Bullying Rife in NZ Hospitals

The NZDoctor.co.nz website reported today on last night’s Wellington medical forum on the subject of burnout in the medical profession.

Experts said that doctors in New Zealand aren’t good at giving each other the support and affirmation needed to avoid burnout. Furthermore, hospitals are rife with bullying

Hospitals rife with bullying
“A bullying culture exists at hospitals, said forum chair John Carter, clinical leader of haematology at the Wellington Blood and Cancer Centre…
Attendees at the forum, part of the Inaugural International Cancer Symposium organised by Otago University, Wellington, heard psychiatrist and academic John Adams emphasise the medical profession’s poor record of giving mutual support and feedback.
This is an important factor in burnout, says Dr Adams, chair of the Medical Council.
By the time doctors come to the council’s attention, when their behaviour is affecting other staff and patient care, stress and burnout have led to physical health problems.
Depressive symptoms, anxiety, sleep disorders and/or substance abuse will have developed, and a stigma is attached to seeking help, Dr Adams says.
The earlier the problem is identified, the more likely its impact on the individual will be ameliorated…”  read the full report here

Which is ironic considering that New Zealand’s laid back lifestyle is used as a major selling point to attract overseas doctors into the country.

New Zealand has been suffering a severe shortage of medical specialists for some time.

Coincidentally The NZ Herald published an article today headed Doctor shortage reaches ‘crisis’ level, saying that a spiraling shortage of doctors “has sparked a warning of future “severe safety issues” in New Zealand hospitals.”

Association of Salaried Medical Specialists director Ian Powell told the paper that the flow of New Zealand doctors overseas and difficulty of replacing them had put many hospitals in crisis.

Patients could suffer from increasing medical mistakes and treatment delays without urgent action, he said.
“The situation is already unsustainable. We’ll have severe safety issues if this continues.
“New Zealand is losing too many of the younger doctors we train so well overseas, losing too many of our current public hospital senior doctors overseas and struggling to recruit in a very tight and internationally competitive market.
“Eventually these chinks are going to get so big that the system breaks down.” … read the full report here

Some things you may like to know about the health service in New Zealand:


Understaffing

• There is a workforce crisis in New Zealand’s hospitals. Specialist senior doctors are being lost and there is a shortage of cancer specialists. Staff are lost to Australia (where the salaries are 35% higher) and to private practice. The causes are low pay by international standards, overwork and lack of resources to do the job.

• New Zealand has an estimated shortage of around 600 specialists and that’s set to get worse, according to the Association of Salaried Medical Specialists. Growth has not kept pace with increasing need in an aging population.

• The senior doctor’s union estimates there is a shortage of 638 medical and surgical specialists and that having to treat too many patients is driving doctors away from NZ. The country “needs at least 1100 more specialists if it were to match the number per head of population in Australia, the union says in a discussion paper based on data from 2007 and 2008.” Source NZ Herald.

• New Zealand’s has a high dependence on overseas-trained doctors, the highest in the OECD , who comprise 40% of specialists. In some areas, such as psychiatry, the figure is closer to 60%.

• So many NZ trained registrars go overseas when they’re qualified that it’s hardly worth training them at all. Medical registrars can earn around $70,000 more in Australia and  difference in salaries is one of the major drivers for the exodus. “The situation is a crisis and a crisis generally comes before a collapse” -says Association of Salaried Medical Specialists executive director Ian Powell.  See the bullet point above for the other drivers.

But its not just the medical profession that are suffering in New Zealand, patients are doing it hard too:

Adverse Effects on Patient Health

• A shortage of Oncologists in the central part of the North Island means that some cancer patients are being refused chemotherapy. Instead of being placed back on waiting lists patients are being referred back to their own doctors (as of Jan 2011) Affected patients include those suffering relapses of some cancers, including cervical, oesophagus and melanoma.

• The Chief Exec of the NZ Cancer Society said

“It might not be what we want to hear, but it is honest … It is good to know they will not be hiding patients on waiting lists.”

But the list of cancers that won’t be treated had only been intended for clinicians to see, not the general public.

• Cancer treatment services are under such pressure that current treatment levels are unsustainable unless more money is spent. Rationing is likely to “become a feature.”

• An economist said that New Zealand’s cancer-treatment rates were lower than the average for developed countries.”Already we have unmet need, so I guess the message is, get used to it.”

• 261 people in Canterbury are waiting more than six months for cancer-detecting colonoscopies, raising alarm among doctors. In July 2009 the figure stood at 75 people. A private procedure costs £1,000.

• A “postcode lottery” health system is failing people as there is “inequitable” access to treatment depending on where patients live. One woman failed to have a brain tumour diagnosed for over three years. A report into her case has highlighted serious deficiencies within NZ’s public health service.

• Hospital errors causing serious harm are rising. In the year to June 2010 there were

“374 patients who were involved in a serious or sentinel event, of whom 127 died; compared with 308 events, including 92 deaths, the year before.”

Migrants Tales

Are you still considering a move to NZ to work in the medical profession? Read some of our Migrants Tales, for example this one
“The Health Care System Is Second Rate”

This story was written by a nurse with over 30 years of experience. In it she tells of prejudice and how difficult it was to find a job. She also talks about how thousands and thousands of health care dollars are being wasted because there is no incentive to change and of how people wait so long for some tests and treatments that permanent damage is done to their health. She is minded to stay and work through this but her Kiwi partner is starting to look toward Australia to make some money….read on

You may also find interesting:  “Kiwis Missing Out On Vital Medicines with Fatal Consequences”


Today's posts - click here

New Zealand Health Service Plummets in Ratings

New Zealand has moved from first to fifth place in international health rankings of seven countries, carried out by the Commonwealth Fund (click table above to enlarge)

The slide is  due mostly to issues of access, high costs preventing people from visiting doctors or filling prescriptions, safety and management of chronic illness and New Zealanders being the patients most likely to get an infection whilst in hospital. They were also in the bottom three for medication errors and being the victim of a medical mistake.

Interestingly, it was ranked last for the percentage of money spent on health administration and insurance. According to Stuff:

Labour health spokeswoman Ruth Dyson said the fall was “devastating”.
New Zealanders had worked hard to get an excellent healthcare system and were now “just watching [it] slip away”.
Government contracts held by district health boards for community-based management of chronic conditions had been cut around the country, she said.
The high infection rates were a surprise, but could be the flow-on effect of Government “penny pinching”.
It was disappointing New Zealanders were still struggling to access primary healthcare as it was crucial to early treatment and keeping people out of hospital, she said…”

Per head Australians spent US$3,357 on helathcare, Canadians US$3,895, Germans US$3,588, the Netherlands US$3,837 and Britons spent US$2,992 on health in 2007. New Zealand spent the least at US$2,454.

We can’t say that we are surprised by New Zealand’s poor showing and this is why:

New Zealand has a workforce crisis in its hospitals with specialist senior doctors being lost, there is also a shortage of cancer specialists, paediatric surgeons  and radiologists and when doctors and specialists speak out about their concerns over patient safety they are censured, most of them simply resign rather than take the flack for being a whistle blower.

The average medical student in New Zealand finishes training with a debt of $75,000, forcing many of them overseas soon after graduating. Australia is their most likely destination. But money isn’t the only factor making them leave. One study found that  just 25% of students believed they would be valued as employees by hospital management or the Government, something that affects their long term commitment to their country and has implications for specialist training.

261 people in Canterbury are waiting more than six months for cancer-detecting colonoscopies, raising alarm among doctors. In July 2009 the figure stood at 75 people. A private procedure costs £1,000.

The Health Ministry is allegedly among the worst performing government departments. According to a report card ranking state agencies and bosses excessive red tape, bureaucratic systems and ineffective consultation hampering  a number of government departments. It placed the Health Ministry bottom for value for money overall, and said it was “struggling“ and

“really confused, with too many sections not knowing what others are doing, and doing stuff without consultation in the affected communities.”

Disgust at the plight of one hospital -Hawera – has inspired a well-placed business analyst to blow the whistle on what he sees as millions of dollars worth of financial inefficiencies and loss at the deficit-plagued Taranaki District Health Board.

Paul Anwyll left his job as a business analyst at the TDHB’s Management of Information Unit…citing “weak leadership and poor management” as reasons in his letter of resignation. An experienced auditor, the Englishman said he had identified financial problems and loss but the TDHB had refused to consider his proposal of a test study that could potentially save them millions.”

Pharmac doesn’t allow New Zealanders to access new medicines for five to 10 years after they are widely used elsewhere in the world. It  waits until they are generic until they are widely used. The system keeps prices down for the Government but is criticised for restricting drug choices and delaying the arrival of some new medicines.

There was a 50% rise in complaints against pharmacists in the year to June 2009 , including 5 pharmacists who were convicted of crimes. Similar sounding and look-alike medications are ‘to blame’ for the rise. City Health Pharmacy in Palmerston North was fined $10,000 in 2008 after six drug dispensing mistakes in two years, including giving a two-year-old an anti-psychotic drug instead of cough medicine; it’s still in business. There is no compulsory bar-coding of drugs.

For a first hand account of what it’s like to work in New Zealand’s health service you may wish to read our Migrant Tale  “The Health Care System is Second Rate.” Written by a nurse with over 30 years experience, she talks about resistance to change and the wastage of thousands of dollars because there is no incentive to change things.

At the time nurses in Nelson were speaking out about horrific workloads that were causing many to resign. Nurses went public because of a lack of action when they raised their concerns with the New Zealand Nurses Organisation and hospital managers.

For more read our Health and Death page on Wordpress.

One reader of the blog left the following comment for us a week ago, if health care in New Zealand matters to you you may wish to read Gareth Morgan’s book -see a report on it here

I would like to mention that gareth morgan has a book about the nz health care system that anyone migrating for the health care ought to read, seriously.
Health Cheque: The Truth about NZ’s Health System it is called
It’s a frank book that discusses the problems with the way they rationalise care in which he states a theory that the high quality of the doctors and nurses are the only thing holding the system together.
Yet New Zealand has the highest percent of migrant doctors in the OECD, a staggering 52%
http://hpm.org/en/Surveys/The_University_of_Auckland_-_New_Zealand/15/Strategies_to_overcome_workforce_shortages.html
says in the review this book that:
“The New Zealand health workforce is under pressure from a number of sources. In addition to those problems that are shared by other countries – such as an increase in the proportion of part-time workers due to the feminisation of the workforce, increased demand for health services, and the aging of the health workforce – New Zealand faces major challenges from the internationalisation of health workers. It has the highest percentage of migrant doctors among OECD countries (52 percent compared with an OECD average of 36 percent) and one of the highest for nurses (OECD, 2008). **It also has one of the highest rates of outward migration of health workers. Four years after graduating, around 25 percent of NZ trained doctors are no longer registered in New Zealand and the loss increases to around one third after 9 years.**”
The doctors and nurses seem to mostly be british people who are outdoorsy migrants, or locum americans taking a working vacation, or political or crime refugess who could not get into other countries such as oz or canada. The kiwis just bugger off out of their own country and people from countries where the native language is not English are often only offered less responsible positions, in caregiving and cleaning.

The National led government has recently announced that it will be putting further pressure on the health service by giving employers the authority to make workers obtain GP sickness certificates for a single day’s sick leave from work.

“General Practice New Zealand chairwoman Bev O’Keefe said the change could put pressure on medical centres.
“The issue for general practice is how we accommodate all those people who need to claim medical certificates because they will need to be seen and assessed which means they are going to impact on what is already the heavy workload of general practice. “One thing we are not happy to do is to furnish medical certificates without seeing people because that’s just hearsay.” Another issue was people may go to work ill.”

Today's posts - click here

Migrant Stories - "The Health Care System Is Second Rate" - Updated: "Horrific Workloads"

11 February 2010
Continuing in our series of Migrant Stories: first hand accounts of migrant life in New Zealand, taken from locations around the net.

This story was written by a nurse with over 30 years of experience. In it she tells of prejudice and how difficult it was to find a job. She also talks about how thousands and thousands of health care dollars are being wasted because there is no incentive to change and of how people wait so long for some tests and treatments that permanent damage is done to their health. She is minded to stay and work through this but her Kiwi partner is starting to look toward Australia to make some money.

"As a nurse in the US with over 3 decades of experience, I can tell you I had one helluva time trying to get registered to work as a nurse in this country. I have found there is prejudice here - even if you are skilled and willing to work, not coming here looking for a handout - just a JOB. (I lost track of the number of applications I filled out - to do ANYTHING - before I literally got lucky and got a job at a DHB hospital as a Health Care Assistant, which was a major stepping stone to getting the registration.)

My partner, a kiwi, was just as surprised (and disappointed) at the difficulty I had. I make a good living here, and it's because I do work hard. And, to be honest, I'm going through some not unexpected issues where I work - but in talking with other foreign (and young, less experienced) nurses, it seems to be the norm. So I am just biting my tongue and getting through it; I know enough to recognize it and I can deal with it. Some of it is because it's New Zealand, some of it is because it's nurses.

Another negative here - they are resistant to change moreso than anywhere I've ever seen. I worked in the health insurance industry for 10 years before I came here, and one of the things I looked for were areas where money was wasted. Here, I can see thousands and thousands of health care dollars wasted because there is no incentive to change things. And they do some things here the same way we did them in US hospitals when I was a student nurse. And since residents here see health care as "free", they really don't care. And they don't realize the health care system is second rate. Yep, I said it and I really believe it. I see things every day that scare the hell out of me. People have to wait days for some tests and treatments that would be done in a matter of hours in the US. By then, permanent damage has been done. But, oh well, that's just the way it is.

The saddest thing is, I believe New Zealand, because it IS a small country, has the potential to be a world leader in health care. Too bad it will never happen, because nothing will change unless there is a catastrophe that makes it absolutely necessary and without option.

My life here is simpler, and I do delight in the small things - like seeing the covey of quail cross the road when I'm on my way to work in the morning, or seeing gorgeous flowers in bloom, or just simply the ever changing scenery (which at the moment is pretty brown and crispy.) So, I'm staying, even though I know my partner is starting to get the itch to go back to Oz and make some money. He has been looking for a job for several months. So, yeah, even if you have experience and education, that doesn't mean smooth sailing as far as getting a job here.

Excuse me, though, as I must put on my rose-colored glasses and go sit in the sun. (First applying sunscreen so I don't develop skin cancer!)"

Doctors and Nurses Notes
There is a workforce crisis in New Zealand's hospitals. Specialist senior doctors are being lost and there is a shortage of cancer specialists. Staff are lost to Australia (where the salaries are 35% higher) and to private practice. The causes are: low pay by international standards, overwork and lack of resources to do the job.

In 2008 The College of Nurses, Aotearoa, NZ Inc. advised the incoming government of the following problems:

*"Unmanageable workloads and limited job satisfaction through inability to maintain professional standards of care deter people from remaining in the nursing profession. Most nurses graduate with high levels of debt and emigration is seen as a sensible option for many who face many years of debt repayment in New Zealand.  Currently 23% of the NZ nursing workforce is imported, often from countries which can ill afford to lose nurses.

* The many innovations and initiatives that nursing has striven for (such as establishment of the Nurse Practitioner role and increased nursing services in PHOs) are consistently slowed, impeded or blocked at health policy level.

* The magnet hospital movement is a strongly evidence based solution to patient safety and nurse workforce recruitment and retention. It remains largely ignored in NZ despite vigorous efforts by nursing to see it promoted.

* A larger Maori nursing workforce is needed to provide services to Maori"

See also an article in The Nelson Mail, 6 March 2010: "Nurses fear cutbacks put lives at risk" :

" The Nelson Marlborough District Health Board has been told by Health Minister Tony Ryall to stop spending so much money because of its worsening deficit, but nurses are saying the constraints are putting patients' lives at risk.

Nurses who expressed concerns over these risks are too scared to be named for fear of losing their jobs...


...(A) nurse said sometimes there were only two or three nurses on an afternoon shift for a full ward of 30 patients and one house surgeon for the whole hospital. "Concerns have been raised through the appropriate channels and nothing gets done about it," she said.

A third nurse, who left her job because of the stress, ended up hating nursing. "You leave there feeling like you haven't done your job."

There was a culture of bullying and a "sit down and be quiet culture" at the hospital, she said."

Updated 11 March 2010: The Nelson Mail
"Nelson nurses tell of 'horrific workloads'"

"...One nurse, who said she sought counselling after months of stressful shifts, ended up resigning. She said six other nurses had also left their jobs at the ward she worked in since September last year and most were not being replaced.

The woman, who wants to remain anonymous, said she was speaking out because she believed it was important to battle for patient and nurse safety. She believed nurses needed a lawyer to work in their defence because of a lack of action over their concerns from the New Zealand Nurses Organisation and hospital managers. Letters shown to The Nelson Mail outline a detailed complaint she made to senior management, including the director of nursing, last year.  In the letter, the nurse points to a shift last winter which prompted nurses to file an incident form.

It was one of the "many horrific shifts" she had to work. There were four nurses when six should have been on with six admissions, a cardiac arrest and a death. She had no meal break and each nurse had seven to eight patients as well as a student to oversee...

SPEAKING OUT

Former Nelson Hospital nurse: "As nurses we expect the odd busy horrible shift, but this becomes an ethical dilemma when the majority of shifts are like this."

"Lives have already been put at risk, with deaths occurring."

"The environment at this hospital is already at crisis point, with staff leaving and patient deaths. How the hell are staff going to cope with cutbacks if the environment has already been so badly affected in the past few years? The winter will be a nightmare from hell."

Current nurse: "Maternity staff have been leaving in droves over the past 18 months and there has been a policy not to replace them."

See also:

Radiographers strike could threaten hospital treatment 

Residents of Queenstown are getting only about half the health services of similar sized centres in Otago and Southland

Director General of Health to 'stand down'



Today's posts - click here

Another Pregnant Woman Told To Leave New Zealand: Pregnancy Now Equated To Sickness In Human Rights Abuse

Another pregnant woman, Virginie Breuzard (photo above) has been told to leave New Zealand. Earlier in the year a number of other women were also told to leave, among them Sun Won Kim and Jurga Skiauteris who would not be allowed to have their babies in NZ, even though the latter had complications that would've made travelling dangerous for her. After the press got hold of their stories the government backtracked and allowed them to stay.

Human Rights Abuses
The Human Rights Act 1993 prohibits "discrimination due to pregnancy", but there is a specific provision to exempt immigration matters. But within the International Covenant on Civil and Political Rights are provisions for protection based on gender. If throwing out a woman because she's pregnant isn't a contravention of that what is - is the 1993 Act contrary to international conventions?
According to Kerry Williamson in the Dominion Post:

"Virginie Breuzard will be forced to return to France in three weeks, have her baby in her home country, then return to Nelson to finish her studies.

She feels she is being discriminated against because she is not sick – just pregnant. "I'm not sick, not at all. It's because I am pregnant that they are kicking me out."

Ms Breuzard, 28, came to New Zealand in September to complete an NZQA-registered aromatherapy course in Nelson, the only one of its kind available in the Asia-Pacific region, after a year of distance learning from Indonesia, where her husband ran a company.

She admits she was pregnant when she arrived in the country on a visitor's visa, but was unaware that it would be a problem. As part of her application to Immigration New Zealand, she sent a letter from her insurer and Nelson Hospital stating that her medical costs would be met.

Her school, Aromaflex, also wrote to Immigration telling them she needed to be in the country for six months to complete the course and sit an exam.

Seven weeks later, Immigration wrote telling her she had been refused a study visa because she did not meet health requirements and that she would need to leave the country to give birth. Ms Breuzard must leave by November 24, because doctors say she should not fly after that due to her pregnancy.

"I'm very angry," she said. "And because I've told the truth about being pregnant, they are kicking me out. They have told me, `You give birth somewhere else and then you come back.' It's discrimination."

The Immigration website states pregnant visitors to New Zealand "are not considered to have an acceptable standard of health as it is likely you will impose significant costs and demands on New Zealand's health services."

An Immigration spokesman said that whether a person had health insurance was irrelevant, and that the policy was in place to limit demand on hospitals.

"Aligned to this there have been regional shortages of antenatal care in New Zealand in recent years."

Are the provisions for ante natal care really so tight that even privately funded births can't be accommodated? and what about the thousands of New Zealand women who give birth every year in countries overseas, thereby relieving pressure on their own health service? What would happen if they were all sent home?

I'm sure that in an ideal situation Ms Breuzard would far prefer to have her baby in France but had made the trip to New Zealand to study a very specialised course, her baby won't have NZ citizenship either so there's probably no 'agenda' here, there appears to have been no intention to deceive on her part.

It's time to improve the maternity provision for all women in New Zealand if it hasn't even got the capacity to accommodate privately funded women such as Ms Breuzard.

See also:
Pregnant women ordered out of New Zealand 

NZ Human Rights Record Under UN Microscope


Today's posts - click here

Pregnant Lithuanian Tourist, INZ Still Getting It Wrong

Following numerous news stories this morning about the INZ forcing a Lithuanian Tourist to leave NZ despite complications from a high risk pregnancy (see Another pregnant woman kicked out ) Jonathan Coleman, Immigration minister, has had to react swiftly to limit further damage to the bruised and battered reputation of INZ.

INZ wrote to Mrs Skiauteris saying "As you no longer hold a valid permit, you must arrange to leave New Zealand immediately. If you do not leave, Immigration NZ may take further action against you." despite Mrs Skiauteris' antenatal consultant Alex Ivancevic writing to them to tell them "Her pregnancy is a high risk ... She is strongly advised bed rest and avoidance of any activity that might potentially provoke pre-term labour."

The text of Jonathan Coleman's press release is as follows:

"Pregnant Lithuanian visitor can stay

Immigration New Zealand's decision to decline a visitor's permit to a Lithuanian woman suffering pregnancy complications was a poor one, says Immigration Minister Dr Jonathan Coleman.

"Immigration New Zealand has reviewed the decision and offered the woman a visitor's permit allowing her to remain in New Zealand beyond the birth of her child. While her visitor's permit remains valid she is able to apply for further permits," Dr Coleman says.

"The woman had been advised by her doctor that travelling would place herself and her unborn baby at risk.

"I believe that declining the permit was a poor decision by the department. I am pleased that common sense has prevailed and that the woman has now been issued a permit allowing her to stay in New Zealand."

A recent Auditor-General's report into Immigration New Zealand raised serious concerns about the quality of decision making processes within the organisation, and found an unacceptable variation in quality of decision making between branches.

"The Auditor-General's report highlighted the need for improvement at all levels of the organisation. Substantial improvements to decision making and service as outlined in that report must be made," Dr Coleman says.

"The department must deliver a consistently high standard of service to its customers."

Great news for Mr and Mrs Skiauteris. Isn't a bit of adverse publicity a wonderful thing.

Here's hoping for a safe and trouble free delivery for the couple and that they are able to access the services they need in New Zealand.

Maternity Unit Suspended, DHB Accused of Covering Up Baby Death

Yet more evidence that maternity services in New Zealand have reached breaking point. For background to this issue see Pregnant women ordered out of New Zealand and an article in the February edition of the NZ Listener "New Zealand's maternity system is an unfortunate experiement from which the rest of the world will learn"


From the Herald on Sunday, by Cliff Taylor.
"Health authorities in Northland are being accused of a cover-up over the death of a baby at Dargaville Hospital.
An inquiry is under way into what is believed to have been a stillbirth at the hospital in early January.
Birthing at the hospital has been suspended while the investigation is carried out, forcing women in labour to be transferred 58km over a twisting, hilly road to Whangarei Hospital.
Pregnant women in the town have told the Herald on Sunday they have concerns about their safety and that of their babies, and have demanded more information from Northland District Health Board.
The DHB denies there is a cover-up, although neither it nor the hospital will even confirm the death or what is being investigated.
The DHB says the maternity unit is not being used for births after a "clinical incident" at the hospital.
A local newspaper in Dargaville reported a stillbirth at the hospital in January, and another printed several death notices....."
More here: Maternity unit suspended

"Political Apathy Killing Kids"

New Zealand's Pediatric Society has told a parliamentary committee that the country has the world's worst rates of child death and injury from preventable causes in the developed world, a damming indictment of the state of the nation's health service, coming hot on the heels of admissions that maternity services were stretched to breaking point.

Third world, poverty and overcrowding
In a Dominion Post report by Ruth Hill and Kelly Burns it's been revealed that the country's own doctors are saying that New Zealand's hospitals are overwhelmed by epidemics of infectious diseases associated with poverty and overcrowding, such as skin infections, whooping cough, chronic lung disease, pneumonia and rheumatic fever:

"Kiwi kids are dying in accidents and from abuse and Third World diseases due to political apathy, doctors and child welfare experts say.

MPs were told yesterday by the Paediatric Society that New Zealand has the worst rates of death and injury from preventable causes in the developed world and much more is needed to reverse the trend.

And in a report due out today, the children's commissioner calls for extra funding to educate parents about the dangers of shaking babies, as it reveals why about 45 children under five are seriously injured and five killed each year at the hands of carers.

Starship children's hospital paediatric surgeon James Hamill told Parliament's health select committee a third of all child deaths were due to trauma, but the only paediatric intensive-care unit in New Zealand was at Starship.

Overseas studies show children in adult intensive-care units are twice as likely to die compared with patients in paediatric ICUs.

Dr Hamill, who chairs the College of Surgeons trauma committee, said while it wasn't possible for every hospital to have a paediatric ICU, national standards for dealing with child trauma victims and better data collection were needed.

MPs were also urged to consider other measures, such as 20kmh zones around schools, restricting the minimum age for a full driver's licence to at least 18 and better restraints for children in cars.

Capital and Coast paediatric surgeon Brendon Bowkett said hospitals were being squeezed by epidemics of infectious diseases associated with poverty and overcrowding, such as skin infections, whooping cough, chronic lung disease, pneumonia and rheumatic fever..."

Read on here: Political apathy killing kids

Regular readers of this blog will know that

• New Zealand was recently placed a shameful 30 out of 43 developed nations in the Save the Children Annual Children's Index. The countries that topped the list in order - Sweden, Italy, Netherlands, France, Austria, Iceland, Malta, Japan, Luxembourg and Spain.

• New Zealand is ranked third worst country for child maltreatment deaths

Now that the country's own health professionals are sounding the alarm bells perhaps politicians will sit up and take this issue seriously.

Sung Won Kim - Korean Community Intervenes

The Korean community has made representations on behalf of horticulture student Sung Won Kim, who has to leave New Zealand by June 21 because she became pregnant.

According to the Herald newspaper Immigration New Zealand wrote to Ms Kim saying

"The fact that you are prepared to pay for all medical treatment has been accepted. However, NZ has a shortage of maternity care specialists and midwives, therefore you would be putting additional strain on our already short services."

More here: NZ Herald

For background see: Pregnant Women Ordered Out of New Zealand

Pregnant Women Ordered Out Of New Zealand

Lincoln Tan has written an expose in today's New Zealand Herald in which he revealed that women on temporary visas are being forced into leaving New Zealand if they fall pregnant.

Sometimes it's hard to believe that New Zealand was a signatory to the International Covenant on Civil and Political Rights (ICCPR) a United Nations Treaty based on the Universal Declaration of Human Rights.

New Zealand is one of the few countries that didn't incorporate the ICCPR into law, instead it supposedly gave effect to many of the rights contained within it by passing the New Zealand Bill of Rights Act in 1990.
A report by civil rights lawyers to the United Nations says New Zealand law allows significant human rights failings and breaches of international treaties,

The shadow report written by former Council for Civil Liberties chairman Tony Ellis and a team of lawyers was submitted to the United Nations.
It said New Zealand could do better in many areas of human rights law and that there were several deficiencies in respect of New Zealand’s international human rights obligations.
The Human Rights Act 1993 prohibits "discrimination due to pregnancy", but there is a specific provision to exempt immigration matters. But within the ICCPR are provisions for protection based on gender. If throwing out a woman because she's pregnant isn't a contravention of that what is - is the 1993 Act contrary to international conventions?

It's deplorable that New Zealand openly practices eugenics in its selection of 'suitable' migrants, e.g. families with children with Downs Syndrome or Autism, or overweight mums are refused entry, without victimising women for exercising their basic human right to have a child.

Some will say that these women are a burden to an already overstretched health service struggling by on very limited resources, but the sad fact is that even if they offer to pay for private obstetric care they are still shown the door.

New Zealand is very content to rake in billions of dollars from foreign students (international education is worth over $2.3 billion a year, making it the fifth largest earner) and will tax skilled migrants to the hilt but it puts up the shutters when asked to provide something in return. Perhaps some of those dollars should be put into improving the health service for all.

Much was made recently of New Zealand placed sixth in the 2009 Save the Children's annual Mothers' Index (perhaps to draw attention away from its rather shameful position of 30 out of 43 in the Children's Index) the abuse of pregnant women's rights has got to be reflected in next year's index if it is to be taken seriously

One of the women has taken her case to the NZ Human Rights Commission but looks like she stands little chance of getting a satisfactory outcome.

What next, pregnancy tests at the border before visas are issued and women terminating their pregnancies to remain in New Zealand?

I suspect that the latter is already happening.

NZ Health Service: 76 Avoidable Deaths

More signs were released today that NZ's health service is on the decline.

A report by the Ministry of Health's Quality Improvement Committee (QIC) entitled: 'The Serious and Sentinel Events List' detailed 258 incidents, including 76 deaths in the year to June 2008.

This is a significant increase over the previous year when 182 incidents and 40 deaths were recorded. All of the events could've been avoided.

The list was drawn from 21 district health boards.

The Chairman of the QIC said that each case was preventable and the aim of the report was to prevent recurrences.

According to the NZ Herald

"In Auckland, all a paitent's teeth were removed, rather than just the scheduled several teeth, because a referral letter was scanned under the wrong patient's name.

In another Auckland incident, incorrect laboratory results showed a pregnant immigrant had TB, prompting the termination of the pregnancy.

The Hutt Valley DHB reported a case in which a patient terminated her pregnancy after it was wrongly identified as ectopic.

A Canterbury patient required a second operation to remove a surgical drape left inside her in the first operation.

There were several reports of anaesthetised patients falling from operating tables.

More than half (53 per cent) of the events associated with the death of a patient were a result of suicide, and there were several cases in which mismanaged births had contributed to the deaths of infants.

Canterbury reported 41 incidents, the highest number, followed by Waikato with 36, Auckland 30, Counties Manukau 23 and Southland with 18.

The rest ranged between 16 (Capital and Coast) and two (Wairarapa and Midcentral)."

Perceptions of Migrant Doctors in New Zealand

An interesting report appeared in the NZMA in February 2006.

The study identified four key issues that afffected Overseas Trained Doctors (ODTs) in New Zealand:

"Work issues which included difficulty finding employment and difficulty integrating into their work role;

A bridging programme which improved the ability of OTDs to gain knowledge and experience of the New Zealand medical working environment;

Financial difficulties which were a major impediment to attaining registration and a career pathway in New Zealand; and

Bureaucratic barriers (including examinations and information availability), which were seen as necessary but unsympathetic processes in gaining registration."

The full report may be viewed here, if you are considering migrating to New Zealand with a view to working in the healthcare sector you may wish to read it.

Recommendations made in the report include:

• "Acknowledging the process of attaining registration and integrating into the medical workforce as one of joining a medical community;
• Recognition of the differences in medical cultures that exist around the World and the difficulty OTDs may have in understanding and learning their adopted medical culture;
• Creating a “one-stop-shop” to provide all relevant information about registration requirements, employment opportunities after registration, and further career options;
• Ensuring the examination process is transparent in terms of pass rates, content, and methods of examining;
• Maintaining an equivalent of the “bridging programme”;
• Ensuring that work positions are available to OTDs and that these positions are commensurate with their experience;
• Ensuring the transition into hospital medicine is carefully regulated and appropriate support is offered;
• The informal communication networks that exist amongst OTDs are recognised and incorporated into an overall strategy aimed at successful integration into the workforce."

Medical Students Have To Be Taught How to Stay and Work in New Zealand

"There are shortages of doctors, especially in primary care, and more medical graduates should help," said Professor Abbott. "However, they will need to receive a different sort of education that fosters the values, competencies and commitment to equip them to stay in New Zealand and make a positive difference at community level."

This statement was made by Professor Max Abbott, AUT University Dean of Health and Environmental Sciences and Deputy Chair of the country's largest district health board. He was commenting on a proposal to increase the number of medical students in New Zealand and on the workforce crisis in the health sector.

Healthcare areas with the worst shortages of staff are midwifery and dental services, both areas are need of urgent funding. There are shortages of doctors too, particularly in primary care. However, Auckland University of Technology is having to reduce some courses due to cut backs in funding, which come at a time when there are significant shortages of professional staff in some areas.

In May a report appeared on the Unison web site quoting Dr. Annette Huntington from Massey University's School of Health saying that New Zealand had reached “crisis levels” in the shortage of nursing staff, with many new graduates from NZ nursing programmes lured away by the promise of better pay in hospitals overseas.

45,000 registered nurses make up approximately 60 per cent of New Zealand’s health workforce.

Professor Abbot's solution is:

"We need to be much more flexible in our thinking about who does what in the health sector, especially in primary care. We need many more nurse practitioners and other health professionals who extend their expertise and scopes of practice. All health professionals need to learn to work more effectively in multidisciplinary teams and be more responsive to patients and communities."

Reasons for the shortages

Maurice Drake, head of Nursing at Unitec, says:

"There are a number of possible reasons for these shortages, including low pay, stressful working conditions and increasing media scrutiny of healthcare professionals"

Drake also notes the difficulty trained nurses who have been out of the workforce have in returning to nursing, especially those with children. “There needs to be more flexible ways of working....training more nurses is not the answer, due to a lack of clinical placements for students."

More
Boosting medical student numbers not the solution
NZ a global player in Nursing shortage
Crisis in Waitakere's after hours healthcare
In Unison: Nursing Shortage a Crisis

Cancer Patients Sent To Australia

Waiting times for radiation therapy in Auckland have become so long that some patients are being sent to Australia for treatment. Readers who know something of the recent history of the NZ health service will know that there has been a dire shortage of radiologists in NZ for quite some time.

Source: NZ Herald, Tues 9 Sept 2008

Cancer patients of Auckland District Health Board are again being sent to Australia for treatment, because the region's radiation therapy waiting times have blown out.

Six have agreed to cross the Ditch for treatment and 11 will go to Waikato Hospital.

The now-usual mix of staff shortages and machinery failures is behind the latest episode of the decade-old problem - plus a big increase in patients needing immediate treatment. The new twist is that while New Zealand's first private radiation therapy clinic may be contributing to the difficulties, it could also help to solve them.

Auckland Radiation Oncology plans to open its Epsom clinic in November.

The health board said yesterday that five of its radiation therapists had been hired by the private clinic and this had contributed to the worsening delays.

The board said waiting times for "low acuity" patients had been four to six weeks for the past year, but were now at least 12 weeks.

Susan - she asked for her real name to be withheld - is one such patient. A 55-year-old who had a partial mastectomy on July 1, she was booked to start radiation therapy this Friday. That would have been just short of eight weeks from when her specialist recommended the treatment.

But last Friday a board official rang to postpone the appointment without stating a new date, and to ask if Susan could go to Waikato Hospital for the 20 doses of radiation.

But she works fulltime and could not spend four weeks in Hamilton at such short notice. Now she is starting to worry about risks from the delay.

"I live in a big city with a big hospital. I expect I should be able to have my treatment in the largest city in New Zealand. There's something wrong when people have to be sent elsewhere to smaller cities or to Australia."

The Health Ministry in 2001 said the maximum wait for "priority C" patients like Susan should be four weeks. Last year it changed this to a target of less than eight weeks.

The board's clinical director of radiation oncology, Dr Andrew Macann, said some therapists had left for personal reasons, such as going overseas. It had hired five since March, but the overall losses, including those to the private clinic, had made it more difficult to meet the suddenly increased need for treatment.

The board would consider contracting the private clinic to treat patients from the public sector.

But even private clinics are struggling to recruit Radiographers:

Pacific Radiology cleared to acquire Wellington Radiology

Dec 20, 2007
The Commerce Commission has cleared Pacific Radiology Limited to acquire all the assets of Wellington Radiology Limited...In the Greater Wellington region, there are only two private providers of radiology services: Wellington Radiology and Pacific Radiology. The acquisition would result in there being only one provider in the region...

Wellington Radiology is owned and operated by two radiologists, one of whom intends to retire. As there is a nationwide shortage of radiologists, Wellington Radiology has been unsuccessful in finding a radiologist to replace the retiring partner...

Because of this, Wellington Radiology has sought to sell its business but has not attracted any offers from outside of the region, despite concerted efforts to do so. This is largely due to the shortage of radiologists.

Consequently the Commission has concluded that the acquisition of Wellington Radiology Ltd by Pacific Radiology Limited would not have, or would not be likely to have, the effect of substantially lessening competition in the market.

A market that seems to be shrinking by the day. It's not just Radiologists that are in short supply, a few months ago this article appeared on One News . It's not just the patients that are going overseas.

Shortage Of Medical Radiation Technologists

Mar 2, 2008
A shortage of medical radiation technologists in the Waikato is causing a major disruption to breast screening services in the region.

The district health board has been struggling to secure enough MRTs, but says the problem's become urgent over the past couple of weeks.

Chief Operating Officer Jan Adams says a competitive international market, an aging workforce and a decline in the amount of new graduates coming out of training is creating the shortages.

She says they're working to recruit people by offering flexible working conditions.

Jan Adams says the shortages aren't affecting other services at this stage.

Deaths From Shortage of Hospital Beds Comparable to Road Deaths

The New Zealand health service continues to operate at breaking point with the number of people dying due to bed shortages being equal to the numbers killed on New Zealand's roads every year.

Source NZ Herald, 8 Sept 2008

The ideal occupancy of inpatient wards is 85 per cent but many New Zealand hospitals run at more than 90 per cent, especially in winter. Waikato Hospital reached 109 per cent last Monday. The college says the core problem is lack of beds and a 15 per cent increase is needed in Australia and New Zealand.

In the Auckland region, a 15 per cent increase would add 315 beds to the present stock of around 2100.

New Zealand's public hospital beds have declined from 2.48 per 1000 people in 1988 to 1.56 in 2006 - largely through reduced lengths of stay and increased efficiencies like day surgery.

When Auckland City Hospital opened in 2003, amalgamating four hospitals, doctors criticised the 7 per cent reduction in beds. At around 1000 , it is still slightly below the 1062 before amalgamation.

The Waitemata District Health Board will have added 68 beds by the end of this month and plans 300 more by 2013.

Overcrowded emergency departments lead to worse outcomes because of factors like delays in starting antibiotics for pneumonia, delayed heart-attack care and patients simply being overlooked because they are on a trolley in a corridor. Auckland City Hospital no longer permits patients to wait in ED corridors because of this risk.

Little seems to be being done to alleviate the many problems the health service suffers from , even though this is an election year and Labour votes are crucial if they are to remain in power.

On Friday of last week a press report cited difficulties in hiring and retaining nurses for a cardiothoracic and vascular intensive care unit and loss of "surgeon confidence" (because of problems with a clinical computer system and sterilisation of surgical instruments) causing a 2o decrease in cardiac surgery in Auckland. Bypass operations at Auckland City Hospital are down from 641 five years ago to 454 in the last financial year.

New Zealand Behind the Developed World

Far from having a centre of cardiac excellence, New Zealand now has a low rate of state-funded bypass and valve replacement surgery by comparison with other developed countries, and New Zealanders' risk of dying with diagnosed cardio-vascular disease is now 35 per cent greater than Australians' risk.

Source: NZ Herald Fri Sept 5, 2008

The following comments appeared in the Herald's "Your Views"

"This government has run down the health system so badly. My cardiologist told me the wait was 3 months for my semi-urgent surgery. Labour then came into office and 2 years later I got the call!

This country needs more medical staff - pay higher rates so they stay here in the first place. Operating theatres need to be working around the clock - 24 hours per day.
There needs to be less paper pushing in the health system and more operations performed. Quite simple really - why is it so hard to do?

The fact some ill patients have to go to Australia to be treated is not only more expensive, but an appalling concept.

This Labour government has no respect for the New Zealand people. Helen Clark would rather see more taxpayers money funding government television ads and her election campaigns (yes - that's her latest proposal!) than assisting the health of New Zealanders. She is a disgrace."


"..I've seen time and time again my patients die while waiting as an inpatient in a peripheral hospital on a urgent waiting list for either bypass or valve replacement. I'm sure the CCU and ICU staffs are doing a terrific job with limited resources.
But I've lost hope with this labour govt and the health system. Some comments are quite right, if you're unlucky enough to have a cardiac condition Australia is definitely a better place to get treatment than in NZ. On the bright side I'm working in Aussie now, hoping the next govt (National) will do better than the current one."


"Auckland is not the only area with problems-I am in Tauranga and last year had an (urgent) triple bypass-when my condition worsened, Tauranga hospitals response? It can be dealt with by "tablet therapy" (whatever that is)-my solution-I paid for it to be done in Auckland (and the result was fantastic)-frankly give me Auckland over Tauranga any day"


"The CVICU is very short staffed which is having a significant impact on heart surgery.but so is the rest of ACH! The usual scenario is when heart surgery is cancelled for reasons other than short staffing in the ICU, the ICU staff are then redeployed around the hospital because The rest of the hospital is staffing critical! Than means the ICU staff get a double wammy.they work their backsides off, many doing extra shifts etc.to make what little heart surgery that does happen actually happen, then when there is a slow down, they are sent to other wards to work! This is one of the primary reasons the nurses leave but yet it still goes on!"