Archive for ‘Health’ Category

As advertised

datePosted on 17:30, April 27th, 2010 by Lew

Late last year, when the ACC ructions were underway, the professionals working in the sector warned that people would die as a consequence of the reforms mandated by the new Clinical Pathway on the assessment and treatment of sexual abuse victims.

Since then, and on the basis of the pathway, ACC has taken to declining claims despite publicly claiming consistently throughout the past six months and as recently as today that there was no cost-cutting imperative. This has resulted in a drop of more than 90% in the number of claims approved year-on-year. Explain that, if you can. Nick Smith couldn’t, though he tried to do so during Question Time. It has also caused a chilling effect in which people are simply not applying, since they’d have to undergo the trauma of the exhaustive documentation and excessive review required by the pathway only to have their claims declined.

It’s impossible to separate these reforms from the overarching government plan to privatise — partially or wholly — ACC, and when viewed in this light it becomes clear what’s going on: this is how insurers make their profits. And, just lilke it said on the box, people are dying. It’s a good thing there’s going to be a review, but what’s better is that the sector is organising their own review in parallel. Should make for an interesting compare-and-contrast. I am aware that certain senior National party MPs are aghast at the conduct of ACC, so there may begin to emerge some pressure from within the party for change, as well as from outside. We’ll see.

L

Current events

datePosted on 13:53, April 27th, 2010 by Lew

I was reluctant to post while I had the chance on ANZAC day, since there was such a good debate going on, and now I’ve (temporarily) run out of time again. So just a few quick observations.

  • Phil Goff’s one-two punch on the top tax rate and Auckland governance is solid, and both are good orthodox Labour positions for him to take. But it’s more of the same: lacking verve and failing to get cut-through as a consequence. I mean to post on the positioning of the taxation pledge at some stage, but in case I don’t get to: this is a good opportunity for Goff to demonstrate compromise as well as differentiate himself, by coupling a reimplementation of the top rate with an increase of the threshold.
  • Even without Sunday’s tragic helicopter crash, Goff’s timing was poor in making these two announcements before ANZAC Day. I guess you take the opportunities you can get, but delaying things by a week would have been more useful in my view.
  • As an aside, my mum knew the three late airmen vaguely through Search and Rescue, and confirms the universal sentiment that they were of the very best sort. I’m pleasantly surprised that the crash hasn’t turned into a witchhunt about why we’re still using Vietnam-era hardware; as true as the sentiment might be, we can all do without people thundering “if we’re going to have a military, we owe it to our troops to have it decently-outfitted” under circumstances such as these. Such is the power of ANZAC day, I suppose.
  • On a related point, the discipline with which the military, government, police and media have adopted the Air Force’s framing terminology in this event is remarkable. All four groups are talking about “the Air Force family” and exploiting the metaphor for all it’s worth. Those words are used almost every time one of these people stands in front of a microphone, and in addition the three deceased are “brothers”; Mark Sainsbury reported live last night from the family’s “lounge”, the squad room at Ohakea air base; all four have referred to the Iroquois as being like “your grandfather’s axe” — the reference being that, although it’s very old, when the handle is worn it gets replaced, and when the head is worn it gets replaced, so while it’s his axe in spirit, it actually contains no parts of the original tool and is as good as new in function. On the one hand, this is compelling symbolic stuff: nobody who deviates from this framing can really be said to be showing the proper sort of respect and deference; on the other hand, it’s a bit creepy for everyone to be falling into lockstep behind Defence HQ communications. There are ways of saying these things without using the exact same words, and the constant repetition spooks me. Maybe I’m just sensitive. [Edit: There was a clean sweep for “Air Force family” or something similar in speeches supporting the Prime Minister’s parliamentary motion of condolence. No shock there, I suppose.]
  • On a somewhat lighter note, Councillor Tony Jack has picked the wrong district council to put a motion banning macrons in council materials. This is the Kāpiti Coast District Council, who moved to put the macrons into Paekākāriki and Ōtaki only a month ago. Jack’s motion was voted down, at which point he predictably declared that PC had gone mad. Bless. Of course, the Stuff article doesn’t contain the macrons, so I guess he wins as far as that goes.
  • Tim Watkin at Pundit continues to write excellent sense and ask smart questions about race relations in Aotearoa New Zealand. I think the emphasis in Tim’s piece is just right — there is a legitimate claim to indigeneity for non-Māori, but it’s not so obvious as Trevor Mallard’s “I was born in Wainuiomata”, and there’s a lot to work out before such definitions can be settled upoin comfortably. I’m all for having this discussion. I particularly like the ornithological allegory drawn by commenter “william blake” — we are all Pūkeko!
  • Also on a lighter note, a (very) atheist friend whose six year-old daughter has chosen to go to Bible study classes recently asked him if, because Jesus had risen from the dead, that meant he was a zombie. It apparently took every ounce of his parental commitment to letting his girl make up her own mind to explain the origins of zombie stories, how myths come about, etc. rather than just saying, yes, Jesus is a zombie. Good on him — not sure I would have had the fortitude.
  • Speaking of things biblical, and of belonging, Joanna Newsom has a new album out, and here’s the first single — about tilling one’s own bit of the Garden of Eden:

Ok, so not so brief after all. Discuss. I’ll dive back in as I can. You can treat this as an open thread as well: post what you want to talk about.

L

ACC: tell ’em

datePosted on 22:37, September 16th, 2009 by Lew

I have received the following communique originated by NZ Association of Psychotherapists member Kyle MacDonald; an easy means for you to tell the Minister for ACC what you think about sexual abuse recovery rationing:


Grass Roots Political Action, a step by step recipe.

“The death of democracy is not likely to be an assassination from ambush. It will be a slow extinction from apathy, indifference, and undernourishment.”
— Robert M. Hutchins

  • Time required: 10 minutes.
  • Ingredients: Four pieces of A4 paper. Two envelopes.
  • Method: go to Kyle’s website www.psychotherapy.org.nz and click “Grass Roots Political Action: A step by step recipe”.
  • Select which Minister, and print one out for Pansy and one for Nick.
  • Read the letter; react and critique.
  • Insert your details into the angle-brackets. Change the wording to your heart’s content; the more varied the letters the better!
  • Print, and sign.
  • All mail to Parliament is free, so simply pop in an envelope!
  • Bask in the glow of flexing the democratic freedom you are lucky enough to possess, and pass both the word, and this email, on to everyone who you can possibly think of…

Update: There’s also a petition, for what that’s worth.


Grass Roots Political Action Part II – Gather Support.

“In a democracy dissent is an act of faith. Like medicine, the test of its
value is not in its taste, but in its effects.”

— J. William Fulbright.

Dear friends, colleagues and supporters of counseling and therapy in
Aotearoa New Zealand,

Many of you will now be aware of attempts by ACC to change the Sensitive
Claims Scheme which provides counseling to victims of sexual assault and
abuse. These changes are being rushed through with inadequate consultation
and the professional organizations representing the providers of this
treatment have been lobbying parliament to stop the changes.

Now there is something you can do to help! Follow this link to an online
petition and sign up to show your opposition to the proposed changes.

http://www.petitiononline.com/ACC0909/petition.html

Please also circulate this petition as widely as you can to friends, family,
colleagues, clients and your professional networks. The aim will be to
present this to The Minister for ACC Hon. Nick Smith prior to the 12th of
October.

Thank you for your time,

Kyle MacDonald
Psychotherapist


There. Easy.

L

Sexual abuse recovery rationing by the ACC

datePosted on 10:04, August 24th, 2009 by Lew

This morning the New Zealand Association of Psychotherapists delivered an open letter to the Minister for ACC asking him to explain and justify the proposed changes to ACC’s sensitive claims policy. This issue was covered by Anjum last week and is now picking up steam.

Briefly, the proposals (which are due to come into effect in September) would change both the nature and amount of entitlement of treatment to which sexual abuse or assault victims are entitled. The changes represent a move from a therapeutic model mostly operated by psychotherapists and counsellors to a symptom-management model mostly run by the mental health system. Victims’ entitlement to treatment will generally be reduced to a maximum of sixteen hours, essentially meaning that many victims of the most severe abuse will not be fully treated. In addition, victims will need to explain themselves to as many as three different assessors in order to access this limited treatment, with each assessment a form of revictimisation. As if that wasn’t enough, knowing that many cases simply will not be treatable in the mandated 16-hour timeframe, some psychotherapists have indicated that they will refuse on ethical grounds to begin the work, knowing that they cannot finish it, on the basis of the ‘first, do no harm’ principle which underscores their practice as clinicians.

This means the already-high barriers to effective treatment of sexual abuse trauma are about to get higher. In effect, they are being rationed so as to exclude the ‘worst’ cases who require the most work (and therefore the most cost) to treat. However the revictimisation of repeated assessments and the uncertainty of treatment form a strong disincentive – not wanting to open a wound without being sure it can be closed, many people will simply not seek treatment, and many counsellors will simply not be able to provide it on ethical grounds. This chilling effect will lead to sexual abuse being pushed further underground and the problem fading from the public view to a greater extent than it already is, with potentially catastrophic long-term social consequences. At last count, sexual abuse cost NZ about $2.5 billion per year including the costs of crime, imprisonment, drug and alcohol, other health issues, unemployment and the cycle of abuse which an absence of treatment sustains. For the cost of a few million dollars in treatment, how much will that be allowed to increase?

The most absurd thing is that these are cuts to front-line services for victims of serious crime; the very thing the government said it would be increasing. ACC’s Sensitive Claims Unit costs $30m or so annually to deliver $20m of front-line services, and these cuts will shift that balance much further toward the back-office by relying more heavily on already-overworked case managers and the top echelons of the practice – psychiatrists and clinical psychologists who currently do 10% of the work – rather than the relatively cheap and numerous psychotherapists and counsellors who do the other 90%.

For the inevitable conspiracy theorists, this also isn’t a matter of psychotherapists feathering their nests – for most, ACC work is a small part of their practice, and not an especially lucrative part of their practice, since most can charge (much) more on the open market than what ACC will pay.

Expect this to be a fairly big deal in the coming weeks. It is an issue which is deeply embedded in many policy fields: justice, victim’s rights, human rights, child abuse, crime, drug and alcohol abuse and mental health are just a few. It’s not going away, because sexual abuse is not going away.

L

Disclosure: I was involved to a small extent in the process around this open letter. I have family members on both ends of this issue – both providing and receiving treatment. You probably do, too, even if you don’t know it.

In the United States on Sunday George Tiller, a doctor, was shot and killed as he attended church. Tiller, who ran one of only three remaining clinics providing late term abortions in the US, had been shot in 1993, his name has been on anti-abortion assassination lists and his clinic was bombed in 1985.

In New Zealand we have never had an abortion doctor killed, but we have had doctors, nurses and clinic staff threatened, attacked and harassed. I pray that no further anti-abortion violence comes to New Zealand, and at the same time I pray that we will progress the issue to give women the right to control their own bodies and that we will find a social consensus for a woman’s right to choose.

But right now the cost seems very high, and all I can do is pray for the safety of everyone ensuring women continue to have access to the limited choices they are given. George Tiller was a great man whose personal actions gave more to women than I could ever hope to.

I try to not end too many posts with lyrics, but today I can’t help posting a section of Ani DiFranco’s Hello Birmingham. With an echo of Pablo’s recent posts, she is talking, at least in part, of the powerlessness of electors to make the changes that matter.

           now i’ve drawn closed the curtain 
in this little booth where the truth has no place 
to stand 
and i am feeling oh so powerless 
in this stupid booth with this useless 
little lever in my hand 
and outside, my city is bracing 
for the next killing thing 
standing by the bridge and praying 
for the next doctor 
martin 
luther 
king 
  

it was just one shot 
through the kitchen window 
it was just one or two miles from here 
if you fly like a crow 
a bullet came to visit a doctor 
in his one safe place 
a bullet insuring the right to life 
whizzed past his kid and his wife 
and knocked his glasses 
right off of his face 

and the blood poured off the pulpit 
the blood poured down the picket line 
yeah, the hatred was immediate 
and the vengance was devine 
so they went and stuffed god 
down the barrel of a gun 
and after him 
they stuffed his only son

National & the tobacco industry

datePosted on 08:46, March 4th, 2009 by Anita

Tony Ryall has, once again, taken the moral low road and is refusing to ban cigarette displays in shops despite evidence that cigarette displays increase teenage smoking. This in a week that a similar ban was announced in Northern Ireland, joining bans in Ireland, Canada, England, Wales, much of Australia… oh shall I just call it “most of the developed world”?

Why does this matter? (Other than caring about the lives and health of New Zealanders)

  1. National is, once again, picking the tobacco industry over people’s lives and health
  2. National is, once again, choosing the moral wrong for the employers and owners’ benefit
  3. National is, once again, showing the signs of a party financially entangled with the tobacco industry.

In case you don’t have a copy of The Hollow Men to hand, I offer you some highlights:

  • Matthew Hooton, long time National mouthpiece, ex-National staffer and National lobbyist has done private pro-tobacco PR work and lobbying. His work was used by Rodney Hide to attempt to stall anti-tobacco legislation.
  • British American Tobacco’s chief lobbyist is a significant National Party donor and has been invited to caucus parties.
  • Key’s political advisors, Crosby|Textor, name British American Tobacco as a client of Mark Textor.

Sweet eh, politicians and industry working hand-in-hand – that must be the “pragmatism” John Key talks about.

Perspective

datePosted on 07:33, February 18th, 2009 by Lew

The Standard and Kiwiblog last night, but not for the first time, crystallised what it is to be two sides of the same political coin. Both covered Health Minister Tony Ryall’s removal* of Richard Thomson from the Otago DHB chair using, respectively, the verbs to sack the old one and to appoint the new one. The difference in emphasis couldn’t be clearer.

For what it’s worth, DPF’s headline is more correct. Ryall didn’t actually fire Richard Thomson, he has been removed from the chair but will remain a DHB member (though the Herald article referenced in the Standard post also uses the `sack’ terminology). On the other hand, I think Tane’s analysis is more correct – Thompson has been removed from the post for political reasons more than for reasons of governance. However the governance failure was bad enough that Ryall was on safe ground in doing so – he’s got two birds with one stone here.

L

* see how hard it is to avoid partisan terminology?

[Edit: Silly me for believing the Herald – it’s spelt Richard Thomson – changed.]

12Previous