Striking senior New Zealand doctors have hit back at the Health Minister’s attack on their union for “forcing” patients to wait longer for surgery and appointments, due to their 24-hour industrial action.

Respiratory and sleep physician Dr Andrew Davies, who was on the picketline outside Wellington Regional Hospital, said for him and his colleagues, it was “not about the money” — it was about the inability to recruit.

“We’ve got vacant jobs that we’re not allowed to advertise,” he said. “It’s lies that they’re not getting rid of frontline staff.

• READ MORE: Gallery: Doctors, health workers challenge NZ government over national crisis

“The job is technically there on paper, but if you’re not going to advertise for the job, you’re not going to fill it.

“In our department, we’ve waited months and months and months to fill some jobs, and you don’t just get a doctor next week. It takes six months for them to come.”

Dr Davies said no-one wanted to strike and have their patients miss out on care, but thousands of patients were already missing out on care every day, due to staff shortages.

“Every week, we’ve got empty clinics,” he said. “There is space in the clinics that’s not being used, because there’s not a doctor in the chair there.

“While, today, that’s 20 percent of the work of the week gone, because we’re on strike, in some departments, it’s 20 percent every week.

“Every day of the week, there’s a 20 percent deficit in the number of patients people are seeing.”

5500 doctors on strike
Nationwide, about 5500 members of the Association of Salaried Medical Specialists are on strike until 11:59pm today, causing the cancellation of about 4300 planned procedures and specialist appointments.

In a social media post, Health Minister Simeon Brown blamed the union for the disruption, saying an updated offer last week — including a $25,000 bonus for those moving to “hard-to-staff regions” — was rejected by the union, before members even saw it.

Union executive director Sarah Dalton said she would be very happy to facilitate a meeting between doctors and the minister — or he could accept the invitation to attend its national conference.

“They would love to feel like someone up there was listening,” she said. “They don’t at the moment.

“We need to move away from rhetoric, and actually have some time and space for meaningful discussion.

“That’s one of the reasons we’re on strike today. After eight months of negotiating, there was nothing on the table from the employer.

“It was only after we called for strike action that anything changed, so let’s do better.”

Critical workforce shortages were undermining patient care and the current pay offer, which amounted to an increase of less than one percent a year for most doctors, would do nothing to fix that, Dalton said.

“How do you tackle vacancies? You put more time and effort in good terms and conditions for your permanent workforce, and you stop spending spending $380 million a year on locums and temps.

“We shouldn’t have that heavy reliance on those people, so we’ve got to change it.”

NZ training doctors for Australia
After many years of study subsidised by the New Zealand taxpayer, Maeve Hume-Nixon recently qualified as a public health specialist, but may yet end up going overseas.

“I actually thought last year that I would have to go to Australia, where I would be paid another $100,000 minimum, because there were no jobs for me here, basically.

“In the end, I managed to get an emergency extension to my contract and this has continued, but I don’t have security and it’s a pretty frustrating position to be in.”

Neurologist Dr Maas Mollenhauer said he was not able to access the tests he needed to provide care for his patients.

“I’ve seen patients that I have sent for urgent imaging, but they didn’t receive it, and then I got an email from one of my colleagues who was on call, telling me that patient had rocked up to the Emergency Department and, basically, the front half of their skull was full of brain tumour.”

Cancer patients waiting too long
Medical oncologist Dr Sharon Pattison said the health system had reached the point where it was so starved of people and resources, it had become “inefficient”.

“Everyone is waiting for everything, so everything takes longer, and we are waiting until people get seriously ill, before we do anything about it.”

The government’s “faster cancer treatment time” target — 90 percent of patients receiving cancer management within 31 days of the decision to treat — would not give the true picture of what was happening for patients, she said.

“For instance, if I have someone with a potential diagnosis of cancer, there are so many points at which they are waiting — waiting for scan, waiting for a biopsy, waiting for a radiologist to report the scan to show us where to get the biopsy.

“That radiologist may be overseas, so if I want to talk to that specialist I can’t do that. Then the wait for a pathologist to report on the biopsy can now take up to 6-8 weeks.

“We know that, for some people with cancer, if you wait for that long before we can even make your treatment plan, we’re going to make your outcomes worse.

“The whole system is at the point where we are making people more unwell, because we can’t do what we should be doing for them in the framework that we need to.”

This article is republished under a community partnership agreement with RNZ.

Thousands of senior hospital doctors and specialists walked off the job today for an unprecedented 24-hour strike in protest over stalled contract negotiations and thousands of other health workers protested across Aotearoa New Zealand against the coalition government’s cutbacks to the public health service Te Whatu Ora.

In spite of the disruptive bad weather across the country, protesters were out in force expressing their concerns over a national health service in crisis.

Among speakers criticising the government’s management of public health at a rally at the entrance to The Domain, near Auckland Hospital, many warned that the cutbacks were a prelude to “creeping privatisation”.

• READ MORE: Wellington doctors defend nationwide strike action over recruitment

“Health cuts hurt services, the patients who rely on them, and the workers who deliver them,” said health worker Jason Brooke.

“Under this coalition government we’ve seen departments restructured, roles disestablished, change proposals enacted, and hiring freezes implemented.

“Make no mistake. This is austerity. This is managed decline.

“The coalition can talk all they like about spending more on healthcare, the reality for ‘those-of-us-on-the-ground’ is that we know that money is not being spent where it’s needed.”

Placards said “Fight back together for the workers”, “Proud to be union”, “We’re fighting back for workers rights”, and one poster declared: “Don’t bite the hand that wipes your bum — safe staffing now”.

Palestine supporters also carried a May Day message of solidarity from Palestinian Confederation of Trade Unions.

• Photographs: David Robie/Asia Pacific Report    Other photos, videos here
  

Fighting back for NZ's public health system

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National Party leader Christopher Luxon made claims about health outcomes that were clearly false. Why was he left unchallenged?

In the TVNZ leaders’ debate last night, Luxon and Labour’s Chris Hipkins had a testy exchange over Māori healthcare.

Hipkins held firm on the creation of a Māori Health Authority, established last year, arguing strongly that the persistent gaps in health outcomes and care justified it.

• READ MORE: NZ election 2023: Hipkins and Luxon in fast-paced debate but fail to excite pundits
• Other NZ election 2023 reports
• Full RNZ data on Māori healthcare

Luxon was equally clear in opposition to it. He framed his critique of the authority around an alleged complete lack of progress on Māori health outcomes. He was very specific.

“Every single health outcome has gone backwards under Chris’s government,” Luxon said.

“Six years, not one has improved for Māori or for non-Māori.”

While sweeping in nature, Luxon’s claim did not get a direct response from Hipkins.

Luxon repeated a similar line later in the debate.

“Gone backwards. Chris, under your government, every single health outcome for Māori or non-Māori [has gone backwards]. You can’t have that.”

Hipkins did push back on this occasion, citing the ongoing reduction in rates of smoking.

Luxon’s claim was far from true — there are a number of areas where health outcomes for Māori and non-Māori have improved while Labour has been in charge.

But it is perhaps understandable that Hipkins was not quick to correct Luxon because the data — even though it’s better in many respects — is still grim. Maybe Hipkins did not wish to dwell on this.

Improved health outcomes
There are a number of health outcomes where, for Māori, statistics have improved.

Perhaps Labour’s biggest boast is their track record on bringing down lung cancer and smoking rates for Māori.

Lung cancer is the second leading cause of death for Māori in Aotearoa. But according to the Ministry of Health, rates of lung disease for Māori have come down.

In 2017, the rate per 100,000 people was 79.9 for Māori. By 2019, it was down to 68.4. This also aligns with smoking rates among Māori dropping.

Pre-colonisation, Māori did not smoke. However, when tobacco was introduced to Aotearoa in the 18th century that quickly changed.

Smoking has been particularly harmful for Māori who have higher smoking rates than non-Māori and experience greater rates of death and tobacco-related illness.

In 2017/18, the smoking rate for Māori adults was 35.3 percent. By 2021/22, it was down to 20.9 percent (approximately 127,000 people).

Rates were falling under National but they have continued to drop under Labour, which has rolled out a number of initiatives in an effort to reduce nation-wide smoking rates.

As part of the Smokefree 2025 Action Plan, historic and world-leading legislation mandated an annually rising smoking age that will mean that anyone born on or after 1 January, 2009, will never be able to purchase tobacco products.

Other cancers
Overall, cancer registrations rates among Māori fell from 416 per 100,000 people in 2017 to 405.7 in 2019.

Breast cancer registration rates for Māori women fell from 140.7 per 100,000 people in 2010 to 122.5 per 100,000 in 2019. Prostate cancer registration rates for Māori fell from 105.5 for Māori in 2017 to 103.5 in 2019.

For non-Māori, overall cancer registration rates increased slightly from 323.2 (2017) to 332.4 (2019).

Life expectancy
The life expectancy gap between Māori and non-Māori may be the most telling indicator of all when it comes to inequities.

According to the latest available data from 2019, life expectancy at birth for Māori men in 2017-2019 was 73.4 years, up 3.1 years from 2005-2007 data.

The life expectancy for non-Māori men is 80.9 years. For Māori women, it was 77.1 years, up 2 years from 2005-2007. Non-Māori women are expected to live to 84.4 years.

While Māori life expectancy has increased over time, the gap to non-Māori persists.

At the current rate of progress it will be more than a century before Māori and non-Māori have equal life expectancy, a study by the Association of Salaried Medical Specialists found in 2021.

Child immunisation
In the debate, after Hipkins raised smoking as an area of improvement, Luxon said child immunisation was a concern. On this, he was correct.

Over the past six years, child immunisation rates have steadily fallen.

In 2017, 86.2 percent of eligible Māori five year olds had completed all of their age-appropriate immunisations. As of last year, the rate had shrunk to only 71.8 percent. That is an alarming 16 point drop in the period Labour has been in power.

In April of this year a report commissioned by Te Whatu Ora’s Immunisation Taskforce found that immunisation failed to achieve “adequate on-time immunisation rates in young tamariki” and to immunise Māori, meaning those who were most susceptible to “vaccine-preventable disease” had the lowest immunisation coverage.

The report highlighted the worst rate in the country — just 34 percent of Māori children in South Auckland were fully vaccinated. It attributed part of the problem to vaccinators being diverted to the country’s covid-19 pandemic response.

“This caused childhood immunisation rates to plummet. These rates are now the lowest they have ever been and ethnic disparities have further expanded,” it said.

The report outlined 54 recommendations covering funding, delivery, technology, communications and governance across the programme.

In the debate, Hipkins suggested the anti-vaccine movement was part of the problem, which he sought to link with National.

National has proposed an immunisation incentive payment scheme. The plan would see GP clinics paid a lump sum for achieving immunisation targets, including full immunisation for two-year-olds, MMR vaccines for ages 1-17, and influenza vaccines for ages 65+.

The clinics would have to either achieve 95 percent coverage for their childhood patients, and 75 percent for the flu shots, or achieve a five percentage point increase for each of those target groups, by 30 June 2024 to receive the payment.

Labour’s Dr Ayesha Verrall said a similar scheme already existed.

Labour has also failed to halt type 2 diabetes, the country’s biggest and fastest growing health condition.

Ministry of Health figures show that in 2021 there were 302,778 people with diabetes, predominantly type 2. Since the Labour government came into power in 2017, the estimated rates of the number of Māori with diabetes per 1000 has risen from 66.4 to 70.1 in 2021.

The rates for non-Māori have also climbed from 27.8 in 2017 to 30.1 in 2021. It is also important to note that the rate of diabetes in Aotearoa has been steadily rising over the past 50 years.

Type 2 diabetes can also lead to devastating health conditions and complications, including heart failure, kidney failure, strokes and limb amputation.

According to Ministry of Health data obtained by RNZ under the Official Information Act, since 2011 there has been a 39 percent increase in diabetic limb amputations across the whole population.

For Māori, the number has more than doubled in the past decade from 130 in 2011 to 211 in 2021. Under Labour, the number of Māori diabetic limb amputations rose by 15 percent.

Māori are still 2.8 times more likely to have renal failure, another complication of diabetes.

Mental health
According to Te Whatu Ora, the rate of suspected suicide per 100,000 Māori population in 2021/22 was 16.1. This is not a statistically significant change from the average of the past 13 years.

This article is republished under a community partnership agreement with RNZ.

Te Whatu Ora’s new winter health plan fails to address workforce shortages and staff burnout in Aotearoa New Zealand, frontline healthcare workers say.

The organisation launched its 24-point plan on Wednesday, saying it would help hospitals and GPs cope with an expected surge in patient demand over the coming months.

Under the plan, people with minor ailments will be able to be assessed by a pharmacist and given free or subsidised medication in line with if they had visited their GP.

• READ MORE: Other NZ public health reports

Family doctors will also be able to refer patients for X-rays and ultrasounds in a bid to reduce hospital admissions.

Regional and national escalation plans will be in place to help improve hospital capacity by “diverting resources and patients within and across regions to support under-pressure facilities”.

But a doctor from Middlemore Hospital’s emergency department, who spoke on condition of anonymity, said while diverting patients and resources sounded “good in theory”, there needed to be the staff available to deliver that plan.

There was so much burnout among doctors and nurses, she said.

“You can’t flog a dead horse.

Staff ‘not available’
“In practice these escalation plans involve going through a checklist of different resources that can be provided to help, but you then find out they aren’t available — due to staffing issues.”

A nurse from the hospital’s ED agreed chronic workforce shortages would prevent many of the proposals ever working.

“It all sounds all great, but where is Te Whatu Ora finding all the staff to do these things and how are they going to do it in a healthcare system that is already understaffed and in crisis?”

Giving pharmacists a greater role to play could also be problematic as they were also busy and were not trained to diagnose patient ailments, the nurse said.

In February, Te Whatu Ora identified Middlemore Hospital as one of eight national ‘hotspots’ needing extra support before the winter flu season.

Former chairperson Rob Campbell admitted the workforce shortages plaguing Middlemore’s ED would not be addressed in time for the flu season.

It followed comments from frontline healthcare workers who said the hospital’s ED was haemorrhaging staff and they were concerned about its ability to function during winter.

‘Doing what we can’
In a statement, Te Whatu Ora (Counties Manukau) interim lead of hospital and specialist services Dr Vanessa Thornton said while there had been growth in staffing numbers nationally, it needed to continue to grow its workforce.

“We know that pressure from shortages across our workforce is being felt on the frontlines of our health system. We can’t fix those shortages quickly – but are doing what we can to alleviate pressure and get more staff into our hospitals and other services.”

She said that includes making it easier for internationally qualified staff to work here and assisting qualified nurses to return to practice.

Local Democracy Reporting is Public Interest Journalism funded through NZ On Air. It is published by Asia Pacific Report in collaboration.

South Auckland’s poor turnout for the 2018 Aotearoa New Zealand national census could have cost the region $130 million in health funding.

And, according to an expert, that cash could have helped tackle the area’s battles with diabetes and obesity.

Te Whatu Ora Health New Zealand said the defunct Counties Manukau District Health Board lost $130m in health funding in its last four years due to the low turnout in the area during the 2018 census.

• READ MORE: Other NZ census reports

Information from the five-yearly stocktake helps determine how billions of dollars in government spending is allocated across health, education, transport, infrastructure and other services.

Counties Manukau has more people with diabetes than any other health region in the country.

Te Whatu Ora (Counties Manukau) Director of Population Health Gary Jackson said additional money would help fund programmes to battle two issues affecting many people in the region.

He said there were 52,000 diabetics in Counties Manukau and that figure was growing by 2000 people a year. It is also home to 19 percent of all New Zealanders in the most extreme BMI group.

Only 71 percent response
Figures released by Stats NZ this week show only 71 percent of people in South Auckland have so far completed the census in 2023, compared to 83 percent nationwide.

Te Whatu Ora Chief Financial Officer Rosalie Percival said getting people to provide their details was vital to ensure areas like Counties Manukau got the healthcare services they needed.

“Health providers know about the people who turn up at their door needing care — but they have no other way of knowing about the presence of people who haven’t recently needed to use the health system,” she said.

“The data gained from the census helps to inform important decisions about planning for the needs of local areas and subsequently healthcare spending.”

However, Buttabean Motivation (BBM) founder Dave Letele said getting people to complete the census was not easy.

Letele, who is potentially standing for Te Pāti Māori this year, was an ambassador for Census 2023 and was involved in a social media campaign which kicked off late last year to get more people to take part.

“There’s a massive distrust between our people and the government and that’s what we need to overcome,” Letele said.

Wary about personal information
He said as a result a lot of people were wary about sharing their personal information with authorities.

“But it’s not just something you can throw money at to fix it.”

Deputy Government Statistician and deputy chief executive for census and collection operations Simon Mason confirmed the turnout at the last census in 2018 was poor in Counties Manukau.

“That is why it is critically important that people complete the census — so their communities are counted . . .”

Mason said the 2023 event was designed to address barriers to participation, including having more collectors and alternate formats for people to complete it and support a wider range of people.

A spokesperson for Stats NZ said it would still have field teams collecting people’s responses until May 3 and will be running census support events until June 4.

Pacific Media Watch reports that the Counties Manukau health population is ethnically diverse with the largest Pacific population and second largest Māori popukation of any New Zealand health board.

In the 2018 census, 16 percent of the population served by CM Health identified as Māori, 22 percent as Pacific, 28 percent as Asian and 34 percent as NZ European/other groups.

Local Democracy Reporting is Public Interest Journalism funded through NZ On Air. It is published by Asia Pacific Report in collaboration.

COMMENTARY: By Rob Campbell

Just as we are making some progress on diversity and inclusion policies in business governance and management my perverse mind is starting to have doubts.

Initially around gender diversity I was an enthusiastic camp follower. It seemed a relevant part of progressive social change.

As Te Whatu Ora chair, I was an advocate and supporter of a much stronger role for Māori in health governance and management. I was a strong promoter of inclusion in all my roles such as at Summerset, Tourism Holdings and Sky City.

• READ MORE: Other Rob Campbell articles

I was recognised for this when awarded Chair of the Year a few years back, and the Beacon Award from the Shareholders’ Association at about the same time.

I think that we have made progress at business board and senior management level — by no means complete but barriers have been reduced and seats filled more appropriately.

I confess that even while I and many others were advocating and implementing this, my doubts crept in as the narrative morphed from one primarily about rights into one more based on demonstrated benefits, for example, to profitability.

Then the prize-giving started, the “champions” preened, and one could not help but wonder what interests were really being served. It really was not all that difficult or radical in its impact as after all — the replacements were from the same class and education and non-cis gender characteristics as the old.

Long overdue
It is a good thing rather than bad of course, long overdue and still far from complete.

But the old hierarchies and principles of business control, practice and ownership have not been that much affected. We have more women in influential roles but the roles and expectations of those in the roles have not changed very much. Higher gender representation is a step on the way to gender equity in the workplace but not a final goal.

My perception is that ethnic diversity is facing an even harder road. There has been some progress but it seems that neither the will nor the availability of “suitable” candidates is as strong as it is on gender.

Of course this tells us something — our perception about what is “suitable” is limited and excludes all but a few from non-Pākehā communities. It is not that such communities do not have highly capable leaders but that the capability does not readily match the ways business expects its governance and management to be.

You could be kind and call this a cultural difference. Similar issues may hold back business governance diversity in terms of non-cis gender differences and neuro differences. Maybe what business wants is not real and far reaching diversity but “acceptable or non-disruptive” diversity.

Welcome to the boardroom and the executive floor on the terms that have always prevailed.

So this makes me think about “inclusion” too. There is an increasing range of inclusion programmes, training and schemes. My inclination is to welcome and support these and, as with gender, I have seen and celebrated individuals step up within such processes and succeed.

Cue more prizes, awards and media releases.

Common theme
But I see a common theme as we progress. Business is making pathways some for people from other cultures to become acceptable or suitable — on the terms of business. Colonialism has always done this politically and we can see this commercially as well.

These are adaptable social systems well capable of changing appearance without changing substance.

Companies co-opting or paying mere lip service to diversity and inclusion? It’s almost universal.

I admire the people who take these opportunities. They often have to change a lot, to take on more than their peers at work, to model and represent. But business inclusion is inclusion into the world of business not business changing to match another culture, other than quite superficially.

I wonder if these processes are not more akin to “assimilation” than genuine diversity and inclusion. That is, always on the terms of the boss. Welcome to our club, on our terms. This assumes superiority of culture.

Just like assimilation sought to obscure and diminish the outside, the minority, the different in order to seem to include. Ultimately assimilation was seen for the destructive force in social policy that it was — a steamroller to flatten diversity not to encourage it.

Like assimilation, I don’t think, now that my thoughts have run to this point, that our “D&I” policies, appointments and programmes, will really be much of a force for change.

That does not make them bad, but lets not pretend they are more than they are. The same people still mainly fill the same roles according to the same rules, doing the same things, as they did before.

I welcome anyone who can convince me otherwise. I don’t like being the grumpy, cynical old man.

Rob Campbell is chancellor of AUT University and chairs NZ Rural Land Co and renewable energy centre Ara Ake. He is a former chair of health agency Te Whatu Ora, the Environmental Protection Authority, SkyCity Casino, Tourism Holdings, WEL Networks and Summerset. He trained as an economist and originally worked as a unionist before eventually becoming a professional director. This article was first published by Newsroom and is republished with the author’s permission.

In Pyongyang there is a public service which would appeal to our own Public Service Commissioner in Aotearoa New Zealand. It never makes any dissenting or controversial view known.

Rather it readies itself for any potential change in the face of the Kim family leadership. Ever ready to resume the daily grind of boot-licking and box-ticking of a docile public service.

It is, as I like to say, neutered rather than neutral, but from above it can be very hard to tell the difference.

• READ MORE: Health NZ chair fired over ‘political’ post, but says govt ‘overreacted’
• Rob Campbell on thin ice after Three Waters comments
• Rob Campbell ‘very disappointed’ over removal as EPA chair – ‘Muldoonism in action’

In the ideal world that seems to be preferred in “PyongPoneke”, there is no room for open debate and each word means what the Public Service Commissioner says it means.

It is rather like the world described by Lewis Carroll: “When I use a word”, Humpty said in a rather scornful tone, “it means just what I choose it to mean — neither more nor less.”

“The question is,” said Alice, “whether you can make words mean so many different things.”

“The question is,” said Humpty Dumpty, “which is to be master — that’s all”. Thank you Commissioner Humpty for your work taking the word “impartiality” out of the dictionary and into the public service world.

Imperial and colonial past
I am not against the public service. I am strongly for an excellent, efficient, equitable and effective public service. But you do not get that in a modern and complex society from a model of public service derived from a monocultural, inequitable and dare I say it (yes I do) imperial and colonial past.

In the real world what they like to call our public service is in fact a politically subservient service, far removed from the public it is supposed to serve.

This comment is not directed at the many thousands of public servants working closely with those they serve.

These people, the real public service, are often underpaid and overworked. They spend much time battling with the rules and processes and prejudices imposed on them by those at the top of the tree. Many are scared to speak up, so they leave or stay quiet.

I understand why, they need the job too much to risk being branded difficult. Not a few of them write to me, call me, or stop me in the street. And it is not to say “get back in line”.

They and the mandarins themselves know what the problem is. There is a square mile or so around the Beehive in Wellington, which is like the Vatican in Italy. A different country within a country. The world looks totally different from there.

Those there are mainly there for the same reason, and they are faced inwards, mentally at least, towards what they see as power and away from the people, the public they are supposed to serve.

They cannot understand Ōtara, or Cannons Creek . . .
They cannot see, hear or understand those in Ōtara, in Te Tai Tokerau, in Tairāwhiti, in Cannons Creek, on the West Coast or rural Southland.

Alongside the big consultancy firms that share their buildings, their CVs and their views, senior advisers draw up plans for the rest of us on whiteboards.

These are parsed by the “tier one” people who over coffee, wine, or whisky cosily massage these into an acceptable form for politicians. Just enough choices to create an illusion of political control, but not so much as to upset the system.

Are these people impartial or neutral ? No, they do not need to be. They have strong views which reflect the caste they belong to. Some of them even jokingly refer to this as “Poneketanga”.

They engage rafts of “communications” people to sell the story — often poorly as in Te Whatu Ora, where there are more than 200 such people and where despite that overload PR firms are often called in to sell better.

Back to basics
This is not a way to create an efficient, effective, excellent and equitable public service. To do that we will have to go back to some basics about the purpose of public service today and in the future.

To my mind this would include:

• Opening up jobs to a much wider range of people with real world experience, be that commercial or social, in forms that are not all for a lifetime, but which enable free and ongoing interchange;
• Opening up policy-making to start from the “bottom up”, and which are not based on “top down”, carefully framed, bogus consultations;
• Allowing people to speak their minds and debate difficult issues without having to assume that future political winners are not so prejudiced and narrow-minded as to refuse to work with anyone with a different opinion to theirs; and
• Paying real attention, not playing pretend attention, to the professional bodies and unions which represent staff, who mostly will prefer rightly to get on with their jobs.

None of that seems hard or dangerous to me. After all, it is only changing a public service model which has produced or failed to prevent all of the many crises we can observe around us.

Rob Campbell is former chairperson of Te Whatu Ora (Health New Zealand) and the Environmental Protection Agency (EPA). This article was first published by Stuff and is republished by Asia Pacific Report with the author’s permission.

The baby in Aotearoa New Zealand whose parents did not want him to receive blood from people who may have had the covid vaccine underwent urgent heart surgery today.

Anti-vaccination lawyer Sue Grey confirmed to RNZ Checkpoint late this afternoon that the baby, known as baby W, had undergone surgery today.

Grey said she had received a text message from the baby’s parents confirming the surgery was finished and the six-month-old was doing well.

• READ MORE: No appeal against ruling in NZ baby blood case, surgery to go ahead
• Other blood case baby reports

Baby W was this week placed under the guardianship of the High Court until the completion of the surgery and post-operative recovery.

Te Whatu Ora asked the High Court to take guardianship of the baby this week to allow the surgery to go ahead with blood from the NZ Blood Service.

Doctors from Te Whatu Ora were made agents of the court to carry out the surgery, including the administration of any blood products, while his parents were agents of the court for all of his other care.

Protesters gathered near Auckland’s Starship Hospital today to support the parents.

Protesters near hospital
About 60 protesters were near the hospital many with signs such as “do not experiment on our children” as they awaited an update on whether the operation had gone ahead this morning.

A new ruling last night ordered the parents not to obstruct health staff at Starship Hospital.

In a statement this morning, police confirmed they were present at the hospital yesterday evening and overnight.

In a statement last night, Justice Gault said he had been informed by the lawyer acting for Te Whatu Ora that the baby’s parents had prevented doctors from taking blood tests, performing a chest X-ray and an anaesthetic assessment.

The parents objected and the hospital asked the police for help.

A new ruling last night ordered the parents not to prevent medical staff from carrying out their work.

The health service said officials would not be commenting on specific details of individual patient care or providing clinical status updates for ethical and privacy reasons.

Person trespassed
Te Whatu Ora Te Toka Tumai Auckland Interim Director Dr Mike Shepherd had said it remained a priority to work alongside the baby’s whānau to care for him.

“In addition, we’re doing everything we can to support our teams through a difficult situation for all involved,” he said.

He confirmed a person had been trespassed from the hospital.

“As general comment, from time to time, it may be necessary to trespass an individual or individuals from our site, sometimes only for a few hours, if they are impacting on our clinical team’s ability to care for patients.”

This article is republished under a community partnership agreement with RNZ. 

The parents of a New Zealand baby at the centre of a legal dispute that has made global headlines will not be appealing against a judge’s decision to hand guardianship of the child to the High Court.

The four-month-old — known only as Baby W — requires urgent open heart surgery, with both blood and blood products required for the operation and potentially its aftermath.

Te Whatu Ora/Health New Zealand took the case to court because the parents refused to allow blood transfusions from anyone who might have had the Pfizer covid-19 vaccine.

• READ MORE: Vaccinated donor blood: Parents’ meeting with doctors ‘hijacked’ by anti-vax support person
• LISTEN TO RNZ MORNING REPORT: Interview with University of Otago bioethics lecturer Josephine Johnstone duration

The NZ Blood Service does not differentiate between blood from vaccinated and non-vaccinated people, saying there was “no evidence that previous vaccination affects the quality of blood for transfusion”.

A judge on Wednesday ruled in favour of Te Whatu Ora, allowing the surgery to go ahead with whatever product the NZ Blood Service provides. Doctors, having been made agents of the court for the surgery, said on Wednesday afternoon they would be ready to operate within 48 hours.

The family’s lawyer Sue Grey and high-profile media supporter Liz Gunn said this morning there was no time to appeal against the court’s decision, but they had confidence the child would “get the best possible care with the best, safest blood” because “the government cannot afford anything to go wrong for Baby W as the world is watching”.

“The priority for the family is to enjoy a peaceful time with their baby until the operation, and to support him through the operation,” the pair said in a post on the New Zealand Outdoors and Freedom Party Facebook page.

Grey co-leads the party.

The baby will be in intensive care for up to a week and under Te Whatu Ora’s guardianship possibly until the end of January, allowing time for their recovery. The doctors were told to keep the parents “informed at all reasonable times of the nature and progress of [the baby’s] condition and treatment”.

Te Whatu Ora has been approached for comment.

Judge’s ruling expected
The ruling should not have come as a surprise, University of Otago bioethics lecturer  Josephine Johnstone told Morning Report on Thursday.

“This may seem like a very 2022 case and it is in many ways, but it connects to lines of decision over time where there have been disputes about what’s in the best interests of a child that has very serious medical needs,” she said.

“So this is consistent with previous cases around the refusal of blood products for children whose parents are Jehovah’s Witnesses… or refusal of medical care for cancer treatment for children whose parents have alternative health and science[ views, which is sort of similar to this. In many ways it’s consistent with those decisions. It’s not really a break in that way.”

Johnstone said the parents’ authority over their child’s health and upbringing was being limited in only a very minor way.

“The parents still have all of the other decision-making authority that parents have. And parents do have enormous latitude to make decisions about how to raise their children — what religion to raise them, what kinds of beliefs, what kinds of home to create, what kind of traditions, they have enormous decision-making power about children’s [medical treatment], but it’s not unlimited.

“In very rare cases where it’s a life-and-death situation, we can expect the courts to step in — and that’s exactly what happened.”

Johnstone’s view was backed up by Rebecca Keenan, a former nurse who now works as a barrister, specialising in medical law.

Put child ‘firmly first’
“[The court has] put the child firmly first and have gone by the evidence and supported the health board,” she told Morning Report.

“From reading the judgment, you can see that the parents have been taking their baby out of hospital, against medical opinion, and there’s obviously been a real breakdown in the relationship between the parents and the medical staff.”

Wednesday’s judgment outlined a meeting in late November during which the parents’ support person “proceeded to pressurise the specialists with her theory about conspiracies in New Zealand and even said that deaths in infants getting transfusions were occurring in Starship Hospital”.

Johnstone said while having a support person in meetings with medical staff was a right, it was clear in this case they were not helpful.

“One has to imagine that the involvement of some of the anti-vaccine campaigners has escalated not just this case at the national level, but even the discussions between the family and their medical team, so that’s explicitly mentioned in the case and is definitely a factor in how things must have got to the point where a court order would be needed.”

While not an unexpected ruling, Johnstone fears it might further strain the relationship between parents with alternative views on medical matters and their doctors.

“Any family who has these views and has a very sick child, their healthcare providers are going to have to work that much harder to keep them engaged and keep their trust … a big challenge,” she said.

Pleased over care
Speaking to RNZ’s First Up earlier on Thursday morning, Deputy Prime Minister Grant Robertson said he was “pleased” Baby W would soon be getting the care he needs.

“Nobody underestimates the emotion and the challenge and the difficulty here, but we have to do what’s right for the child.”

The case has made headlines globally, with coverage on BBC News, CNN and The Guardian.

This article is republished under a community partnership agreement with RNZ. 

Manukau Urban Māori Authority (MUMA) is welcoming the government’s health reforms as an important first step to improving Māori and Pasifika health in south Auckland.

But some in the health sector say the jury is still out on what will be achieved in Counties Manukau.

Under the reforms, the country’s 20 district health boards have now been replaced by Te Whatu Ora (Health New Zealand).

• READ MORE: Other Health New Zealand reform reports

The new Crown entity will be responsible for running hospitals, primary and community health services.

The government says it will allow for more consistent delivery of health services nationwide and help stop the postcode lottery people face accessing healthcare based on where they live.

The reforms also include the establishment of Te Aka Whai Ora (the Māori Health Authority) to improve indigenous health which will work in partnership with Health NZ.

Muma chairman Bernie O’Donnell has seen the country’s district health boards work first-hand, as a member of the now-defunct Auckland DHB.

Greater responsibility for Māori
He said establishing a Māori Health Authority would give Māori greater responsibility for the delivery of their own health services.

“For too long the health system hasn’t addressed the wellbeing of Māori, or those at the bottom of the cliff,” O’Donnell said. “The reality is we couldn’t continue with what we had. Something had to be done and this is it.”

He said critics of the health reforms are defending a system which had to be replaced.

“The old way the DHBs were run didn’t work for our people. For too long it’s been non-Māori telling us what’s best for us.”

He said ongoing issues left by the Counties Manukau DHB, such as Middlemore Hospital’s under-pressure emergency department and its workforce shortages would all have to be addressed under the changes.

“But what we’re expecting is that Māori and Pasifika health in south Auckland will get better under the reforms,” O’Donnell said.

However, he admitted there’s a lot at stake.

‘Time will tell’
“If that doesn’t happen we won’t have achieved anything of significance,” he said. “But only time will tell.”

Yet not everyone is as certain as O’Donnell on what impact the changes will have.

Turuki Healthcare chief executive Te Puea Winiata said there were still a lot of unanswered questions about the reforms.

Winiata said the creation of the new authority dedicated to indigenous health is an important first step.

But she said it was vital that the new entity had the ability to make its own decisions and help support Māori self-determination.

“The resourcing of the Māori Health Authority is going to be critical to its success,” she said.

Many reform attempts
Winiata said she had worked in the health sector for the past 30 years and in that time had seen a number of attempts by the government of the day to restructure the health system.

She said it was hard to predict what impact the health reforms would have in south Auckland.

“But I think in 12 months’ time we will be able to look at what changes have been made and see what’s been achieved.”

Local Democracy Reporting is Public Interest Journalism funded through NZ on Air. Asia Pacific Report is an LDR partner.