Latest news with #RuthHill
Scoop
15 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.
RNZ News
2 days ago
- Health
- RNZ News
Chronic under-resourcing of cardiac care costing lives
Heart disease is costing the country nearly $14 billion a year in direct costs to the health system and early deaths of one in five New Zealanders. That was the stark analysis from Otago University research, which shows chronic under-resourcing of cardiac care is costing lives. Ruth Hill reports. And for more, Health New Zealand's Chief Clinical Officer, Richard Sullivan spoke to Lisa Owen. Tags: To embed this content on your own webpage, cut and paste the following: See terms of use.
Otago Daily Times
14-07-2025
- Health
- Otago Daily Times
Vaccine hesitancy growing in at-risk communities
By Ruth Hill of RNZ A growing number of families living in communities most vulnerable to infectious disease outbreaks are refusing to have their children vaccinated. Immunisation experts fear this worrying trend will make it impossible to reach the government's target of 95 percent coverage by 2030. At Ngā Mataapuna Oranga primary health organisation in Western Bay of Plenty, health workers are not passively waiting for whānau to bring their babies in for vaccination. A manager and kaiwhakahaere, Jackie Davis, said it had managed to boost immunisation rates by 10 percent in the last year through the heroic efforts of nurses, community workers and GPs. "[We've even had] community teams lurking in bushes, waiting to ambush mums coming home from shopping," she said wryly. In a league table of primary health organisations (PHOs) published by Health NZ, Ngā Mataapuna Oranga has the highest decline rate, with 25 percent of families refusing immunisation. As a small PHO, with just four general practices, it only took a handful of families to decline immunisation to drop its rates below target, Davis pointed out. However, she admitted it was up against persistent anti-vaccination propaganda, which spread like contagion via social media. "I guess their promotion is just as good as our promotions are, so they counter a lot of the work we do." Nationally, 79.3 percent of two-year-olds were fully vaccinated in the first three months of the year - marginally better than at the same time last year. In some regions however, rates were much lower: Northland had just 66.4 percent coverage, while in Tairāwhiti and Bay of Plenty, it was around 68 percent . Davis said the Covid pandemic damaged trust in the health system and it was taking time to rebuild those relationships. "I think too that we have to balance our attempts at immunisation in relation to our relationships with our families. "To put it bluntly, sometimes we're going two or three times to the same families. And at the end of the day, from their perspective, they're over us." Decline rates threaten 95 percent target - expert Infectious disease expert professor Peter McIntyre, from Otago University, said before Covid, decline rates for childhood immunisation were around 5 percent. However, for about one in three PHOs in those Health NZ figures, the decline rate was now more than 10 percent. "This substantial increase in the proportion of families declining, effectively makes that impossible." Unfortunately, vaccine distrust had got a stronger hold among Māori and Pacific communities, which already had more "delayed" immunisations, he said. "What the decline figures are telling is that these are people who are indicating they just don't intend to get their child immunised full stop, which is a development that's really worrying, because decline is a whole lot worse than delay." Full coverage remained a worthy goal, he said. "But if we really have to choose - which maybe at this stage we do - we want to focus on: How good is our protection against measles? What's that looking like? What do we have to do about it? And maybe whooping cough as well. And meningococcal B." More younger parents and caregivers vaccine sceptical Ngāti Porou Oranga in Tairāwhiti recorded the lowest coverage with just 38.5 percent of two-year-olds fully vaccinated in the first three months of the year. No-one from the PHO was available to comment. Eastern Bay Primary Health Alliance in Bay of Plenty said its figures had improved: 58.4 percent of enrolled tamariki were fully immunised as of 1 July, up from 52.5 percent in the previous quarter. Chief executive Katarina Gordon said however it was also seeing a growing number of whānau "expressing hesitancy or choosing to decline immunisation". "We're seeing a steady increase in vaccine hesitancy particularly among younger parents and caregivers. "Some are actively declining, but many are simply unsure or misinformed. Social media misinformation, past experiences of the health system, and general mistrust all contribute to this hesitancy." Many whānau were living in rural or remote areas, with limited access to transport, housing instability and economic hardship, which meant day-to-day needs often took priority over preventive healthcare like immunisations, she said. Health providers were struggling themselves with limited clinic availability, workforce shortages (especially nurses and outreach staff) and high demand, which meant some whānau faced long wait times or limited options for appointments. "Mobile outreach services help, but capacity is stretched, and funding is not always available and or sustainable." Despite these challenges, Eastern Bay Primary Health Alliance continued to work with its practice network, outreach teams, Hauora Māori partners the National Public Health Service and Te Whatu Ora Health NZ to boost immunisation rates. "We remain committed to ensuring all interactions with whānau are timely, respectful, and culturally safe."
RNZ News
10-07-2025
- Health
- RNZ News
Health experts claim Regulatory Standards Bill will undermine public health system
health politics 33 minutes ago 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.
Scoop
09-07-2025
- Health
- Scoop
‘Slash And Burn' Increases Poor Health System Decision-Making: Witness Maternity And Gynaecology
In Aotearoa New Zealand's health system there are 36 branches of vocational (specialist) medicine registered by the Medical Council. These are called 'scopes of practice' which allow doctors to work independently of supervision (doctors with general scopes of practice require some form of supervision). Overwhelmingly these specialities have one or two names such as 'dermatology', 'general practice' and 'orthopaedic surgery'. Consequently, a speciality with 'and' between two words is unusual. Obstetrics and gynaecology (usually referred to as O&G) is an 'unusual'. They are somewhat like twins or close cousins. Whereas the former is obviously about birth, the latter involves the treatment of women's diseases, especially those of female reproductive organs. 'Slash and burn' strategy Like almost all the other vocational scopes of practice, O&G suffers from a crisis of severe workforce shortages due the political neglect of successive governments. Cutting maternity beds at Wellington Hospital is part of a wider 'slash and burn' strategy led by Health New Zealand (Te Whatu Ora) Commissioner Lester Levy over the past 12 months. I have discussed this strategy previously in the context of health IT (15 December): Slash and burn health IT strategy. I have also discussed it in the context of gutting specialised health teams (22 January): Gutting specialised health teams. The maternity service crisis is national, not just local. By way of example, Hawke's Bay Today (8 July) reported that more than 900 women in Hawke's Bay are waiting to see a gynaecologist, many of them facing 'unbearable pain': 900+ Hawke's Bay women suffering unbearable pain. 'Slash and burn' leads to poor decision-making On 7 July a story by health journalist Ruth Hill on Radio New Zealand's Morning Report revealed a shocking new development: Cutting maternity and gynaecology beds in Wellington Hospital. Health New Zealand was planning to cut beds from its gynaecology and maternity wards in Wellington Hospital in a trial aimed at making more room for patients from its overcrowded emergency department. While management claimed that the maternity wards often had empty beds, those with the experience and expertise to know more (O&G specialists and midwives) disputed this. Instead, they feared there would be huge pressure to discharge mothers and newborns too quickly. The Midwives Union MERAS (Midwifery Employee Representation and Advisory Service) Co-Leader Caroline Conroy said Wellington Hospital's maternity unit was 'one of the busiest in the country'. Further: The monthly stats we get at staffing meetings show the bed utilisation is over 100%. So it's a really busy unit. She also made another interesting observation with her suspicion that the Government's health targets for emergency wait times and elective surgery were squeezing capacity elsewhere. This is one of the problems when they set targets, and we've seen this in the past – when the focus and funding goes on those targets, and other services are not given priority. O&G specialists college slates maternity bed cuts Meanwhile Royal Australian New Zealand College of Obstetrician and Gynaecologists vice president Dr Susan Fleming said, in the above-mentioned Ruth Hill piece, a further squeeze on maternity resourcing was disturbing. Demand in obstetrics is not predictable. Even 'elective' procedures like caesareans are not truly elective. You can push them back hours or even days sometimes, but you don't have a lot of flexibility. When there's a peak of demand around acute presentations in labour and a demand for inductions and caesarean sections, then there's no flex capacity, and then the only thing you have is to discharge women from the post-natal wards early. Further: …my understanding is that most maternity units across New Zealand are still struggling with midwifery resourcing, and particularly with the smaller units, with obstetric resourcing. The following day (8 July) Morning Report covered further staff distress over the maternity bed cuts: Maternity staff beg Health NZ not to cut beds. Inglorious backdown Former British Labour Prime Minister Harold Wilson is known for several 'pearls of wisdom'. One which is often repeated is that a week is a long time in politics. This is equally so with health systems; sometimes only a couple of days. By late 8 July Health New Zealand was reporting a complete backdown by reversing its decision to cut maternity beds. This was covered the following day by Morning Report: Backdown. Also see later in the programme the item by senior reporter Natalie Akoorie: Senior doctors welcome U-turn. This backdown was a huge embarrassment for the national health bureaucracy statutorily responsible for Aotearoa's planning and provision of healthcare. Rather than management on the ground, however, prime responsibility rests with the poor political leadership of the health system by the current and previous governments. This was reinforced by Commissioner Levy's destabilising 'slash and burn' strategy coupled with Health Minister Simeon Brown's simplistic soundbite advocacy. Take-home points Health New Zealand was created in 2022 by an unwanted restructuring and has been internally restructured ever since. Instability and all that consequentially follows have been the inevitable outcome. A big part of this outcome was the large loss of experienced senior and middle level health managers with operational experience. These managers often had a health professional background. It is highly likely that those managers responsible for the decision to cut the maternity beds had much less experience and insight over the risks than those employed by the former Capital & Coast District Health Board before its disestablishment on 1 July 2022. The short-lived but distressing bed-cutting decision demonstrates a failure to recognise where relevant expertise and experience resides. At the point when the idea of cutting maternity beds arose there should have been immediate engagement with O&G specialists and midwives over the implications and risks. Further, having received their advice, they should have heeded it. The final take-home point is the importance of voice in healthcare. I have previously discussed this importance in BusinessDesk (6 September 2022): Healthcare accessibility depends on health professional voice. It was the voice of the midwives and O&G specialists (and their unions, MERAS and Association of Salaried Medical Specialists, plus the O&G professional college) along with good reporting by Radio New Zealand that forced the backdown. Nothing more and nothing less! 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.
