Ear treatment cuts another attack on the poor

Written By: - Date published: 3:58 pm, January 15th, 2013 - 27 comments
Categories: child welfare, class war, health, national - Tags: , , ,

This is a topic that came up over the break that I noted to write about when I got back to posting. The Nats want to cut the budget for surgery to install grommets, a technique for treating persistent ear infection (especially in children). The rationale is summarised in this Herald piece:

Govt eyes cuts to elective surgery

The National Health Committee has to find savings of $30 million this financial year from elective procedures deemed to be of little benefit. The money would be used for smarter investment in other parts of the health system.

The only specific elective procedure the committee has so far named for “disinvestment” is the insertion of grommets. Grommets are tiny ventilation tubes placed in an incision in the eardrum to treat persistent, painful infections called glue ear.

[The committee] … draws on a Welsh health system report that evaluated 550 elective procedures deemed to be of “relatively low priority”. … The Welsh report’s specific procedures are listed under 17 surgical and dental headings, including tonsillectomy, grommets, varicose veins, haemorrhoids, dilatation and curettage, hysterectomy, gallbladder removal, caesarean section, lower-back procedures, circumcision, eye-lid surgery, nose surgery and surgery to correct protruding ears.

OK, so, there are 17 “headings” to explore, including purely cosmetic options like the correction of protruding ears, and so far the only one specifically mentioned and targeted is grommets. That’s a procedure which in many cases helps restore the sense of hearing, and is used mainly by (you guessed it) children in poor families. Brilliant.

The committee said it had completed a technological note on the use of ventilation tube grommets for treating middle-ear infections (otitis media). “The evidence indicates that the use of ventilation tubes is of limited value in treating otitis media with effusion, although it does not suggest that it should be stopped completely.”

New Zealand’s rate of grommets use is about 75 per cent greater per capita than Britain’s. “The difference represents a cost to New Zealand of approximately $4.4 million per annum,” the committee says.

Save $4.4 Million a year by bringing ourselves in to line with Britain. Did anyone on “The Committee” stop to ask if it was Britain or NZ that had it right? Of course not. But Kiwi doctors have let us know what they think:

Doubt over savings from restricting ear treatment

A leading surgeon doubts the Government will be able to save money by cutting down on treating children’s ears with grommets.

Scott Stevenson, an ear, nose and throat surgeon, was commenting on a government group’s suggestion New Zealand could save $4.4 million a year if its rate of grommet insertion was lowered to Britain’s level.

“The savings probably aren’t there,” said Mr Stevenson, the chairman of the New Zealand board of the Royal Australasian College of Surgeons. … Mr Stevenson said the college had concerns about the ideas the National Health Committee expressed on grommets in a discussion document and he had responded “fairly vigorously”.

The ideal intervention rate for grommets was unknown. “No one has looked at that and said are we over-treating or is the UK under-treating.

“Maori and Pacific people have a high incidence of middle-ear disease. I would hate to see anything done that impacts on our ability to look after some of our most economically deprived and underprivileged kids.” [my bold]

Auckland ear, nose and throat surgeon Dr Colin Brown said, “The UK is not a good reference point in terms of whether we do more or less. In my opinion children are substantially under-treated in the UK.”

I’m with Kerre Woodham on this one – I have personally known too many kids who have been helped by grommets. I would hate to see any cuts to what is often a vital procedure – especially when we could be starting with protruding ears instead. Last word (from the same piece as the above quote) to Labour’s Maryan Street:

Labour’s health spokeswoman, Maryan Street, said reducing the number of grommet operations for children – without a direct investment in measures to reduce the need for the treatment – would be a false economy that led to “more kids sitting in class unable to listen and learn”.

Exactly.

27 comments on “Ear treatment cuts another attack on the poor ”

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  1. Blue 1
    15 January 2013 at 4:26 pm

    Right-wing government at their most disgusting. They don’t care if children from low-income families go deaf or suffer permanent hearing loss.

    When those children struggle at school and show up in crime, unemployment and health system statistics later in life, the right-wing will do their usual song and dance about how they’re just lazy and stupid and need a good kick up the arse.

    I think National have bought themselves a fight on par with class sizes over this one, however. Many parents in NZ have experience with their children getting ear infections and needing grommets. They also object to kids being permanently disabled because of government policy.

    Tony Ryall’s oversight of the Health portfolio just fell off a cliff.

  2. higherstandard 2
    15 January 2013 at 4:36 pm

    Hi R0b

    Can you please link to the bit where “The Nats want to cut the budget for surgery to install grommets”

    I’m pretty sure this is just a discussion document put forward by the NHC for comment from the respective colleges, I’d be very, very surprised if there was any cuts too this particular procedure as like immunisation it’s a very effective and cost effective intervention.

    Assuming this information was released by the government, if I was you I’d look at what is not being said, if it’s just a media initiated story I suspect it was a slow news day.

    • McFlock 2.1
      15 January 2013 at 4:52 pm

      So the directive to save $30 mil is self-imposed?

    • Bill 2.2
      15 January 2013 at 5:02 pm

      Acknowledge your point that it’s not accurate to state that “The Nats want to cut the budget for surgery to install grommets”… seeing as how it’s a committee in it’s preliminary stages of investigation.

      But to be looking for savings of $30 million in the Health Service for the sake of ‘smarter investment’ in the Health Service is very bloody questionable on the grounds that it is (likely/possibly – choose your own qualifier) being driven by ideology rather than concern for ‘coal face’ services delivered by the Health Service.

      edit. Having just seen r0bs comment below, I retract my acknowledgement of inaccuracy 🙂

    • r0b 2.3
      15 January 2013 at 5:06 pm

      It’s there in the first piece linked to, but here’s a short sharp summary:

      http://www.radionz.co.nz/news/national/125166/grommets-targeted-as-govt-razor-gang-eyes-health

      The Nats have specified a saving of $30 million a year – the first recommendation of the committee they set up to do it is that $4.4 million can be saved from cutting grommets. Health Minister Ryall (apparently when asked about this) has been supportive of the committee, hence I think it’s fair to say that “The Nats want to cut the budget for surgery to install grommets”.

  3. One Tāne Huna 3
    15 January 2013 at 5:04 pm

    Controversy over this operation re-surfaces every few years, especially when the NHS needs to save money. The most recent example was a Personal View column in the British Medical Journal (Friday, November 19) by a general practitioner from Glasgow, Des Spence, who made a rather emotive attack on ENT surgeons who look after children. This has provoked many ENT surgeons to respond to the BMJ, suggesting that Dr Spence has misrepresented and ignored evidence, including the fact that many fewer operations are actually done today compared to when the procedure was first evaluated in the 1980s. Many ENT surgeons have said that they do operate selectively and when appropriate, as recommended by NICE.

    “Some of these arguments surrounding grommets are historical rather than factual,” said Vivienne Michael, Chief Executive of Deafness Research UK. “Otitis Media is not a trivial condition and in serious cases, grommets are essential. Unnecessary procedures were undoubtedly performed in the past when the condition was not well understood. But this should not be used as a justification for cutting funding for an often valuable procedure. With pressures on funding, we are concerned there may be delays in treatment for those children in whom the condition does not resolve itself. In the long-term, this won’t save money and, for the children seriously affected, there could be significant impact on their development which grommets could have easily alleviated.”

    Deafness Research UK

    Other sources refer to “an epidemic of surgery” for glue ear (Journal of Epidemiology and Community Health 1995;49:234-237), but speaking of epidemics, The Lancet tells us that since Rogernomics and Ruthenasia, New Zealand has experienced a massive increase in infectious disease admissions, of which glue ear is but one. It is also “the main cause of hearing loss in New Zealand” (Word DOC).

    I doubt the comparison with the UK is valid. Shonkey is as Shonkey does.

  4. Financially literate 4
    15 January 2013 at 5:07 pm

    For those interested in the report itself the link and excerpt is below. Link to the latest Cochrane review also provided.

    http://nhc.health.govt.nz/committee-publications/priorities-activities-and-next-steps-national-health-committee-report

    50. As an example, the NHC has completed a TechNote on the use of ventilation tubes for the treatment of otitis media. The evidence indicates that the use of ventilation tubes is of limited value in treating otitis media with effusion, although it does not suggest that it should be stopped completely.
    51. The following diagram shows that insertion rates in New Zealand (represented by the green line) are, on average, considerably above the average UK intervention rate (the red line). The difference represents a cost to New Zealand of approximately $4.4 million per annum.
    52. The NHC is suggesting that by focusing on the pathway of care for children, both in primary care and in secondary settings, and through increasing integration between settings, there is potential to both provide children with more appropriate and more effective care, while simultaneously reducing wasted expenditure for the DHBs.

    http://summaries.cochrane.org/CD001801/grommets-ventilation-tubes-for-hearing-loss-associated-with-otitis-media-with-effusion-in-children

    Evidence suggests that grommets only offer a short-term hearing improvement in children with simple glue ear (otitis media with effusion or OME) who have no other serious medical problems or disabilities. No effect on speech and language development has been shown.

    Glue ear is the build up of thick fluid behind the ear drum. It is a common childhood disorder, affecting one or both ears, and is the major cause of transient hearing problems in children. The insertion of grommets (ventilation or tympanostomy tubes) into the ear drum is a surgical treatment option commonly used to improve hearing in children with bilateral glue ear as unilateral glue ear results in minimal, if any, hearing disability. This review found that in children with bilateral glue ear that had not resolved after a period of 12 weeks and was associated with a documented hearing loss, the beneficial effect of grommets on hearing was present at six months but diminished thereafter. Most grommets come out over this time and by then the condition will have resolved in most children. The review did not find any evidence that grommets help speech and language development but no study has been performed in children with established speech, language, learning or developmental problems. Active observation would appear to be an appropriate management strategy for the majority of children with bilateral glue ear as middle ear fluid will resolve spontaneously in most children.

    • George D 4.1
      15 January 2013 at 9:23 pm

      Thanks. I was going to post a link to the Cochrane review – for those unfamiliar, they’re a review of all available evidence on a particular topic in medicine, and are considered a ‘gold standard’ of evidence review.

      I’m strongly in favour of evidence-based medicine, with priority funding going to procedures that demonstrate clear benefit at a reasonable cost, and less priority going to those that offer little benefit, or cost a very large amount for the benefit they offer. It’s what we do with ACC, and it works very well there.

      The challenge with health is to keep the budgets in line with costs, and you can do that by cutting costs, or by cutting budgets. The very real risk under any National Government is that you end up doing both.

      • McFlock 4.1.1
        15 January 2013 at 9:44 pm

        yep. I like EBM too, although the pain issue should also be in mind (not just hearing/speech).

        It seems to me that they’ve gone “save $30mil” and we just hope that all the surgeries not funded are not essential.

    • higherstandard 4.2
      17 January 2013 at 8:36 am

      Thanks for that.

  5. bad12 5
    15 January 2013 at 5:15 pm

    The cuts to budget Health are becoming apparent around the edges, it was highlighted in another recent post where someone in short stay accommodation for a head injury,(presumably the private provider was being funded via vote Health), had ended up in the night shelter once ‘the short stay’ nature of provision had run its course,

    Lower back procedures, according to my Doctor, will not be undertaken until there is a life threatening situation,

    Rape Crisis and Woman’s refuges are being starved of funds either by Health or the Ministry of Social Development…

    • mike e vipe e 5.1
      15 January 2013 at 5:23 pm

      More work for failed Charter schools and prisons brilliant idea from the Nasty NATS

  6. Dan1 6
    15 January 2013 at 7:37 pm

    A very sad call. Our oldest lad had glue ear, earache and was generally miserable for two of his first four years. The cycles of illness would come around every three months. His speech was definitely below par. He was on a continual round of antibiotics.

    The grommets changed everything, and with speech therapy, he came up to par. It was the high frequency sounds that he had missed out on.

    I cannot believe this decision. You might save $4.5m on the operation, but lose much more with medicines and remedial education and the loss of considerable potential amongst our young people. Without funding for this operation, many more kids will lose hearing.

  7. millsy 7
    15 January 2013 at 7:56 pm

    Ryall has learnt from the mistakes made by Upton, Birch, and of course, English. Rather than a hard out smashing down of the gates, and bingeing out on hospital closures, Ryall plans to gut our hospital system more subtly. The rise in prescription charges and the proposed ‘disinvestment’ in glue ear operations (gotta love the jargon), probably to pay for pensioner hip operations, and cancer treatments for desperate housewives are but two of these measures.

    By the way, here is the list of hospital closures I promised you all. brought to you by one of Muldoon’s positive legacies — the Official Information Act.

    • McFlock 7.1
      15 January 2013 at 9:05 pm

      Interesting list.

      How much did they charge you for the request? One thing to check it against might be hospital openings and ward bed capacity (can’t remember the exact term) in each hospital, for followup requests.

      • millsy 7.1.1
        15 January 2013 at 9:09 pm

        No charge at all. Response was reasonably quick too. Format is pretty dodgy though. I might look at seeing if I can dump it into a spreadsheet later on.

    • tc 7.2
      16 January 2013 at 6:59 am

      ‘ bringing ourselves in to line with Britain’ is more neo liberal claptrap, the UK is not who we should be emulating.

      Millsy’s onto it, waikato hospital is overflowing as the other regional hospitals have had so many cuts they can’t deliver those frontline services they bang on about keeping so waikato gets them.

      Ryall’s also quietly culling in the back office and creating a mess as it’s needed to supports frontline services. Health runs at 10% CPI so no $$$ increase is effectively a 10% cut across the board, Ryall’s a dirty word to healthcare workers and less than honest in the house with his more doctors and nurses statements.

      • LynWiper 7.2.1
        16 January 2013 at 7:20 am

        I for one am very happy to see Ryall’s pigeons coming home to roost. I don’t know how he has managed to stay under the radar for so long.

        • tc 7.2.1.1
          16 January 2013 at 9:45 am

          Health in NZ is pretty much 100% gov’t funded so where do you go if you call him out as the NACT are a vindictive lot who’ve already removed a few troublesome sorts to set the tone.

          If only we had a media, that loralei mason on TVNZ is as much a health reporter as I’m an astronaut.

        • Colonial Viper 7.2.1.2
          17 January 2013 at 8:53 am

          I for one am very happy to see Ryall’s pigeons coming home to roost. I don’t know how he has managed to stay under the radar for so long.

          He’s one of the most capable members of the Key Cabinet. Health, like Education, is usually a kiss of death for anyone who is not truly Ministerial material and Ryall has got through with barely a squeek so far.

  8. Dan1 8
    15 January 2013 at 8:42 pm

    Thanks Millsy. A fascinating list. The smaller towns have missed out. Psychiatric services over the last 12 years have been a clear focus. Helicopters and intensive care have their place in an emergency but the friction of distance for families is costly in time and $$$ for any ongoing treatment.

    • McFlock 8.1
      15 January 2013 at 9:02 pm

      One of the things that’s become evident to me over the last few years is that we are still really good at saving kids’ lives.

      Sadly, we’re shit at stopping them needing emergency treatment in the first place.

    • millsy 8.2
      15 January 2013 at 9:07 pm

      Got the Mason Report and the Gibbs Report (the one that inspired the 1991-96 health reforms) as well. Im trying to get a lot of these reports and documents via OIA request and post them online in one place so they can be accessed by those interested. With the advent of the internet there is no reason why historial government reports cannot be placed online for all to see.

  9. Murray Olsen 9
    16 January 2013 at 5:57 am

    I predict they’ll appear to back down and agree to fund grommets, but cut funding for virtually everything else on the list. That seems to be Key’s modus operandi – choose a particularly sensitive and emotive area to float an idea, never intending to push it through, and then making cuts elsewhere. Then they’ll probably stop funding grommets next year and say that they are regretfully forced to do it by a plague of locusts in Upper Egypt or something. At least half the population will probably swallow their bullshit.
    Shearer will say that anyone whose kids need grommets will be assessed by social workers to see if any welfare money they receive is being spent in a responsible manner. It’s only fair, after all.

  10. Frank Macskasy 10
    16 January 2013 at 1:36 pm

    This is something I looked at, and compared it to National’s health “reforms” in the mid/late 1990s. Unsurprisingly, the similarities are there in plain sight.

    The health cuts and grommet-issue here; http://fmacskasy.wordpress.com/2013/01/11/childrens-health-not-a-high-priority-for-health-minister-tony-ryall/ – which interestingly leads on to similar cuts that the current National-led government is carrying out. Full report here; http://fmacskasy.wordpress.com/2013/01/16/its-fundamentally-a-fairness-issue-peter-dunne/

    Interesting when one connects the dots…

    The cuts to state social services is, again, unsurprising and is a re-hash of the ’90s. What has changed is that the cuts are more subtle this time – and the MSM are nowhere as vigilant in reporting government policies and their flow-on effects.

    It also doesn’t help that current affairs and investigative reporting these days is minimal, and replaced mostly by crime “news”, reality TV, American sitcoms, and in case the 6PM News didn’t deliver up enough crime – TV offers endless crime “dramas”.

    Newspapers have been gutted of their best talent, with Simon Collins at the Herald perhaps the last remaining top journo. The rest now work for politicians and the corporate sector as PR spin-doctors.

    The greatest difference though, is that NZ First is not politically part of the picture. Their coalition deal with the Nats in ’96 made the Bolger/Shipley-led regime probably the most unpopular in living memory. So the media was only to happy to focus on social issues, to feed/reflect public feelings.

    Compare it with the Herald report, on 8 January,

    The National Health Committee has to find savings of $30 million this financial year from elective procedures deemed to be of little benefit.

    The money would be used for smarter investment in other parts of the health system

    See: http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10857848

    Notice that there are no quotation marks anywhere through the above two paragraphs – especially the last statement. The statements are presented uncritically as reportage – not as government media statement reflecting National Party policy.

    In fact the whole “money saved will be reinvested elsewhere” theme re-occurs throughout media reporting – though no one in the MSM seems tro have picked up on it.

    None of the “savings” (ie, cuts) will be reinvested of course. That’s BS.

    The Nats are desperate to show a budget surplus by 2014/15, and if kids have to go through their childhood with hearing loss; failed schooling; and an adult life at the bottom of the socio-economic heap – well, at least Bill English will be able to report, at election time, that National made a $66 million surplus. And John Key will do a little happy gangnam-style dance again…

  11. kiwicommie 11
    17 January 2013 at 8:17 am

    So National’s plan is bring NZ into line, makes sense when you put it with their other achievements like high unemployment, slow growth, trade deficits and general chaos. So when can we see UK style riots in Auckland, John Key better watch out that the would be rioters don’t target his fancy house.

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