The people working for medical cannabis

Have we got we have got medical cannabis laws right? Russell Brown asks this at NZ Herald on Medicinal cannabis: For the love of her son:

The death of Rose Renton’s son prompted a dramatic change in the direction of her life. Russell Brown explores whether we have got medical cannabis laws right.

At the request of his family and doctors, Alex became the first New Zealand patient to be granted ministerial approval to import a non-pharmaceutical grade cannabis product in June 2015. The treatment couldn’t save him, but New Zealand’s conversation about medical cannabis turns on the weeks he spent in hospital, his brain in crisis.

In the course of approving the request to import an oil containing cannabidiol (CBD), Associate Health minister Peter Dunne had officials draw up guidelines for future applications, which had been provided for in law for years but never made before.

Helen Kelly applied, unsuccessfully, for another cannabis product under those guidelines. Dunne ordered a review and the Labour Party promised to make access easier.

This year, Dunne removed the requirement for ministerial approval for CBD products altogether.

And now, Alex Renton has landed his mother in court. Rose Renton, who lives in Nelson, is the most high-profile of a series of “green fairies” to face charges of growing, processing and possessing cannabis for supply.

Although Kelly very publicly eased her pain with the cannabis products people brought to her door, no one seemed inclined to make any arrests. That has changed this year.

That’s a shame. Police discretion could be used if it is not in the public interest to prosecute.

Shane Le Brun, who has participated here, has a different approach – to change the medical and legal systems.

A few kilometres, almost in line of sight of Rose Renton’s house, Shane and Kat Le Brun are fighting a very different battle — not to reject the system, but to make the system work better.

They had been married three months, he an army munitions officer, she an early childhood teacher, on the day in 2010 when their lives changed. Kat stepped out on an icy deck at the school where she was working, “my leg went from underneath me and I landed awkwardly on my back and butt. That was it.”

Doctors eventually discovered three of her spinal discs had prolapsed. In the seven years since, the 31 year-old has had spinal surgery and then been re-injured — knocked over by a child in a sandpit — and twice gone into respiratory arrest from opioids administered by emergency medics.

Her condition is managed to some extent with methadone, the only opioid prescribed for long-term use. It’s slowly destroying her teeth.

Over time, she’s had various powerful opioids, ketamine, gabapentin, valium and an anti-depressant (stress is known to aggravate her condition). She has tried cognitive behavioural therapy and acupuncture.

And on one terrible evening in hospital, when she couldn’t stop screaming, she was given an anti-psychotic and shut in a room by herself for the night.

But there is one treatment she’s not allowed — or at least, can’t legally get. Cannabis.
She says that the first time she tried cannabis (“I got it from a family member”) she slept well for the first time in four or five years.

Shane, who now works in IT, had already taken a nerdish interest in her pain medication (to the extent that they suspect he appeared to “know too much” and was incorrectly flagged as a drug-seeker by the system) and turned his attention to cannabis.

He formed a charity, Medical Cannabis Awareness NZ, which campaigns for the availability of affordable medicines via the non-pharmaceutical provisions first used by Alex Renton’s doctors.

Last year, MCANZ was responsible for 80 per cent of ministerial approvals for their use. Ministry officials who were once suspicious of medical cannabis now speak to him regularly.

Ironically, the one he hasn’t been able to help is Kat.

“I do find it very difficult,” she says. “It feels at times that he’s fighting harder for others than he is me. At the height of my pain, I have been known to throw a few pillows at Shane and say to him, you’re doing all this work and you have been for so long and I’m still not further ahead.

Her frustration is compounded by the stigma Shane’s advocacy attracts.

“I have been discriminated against because of what Shane does. I think people hear the world cannabis and freak out — because it’s illegal in their eyes. And all they know of when you say that word is getting high.

That’s a real shame, but eventually, hopefully soon, she will benefit from Shane’s efforts.

Kat’s own bid to be legally prescribed a cannabis product hit a familiar roadblock — doctors. A senior medic at Burwood spinal unit told them there was insufficient evidence for him to prescribe Sativex, the only Medsafe-approved cannabis product in New Zealand.

“I presented the doctor with a printout of a trial of Sativex for allodynia and hyperalgesia,” says Shane. “And he tried to change the topic because I basically knew more than he did.”
Kat adds: “The report came back and said ‘the husband seems to know a lot about cannabis’ and made it seem really dodgy.”

“We had to go doctor-shopping,” Shane says. “It’s disappointing, because she’s exhausted all reasonable options.”

The ministry has since taken a different view, acknowledging that a cannabis product is a benign option for Kat and approving access. Now, they face the other big roadblock for legitimate medical cannabis in this country: cost.

The cost of producing, testing and proving medicinal products is high, especially when there is a very restricted market.

Last year, MCANZ helped Auckland MS patient Dr Huhana Hickey win approval for a functionally identical product made by the Canadian company Tilray.

But that has ended up being more costly than they’d hoped and the couple are now pinning their own hopes on a similar product made by another Canadian company, CanniMed.

Remarkably, the Ministry of Health is now prepared to approve CanniMed’s whole dried cannabis products, for use in vapourisers. It has also tabled work on regulations for growing cannabis locally for research as part of advice to the new Government.

Shane believes local production to precise medical standards is the only long-term answer.

“The patient population views the green fairies and illegal suppliers as heroes,” he says.

“As a charity, we cannot condone or promote illegal activity. But come on — there’s 100,000 people who claim they use cannabis medically at least sometimes and around 50 people in the country accessing it legally at any one time. There’s just a huge disparity.

Lawyer Sue Grey has taken another approach.

She was a specialist in environmental law when, five years ago, she was asked to act for 61 year-old Golden Bay woman Victoria Davis, who had been charged with cannabis cultivation and possession. Davis had been growing for her husband John, a double amputee wracked with phantom pains.

Grey won her client a discharge without conviction, in part by presenting a doctor’s letter to the judge.

She thought she would move on, but in 2015, Davis recommended her to another Golden Bay resident in legal trouble, Rebecca Reider. Reider was facing serious charges after posting herself two bars of cannabis chocolate — which had been legally prescribed to her for chronic pain in California and delivered to her family’s home.

Again, Grey presented medical records and Reider was eventually discharged.

But she also studied the Misuse of Drugs Act and discovered that Reider was allowed to import a controlled drug if it was prescribed and she brought it in herself.

Then, advocating for terminal cancer patient Tom Harris, Grey challenged the Ministry of Health’s position that CBD is a controlled drug under the Misuse of Drugs Act. The Government’s own agency, ESR, wrote in unequivocal support of her argument.

CBD officially remains a controlled drug — but when Dunne announced this year that CBD prescriptions would no longer require ministry approval, it was effectively a surrender.

But the situation remains vague and confusing.

The law, Grey agrees, is a real mess. She says she feels for the police.

“I’ve spent a lot of time working with the Nelson police, the drug squad and the prosecutors. When I first started working with them they had zero tolerance for any excuse for medicinal or any other cannabis.

“Now, they’ve really learned a lot — but they’re in a difficult position because their job is to uphold the law. They have discretion, but they have to report to their bosses. They’re the meat in the sandwich, really.”

Ultimately it’s our MPs, our political parties, and our Government that put the front line police in an invidious position.

Dunne tried to progress things on the medical front, but was hampered by an unsympathetic National government.

Labour have promised progress, Greens should be a shoe-in for support, but it will still require support from NZ First or national to change out of date and hopelessly impractical laws.

But the Minister now responsible for the health side of cannabis, David Clark, could push progress along there.

And surely the Minister of Police Stuart Nash could give some direction on the policing side of cannabis, especially where illness is involved.

Renton, Le Brun and Grey have done a lot and have achieved a bit, but it’s time for our elected representatives to take responsibility for a messy and stupid situation.

If Jacinda Ardern chose to show leadership on this she would be likely to get a lot of popular support. People are suffering necessarily and sadly.

 

Ministerial Advisory Group for health

The Minister of Health, David Clark, has announced “the urgent establishment of a new Ministerial Advisory Group on the Health System”.

Advisory groups, working groups, committees and commissioned reports are all things that are used in Government to kick the can down the road, to bury a promise, to deliberately delay.

For example the Tax Working Group seems to be a device to get advice that the Government wants to hear. After nine years in Opposition one could wonder why Labour hadn’t already done all the research needed to inform adequately on reforming our tax system.

But I think the health Advisory Group may be justified. Clark is not very experienced in Health, and it is one of the most demanding portfolios, with one of the biggest responsibilities. Life and death is at stake, costs are escalating, as is the age of the population, so it is difficult to get the right levels of care to balance on a budget.

New Ministerial Advisory Group established for Health

Health Minister Dr David Clark has announced the urgent establishment of a new Ministerial Advisory Group on the Health System.

“Since becoming the Minister of Health, it has become increasingly clear to me that all is not well within our public health system. Nine years of under-resourcing and neglect have taken their toll.

“New Zealanders deserve better and the Labour-led Government will not sit back while the public is short-changed by a health system operating under such stress. We have a significant health agenda to roll out, including in primary care, mental health and disability services.

“We’re committed to investing an extra $8 billion in health, and it is vital to have a health system in its best shape possible to ensure all New Zealanders can access quality health and disability services.

“The Ministerial Advisory Group will help ensure that investment makes a positive difference to people’s lives. It will provide fresh perspective and independent advice about how we can improve our health system and deliver better services to New Zealanders.”

Dr Clark has appointed Sir Brian Roche as chair of the group. Professor David Tipene-Leach, Muriel Tūnoho, Dr Karen Poutasi and Dr Lester Levy have also been appointed members for a term of two years. They will report directly to the Minister of Health.

“These five individuals are extremely experienced and highly regarded in the health and disability sector.

“I’ve asked them to advise me on lifting the Ministry’s performance and leadership, strengthening relationships across the sector, and helping to deliver the Government’s strategic direction for health. This work is critical to improving the quality of our health services.

“There are good people nationwide working hard to improve people’s health. Both they and the public deserve the highest standards of leadership and performance,” says Dr Clark.

Background Information:

The Ministerial Advisory Group on the Health System is a Ministerial Committee established under section 11 of the New Zealand Public Health and Disability Act 2001.

Chair Sir Brian Roche has extensive governance and management experience, a former Chief Executive of PWC NZ, oversaw a significant transformation of the New Zealand Post Group as Chief Executive and is an experienced chair of numerous entities, both Crown and private.

Professor David Tipene-Leach is a Professor of Māori and Indigenous Research at the Eastern Institute of Technology. He has a distinguished medical practice and academic history, and has led innovative public health projects on prevention of long-term conditions, particularly diabetes.

Muriel Tūnoho is president of E tū, one of New Zealand’s largest unions and national coordinator for Healthcare Aotearoa, which represents many community and iwi controlled primary health providers. She is also involved with Hutt Union & Community Health Service and is an executive member on the Living Wage Movement Aotearoa board.

Dr Karen Poutasi is a former Director-General of Health. She oversaw the establishment of district health boards and the amalgamation of the former Health Funding Authority with the Ministry of Health. She has extensive experience at both a governance and management level, with deep knowledge and networks in the health system.

Dr Lester Levy has extensive knowledge of the health sector. He is Chair of the three Auckland district health boards, and has a wealth of experience in other private and government governance roles.

The best possible advice is essential for making decisions on health, and this group should the Minister.

David Farrar gives it a tick in Clark pushes out Chuah:

I don’t know all the members but Roche, Poutasi and Levy are well regarded and could well play a good role in improving the performance of the Ministry of Health.

Clark dines pushing Chuah: Outgoing health boss ‘not pushed’

Labour has been highly critical of Chai Chuah in the past but it was his choice to resign, David Clark says.

Hobson’s choice perhaps, but as Farrar said, Clark needs to have confidence in the Health boss.

In Parliament yesterday Clark responded to patsy questions (and one from the Opposition) with some of his expectations.

12. Dr LIZ CRAIG (Labour) to the Minister of Health: Why has he established the Ministerial Advisory Group on the Health System?

Hon Dr DAVID CLARK (Minister of Health): Today, I announced that I have established a ministerial advisory group because it has become increasingly clear to me that all is not well within our public health system. I require strong, independent advice about how we can lift the ministry’s performance and leadership, to begin to address the challenges facing our health system and, in particular, to rebuild the relationships that were seriously strained under the previous Government.

Dr Liz Craig: Thank you, Mr Speaker. What does he expect the ministerial advisory group will do to improve New Zealand’s health system?

Hon Dr DAVID CLARK: I expect that the ministerial advisory group will provide the strategic advice required to deliver on this Government’s commitments in health and ensure that the $8 billion we have committed to investing in health will make a positive difference in people’s lives. This will include, for example, improving access to primary care by lowering the costs of visiting a GP.

Dr Shane Reti: Isn’t it more correct to say he’s set up the ministerial advisory group to tell him what his health plan in health should be, because he doesn’t have a plan?

Hon Dr DAVID CLARK: No.

Dr Liz Craig: Will the ministerial advisory group improve relationships across the health sector?

Hon Dr DAVID CLARK: One of the first things I expect the ministerial advisory group to do will be to rebuild relationships across the health sector. Strong and productive relationships are required to deliver the healthcare New Zealanders expect and deserve. I’m confident that the ministerial advisory group will be able to do this, and I have no doubt that its members will be talking and listening to district health boards, primary health organisations, and others up and down the country.

A line up of doctors, with both Craig and Reti having worked in health roles. That’s not necessarily all positive, the last Minister of Health, Dr Jonathan Coleman, seemed to lack in communication skills, something that’s essential in this portfolio.

I wish Clark and his Advisory Group well – I may need their help some time in the future, and there’s been some scary bad health stories coming out of Dunedin Hospital – the hospital whose case for replacement has been kicked down the road for a while now.

Mike King predicts a rise in suicide rate

Mike King, who is closely involved in addressing the high rate of suicide in New Zealand, predicts the numbers will go up.

NZH: Mental health advocate Mike King is predicting a rise in our suicide rate

“We have to understand there are so many suicides that aren’t recorded.

“Coroners have to be 100 percent sure. So if there’s alcohol in the system, there are drugs in the system, if there’s any doubt at all that it may not have been [suicide], they are not recorded,” Mr King said on RadioLIVE on Saturday.

“The reason that those statistics are going to climb over the next few years is because as people have an understanding that this is a real thing, the threshold comes down.

“So please New Zealand, don’t be surprised when these numbers come up.”

That may be a warning based on what King sees happening (and not happening), it may be a shock tactic to make more happen in suicide prevention, or it may be a bit of both.

New mental health figures reveal 11.8 percent of 15- 24-year-olds are affected by psychological stress, defined in the Ministry of Health survey as having “high or very high probability of anxiety or depressive disorder”.

It’s an increase on last year’s 8.8 percent figure in the same age bracket, moving from 58,000 to 79,000 people.

That’s a lot of young people at risk.

Around one in ten young New Zealanders seeking mental health is having to wait more than two months to see a specialist.

New Zealand also has the highest suicide rate in the OECD for 15- to 19-year-olds.

Whatever it is we have a major problem with suicide in New Zealand.

Mr King says experts who blame poverty, housing and colonisation for the suicide rate are sending a dangerous – and incorrect – message.

This may in part be aimed at new Minister of Health David Clark who this week referred to poverty and colonisation – New Health Minister David Clark on youth suicide: We have a problem and we need to talk about it:

Labour campaigned on mental health and pledged the return of the mental health commissioner and an inquiry into mental health.

Terms of reference and other details around the inquiry were yet to be settled, Clark said, but forecast it as wide ranging, considering issues of colonisation and poverty.

He spoke of “hardship, or the after-effects of colonisation, or trauma in their own lives or personal histories”.

King’s view:

“Of the thousands of kids that I’ve spoken to that have been suicidal not one of them has come up to me and said, ‘Mike I want to kill myself because of housing’. Not one of them has said ‘I want to do it because of poverty’.

“What we are being told are the reasons and what I am hearing on a daily basis are completely different.”

“For most young people, their suicidal behaviour is driven by a little thing that everyone owns called the inner critic. That little voice constantly undermines their logical thinking.

“Self-esteem comes from having your thoughts and opinions validated by the significant adults in your life.”

Mr King says the solution will be found with communities supporting one another and not with the Government.

That’s a biggie – in our modern satellite society community interactions and support have shrunk. ‘Community’ is more often than not electronic based, especially for young people.

Rural suicides are a problem – modern farmers often work alone, rural communities are much smaller with a much smaller rural workforce, and despite their faults rural pubs are disappearing – perhaps in part the reduced road toll has become an increased suicide toll.

Clark:

“I think we need a public conversation about this. We can’t avoid it as a country. We have a problem and we need to talk about it.”

Perhaps a good place for him to start is with a private conversation with Mike King.

Minister of Health on colonisation and youth suicide

In an interview with NZ Herald new Minister of Health David Clark linked youth suicide with colonisation – New Health Minister David Clark on youth suicide: We have a problem and we need to talk about it

Labour campaigned on mental health and pledged the return of the mental health commissioner and an inquiry into mental health.

Terms of reference and other details around the inquiry were yet to be settled, Clark said, but forecast it as wide ranging, considering issues of colonisation and poverty.

He spoke of “hardship, or the after-effects of colonisation, or trauma in their own lives or personal histories”.

He was questioned about this in Parliament yesterday.

Hansard transcript (slightly edited):

7. Hon Dr JONATHAN COLEMAN (National—Northcote) to the Minister of Health: What quantifiable health service improvements, if any, will his policies deliver?

Hon Dr DAVID CLARK (Minister of Health): This Government is committed to providing affordable access to quality healthcare for all New Zealanders. This will happen in many ways; there are too many examples to list. However, to pick just one, I can tell the member that more people will be able to access affordable primary healthcare.

Hon Dr Jonathan Coleman: By exactly how much will he lift the number of elective surgeries above the 174,000 delivered in the past year, given his commitment to increase access to elective surgery?

Hon Dr DAVID CLARK: I will not be rushed into committing to specific targets. I want a health system that is honest and transparent with targets not like the previous Government’s one, which was pumping statistics by performing Avastin injections and skin legion removals that could have been done in primary care.

Hon Dr Jonathan Coleman: I raise a point of order, Mr Speaker. It was a very direct question. If he doesn’t have an answer, he should just say so.

Mr SPEAKER: No. I probably was a bit slack letting him go on after he answered the question in the first sentence.

Matt Doocey: By how much will he reduce the suicide rate over the next three years now that his Government has taken responsibility for the rate, as reported in the New Zealand Herald yesterday in the article entitled “… New Health Minister pledges change on youth suicide”?

Hon Dr DAVID CLARK: One suicide is one suicide too many. I do not believe it will be possible to eliminate suicide in the first term of this Government, but we are committed to lowering the rate of suicide in New Zealand, and I am looking forward to beginning the mental health inquiry.

Dr Shane Reti: What did he mean exactly by his statement to the New Zealand Herald yesterday that addressing colonisation will be an important part of his mental health inquiry?

Hon Dr DAVID CLARK: That is one factor that I said to the New Zealand Herald I expect will come up in the inquiry.

Hon Dr Jonathan Coleman: Can he explain the improvements his policies will have on the link that he believes exists between colonisation and youth suicide?

Hon Dr DAVID CLARK: This Government will commit to a mental health review—an inquiry, a ministerial inquiry—and that inquiry I have asked to be broad. It will cover a variety of topics, including the one the former Minister has raised, and I expect it to provide answers that will help us to provide mental health services that New Zealanders need.

It was a topic that the Minister raised in his interview with the Herald.

New Zealand has an alarmingly high level of youth suicide, and of all types of suicide. The annual suicide toll is now over 600, far higher than the road toll that has had huge funding to try to reduce it.

It is an urgent problem that needs action faster than a general mental health review, and the causes of suicide are much wider than just mental health. Many of those who commit suicide are never in the mental health system.

“I do not believe it will be possible to eliminate suicide in the first term of this Government” – it won’t be possible to eliminate suicide in any time frame.

“…we are committed to lowering the rate of suicide in New Zealand…” – as was the last Government, without success.

“…and I am looking forward to beginning the mental health inquiry” – I’d like to see more urgency and action than that.

Unseemly stoush over youth suicide

Of all things youth suicide is one of the worst issues to become a victim of unseemly political niggling, but that is what has happened between the new Minister of Health David Clark and the previous Minister, Jonathan Coleman.

Coleman had problems with diplomacy and public relations, but Clark seems to have not graduated fully from being in opposition yet.

NZH:  New Health Minister David Clark on youth suicide: We have a problem and we need to talk about it

Labour campaigned on mental health and pledged the return of the mental health commissioner and an inquiry into mental health.

Terms of reference and other details around the inquiry were yet to be settled, Clark said, but forecast it as wide ranging, considering issues of colonisation and poverty.

He spoke of “hardship, or the after-effects of colonisation, or trauma in their own lives or personal histories”.

Past practices of shutting down debate on suicide did not deal with an issue that was persistent, Clark said.

“I think we need a public conversation about this. We can’t avoid it as a country. We have a problem and we need to talk about it.”

But he also challenged media to tell stories of survival and recovery, and not to dwell only of those who had taken their lives.

Not talking about it has failed so talking about it makes sense – as long as it is sensible talk. However continuing a political slanging match is not a good place to start.

New Health Minister Dr David Clark has leveled a stinging accusation at the previous government and his predecessor Dr Jonathan Coleman, saying funding and priority shortfalls led to more victims of suicide. Clark made the comments during an interview with the Herald as part of its Break The Silence campaign on youth suicide.

The interview charted the new Government’s hopes for greater suicide preventions and a pledge that more would be done to save the lives of those contemplating taking their own.

Our teen suicide statistics are the worst in the developed world and we have the second greatest number of self-inflicted deaths among those aged 25 and under.

The latest suicide statistics had the highest number of suicides ever – 606 people took their lives. And the figures were little better measured against an increasing population showing little movement in the last decade.

It is a problem that has proven difficult to deal with.

Clark was critical of Coleman and the previous government during the interview, saying officials were “frustrated” over the failure to develop a new Suicide Prevention Strategy after the previous one expired a year ago.

He also criticised Coleman for failing to match an increase in people seeking mental health support with funding.

Political bickering is not a good start to trying better ways of dealing with it.

Asked if that cost lives, Clark initially said it was “very hard on an individual level to say that somebody died because of a lack of funding”.

He then said: “The proposition you’ve put is one that seems reasonable to me, that if you don’t support people, more people are going to take their own lives. I don’t think we can deny that.”

Asked how he felt about there being no current suicide prevention policy, Clark said: “I have expressed publicly frustration with the previous minister. I don’t think there’s much point dwelling on that now. I feel the burden of office that I have picked up. I want to make sure we are in a position as government to find solutions.”

A response: Jonathan Coleman says he’ll hold new health minister to account over suicide target

National’s former health minister Dr Jonathan Coleman says he will be holding the new health minister to account if New Zealand’s suicide rate does not drop.

Coleman declined to be interviewed by the Herald for the story but spoke to Newstalk ZB’s Larry Williams this afternoon.

He told Williams he was surprised Clark was personalising the issue.

“Dr Clark is now signalling he is going to take personal responsibility for the suicide rate from this point on with a zero suicide target … I think he’s making a real rod for his own back,” he said.

“Of course we want to get the suicide rate down … it’s an extremely tragic and difficult area and I’m just very surprised that he’s prepared to talk like this – he’s not doing himself any favours.”

Coleman defended his record on mental health, saying the National government had put an extra $300 million of funding for mental health in the 2017 budget, with $100 million going into spending on portfolios like social welfare, housing and education that impact on mental health.

It’s too soon to know if that extra funding will make any significant difference, and it can easily be argued that it is too little, too late (that can always be argued in politics).

Asked by Williams if any government was accountable for New Zealand’s suicide rate, Coleman said it was “foolish” for the new health minister to say so.

“I genuinely wish Dr Clark well in improving that suicide rate because he’s now set the target, he’s said he will taking personal responsibility and I will be holding him to account over that,” he said.

“I hope he does succeed because this is people’s lives – but clearly if he doesn’t he will be failing to deliver on one of biggest things he campaigned on.”

It’s disappointing to see both Clark and Coleman making this issue political and personal. It is far too serious and important to be overshadowed by bickering.

Health is a very difficult portfolio to manage, because there will always be deaths, and there will always be demands and pressures on funding.

Youth suicide – and don’t forget middle aged suicide which is as big a problem – deserves better from both the Minister and the ex Minister.

Q+A: health debate – Coleman & Clark

On Q+A this morning: Who has the best policies for our health system?
Watch our health debate – Political Editor Corin Dann with Labour’s Dr David Clark and National’s Dr Jonathan Coleman.

Image may contain: 2 people, people smiling, glasses

Coleman and Clark also featured on The Nation yesterday (repeated this morning at 10:00 am).

Labour on health:

Health

Additional $8 billion investment in health over four years

See the details in our fiscal plan here.

Cut GP fees by $10 a visit with $8 GP visits for Community Services Card holders

From 1 July 2018, Labour will lower the cost of GP visits by $10 through:

  • Lowering the VLCA fee cap by $10 to $8 for adults and $2 for teens (under 13s are already free), with a funding increase to VLCA practices to cover this
  • Increasing government funding for all practices that lower their fees by $10, low (show all)

Continue reading →

National responded to Labour’s $8b:

Labour’s mythical $8b extra health spend

The Labour Party has been trying to pull the wool over everyone’s eyes with its mythical $8 billion extra health spend, National Party Health spokesman Dr Jonathan Coleman says.

“The ‘$8 billion more’ health spending argument is smoke and mirrors. They are simply rolling out normal baseline increases and comparing them with a mythical situation of an alternative government that apparently doesn’t add a single dollar to health expenditure for four years. That’s laughable and has simply never happened,” Dr Coleman says.

“The Labour massive extra spending myth also shows up in the amount of new budget money they propose to add each year. Labour is planning to add less in health for each year in the next four years than the National Government has added in the last budget alone.

National new budget operating spend (actual):

  • 2017/18        $879 million

Labour proposed new budget operating spend:

  • 2018/19        $847 million
  • 2019/20        $689 million
  • 2020/21        $826 million
  • 2021/22        $795 million

“The reality is every government makes big increases to the health budget. Of course it’s all about what you do with the money rather than the money itself. And the National Government has an absolute focus on lifting results from the health investments we make.

“The irony is that whether you measure by our respective history of results or just the dollars, when you compare Labour’s proposed plan with National’s track record New Zealanders would receive less from the health sector under Labour.”


The Nation: Coleman v Clark on health

 

There will be a debate this morning on The Nation on health spending, between the Minister of Health Jonathan Coleman, and Labour’s health spokesperson David Clark. These two have clashed a number of times in Parliament.

Health is on of the biggest issues of concern to New Zealanders. In the latest Herald-ZB-Kantar TNS online survey of 1000 voters…asked which of eight issues was most likely to affect their vote:

  • Economy 25%
  • Health 16%
  • Housing 12%

You need a healthy economy to provide good health care (and housing).

Providing healthcare is very expensive. here will never be enough money to provide all the health care wanted. Governments have to balance health spending against need and against other spending demands.

Labour have claimed that health funding has been effectively cut.

Stuff: Frustration, disappointment over health funding in Budget 2017

Patients and healthcare workers say they have been left frustrated and disappointed by “inadequate” funding for health in the 2017 Budget.

They said the Government’s announcements on Thursday would not go nearly far enough in addressing concerns about overworked staff, access to new medicines, and access to mental health treatment.

The Government said total health spending would be a record $16.77 billion in 2017/18 – an increase of $879 million, with an overall increase of $3.9b over the next four years.

However, the record claim does not take inflation into account, and sidesteps the fact that almost half the spending will go toward mandated wage increases as part of the pay equity settlement.

Budget 2017: Health funding to record levels with $1.7b injection to DHBs 

A strained health sector is set to receive a record $3.9b shot in the arm, with $1.8b going to District Health Boards (DHBs) alone.

While DHBs funding is above the $1.7b figure Labour claims has been stripped out of the health service, the Council of Trade Unions is warning the devil is in the detail.

The increase to DHB funding has built on previous years – going up to $1.8b across four years, up from $1b last year. As a yearly figure, DHBs will get $439m, up from last year’s $400m.

 

An Ashburton farmer on vitriol and inconsistency in the water debate

David Clark, an Ashburton farmer, on hatred, vitriol, water tax, and farming’s contribution to the rural based economy:


It really saddens me to hear and read to the hatred and vitriol that been brought into this election campaign and I am very concerned at the rift between urban and rural and the disconnection between food production and our population.

We live in a nation of low unemployment, a world standard low cost health system, a no-fault accident compensation scheme, social welfare and pension provisions. We have an extraordinary high degree of food security in this country.

I live in a district whose main town has virtually the lowest unemployment in New Zealand. We have a vibrant, multi-cultural community that offers a wide range of employment opportunities and a very high level of community facilities. This is much transformed town that come out of the ‘80’s with its tail firmly between its legs.

Ashburton is a town that has been transformed in the last 25 years; this is a town that has been transformed by the development of irrigation, both in arable and dairying land uses. This district grows over half of the world’s carrot and radish seeds along with a wide variety of other crops exported worldwide. We produce 8% of the National Dairy production.

I am an arable farmer using irrigation to grow seed crops that are exported worldwide and grain and vegetable crops for domestic food consumption as well as finishing lambs for NZ butchers and export.

We first put irrigation on in ’98 and then in 2011 installed pivots to achieve more efficient water use and lower leaching than the older irrigators we had originally operated, at a cost of well over $1 million. We did that voluntarily because it increased our production, reduced our water use and significantly reduced our environmental footprint, however we could only justify that expenditure because our business was bankable.

Our business proudly supports local firms for the provision of goods and services and like our fellow farmers, most of the gross income is spent in the local community and profit, if any is largely reinvested in our business via local firms.

We operate our tractors on GPS guidance, running at 20mm accuracy to reduce overlap, our fertiliser spreader is GPS controlled and records all applications to a geo-spacial map, our combine weighs every kg of crop and overlays that data onto a map so we can track inputs and outputs accurately here as a result of investment in technology. It is investment in this technology that is achieving improvements in our environmental footprint.

On Friday night I attended a public meeting to hear Labour Water Spokesperson David Parker present his proposal for a tax on irrigation water. His presentation was headed by “How did we get to this?” and showed a series of photos from around New Zealand of environmental degradation caused by agriculture. The photos showed practices that are unacceptable for sure, no argument about that, but a selective portrayal of the worst of the worst in my view.

At not one point did I hear any positive comment of the actions of the farming community in NZ. But interestingly none of the photos depicted anything in Mid Canterbury, had nothing to do with arable agriculture and only one shot of Coe’s Ford after three years of drought had any connection to irrigation. There was only one photo of a degraded urban waterway and that was one that Federated Farmers had provided to Mr Parker earlier in the day and challenged him to display.

The purpose of the meeting and continuation of his presentation was to explain the Labour Party’s intention to impose a tax on irrigation in NZ with the intent of using the money raised to repair environmental damage.

The missing part of this logic was that his slide show did not depict irrigation as the cause of the degradation and this is confirmed by a report by Irrigation NZ that shows there is no correlation between areas of high irrigation development and regions with poor water quality in NZ.

So why tax irrigation? And Irrigation predominately in Canterbury and Otago that are regions with good water quality?

I listened to the proposal and wondered why, if using a public resource for private profit was so villainous, why would a food producer using irrigation be taxed, but a soft drink company abstracting water from the Auckland Municipal supply be exempt? I heard the argument popular in Ashburton about export water bottlers, but if the bottling company pumped from their own well, they would be captured by this tax, however if the plant connected onto the local Council reticulated supply, their export activity would be water-tax free.

I sat in the meeting heard a whole lot of vitriol and bitterness extended towards the agricultural community and I reflected on the fact that it was August 18th and that night our monthly bills would be paid and a not insignificant sum would be transferred to local businesses, local businesses that the attendees relied on for either direct or indirect employment or for taxation to fund their social payments. The receipts from our production re-cycle many times through our local community, and I’m pleased about that.

I reflected on the reality that in the last ten years a qualified tradesman in Ashburton could pretty much name their charge out rate or hourly wage on the back of rapid development, both urban and rural, largely, virtually entirely, whether direct or indirect, on the back of the productivity achieved irrigation in the Ashburton District.

This is a town where professionals view their income earning potential as better than in large cities, a town that offers an unemployment rate equal to the lowest in the country. A town with a man-made lake providing a housing location and leisure facility for all; a lake that is packed on any summer’s afternoon.

We have a town with a new art gallery; and a new aquatic centre costing $35m. A fantastic complex on which the paint was hardly dry and some around the town were grizzling that it needed the addition of a Hydro Slide for the children.

I listened to the anti-farming vitriol, and heard how they believed that we were stealing water and the town folk saw no benefit. Every dollar we earn is re-cycled into our local community, the employment generated by our business, direct or indirectly is significantly higher than it was in 1994 when we moved to a dryland sheep farm running 2,000 ewes.

A theme, which seems to be propagated at present by the Left is that Water Quality is a Rural problem, and therefore of Agricultural origin.

I accept that farming has an environmental footprint; no doubt, I also accept that practices need to and will change. In my view, technology and regulation will go hand in hand to solve those problems. Interestingly the three key policies that David Parker said he would implement are already in place by way of the Canterbury Land and Water Plan and he congratulated the National Government appointed Commissioners at ECan on introducing a robust water management framework.

But I don’t think that is the end of the debate. We regularly swim with our children in the river that bounds our farm; in fact I would happily drink it. I, along with thousands of others enjoy recreation in Lake Hood which is fed by the Ashburton River.
But the media and the Left would portray our rivers as dangerously polluted and degraded.

In comparison, I cannot swim in the Avon or Heathcote, nor the Christchurch Estuary which are subjected to storm water flows, overflows from the sewer network, seepage from broken sewers and heavy metals and petroleum contamination, which at times are several hundred times safe levels. Sure Christchurch has been devastated by the earthquakes, but the pollution of these urban waterways long pre-date the earthquake.

I would look forward to the day we can safely swim in the Avon adjacent to Oxford Terrace.

We hear much of the risks of the Ruataniwha Dam, but overlook the reality that the Hawke’s Bay’s two cities pump their sewerage out in the bay. Invercargill City is currently arguing in the Courts to renew its consent to discharge sewerage into four waterways including a lagoon.

In the Hutt Valley the sewerage system has contaminated an aquifer and will likely require the long term chlorination of the local water supply.

I grew up in South Auckland and enjoyed swimming at their most magnificent beaches during summer. The situation now is that one million cubic metres of sewerage and wastewater pours into the harbour every year regularly requiring the beaches to be closed to swimmers.

Two summers ago we stopped for lunch at a public picnic table looking out to Lion Rock at Piha. As our children walked across the mown grass their shoes turned green from the septic tank leachate oozing from the ground. Their shoes and the whole area stank; it sure didn’t do much for our appetite.

Yet the Left are silent on urban water quality issues, best not scare the voters with any suggestion they may need to fund the upgrade of their own effluent disposal system. It is far more politically expedient to poke the borax at farmers. We all have a footprint on this planet, and poor water quality has many causes and we are all responsible for the many solutions. Taxing only one group is not that solution.

Across New Zealand we are covering much of our elite food producing soils with the ongoing march of urban sprawl, permanently removing this land from production. Surely mankind cannot have more of a footprint that covering food producing soil with concrete.

In our world, we are challenged to produce food at the lowest price in the world. We do so by employing world leading technology to be some of the most efficient producers on the planet. Why would I say the cheapest in the world? Well, if we are not, the manufacturers and supermarkets will turn and import the ingredients quickity-split.

You see, as much as we talk about providence of supply and country of origin, animal welfare and environmental footprint, the brutal reality it that the vast bulk of consumers purchase the grocery item that the supermarket has a “special” tag attached to and couldn’t give two-toots as to where it came from or what standards it conformed to.

Our family has proudly farmed continuously in various parts of NZ for 140 years; I am but a caretaker and would hope that at least one of my children might take our family forward as food producers. It is in our very best interests to ensure that this property is in better condition for the next generation than when I began my stewardship.

I have listened to the hatred, I have read the posts on social media riping into farmers and it saddens me. This is a very nasty election campaign and I hope it is not a reflection on society as a whole.

It is a wet Sunday afternoon and I have stock to check on, best get my wet weather gear back on and get cracking.

David Clark.

As posted on Facebook

Bad health in Parliament

The Minister of Health has a very demanding job, but that doesn’t excuse being an arrogant ass.

It’s a serious issue. for many. A lot of people have good cause to have serious concerns about the delivery (or often non-delivery) of health care.

7. Dr DAVID CLARK (Labour—Dunedin North) to the Minister of Health: Why did he say yesterday in the House, “I do not need to check with DHBs around that”, when asked if he was sure about his claim that every other district health board is currently “managing to deliver the operations that are needed”?

Hon Dr JONATHAN COLEMAN (Minister of Health): As I said in the House yesterday, I do not need to check with district health boards (DHBs) around that, because it is a fact that we are delivering 50,000 more operations than 8 years ago.

Dr David Clark: What assurance will he give that IT glitches, like the one that stopped medical professionals accessing patient letters this morning at Counties Manukau for 2½ hours, are not impacting on delivering the operations that are needed?

Hon Dr JONATHAN COLEMAN: That sounds deeply operational. I am surprised that at this time of the political cycle the member is not trying to raise his game to a more strategic and political level, but be that as it may; I will go back and ask a question about that. At the same time, I will be able to assure him that there is an extra $470 million of money that has gone into Counties Manukau, as well as a lift of 4,500 operations at Counties Manukau, an increase of 34 percent compared with 8 years ago when that crowd was running the system.

Dr David Clark: I seek leave to table a message to Counties Manukau DHB staff relating to clinical letters being unavailable to medical staff for 2½ hours due to an IT glitch this morning—to help the Minister out.

Mr SPEAKER: I will put the leave. Leave is sought to table that particular letter to staff. Is there any objection to it being tabled? There is not. It can be tabled.

Document, by leave, laid on the Table of the House.

Dr David Clark: Does he believe there are enough hospital beds for patients to meet demand pressures when at the beginning of August, 2 weeks ago, Middlemore Hospital was at 116 percent full capacity in medical, surgical, adult rehabilitation, and health of older people wards, with 358 patients going through the emergency department in one day and 52 patients left sitting waiting for an in-patient bed?

Hon Dr JONATHAN COLEMAN: Of course, history shows I always have to check that member’s numbers, but be that as it may, of course winter is a busy time in our hospitals. It has been an especially vicious flu season, despite 1 million vaccines being distributed, but the member will be really pleased to know that, actually, we do have the capacity in our DHBs to absorb this sort of situation.

Dr David Clark: I raise a point of order, Mr Speaker. I will assist the Minister again. Actually, one of them was 128 percent over, and I have the—

Mr SPEAKER: Order! [Interruption] Order! If the member is now seeking to raise a point of order, then he does it. What is the point of order?

Dr David Clark: I seek leave to table an internal email detailing just how overfull the Middlemore Hospital was.

Mr SPEAKER: Leave is sought to table this particular internal email. Is there any objection to it being tabled? There is not; it can be tabled.

Document, by leave, laid on the Table of the House.

Dr DAVID CLARK: After 9 years in Government, what is he doing about the fact that the most recent figures show that once eye injections, skin lesion removals, and other quick operations traditionally done outside the hospital setting are removed from elective surgery figures, year on year fewer elective surgeries were being done in Counties Manukau?

Hon Dr JONATHAN COLEMAN: I find that extremely doubtful. I am not sure where the member is going with this line of questioning. These are very important operations. If he removed every important operation they were doing at Counties Manukau, none would be being done. Across the system as a whole, even if you removed these very important eye injections and skin operations, some of which have to be done under general anaesthetic, we are still doing 30,000 more operations per year than when that crowd was managing it.

Dr David Clark: After 9 years, how much longer will people have to wait when he says “[T]here is no doubt that in health there is always more to do.”, when all the wards in one of our largest hospitals in New Zealand are fully staffed and are in need of close to 70 extra beds before patients arrive each day?

Hon Dr JONATHAN COLEMAN: I think the member needs to just reread his question in his mind, because, frankly, the whole thing just does not make sense, but despite that what I would say is that 9 years on, across the hundreds of services that our health system provides you would struggle to find more than a handful that are not performing better than 9 years ago. There are 50,000 more operations, 150,000 more appointments, and 7,000 more doctors and nurses in the system, and, yes, maybe from time to time the IT system might go down for 2 hours at Counties Manukau. If he thinks that is bad, he should try the IT system in Parliament for comparison.

Dr David Clark: After 9 years, what does he say to clinicians across the country who are pleading for their hospitals to be given more operating theatres, more specialist doctors, and more funding; and is this the “health system that’s the envy of the world” that he envisaged?

Hon Dr JONATHAN COLEMAN: The member needs to start becoming a bit more positive about New Zealand and our health system, because, actually, it stacks up pretty well. I can tell you that if you look at the facilities we have built in health across the country—$1 billion of health rebuilds in Christchurch, West Coast is being done, Dunedin is next, 6,900 more doctors and nurses in our hospital system, 50,000 more operations, and 150,000 more specialist assessments. What I would say to those specialist doctors is that if this guy was ever running the health system, they would be in really big trouble.

Mr SPEAKER: Order! We do not need to go there.

Clark v Coleman on mental health funding

Labour’s health spokesperson David Clark versus Health Minister Jonathan Coleman in Question Time on Tuesday – this approach doesn’t help the mental health debate.


Health, Minister—Statements on Authors of People’s Mental Health Report

11. Dr DAVID CLARK (Labour—Dunedin North) to the Minister of Health: Does he stand by his statement about the authors of the People’s Mental Health Report, “they’re very left-wing, anti-Government protesters”; if not, when will he apologise to the 500 people who wrote their own stories about experiences with the mental health system as part of the report?

Hon Dr JONATHAN COLEMAN (Minister of Health): Yes, and my statement distinguished between the genuinely motivated story submitters and those ActionStation organisers with some political agenda. My quote was: “When you look at the people behind it, [you know] they’re very left-wing, anti-Government protesters.” As I say, ActionStation is back on Thursday with another, separate, anti-Government protest within the health area, and it could be back week after week with different topics. And just for the record, the ActionStation campaign coordinator is Mr Rick Zwaan, the Green Party’s Wellington election campaign coordinator, who used to work as Kennedy Graham’s researcher. [Interruption]

Mr SPEAKER: Order! [Interruption] Order! Supplementary question, Dr David Clark. [Interruption] Order! I have asked for less interjection from everybody so that Dr David Clark can ask his supplementary questions.

Dr David Clark: Has he read the report; if so, does he accept that its aim, as recorded in the executive summary, is to give space to the stories of what is really going on and going wrong in our mental health services?

Hon Dr JONATHAN COLEMAN: Yes, I have read the report, and especially the executive summary, the first line of which is a totally false premise. It talks about $140 million being cut from health funding. Well, actually, health funding has gone up by $300 million, which kind of proves the point that this is a political document.

Dr David Clark: Does he think the contribution of Robbie, who described support services as expensive and inadequate, and which, he says, “almost drove him to take his own life”, should be dismissed as the experience of a left-wing, anti-Government campaign?

Hon Dr JONATHAN COLEMAN: I have already answered that. Look, I think Robbie’s experience is worth listening to, but that does not change the fact that this report is produced by a group of people who are permanent anti-Government protesters. If the member does not believe me, go and look at their website. They will be back here, week after week, on subject after subject after subject, because they do not like the Government.

Dr David Clark: Does he think the contribution of Mike King, who “describes despair and hopelessness in the face of inadequate access to mental health services”, should be dismissed as the experience of a left-wing, anti-Government campaigner?

Hon Dr JONATHAN COLEMAN: Look, I think the member needs to speak to Mrs King about how you think on your feet. I have answered that question already. The organisers are from ActionStation, and it is the permanent anti-Government, left-wing protester. Mr King is a very good man—Mike King, as opposed to Mrs Annette King—who is genuinely motivated, and I do not detract from his efforts. But, as I say, when you have people like Mr Rick Zwaan, who used to work for Kennedy Graham, and his friends from the Green Party, I think it is pretty obvious that this is political.

Dr David Clark: Does he think the contribution of “the many parents who submitted in regard of their children’s experience of huge waiting lists and lack of funding” should be dismissed as the experience of a left-wing, anti-Government campaign?

Hon Dr JONATHAN COLEMAN: I point out to the member that he does not have to take all his supplementary questions, and if he cannot think of new material in response to the answers, he should just stop. [Interruption]

Mr SPEAKER: Order! We will deal with them one at a time.

Chris Hipkins: I raise a point of order, Mr Speaker. For two answers in a row, the Minister began by insulting the questioner rather than addressing the question. But the main substantive point is that despite the abuse in that last answer, he did not even address the question that was asked.

Mr SPEAKER: On this occasion—[Interruption] Order! I have been increasingly worried about the interchange between these two members and some of the answers that have been given on occasion by the Hon Dr Jonathan Coleman, but, on this occasion, when I consider the three questions that were asked, they were, effectively, the same question each time. Therefore, I can understand the frustration of the Minister in having answered the question the first time—he, effectively, gets the same question for the next two occasions.

Dr David Clark: I raise a point of order, Mr Speaker. That question, in my view, was not addressed, because he had talked about ActionStation, which is the compiler of the report. I am asking a specific question about the comments from the parents within the report. That is a very specific and non – politically loaded question.

Mr SPEAKER: Order! I would like to assist the member, but when I consider the answer that was given to, I think, the second supplementary question, that, effectively, was an answer that was then quite suitable for the rest of the questions the member asked, which were, effectively, just drawing on the experience of someone else within the book. The Minister was quite clear in saying he is not in any way critical of the experiences that were detailed in the report; he was certainly critical of the authors who put the report together.

Hon David Parker: I raise a point of order, Mr Speaker. With respect, is the problem with that not that the Minister is trying to write this off as being a left-wing conspiracy—that is the essence of his answer? I think it is quite proper for members of the Opposition to put instance after instance after instance that paint a different picture. I think the Minister should have to address each of those instances, rather than just cast aside a political insult telling him he should learn how to ask different questions.

Mr SPEAKER: Order! I do not agree that it was a political insult. The question was answered. There was no attack on the various contributions that were made within that report by the Minister. There was certainly a feeling that the authors were not of the same political persuasion as the Minister. That is acceptable.

Dr David Clark: To clarify—

Mr SPEAKER: No. [Interruption] Order! [Interruption] Order! Would the member please resume his seat. [Interruption] Order! Would the member please resume his seat. I have ruled on that matter. The member is now starting to challenge the Chair and debate with the Chair. That in itself will lead to gross disorder in this House. Question No. 12—Melissa Lee—[Interruption] Order! [Interruption] If I hear a further interjection from Carmel Sepuloni while I am in the Chair today, she will be leaving the Chamber. She has been consistently interjecting throughout question time in a very—[Interruption] Order! If the member wants to go now, I can make that arrangement very easily. I expect cooperation, particularly from whips, and the level of interjection that has been coming from Carmel Sepuloni throughout question time is unacceptable. When I rise to my feet, for those interjections still to continue is just not acceptable to this House.