Auckland District Health Board says it is clamping down on all unnecessary spending in a bid to rein in a new deficit quickly. New Zealand's biggest-spending DHB is determined to break-even this financial year by saving $6 million dollars before the end of June without having any negative imapct of quality of care or patient safety. This item includes comment from ADHB Chair Lester Levy, CMO Margaret Wilshire and Dr Judy Bent, Clinical Director of the Greenlane Surgical Unit and member of the ASMS Executive. The item can be listened to here

This week’s Union Report focusses on the Talley's AFFCO meatworks dispute. The dispute affects 1200 employees and is NZs largest current industrial dispute. The interview is with CTU President Helen Kelly and Meat Workers Union Secretary Laurie Nankivell and discusses the key issues behind the dispute, current working conditions for AFFCO employees, Talley's behaviour since becoming 100% owners of AFFCO and the implications of this dispute for industrial relations in New Zealand. (The interview can be seen here)

The six-month countdown to MPS’s international conference on quality and safety in healthcare has begun.  As the countdown to the Olympics ignites sporting fever across England’s capital city, the Medical Protection Society (MPS) has started the six-month countdown to its international conference –Quality and Safety in Healthcare: Making a Difference.  The two-day conference will bring international experts from around the world to London to share their knowledge, experience and expertise on quality and safety in healthcare.

Sione Tu’itahi has been appointed as the new Executive Director of the Health Promotion Forum of New Zealand Runanga Whakapiki Ake I Te Hauora o Aotearoa. An educator, author and public health professional, Sione has been the Deputy Executive Director of the Forum for the past four years. “We are delighted to have Sione with his wealth of professional experience and leadership in the education and public health sectors over the last 18 years,” says Donna Leatherby, Chairperson of the Forum.

Burnout rates which affect more than a quarter of young surgeons are being addressed at Counties Manukau District Health Board with a programme to make doctors remain vigilant about their quality of life.  A study in the New Zealand Medical Journal last year noted 27 per cent of young surgeons here and in Australia reported burnout. Risk factors included being female, working in small hospitals and putting in more than 60 hours a week.

Increasing prescription prices to subsidise other health services punishes the wrong people, says Labour’s Health spokesperson Maryan Street.  “The Government’s announcement today to increase prescription subsidies from $3 to $5 shifts the burden of balancing the Government’s health budget to our most vulnerable.  What Tony Ryall is doing is asking low and middle income New Zealanders, who already struggle to meet their basic needs, to cough up more cash at the counter to subsidise treatment for others."

Medical student leaders are arguing doctors have a duty to initiate changes to the policies and living conditions behind poor health.  Student doctors should be ambitious for changes to the social determinants of health, New Zealand Medical Students Association representatives say in a video ahead of a vote on health equity to be held at their conference this week.  "As future health professionals and doctors, we will be the ones dealing with the consequences of health disparities, so why shouldn't we be the ones to initiate the changes?" asks Ari Pfeiffenberger, external vice-president.

Health Minister Tony Ryall today announced the Government will increase the $3 prescription charge to $5 per item up to a maximum of 20 items from 1 January 2013. The savings will be reinvested in the health sector. “The National-led Government is committed to protecting and growing public health services,” Mr Ryall said at a pre-Budget announcement with Prime Minister John Key.  “Despite tight financial times and what will be a zero Budget on 24 May, health will receive a big funding boost, which will come from savings within health and across the Government’s accounts.

The Budget next week will provide $101 million of extra funding over the next four years for more elective operations and scans, and improved cancer services, Health Minister Tony Ryall says. In a pre-Budget announcement with Prime Minister John Key, Mr Ryall said the extra Budget funding would invest in four new initiatives. “This is part of our commitment to deliver more and better frontline health services where they are most needed, while ensuring we responsibly manage the Government’s finances,” Mr Ryall says.

The 12^th round of Trans-Pacific Partnership (TPP) negotiations begins in Dallas, Texas today between Australia, the US, New Zealand, Chile, Peru, Singapore, Brunei, Malaysia and Vietnam, amid criticism by fair trade groups and prominent lawyers.  “The negotiations have slowed, as many governments resist US proposals to give pharmaceutical companies more rights to charge higher prices for medicines, and there is growing resistance to US proposals for the right of investors to sue governments for damages over health and environment legislation,” said Dr Patricia Ranald, convener of the Australian Fair Trade and Investment Network.

Despite ME and Chronic Fatigue Syndrome affecting around 20,000 New Zealanders, many people are unaware the conditions exist, says Maryan Street, Labour's Health Spokesperson.  "May 12 is ME/CFS Awareness Day and has been chosen because it is the anniversary of Florence Nightingale's birth. She contracted a ME/CFS-like illness in her mid-thirties and spent her remaining years virtually bed-ridden. ME/CFS is a real disease. It is recognised by the World Health Organisation as a neurological illness and is characterised by incapacitating fatigue and problems with concentration and short-term memory," she said.

More patients will get operations sooner as a result of a $7 million investment announced by Health Minister Tony Ryall. The funding of $7 million will expand productivity programmes led by surgeons, anaesthetists, theatre nurses and other health professionals to improve quality and reduce delays for patients having operations. The extra funding has been awarded to 11 district health boards (DHBs) to implement 21 projects which cover all aspects of surgery, from a patient’s first specialist appointment, to their surgery, recovery and follow up appointments. Projects being implemented include:

Overtime hours do not fully explain one of the highest payments in the country for a medical specialist, Association of Salaried Medical Specialists executive director Ian Powell says. Parliament's health select committee heard yesterday that a medical specialist paid between $820,000 and $830,000 by the Southern District Health Board during the last financial year was doing well over their normal hours. Labour health spokeswoman Maryan Street asked DHB representatives by video-conference in Invercargill to explain the "extraordinary amount for any one person" .

The Government has agreed in principle to stub out the brightly-coloured branding of cigarette packets - just as tobacco companies' court actions to overturn Australia's plain-packet law are getting under way.  Forcing tobacco into plain packaging is considered a key policy to help break the cycle of new, teenaged smokers becoming addicted.  Unbranded packets have been shown in New Zealand research with young people to lack the cool factor associated with cigarette branding for decades.

For every overwhelmed health worker who ever thought ‘This isn’t the job I signed up for,’ Dr Robin Youngson has uncovered the secret of happy and fulfilling practice. In TIME to CAREthis crusading New Zealand anesthesiologist reveals himself as an accomplished author and researcher.  In a style reminiscent of Bill Bryson, TIME to CARE draws together fact, narrative and observation to offer a deeply compassionate and insightful account of a health system which is failing both patients and practitioners, worldwide. A system still centred on institutions which routinely dehumanize and bully doctors, nurses and patients alike.

Prior to the austerity measures, Greece has been a “pharmaceutical paradise,” since medicine sales were extremely high and their costs were paid by the Greek state, admits the General Director of Pfizer Hellas pharmaceutical company.  “Athens has been a pharmaceutical paradise, because the consumptions was 2 or 3 times higher than any other European country, and its costs were undertaken by the Greek state. But this situation was changed after the austerity measures imposed to Greece because the government limited its medicine budget by 35%,” French President and General Manager of Pfizer Hellas Gaudreault Pierretold La Presse.

Spending on healthcare in New Zealand is the second lowest per person among a group of developed countries, a new study by US-based private foundation The Commonwealth Fund has found. According to the report, this country spends US$2983 (NZ$3721) per person each year on healthcare, lower than all the other 12 countries in the survey apart from Japan, where the figure is only about US$100 lower. The United States was at the top with US$7960, Norway second with US$5352, while Australia was well down the list at US$3445.

An American business lobbyist has given a sober assessment of Trans-Pacific Partnership [TPP] talks, citing a ''chasm'' between leaders' ambitions and their negotiators' positions. The TPP is a developing multilateral free trade agreement that aims to further liberalise the economies of the Asia-Pacific region including New Zealand, Australia, the United States, Chile, Peru, Singapore, Malaysia, Vietnam and Brunei. It is estimated to be able to boost trade by $1.1 trillion by 2025.

There have been a number of significant and successful stakeholder events over the past few months that HWNZ has been very pleased to have been a part of. Recent events include: Le Va’s ‘Growing Pacific Solutions for our families’ conference which brought together over 300 delegates from across the health, social services and disability sector; ‘Shine the Light’ Allied Health, Scientific & Technical Conference; New Zealand Medical Students Association Leadership Forum; Nurses in Cancer Care Workshop; Matua Raki’s Addiction Treatment Leadership Day.

Professor Des Gorman is the Executive Chair of the Health Workforce New Zealand (HWNZ) Board and a Board Member of the National Health Board (NHB). Here Professor Gorman discusses how HWNZ has unified and simplified the processes through which we plan, train and fund health workforce development in New Zealand to ensure a sustainable and fit-for-purpose health workforce, which will benefit staff, patients and the public.

A new toolkit to assist district health boards to further reduce waiting times and improve the quality of elective surgery has been launched by Health Minister Tony Ryall.  “District health boards have been making great progress increasing elective surgery for patients performing 27,000 more operations now compared to numbers in 2008. But there’s still room for improvement.  “Elective surgery, such as hip and other joint operations, cataracts and grommets, improves the quality of a person’s life by relieving pain and restoring ability.

The RNZCGP has unwittingly stumbled into the Sky City storm relating to convention centres and pokie machines.  RNZCGP Auckland members are threatening to boycott the college's conference and have voted unanimously against it being held at Sky City.  College Auckland faculty board chair and west Auckland GP Lois Paton says the board met last week and has sent an urgent request to the college to reconsider holding the conference at the casino's convention centre.

New figures obtained by ONE News (see story here) show hospitals may be giving patients better value for money. Research over a three-year period proves hospitals increased the number of patient treatments every year by as much as 5% for every taxpayer dollar spent. However, a woman whose father has spent the last three weeks in and out of hospital with heart problems says his treatment could have been better.

This issue of Eurohealth, the second with a new layout and design, provides an overview article case studies on health system responses to the financial crisis from the Czech Republic, Estonia, Greece and Ireland. Other articles include: the patient perspective on the Professional Qualifications Directive; the evolution of obesity in Spain; the performance of chronic care system in Denmark; competition in the Dutch health insurance system; pharmaceutical market reforms in Portugal; and Eurohealth Monitor. 

The number of New Zealanders with health insurance dropped almost 2 percent in the year to March, according to figures released today by the Health Funds Association (HFANZ).  Chief executive Roger Styles said the March 2012 quarter saw a decline of 0.5 percent in lives covered – or 7100 people – bringing the total number of lives insured to 1.351 million. This was a decrease for the full year of 25,700 people, or 1.9 percent, compared with March 2011.

The Southern District Health Board proposes establishing a "director of patient services", instead of two chief operating officers.  Designed to put decision-making on a regional basis, a proposal to restructure the executive management team is out for staff consultation.  The patient services director would also be deputy chief executive.  Deputy patient services directors would be based in Southland and Otago.

Second marriages, Dr Johnson observed, are a triumph of hope over experience. Sadly this seems also to be true of some of the government’s cost-cutting schemes – notably the ones that, like an arranged marriage, rely on bringing together the administrative parts of various ministries in the hopes that this will magically make them work better.  This is particularly obvious in shared services schemes, where people working in different departments – IT teams, for example – are brought together into a centralised IT hub. It looks, on the surface, like an obvious step.

The bailout deals for Ireland, Portugal, and Greece include startlingly detailed changes for their national health systems. Nick Fahy asks whether the tighter European rules proposed to save the euro will mean the EU steering national health systems across all of Europe? ... download the full BMJ article here

A health board is consulting its lawyers after surgeons had to complete an operation and keep a patient alive by torchlight when contractors unexpectedly shut off their power last month. NHS Lothian disclosed that the unscheduled power cut, midway through an operation at Edinburgh Royal Infirmary in late March, shut down all electrical machinery in the theatre for 11 minutes, including breathing machines and heart monitors. It meant surgical staff had to use hand-ventilators to keep the anesthetised patient breathing in complete darkness for 90 seconds and then by torchlight for another nine-and-a-half minutes, while monitoring the patient's pulse by hand, as surgeons completed the operation without any power.

Dr Ruth Spearing has praise for the way the Canterbury health system is performing, and a warning.  While so much in Canterbury is broken at this time, one thing working better than ever is the health system. It feels good to write those words after a rocky few years in the mid-1990s and early 2000s when many clinicians, ourselves included, couldn't have said this with confidence.  We know how well our health service functioned after the February 22 earthquake. Despite so many of the basic facilities being down, acute admitting teams were able to deal with the huge influx of patients through the Emergency Department.

The Southern District Health Board will be restructured to create regional clinical service groupings, rather than duplications, in Dunedin and Invercargill. New chief executive Carole Heatly, a Scotswoman who started last month, said yesterday she had spent much of the past six weeks on the "shop floor" gaining an understanding of the DHB's issues. "It's fair to say the organisations, Southland and Otago, merged [in 2010] ... but we've got a number of things we need to do to make that merger real for the people who work for the organisation."

Only 495 extra children who are about to turn two need to be immunised before 30 June for New Zealand to achieve the 95 percent immunisation coverage recommended by the World Health Organization this quarter.  “World Immunisation Week, 23-29 April, is an opportunity to encourage parents to protect their children from preventable diseases by getting them immunised on time” says Health Minister, Tony Ryall.  “High immunisation coverage is important to protect not only the health of individual children, but also to protect the community from the spread of disease."

The honeymoon appears well and truly over between the senior doctors' union and Health Minister Tony Ryall. In a paper to an Australian Medical Association meeting in Canberra this week, Association of Salaried Medical Specialists (ASMS) executive director Ian Powell delivered a stinging critique. Mr Powell said Mr Ryall had a "highly personalised" style, running the portfolio with his own "inner circles". These "insiders" were now reporting a tougher attitude. "Instead of being asked by [Mr Ryall] what they know about or think about particular issues, it is now notification of what he intends to do.

The Southern District Health Board has backed down on planned cuts to medical staff at Dunedin Hospital's emergency department, the Association of Salaried Medical Specialists says.  Emergency department specialist Dr John Chambers, who is also a union representative, said the DHB had reconsidered weekend medical staffing.  Two senior registrars whose posts were to be discontinued in June would continue, he said. Two 10-hour locum shifts at weekends would also remain.

“The tobacco industry will use every legal avenue it can to stop New Zealand introducing plain packaging laws”, predicts University of Auckland Professor Jane Kelsey, who is just completing a report on the impact of trade and investment agreements on New Zealand’s smokefree policy.  “This is a battle between life and death for New Zealanders and life and death for the tobacco industry. The industry will fight it all the way, backed by its bottomless treasury.”

Plans to introduce plain packaging of cigarettes could come unstuck as a result of New Zealand’s involvement in trade talks – which so far remain in secret. FIRST Union, a union involved in the TPP Watch campaign, said that the plain packaging of cigarettes was a significant measure in reducing harm caused by smoking, and congratulated Tariana Turia, and Hone Harawira before her, on this move. But FIRST Union General Secretary Robert Reid said he feared the move would likely be challenged in the future by the tobacco lobby if New Zealand signs the so-far secretive Trans Pacific Partnership Agreement.

At a recent meeting at your offices, Dr Prudence Stone (Smokefree Aotearoa) and NZNO Policy Analyst, Marilyn Head outlined health sector concerns with some aspects of the TPPA. They were assured that the Ministry of Health was undertaking some analysis of the TPPA in relation to public health, and anticipated the months leading up to the planned meeting in Aotearoa New Zealand would allow time to explore the potential risks and canvas expert and public opinion. ... (the full letter can be downloaded here)

The Green Party is supporting Government moves to introduce plain packaging of cigarettes, but says it needs to stand up to legal attacks from the tobacco lobby.  “The plain packaging of cigarettes is good for New Zealanders health and we support it,” said Green Party Co-leader Metiria Turei. “There is clear evidence that the plain packaging of cigarettes will help to reduce smoking addiction. ....  The tobacco lobby shouldn’t be able to write the laws of New Zealand through their legal threats."

In a speech today to the Australian Medical Association's Industrial Co-ordination Meeting, ASMS Director Ian Powell claimed that "it seems New Zealand’s public health system is reaching a tipping point in recent months, since the last Industrial Coordination Meeting and, more significantly, since the general election last November". He went on to assert that "the government is adopting a more assertive hard line position overall but also including in health. The Minister of Health Tony Ryall has a highly personalised manner of working and has his own inner circles (some more ‘inner’ than others). Those insiders are now noting a shift in the Minister’s style of working them. Instead of being asked by him what they know about or think about particular issues, it is now notification of what he intends to do". .. (the full speech can be downloaded here)

A Ministry of Health investigation has cleared the Southern District Health Board's breast-screening programme of concerns its rate of "false negatives" was unacceptably high.  The investigation of BreastScreen HealthCare was launched last month after a clinical audit suggested there had been delays in diagnosing cancer in 28 women between 2007 and 2010. "The mammograms were re-read by an expert group, and it was found that the false negative rate was at an acceptable rate," a ministry statement said yesterday. However, extra support put in place when the urgent investigation was launched would continue.

The Medical Council is excited to announce the launch of their new web site, which has gone live today and can be found at the same address: www.mcnz.org.nz. Our site’s homepage ... contains three sections that allow visitors access to information based on their needs rather than having to sift through everything to decide what is of interest to them. In redesigning the site we have focused on making the navigation simpler for you. We use plain English wherever possible.

A review by Professor Michael Ardagh and colleagues from the University of Otago, Christchurch and the Canterbury District Health Board, shows emergency health services coped well with the major earthquake in Christchurch on February 22 last year, despite being placed under enormous pressure.  The review has just been published in the top international medical journal The Lancet, graphically describing the impact of the 6.3 earthquake on the Emergency Department (ED) at Christchurch Hospital and the huge patient demand.

Southern District Health Board chairman Joe Butterfield has denied a claim he is cutting medical staff at Dunedin Hospital's emergency department, but says staff need to stick to agreed budgets.  Hospital emergency department specialist Dr John Chambers, who is also a union representative, said Mr Butterfield appeared to be the "main driver of the idea of actually cutting medical staff to try and balance the books". Mr Butterfield has made strong comments at recent board meetings about a doctors' wages cost overrun at Dunedin Hospital.

The international recall of a second metal-on-metal hip replacement device should cause the government to re-think its decision to block a Health select committee inquiry into these devices, says Labour’s Health spokesperson Maryan Street. 
"National MPs on the committee blocked my last call for an inquiry into the Johnson and Johnson hip replacement devices. Now we have a second recall and the need for a proper New Zealand inquiry becomes urgent," said Maryan Street.

A fellow National Party MP - and doctor - helped discover colleague and former West Coast-Tasman MP Chris Auchinvole had heart problems.  Within days of mentioning to fellow National MP and doctor Paul Hutcheson that he was experiencing pain while walking up stairs, he had a stent put in an artery late last week.  Mr Auchinvole said today he was feeling better than he had in a long time, but had been told he could not work for three weeks.  "The cardio unit in Wellington kindly put a stent in an artery that they found was 90 per cent occluded."

The DHB workforce plans have now been received; they show common themes and shared direction, including the importance of improving workforce data and intelligence, enhancing engagement with staff and speeding up the development of new and extended roles and scopes of practice.  More detailed feedback regarding individual plans will be provided following the usual NHB processes over the coming weeks... the full Bulletin can be downloaded here

I want to express my serious concerns about the proposals for elective surgery that are being considered (and even actively pursued) at North Shore Hospital by Waitemata DHB. Essentially the DHB is looking at contracting out or otherwise shedding responsibility for the provision of elective services at its new Elective Services Centre, and is also intending to use major financial incentives for productivity improvements by specialists carrying out elective procedures.

If the main political conflict of the 20th century was about regulation and the role of the state, that of the 21st century is about deregulation and the role of the market. Whereas the welfare state embraced the role of government, the market state is sceptical of government and favours competition and choice. The debate over the fate of the NHS in England, triggered by the government’s determination to replace a largely publicly provided service with an increasingly privatised one driven by competition, is a microcosm of the wider conflict between the welfare state and the market state... Download the full article here

Increasing demand, a finite budget, and Treasury policy have forced public organisations such as district health boards to look to the private sector for help with funding.  The Government recently instructed the Canterbury DHB to consider a public- private partnership funding model when planning for the rebuild of Christchurch Hospital. The CDHB and the Government must learn from the British experience, where public-private partnerships for public works are known as private finance initiatives (PFIs) and have been used for more than 20 years.  In Britain, PFIs as a way of funding hospitals are "now dead in their current form", according to the Financial Times and are being subject to Treasury and Government review.

Many hospital emergency departments are caring for patients in units where they can "stop the clock" on the Government's six-hour target.  District health boards are striving to comply with the target that 95 per cent of ED patients are admitted to a ward, transferred or discharged within six hours.  Compliance sits at 92 per cent in the latest national statistics, up from 80 per cent when the target was introduced in mid-2009.

Faster treatment of the nearly one million patients seen in New Zealand hospital emergency rooms annually is said to be saving lives.  Before the 2009 introduction of the Government health target designed to speed up care, emergency physicians estimated that around 400 lives a year were being lost because of delays. New research from Australia has indicated a formal target to speed up emergency care may be saving lives. 

It is a bit rich that Tony Ryall is now moving to work with the Australians to regulate medical devices when he personally railed against such moves five years ago when in Opposition, says Labour’s Health Spokesperson Maryan Street.  "We put up regulatory legislation when we were in government which Tony Ryall took great delight in opposing, even though it was the right thing to do for New Zealanders. That legislation had to be withdrawn because we did not have enough votes in the House for it to proceed.

The Medical Council of New Zealand today released the names of the four top polling candidates following its recent election. The successful candidates are:

• Dr Rick Acland
• Dr Jonathan Fox
• Dr Peter Robinson
• Dr Richard Sainsbury

The head of Dunedin Hospital's emergency department (ED) has resigned in frustration at what he says are planned staffing cuts.  Dr Tim Kerruish resigned as clinical leader yesterday morning after about 15 months in the role, effective immediately, but will stay on as a specialist. His position was "untenable" because of a disagreement with management over doctor numbers.  Senior medical staff had "serious doubts" about providing a safe level of cover, he said.

The Government’s superior ‘we know best’ attitude will be a bitter pill for the 500-plus New Zealanders fitted with hip replacement devices that have been recalled in other countries, Labour’s Health spokesperson Maryan Street says.  “National needs to explain to those people why it has blocked an inquiry into the metal-on-metal implants - manufactured by Johnson and Johnson - when an inquiry in Australia, lawsuits in the US, and an investigation in the UK have led to the devices being recalled. “An inquiry in New Zealand is no less justified. There are 507 Kiwis fitted with these devices which, if faulty, can lead to metal toxicity.

Professor Michael Baker from the University of Otago in Wellington led the research published in the Lancet - he says what's needed is a concerted multi-sectoral government response. Listen to the full interview (16'46") here

News that a group responsible for developing national guidelines for medical experts is likely to be scrapped is causing huge anxiety within the profession, Labour’s Health spokesperson Maryan Street says.  "The Guidelines Group provides expert advice on best practice across all health disciplines to New Zealand doctors. Redundancy notices have been issued to all staff following the non-renewal of several lucrative contracts, including one with the Ministry of Health worth $590,000.  That means busy professionals will no longer have access to trusted, evidence-based guidelines and clinical recommendations specifically targeted at Kiwis."

A proposed new model for community pharmacy has a stronger emphasis on services to patients with higher needs and a strengthened role for community pharmacists, working in partnership with prescribers, such as GPs. The 20 District Health Boards today begin a month-long information and consultation process with local pharmacists and a range of key stakeholders across New Zealand to explain the new service model. Julie Patterson, Lead DHB Chief Executive for Pharmacy, said the proposal is an exciting development for the pharmacy profession.

The ASMS has been approached by Oxfam to promote Oxfam’s Biggest Coffee Break during Fair Trade Fortnight (5-20^th May 2012). The theme for this year’s campaign is how the choices we make every day make a big difference as they have an impact on the world around us. Oxfam is asking you to recruit people to host Coffee Breaks in their homes, schools, workplaces or any other location they like. You can use whichever communication techniques you prefer, phone, email or face to face, “liking” Coffee Break on Facebook and directing your friends to the page (www.facebook.com/oxfamcoffeebreak). Further information can be downloaded here.