Marijuana.
Such a strange word that one may have difficulty in getting a tongue around it but , nevertheless, with some of the politicians admitting to having tried this drug and politicians asking for decriminalisation, the debate erupted again and again during the last government and seems to be about to do so in this Labour Government term.Probably our children as teenagers didn't experience it although some did alcohol but the after effects of marijuaana are much more noticeable . Was appalled that a School Principal was complaining that after the weekend binge on marijuana , 10 - 15% of his senior pupils were not fit to be taught until Wednesday at the earliest - he apportioned blame to the ethics of the parents .
Was even more devastated to read the heart felt reaction of one mother whose 17 year old daughter had been perpetually stoned for the past eighteen months - she noted that from her observations and what she has heard , that the percentage of white middle class children drug dependent is more likely to be 60% - can you believe that !
There are certainly more problems for teenagers today than ever there was in our day .
Public participation in health
We are most concerned at the lack of public input into many areas of health and have over the previuos years particularly continually pressed the then RHAs , the HFA, then CHEs, the HHSs and now the DHBs and the politicians for inclusion of public representation on committees and Boards .Early in the term of the first government Labour MP Geoff Braybrooke brought forward a private members Bill to have Local representation on CHE Boards. He believed that locals should have some say about what happens in their public hospital and this was a way to ensure this .
The Bill was thrown out of Parliament without being referred to a select committee hearing and strangely , or perhaps not , even though local representation was a plank of New Zealand First policy , they voted with their National coalition partner to reject the Bill.
We wrote to Ron Mark who replied that NZ First had decided that the Mr Braybrooke's Bill was too restrictive and that they would pursue it as a wider area of government policy which apparently , the then Associate Minister of Health, Mr Kirton was taking to Cabinet on the general principle of elected health officials. However Mr Kirton was sacrificed because he became too much of an irritant to the Health Minister . Regrettably his replacement did not pursue this project
We thus waited and saw nothing eventuate , but would have thought that a change to the then CHE Boards would have been a start - however one has to remember that one of the major restrictions in that coalition agreement was that no member of that coalition shall vote for any opposition or private members Bill without written permission so perhaps this was invoked by the major party.
Now with the current Labur Government we have a return to the Braybrooke concept but its really a half hearted attempt to include for the public demand for representation on hospital boards.
The current siuation does allow for the election of board members but being at the same time as the local body elections it is inevitable that it will be along party lines - not a great way to select people with health rather than political interests.
Return to index
If it was possible to legislate that there must be two Maori on the DHB then it is
equally possible in our view to legislate for membership of the advisory committees.
There is no indication that the present Minister has any other solution
to the waiting/booking list problem and there is nothing in the creation
of the new health structure that will in effect assist.
We must not allow this creeping privatisation of the health system
to continue under this new DHB system.
Consultation in health
We are , as mentioned above ,most concerned at the lack of public input into many
areas of health and continually during the time of the HFA and
the politicians pressed for inclusion of public representation on committees and Boards .
There was a politically expedient decision or artifice to have public
represented on the then HHS boards or in plain language , hospitals , by Council nominated
representatives. This did not in our opinion provide public representation especially
as the nominee has to approved by the government.
However there was at that time no political will to do anything
else except this token gesture so situation still remained the same basically until the
change in government
Now we have the creation of District Health Boards ( DHBs) which is intended to
provide the consultation aspect.The problem with this arrangement is that the boards are
to have three advisory committees appointed by the Board so inevitably they will reflect
the Board's viewpoint. It could have been simple to legislate that a number of the
advisory committee members should come from providers and community organisations.
Also there is no defined way that the public can input into these advisory
commmitees unless they , the commitees , choose to ask for public consultation.Booking lists
Previous Ministers protested that under the waiting list system some people were
put on the list in anticipation that by the time their name reaches the
top of the list they would be sick enough to need surgery and therefore
the booking list which gives certainty is best .
Successive Ministers starting with Mrs Ship;ey back in 1995 have
urged that all the then CHEs implement a booking list system in order to
receive the money allocated to reducing the waiting lists.
In November 1995
the then Minister of Health , Mrs Shipley, instituted a proposal that all
waiting lists are to be replaced by booking system , so that , after
initial assessment by a specialist , patients will receive immediate
treatment ,
or be given a date for treatment no more than six months away ,
or if they do not meet the criteria for the procedure , be referred to
their primary care providor for treatment if necessary , and ongoing
management and review should their condition change .
It was desired that the maximum waiting time for first specialist
appointments for non-urgent conditions be six months , with 90 percent of
people seen within two months of referral .
The institution of the booking list system was not accepted by many of the
clinicians working in the hospitals as they believed that it was not an efficient
way to solve the problem of those waiting for surgery .
However the Minister
had made any extra monies for the elimination of waiting lists conditional
on the provision of a booking system .
The actual functioning of the
booking list system requires the GP to refer patient to the specialist who
then has the responsibility to determine whether surgery is required
within six months and if not the patient goes back to the GP until sick
enough to qualify .
In practice , the fact that one is placed on a
booking list , does not necessarily mean that treatment will be available
, as , despite having a position on the list , the places are shuffled about
by more urgent cases and emergency cases . As there is a limit to the amount
of surgery available due to monetary constraint the booking list just does
not give the certainty it should.
While any move to reduce waiting lists is to be applauded , the booking
system merely keeps the waiting list at a level predetermined by the money
available and transfers those not booked in , to a waiting list at GP
level as the patient waits until the condition deteriorates sufficiently
for the specialist to move the patient to the booking system.
As far as government is concerned this establishes a waiting list at the
DHB that can be manipulated by financial constraint.
We would have no qualms whatsoever about the booking list system if
it was adequately funded so that it could work efficiently. Privatisation of public health services
Grey Power continues to be worried about the stealthy privatisation
of the health system promulgated by the ability of the DHBs to place contracts with private suppliers
for procedures which could be done in the public system. Now that the HFA has
been disestablished the purchasing has been devolved to the District Health
Boards so we now have 21 separate purchasers..
Supporters of the
concept of private hospitals claim that it doesn't matter where the operations
are performed as
long as they are done . This narrow view overlooks the fact that every
business requires a certain level of income to defray the standing costs of
operation. This is particularly so in the public sector where the facilities
available have to fully utilised so that the personnel required to staff
these areas are fully employed.
Now local DHBs have the facility to utilise the funds to purchase where they
wish. However in reality there are many functions that are provided to the
public system by private providers but the difficulty in the future is that there
will be now not be one purchasing authority but 21 different purchasers who will
have different purchasing priorities and abilities so that it will be very difficult
to determine just how many services are being contracted to private providers.
Now that the hospitals themselves will be responsible for purchasing it will
be very interesting to see how the various DHBs handle the requests from the
local private hospitals for operations atht both they and the DHB can handle.
One can only point out the proliferation of private
hospital facilities not only for continued care but for operations such
as hip knee and heart.
Any public money that is spent in the private sector is not available to the public
sector on which most of us depend , so that over time the public system will
shrink as there has not been the necessary amount of throughput to keep all
the facilities operative.
There is no accountability regime involved so that the placing of contracts
can quite easily be one of personal preference which we consider to be
entirely inappropriate .
At this time the private system is very dependent for its expansion
on the receipt of public contracts to perform publicly funded operations in
private facilities. If this practice increases the public system will contract.
Once that happens then in the private system the amount of money that the patient can
pay will be the criterion not the needs of the patient . The booking list problems
Grey Power is concerned that in health we have the continuing problem
of adequate access to health care.
There is no doubt that once a patient is admitted into the hospital system
that the care that is given in the main cannot be faulted. There are very
few complaints about treatment received in the hospital environment except
for some isolated cases.
The booking list arrangement first promulgated by Mrs Shipley when she was
Minister of Health has only served to hide the number of people awaiting
surgery. Granted that for those on the booking list there is some certainty
that they will get their surgery within a specific time . However once again
, even this is suspect as the funding for this elective surgery and emergency
surgery is from the same pool , so that an influx of emergency cases will
displace those on the elective list.
However the MoH issues instructions every so often to remove people from the
waiting list so that the government will not be embarrassed by the number of
untreated patients on teh list
For those not on the booking list there is the never never world of shuttling
between GP and specialist until the disability comes so serious that it
rates sufficient points to be transferred to the booking list .
But if the booking list is too full , then the points level required is
adjusted accordingly so that the booking list can cope with the patients
placed on that list .
There is no redress for patients not in the hospital system and waiting
for elective surgery of any kind.
The Health and Disability code of rights applies only to patients in the
system and this is in effect the government refusal to recognize that
there is an actual and substantial waiting list at GP level. This is the
forgotten and little publicised effect of the booking list but a real
problem to some 160,000 patients waiting to become part of the recognised
booking system
Even those on the booking lists are not assured of treatment as emergency
cases take precedence. The system totally ignores the plight of those on the
ever-increasing GP waiting lists where they wait until their condition
deteriorates sufficiently until they meet the assessment by the specialists
so that they can be placed on the booking list.
There are no solutions except words offered by either the present government
or those that would wish to government - words do not cure disabilities
but perhaps the problem being disguised by the GP waiting lists will just
be left to fester there and become part of our primary care problems.
Involvement of private insurers
The Grey Power New Zealand Federation position on private involvement in
public hospitals is quite clear, in that we wish to recover and preserve a
public health service to ensure that there should be no privatisation of
existing services without at least majority agreement by the community
affected after genuine consultation process .
Trusts which are becoming increasingly involved with hospital services
in minor cities may indeed provide a means of saving the proposed loss
of specialist services at a hospital but there is a great difference in
going down the appointed plan by accepting it as consultation.
This process is made difficult by the acceptance of well meaning health
professionals . Any trust arrangement to be proper must include publicly
elected members and this in the main is not apparent in the present trust
arrangements which are tending to have commercial partners .
Private members of trusts must expect some pay-back from the arrangement ,
at the very least preferential treatment for their members
Protocols exist for private use of public hospitals . These ensure that
there are proper procedures in place to cater for the public patient so
that they are not disadvantaged as far as treatment preference with respect
to the private paying patient . The same safeguards are not apparent in
trust arrangements.
We have severe reservations about the involvement of private health companies
in the development of an ICO . Our consideration of an integrated care
process is that , by necessity, it must involve the general practitioner
and the hospital specialists so that a continuum is developed that ensures
that the patient is provided with an adequate level of care from admission
to discharge , without undue difficulty . The nature of the care process
must be one that is developed not only by the medical people involved but
everyone from cleaners , nurses to specialists and managers with adequate
and open public consultation .
This to our mind does not need an input from a private health care provider
and we see no place for this except to provide a fall back position for
finance should the guarantee for government funding either not be provided
or not be met and the alternative of public funding by rate increases be
unacceptable.
Finance from a private source must , of commercial necessity , come at a
price .
The ultimate price may well be the managed care approach where treatment in
the public hospital becomes decided by financial imperatives where care is
given to the private insurers clients in preference to or exclusion of the
needy public..
The danger is not, the sensible co-operative approach of integrated care but
when it is used essentially as a camouflage of financial take over, which
overseas experience shows to lead almost
inevitably to "managed care" which is quite another matter . We therefore
strongly resist any private insurer's participation in an ICO . .
Private Health Insurance
As the commercial sector has placed a " best before 45 " label on the working life
so now the private health insurers have decided that large discriminatory increases
in premiums shall apply to all those 45 to 64 ,as well as the current high
premiums for those over 65 which has caused , as was wished , a drammatic decrease in
those elderly able to afford private , however restricted , insurance.
Obviously the greatest need for health is when one is young and then when old .
Old now seems to be defined as 45 .
Just how long will it be before the
young are penalised similarly so that only those 30 to 45 who need little
insurance will be able to afford it.?
![[Previous page]](back.gif){kind=small}
![[home page]](home.gif){kind=small}
![[Top of Page]](top.gif){kind=small}
![[next page-ResCare page]](next.gif){kind=small}