New Zealand is presented often as having a ‘world class’ health system, however it is underfunded and understaffed, with some regions suffering from a severe lack of medical specialists.

By April 2015, according to the World Health Organisation, New Zealand health system ranked 41st in the world, behind Singapore at 6th, the UK at 18th, Australia at 32nd, the USA on 37th place & Cuba at 39th.

Every year there are hundreds of avoidable deaths in the country’s hospitals. For example, in 2013  Eunice Richardson, 80, died after she was given Trimethoprim, a bacteriostatic antibiotic for a urinary tract infection when she was recovering from hip surgery. She was wearing a MedicAlert bracelet warning about her severe reaction to Trimethoprim, and each page of her documentation bore a large orange sticker warning about her allergy. “She was very particular about it and making sure that every doctor knew about it,” her husband Laurie Richardson said. She lost 60% of her skin to massive swollen blisters and died in pain in her husbands arms.  Her death prompted nothing more than an apology from the Canterbury District Health board chief executive David Meates. source

Many Kiwi patients say their health system is not held accountable when things go wrong. For example. Lynne McKay’s life was ruined for years by multiple hip replacements that left her in agony. “What really hurts” the former registered nurse said “is that our health system still fails to hold anyone responsible.” source

This was published in a daily newspaper, Sept 2012:

“Several hundred lives would be saved each year if some of New Zealand’s highest public hospital death rates were brought down to those of the better-performing district health boards.

A Herald investigation has found that the Waikato District Health Board has had among the highest in-hospital “standardised” mortality rates in recent years.

In a five-year period, it had the highest rate for three years…” more here

Another one of New Zealand’s most shocking health statistics is its very high suicide rate. A Mental Health Commission report showed New Zealand’s suicide rate for girls aged 15 to 19 is the highest in the OECD (August 2011) source

There is also a reluctance to release data on hospital morbidity, this is from the article above:

“Figures comparing hospital death rates are routinely available to the public in Britain and Canada, and Australia has endorsed using this kind of information as an indicator of healthcare quality and safety.

In New Zealand, the details have not been readily available, and the five-year figures for the Herald investigation were obtained from the ministry under the Official Information Act.”

There have been countless privacy breaches, the most recent being the release of the private medical information of 24,000 New Zealanders. Their highly confidential personal details were sent in a spreadsheet to almost 1,000 pharmacists in an email that was intended for internal viewing only source:

A number of Government agencies have admitted privacy breaches over the last three years. In 2013, a major breach by the Earthquake Commission saw details of more than 80,000 claimants sent to the wrong email address.

The EQC also sent a claimant an email with an attached spreadsheet with 2200 names, stopped cheque details and claim amounts worth about $23 million.

Also in 2013, the Ministry of Education owned up to a staff member attached the wrong letter to an email, Immigration New Zealand sent two emails with client email addresses to more than 200 advisers, lawyers and individuals, the Ministry for the Environment sent about 150 people each other’s private email address and a Hawkes Bay District Health Board worker mistakenly released a patient’s confidential medical file to the media.

Maternity

Although New Zealand scores highly on ‘best place to be a mother’ surveys, the reality for pregnant women and their children is often harsh, embarrassing data is often not made routinely available to the public:

aim.org.nz

• “Every year in New Zealand, more than 600 babies die during and around childbirth.  Many of these deaths are registered ’cause unknown’.

• In New Zealand, the Ministry of Health counts ‘live’ babies and ‘dead’ babies.  There is no nationwide register for children injured or disabled at birth.  Even the most severely brain injured children don’t count as such.

• In the 1960s New Zealand ranked amongst the top five countries in the developed world for our low infant death rate.  We’re now in the bottom ten.

• You are twice as likely to die as a pregnant or new mother in New Zealand than you are of being killed on the roads.

• 50% of all pregnancies in New Zealand require medical assistance for the safety of the mother and/or child.

• 15 years ago midwives had to be trained nurses – now they don’t.  However they can now work independently and apart from any medical assistance.”

• “The Ministry of Health has ordered a review of neonatal services amid concerns about overcrowding. Mothers are transferred to other cities to give birth when their own hospital’s neonatal unit cannot accommodate them. Twenty-eight women were transferred from Christchurch Women’s Hospital in the 2013-14 financial year. A further 12 were transferred in the second half of last year. The unit is funded for 41 cots and has space for 46, but at one stage last year had 54 babies in its care.” (March 2015)

• “Christchurch Women’s Hospital is sending mothers to other cities to give birth because of neonatal unit overcrowding. Twelve were transferred in the second half of last year. In the 2013-2014 financial year 28 were transferred. The neonatal unit has 41 cots, 11 of them in intensive care and 30 in special care. Last year the unit exceeded that capacity every month except one. At one stage last March there were 54 babies in the unit. In April the unit was over capacity for the entire month, reaching 49 babies. In September the unit had 52 babies in its care and was over capacity for 26 days.” (March 2015)

Disease, Ill Health and Morbidity

• “Hospital admission rates for skin infection in young children in New Zealand are higher than in other developed countries and have steadily increased over the past 20 years, a study says. A study of two bacteria most commonly responsible for rheumatic fever and skin infections – Staphylococcus aureus and Streptococcus pyogenes – by a group of researchers from Auckland University was this week published in the New Zealand Medical Journal.” (March 2015)

• New Zealand is known as the skin cancer capital of the world. Within the country Taranaki has the highest incidence of skin cancer with 70.3 per 100,000 people. The next-worst is the Waitemata District Health Board region with 50.2,  the Bay of Plenty 40.8,   Nelson-Marlborough 42.8 and Southland had the lowest at 20.1. The overall rate for New Zealand rate is 51.8.

• Every year there are  about 500 completed suicides in New Zealand, plus 5,000 hospitalisations. New Zealand leads the world in the highest rates of suicide for under 36 year olds.

• There is little support for the families of suicide victims and NZ society treats suicide as a taboo subject, despite it killing 50% more people than die in road traffic accidents every year.

• “A spate of meningococcal cases in Northland has health authorities on the verge of declaring an outbreak, as an eighth person is admitted to hospital with symptoms of the disease. Seven people have contracted meningococcal disease in the region, with two deaths during the past two months.” (8 september 2011)

• “The Gisborne region is “clap capital” of the North Island, according to latest figures on sexually transmitted diseases, with Hawke’s Bay not far behind. The highest overall annualised rate – per 100,000 population – of gonorrhoea was reported for Tairawhiti DHB (314) followed by Hawke’s Bay DHB (123). Over 60 percent of the positive patients were aged 15- to 24-years, with the highest incidence in the 20- to 24-age group for men and the 15- to 19-year age group for women.”

• Kiwi youth suffer some of the worst health outcomes in the developed world. New Zealand youth have higher rates of mental illness, suicide, teen pregnancy and suffered more injuries than young people in other OECD countries.

• Out of a population of 4 million there are 360,000 working-aged New Zealanders on welfare benefits or accident compensation. That’s 12.4 per cent, or one eighth, of all those aged 15 to 64 – up from just 2 per cent a half-century ago.

• Cancer testing at Wellington Hospital “was so poor auditors were worried about the “potential implications for patients’ treatment”. An audit, released under the Official Information Act, shows an area of the histology lab that tested cancer tissue for treatments had problems stretching back for at least a year.

• Around 1,100 New Zealanders die prematurely from air pollution with an associated health cost of $1.14 billion every year, according to a Health and Air Pollution in New Zealand (HAPINZ) report. Much of the pollution comes from the solid fuels (coal and wood) that many households use as their chief source of heat during winter.

• 50% more Kiwis die of heart attacks each year than in comparable countries. NZ suffers 63 deaths per 100,000. The median for OECD countries is 44.  “New Zealand spends far less on hospital and healthcare per person” according to report by Johns Hopkins University.

• More than 83 New Zealanders have drunk themselves to death since July 2007, coroners’ figures show. Another 1000 people a year were estimated to die of alcohol-related causes, and thousands more were injured as a result or their own or somebody else’s drinking.

• “NZ has 14 times the average OECD rate of rheumatic fever, five to 10 times the rate of whooping cough and pneumonia compared with the United Kingdom and United States, and four to six times the rate of child maltreatment compared with the best countries.”

• NZ’s Road death toll is twice that of the UK. I n 2007/8 there were 366 road deaths in New Zealand, that’s 8.6 road deaths per 100,000 of population, the UK’s  average is 4.3 road deaths per 100,000 of population

• 29 people died and at least 540 were seriously injured in adventure tourism activities over a 5 year period.

• Road accident deaths in Northland since 1980 are equivalent to the population of a small NZ town.Over 1,100 people have died.

Health Service

Effects on Patient Health

• “A former Blenheim midwife who told a teenage mother to keep her legs together and be “ladylike” after a tear that meant she could barely walk for weeks has been reprimanded by the Human Rights Review Tribunal. A declaration by the tribunal at the end of February found Natasha Thomson breached the Health and Disability Commission Code of Consumers’ Rights by failing to provide services of an appropriate standard to a 16-year-old mother. The tribunal decision said Thomson was working as a community-based registered midwife in 2011 when she started providing care to the patient. Thomson had been working as a midwife for about nine months at the time.”
• “A Christchurch woman died from fatal error made while she was undergoing treatment for an aneurysm (March 2015), a coroner’s inquest has heard. Bonnie Schlef died on February 14, 2013, two days after she was admitted to Christchurch Hospital to undergo a coiling procedure for treatment of an aneurysm…(she) suffered a fatal injury when the interventional radiologist, Dr Andrew Laing, forgot to deflate a balloon being used to help insert the coil before trying to withdraw it from her vertebral artery.”

• “The family of a man who died after his broken leg was untreated for four days say the hospital’s weekend woes have not been addressed more than three years later. Farmer Foster Percy was fit and healthy when he went into hospital. Four days later he was dead. His family say his fate shows the peril of going into an under-resourced hospital on a weekend. The Health and Disability Commissioner has found there was a “significant oversight” in the care 73-year-old Percy received. Wairarapa District Health Board has since apologised to his family for its errors and promised changes.” The hospital was Wairarapa Hospital in Masterton.

• ‘Frustrated’ geriatrician leaves – bad news for New Zealand: “Dr Gerry McGonigal has expressed frustration at the way elder care and stroke services are arranged and delivered in many New Zealand hospitals. He is returning to the UK this month. This is bad news for New Zealand, which faces an overall shortage of geriatricians. Wellington hospital not having a specialist stroke unit is very unusual for a major tertiary centre in a developed country. “I could understand a very small hospital not having a stroke unit but this is a main centre. Stroke units were one of the major therapeutic advances of the late 20th century! Without such a unit it is not possible to deliver quality stroke care and this is one of the main professional drivers I have to return to the U.K,” he says. source (9 Sept 2011)

• A shortage of Oncologists in the central part of the North Island means that some cancer patients are being refused chemotherapy. Instead of being placed back on waiting lists patients are being referred back to their own doctors (Jan 2011) Affected patients include those suffering relapses of some cancers, including cervical, oesophagus and melanoma. Chief Exec of the NZ Cancer Society said “It might not be what we want to hear, but it is honest … It is good to know they will not be hiding patients on waiting lists.”  But the list of cancers that won’t be treated had only been intended for clinicians to see, not the general public.

• Cancer treatment services are under such pressure that current treatment levels are unsustainable unless more money is spent. Rationing is likely to “become a feature.” An economist said that New Zealand’s cancer-treatment rates were lower than the average for developed countries.”Already we have unmet need, so I guess the message is, get used to it.”

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

• Hospital errors causing serious harm are rising. In the year to June 2010 there were “374 patients who were involved in a serious or sentinel event, of whom 127 died; compared with 308 events, including 92 deaths, the year before.”

• “Gynaecology patients are facing long waits to see specialists at Blenheim and Nelson hospitals.” 40% of patients on the hospitals’ waiting lists are women waiting to see a gynaecologist. Gynaecology as a “big area of concern” which has failed to meet Health Ministry targets every month since August 2010. Very often women are referred back to their GPs instead of a specialist. (source) Click on the link to see details of the lists for Wairau.

• One woman, who needs a hysterectomy urgently and has been hospitalised with recurrent haemorrhaging,,  has been waiting for five weeks and hasn’t even received a referral letter to tell her when she will see a specialist.

• An 85 year old woman had a not-for-resuscitation order placed on her file at Palmerston North Hospital, her son says that it was done without either her, or her family’s, consent.

• A Golden Bay resident was allegedly told by a hospital to engage a private nurse to care for her sick mother because they were too busy to give her mother the care she needed. It cost Ms Davis $100 a day for 10 days for a private nurse to come into the hospital to look after her mother, Josephine Fargo.

• A 100 year old woman died from scabies, after her condition had gone untreated for too long at a Tauranga rest home. A Herald article said that the family of the dead woman weren’t alone in their concerns over her treatment and care. “Several recent reports point to a tsunami of problems bearing down on the sector: a burgeoning ageing population; a lack of facilities; a lack of Government money; and poor standards, auditing and complaints procedures.

• Access to contraception is limited because the NZ market is too small for some companies to operate in. NZ women are missing out on a wide range of contraception available in other countries. New Zealand’s annual abortion rate is 19.7 per 1000 women, compared with 7.2 in Germany, 13.2 in Scotland and 19.3 in Australia. Source

• Thousands of people attended protest rallies in Southland in an effort to prevent neurosurgery facilities being closed down in Dunedin and moved to Christchurch, an hour’s flight time away by emergency helicopter.
  

• Fees for after hours medical services are putting young lives at risk in Porirua: $17 for children under 6 and up to $56 for older children.Half of Porirua’s children live in low decile households.

• A fault in a refrigerator at Wellington regional hospital may have gone undetected for 10 years. The viability of up to 16,000 tetanus boosters may have been affected and patients may not be fully immunised against tetanus

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

• Pharmac has just announced that it will at last fund a drug to treat Alzheimer’s – more than a decade after it became available (May 2010) They waited until until one of the original drugs, containing donepezil, came off patent and a generic version was offered at a greatly reduced price.  More than 40,000 people in New Zealand are believed to have dementia. More than half have Alzheimer’s.

• “A drug credited with saving lives is facing unacceptable delays for public funding” say a cancer specialist. MabThera, (rituximab, commonly used in other countries) is one of a new generation of smart drugs like Herceptin that targets specific characteristics of cancer cells, is already funded for an aggressive form of lymphoma. But the application for it to be used for follicular lymphoma, which makes up about a third of the 770 lymphoma cases in New Zealand, has languished among drug agency Pharmac’s decision-making processes” said Auckland oncologist Peter Browett. (source)

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

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

Effects on Medical Staff (violence at work, stress etc)

• The Head of Wellington’s District Health Board has quit his $430,000 a year job rather than  than make any further cuts that could jeopardise patient care. The opposition party say that that government cuts are pushing the health system to the brink of a financial crisis.

• “Hospital staff are not reporting an increasing number of assaults because of an ingrained acceptance of patient violence, workers and unions say. At least one Wellington Hospital worker has resigned and others have taken up to six days off work in the past nine months because of assaults. That situation is mirrored at other hospitals.”

• Tauranga Hospital staff were assaulted 40 times on the job last year and police were called to the hospital 35 times following assaults.

Under Staffing

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

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

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

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

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

• “New Zealand’s paediatric surgeon work force is declining as trainees are lured to Australia… Between 2005 and 2009, the number of paediatric surgeons dropped from 16 to 14. Christchurch Hospital clinical director of paediatric surgery, Spencer Beasley, said New Zealand needed 18 or 19 paediatric surgeons. There was a worldwide shortage and only three of the past eight Kiwi trainees are working in New Zealand.“

• Junior doctors at Christchurch Hospital say patients and doctors are at risk because of understaffing. A spokewoman for the RDA said that over the last 4 weekends there weren’t enough junior doctors on duty. The acute area only had 3 out of a necessary 5 juniors and there was neither an orthopaedic house surgeon, nor an acute-surgical house surgeon on duty over the weekend, or the previous night. According to a report in The Press the doctors were supported by the out-of-hours clinical coordinators who had written to the CDHB chief executive saying that “shortages were compromising patient safety.” (27 Jul 2010)

• A surgeon has been censured again for speaking out over his concern about the safety of radiololgy services in W(h)anganui. “Mr Solomon said in March a single Whanganui radiologist was doing the work of three doctors and was being paid more than $600,000 a year – three times the usual radiologist’s salary…In 2007, Mr Solomon was censured for the first time by the board, for speaking out about patient safety fears because of alleged staffing shortfalls.” (July 2010)

• “Taumarunui Hospital is facing a critical shortage of qualified medical staff after one of its remaining two doctors resigned in the wake of the town’s after-hours care crisis.” (March 2010)

Inefficiencies

• The education and health ministries are among the worst-performing government departments, according to a report card ranking state agencies and bosses. The report found excessive red tape, bureaucratic systems and ineffective consultation are hampering government departments. The Health Ministry, bottom for value for money overall, was “struggling“. It is “really confused, with too many sections not knowing what others are doing, and doing stuff without consultation in the affected communities.”

• Half-way through the year and Southland has already blown its drugs budget, by $1.8 million. Doctors are being made to ensure that doctors only prescribe cheaper alternatives. The total overspend for 2010 is projected to be $17 million. (added 8 June 2010)

• “Disgust at the plight of Hawera Hospital has inspired a well-placed business analyst to blow the whistle on what he sees as millions of dollars worth of financial inefficiencies and lossat the deficit-plagued Taranaki District Health Board. Paul Anwyll left his job as a business analyst at the TDHB’s Management of Information Unit…citing “weak leadership and poor management” as reasons in his letter of resignation. An experienced auditor, the Englishman said he had identified financial problems and loss but the TDHB had refused to consider his proposal of a test study that could potentially save them millions.”

• South Island health boards are spending millions of dollars to fly in medical specialists from overseas to cover staff shortfalls. The West Coast District Health Board spent more than $1.3 million over the past financial year employing senior medical staff from overseas. This included more than $130,000 on flights and accommodation. (added  March 2010)

• “ACC has launched an inquiry and offered to pay a sexual abuse victim $10,000 after accidentally sending her patient file to her local superette – where it was opened by the shop’s owner…The file, managed by ACC’s sensitive claims unit, contained an estimated 250 pages of psychological reports and case notes.”