The appointments started on the Monday at 9am and finished at 1pm on the Friday with most days starting at 8am and finishing at 6.30. but the visits were extensive.
During all the visits where appropriate and especially with Ministers it was stressed that our members main concern
even above health concerns and the level of superannuation was the unregulated ever escalating cost of electricity and
energy which have shown dramatic rises over the last 4 years.
It was pointed out that the costs of these increases
had to come from a fixed income such as New Zealand Superannuation so that savings had to be made on food and clothing
and transport.
The end result of this was that lack of the ability to have adequate heating meant early bedtime to keep warm and possibly entry to hospital with influenza and malnourishment – it is a fact that 15% of the admissions to hospitals are malnourished.
The agreement with Oz covers pharmaceuticals , medical devices and complimentary medicines. Agreement has been reached with big and small manufacturers and the importers i.e. the industry but there is still opposition from the health food importers mainly it would seem politically inspired.
It should be noted that there is no regulator for medical devices – prostheses et al, in NZ but there is in Oz .
Medsafe will still do checks and approvals which will also apply in Oz as theirs will here.
All products that
claim to be a cure viz green lipped mussels for cancer would have to proved by research and results.
The control mechanism is risk based where the higher the risk the greater the regulation .
In essence there is a single NZ office and a single Oz office side by side working together and there is not overwhelming
control by Australian States just the one OZ office.
Radiotherapists
Some time ago there was a shortage of radiotherapists such that patients were being sent to Australia for treatment .
Then 16 were trained a year and this has been increased to 38 per year , the basis being that from the second year they
were paid on an increased level such that the provision of radiotherapist in NZ are now reaching the international standards .
They are bonded for the same time that their training is paid for in the 3 year course and the applicants per year for
the course, 150, far exceed the 38 places .
Radiotherapist are also required for new prostate cancer treatment – the Bracey treatment where radioactive slivers are placed in the prostate and radiated for slow release seeded treatment.
Orthopedic procedures
The procedures as announced in the previous budget are ahead of budget in that 2000 extra have been done but sustainability has proved a problem as there are a shortage of 5 orthopods in the system and also the money for the nurses trained in orthopedics to back them up.
Interestingly it was commented that prescribing by optometrists is now allowed so that they can prescribe eye-drops etc.
Cataracts
We touched also on the difficulties that there were with ophthalmologists who are happy to accept the results of preliminary examination by optometrists when in the private system but reluctant to so do for the public system. Cataract operations have increased and because of higher throughput the cost of operations has come down .
PHOs and increased charges GPs/DHBs
The existing system between PHOs and GPs is one of trust, ethics and contract. With regard to increased prices being charged
by GPs which may not have been submitted to and approved by the DHB. There is a complaint system as the MoH can call for a
fee review which requires justification of the fee rise. The payment to GPs for practice nurses has not changed so that if
there is a charge for services previously given free then this should be raised with the DHB.
The Minister also stated that Grey Power could be of great assistance in acting as a watchdog for doctor’s fees. 97% of the
country is covered by PHOs and the average cost per visit nationwide is $24 – $28. The subsidy now paid to doctors is $26.75.
It is possible that there will be spot random checks on the amount doctors are charging if doctors do not pass on the
major part of the subsidy to the patient
Hearing aids
This is in Hodgson’s Bailiwick but we did discuss this with the Minister . There is a “ get check “ programme of which we are
not aware but details will be forthcoming. There is an environmental support services report on hearing aids which may help.
There was no information of the scale of charges by audiologists that were included in the final cost to client but they may
well investigate this.
Rest home rehabilitation
Where specified or by request rehabilitation time is available in selected Rest homes . Asset and Income testing does not apply if rehabilitation is specified but only the first 6 weeks applies for which the DHB has purchased beds . If this is an optional choice then client pays
This is a relatively new incorporation into the rest home area and the Minister is enthusiastic about it. Home care industry travel issues
The last budget included a 12% increase in funding and currently the DHB and ACC are discussing that no home based care will be negotiated unless fair travel policy in implemented. The MoH and DHBs are in negotiation on the basis that of the $17 paid via the DHBs to providers some $11 gets to workers in the field ..
Contracts will specify a fixed percentage must go to workers but this has as yet to be agreed with providers.
Community First Projects
3 projects are under way and all are a little different – under the ASPIRE banner which includes Canterbury COSE
(Co-ordination of Services For Elderly) project.
We discussed the Unpaid care industry where respite care is only concession.
Minister agreed that it is a problem and indicated that this should be taken up with Ruth Dyson as it is in disability area.
NASC function
The Minister does not agree that it is a resource management tool as insists that the system has accountability and although gate-keeping the ultimate is that assessment be rigorous , thorough and uniform.
The solution is the use of the computer based interRIA a Canadian based program which has been successful elsewhere .
This is currently being trialed in NZ with 5/6 DHBs and involves a lengthier assessment than at present but mainly the same –
however the result of the needs assessment depends on the availability of the treatment required – living circumstances ,
family situation etc
Hearing Aids
It was agreed that the $198 subsidy for the elderly was meagre and also appreciated that the cost of hearing aids was beyond most elderly but apart from this recognition no indication that it was considered a problem.
( it was only after the meeting that we realised that the threshold was below the married rate of superannuation )
The Minister, supported by the officials, advised that the regulations to make the Rates Rebate an actuality have been presented
as Orders in Council so they have been cemented in place by this means. We did circulate this advice to the Associations as
it was considered good news as the Rates Rebate Scheme is important to us and a credit to the Government but it fell apart when
we were subsequently advised that the regulations have not gone to the Governor General as orders in Council.
This is a pity as Orders in Councils are rarely reversed by an incoming opposition..
The Minister is now responsible for Retirement Villages Act and advised that the Retirement Commissioner had sent out documents for consultation and is preparing advice for the Minister on the changes to the code submitted by the RVA.
Grey Power have not received any notification and we expressed concern to the Minister .
He lamented that the good things arising from them as a coalition partner like establishment of Kiwi Bank and four weeks annual leave are not recognized by the public.
If his party is part of the next government then he will like to promulgate .
We advised that we had discussed this with Mike Smith the GM Regional Offices and a different letter has been raised.
In essence the letter clarifies that there are job opportunities becoming available for mature workers which might interest this group.
We mentioned the rates rebate scheme and expressed disappointment that there was no individual announcement to our organization even though individual MPs may have written to their constituents, those members that were in opposition held electorates would be unaware.
We expressed concern re the single benefit scheme because it has not as yet been clarified as to how that would affect the disability allowance that a lot of elderly receive.
The Moloney petition was raised and we confirmed that this was not a Federation initiative.
The possibility of raising the level of NZS to 66% per cent was discounted but we will be provided with data from the MSD so that we know what advice has been given to government on this issue to make this decision.
We will receive details of the SAGES program which is based on Super Grans but unfortunately male participation is limited and minimal.
In essence there is no intention of correcting the anomaly of the NZS being based on the previous December Quarter CPI figured that
it falls below the 65% over the year as this has always occurred .
Also there is no consideration to raise the level to 66% to
forestall the situation.
Talked about work and Income and their letter to 60 – 65 year olds from Auckland and Christchurch offices about
job interviews and penalty for non-appearance.
Advised that we had discussed a revised letter with Mike Smith GM Regional Offices and the situation seems to have
been resolved but it should have never arisen in the first place.
Asked where the Bill for the Power of Attorney was and advised that it was held up because of regulations and definition of impaired. Difference of opinion between Justice Ministry and Office for Senior Citizens.
The Office for Senior Citizens will be working on a code of practice for Equity Release and we will be involved.
The Lehmann case for asbestos poisoning was raised . From 1992 t0 2001 there were no lump sum payments for ACC .
Introduced lump sums then in 2002 – for less than 10% impairment there was nothing but above it was graduated.
The problem then raised was that there had to be a date of enactment and injuries before that discounted .
If asbestos was `accepted as a pre condition then this could bring a lot of other conditions . It was decided to
set a date 2002 and have an independence allowance from that date of $65 per week with option of capitalizing the
$65 for 5 years as a lump sum.
In a review of the Lehman case a decision was given for a lump sum payment – the ACC disputed this and took a
case to court but funded the appeal that the Lehmann made as well as its own case.
ACC – if over 65 one can get compensation for loss of earnings for a year but after that make a decision to continue with either ACC or NZS.
Caregivers transport
Transport NZ will issue data which will correct this in that it so not a passenger carrying service and exempt
caregiver from the hire problem.
However the caregiver should check that the individual insurance policy allows the caregiver to drive clients car.
We commented on the $300 million cost of removing the interest from student loans is that we considered that perhaps being able to borrow money without interest would need some considerable policing. It was interesting that after a budget that promised very little and if so far in the future that this money came from a $1.9 billion contingency fund.
Superannuation and the inability of the government to accept that the current system of using the December quarter CPI and applying the adjustment at the following April , inevitably means that the level of payment will fall below the statutory 65% minimum level and government’s acceptance that this is acceptable.
We also commented an a Minister of the Crown giving us incorrect information..
We talked about the income test for long term residential care and confirmed that the first $780 of income is exempt but for the resident all but the hospital rate is used from the NZS to pay for the care . the rest of the payment is the greater of either the $636 subject to CPI adjustment or the rate that is paid to local rest homes. The remainder of the payment comes from family income of which 50% of any private pension or annuity is exempt but any income from investments is used but not income from employment that the partner at home may have.
Stephen Jacobs was asked about the NASC Needs Assessment and Service Co-ordination which was created in 94/95 to address the
problems of those that had a disability that lasted more than 6 months
This was launched in the time when there were four RHAs all of whom operated their own health system and all treated
the NASC function differently.
Some used it strictly as resource management and strictly adhered to 4 hours personal and two hours domestic care
irrespective of the needs of the client while others provided the service the client actually needed
. In 2003 there were 21 DHBs in which the NASC teams had different briefs :- 11 handle all age groups , 5 for 65 plusonly and 5 for less than 65 . – that is they have NASC teams in house that did these functions while the others were catered for by outside agencies Canterbury for instance only did 65+ and Lifetime , an Agency, provided the NASC function for the other ages.
The NASC in a DHB can either be internal or contracted out to an agency .
For the 65+ people there are available a number of funding sources – DSS funding , personal health , mental health and ACC.
The individual patient either wants or needs nothing or has various needs . The NASC system while it is considered by some to be a resource management tool for funding is basically designed to provide patients needs. The DHBs makes the scheme work either in house or through an outside agency.
The current scheme is based on assessment being rigorous , thorough and uniform . the patient is triaged i.e. is interviewed by three professionals – a Doctor , social worker and nurse so that there is one single point for assessment. – which may determine that the patient goes to a specialist , a social worker etc so that the interview identifies what happens next.
. This assessment is either in house or contracted – for Wellington the DHB is contracted to Nurse Maude a Christchurch based organization. In addition outside the NASC system the GP or the emergency department of a hospital can refer the patient to a scheme like COSE which is coordinated services for the elderly , a scheme developed ion Canterbury and is a model for other areas.
In the current system there are 5 bands ranging from where there is very low level of care needed to very high with the monetary restrictions of $750 to $450 .
Attention is now being given to consider the treatment possible which if it involves say $15,000 per year over 5 years that
it may be cheaper to do the operation now.
To help in this determination the individual is matched to one of the 5 bands in the
expenditure levels.
The NASC system is slowly turning to a patient orientated scheme but not all DHBs operate it in this way.- for instance with cataracts that may be severe enough to require treatment in the home to the extent of $50 per week over an extended period it may be cheaper to do the operation .
A little time ago they issued a statement on poverty in NZ which had added to it a statement by the reporter that attended the launch . The statement set a level of poverty as $27,600 which is well above the married rate for New Zealand Superannuation – we made a media release on this figure which has subsequently proved wrong. The letter from the CEO of MSD, Peter Hughes, has been circulated to the Associations and this gives the correct figures for the poverty level as derived from this study..
We attended a meeting at which Bryan Perry the author of the study gave a special presentation to us .
We have copies of the power point presentation available if you wish so please request from the Office. The presentation was very good but the paper may be somewhat lacking as there was a lot of verbal explanation of the slides.
The basis of the research that led to the paper was to consider the various types of families ranging from one where there is just a single person to where they are married couples with children. In the considerations it was conceded that 2 or more people income sharing can live more cheaply than one..
It was considered that after housing costs was the best way for comparison and to use equivalised income as a a way of putting all households and economic family units on a reasonably comparable footing for income analysis based on the concept that 2 or more can live together more cheaply than when each lives on won and that children cost less than adults. Who are the 65+ poor – this done using an after housing cost income measure as in the social report.
A fifth of the 6-7% below the line are mortgage free home owners who have before housing cost income below NZS rates – the rest are renters or home owners with a mortgage with relatively high housing costs ( $5,000 to $8,000 pa) and only NZS as income . Almost all are single and two in three are female this is consistent with the results from the living standards research.
Apart from him seeming to be singly uninterested in the level of superannuation we just talked in generalities about the future possible government of the country but in superannuation he was in effect following the party line.
The money supporting the Cullen fund could be more wisely invested here in adequate homes for people , in the health system and solving the comfort of the elderly in that they are living in healthy and not damp ill ventilated dwellings.
Care givers in the home are not paid enough . It is considered that residential care is very expensive and one is better off in own home . To this end there should be a program to retrofit a home and there should be an energy audit for all new homes with wind power being more affordable should be the main choice for generation as neither hydro nor coal is good for the environment.
There was a little discussion on the use of wood burners which is not favoured .
Finally on the matter of the level of NZS there was some empathy to lift the base level of NZS.
Mike is always an interesting character to talk to .
We firstly expressed our concern that we had received inaccurate information from a Minister re the rates rebate Scheme and made the point that it was a very good piece of PR for the government and that it should be advertised widely when the actual orders on council go through. The PM did comment that orders in Council can be changed by an incoming government so are not set in stone.
We had been told by other Ministers that they had written to their constituents re the rates rebate scheme but we commented that there were many elderly in non government electorates who would not necessarily be aware as there had been little media publicity about the scheme.
We talked of the burden of the ever escalating price of electricity and the effect the cost of this has on the living
standards of the elderly on fixed income.
The Prime Minister was also very interested in heat pumps as an alternative home heating and the cost of operating same.
Cataracts and our appreciation of the latest moves to increase the number of procedures was mentioned as were hearing aids and the impossibility on the current subsidy for the elderly to purchase them, the variable nature of accessing elective surgery.
The impossibility of living on the base rate of NZS against the background of rising costs and the retrospective nature of CPI adjustments was stressed . We strongly advocated our desire to see a lift in the level even if only to 66% to prevent the level as it does falling below 65%.
The meeting was pleasant and informative.
He was non committal as to whether he would be part of a coalition and one got the impression that he would be happy to stand to one side and support a minority government in certain policies in return for implementation of some of his policies.
For senior citizens NZ First offers a gold card of benefits , higher superannuation , lower medical costs , reduced rates , power and telephone charges and increase the income that may be earned by non qualified spouse.
They are committed also to strong primary care strategies which includes the PHOs although has some doubts about the smaller PHOs which seem to cost more.
Will not be cutting health expenditure and will continue with present level but will be evaluating the system . Has some concerns re the shortage of specialists and is aware of the care givers in the home problems which would be addressed by his government
Concerned with the cost of Rest Homes and the provision of fees for rest homes – perhaps would consider a gradual adjustment to fees based on an increase in productivity.
John Key is to confirm our understanding that, because the married rate of superannuation is based on the nett average after-tax ordinary-time weekly wage, tax cuts would not affect the amount actually received by superannuitants, except that in due course, when the decrease in tax raises the after-tax weekly wage, the amount received by superannuitants may rise.
The nett value is grossed up to include tax so that those people receiving other income can include NZS in
their tax calculations.
If that understanding is correct, this in effect means that tax cuts would not immediately affect the income
of a superannuitant.
A National government would maintain the current 65% level of NZS at age 65, without means test or surcharge, and would also continue with the current $2 billion annual contribution to the New Zealand Superannuation Fund. They did not favour an increase in NZS.
The situation of continually escalating electricity prices was raised and acknowledged. The National Party people blamed that situation very largely on two factors:
. They are aware of the issue of the billing of electricity and would support an itemized bill indicating the cost of the individual cost contributers.
National consider that the rates rebate scheme has some significant problems including indexing and the fact that it provides no benefit to those living in retirement villages.
The meeting was very amicable and we were grateful of the chance to talk with them.
Dietary supplements with all kinds off ingredients are regulated under the Food Act cant make any claims for curative properties legally Therapeutic products like over the counter remedies are part of their overview. It was stated that the Green Party is very vocal about Genetically Modified Foodstuff but is not interested in any control of ingredients in vitamins and health foods.p There is currently a rearrangement taking place to cater for the recent agreement with Australia. The new setup will consist of a Ministerial Council which will be the Health Ministers of NZ and Oz.
Who will appoint a board of Five – a chair , a managing Director , NZ health expert ,
Oz health expert and a commercial/law person .
Under this will be agency staff top deal with prescription medicines , non prescription medicines ,
complimentary medicines and devices. These agencies being established in Canberra and Wellington..
The staff are not to be NZ Or Aust. public servants and will be a meld of Medsafe staff in Wellington
and Therapeutic Goods Agency staff in Canberra. The funding will come from the fees paid by the NZ and
Aust. industries .
One application to agency will be approved for both countries.
Medicine are regulated proportional to risk - in some case an application for a prescription medicine can
be supported by over 100 kgs of paper – this is evaluated by a special expert committee and approved/rejected.
Generic medicines apply with a smaller data set and over the counter medicine is smaller still .
Complimentary medicines have a low data set but they are not free of risk. Needs an efficient system
that approves safety but not for high risk.
There is an issued list of substances ( some 4000 items ) that can be used to make up medicine and companies
can use these lists
Most of these products are web based and the formulation is listed and self declared by the industry participants .
This system is sympathetic to industry to assist authentication. If the preparation does include ingredients
not on list then these ingredients have to be approved.
There was much more information but it was hard to get it all down so another visit will make some of the things a little clearer.
We discussed the publication and learned that there is no government funding and that they are currently rewriting the publication . Our own LSQ was mentioned as was the possibility for it to carry an article from them – will send a copy of the last issue as they are also interested in possibly advertising.
. We were interested to learn that home visits by pharmacists is being trialed in the New Brighton area in Christchurch where 7 or so chemists are providing home visits .
The main complaint that comes from their members is apparently the difficulty that they have when the subsidized brand medicine is switched to a generic – some consider that this should be a Pharmac function but the Guild believe that this is a pharmacy responsibility to talk to the person collecting a generic medicine.
One thing that was noted was that there is a whole section on care givers both in home and institutions.
In superannuation they will change the formulation of the NZ Super by basing it on forecasted changes in CPI
and increases in average wage thus preventing it falling below the 65% mark – this will lead to a 5.4% increase
in coming year..
They intend to make the first $3000 of earned income tax free and as this would flow into the level of the
after tax wage then there would be an adjustment to the level of superannuation.
When it is possible we will circulate the policy but meanwhile we must honour the confidentiality.
We had advised that we wished to speak to him about
As another appointment was not possible Peter Rutledge, a member of the energy committee, who was with
us for this particular visit will make contact with the Ministers office and arrange a time to meet
with the Minister.
We do not expect that the current attitude will change but consider, even so, that we have a
responsibility to and must keep on trying to get lower electricity prices or get government to
recognize that this is a major problem for our members and make an adjustment to superannuation to compensate.
The problem that they are trying to fix with the PHOs is that some of the population are in a group where the health is static so that the gap between groups is increasing over time.
Chronic diseases are increasing and will grow exponentially – childhood obesity is increasing and this is repeated in diabetes. These diseases will increase and take over the health dollar.
It is believed that Primary Care can make the difference but this seems at this time to be mainly
GPs services and there is a need to move to include other health workers. The Boards drive the PHOs
rather than the IPA that is associated with them.
There are 6 PHOs in Auckland who are co-operating together and this has helped with overheads .
The DHB/PHO relationship is critical with such outcomes as district health nursing is more effective
the PHO especially in programmes like parenting for single and double parents.
The establishment of national information for PHOs has not met with great success but some areas have
close relationships – Northland DHB meets weekly with their 6 PHOs . A PHO Community Council comes
from representatives that are actually consumer representatives and not providers..
The success is dependant on local leadership so needs a resource in local community rather than remote arrangement.
There has been established a PHO Chairs Forum in the South Island and the MoH will attend such meetings if required.
97% of the country has been covered by PHOs in the last 2 and a half years. It is interesting that in the areas the retail outlets define the society – the affluent areas tend to have greengrocery and butchers shops and the poorest have betting shops and fast food outlets.
The vast majority of Maori and pakeha go to mainstream providers . Maori health have an open policy in that anyone can attend.
We talked about the future staffing of the PHOs and GPs and it seems that new graduates much less interested in practice and management as they would rather be in a team situation , which provides much food for thought .
There is an excellent 2005 publication from the MoH titled “ A Difference in Communities : What’s happening in Primary Health Organisations “
The section has spent much time providing information about the changes to the asset and income testing regime.
In 2002 the National Health Committee promoted the necessity to have a continuum of care and from this the health of older person’s team developed the Health of Older Persons strategy – the level of the over 65 population will increase dramatically from 2010 bringing with it attendant health problems.
Chronic illnesses start to impact on life , like osteoporosis developing in older people . To meet this requirement and other illnesses like diabetes , heart trouble and frailty to name a few , practice nurses are tending to specialize in care for older people. Health services and disability services are now more closely aligned and the NASC system is being used to develop a one stop shop where the services that are needed come to the person rather than having to seek services in a variety of places.
DHBs are not creatures of the Ministry and are responsible to the Minister – the Ministry is the Ministers Agent and it sets the strategy and monitor plans for the specific directions required.
The Older Persons Strategy has to be implemented to suit the community and to this end it is necessary to have a National assessment tool to get consistency and currently a Canadian tool interRIA is being trialed.
Inflation growth and older population increases in DHBs funding used for service growth and service change. Basically this funding is being invested in Primary Health and also investing in home support to avoid increases in residential care support
There are still wide variances in areas e.g. Wairarapa are good at home support while Otago has a high level of residential care and this stresses the need for a national assessment tool so that everyone has the same level of assessment.
Currently there is Environmental Services report ex Auckland from the Disability Resource Centrew which is under discussion at MoH but not yet released.
It treats sensory impairment separately and has comments on the unfairness and inequities in the system . The problem is that audiologists are assessor and provider and the MOH/ACC pays the cost of Hearing aid which are sold through the audiologists - in Oz they out to tender for hearing aids and so should we.
Surprisingly the services for older persons is mainly for people in rest homes as the provision for homes is covered. Apparently apart from beds which is the responsibility of rest homes themselves other requirements like wet showers hand rails etc are provided to rest homes .
One of the comments made in the report is the provision of a suspensory loan arrangement to provide the cost of the equipment which would be written off over say 5 years.
A priority system is operated levels 1, 2, 3 but currently only priority 1 is used due to funding.
The service does allow for a person that has had a stroke to be visited by an OT who will do
an assessment for future treatment and facilities needed.
The end at last
| Home | Return to Additions 2005 |