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6:00 am, January 4th, 2023 - 40 comments
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Had an interesting long chat with a surgeon from one of our DHBs yesterday (not going to identify them).
Some interesting takeouts: Post code lottery in cancer outomes is indeed a thing, but not ion the way the media portrays it. Wait times for treatment are broadly the same. However, post treatment oncology services vary widely depending on where you live. In many DHBs your follow up care is on you – you've got to ring to get appointments, chase up the testing. In the big cities though the resources exist for the health system to follow you up. The issue isn't particularly money, but rather getting qualified oncology staff who want to work in out of the way DHBs.
The DHBs are, indeed, a complete nightrmare of petty fiefdoms and poor cooperation at the management level, although clinical staff mitigate a lot of that.
The last thing surprised me – this surgeon told me it should be an absolute priority to gain greater independence in the manufacturing of key vaccines, drugs and medications – insulin, basic paracetamol/NSAIDs and steroids, and generic asthma and blood pressure drugs – were specifically mentioned. Some capacity to manufacture these should be held domestically was the strongly held view.
Anyway, thought I share the observations of an extremely smart person who has been at the coal face for a while now….
Sanc….I've been in the UK recently (and wandering around Spain now) and the problems with nurses/junior doctors/the PUBLIC health service (private well off people are fine of course) seems to be not just in NZ but in many countries.
Coincidentally, I had a conversation with a friend yesterday who has been working in the Health Sector in Australia for over three decades now.
Her current role is in Nursing Management and Change Management Training.
We were talking about the retention and training of nurses in both Australia and NZ. We spoke about the reduction of training costs for RN's in Australia, which was not duplicated here (Covid training Fees Free was limited to Enrolled Nurses AFAIK). She also mentioned the disparity in training when accepting overseas trained staff. With countries where there were equivalent and close relationships, ie. Canada, England, NZ, US the staff were pretty much on a par, in terms of practice. Other countries were not as reliable in terms of consistency, which may be a cultural issue rather than training.
However, many UK nurses have an extra level of training after basic qualifications, when they specialise in a particular discipline – eg. oncology.
In Australia – this specialisation occurs by placement and practice on the ward, and is not usually accompanied by further theory or qualifications. UK nurses with these extra specialised qualifications are not recognised by Australia, leaving them on a par with basic RN nurse pay rates. In fact, they are equivalent to clinical practitioners in Australian heathcare (with a higher payrate), but have to fight to have this recognised. So far, the Australian government response has not been to make any changes, and so there is an attrition rate as those highly qualified nurses return back to the UK as job satisfaction is low, and they lose faith in the Australian system valuing them.
I'm not sure what occurs in NZ, as regards this issue.
Surely you mean Whatu Ora?
cause
To begin reforming the health system, the 20 DHBs were disestablished and their functions were merged into Te Whatu Ora, which now leads the day-to-day running of the system for the whole country.6/09/2022
https://www.futureofhealth.govt.nz/health-nz/#:~:text=To%20begin%20reforming%20the%20health,system%20for%20the%20whole%20country.
Covid cases are still being reported by DHB/Region – see map here:
https://www.rnz.co.nz/news/in-depth/450874/covid-19-data-visualisations-nz-in-numbers
I guess changes would disrupt continuity of data comparison.
According to the government the DHBs don't exist anymore.
They might still use hard/software until the full transition is completed, but as of the June 2022 there were no more DHBs. And whatever assets the DHBs had at the time they were dissolved these are now the assets of Te Whatu Ora.
And yes, the DHBs were underfunded, overworked and appreciated by none but they no longer set the rules or provide the budget nor plan anything, that is all now done by Te Whatu Ora. They were reformed away by Andrew Little, Minister of Health, Creator of Te Whatu Ora, under the Labour Party led by Jacinda Ardern. It is actually one of the things they are proud of.
What ever the short comings of todays Te Whatu Ora they are the shortcomings of Te Whatu Ora. To pretend that the DHBs are still doing anything today is misleading.
"The DHBs are, indeed, a complete nightrmare of petty fiefdoms and poor cooperation at the management level…"
That was plain for all to see and as far as I can tell is the basis for the reforms now underway. Andrew Little has explained the problems over and over again yet the Oppo parties – backed by a disingenuous bunch of media hacks – keep questioning his motivations as if he hasn't explained anything and is a complete idiot.
Its pathetic to watch the ignorant and foolish public fall for it, and does make me wonder about the poor cognitive abilities of so many voters. Is it an education failure or the results of hostile bombardment by right-wing media? Or is it both?
In my opinion, the problems with our health system go all the way back 3 decades to the Birch health reforms.
I offer up this over-the-holidays conversation with the son of a close family friend. He's just about to jet overseas to Oz – to further his career.
He's a doctor – 2 years out of med school who wants to specialize as an oncologist (he's interested in both research and treatment). You'd think that the NZ medical system would be falling over backwards to find a way to foster his career here…. but no.
He's missed out on the oncology residency (very limited numbers, I understand) at Auckland – no further communication, just a letter. And, given that he'd need to shift cities in any case (if there was, indeed, anything available in NZ), he looked over the ditch at what was on offer in Oz. He's ended up with a very attractive offer in Queensland, which will foster his career, and pay him considerably more. He's off at the end of the month – and I'd be surprised if he ever returns. A total loss of 7 years plus education and training to NZ.
Not neoliberal economics, in other words. We need to be prepared to pay the extra cost for that supply security – yet both our main parties are madly committed to keeping govt debt and taxes low by world standards.
Did the surgeon say why? I completely agree, because the global supply of such things is no longer guaranteed, but am curious what his thinking was.
He sounds very sensible and alert to the issues.
A short time ago, and I don't remember where exactly, Jenny, a commenter with whom i often find myself debating the Ukraine issue, pointed out that Putin in April had turned down an initiative for an interim ceasefire. I had not been aware of this and made some fairly non committal response. However, Malcolm Evens has very recently made a post to The Daily Blog which claimed, in passing, that a deal had been brokered between Kyiv and Moscow, but that Boris Johnson had talked Zelensky into backing away from it.
And the media also failed to publish the peace initiative brokered when Kiev and Moscow reached a negotiated interim settlement in early April, whereby Russia would withdraw to its pre-February 24 position, and Ukraine would promise not to seek NATO membership in return for security guarantees from a number of countries. However, at the very last minute, then-UK Prime Minister Boris Johnson reportedly flew to Kiev and demanded that Zelensky step away from the talks, a shocking fact that has barely been mentioned in English-language news media.
https://thedailyblog.co.nz/2022/12/31/new-study-exposes-the-medias-role-in-the-war-on-truth-in-ukraine/
I mention this, not as a criticism of Jenny, but because I think that if this is true (Evens does not provide a link) then it is pretty shocking that Johnson would do such a thing; and shows the US and British motivations for their involvement involvement in the Ukraine conflict to be pretty venal.
Firstly there are no details of any purported settlement to publish.
Secondly if it had happened (which seems unlikely to me) then it would have been in the peace talks on March 29th/30th. it was overtaken by events after the forced Russian withdrawal from Bucha a day later and the discovery of Russian atrocities against civilians a day later. Responsibility for actions against Russian perpetrators would have then been part of any peace settlement, something that Russia never seems to demand any accountability of their military or security forces. Plus the Russian line at the time was that it was all a manufactured incident by the Ukrreainians.
Thirdly, Johnson only visited Kyiv well after a speech by Zelensky to the UN demanding accountability of Russian actions that scuppered any hope of early peace agreement.
You should probably look at the actual history, rather than some manufactured time line for internal propaganda written by an fool apologist making up fairy tales.
Wikipedia has a pretty good timeline of the known peace negotiations.
If you read the timelines, the barbaric behaviour of the Russian troops and FSB in places like Bucha after the forced withdrawal of Russian troops before the April 1st evidence of atrocities were what prevented any hope of a early peace settlement.
This was the report on the 4th of April address of Zelenzky. Curiously Malcom Evans didn't mention this in his analysis. Possibly because they are in favour of atrocities by Russia in occupied territories – which would be my current working hypothesis in the absence of a denial and explanation of their moral stance.
Ukraine's President Described Nightmarish War Crimes By Russian Forces In Bucha
After that address, the media had their own direct access to the Bucha and other atrocity sites to verify the atrocity claims well before Boris Johnson visited Kyiv. He didn't visit until the 9th of April.
Which is what made this particular bit of Russian propaganda a pile of limp bullshit for blind fools supporting documented military and FSB atrocities.
Thanks for that Iprent. I was aware of all this, but you have given a lot more detail, which is informative.
I think you have wasted your energy replying to Mike et al though. The bones of all this has already been pointed out to them previously by various of us. But it doesn't seem to sink in unfortunately.
Also, whatever Russia says about wanting to negotiate, its actions speak louder than words. Its recent actions in "annexing" parts of Ukraine, some of which it didn't even occupy at the time, really scuppered any prospect for negotiation.
Up until then, it was possible to envisage some sort of land-lease arrangement between Ukraine and Russia that would have given Russia legal access to Ukrainian territories such as Crimea or the Donbas, but would have ensured that sovereign ownership remained with Ukraine.
But, unfortunately, Russia has now made negotiated deals nigh on impossible, in the short term, anyway.
The main point of my comment was Boris Johnson's words:
British Prime Minister Boris Johnson who told Zelenskyy "Putin is a war criminal, he should be pressured, not negotiated with," and that "even if Ukraine is ready to sign some agreements on guarantees with Putin, they are not."
Russian atrocities in Bucha, egragious as they may have been, should not have been a reason for Zelensky to abandon peace talks – just the opposite in fact. Almost certainly it would have been Johnson's comments that decided him.
PS: Who are “they”, by the way? Presumably the British (and the Americans).
Before you can use this supposed statement as a basis for an argument you need to provide an authoritative source to prove that the statement was ever made in the first place, and also, the context for the statement so we can assess whether it actually has the spin you are trying to attach to it.
But, so far as peace negotiations go, it is a good idea to listen to someone who actually knows what they are talking about. Nielson is a military analyst at the Danish Defence Academy, and a captain on a Danish war ship.
Nielson makes several points:
Firstly, if the current dispute could have been resolved through negotiations, it would have been.
Secondly, war defines the parameters for the peace talks. At the moment, both sides think they can win, and that both sides have totally incompatible demands. Hence, there is little prospect for successful negotiations at the moment.
But if one side sees they are losing, or that they may lose any advantage they have, they will be more likely to enter peace talks. For instance, if Russia keeps getting driven back, or if the Ukrainian population tires of constant attacks on infrastructure etc, and puts pressure on Zelensky to settle.
Thirdly, premature peace talks can prolong a conflict. This is because if negotiations are premature, both sides will enter the negotiations with unrealistic demands that will not result in any resolution.
So, it appears there is still more fighting to happen before any peaceful resolution can occur. Russia is more likely to enter negotiations in good faith if it realises that Western support is unwavering, and that continuing the conflict will just mean things keep getting worse for Russia.
Thirdly, that premature peace talks
And, your complaint about media bias in your first comment is a bit silly.
It is similar to a rugby team complaining that the ref was biased because of awarding most penlaties against that team. However, during that game, the team had continually engaged in blatant professional fouls.
Hint: flattening Ukrainian cities, shelling schools and hospitals, and committing terrible war crimes isn't likely to get a lot of positive press.
Link?
The supposed source for that comment is extremely tenuous. Supposedly, an unnamed source from Zelensky's team.
I doubt very much it is possible to provide a link. A bit similar to the supposed promise never to expand Nato eastwards which is often stated but has little actual evidence to support the comment ever being made.
Wow – up is down and black is white. So you leave more of your territory and citizens in the hands of people who do that sort of crap….and think you can also trust them to keep to any deal. War crimes are an excellent reason to keep fighting.
Your post at TDB said:
I'd say that you have completely and probably deliberately misrepresented this as a 'demanded'. Your quote above makes that pretty clear. There is no evidence of there was a demand at all. It just looks to me like you do not understand the bounds of national sovereignty. Especially when you now say..
If you dig through your quoted section without your ridiculous ideological blinders on it, the answer is completely obvious.
Assuming that quote is correct, then Boris Johnson was talking as a PM of the sovereign nation of the UK. The ‘they’ in that context can only be that of the UK.
The reason for this is obvious for anyone who'd reads anything about diplomacy, the legal positions that underlie it, and simply the authority limits of what nations allow other nations to do on their behalf (which invariably is – only if we explicitly say that you can and you state that).
If he had been giving the position of the US (a different sovereign nation) – then he would have explicitly said so having gotten permission to do so. Otherwise the US would have had Johnson's guts for garters while also repudiating his words.
What Johnson clearly said was that the UK (they) was not willing to give "guarantees with Putin" – presumably written about security or sanctions or NATO expansion as the most likely subjects. Your quote is not explicit or (as usual) sourced.
The UK position is probably because Putin has repeatably violated previous written guarantees about the Russia Federation protecting Ukraine security and borders with a succession of invasions and attempts to subvert the governing of the sovereign nation of Ukraine. If you don't know what I am talking about, then I'd suggest that you find out before your ignorance is exposed.
Similarly the UK cannot speak for NATO about guarantees about NATO expansion. NATO requires unanimity on any decisions about the decisions of NATO from all members. If the UK wasn't willing to provide a yes, then there would be no guarantees with Putin from NATO.
Both of those are decisions that the UK can make in the absence of any other nation.
And need I say it (but obviously yes based on your apparent lack of basic understanding).
The leaders of the UK cannot speak for Ukraine, nor can the leaders of Ukraine speak for the UK, US or anyone apart from their own nation. National sovereignty is a fundamental of international law and diplomacy. It is also enshrined in the UN charter and was quite specifically put in place to ensure the self-detirmation of nations after centuries of wars by imperial ambitions of other states.
I'd also be interested in you stating your position about national sovereignty and imperialism. Because almost everything I ever read from you reminds me of a grasping 19th century imperialist. Just as the official statements out of the Russian Federation also remind me of previous Russian imperialism in central Eurasia in the 19th and 20th centuries.
Which really begs the question about how your personal morality allows you to think like that. But leaving aside your casual approach to invasion, casual rape, arbitrary murder, systematic theft, and forced 'evacuations' by the Russian Federation invaders…
But they were mentioned. What was noticeable was that the main reason given for their support for invasion and deliberate subversion of parts of the Ukrainian nation from 2014 onwards was the purported atrocities against the civilian population of Russian speakers in the Crimea and Donetsk. The expansion of NATO was definitely a secondary consideration.
I say purported, because it is hard to nigh well impossible to locate actual substantive evidence that these atrocities existed. There is a lot of hearsay. All of the evidence that I have seen so far indicates armed militias and accidents in combat zones. This includes a number of official investigations from external nations looking for evidence of war crimes or crimes against humanity.
Whereas what happened in Bucha and many other sites were deliberate atrocities against civilians carried by invading Russian troops and security forces. These are all war crimes and crimes against humanity.
Anyway if that was cause enough for Russia to go from diplomatic to military invasion solutions in the Crimea and the Donensk. Then to me it appears to make your opinion (and possibly that of the Russian Federation) to say that the same alleged atrocities but with actual evidence is not a cause to bring war crimes and to continue military action is extremely hypocritical.
I'd have to troll back through your comments here to dig it out. But I seem to remember seeing you saying that purported atrocities in the Donenk as part of a your justification for the Russian invasion last year. Of course that could just be you mindlessly parroting propaganda without thinking it through.
An alternate explanation that I can see for your position and that of the Russian Federation position about not examining evidence of crimes against humanity is the same position 'subhuman' or 'uberman' position used by slavers, racists, and nazi death camp advocates.
Which again leads me to the question about your personal morality and political positions. Pwerhaps you should elucidate exactly what your personal positions on crimes against humanity and war crimes is.
BTW: please don't rabbit on about hearsay non-written guarantees about NATO to me. Hearsay guarantees simply aren't worth the paper they're not written on.
I commented on Ukraine and Russia making peace, once during the negotiations and twice afterward,
.https://thestandard.org.nz/open-mike-28-10-2022/#comment-1918232
.https://thestandard.org.nz/freedom-is-not-guaranteed-sometimes-you-must-fight/#comment-1910337
.https://thestandard.org.nz/open-mike-30-03-2022/#comment-1879756
Basically Zelensky offered Russia an immediate ceasefire if Russian Forces would agree to return to the territories in the Donbas that Russia had occupied before Russia's full scale invasion of Ukraine in February. (With an agreement for further negotiations between Moscow and Kiev for a final peaceful settlement over these disputed territories). Sounded fair and more than generous to me.
Ukraine being a democracy, and without the power to rule by decree, Zelensky also offered to hold a binding nationwide referendum on full neutrality between the Nato allies and the Russian Federation. Again on the condition of a ceasefire to allow the referendum to proceed.
The Russian Federation negotiators, rejected all peace overtures by Kiev.
Making no progress in the negotiations with Moscow, Zelensky then went over the heads of the Russian delegation on Telegram, the messaging service favoured by Russians, to put the same peace offers to the Russian people directly.
As for the Bucha timeline, which as Lynne mentioned, acted to harden Ukraine's resolve to fight on. To try and find some common ground with the pro-Kremlin commenters, I try to avoid heated arguments over disputed atrocities, (no matter how well documented), claimed by either side, and instead concentrate on atrocities that can't be disputed. Like for instance video of Russian missiles slamming into civilian apartment buildings.
There's something wrong with these people.
Metal detectors were removed from outside the House chamber with the start of the new Republican-controlled House on Tuesday.
The extra layer of security was ordered put in place by then-Speaker Nancy Pelosi (D-Calif.) in the wake of the Jan. 6, 2021, attack on the Capitol.
https://thehill.com/homenews/house/3796927-metal-detectors-removed-from-outside-the-house-chamber/
"Lauren Boebert said, as the metal detectors were removed behind her. “Today, they are being removed and we are turning Pelosi’s House back into the people’s House.”
She would say that. I suppose she's all for as many guns as possible when whoever it is decides to take over the House and really make it the people's house by doing what those she supports tried to do on Jan 6 2021.
Well she would – She's attempted to carry guns into the House of Representatives before. And utter maniac.
Well that's about all they are likely to achieve over the next 2 years. Can't even get themselves sufficiently organised to elect a Speaker – and doesn't look like they will be able to any time soon. The Repugnants are such a fractured mob of malcontents now they are completely unfit to govern.
The so called Freedom Caucus (does not include Green, does include Boebert and Gaetz) have demands such as spending cuts (Social Security and Medicare) and the creation of a select committee modeled after the one that investigated the federal government after Watergate (they want license to go after people in government).
So, such people want to be able to be personally armed in the House? Why is that? Insecurity- I must be armed to protect myself? I don't trust the people who are employed to protect me, or trust their detection machines? I don't trust the society I live in enough not to be armed, that fear is my ever-present companion?
Or are they secretly hoping for some event to make their lives remarkable, Rapture seekers awaiting the-Second Coming to feel fulfilled?
I don't get the belief, the psychology, the motivation of it all.
To make it easier next time they arrange a 6 Jan coup. Not holding people accountable emboldens them.
hopefully simon dallow will do the right thing and resign and never come back to teevee ever. He is shallow biased and completely self serving and New Zealand deserves better.
What does this mean?
Link please?
"…New Zealand deserves better."
Yeah!
Coz!
Twitter outages in NZ & Aussie today. Website not loading, feed v slow, many unable to tweet
Twitter slow or completely down for New Zealand, Australian users – reports | Newshub
https://twitter.com/RyanSproull/status/1610399311959068673?s=20
just had a look at some TS embeds, and they're still visible.
eg https://thestandard.org.nz/twitter-as-slow-motion-trainwreck/
can't open them in twitter of course.
oh, twitter pages actually loading now. I couldn't get them to work at all earlier.
do you have a backup plan? I'm on mastodon periodically, but it's quite different from twitter.
yeah I set up a Mastodon account, but its not the same
we will still have TS for the politics 🙂 (it's not the same either).
testing to see how dysfunctional twitter is and I see that 'woke' is trending in NZ. Only it's tweets like this
😁
https://twitter.com/adamsonsonadam/status/1610566866371502081