand the full picture. This subjectivity, however, allowed some room to acknowledge other forms of suffering, including psychological, existential, and spiritual suffering. For some practitioners, this subjectivity was seen as a positive point, allowing patients to determine whether and how they were suffering. Experienced clinicians were often better equipped to do this and acknowledged that assisted dying involves a steep learning curve for junior practitioners. And then there's the stigma. In smaller communities, some practitioners feared backlash from colleagues, neighbours, and even family. Many kept their involvement quiet, worried about judgment or misunderstanding. For some, this secrecy added another layer of emotional strain to an already demanding role and limited their ability to seek support. Finally, we must acknowledge the logistical burden. Most assisted dying practitioners were, and still are, doing this work on top of their regular duties, after hours, on weekends, driven by compassion rather than compensation. Their dedication was extraordinary, but it may not be sustainable without better support. What comes next This study was just the beginning. It gave us a snapshot of the early days, a time of uncertainty, courage, and profound human connection. Since then, some challenges have been addressed, which is encouraging. But others remain, and we must keep listening, learning, and evolving. Assisted dying is not just a legal or medical service; it's a deeply human one. If we want it to succeed, we need to support the people who make it possible. That means clearer guidelines, better training, more public awareness, and a culture that values openness over silence. We are proud of this research and grateful to the practitioners who shared their stories and experiences. Their voices are essential. They remind us that behind every policy is a person and behind every person is a story worth telling.
RNZ News
12 hours ago
- RNZ News
'Silent crisis': Asian people missing out on mental health support
Asian Family Services commissioned the mental health and well-being report. Photo: 123RF Asian people in Christchurch are missing out on mental health support because of language and cultural barriers, as part of a "silent crisis" of worsening national statistics, community leaders say. A mental health and well-being report commissioned by Asian Family Services published in July found that 57 percent of respondents were at risk of depression , which was a 12 percent increase on the figure reported in 2021. Asian Family Services chief executive Kelly Feng said 69 percent of Korean respondents and 63 percent of Indians showed signs of depression, while life satisfaction among all Asians had fallen by 11 percent since 2021. "These findings point to a silent crisis," she said. "Asian communities are navigating mental health challenges, discrimination, disconnection, often without adequate support. We urgently need culturally responsive interventions in schools, workplaces and healthcare settings." Kelly Feng Photo: RNZ / Yiting Lin Asian Community Transformation Trust founder Allen Hou said people's struggles were compounded by a lack of bilingual mental health professionals in Christchurch. Canterbury's Asian population had grown by 30 percent since 2018, but support services lagged behind other regions, he said. "Even if people have that knowledge and want to access help, that's when they face the common challenges we know of language and culture - 'I can't speak my heart language to describe my issues and my emotions and therefore I can't engage and utilise this service fully'," he said. Hou estimated there were only a handful of mental health professionals in Christchurch who spoke Asian languages. "We're doing our best to advocate for the community about the needs and encourage them to consider that as a career path even for their children. We try to meet with counselling students who are Asians and just encourage them in this space," he said. Allen Hou from Asian Community Transformation Trust. Photo: RNZ / Anna Sargent Hou founded the Christchurch-based charitable trust in 2021. The group works with organisations, schools and GP practices to help bridge service gaps. "Since we started we heard continuously from organisations in Christchurch that service people, council and other spaces that they've never come across an organisation like us. It makes us think we're onto something that no-one has been trying to meet in Christchurch," Hou said. Hou said stigma and shame around poor mental health remained strong in some Asian cultures. While Christchurch recorded the highest life satisfaction of any city in the report, Feng said it also reported higher than average barriers to accessing mental health services, echoing Hou's experience on the ground. Feng said calls to Asian Family Services' Asian Helpline had tripled since Covid-19, rising from about 3000 annually to about 10,000. The organisation's report was based on an online survey of 1016 Asian adults in May, funded by the Ethnic Communities Development Fund, which is administered by the Ministry for Ethnic Communities. The report was the third of its kind, with earlier versions published in 2020 and 2021 . Feng said discrimination remained a significant problem, with more than one in five people experiencing race-based bias. "Only 56.5 percent Asians felt like they were accepted by the community. It's really challenging for people feeling like they are just not part of the society," she said. Hou, who immigrated from Taiwan to New Zealand aged 11 in 1998, said moving countries was often stressful. "At my age the main struggle was language, the sense of being able to make friends and understanding what was happening at schools. For my parents it's different things like medical systems, for example in Taiwan where we're from we just go to hospital, but in New Zealand you have to find a GP and everything goes from there," he said. University of Auckland social and community health senior lecturer Dr Vartika Sharma said 75 percent of ethnic minority communities in New Zealand were born overseas. "They might've come from countries where mental health is still quite stigmatised so they don't have the vocabulary to talk about mental health. That all becomes quite challenging in terms of acknowledging it's a problem in the first place," she said. Sharma said a lack of high-quality data on the mental health of Asian and Middle Eastern, Latin American, and African women and girls in New Zealand also made it harder to design effective services. "It's a point of worry because it's a population that's expected to grow, and we don't want them to be invisible," she said. Stats NZ projections show Asians will make up about 26 percent of New Zealand's population by 2043, up from 16 percent in 2018. If it is an emergency and you feel like you or someone else is at risk, call 111. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
