9 July 2015

The issue of end-of-life care is on the agenda again. I am not one who believes that doctors should be able to kill terminally ill patients, but then I doubt many New Zealanders do either. In any case, the issue is far more complex than that, which is why a wider inquiry is justified.

All of us who have experienced the pain of watching someone close to us suffer a lingering and often painful death have felt the anguish and powerlessness of wanting to do more to help, but being unable to do so. We have admired the dedicated and compassionate efforts of those involved in palliative care and know of the medications now available to ease pain and make the last stages of life more comfortable, and are hugely appreciative of that.

But, at the same time, we are becoming more aware that end-of-life care is but one aspect of overall health care. Advanced care planning, where people discuss with family at earlier stages of life what their expectations are when they become old and/or frail or suffer from a terminal illness, is becoming equally important. Similarly, understanding people’s expectations is also a significant consideration as well. At a time when the bulk of health spending occurs in the last five years of a person’s life, are we certain that is what they want, or do they simply want a dignified, managed exit?

Medicines management is another factor. For years now it has been an open secret that doctors manage the demise of terminal patients through adjustment to medication levels to ease suffering and assist gentle death. Nor is it a new practice – King George V’s doctors reportedly managed his death nearly 80 years ago so that it could be announced in the morning papers. But doctors managing life as it ebbs away is different from actively securing its end.

Nevertheless, the moral argument about the sanctity of natural life and that no-one has the right to interfere with it begs the question somewhat. While I have sympathy with that view in an absolutist sense – hence my vehement, unwavering opposition to capital punishment – I acknowledge that in many terminal cases, it is questionable (as a consequence of medication and other life support measures) whether a patient is actually living a natural life any more. Therefore, the morally absolutist argument may no longer be relevant in all cases.

And then there is the question of free will. I was always taught that the most precious gift we possess – which defined us as human beings – is free will, the right to be able to decide for ourselves. Any debate about the end of life cannot overlook this fundamental point. What a patient “wants” should rank ahead of what “we can do” for the patient in such circumstances, provided the patient’s decision is rational and informed, which brings us back to the advanced care planning argument. In such instances, do the rest of us have the right to override a patient’s wishes? Providing a patient who requests it with the means to end life in such circumstances is arguably different from another person deliberately ending that life. The ultimate recognition of free will is, after all, respecting people’s exercise of it.

A public discussion about all these issues would be welcome and timely. Ideally, an independent expert panel should be established, with a wide-ranging brief to consider and advise upon all aspects of end-of-life care and how it should be managed. This inquiry should undertake widespread public consultation leading to the presentation of full and thorough recommendations to Parliament for action. For its part, Parliament needs to show its willingness to both lead and respond.         

  

 

 

 

 

3 July 2015

Sometimes politics can be a frustrating business.

The debate about social housing and the possible interest of a Queensland social service provider in purchasing around 400 Housing New Zealand properties is one such example. All sorts of outlandish claims are being made, most with little relation to reality.

I start from the perspective that the state has a basic obligation to ensure its people have the opportunity of being adequately housed. In New Zealand we accept that as a national responsibility, whereas in other countries it is more likely to be a local government function. Be all that as it may, the concept of State Housing dates from the time of the first Labour Government, although Seddon toyed with the idea almost 40 years earlier, and successive governments have maintained that legacy. Only a brave – or foolhardy – government would tamper with that fabric.

Now here is where the argument becomes a little different.  The current government is looking at how it can uphold its housing obligations, in a way that is appropriate to the circumstances of our times. Much of the State Housing stock is old and run down, over many years, and arguably, given the way our cities have developed, not necessarily located in the best places. To upgrade and modify it would cost a small fortune, money the government simple does not have, and at the end of the day would leave us with about the same level of public housing stock as we have now, with no great impact on reducing the demand for social housing.

So, it has decided to sell a significant proportion of its old stock to non-government providers to upgrade and manage for clients, while using the proceeds to develop additional modern stock to meet needs. That strikes me as a pragmatic approach, smacking of the type of innovation New Zealanders generally like to be proud of.

Now, of course, it is early days, and a little too soon to become focused on particular potential buyers, but the prospect of sales to overseas operators should be neither surprising, nor concerning. After all, the properties cannot be shifted from New Zealand, and the government will be able to impose whatever conditions of sale it chooses to ensure that its objectives are met. So a case can be made for at least considering the idea further.    

My frustration arises when I hear blanket opposition expressed to the very idea on the most spurious of grounds – like privatising the stock, yet successive Labour and National governments have been selling off “surplus” state houses for years.  What I have not heard are too many credible suggestions of how our public housing shortfall might otherwise be met. During a recent television debate, a particularly ignorant and boorish Labour MP claimed the answer was for the government to just build 100,000 more houses. When I challenged her as to how they would pay for them, her response was to call out to one of her colleagues in the audience, “how are we going to pay for them?” which shows the shallowness of her position.

I doubt the government's proposals are flawless, and a lot of work needs to be done yet, but the legislation implementing the policy will go to a select committee where it will no doubt be thoroughly examined and tidied up.

However, I have no doubt that the challenge to provide affordable housing requires bold and innovative solutions and that the approach is one worth considering further. A roof over one’s head is after all, a roof over one’s head, no matter how it is provided.

 

25 June 2015

This is a special extra edition of Dunne Speaks, because I need your help. Last week I wrote about the review of the Fire Service, and how I am getting out and about at the moment, listening with an open mind to people’s views on the future direction our fire services should take.

Over the past three weeks, I have talked to firefighters from the different services in Canterbury, Manawatu-Whanganui, Northland, Southland, Bay of Plenty, Wairarapa and Wellington. And I have more visits to make yet. I have also heard from the wider community: from forest owners, farmers, council representatives and business owners.

There is a clear message from all these stakeholders that the time is right to address the issues that are putting our fire services under pressure. They have all given really useful feedback on the discussion document released last month. 

I have shared with them my thinking about the way ahead and I am encouraging them put their ideas into a submission.

Some stakeholders are comfortable with Option 2: Coordinated service delivery. Others have suggested that it is time to move towards Option 3: one national fire service.

If there was to be one national fire service, stakeholders say it would need to incorporate local decision-making, be an organisation that was responsive to local needs, and would need careful transition planning.

So I have made it clear in my conversations that active community engagement is going to be a cornerstone of any new model.  A new way of managing and delivering fire services will need to take account of the wide variety of local conditions and circumstances in each community. 

I have therefore asked officials to think about how community engagement could be part of our fire services. A supplementary paper to the Discussion Document (attached http://www.dia.govt.nz/vwluResources/FSR-Supplementary-paper-PDF/$file/Feedback-from-stakeholders.pdf) might help you in preparing your own submission on which option, or combination of options, is going to give us the best way forward.

Under either Option 2 or Option 3 we need to ensure skilled and capable staff have minimal disruption to their work.  We need to keep skilled and capable leaders for our fire services and communities as provided in roles such as principal rural fire officers and chief fire officers.  We need to make sure that any change is well managed.

Please make a submission by clicking on  discussion document. That will help us design the best future fire services for New Zealand. 

24 June 2015

The right to be a citizen is one of the most fundamental rights we possess. Be it something we acquired because of our birth in this country, or because it was subsequently awarded to us, or whether it be the citizenship of another country, it is an inalienable characteristic of who we are. Throughout history the assertion of the right to citizenship has been paramount in the fight for equality. It cannot be easily cast aside or removed. The French Revolution, the American Civil War, and more recently President Kennedy’s “Ich bin ein Berliner” speech, and Nelson Mandela’s long walk to freedom have all in their own way emphasised the importance of citizenship.

The quest for citizenship makes moves like those currently under consideration in Australia to remove citizenship from Australian foreign fighters abhorrent. While New Zealand properly retains the right to cancel a person’s passport for security or other reasons to restrict their rights of movement, we would never contemplate stripping a New Zealander of citizenship and leaving them stateless, nor should we.

But there is another far more positive aspect to citizenship to consider. Citizenship is a badge of belonging – a recognition that the country of which one is a citizen is not just the place where one lives, but the place one can properly call home. And with that goes a certain amount of pride. Citizenship helps bind us all together, no matter the diversity of our origins and circumstances. Every week, I approve the applications of hundreds of people, from all over the world, who have met the 5 years residency requirement to become New Zealand citizens. On many occasions throughout the year, local Councils up and down the country hold ceremonies at which new citizens take the oath of allegiance as citizens of our country. (It is now hard to imagine that up until the mid 1990s citizenship certificates were just routinely mailed out to new citizens without any other fanfare. I was also the Minister back then and I made it mandatory for there to be proper locally run citizenship ceremonies that all new citizens were required to go through. Despite the grizzles from some Councils at the time at the additional costs they would incur literally for tea and biscuits, it was the right decision, and we are clearly the better for it.)

Today, I think there is scope for further changes to better promote citizenship. In short, I want to see more of those who come to live in New Zealand encouraged to become citizens once they qualify. I have therefore asked officials to look at ways we can better promote the advantages of citizenship to residents, and encourage more of them to apply to become citizens once they qualify. The diversity of our citizens makes us stronger, and the infusion of their languages, cultures, histories and traditions into ours makes us a better, stronger nation, more able to make an effective contribution in the international community.

18 June 2015

One of my responsibilities as Minister of Internal Affairs is the New Zealand Fire Service. This organisation of around 12,500 personnel, of whom over 80% are volunteers, is not only New Zealand’s premier emergency service, but its paid staff and urban and rural volunteers consistently rank very highly amongst our most respected occupations. Whatever the community incident – structure or vegetation fire, urban search and rescue, roadside assists or cutting people out of cars, and yes, even cats in trees – the New Zealand Fire Service is there to help.

Yet like all venerable institutions, the Fire Service needs to change to remain an effective service in the years ahead. And here is the rub: although it was nationalised in 1975, the Fire Service has remained basically unchanged since Ballantyne’s fire in 1947. (Ballantyne’s is the iconic Christchurch department store destroyed by fire with the loss of 41 lives in November 1947 – still our biggest fire tragedy.) Much of what the Fire Service does has changed since then, yet its basic structure is still rooted in those times. So we are currently undertaking the biggest review of the Fire Service since the Commission of Inquiry into Ballantyne’s fire.

In the last couple of weeks, I have been at meetings of firefighters and community stakeholders from Kaikohe in the north to Invercargill in the south and points in between, with more to come, to hear what they think the Fire Service of the future should look like. Everywhere I have been so far I have been struck by an undeniable mood for change, but also by a couple of important conditions people want to attach to change, however big or small it might be.

The first is that because of the overwhelming reliance of the Fire Service on its volunteers – urban and rural – the fundamental emphasis has to be on building a better experience for the volunteers, as well as the paid staff, in terms of training, respect and equipment, both to ensure all our firefighters today are as well equipped, prepared and resourced as they can be, and also to attract the volunteers we will need for the future.

And the second flows from the first. If we move to a genuinely unified national Fire Service, or make steps towards that, people want to be assured that the particular interests and differences of our regions are reflected in the new structure. And they are right – New Zealand is a diverse country where one size does not fit all. The needs of Otago/Southland, or Northland, or the West Coast, for example, are as different from each other as they are from Wellington or Auckland. To succeed, the new structure will have to reflect that and ensure that the interests of local communities, from where our firefighters have traditionally sprung, are recognised and valued.

The Government has deliberately (and wisely) not stated a preferred outcome at this stage. Our consultations are based on wanting to hear what communities think, so we can devise a system that meets their needs. Once the public consultation process ends in mid July, my officials and I will work to develop the new model, which I want to put before Cabinet later in the year. My aim is to get the necessary legislation through Parliament next year, and to have the new Fire Service in place by April 2017.      

          

 

 

 

 

11 June 2015

Earlier this week I approved the use of a medicinal cannabis product (actually a hemp derivative) in the case of a critically ill teenager.

The decision was an unremarkable, as it was fair and obvious. To have done otherwise in the particular circumstances would have been heartless in the extreme. The public protests and the sentiments of the well-meaning worthies counted for nothing with me in this case. It was much more a matter of plain old common sense.

In the wake of that decision there have been many wrong and naïve conclusions from the enthusiasts and the antagonists that the floodgates have been opened, and that the widespread availability of medicinal cannabis of every type for all manner of aches and pains is now just around the corner. How wrong they are!

Nothing has changed. No precedent has been created. All that has happened is that a long available procedure by which doctors can seek approval for the use of a restricted product in the treatment of a particular condition has been utilised for the first time to access a medicinal cannabis product in an extreme case.

As for the wider issue, I said a couple of months ago that I had sought advice from officials on developing international trends and their relevance to New Zealand. That work is ongoing, and we are monitoring developments in a number of jurisdictions, Australia and the United States in particular, to determine the best approach to take in the public interest of New Zealanders.

Whatever we do, it is important to note that we will treat medicinal cannabis no differently to other new medicinal products seeking entry to the New Zealand market.  Medsafe employs a rigorous evidence and clinical trial based process for registering and approving new medicines, and that will be followed in this instance. It should also be noted that there are no pharmaceutical manufacturers currently seeking to introduce cannabis based medicines into New Zealand. It is not the Government’s role to overturn or upend an established process for any prospective new medicine in any circumstances, so any medicinal cannabis based products will be treated no differently in that regard.

It is important too to note that medicinal cannabis products are in the main sprays or oils. No-one is talking about the cannabis leaf, so those who argue that just a few puffs have a medicinal benefit and they should be allowed to cultivate what they need are woefully out of touch. Whatever else may happen, changing the legal status of the cannabis leaf is not on the Government’s agenda, nor even its distant horizon.

Some have hailed this week’s decision as the start of a “sensible” discussion of drug policy. I am deeply suspicious of that pejorative approbation – those making that call are invariably cannabis legalisation advocates, best ignored as just one more vested interest.

No, this week’s decision was simply the practical exercise of compassion and balance in an extremely tragic and unusual case.    

4 June 2015

For a moment earlier this week I found myself in agreement with the Greens’ new co-leader James Shaw and his call for the government to work with other parties towards an agreed emissions reduction target as part of our approach to curbing the impacts of climate change. After all, Shaw seems such a sensible chap, and many other countries are moving in this direction, so it seemed a not unreasonable idea to try to work towards such a consensus in New Zealand. At last, I naively thought, the Greens are shedding their dogmatism and have worked out that the way to work with other parties is to co-operate with them, not to badger and harangue them.

But it was only a brief lapse on my part. The more Shaw pushed his ideas before a clearly uninterested Prime Minister, the more it became clear that John Key was not being asked to sit down and talk about a commonly agreed target, but to just adopt the Greens’ pre-determined target. The Greens, after all, as they smugly keep reminding us, are a party of principle, so can never be wrong. All of which explains why as the oldest of our newer political parties they are the only ones never to have been part of a government, and why both National and Labour have been extremely wary of working too closely with them. Their sanctimony would simply be too much to bear. Those who had hopes Shaw might be the circuit breaker will have been sorely disappointed by the outcome of his first foray. Nothing has actually changed, it seems, and the Greens are as isolated as ever.  

The big loser out of all this is the environment – the cause the Greens profess to care so passionately about. New Zealand needs an influential Green Party, but will probably now go in to the next round of climate change discussions with a very modest emissions reductions target. UnitedFuture and the Maori Party have shown some environmental credentials, as their stands on seeking to prevent National’s attempts to gut the Resource Management Act have shown, but with only three seats in Parliament between them cannot at this stage sustain the influence a mainstream environment party would have.

Here is the problem in a nutshell. Many New Zealanders care passionately about preserving our environment and worry that successive governments have not been doing enough in that space. Yet these same New Zealanders do not want to put their heads above the environmental parapet, because some of the extreme (and often not-environment related) positions the Greens have taken over the years have attracted so much ridicule and scorn.

I think James Shaw instinctively understands this conundrum, and wants to change the perception, but I doubt the wider Green Party will let him. He has already discovered this week that the moral high ground is not always the place to be if you want to make real change in politics. It is fine if you just want to make a statement, and never be held to account for it, something the Greens have thus far been past masters at. But if you want to achieve things in politics, you have to be prepared to get on the same ground as others, and work alongside them patiently, compromise by wretched compromise if need be, until you finally achieve your objective. Moving the Green Party onto that space will be James Shaw’s biggest credibility challenge.