More than a decade in the making, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was passed in late 2016 but the changes made will only come into effect on 31 January. The Bill amended eight Acts to replace references to ‘doctors’ or ‘medical practitioners’ where nurse practitioners (NPs), nurses and other health practitioners are now qualified to carry out those roles.
“One of the things I’m most excited about is overseeing the enactment of this legislation that is coming in at the end of the month,” said Clark.
“This means that nurses will be able to issue sick notes for work and NPs can issue death certificates,” he said.
The amended Acts also remove the current anomaly where NPs can sign ACC forms and sickness benefit forms but cannot sign a certificate for ordinary sick leave from work.
Roles changing under the new legislation (see full details at end of story) include:
Outgoing chief nursing officer Jane O’Malley described the passing of the bill in 2016 as the “culmination of years of work” from the nursing sector, the Ministry of Health and other agencies.
“We’ve got to make the most of particularly the nursing workforce, with its 53,000 nurses who oversee the largest unregistered workforce in the sector,” said Clark. “If we have these people active and practising at top of scope, there’s a huge opportunity for our health system to deliver more care within the fiscal restraints that we have.”
The Minister talked about the legislative changes in an interview with Nursing Review this week in which he also discussed pay expectations and briefly touched on pay relativity for nurses working in sectors such as aged care and Māori and iwi health providers.
Clark said pay relativity was something that needed to be looked as part of the primary health care review. It is understood that the terms of reference are currently being worked on for the review of the primary care funding system promised by the incoming government within its first 18 months.
“I do want to see different models of care looked at,” said Clark. “I think that is required if we’re going to have a sustainable sector that actually delivers better access to quality care for New Zealanders.
“We need to recognise that in many areas, particularly those that are rural or underserved, they have workforces – and nursing workforces – that are actually practising at the top of their scope.” Clark said he believed that was where the opportunities were – ensuring that people were supported to practise at the top of their scope.
Clark added that his job as Minister of Health was to defend the interests of the patient.
“I’m not there to represent any particular workforce but to ensure the best outcomes for the public patient, and that involves ensuring that the workforce is sustainably funded and we have healthy workforces and safe staffing levels.
“I think the only reason our health system is in the good shape that it is, is because of the good grace of the workforces that have been subject to underfunding over the last nine years,” Clark told Nursing Review.
He said the new Government was committed to putting that money back into the sector, but it would take time. It would also take time to build a sustainable health workforce and the capacity to employ more new graduate nurses, he said.
LEGISLATION CHANGES FOR 2018
AMENDED ACTS
Holidays Act 2003: Health practitioners will be able to certify proof of sickness or injury.
Burial and Cremation Act 1964: Nurse practitioners will be able to issue certificates for the cause of death for patients in their care.
Medicines Act 1981: Nurse practitioners will be able to supervise designated prescribers (such as authorised registered nurse prescribers or RN prescriber candidates).
Mental Health (Compulsory Assessment and Treatment) Act 1992: Nurse practitioners, or registered nurses working in mental health, will be allowed to complete a health practitioner certificate for applications for assessment under the Act. An NP will also be able to conduct an assessment examination if approved by the Director of Mental Health. The Director can delegate this approval to the Director of Area Mental Health Service.
Accident Compensation Act 2001: Health practitioners providing treatment to a client will be given the opportunity to participate in preparing clients’ individual rehabilitation plans. Suitably qualified health practitioners will also be able to prescribe aids and appliances.
Oranga Tamariki Act 1989 (formerly the Children, Young Persons, and Their Families Act 1989): Health practitioners will be able to carry out medical examinations ordered by the court when considering whether children or young people have been abused, if the court considers that these health practitioners are qualified for that purpose. In addition, a social worker will be able to ask for medical examinations to be completed by health practitioners qualified for that purpose.
Misuse of Drugs Act 1975: Nurse practitioners, registered nurses working in addiction services and pharmacist prescribers will be allowed to prescribe controlled drugs for the purposes of treating addiction.
Land Transport Act 1998: Health practitioners will be able to request blood tests from drivers and assess and report on their fitness to drive. It will be illegal for someone to refuse a blood test from a health practitioner. Other amendments enable health practitioners to take blood, handle evidential specimens and appear in court to give evidence.
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Voting in the three-yearly election for the three Council members elected by the profession closed on September 1, but the timing of the election and change of government has meant the results remain in limbo.
The Council can’t announce the elected council members until the Minister of Health has approved the nominated candidates. This was initially expected to happen before Christmas but the Nursing Council says it now understand the nominations are due to go before the Appointments Committee at the end of January.
Just over 10 per cent of eligible nurses voted in the election – the same turnout as the elections held in 2011 and 2014. There were 16 candidates for the three positions, including the current chair, deputy chair and a council member.
]]>Memo Musa, head of the New Zealand Nurses’ Organisation and Professor Jenny Carryer, executive director of the College of Nurses were responding to Health Minister Dr David Clark’s announcement today of the urgent establishment of a five-member Ministerial Advisory Group. That announcement followed quickly in the wake of the early resignation of the Director-General of Health and Ministry of Health chief executive Chai Chuah announced yesterday.
Musa applauded Health Minister David Clarke’s decision to set up an advisory group to take a really good look at the health service. “…However nurses must be included at this level of decision-making. We will raise this issue with the Minister next week.”
Likewise Carryer described the new advisory group as “an excellent opportunity” to provide an urgent challenge to the health status quo but said it was “deeply disappointing that a senior nursing voice is not present” on the group.
“Well over 40,000 nurses are closest in every location to the consumers who are the centre of our focus and thus they have a great deal of insight into the necessary changes,” said Carryer.
Musa added that the issues facing nurses and the nursing profession – like safe staffing, new graduate employment, nurse workforce shortages and pay equity – would require “strategic foresight, courage and determination to resolve.”
Carryer said under Chai Chuah’s leadership the Ministry had “had a vision of what needed to change in health to accommodate the future”. “However they have struggled to align operational concerns with that vision. Often that is because the same interests are always around the table providing advice and determining the future.”
Musa said Chuah had made great contributions to the health system in a number of senior health management roles, including overseeing the review of the New Zealand Health Strategy while he was Director General.
“Chai’s stewardship of the health system has been at times managed under extreme pressure but throughout these times we have had a good working relationship with him,” Musa said.
“The health system has been under strain because of the previous government’s decisions to underfund it year after year. DHB chief executives are under huge pressure too and some resigned.”
“They were constantly asked by the last government to cut costs, at the risk of patient and staff safety. This is clearly an unacceptable proposition and this stress has also strained professional relationships at the top level of management and across the health system.”
Musa said it was now important to quickly establish stable leadership at the Ministry so the new Government’s ambitious health programme could be implemented.
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Clark made the comments during an interview with the New Zealand 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.
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.
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.”
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.
He had personal experiences of suicide in his family, Clark said, and among those he knew, or had encountered through his work as a Presbyterian minister or Youthline counsellor.
But he said those experiences would not be unusual for any New Zealander, with everyone likely able to relate their own personal story of suicide affecting those in their lives.
Coleman would not be interviewed on the comments. Through a spokeswoman, he said: “Dr Clark has made it clear for some months that he believes the Minister of Health is accountable for New Zealand’s suicide rate. It’s now up to him to set targets and to meet them.”
He also said officials would not be pleased to have the new minister speaking publicly about those in the previous government.
Asked if he would contribute to the upcoming inquiry into mental health, Coleman’s email said: “It is very hard to comment on a mental health inquiry as absolutely no details have been provided by the new Government.”
WHERE TO GET HELP:
If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
• LIFELINE: 0800 543 354 (available 24/7)
• SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757
The Prime Minister Jacinda Ardern announced yesterday that Cabinet had agreed to extend the current 18 weeks paid parental leave to 22 weeks from July 1 2018 and to 26 weeks from July 1 2020.
Kerri Nuku, the kaiwhakahaere for the New Zealand Nurses Organisation (NZNO), welcomed the extension of paid leave to 26 weeks (six months) pointing out that breast feeding for the first six months of life is recommended by the World Health Organisation as giving a better start for babies.
She said NZNO was a long-time supporter of extending paid parental leave because nurses and midwives understood the huge impact that family bonding has on a child’s health.
“Vulnerable mums, especially single mums, should be able to return to work when they are ready and this extension gives them a little more time without extra money worries. The bond with baby is so vital and it is a government’s duty to support that,” Nuku said. She said parents and babies benefited, also businesses by keeping loyal and trained staff, and society in general by helping to support New Zealand families.
Extending parental leave was a key pledge on Labour’s 100 Day Plan and supported by all parties in government. Ardern said currently 28,000 parents enjoy 18 weeks of paid parental leave – but that was one of the lowest rates in the OECD. She said the increased support for working families had a net cost of $325 million over four years and was budgeted for in its fiscal plan.
“We want children to have the best start in life,” said Ardern. “Evidence shows that having a parent at home as long as possible to care for a child provides a huge benefit for that child’s development.”
Nuku said NZNO would also like to see the barrier removed of having to work an average of 10 hours a week before you can access paid parental leave.
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Yesterday English confirmed former Health Minister Jonathan Coleman as opposition health spokesman and announced Waimakariri MP and former Canterbury District Health Board manager Matt Doocey as mental health spokesman.
Cantabrian Doocey has an MA in health care management from London’s Kingston University and worked in mental health and healthcare management in the United Kingdom before returning to Christchurch after the Canterbury earthquakes. He was elected to parliament in 2014.
Other health-related spokespeople announced included Whangarei MP Shane Reti as associate health spokesperson and list MP Jo (Joanne) Hayes as Whānau Ora and associate children’s spokesperson.
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“Industry should know we are pretty serious about making sure this is dealt with,” Ardern told Mike Hosking on Newstalk ZB.
Her comments come after the Herald reported new Health Minister David Clark as not ruling out regulation or a tax. Ardern reiterated that position.
“We know we have got a problem. And I think people would be surprised by how much sugar is being placed in everyday items.”
Ardern said a sugary drinks tax was not the only answer, given the high sugar content across other processed foods.
“We want to work with industry to try and get that rate of use down. Try and encourage industry to do that themselves. But we are leaving all options on the table.
“We are making sure we use some of the options that still exist before that [considering a sugary drinks tax]. There are examples in the UK where they got salt down dramatically by working alongside industry. We should make use of those options.”
Professor of Population Nutrition and Global Health at the University of Auckland Boyd Swinburn said Labour was right not to rule out tough action including a sugary drinks tax.
“It is actually very refreshing to see a government who is prepared to look at the evidence and look at every possibility that’s on the table that’s been recommend. So this is a breath of fresh air,” Swinburn told Newstalk ZB.
Labour accused the last Government of inaction on the issue of obesity and accused some manufacturers of rigging a labelling system designed to flag healthy products to shoppers.
Health Minister David Clark said his preference was to work with the industry to develop a better front-of-pack labelling system, and to set firm goals to reduce sugar content in packaged food.
Clark said there was “growing evidence” around the effectiveness of a sugary drink tax, but such a step wasn’t a silver bullet because it was only focused on drinks.
“I want to talk with industry first before going down any track like that.”
One likely change will be to labelling on food packaging. Currently there is a Health Star Rating System that is meant to signal the healthiness of the product by the number of stars on the front of the packet.
Clark believes there is a flaw in the voluntary system, in which manufacturers can “cancel out” the effect added sugar and other unhealthy ingredients have on a star rating if the product contains healthier ingredients like grains.
He said he would seek further advice on whether the Health Star system would be retained, or a new front-of-pack system introduced.
“There are some anomalies in the current system. It seems strange that breakfast cereals can have some fibre in them and then suddenly they get a high star rating despite having a lot of sugar.”
Asked if front of package health labelling could be made mandatory, Clark said he would consider all options but wanted to get advice first, and talk to industry.
Labour’s previous health spokeswoman, Annette King, said she agreed with celebrity chef and healthy food campaigner Jamie Oliver that people would be more conscious of what they were eating if they knew the number of teaspoons of sugar or salt that is in their food, and Clark has said a label that displayed such information could be helpful.
“I think there is room for more explicit labelling to indicate the amount of sugar in food products,” Clark told the Herald.
“And I also want to have constructive conversation with industry about how they think they could reduce sugar content over time in products. Personally, I think the most constructive approach is to work with industry. But I have also indicated that if the result that we need isn’t achieved then we are prepared to regulate.”
Timelines would eventually be set, Clark said, but he acknowledged that wouldn’t be straightforward.
“My experience is industry prefers to have clear expectations and be able to manage its own destiny. So I’m hoping that there will be a constructive relationship there.”
The New Zealand Food and Grocery Council declined to comment.
Sue Chetwin, chief executive of Consumer New Zealand, said the current Health Star system had serious flaws and her organisation supported an overhaul, and wanted it to be mandatory across more products including frozen foods.
“What they really need to do is change the algorithm … a cap would be a simple way so once you got to a certain level of those bad foods then you couldn’t get a Health Star rating that was, say, above two or something like that.”
Another change supported by Consumer that will likely be made under the new Government is a requirement for country of origin labelling on single ingredient food such as fruit and meat.
Former Green MP Steffan Browning’s Consumers’ Right to Know (Country of Origin of Food) Bill is at select committee stage, having been supported at first reading by all parties except Act.
]]>Incoming Prime Minister Jacinda Ahern announced today that Manukau East MP Jenny Salesa will become the associate minister of health as well as the country’s first Tongan-born and Tongan-speaking Cabinet minister Also announced as an associate minister of health, but outside of cabinet, is US-born Green Party health spokeswoman Julie Anne Genter. (See Salesa’s and Genter’s full portfolio lists below).
Salesa, who has degrees in education and law from the University of Auckland, first came to New Zealand when she was 16 to further her education. Her commitment to warm, dry affordable housing springs from her family’s early experiences of homeless during their first 2-3 years in New Zealand which were spent moving from family to family in South Auckland and living in overcrowded conditions. She entered parliament in 2014 after more than 20 years’ experience worked as a health and education policy specialist in New Zealand and the US.
“I am immensely proud, as an immigrant and as a Pacific woman, to show that anyone who comes here can dream big and can be successful, through perseverance and hard work, at whatever they set out to do,” said Salesa. “New Zealand was a land of opportunity for me and as a Cabinet Minister I can play a part in ensuring it remains so for everyone who chooses to live here”, she said.
Salesa said she was honoured by her appointment in “this ambitious Labour-led Government, which has the mandate to tackle New Zealand’s housing crisis, the recent years of funding cuts and neglect in health and education and to ensure that economic growth delivers for all Kiwis.” Salesa, who entered parliament in 2014, said she was looking forward to briefings and then knuckling down to work.
Julie Anne Genter grew up in Los Angeles – where her father was a doctor and her mother a dietitian – and has been the Green’s health spokeperson for just over a year. Speaking to Nursing Review prior to the election about the Green’s health policy – that specifically mentioned free visits for under-18s to nurses as well as doctors – Genter said: “Of course we see nurses as vitally important contributors to health care and they need to be part of our policy solutions.”
She also said pre-election that the Greens wanted a sufficient funding increase to the Health Budget to allow for wage increases to keep pace with the cost of living. Other priorities were a mental health inquiry looking at not only investing more money but also effective early prevention and ensuring staff in acute wards were not overworked and struggling to cope with demand. “A lot of our health initiatives are outside the health portfolio like our transport and housing policies which would go a long way to creating healthier and happier towns, cities and environments.”
The UC Berkeley graduate studied in Paris before coming to New Zealand in 2006 where she gained a Masters of Planning Practice at the University of Auckland and worked as a transport consultant. She worked as a political and media advisor at Parliament before becoming an MP in 2011.
In June this year Genter’s Misuse of Drugs (Medicinal Cannabis and Other Matters) member’s bill, which would make it legal for the terminally ill and those suffering a debilitating condition to use cannabis with the support of a doctor, was drawn from the ballot.
MINISTERS of HEALTH
David Clark
Minister of Health
(Also Associate Minister of Finance)
Jenny Salesa
Associate Minister of Health
(Also Minister for Building and Construction, Minister for Ethnic Communities, Associate Minister for Education and Associate Minister of Housing and Urban Development)
Julie Anne Genter (Green Party)
Associate Minister of Health
(Also Minister for Women and Associate Minister of Transport)
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“I feel sorry for David Clark,” said Professor Jenny Carryer, executive director of the College of Nurses. “I think he’s inheriting a terrible mess…a slowly imploding health system.”
Incoming Prime Minister Jacinda Ahern today announced Dunedin North MP and former Treasury analyst and Presbyterian minister Dr David Clark as the new Minister of Health. Joining him as associate ministers of health will be the country’s first Tongan-born minister, Jenny Salesa and Green party health spokesperson Julie Anne Genter. Both Clark and Salesa are in cabinet (numbers 10 and 15 respectively) while Genter holds portfolios outside of cabinet.
Carryer said she was absolutely delighted at Clark’s appointment. “He has a strong background through Treasury of using evidence to inform policy and he is clearly a thinker and is background gives me great confidence that we will see some much more effective decision-making.”
She also noted incoming deputy Prime Minister Winston Peters’ comments last week and agreed that “we have been hell bent on a neoliberal/capitalist direction and it’s long overdue for a rapid reversal of how and why we do things…and where we get advice”.
Jane MacGeorge, acting chief executive of the New Zealand Nurses Organisation (NZNO), said the new minister showed a good understanding of the social determinants of health such as poverty and the quality of housing. (See also earlier related story: Nursing unions welcome new government)
She said NZNO planned to meet with the Minister soon to discuss building a more sustainable nursing workforce and the need for nurses to be consulted on policy impacting on nursing and health. MacGeorge said the ‘health spend freeze’ of the last few years had had a negative impact on nursing, particularly staff shortages impacting on the care nurses can provide patients and nurses’ ability to get coverage for professional development leave.
Dalton Kelly, chief executive of the New Zealand Rural General Practice Network, also welcomed the new minster and looked forward to working with him to “resolve the long-running health challenges facing rural communities.”
“It is encouraging to see that both Labour and New Zealand First have common ground in terms of primary care health policy, such as the recruitment and training of more GPs and health professionals, a review of the number and funding of DHBs and PHOs and a need to review and improve mental health services,” said Kelly.
Ian Powell, executive director of the Association of Salaried Medical Specialists said Clark had already shown a good grasp of the portfolio and the association had “high hopes that he will be willing to tackle the challenges facing public health. “These include years of significant under-resourcing of public hospitals, longstanding shortages of senior medical specialists, a high level of unmet need in our communities, and disruptive privatisation moves.”
He said members looked forward to working with the new minister to rebuild the public health system and ensure equitable, quality access to health care for all.
David Clark was born in Auckland and graduated from the University of Otago in 1996 with a BA and a Bachelor of Theology. He was a Presbyterian minister for three years before returning to the University of Otago to gain his PhD after which he was a Treasury analyst for three years then an advisor to then Labour cabinet minister David Parker in 2006-07 (under the Helen Clark Government). He returned to Dunedin in 2008 to become warden of Selwyn College until elected as MP for Dunedin North in 2011. On the resignation of longstanding health spokesperson Annette King he became Labour’s health spokesperson. The new Minister of Health has twice completed the New Zealand Ironman course at Taupo.
MacGeorge said it was pleased to see the new Government’s emphasis on ending child poverty and commended the incoming Prime Minister’s stance by becoming the Minister for Child Poverty Reduction. She said it also wanted to see more Māori nurses attracted into nursing and more nurses going into mental health. Plus it wanted the sector’s more senior experienced nurses to stay in nursing and for employers to accommodate these nurses’ needs to keep them in the profession.
David Clark
Jenny Salesa
Julie Anne Genter (Green Party)
Jacinda Ahern
Carmel Sepuloni
Phil Twyford
Nanaia Manuta
Peeni Henare
Aupitu William Siu
Tracy Martin (New Zealand First)
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Labour and New Zealand First have signed an agreement to work together as a coalition including setting out a number of coalition priorities (see health details below) alongside Labour’s own policy priorities.
Labour and Greens have signed a confidence and supply agreement which allows the Greens to determine its own position on policy matters outside the shared policy goals the two parties signed up to (see health-related goals below). A Green Party member will also hold an associate minister of health portfolio.
“In this parliamentary term, New Zealand First policy has a number of priorities to progress which Labour will support alongside its policy programme.” These include the following goals:
“In this parliamentary term, the Green Party has a number of priorities to progress the implementation of the Sustainable Development Goals. The Labour-led Government shares and will support these priorities.” They include the following goals:
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