The local petitions for each DHB area were handed in to Parliament in May 2017. Read the story of the local volunteers and their campaign to Save our Public Health system on the ActionStation blog:
'Health volunteers step it up a level'
17 April - 7 May 2017
For 21 days ActionStation supporters across the country are going out to our communities to save our public health system and make health funding an election issue this year.
Join the event here!
Can you help collect signatures in your local area or organise a local event? Share the petition online or download it from:
Read about our local leaders around the country here on the ActionStation blog.
By Dr. Glenn Colquhoun
The High Chaparral
For most of my career medicine has not been so friendly. I have struggled with doubt. I
have always felt that at any point I might do the wrong thing. For a long time this meant
that consultations were noisy with my own thoughts. Life was lived in two parts. In one I
would go to work and be unsure and struggle with the waiting room and paper trails and
fires popping up. In the other I would imagine. I would dream that I could fly. I would
soar up over the world like a young seagull and look down and be amazed. Moments
would open up like a ranch slider. Inside I found they were timeless. Poetry was good
and medicine was bad. I joked that poetry was the first girl I ever loved, the one I always
wanted but never felt confident enough to ask out, and that medicine was the girl I got
pregnant behind the bike shed and thought I had to make an honest woman of.
A few years ago I began to compile a book based on the stories of a group of patients I
saw over the course of one day in general practice. For a year I visited as many of them
as I could and asked them about their lives leading up to that consultation. I saw them in
their homes and among those things they cared about, then afterwards flew up into the
sky like a seagull with an old piece of string and looked down. When I came to write
about them I saw them with wet eyes – the sort of love that poetry demands of those
who write it.
I noticed that in consultations after that my head would calm sometimes and I would see
my patients’ faces slow down while they were talking. I was reminded of that day
outside the lecture theatre at Auckland University. Now wrinkles began to shimmy on
the faces of my patients. Parrots or bellbirds or fantails would appear on their shoulders
and dead people shuffle shyly out from behind them. Some would hide beneath their
skirts or behind their trousers and others would trail warily after. Some would haunt and
others would protect.
I came to understand that the anatomy I had learnt about at medical school was limited.
Ache and memory gave human beings other anatomies that were entirely specific, and
with increasing confidence I began to palpate these like the quadrants of the abdomen.
After a while I realised I had ghosts of my own and that they were present
in my consultations as well. I kept stumbling on them red-handed.
Card games would spring up in the corner of the office. My wrecked old dad, my
estranged wife, my bright and shining daughter would take the spooks they met on the
other side of the room by the hand and do the real medicine while my patient and I were left to talk about more important less important things. Often they would look at me and
shake their heads as though I was their ghost, a distraction or apparition from some less
These ghosts are with me still. Their medicine is usually either play, i.e., card games,
Ludo, mini-golf or indoor bowls, or conversations over food, i.e., biscuits, tea, potato
chips or jet aeroplanes. Even now one or more of them will follow a patient out the door
to offer them a cup of tea or slice of cake or game of pool. I am too stubborn and fallen
to call this prayer, but perhaps it is. I call it ghost talk. Poetry showed me that a person
is the tip of a fabulous iceberg. The shape we see is the line the pen has drawn onto the
map but it is determined only by the state of the tide at any given time. Beyond this
everyone has a layer of continental shelf.
But I am a GP who has spent his life working with Māori and young people, so I
suppose this sort of medicine has become important to me. I don’t often find myself
wrist deep in an abdomen or busy correcting acid-base equilibriums. Sometimes we
need to be mechanics. People are wheezing or bleeding or in pain. Stuff is dripping out
of them that shouldn’t be. Our physiology and our randomised controlled trials hold
there like Newton’s laws of physics. But on the magic edge of medicine other wonders
play out. Medicine blurs into the spirit and here medicine is as old as the hills. It is black
magic and weirdness. It is a type of quantum medicine where illness, happiness and
longing tangle and weave, blinking in and out and in and out of existence.
There are times for me in the consultation when the intimacy of two human beings
talking rivals the intimacy of the creative moment. In fact, I have come to understand the
consultation is a creative moment. It seems after so many years of chasing my
childhood sweetheart I have found her hiding in the eyes of that girl behind the bike
shed. I have expected for years that medicine should leak into my poetry but never
dreamed that poetry might leak into my medicine in such a way. On my best days there
is no separation at all between both disciplines. I feel as though I have discovered a late
love and, like all of those who have, it is all the more sweet for taking so long to wander
A non-randomised uncontrolled trial
It has taken a long time for me to rebel in medicine. It is full of high priests and
orthodoxy and impetus to act in the way it does because of impetus to act in the way it
does. And there is so much to learn that you might always be distracted learning it and
rarely step back and question. My doubt has been busy with self-doubt. And I have
always had writing to run to anyway when it gets too much. But for a long time I have
grown frustrated by the ten-to-fifteen-minute model of medicine in primary care. It has
always seemed to me designed by designers, and without imagination. And I have been
slowly frustrated by a medicine that usually expects patients to come to it and rarely
reaches out to see people where they are.
I have also been inspired by others – the quiet and gentle rebellion of old teachers like
Professor Sir John Scott, who retained their humanity in all the busyness, and the new
anger of colleagues in primary care such as Lance O’Sullivan.
Most recently I have come to believe that the stories my young people tell me demand
some response from my profession. They are at times a plea to the world of big people
to bring some explanation or justice or relief, however naive that might be. Not to
respond is a defeat in the natural order of things.
In 2012 I took some time out from medicine. I resigned from the clinic I had worked at
for many years because they wanted me to see more patients. My sessions usually ran
over time anyway, and I felt too old and stubborn to change. I wrote for much of the year
and let medicine tick. By the end of that year the distance had made me want to
practise medicine the way I wanted to. I knew I could rely on being employed for two
days a week by the local youth health service, but I also knew that, no matter how
understanding my funders, this would come with expectations about time and location,
and so I took a job for another two days a week as a youth worker in the same area.
From that time on I have been employed by two different organisations under two
different contracts with wildly differing pay scales, but in reality I do one job. I see young
people. We have clinics in the community and in two of the three high schools where
the best of the old model can be retained, but I am also free to leave the clinic each
week to follow up young people who need more time to talk or a ride to the hospital or
who need to know that they are worth a big person checking on how they are doing.
I get to help out on a local alternative education programme for students who have been
excluded from mainstream schools, and I run a creative writing group for those who
share a similar wound. I can see young people individually or in groups. I can see them
for two minutes, ten minutes, thirty minutes or an hour. I can bake with them, eat
burgers with them and watch movies. I can knock on their doors and explain again what
they are bound to have forgotten the first time round. I am poorer but richer. Some joy
has returned to medicine for me.
I think about patients outside of work now and wonder how to reach them as though I
am stuck on a line in the middle of a poem. Medicine has entered my imagination. My
room has filled up with toys and models and props that explain the abstract to more
concrete minds. My subconscious is figuring out what to do next in cases where I am
stuck. This has only ever happened in poetry, answers to problems appearing days later
when I thought I had given up on them. I have stockpiled a shelf full of books to give
away to young people who might find something they can identify with in a particular
story. To be able to hand someone a book instead of a script for fluoxetine or
methylphenidate or something to help them sleep and say ‘this is a story you might like’
seems a great freedom.
Many of the young people I work with have my cellphone number. For years I guarded it
as though it was some sacred barrier that could not be crossed. I am discovering that it is much more convenient for my patients to have it. No one has abused it. Texted
consultations have evolved in which patients are more direct in what they want to say
than they are when they are face to face. In the context of being able to see them face
to face later, it is a useful adjunct.
I’m not sure if any of this will make a lot of difference to youth health in the Horowhenua.
In fact I know that most of it won’t. It will improve some access to primary care for some
people, but so many of the young people I see needed to be seen ten years earlier than
they were, and their families needed services that engaged with them in caring,
constructive and enduring ways. But it is, I suppose, a personal response to the limits
we have allowed to build up around primary care – my own small non-randomised
uncontrolled trial. Strengths in young people can sometimes be seen only by being with
them outside a clinic. This is important because so often the path to establishing the
confidence and engagement of a young person is through growing their strengths rather
than concentrating on what is wrong with them. When we do not see people in their
contexts, we do not see the medicine they possess that can help them get better.
Copyright © 2016 Glenn Colquhoun
Extract from Colquhoun, Glenn, Late Love: Sometimes Doctors Need Saving as Much as Their Patients, 2016, Bridget Williams Books, Wellington, pp.23–30.
By Hamish Hutchinson
New Zealand has a proud history of a public healthcare system that anyone can access. Sadly, this has changed and our public healthcare system is under threat from systemic underfunding. Between 2010 and present, our health system has been underfunded. In 2017 we will need an extra $1.85 billion to restore our health systems budget to 2010 levels. i
This is equivalent to 7400 doctors, 27,750 nurses or 111,000 hip operations. That’s a lot. This figure is based on proportion of GDP. In 2010 the health system took 6.32% of GDP, whereas in 2015 this figure was 5.95% (Figure 1). So while health spending is reported to be increasing, with the government celebrating their record increases each year, the proportion of GDP has actually gone down. Beyond simply being figures and numbers, these changes affect people’s lives.
Two realities occur when healthcare services are underfunded. The first is that stricter criteria are applied when accessing publicly funded services. The second is that public services have to rely on the creation of a market for substitute private services. To highlight this issue, the provision of knee and hip joint replacements can be used to show the effects of healthcare underfunding and how the health system in Aotearoa/New Zealand has growing unmet need and that private health provision is filling this gap.
Shutting the door on people in need
Figure 2. Publicly-funded hip and knee total joint replacement procedures in New Zealand for those aged 20 years and over from 2006–2013 by year. iii
Looking at criteria for accessing publicly funded services, a study published in the New Zealand Medical Journal in April of 2016 looked at the severity of disability a person experienced waiting for a publicly-funded knee or hip joint replacement. ii
They concluded that people waiting for hip and knee replacements in 2014 are more disabled by their condition than people in 2006-2010. That means more pain and less ability mobilise and do normal daily activities. The report announces that people are currently being returned to the care of their GP who in 2006-2010 would have received joint replacement surgery. The threshold for receiving public-funded care is shifting. It is harder for people to access public funded services. The door has been shut on a number of people who should be getting publicly-funded service.
The other reality of underfunding is that increased demand on services will be met by private providers rather than public. A market is created. One of the best ways to show this would be to display hip and knee joint replacement figures from private providers compared to public. The problem with this is that this data is unavailable. Private surgery rates are not available unlike public figures. But irrespective, we can still join the dots from other measures.
A happy reliance on private healthcare providersThe first piece of data, from an article in The New Zealand Medical Journal, shows this concerning trend is around average joint replacement surgery rates. iii
Since 2007, rates around the country of publicly funded joint replacements have not significantly changed, as shown in Figure 2. While actual numbers may have increased (as shown in the denominator column in Figure 2) the rate per 100,000 people per year has remained stable. With an ageing population you can expect demand to increase because people aged over 65 are the highest users of joint replacement services, and with this we should expect to see an increase in public-funded rates per 100,000. Some projections place the increased need for hip joint replacements at 174% and knee joint replacement at 673% by 2030. iv
Currently there has not been an increase in rates in public-funded services to meet the increasing demand. Some of this demand is shifted because criteria has shifted (i.e. it is more difficult to get hip and knee joint surgeries). But because public rates haven’t increased, some of this demand will also be taken up by non-government/private funded services. A private market is therefore propped up by failings in public services.
The second piece of data which shows private providers capturing this unmet need comes from looking at regional differences and comparing private health insurance rates. Throughout Aotearoa/New Zealand there are regional differences in rates of hip and knee joint replacement surgeries. The same study mentioned previously from the New Zealand Medicalv showed that there are regional differences in rates per 100,000 people between DHBs (Figure 3). The top performing DHB was West Coast, which completed 449 surgeries per 100,000 per year, whereas the worst performing DHB was Auckland with 131 per 100,000 per year. The report shows that provision of public funded joint replacement surgery is poorest in main centres compared to smaller regional DHBs. These findings are consistent with Ministry of Health data (Figure 4) which shows which DHBs have the highest rates of private health insurance. vi
So as you would expect, the areas with higher rates of private health insurance are the areas with the poorest rates of hip and knee joint replacement surgeries, these areas being New Zealand’s three largest cities: Auckland, Wellington and Christchurch.
Important to note, once age and social deprivation levels were taken into account, rates of surgery were still lower in main centres compared to regional DHBs. What this shows is that there appears to be a mutual relationship between some DHBs and the provision of private joint replacement surgeries. Are DHBs in the main centres potentially keeping rates low in acceptance that this need will be met by private providers? Are DHBs in main centres content with allowing a person’s financial capacity to determine their access to supposed universal health care?
The third and last piece of data, and most alarming is that 2016 was a record year for private health insurance funding. The Health Fund Association of New Zealand (HFANZ), the body representing health insurers in Aotearoa/New Zealand, reported that “claims paid for the year jumped 9.4 percent to $1.136 billion as insurers funded record levels of elective surgery”. vii
Are more and more people turning to private health providers to get surgery? This would be only reasonable, especially considering the fact that, according to the HFANZ, elective surgery average waiting times have risen from 85 days in 2013 to 304 days in 2016. viii.
One could imagine that this situation is only going to get worse as time moves on and nothing is done – unless of course a person have the ability to pay.
Is this is what we want?So from all of this we have to ask ourselves whether this is okay? Is it okay that our public-funded services are relying on people having private insurance? Is this the sort of public healthcare system we want? Our current system is creating differential access based on income to what should be an absolute right to access.
The Save Our Public Health campaign is raising the issue of public health underfunding in Aotearoa/New Zealand. We want a public healthcare system that everyone can access. That means, irrespective of your wage each week, if you need a hip joint replacement because you are in pain and having difficulty mobilising, then you should get one. You should not need private insurance to get this, and you shouldn’t be made to live in pain because you don’t have private health insurance. This is not our health system.
Our health system is universal. And for it to be truly universal it needs to be funded properly to flourish – not just be in survival mode. We need to save our public health system.
ii Gwynne-Jones D, Iosua E. Rationing of hip and knee replacement: effect on the severity of patient-reported symptoms and the demand for surgery in Otago. N Z MEd J (2016), 129;1432:59-66
iii Harcombe, H., Davie, G., Derrett, S., Abbott, H., & Gwynne-Jones, D. (2016). Equity of publicly-funded hip and knee joint replacement surgery in New Zealand: Results from a national observational study. The New Zealand Medical Journal. 129(1442)
iv Hooper G, Lee AJ, Rothwell A, Frampton C. Current trends and projections in the utilization rates of hip and knee replacement in New Zealand from 2001 to 2026.NZMJ. 2014 Aug 29;127:82–93.
v Harcombe, H., Davie, G., Derrett, S., Abbott, H., & Gwynne-Jones, D. (2016). Equity of publicly-funded hip and knee joint replacement surgery in New Zealand: Results from a national observational study. The New Zealand Medical Journal. 129(1442)
vi Ministry of Health. 2016. Private Health Insurance Coverage 2011–15: New Zealand Health Survey. Wellington: Ministry of Health.
By Ann Cloet and Anna Scorey.
In the last few months we have seen a lot of coverage on the underfunding of our healthcare system. At the same time, the Government insists that 2016 has been a record year in health spending with $550 million per year committed for the next 4 years to relieve demand pressures.
The graph below (based on data provided by Treasury and Labour projections made following the Treasury model) shows that since 2010 spending has never matched the amount of funding actually required. Shortfalls each year have been building up, now amounting to $1.85 billion.
Figure 1: Comparison between actual and ‘required’ yearly New Zealand health expenditure to remain equivalent with 2009/2010 health expenditure levels after taking account of inflation and health demographics.
Aside from the underfunding issue, we also hear about the public healthcare system needing to be more efficient. The Capital and Coast District Health Board was rated one of the most efficient DHBs in 2015, but it still produced a budget deficit of $12 million dollars. To achieve these efficiencies it reduced and closed services, the effects of which are now being felt throughout the public healthcare system.
Effects of ‘efficiencies’
Not filling vacancies
"This is a short-term solution if it's a solution at all. If you don't fill positions that need to be filled you're deferring the problem and increasing the workload on those who need to provide cover”
Association of Salaried Medical Specialists director Ian Powell
St. John Ambulances to strike
“We are not directing our action at patients; we’re doing this for their safety. Paramedics will continue to serve their communities and patients, but they’ll be doing it while underfunded and exhausted” Ambulance Professionals First co-ordinator Lynette Blacklaw.
Junior Doctors to strike
Junior doctors say they have to work 12 consecutive days, with some shifts 16 hours long, which leaves them overtired and is unsafe for patients.
Kenepuru Hospital After Hours to close:
The closure of the centre would mean residents from the Kapiti Coast southwards would have to travel into Wellington for treatment between 11pm and 7am.
Mental Health Services in Crisis:
“We are now no longer talking about a system that is under pressure, but a service that is broken” Kyle MacDonald, psychotherapist and People’s Review spokesperson.
It is important to point out also that our current leaders have the capacity to significantly increase health spending but seem unwilling to do so.
With next year’s elections coming up, we, the people of New Zealand, have the opportunity to make healthcare a vote changing issue. We need to show our politicians that we want an effective government that delivers good quality public services, healthcare being among them.
Click here to join our grassroots movement in support of a fully funded public healthcare system.