Mediawatch: The health of health reporting

"There isn't a single aspect of the cardio team that's well resourced at the moment," the former head of Nelson Hospital's cardiology service Dr Tammy Pegg told TVNZ's 1News last weekend.

She went on to say some patients' conditions had become inoperable while they waited for scans.

"I decided not to do an interview. And then I thought about it and I worried that senior leadership... think that this is just a bit of noise and that it will go away," she told 1News.

She was the ninth doctor from the hospital to speak to 1News about its problems.

It's not just happening in Nelson.

Dr Gary Payinda has been lifting the lid at length on problems in Northland on his Substack blog and he also raised the alarm on RNZ's Checkpoint and elsewhere.

The problems obviously predate the sudden surge of news coverage about a health system 'in crisis.' So why is it so strong now?

"Before, there had been pockets of problems. We'd seen a nursing crisis, we'd seen stories about postcode lotteries or the mental health workforce crisis a few years back. But in the past year we've had this takeover from the Commissioner which has put this veil of chaos over everything," Rachel Thomas, who resigned recently as a health reporter at The Post, told Mediawatch.

"There's a 'hiring freeze' that's not a 'hiring freeze.' Services are at breaking point and are unable to get assistance because of these hiring processes. Support and non-clinical staff are facing cutbacks."

"You've got patients, clinicians, health staff unable to find resolutions on things. So then they go to the media," said Thomas, who is now a writer and communications advisor for the senior doctor's union the Association of Salaried Medical Specialists (ASMA).

In her final piece for The Post, under the headline A stocktake of NZ's health agencies, from an outgoing health reporter, Thomas also listed good things about our system.

"If you're one of those people whose cancer is treated early or your drug is now free instead of having to blitz your KiwiSaver, then your care is the envy of the world," she wrote.

If you contract sepsis after a complicated surgery [speaking from experience] you will get world-class care. If you break your neck and ACC pays your mortgage, your care is the envy of every American."

Thomas has also written about her own experience as a patient getting life-saving treatment, sometimes from clinicians working outside normal hours.

But "things working as they should" do not make headlines - and even "good news" developments don't always cut through.

"Even after its $600m boost from the government, Pharmac managed to make a mess of oestrogen patches, the CEO quit and patients chastised it for a lack of empathy and respect in a stakeholder report," Thomas noted in The Post.

That budget boost came after years of public pressure to lift Pharmac funding. How come there wasn't more "good news" about that?

"There were some positive headlines about that and stories from the people who were benefiting. In December we interviewed people who were going to be around for Christmas because they'd had an extension of life thanks to that," Thomas told Mediawatch.

"But ... those people had already drained their Kiwisavers when those drugs weren't funded. And that particular policy was wrong on many levels because the government was looking at 13 drugs and telling Pharmac what to buy. It was chaotic," said Thomas.

"You're never going to fix the problems if you don't acknowledge that they're there. There's a balance between saying 'crisis, crisis' every day and saying: 'Here's a problem, and here's how we fix it'.

"That's where the media hasn't always been great in the past and where we certainly need to make sure we're (doing) solutions-focused reporting. Otherwise, you go into a black hole."

The waiting game

Healthcare is a life and death matter - and accurate stats really matter.

One of Rachel Thomas's final pieces for The Post revealed Health NZ (HNZ) had confirmed 46 New Zealanders had waited more than three years for treatment by the end of last year.

More than 2500 people had waited at least a year for treatment.

Thomas' article in The Post included a photo of similar data displayed on big screens at a surgeons' conference in mid-2023. But Thomas had to wait 625 days for HNZ to supply similar up-to-date figures, and only after a complaint to the Ombudsman.

"That's information I knew they had because I'd seen a version of it when I was in that room. They ended up arguing that data would have taken considerable time to pull together and go through a validation process.

"But why not release the presentation to me and save us all 600 days and going through the Ombudsman?

"This feels obstructive. That's not how the Act is supposed to work. I really think it just comes down to a lack of understanding of the legal obligations under this legislation that exists to enable us to have free access to information."

Ombudsman Peter Boshier, who recently stepped down from the job after nine years, seemed to agree.

Delayed and denied

"It is difficult to understand how HNZ proposes to work towards the government's targets and meet reporting expectations - if data on surgical and treatment waitlists cannot be compiled," Boshier said in response.

Boshier instructed HNZ to apologise, explain what steps are being taken to ensure accurate information about waitlists can be made available to the public, and review its refusal of OIA requests by citing the problem of "substantial collation".

He told the news website Politik he received 285 complaints against Health New Zealand in the year to mid-2024 - an "astounding" increase of 76 percent on the year before.

Boshier also told RNZ that Health NZ had "created a process... inherently contrary to law" after investigating the response to RNZ's requests for information about Dunedin Hospital for months.

Boshier concluded that HNZ had "told requesters it had made a decision - without saying what the decision was - at a point when an OIA was already overdue," RNZ reported.

"Health New Zealand is a disgrace," Boshier said last month on TVNZ's Q+A, citing its refusal to release some information - and the failure to pass on some it had already agreed to release.

In his final report to Parliament Boshier said journalists and other requesters had become "utterly frustrated with delays... in either obtaining a decision from agencies to requests in the first instance - or in receiving the information they have sought."

The same week the Peter Boshier finished up, RNZ's Anusha Bradley reported that Starship Hospital would soon be without its sole specialist in pediatric palliative care.

Health NZ told RNZ recruitment for an additional specialist and nursing roles was "underway."

It declined to provide details, but after RNZ published the story a job listing for a general paediatrician was posted on Health NZ's website. The job ad was later amended to specify "an"experienced paediatric palliative care specialist."

Health minister Simeon Brown subsequently said he expected HNZ to answer media questions accurately - as well as publish appropriate recruitment adverts.

Is it understandable that under-fire agencies might try to limit their exposure to bad news by obstructing or delaying the release of damaging information?

"I think transparency is too important with an agency that spends $28 billion of taxpayers money and is designed to keep us alive and keep us healthy," Rachel Thomas told Mediawatch.

"Information that used to be regularly released [by District Health Boards] we now have to [request under the] OIA. We can't pick up the phone and call board members."

"We can go to the Ombudsman and the media have the ability to write about these issues and pressure them to front up... then these people and this agency are forced to face the music."

The outgoing Ombudsman has also pointed out some state agencies are now handling many more requests for information. Should the media cut them more slack?

"No, I don't think so. The Official Information Act has always existed to make information freely available. A lot of this information would have been available previously under the DHBs... and I don't have a lot of sympathy for that."

"Often the deadline will come and go and you've barely had an acknowledgement. That's a problem for Health New Zealand to fix."

Taking action

On TVNZ's Q+A the outgoing Ombudsman suggested financial penalties for non-compliance could be charged to highly-paid public sector CEOs.

But many top health bosses have quit in recent weeks.

"There was a surreal few weeks at the start of the year where The Post would write about a health leader or minister having no faith in their chief executive, then the chief executive would quit about a week later," Rachel Thomas noted in her farewell Post piece last month.

"Perhaps the scandals uncovered by Stuff's Paula Penfold of undisclosed skeletons in executive leaders' closets have slowed things up," Thomas herself wrote in The Post recently.

Does the pressure of media exposure have something to do with that?

Could it even make the recruitment of much-needed leaders harder?

"Yes, the media focus will have had something to do with that. But I think there's been a lot of discomfort and discontent brewing among a lot of those sector leaders for a long time. The media is always there to hold the mirror up," Thomas told Mediawatch.

"If we're writing a story where the health minister refuses to have confidence in a leader... I think that's a key problem.

"I had a senior clinician say to me: 'You are the person I read when I'm trying to get information about my employer. That's not right, but that's what it's become. That's why we need strong media."

Thomas is now on the other side of the fence with the ASMS, the union for senior doctors currently planning strike action on 1 May.

"Mayday! Our health system is sinking," its current slogan warns.

Isn't it in the union's interest to make problems as public as possible, even if it damages public faith in the system?

"Yes, there is a bias there - and people are free to accuse me of that now.

"But it comes back to holding a mirror up to the problems and putting pressure on decision-makers to address them.

"A union has a very clear agenda to protect its members. But the interest of senior doctors and dentists is to protect patients.

"I have spent most of my life in the health system as a person with very severe Crohn's disease. That gives you this perspective about other people receiving that same level of care.

"Without our public health system, I certainly wouldn't be alive."

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