National MP Shane Reti says he followed the rules when he joined ambulance crews working after-hours earlier this year and that it provided him with important insights about New Zealand's under-pressure health system.
Reti, a practising GP and National's health spokesperson, said he was with medics as an "observer". Over three months, nearly every weekend, the MP shadowed Hato Hone St John and Wellington Free Ambulance paramedics across the country.
When asked if the patients he observed gave informed consent to him being present, he said: "I participated completely with St John's policy."
The Health and Disability Commissioner's code of rights states patients have the right to make informed choices and give informed consent.
Reti told Q+A he was "completely compliant with St John's procedures and policies".
"I was another pair of hands when St John needed me to. 'Shane, can you grab the 12-lead [ECG machine]? Shane, what do you think about this ECG?'
"I was another pair of hands just like any other observer. Any other observer who participates at St John follows their policies. They're really strict on that."
Hato Hone St John told 1News it gets a variety of requests from the likes of politicians, media and officials to join their staff on shifts.
"In recent times we have accommodated several requests from MPs from various political parties," a spokesperson said.
"We are confident that, under the guidance of our staff, Dr Reti adhered to our observer policy. Our observer policy is compliant with the Health and Disability Commissioner’s Code of Rights."
The spokesperson said their standard practice is to tell patients when observers are present and seek their consent. When this isn't possible, they said senior ambulance staff can make decisions about whether an observer can be there, consulting with whānau where possible.
"No investigation has been initiated following Dr Reti’s time with us. However, Hato Hone St John is reviewing our policy and procedures for observation shifts which we regularly do as part of continuous improvement to our service."
In a statement, Wellington Free Ambulance said Reti did not provide clinical care to patients while he was with their crew.
"Our process includes seeking permission from patients at any call out to have an observer present. All observers are made fully aware of the confidentiality requirements ahead of the shift, which Dr Reti complied with.
"No investigation has been initiated following Dr Reti’s time with Wellington Free," a spokesperson said.
In further comments to 1News, Reti said he had in-person debriefing sessions with senior figures at St John and Wellington Free Ambulance after he followed their crews.
He added he only offered paramedics advice and help when asked.
What Shane Reti saw
It was important to get a first-hand look at what was happening on the frontlines to inform policy decisions, Reti told Q+A. One of his observations was that, in many parts of New Zealand, it wasn't clear what primary health services' role was in after-hours care.
Today marks one year since the largest shake up of health care services in New Zealand. (Source: 1News)
"They're working really hard, and this is a feature of not having enough doctors, of them being exhausted and tired anyway," National's health spokesperson said.
"But there were parts where I might have expected primary care to have an after-hours service that wasn't. That's something that needs to be looked at."
Reti said paramedics could also be allowed to do more as they were willing, capable, and were already filling in some of the gaps in after-hours treatment.
The MP also observed under-staffed and under-resourced emergency departments.
He said it confirmed his belief that EDs needed to be better resourced or they would "break some time soon".
When asked if National would increase funding in the system to help address some of the issues he'd seen, he said "new money" would be put into education and health.
He wasn't yet sure how much funding there would be but said those details would be released in the party's "fully funded fiscal plan" ahead of the election.
The National Party says it's a long time coming. (Source: 1News)
On the issue of a stretched health workforce, Reti said the country would be reliant on immigration in the short term. He said the Government should have added nurses and midwives to the fast-track residency pathway sooner.
"[National has] made an announcement around nurses and midwives, saying there'd be a special visa. They could come into New Zealand for six months without needing a job offer, bring their family, and have work and study rights."
In the longer term, National wants to establish a third medical school at Waikato University to grow domestic talent. Doctors welcomed the move but said more work experience placements needed to be created to train medical students.
Meanwhile, the Government said National needed to explain how they would pay for it. The University of Auckland — which has its own medical school — called it "unnecessary".
It's a concept scrapped by the Labour government nearly five years ago. (Source: 1News)
In April, National proposed a bonding scheme for graduate nurses and midwives to try and keep them in New Zealand.
Nurses said the policy didn't go far enough but was a step in the right direction.
As for whether National could guarantee to increase the pay of health workforce staff above the rate of inflation, Reti said that decision will be made after examining the books if his party is elected into Government.
'There's problems with Pharmac'
Reti said the way Pharmac decides to fund drugs needs to be tweaked.
"I think there's problems with Pharmac… we take roughly twice as long to register medicines as anyone else," he said.
"Part of a solution may be that, in Australia, it's in legislation that you have to regulate or register a medicine within 255 days, and so they do. I think we probably need to move towards that."
Reti said Pharmac should also reconsider how it prioritises funding based on a medicine's costs and benefits, as well as how Kiwis can benefit and what their health needs are. He said this is particularly the case for rare disorders.
"We need to look a little bit further in that because it's not clear to me that in the health need component — which looks at the impact on the individual, on the whanau, on the community, on the health service — that we're bringing into account all the right attributes we should.
"It's the same in the benefits — the wider benefits to society of this medicine over that medicine."
Q+A with Jack Tame is Public Interest Journalism funded through NZ On Air.
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