NZ Allied Health - Level 3 & 4 Reform
NZ Allied Health - Level 3 & 4 Reform
Dear Dr Martin Chadwick/Dr Ashley Bloomfield,
We are contacting you as a cross-disciplinary group of Allied Health Professionals representing Physiotherapy, Osteopathy and Chiropractic, requesting that you urgently review the Allied Healthcare practice guidelines and policies under COVID19 Alert Level 3/4.
As registered health professionals, it is beholden on us to provide our patients with high-quality health care, delivered to high safety standards. The current guidelines from the Ministry of Health, which are enforced by the Osteopathic Council of New Zealand, the Physiotherapy Board of New Zealand and the New Zealand Chiropractic Board as our governing bodies, limits us to only providing face to face treatment where it is considered ‘urgent’. This has been defined as relating to:
• a condition which is life or limb-threatening.
• treatment required to maintain the basic necessities of life.
• treatment that cannot be delayed or carried out remotely without risk of significant harm or permanent and/or significant disability.
• treatment which cannot be delivered by a service which is currently operating or by health professionals that are already in contact with the patient.
The regulatory bodies advised that it was expected ‘a minimal number’ of patients would require face to face treatment under these guidelines. The reality is that no patient seeking physiotherapy, osteopathy or chiropractic treatment would meet the criteria of the first three bullets; and if they did, those professions would be referring the patient to the nearest ED for such life-saving treatment.
It is the last bullet that requires more consideration: GPs, Emergency Departments and medical/nursing staff within our hospitals do not practice manual therapy and are not trained to do so. Furthermore, the hospital-based health workforce have enough of a task ahead of them in ensuring New Zealanders can still receive timely secondary and tertiary level care, despite the logistics of functioning under levels 3 and 4. If the current restrictions remain in place for other practitioner types, those teams will find themselves under enormous and increasing pressure to also manage the needs of patients who cannot access the allied health treatments that would normally keep them pain-free and functional on a day to day basis.
The inevitable likelihood in such a scenario is that those patients would rapidly experience physical and mental deconditioning; there would be an increased uptake in the use of pharmacological alternatives to manage pain. It is widely known that opioids are already over-prescribed in New Zealand and the long term, detrimental effects of dependency on such drugs have been well documented.
New Zealand, like the rest of the world, is likely to oscillate between pandemic management levels for some time to come. The thousands of patients who currently benefit from manual therapy should not be left in limbo, in the hope that things will return to normal sometime soon. Instead, we as health professionals must look to adapting how we practice so that – regardless of the condition being managed – we can treat New Zealanders safely at all times and help to prevent the spread of Covid-19 in the long term.
We are all subjected to the stresses of living under the cloud of Covid-19. However, as members of the Allied Health workforce, we are also intensely aware of the effects that this stress has upon people living with pain and disability. Although the majority of private patients visiting Allied Health Practitioners are highly unlikely to die of their condition, the cumulative effect of chronic pain and disability, increased stress and limited access to support has huge ramifications for the affected patients and their whanau, both in the short and longer-term, if effective management is denied.
We do not believe that the provision of healthcare at Level 3 and above needs to be precluded. Our practices do not involve “aerosol-generating procedures” and it has been shown overseas that manual treatment can be safely provided with adequate safety measures applied. The use of PPE, screening of bookings, the spacing of patients, both physically and in terms of booking times, and the sanitizing of treatment spaces to further reduce the possibility of viral transmission can all be achieved in the provision of allied health therapies. When used in conjunction with contact tracing technology, the working environment of allied health practitioners could be one of the safest environments in the community.
We respectfully request that the Ministry of Health urgently review the practice guidelines and policies for allied healthcare under COVID19 Alert Levels 3 and 4, as we believe that the current guidelines are overly restrictive and detrimental, not only to the healthcare businesses affected but also to the large numbers of patients who rely on Allied Health to keep them pain-free and mobile.
SIGNED BY NZ REGISTERED ALLIED HEALTH PRACTITIONERS.