Latest news with #LetitiaHarding
Scoop
10 hours ago
- Health
- Scoop
Heart Health Care System 'Verge Of Collapse' A Barometer Of Wider Public Hospital Verging
It has been said more than once that overcrowding in emergency departments is a barometer of how public hospitals as a whole are performing in Aotearoa New Zealand's health system. It has now emerged that another barometer is the rate of heart attack patients being treated within clinically accepted timeframes. According to a new Otago University report, Heart disease in Aotearoa: morbidity, mortality and service delivery, commissioned by cardiac advocacy charity Kia Manawanui Trust (the Trust), the rate of these patients not being treated within clinically appropriate timeframes is a massive one-half. While dramatic, this is not as surprising as one might think. New Zealand has just one-third the number of cardiologists it needs. It has led to the regrettably correct conclusion that the heart healthcare system is verging on collapse. Health journalists doing their job This scandal was well reported on 11 August by Radio New Zealand's health reporter Ruth Hill: Half of heart attack patients not treated within accepted timeframes. She quotes the Trust's Chief Executive Letitia Harding in a dramatic, but not overstating, manner observing that the findings exposed a system that was failing at every level. In her words: Heart care in New Zealand isn't just stretched – it's on the verge of collapse. We are failing in all aspects and it's costing New Zealanders their lives. TVNZ gave the report prominent coverage on 1News (11 August): Verge of collapse. Stuff journalist Nicholas Jones, like Ruth Hill, on the same day also gave a good outline of the report's findings: People are dying. Key Findings The reports key findings include: Life-threatening delays: Half of all heart-attack patients are not seen within internationally accepted timeframes. New Zealand has only a third of the cardiologists it should have. Māori and Pacific people hospitalised or die from heart disease more than a decade earlier, on average, than other New Zealanders. Heart disease costs the country's health system and economy $13.8 billion per year ($13 million in 2020). The biggest contributor is hospitalisations but also contributing are lost workdays, GP visits, prescriptions and mortality. [These are minimum costs as some other factors such as emergency department admission costs were not included in this analysis.] Regions with the highest death rates are Tairāwhitii, Lakes (Rotorua-Taupo), Whanganui, and Taranaki. They have the fewest cardiac specialists. Dr Sarah Fairley is a Wellington-based cardiologist. She is also the Trust's medical director. Her conclusion was that the findings by the Otago University study matched the experience of health professionals on the cardiac frontline. Cardiac workforce reality check Sometimes non-government organisations can be overly gentle and deferential in describing bad news such as this. However, the Trust does not pull its punches over the report's findings. It calls a spade a spade. This in the context of heart disease being the greatest cause of mortalities in New Zealand. It was responsible for one in five deaths and 5% of hospital admissions. The Trust is calling for immediate investment in public hospital cardiac care infrastructure – beds and equipment – and a national strategy to recruit and retain cardiology staff. This goes to the root of the 'verging collapse'. Drilling down further, in 2024 New Zealand had 173.2 full-time cardiologists (32.8 per million people). This is three times lower than the average (95 specialists per million) of all countries measured by the European Society of Cardiology. Contrasting the figures 32.8 and 95.0 speaks volumes. However, the cardiac workforce is not just medical specialists. The number of sonographers had dropped from 70.4 in 2013 to just 43.5 in 2024, despite the 17% population increase. Their ratio had nearly halved from 16 per million to 8.2 over the same period of time. Political reaction Health Minister Simeon Brown in response gave some acknowledgement to the report but passed the buck to Health New Zealand (Te Whatu Ora) as if its political leadership were not responsible in some way. He referred to it establishing a National Clinical Cardiac Network which is developing national standards and models of care. In fact, this network was established well over a decade ago when Tony Ryall was health minister (2008-14). The network did good innovative and collaborative work. But the vertical centralisation of the health system under Labour's Andrew Little meant that the network was brought under direct bureaucratic control thereby giving it less oxygen for its independent advice. A further dimension: clinical follow-ups Understandably the impression can be formed that the critical threshold for treatment is to have a first specialist assessment (FSA). In this context this is the assessment by a cardiologist of a patient's heart condition following a general practitioner referral for further investigation. Where, for whatever reason, treatment such as surgery was not consequentially scheduled after the FSA (including because further monitoring was considered more appropriate) a clinical follow-up would normally be scheduled within a clinically appropriate timeframe. In the mid to late 2010s, towards the end of my employment as Executive Director of the Association of Salaried Medical Specialists, I became aware of increasingly serious concerns of a range of medical specialists (not just cardiac) that these clinical follow-ups were being severely delayed As a result, their patients (including children) were facing increased health risks. This includes denial through excessive delay of access to treatment that might have improved these conditions. This was regardless of location – rural, regional or urban. Consequently, the powerful message given by Northland cardiologist and Trust Board member Dr Marcus Lee on Radio New Zealand's Midday Report (11 August) in an interview with Charlotte Cook, resonated strongly with me: Delayed clinical follow-ups. After pushing back on Minister Brown's use of statistics, Dr Lee referred to the downside negative effects on clinical follow-ups after patients' FSAs. The cause of these clinically unsafe delays is the sheer volume of FSAs which had to take priority. Coupled with severe workforce shortages, these patients were trapped in a vice. Consequently, for many, their health conditions worsened to the extent that those who might otherwise have been able to be treated could not be. In other words, they were denied access to necessary diagnosis and treatment. Moral injury Dr Lee also raised the issue of moral injury. In the context of healthcare it refers to the psychological, social and spiritual impact of events on health professionals who overwhelming hold strong ethical values over, for example, denial of timely access of patients to diagnosis and treatment. This includes when events are determined by factors beyond their control, particularly political (especially) and bureaucratic decision-making. In the context of Dr Lee's reference to moral injury it is the cardiologist that has to explain this situation to patients and families of the harm done by delayed diagnostic or treatment access even though it was not caused by him or his colleagues. Although responsibility rests with political and bureaucratic decision-makers they are not the ones who have to explain it to harmed patients and their families. Dr Lee made the point well that one consequence is the undermining of patient trust in him and his colleagues. The heart healthcare barometer and a 'wake up' call A standout observation by the above-mentioned cardiologist Dr Sarah Fairley really struck home with me. In her words: From inside the system, I can tell you that this report reflects what we see every day – a workforce stretched beyond safe limits, patients slipping through the cracks and no end in sight. While this comment was made in the context of the heart healthcare system, it also reads as a standalone comment for the whole public health system, regardless of branch of medicine or type of diagnosis and treatment. The verging collapse of the cardiac care system is a barometer of the public hospital system as a whole. Public hospitals across the health system are in all in this dire situation with differences being in degree, not kind. One only needs to read the latest travesty involving adult inpatient and related mental health services in Canterbury due to ineffective governance, understaffing and cumulative strain for a decade. This disaster was covered by Nadine Roberts in Stuff (12 August): Damming mental health report. Christopher Luxon's government can't be blamed for Aotearoa's deteriorating health system. While it has worsened under his watch, it is an inherited state of affairs. It goes back to the relative underfunding ('light austerity') of the National led government for much of the 2010s and the poor compounding health system stewardship of under the previous Labour led government whose solution was destructive restructuring through vertical centralisation. What characterised all three of these governments is their shared neglect of the severe medical specialist shortages that first became evident in the late 2000s. The last word should be left to the Trust's Chief Executive Letitia Harding. She said that the report should be 'a wake-up call for the government'. She nailed it in one. But it is equally a wake-up call for the government for the whole health system.
Scoop
2 days ago
- Health
- Scoop
New Report Reveals The Grim Reality Of Heart Healthcare In New Zealand
A damning new report has exposed deep flaws in New Zealand's heart healthcare system, where access to life-saving treatment often depends on luck, postcode, and ethnicity rather than clinical need. Commissioned by The Heart of Aotearoa - Kia Manawanui Trust and prepared by the University of Otago, the ' Heart disease in Aotearoa: morbidity, mortality, and service delivery' report reveals a system plagued by chronic under-resourcing, critical workforce shortages, and deadly inequities. Trust Chief Executive Ms Letitia Harding says the report lays bare a system that is failing at every level. "Heart care in New Zealand isn't just stretched - it's on the verge of collapse. "We are failing in all aspects, and it's costing New Zealanders their lives." Key findings from the report include: Life-threatening delays: Half of all heart attack patients aren't seen within internationally accepted timeframes. Alarming workforce shortage: New Zealand has only a third of the cardiologists it should have. Systemic inequality: Māori and Pacific people are hospitalised or die from heart disease more than a decade earlier, on average, than other New Zealanders. The financial burden: Heart disease costs the country's health system and economy $13.8 billion per year A postcode lottery for care: Regions with the highest death rates -Tairāwhiti, Lakes, Whanganui, and Taranaki - have the fewest cardiac specialists. The deadliest conditions: Heart disease accounts for 20% of all deaths in New Zealand. The five heart conditions responsible for the majority are: heart failure, atrial fibrillation and flutter (AFF), acute myocardial infarction (AMI), subsequent myocardial infarction and cardiomyopathy. Trust Medical Director Dr Sarah Fairley, who is also a Wellington-based cardiologist, says the findings match what frontline clinicians see every day. "From inside the system, I can tell you that this report reflects what we see every day: a workforce stretched beyond safe limits, patients slipping through the cracks, and no end in sight." Ms Harding says this report should be a wake-up call for the Government. The Heart of Aotearoa - Kia Manawanui Trust is calling for an urgent government response, including immediate investment in public hospital cardiac care infrastructure - beds and equipment - and a national strategy to recruit and retain cardiology staff.
Otago Daily Times
2 days ago
- Health
- Otago Daily Times
NZ's failing heart care 'on the verge of collapse'
New Zealand has only a third of the cardiologists it should have. Half of all heart attack patients are not being treated within accepted timeframes in New Zealand, which has just a third of the cardiologists it needs, according to a new University of Otago report commissioned by cardiac advocacy charity Kia Manawanui Trust. For the first time, the total cost of heart disease to the New Zealand economy has been calculated at an estimated $13.8 billion a year. Trust chief executive Letitia Harding said the findings exposed a system that was failing at every level. "Heart care in New Zealand isn't just stretched - it's on the verge of collapse," she said. "We are failing in all aspects and it's costing New Zealanders their lives." Key findings from the Heart disease in Aotearoa: morbidity, mortality and service delivery report include: Life-threatening delays: Half of all heart-attack patients are not seen within internationally accepted timeframes Workforce shortage: New Zealand has only a third of the cardiologists it should have Māori and Pacific people hospitalised or die from heart disease more than a decade earlier, on average, than other New Zealanders Heart disease costs the country's health system and economy $13.8 billion per year Postcode lottery for care: Regions with the highest death rates - Tairāwhitii, Lakes, Whanganui, and Taranaki - have the fewest cardiac specialists Lucy Telfar-Barnard. Photo: University of Otago Wellington-based cardiologist and trust medical director Dr Sarah Fairley said the findings by Otago researcher Dr Lucy Telfar-Barnard matched the experience of front-line clinicians. "From inside the system, I can tell you that this report reflects what we see every day - a workforce stretched beyond safe limits, patients slipping through the cracks and no end in sight." Harding said the report should be "a wake-up call for the government". The trust is calling for immediate investment in public hospital cardiac care infrastructure - beds and equipment - and a national strategy to recruit and retain cardiology staff. The total cost of heart disease deaths in 2020 was $13.09b, from 74,708 life years lost. In 2024, New Zealand had 173.2 full-time cardiologists or 32.8 FTE per million people. That is three times lower than the average (95 specialists per million) of all countries measured by the European Society of Cardiology. Ministry data showed no cardiac staff at all in Wairarapa or Whanganui, no cardiologists or sonographers/cardiac physiologists in Lakes, West Coast or Souther Canterbury, and no cardiologists in Tairāwhiti. With 96.3 full-time cardiologists per million, Auckland was the only city with comparable number of specialists to European countries. Waikato (47.5 FTE per million) was half the European average, while others were much less, ranging from 21.4 to 27. The number of cardiology sonographers had dropped from 70.4 in 2013 to just 43.5 in 2024, despite the 17% population increase. The ratio of sonographers had nearly halved from 16 per million to 8.2. Heart disease was responsible for one in five deaths and five percent of hospital admissions. The cost of heart disease: Hospitalisations cost an estimated $538,790,541 a year Work days lost $17,996,766 GP visits $65,166,640 Prescriptions $61,906,660 Mortality $13,094,819,487 Total: $13,778,680,094 These were minimum costs, as they did not include the cost of emergency department visits, nor indirect costs of workdays lost to emergency department and outpatient visits, nor years lost to disability. In a statement, Health Minister Simeon Brown said the government expected Health New Zealand to have a continued focus on strengthening cardiac services nationwide. He said the report highlighted several key areas Health New Zealand must act on, including addressing regional variations in service quality and patient outcomes. "I have been advised that Health New Zealand has established a National Clinical Cardiac Network which is developing national standards and models of care, while also establishing dedicated work streams to ensure consistent, quality care. "This includes funding for new training positions for cardiac sonographers - a key workforce needed to bring down the echocardiogram waitlist."
Otago Daily Times
2 days ago
- Health
- Otago Daily Times
Heart care in NZ 'failing in all aspects'
New Zealand has only a third of the cardiologists it should have. Half of all heart attack patients are not being treated within accepted timeframes in New Zealand, which has just a third of the cardiologists it needs, according to a new University of Otago report commissioned by cardiac advocacy charity Kia Manawanui Trust. For the first time, the total cost of heart disease to the New Zealand economy has been calculated at an estimated $13.8 billion a year. Trust chief executive Letitia Harding said the findings exposed a system that was failing at every level. "Heart care in New Zealand isn't just stretched - it's on the verge of collapse," she said. "We are failing in all aspects and it's costing New Zealanders their lives." Key findings from the Heart disease in Aotearoa: morbidity, mortality and service delivery report include: Life-threatening delays: Half of all heart-attack patients are not seen within internationally accepted timeframes Workforce shortage: New Zealand has only a third of the cardiologists it should have Māori and Pacific people hospitalised or die from heart disease more than a decade earlier, on average, than other New Zealanders Heart disease costs the country's health system and economy $13.8 billion per year Postcode lottery for care: Regions with the highest death rates - Tairāwhitii, Lakes, Whanganui, and Taranaki - have the fewest cardiac specialists Lucy Telfar-Barnard. Photo: University of Otago Wellington-based cardiologist and trust medical director Dr Sarah Fairley said the findings by Otago researcher Dr Lucy Telfar-Barnard matched the experience of front-line clinicians. "From inside the system, I can tell you that this report reflects what we see every day - a workforce stretched beyond safe limits, patients slipping through the cracks and no end in sight." Harding said the report should be "a wake-up call for the government". The trust is calling for immediate investment in public hospital cardiac care infrastructure - beds and equipment - and a national strategy to recruit and retain cardiology staff. The total cost of heart disease deaths in 2020 was $13.09b, from 74,708 life years lost. In 2024, New Zealand had 173.2 full-time cardiologists or 32.8 FTE per million people. That is three times lower than the average (95 specialists per million) of all countries measured by the European Society of Cardiology. Ministry data showed no cardiac staff at all in Wairarapa or Whanganui, no cardiologists or sonographers/cardiac physiologists in Lakes, West Coast or Souther Canterbury, and no cardiologists in Tairāwhiti. With 96.3 full-time cardiologists per million, Auckland was the only city with comparable number of specialists to European countries. Waikato (47.5 FTE per million) was half the European average, while others were much less, ranging from 21.4 to 27. The number of cardiology sonographers had dropped from 70.4 in 2013 to just 43.5 in 2024, despite the 17% population increase. The ratio of sonographers had nearly halved from 16 per million to 8.2. Heart disease was responsible for one in five deaths and five percent of hospital admissions. The cost of heart disease: Hospitalisations cost an estimated $538,790,541 a year Work days lost $17,996,766 GP visits $65,166,640 Prescriptions $61,906,660 Mortality $13,094,819,487 Total: $13,778,680,094 These were minimum costs, as they did not include the cost of emergency department visits, nor indirect costs of workdays lost to emergency department and outpatient visits, nor years lost to disability. In a statement, Health Minister Simeon Brown said the government expected Health New Zealand to have a continued focus on strengthening cardiac services nationwide. He said the report highlighted several key areas Health New Zealand must act on, including addressing regional variations in service quality and patient outcomes. "I have been advised that Health New Zealand has established a National Clinical Cardiac Network which is developing national standards and models of care, while also establishing dedicated work streams to ensure consistent, quality care. "This includes funding for new training positions for cardiac sonographers - a key workforce needed to bring down the echocardiogram waitlist."
1News
2 days ago
- Health
- 1News
NZ heart healthcare system 'on verge of collapse', report warns
New Zealand's heart healthcare system has been described as having "deep flaws", "failing in all aspects", and being "on the verge of collapse" according to a damning new report. The Heart Disease in Aotearoa: Morbidity, Mortality, and Service Delivery report released this morning was commissioned by The Heart of Aotearoa – Kia Manawanui Trust and prepared by the University of Otago. It found that heart disease accounted for 5% of hospital admissions and 20% of deaths in New Zealand. Māori and Pacific people were disproportionately affected, dying on average a decade earlier than other ethnic groups. Around one-fifth of New Zealanders were currently taking heart-related medication. Another finding was that heart disease cost the country $13.8 billion annually, factoring in hospitalisations, prescriptions, primary care, premature deaths, and lost productivity. Heart disease accounted for 5% of hospital admissions and 20% of deaths in New Zealand. (Source: ADVERTISEMENT In 2024, Ministry of Health data showed New Zealand had 173.2 full-time cardiologists, or 32.8 per million, well below the European average of 95 per million. Auckland was the only region close to that benchmark. Several districts, including Tairāwhiti, Lakes, and Whanganui, had no cardiologists or cardiac staff at all according the Ministry data, but the Medical Council reported significantly higher numbers. "This contrasting data shows that the Ministry of Health is not tracking cardiac staffing levels accurately. It is therefore unclear how the Ministry of Health proposes to address cardiac staffing inadequacies when it is unaware of their extent," the report read. Kia Manawanui Trust chief executive Letitia Harding said the report pointed to a system under severe strain. "Heart care in New Zealand isn't just stretched, it's on the verge of collapse. We are failing on all aspects, and it's costing New Zealanders their lives." Māori and Pacific communities die ten years younger on average from heart disease than other ethnic groups. (Source: The trust's medical director Dr Sarah Fairley, a Wellington-based cardiologist, said the findings matched up with what frontline clinicians were seeing daily. ADVERTISEMENT "From inside the system, I can tell you that this report reflects what we see every day: a workforce stretched beyond safe limits, patients slipping through the cracks, and no end in sight." Recommendations from the report included urgent action and investment in cardiology staffing and infrastructure in the Midland and Central regions to ensure equitable access to care. It called for prioritising recruitment and retention of cardiac specialists in high-need areas, establishing a dedicated fund to train and employ 15 new cardiac sonographers annually, and requiring hospital bosses to promptly replace and advertise cardiac roles. The report also urged Health New Zealand to maintain a national record of cardiac staff and expand bed capacity in tertiary hospitals to reduce treatment delays. Health NZ committed to equitable cardiac service In response to the report's findings, Health NZ cardiac network co-lead Cara Wasywich said the organisation was committed to equitable access to cardiac services for all New Zealanders regardless of where they lived. "We accept that levels of heart disease hospitalisation and mortality rates vary in some parts of the country, which is why the National Clinical Cardiac Network was set up. ADVERTISEMENT "The Network is focussed on addressing variations in service quality and patient outcomes, by developing national standards and models of care, as well as establishing dedicated work streams to ensure consistent, quality care." Health NZ acknowledged growing its senior doctor and specialist doctor workforce could be a challenge in some areas and specialities. "Health New Zealand remains committed to retaining and growing our permanent medical workforce."
