Health NZ acknowledges kidney disease care is underfunded

Health New Zealand has acknowledged it has underfunded care for kidney disease in some parts of the country, amid what’s being called a “tsunami” of demand.

The hospital provider runs dialysis care for thousands of patients across the country. It is a life-saving treatment, which cleans the blood of those suffering from the condition.

Currently some patients must drive for hours to access in-centre care at hospitals, especially in rural districts outside of metropolitan areas.

Instead, many living outside of the main cities use at-home equipment to carry out dialysis without any medical assistance, as the machine filters their blood for five hours at a time.

One long-time user of the at-home kit is Janet McDonald, based in Timaru.

“This is all done with needles, big needles into the skin and through into your bloodstream,” she said.

“It is very much a mind over matter thing to put those needles in but, every now and then, the mind fails and we've got no backup. You just have to do it.”

McDonald keeps towels near her bed as she goes through her treatment, three times a week, in case the blood spills.

Support is not available for dialysis at the nearby Timaru Hospital. If there are any issues, she must drive more than two hours for the in-centre care available in Christchurch, sometimes in an ambulance.

“Basically you're responsible for it,” she said.

“If it goes wrong or you become unhooked or something like that, you've just got to save your life and call 111.”

Are you affected by issues in dialysis care? Email thomas.mead@tvnz.co.nz

Meanwhile, there is also a waitlist for some patients to gain access to the at-home equipment.

Patients must be taught how to use the machines without supervision before they can start the treatment. The longer they wait the more their health can suffer.

Tracey Cloughly, a nurse and New Zealand Nurses Organisation delegate at Christchurch Hospital, said she had access to only two training rooms for one of the kinds of dialysis offered, called peritoneal dialysis.

“I'd say 99% is delayed because we've got other patients that we're training,” she said.

The wait was anywhere from three weeks to far longer.

“We've had someone recently up to about three months waiting for training. It just comes down to the capacity of the staff and particularly the rooms,” she said.

In an interview with 1News this week, one of Health New Zealand’s most senior executives accepted there had been a lack of funding in renal care.

Health NZ chief clinical officer Dr Richard Sullivan said work was actively underway on a plan to address the issue, and reduce variations in care between different parts of the country.

“There's no doubt in some districts there has been underfunding and there is clear needs,” he said.

“If you look back in the past with different, district health boards having accountability for that stuff, it was very, very, very variable.”

The national executive director for clinical care said a “national renal replacement plan” would target that directly.

Work had been done to assess the demand so investment could be made in the right places.

“That's really trying to say, ‘okay, what should we do where’, ‘how do you get renal replacement, dialysis therapy out into community’, and ‘what investments we need to do that’,” he said.

The plan was getting close to being completed and would start to go through internal processes next month, Sullivan said.

“We'll hope to be releasing it to the public sometime this year.”

The executive added, as a Timaru boy himself, he wanted to offer care closer to where people were, mooting Ashburton as a potential option in the future for rural patients in Canterbury.

However, it wasn’t economically viable to have in-centre care available close-by for everyone.

“We can't provide all this as close to home for everybody, it's just not affordable for a health system,” he said.

“But we can certainly improve on the care and services we're providing now, reduce that variation and make sure we put that investment in the right places.”

Investment had also recently been made at Christchurch Hospital, he said.

Recruitment is currently underway for six and a half nursing roles and a senior medical officer.

Meanwhile, the Government says it is trying to make it easier for people access care in rural communities.

“We recognise that, for some, travel is still necessary and can place added pressure on patients and their families,” Health Minister Simeon Brown said in a statement.

“That’s why the mileage rate for the National Travel Assistance Scheme was increased by 21% in 2024 – the first increase since 2009 – to help ease the cost of getting to care.”

However advocacy group Kidney Health New Zealand is warning that the current problems will become more acute in future, due to an increasing demand for dialysis.

General manager Madi Keay argued there had been a “lack of planning” with systemic underfunding over many years.

“We have 33 dialysis centres across the country and we're seeing increased pressure on all of them,” she said.

“We know New Zealand has really inequitable access to dialysis and it's heartbreaking. People travel for up to three to four hours to access in centre dialysis that has a massive impact on people being able to maintain their quality of life.”

The general manager warned of what she called a “crashing tsunami” of kidney disease on the horizon.

“We're seeing a 30% demand increase in the next 10 years for dialysis services and we're not seeing the same kind of level of increase in resourcing and long-term planning,” she said.

In response, Sullivan said Health New Zealand was taking the issue “really seriously”.

He said work had been underway for years and again pointed to the renal plan, which is about to go through internal processes.

“I understand there’s variation, [and] understand we could do better but I think we are taking it seriously.”

The executive agreed that demand for renal dialysis was expected to grow by about three or four percent per year. There were currently about 3500 patients on dialysis across the country.

Asked what his message was to patients, Dr Sullivan said he thanked them for their voice.

“We do hear you and we are taking it seriously,” he said.

Meanwhile dialysis patients outside of the main areas like Janet McDonald are pushing on.

For her the status quo is the same, as she undergoes dialysis from home with a long drive ahead if anything goes wrong.

“Let's face it, kidney disease is not a terribly glamorous disease,” she said.

“It doesn't have the front facing that a lot of other problems have. It's very much a forgotten disease.”