President's Blog


The NZSA President, Dr Sheila Hart, writes a regular blog with opinions and reflections of issues affecting the specialty and wider health system.

EOLC Act update and NZ health system reforms

July 2021

In my last blog I focused on the End-of-Life Choice Act and its roll out on 7 November.  I really did feel quite in the dark when I wrote that. Many thanks to everyone who completed the survey we sent relating to the Act – we had a very good response rate and a key message I took from the results is that we have an important role to play in keeping you informed of what is going on in a succinct and manageable format (survey results will be winging their way to you soon).   It therefore seems reasonable to provide a brief update, especially as we received a comprehensive overview from Dr Kristin Good (Clinical Lead, MOH) and Alistair Higham-Lee (Project Lead, MOH) at our joint face-to-face meeting with ANZCA NZNC last week.

Not surprisingly, visible output from the MOH is now increasing, with many months of ground work coming together in terms of policy and training. They are on track with the planned timeline (and acknowledge that it is very tight).  A DHB working group has been set up to try and ensure a coordinated approach to avoid different DHBs developing their own policies and pathways. 

Based on modelling and data from other jurisdictions, the MOH estimates that there will be around 900 applications made for assisted dying in the first year after the Act comes into effect.  About one third of these will progress to the completion. It is anticipated that the majority of assisted dying will occur in the home.

There is no expectation that the responsibility for assisted dying will fall to any one group.   The Attending Medical Practitioner is the practitioner who completes the first assessment, and then usually (but not necessarily) will manage the ongoing care up until completion of assisted dying for the individual (including administration of medications).  This may be someone who is known to the patient, but doesn’t have to be.  Then there is the Independent Medical Practitioner, not linked to the AMP, who gives a second opinion on eligibility.   A third opinion is sought from a psychiatrist if there is any doubt about competence.

So, what does this mean if someone asks you for help with end of life in the perioperative period?  I hope that by November your DHB will have a clear pathway for referral, but in short, it does not mean that you automatically become the AMP.  However, you do have a responsibility to refer the patient to someone who can allocate them an AMP.  The Support and Consultation for End of Life NZ (SCENZ) Group will hold a list of all practitioners that are willing to provide this care (or a local DHB liaison if established). 

If you are a conscientious objector, you don’t have to indicate this anywhere or to anyone (the SCENZ Group will only keep a list of practitioners that are willing, not a list of those who are not).  However, as a conscientious objector, you still have a legal responsibility under the Act to provide contact details for SCENZ if a patient makes a request to you.  I would encourage you all to complete the first training module as this highlights your responsibilities under the Act.  It can be found here:

https://www.health.govt.nz/our-work/regulation-health-and-disability-system/end-life-choice-act/end-life-choice-act-implementation-resources

As already mentioned, the NZSA and ANZCA New Zealand National Committee met jointly last week, as we do annually (although clearly not last year!).  It was a great opportunity to catch up and reconnect, especially as we work synergistically together for anaesthesia in New Zealand.  We had a busy timetable, with updates from the MOH on the EOLC Act as above, and also from the transition unit on health and disability review changes including the formation of the new entity Health NZ, and what our health landscape may look like by July next year.  Trying to fight the cynicism of those that have seen such reforms several times in their career, there was cautious optimism that the changes will bring improvement, and consensus that the current model is not working. Of course, the proof will be in the pudding, and there will certainly be a cost to the reforms that won’t be balanced in the short-term.  

The transition unit team were keen to reassure us that day-to-day working arrangements will not change suddenly in July next year, and they will be working very closely with current DHBs to ensure things run smoothly and that, for example, recruitment and patient care are not negatively impacted by the changes.  As of 1 July 2022, we will no longer be employed by a DHB, but Health NZ.  I did ask about the IT infrastructure improvements needed to manage a single employer, and unsurprisingly it’s a work in progress!

The meeting was the first for our new CEO, Michele Thomas.  She took it in her stride!  We now have a full complement of office staff.  Rebecca Nodwell, our new EA and Networks Administrator, began in April and has definitely hit the ground running.  Those of you involved with our networks will e-meet her soon as she is looking to revamp how we manage communications and document storage to make life a whole lot easier for you all!!   Lynne Mulder-Wood, our Membership Manager, continues to provide great service to our members, and some of you may be aware that Daphne Atkinson, our Communications Manager, has returned. Welcome back, it is great to have you as part of our team again.

A reminder that registrations are open for Whakaora, our Annual Scientific Meeting in October. Let’s show our support for Christchurch for what promises to be a fab program down in the garden city. Find out more https://www.nzanaesthesia.com/

 

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