Table 1 (Statistics NZ, n.d.) outlines the figures compiled by Statistics NZ for the NZ resident population as of December 2019. At that time, the total population was 4.95 million, subsequently crossing the 5 million marks in March 2020. The median age of the population is 37.5 years with a slight preponderance of females. Life expectancy for males is 80 years, with females living an additional 3.5 years longer.

Table 1: NZ population as of December 2019 by gender and sex ratio (Statistics NZ, n.d.)

 Tables 2 and 3 (Statistics NZ, 2021) outline the age structure of the population from the most recent 2018 census and shows that 19.5% of the total population is aged under 15 years and 15.5% aged 65 years and older. The Pacific population in NZ has a much younger age structure, with a median age of 22.1 years and only 5.2% of the Pacific population aged 65 years or older. The Pacific population is increasing at a faster rate with an annual growth of 5.2% three times that of the population as a whole.

Table 2: Age bands, annual growth, and median age of the total NZ population and Pacific population at census 2018 (Statistics NZ, 2021)

Table 3

References:

Statistics NZ. (2021). National ethnic population projections: 2018(base)-2043. New Zealand Government Website. Available from: https://www.stats.govt.nz/information-releases/national-ethnic-population-projections-2018base-2043.

Statistics NZ. (n.d.). Population. New Zealand Government Website. Available from: https://www.stats.govt.nz/topics/population.

New Zealand comprises ~600 islands with a total land mass of  ~265,000km². Almost all the population reside on the two main islands – North and South – with a smattering of other inhabited smaller islands including Stewart Island, Waiheke Island, and the Chatham & Pitt islands. New Zealand’s population density is relatively low at ~18 people per square kilometre but there is considerable variation (Statistics NZ, 2021) with a higher density in the main metropolitan areas. The North Island accounts for 77% of the population and is growing at 2.2% per year, faster than the national average of 1.4% per year. The median centre of the population (defined as the point of intersection of two lines: one equally dividing the population north and south, the other equally dividing the population east and west) is shifting further North toward Auckland, New Zealand’s centre of trade and most populous city at ~1.4 million inhabitants (figure 3). Auckland is home to close to two-thirds of the Pacific and Asian ethnic group populations (63.9 and 62.6 percent, respectively) and 51% of MELAA ethnic groups usually live there.

Urbanisation is ~86%, with most of the population living in or around a major city (World Population Review, 2021).

From the 2018 census (Environmental Health Intelligence New Zealand, 2018):

• 51.2% of the population lived in the 7 major urban areas (population 100,000+) of Auckland, Christchurch, Wellington, Hamilton, Tauranga, Dunedin, and Lower Hutt;
• 14.1% lived in 13 large urban areas (population 30,000-99,999) such as Rotorua, Whanganui, and Invercargill;
• 8.4% lived in 22 medium urban areas (population 10,000-29,999) such as Cambridge, Te Awamutu, and Rolleston;
• 10.0% lived in 136 small urban areas (population 1,000-9,999) such as Thames, Stratford, and Gore;
• 16.3% of New Zealanders lived in rural areas (population <1,000).

A higher proportion of the Māori population lives in small urban areas (14.7%) and rural areas (18.0%), compared with the total population (10.0% and 16.3% respectively). Most Pacific peoples in New Zealand live in major urban areas (75.7%) or large urban areas (11.6%).

References:

Environmental Health Intelligence New Zealand. (2018). Urban–rural profile. Massey University. Available from: https://ehinz.ac.nz/indicators/population-vulnerability/urbanrural-profile/.

Statistics NZ. (2021). Subnational Population Estimates: At 30 June 2021 (provisional). New Zealand Government Website. Available from: http://archive.stats.govt.nz/browse_for_stats/population/estimates_and_projections/SubnationalPopulationEstimates_AtJun17_MR3.aspx#gsc.tab=0.

World Population Review. (n.d.). New Zealand population. World Population Review website. Available from: https://worldpopulationreview.com/countries/new-zealand-population.

Ethnicity

Statistics NZ (n.d.) defines ethnicity as a self-identified measure of cultural affiliation and is not a measure of race, ancestry, nationality, or citizenship. An individual can belong to more than one ethnic group. The 2005 New Zealand standard classification of ethnicity is a hierarchical classification of four levels. Level 1 of the classification has six categories and is used solely for output, not for collection. Apart from Māori, level 1 categories are ethnic groups, not ethnicities as such.

Ethnicity level 1 categories:

1 European
2 Māori
3 Pacific Peoples
4 Asian
5 Middle Eastern/Latin American/African (MELAA)
6 Other ethnicity
9 Residual categories.

Level 2 has 21 categories, which include the larger ethnicities within the level 1 groups – for example New Zealand European, Tongan, Indian. Level 3 has 36 categories, and level 4 has 233 categories (excluding residual categories). Individual ethnicities are aggregated into progressively broader ethnic groupings from level 3 up to level 1, according to geographical location or origin, or cultural similarities. Most government policy and research in NZ uses the level 1 ethnicity categories.

Table 3 outlines the proportion of the level 1 ethnicities in NZ from the 2018 census. The total adds up to >100% due to multiple ethnicities. Europeans make up the largest proportion of the population at 70%, followed by Māori (16.5%) and Asian (15%). Pacific people comprise 8.1% of the population and Middle Eastern/Latin American/African (MEELA) make up 1.5%.

Table 3: NZ level 1 ethnicity (2018 census)

Languages

New Zealand has three official languages – English, Māori, and NZ sign language. According to the 2018 census (Table 4), English is the most common language spoken, with 94.5% of the population able to hold a conversation about everyday things. The next most common languages spoken are Māori (4%), Samoan (2.2%), Northern Chinese (including Mandarin) (2%), and Hindi 1.5% (Pasifika Futures, 2017). NZ sign language is used by 0.5% of the population (Statics NZ, 2020).

Table 4: Five most common languages spoken in NZ from census 2018.

The most common Pacific languages spoken in NZ are Samoan, Tongan, and Cook Island Maori (table 5) (Pasifika Futures, 2017). Over a third of Pacific people can speak at least two languages (table 6), compared to 14.6% of the total population.

Table 5: Number of speakers and proportion who can speak the first language of their ethnic group, census 2013

Table 6: Number of languages spoken by ethnicity, census 2018

References:

Pasifika Futures. (2017). Pasifika People in New Zealand: how are we doing? Auckland Pasifika Futures 2017. Pasifika Futures: Prosperity for Pacific Families.

Statistics NZ. (n.d.). Ethnicity. New Zealand Government Website. Available from: https://www.stats.govt.nz/topics/ethnicity.

Statistics NZ. (2020). 2018 Census totals by topic – national highlights (updated). New Zealand Government Website. Available from: https://www.stats.govt.nz/information-releases/2018-census-totals-by-topic-national-highlights-updated.

Table 7 shows the population projections for 2028 and 2038 for the total population and the Pacific population in New Zealand. New Zealand’s population is projected to increase by almost 15% by 2028 and by 22% in 2038.

The population aged 65+ is projected to increase to 1.04 million (19.4% of the population) by 2028 and 1.3 million (22.5%) by 2038. The proportion of the population aged 65+ for Pacific populations is projected to increase at a much faster rate with an over 70% increase to over 35,000 (7.3% of the Pacific population) by 2028 and nearly tripling in the 20 years from 2018-2038 to over 54,000 (9.2%). Pacific populations will continue to have a younger age structure compared to the total population due to their higher birth rates and this is evident in the almost doubling of the 0-15 years age band in 2038 compared to a static picture for the total New Zealand population.

Table 7: Population projections for the total NZ population and Pacific population

Life expectancy at birth in NZ has steadily increased since the 1950’s with a male born in 2018 expected to live 90.3 years and a female 93 years (Statistics NZ, n.d.). At age 65 years, a male can expect to live 27.8 more years and a female 29.4 years (table 8) (Statistics NZ, 2020). The most recent data on life expectancy by ethnicity is based on the death rates in NZ for the period 2012-14. While the gap between life expectancy of Māori and Pacific compared to the total population is reducing, they are still dying at least 5 years younger than the total population average (table 9) (Statistics NZ, n.d.). This gap is evident throughout the age bands but does narrow in the oldest old to less than a year difference across the three ethnicities.

Table 8: Life expectancy by gender, at select ages, for a child born in 2018 (Statistics NZ, 2020).

Table 9: Life expectancy by age based on the death rates in NZ 2012-2014 (Statistics NZ, n.d.)

References:

Ministry of Social Development. (2016). The Social Report 2016 – Te pūrongo oranga tangata. Wellington Ministry of Social Development 2016.

Statistics NZ. (2020). New Zealand cohort life tables: March 2020 update. New Zealand Government Website. Available from: https://www.stats.govt.nz/information-releases/new-zealand-cohort-life-tables-march-2020-update.

Statistics NZ. (n.d.). Life expectancy. New Zealand Government Website. Available from: http://archive.stats.govt.nz/browse_for_stats/health/life_expectancy/NZLifeTables_HOTP12-14.aspx#gsc.tab=0.

International Migration:

Net migration into NZ for the year ended June 2019 was ~56,000 people, yielding a net migration of ~11 people per 1,000 population (Statistics NZ, 2019a). Retention rates of migrants have been increasing over time, with 89.1% of people granted residency in 2011/12 remaining in NZ after 5 years compared with 79.6% in 2001/2 (Ministry of Business Innovation and Employment, n.d.). The growth in overall migrant arrivals was driven by non-NZ citizen arrivals, with more NZ citizens leaving than arriving (Statistics NZ, 2019b).

Migrants who arrive in the country are typically younger than the general population, with over 2/3 of arrivals aged 35 years or younger. For overseas arrivals, the most common visa type was a work visa, followed by visitor then student visas (Statistics NZ, 2019b).

Internal migration: 

New Zealand residents made roughly 850,000 internal moves a year over the four years to June 2017, at a rate of ~18 moves per 100 population. Around two-thirds of these moves were within the same territorial authority (TA) area. Women were generally more mobile than men and moves peaked for the 15–39-year-olds, with declining rates to age 70+ (Statistics NZ; 2018a).

Statistics NZ (2018b) also shows the broad patterns of estimated population change due to internal migration for all Territorial Authorities in NZ for the year ended June 2017. Incidentally, most areas with the largest net gains or losses also experienced high population growth in recent years. Areas with the highest net internal migration gains in 2017 were Hamilton city, Tauranga city, and Selwyn district (Statistics NZ, 2018b).

Total fertility rate

The total fertility rate in NZ women is 61.7 per 1,000 women aged 15-44 years. Māori and Pacific women have a much higher fertility rate of 90.6 and 83.24 respectively when compared to the 50.9 per 1,000 for Europeans (table 10) (Ministry of Health, 2019). Due to the much younger median age of the Māori and Pacific population, the old age dependency ratio (population >65/ population aged 15-64 per 100 population) in these population groups is less than half that of the total population and one third that of the European population. However, while the total dependency ratio (population aged <15 and >65/population aged 15-64) for Pacific people is only two thirds that for Europeans, the ratio for Māori is slightly higher than that for Europeans (62 vs 60) as they have a much higher proportion of their population aged <15yrs.

Table 10: Median age, fertility rate, total dependency ratio, and old age dependency ratio by ethnicity (Ministry of Health 2019).

References:

Ministry of Business Innovation and Employment. (n.d.). Migration Trends report. New Zealand Government Website. Available from: https://www.mbie.govt.nz/immigration-and-tourism/immigration/migration-research-and-evaluation/migration-trends-report/.

Ministry of Health. (2019). Report on Maternity 2017. Wellington Ministry of Health 2019.

Statistics NZ. (2018a). Internal migration estimates using linked administrative data: 2014–17. New Zealand Government Website. Available from: https://www.stats.govt.nz/reports/internal-migration-estimates-using-linked-administrative-data-201417.

Statistics NZ. (2018b). Internal migration cartograms. New Zealand Government Website. Available from: https://www.stats.govt.nz/experimental/internal-migration-cartograms.

Statistics NZ. (2019a). New Zealand net migration rate remains high. New Zealand Government Website.  Available from: https://www.stats.govt.nz/news/new-zealand-net-migration-rate-remains-high.

Statistics NZ. (2019b). Net migration levels steady. New Zealand Government Website. Available from: https://www.stats.govt.nz/news/net-migration-levels-steady.

The Global Burden of Disease study (GBD) is led by the Institute for Health Metrics and Evaluation (IHME), University of Washington. The GBD estimates are informed by a wide range of data, evidence, and expertise. The study uses a large and diverse set of up-to-date data sources and robust standardised methods to provide a comprehensive and comparative assessment of health loss. It allows us to understand the ‘big picture’ of New Zealand’s health based on recent evidence, with each new cycle incorporating new evidence and insights as they become available. The most recent iteration – GBD 2019 – has just been released (IHME, 2019).

Table 11: prevalence of NCDs, Injuries and Communicable diseases in NZ

Nine of the top 10 contributors to disability are NCDs, with Cancers and cardiovascular disease account for over one third of DALYs in NZ (table 12).

Table 12

A similar picture is seen when looking at all causes of mortality in NZ, with seven of the top 10 causes of death attributable to NCDs. Cardiovascular disease accounts for over a third of all deaths, with NCDs accounting for >90% of mortality across all ages (Table 13).

Table 13: All causes of mortality in NZ

References:

IHME. (2019). Global Burden of Disease Study 2019 (GBD 2019) Data Resources. Available from: https://ghdx.healthdata.org/gbd-2019

As described in the preceding tables, communicable diseases do not confer a significant burden of disease in NZ, only accounting for ~4% of disability and mortality.

As described in the preceding tables, injuries account for 14% of DALYs and 5% of mortality. This is predominantly due to unintentional injury, with intentional self-harm/violence contributing ~2% to each of total DALYs and mortality.

New Zealand is categorised by the World Bank as a high-income country (The World Bank, 2019). Gross Domestic Product for the country as of December 2019 was NZD311 billion with an annual growth rate of 2.3%, equating to a per capita GDP of NZD62,000 (~USD37,000) (Statistics NZ, 2020).

References:

Statistics NZ. (2020). Gross domestic product: December 2019 quarter. New Zealand Government Website. Available from: https://www.stats.govt.nz/information-releases/gross-domestic-product-december-2019-quarter.

The World Bank. (2019). New Zealand. The World Bank website. Available from: https://data.worldbank.org/country/NZ.

For 2018, service industries account for about two thirds of GDP, with goods producing industries ~20% and primary industry 7%.

As of March 2020, government debt as a percentage of GDP was 19.2%. Household debt as a percentage of GDP was 94% (International Monetary Fund, n.d.) and as a percentage of disposable income was 163.4% (RBNZ, 2020). Household debt has increased significantly since the year 2000, with mortgages accounting for most of the increase (figure 14) (RBNZ, 2020).

References:

International Monetary Fund. (n.d.). New Zealand. Available from: https://www.imf.org/external/datamapper/profile/NZL/GDD.

RBNZ. (2020). Household debt. Reserve Bank of New Zealand website. Available from: https://www.rbnz.govt.nz/statistics/key-graphs/key-graph-household-debt.

Gini Coefficient

The Gini Coefficient is a measure of income inequality, with a score of 100 indicating complete inequality (one household has all the income) and a score of 0 indicating complete equality (all households have the same income). New Zealand has a Gini index of 33, sitting in the top third of most unequal countries and higher than the OECD median of 31 (Statistics NZ, n.d.). The index increased significantly in the 1990s but has plateaued since then in the low 30s (Statistics NZ, n.d.).

Gender inequality

The average gender pay gap in 2019 was 9.3% and, whilst lower than the 16.2% reported in 1998, has plateaued at this level since 2017 (Statistics NZ, 2019). However, this gap varies by occupation, from 7.1% for clerical/administrative workers to 16.7% for professionals.

These differences are further magnified when looking at Māori and Pacific populations, who earn between 15-26% less than Europeans (Table 14) as a population or when compared by gender (The Treasury, 2018). Whilst variables such as age, occupation, and highest qualification explain some of these differences they only account for ~40% of the variance, indicating at least some of the remaining variance may be due to discrimination (The Treasury, 2018).

 Table 14: Average wage by ethnicity and gender and their ratio to the European wage (The Treasury, 2018)

Regional disparities 

Table 15 details the OECD wellbeing indicators for the regions in NZ. Regional disparities in health outcomes in New Zealand are the second largest among OECD countries, with Auckland ranking in the top 20% of OECD regions and Gisborne in the bottom 20%. The low performing regions in New Zealand fare better than the OECD median region in six out of the 13 well-being indicators but fall below the OECD median in life expectancy, mortality rate, unemployment rate, homicide rate, disposable income per capita, broadband access and share of labour force with at least a secondary degree (OECD, 2019; n.d.).

Table 15: OECD wellbeing indicators for NZ regions 2018.

Regional inequality is also highlighted by the NZ index of deprivation (NZDep). NZDep is a scale of deprivation derived from variables in the census including income, employment, living conditions and qualifications. It is a scale from 1 (least deprived) to 10 (most deprived) for defined geographical areas of NZ (Atkinson et al., 2019). This means areas with a NZDep score of 10 are in the most deprived 10% areas of NZ. For example, Northland and the East Cape are highlighted as areas with high deprivation.

Māori and Pacific people are overrepresented in deciles with higher deprivation when compared those of NZ European and Asian ethnicities as highlighted when comparing Māori to non-Māori across deciles or NZDep2013 and the population distribution across deprivation scores by ethnicity.

Table 16 describes child poverty statistics in New Zealand in 2019 using 3 different measures (Statistics NZ, 2020). Regardless of which measure is used, Māori, and Pacific people are more affected when compared to Europeans. While 13.4% of children in NZ live in households experiencing material hardship, this differentially affects Māori (23.3%) and Pacific (28.6%) children when compared to Europeans (9.8%).

Table 16: Child poverty statistics for the year ended June 2019 (Statistics NZ, 2020)

References:

Atkinson, J., Salmond, C., Crampton, P. (2019). NZDep2018 Index of Deprivation. Interim Research Report, December 2019. University of Otago, Wellington. Available from: https://www.otago.ac.nz/wellington/otago730394.pdf.

Ministry of Health. (2018). Ngā awe o te hauora: Socioeconomic determinants of health. Available from: https://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-awe-o-te-hauora-socioeconomic-determinants-health/neighbourhood-deprivation.

OECD. (2019). Regions and Cities at a Glance 2018 – NEW ZEALAND. Available from: https://www.oecd.org/regional/NEW%20ZEALAND-Regions-and-Cities-2018.pdf.

OECD. (n.d.). OECD Regional Wellbeing: Auckland. Available from: https://www.oecdregionalwellbeing.org/NZ12.html.

Statistics NZ. (2019). Gender pay gap unchanged since 2017. New Zealand Government Website. Available from: https://www.stats.govt.nz/news/gender-pay-gap-unchanged-since-2017.

Statistics NZ. (2020). Child poverty statistics: Year ended June 2019. New Zealand Government Website. Available from: https://www.stats.govt.nz/information-releases/child-poverty-statistics-year-ended-june-2019.

Statistics NZ. (n.d.). Income inequality. New Zealand Government Website.

The Treasury. (2018). Statistical Analysis of Ethnic Wage Gaps in New Zealand (AP 18/03). Available from: https://treasury.govt.nz/publications/ap/ap-18-03-html#section-5.

Environmental:

The Global Facility for Disaster Reduction and Recovery (gfdrr.org) has looked at the risks posed by earthquakes, tsunamis, volcanoes, and more across the world. New Zealand is ranked high-risk for almost every possible catastrophe, except extreme heat and water scarcity (GFDRR, n.d.).

Infrastructure:

Infrastructure refers to the fixed, long-lived structures that facilitate the production of goods and services, including transport, water, energy, social assets, and digital infrastructure such as our broadband and mobile networks. Broadly speaking, New Zealand has a good national infrastructure base bolstered by the expenditure on infrastructure in recent years to address historic underinvestment.

New Zealand’s infrastructure faces a number of challenges, including the need to renew ageing infrastructure, the pressures of an aging and urbanising population, tight fiscal constraints, changing technology, the effects of climate change, and the increased pressure on our natural resources (The Treasury, 2019).

The National state of infrastructure report 2016 (The Treasury, n.d.) provides snapshots of the state of the different infrastructure aspects.

References:

Global Facility for Disaster Reduction and Recovery (GFDRR). (n.d.). New Zealand. Available from: https://www.thinkhazard.org/en/report/179-new-zealand.

The Treasury. (2019). Infrastructure. (2019). The Treasury website. Available from: https://treasury.govt.nz/information-and-services/nz-economy/infrastructure.

The Treasury. (n.d.). National State of Infrastructure Report 2016. National Infrastructure Advisory Board and the Treasury’s National Infrastructure Unit. Available from: https://treasury.govt.nz/sites/default/files/2019-10/3603102_1%202016%20State%20of%20Infrastructure%20Report.pdf.

Table 17 summarises the employment statistics for New Zealand for the March 2020 quarter. Of the 3.9 million working age population (ages 15-64), 67.5% were in employment and the unemployment rate was 4.2%. While more males were in employment than females (72.4% vs 62.6%), there was a negligible difference between males and females for unemployment (4.1 vs 4.3%). Table 19 reports employment statistics by ethnicity and shows that the unemployment rate for Māori (8.7%) and Pacific (7.9%) is over twice that of Europeans (3.5%) (Ministry of Business Innovation and Employment, 2019).

Underutilisation is a broad measure of spare capacity in the labour market and, in addition, to those who are unemployed, includes three other groups of people in the labour market:

• Underemployed individuals who have the desire or availability to increase their hours.
• Available potential job seekers (e.g., new university graduates) who want a job but are not actively seeking one.
• Unavailable job seekers which include people currently looking for a job but are not available to start quite yet.

Underutilisation was 10.4%, with a higher proportion of females (12.7%) compared with males (8.3%). Underutilisation for Māori (19%) and Pacific (17.1%) was higher than for Europeans (10.2%).

Table 17: Employment statistics for NZ in March 2020

Table 18: Employment statistics by age band, March 2020 (Statistics NZ, 2020)

Table 19: Employment statistics by ethnicity 2019 (Ministry of Business Innovation and Employment, 2019)

References:

Ministry of Business Innovation and Employment. (2019). Pacific Peoples Labour Market – June 2019 Year. Available from: https://www.mbie.govt.nz/dmsdocument/4386-pacific-peoples-labour-market-report-june-2019.

Statistics NZ. (2020). Labour market statistics: March 2020 quarter. New Zealand Government Website. Available from: https://www.stats.govt.nz/information-releases/labour-market-statistics-march-2020-quarter.

The informal economy is defined by the International Labour Organisation (ILO) as referring to all economic activities that are – in law or in practice – not covered or sufficiently covered by formal arrangements. New Zealand’s shadow economy was estimated at ~9% of GDP in 2015 and has been trending downward since 2010 (The Global Economy, n.d.).

References:

The Global Economy. (n.d.). New Zealand: Shadow economy. The Global Economy website. Available from: https://www.theglobaleconomy.com/New-Zealand/shadow_economy/.

New Zealand’s education system (Ministry of Education, n.d.) has 3 levels:

• Early childhood education — from birth to school entry age

Early Childhood Education (ECE) isn’t compulsory but 96.8% of children attend ECE. The government subsidises all children who attend ECE for up to 6 hours a day (to a maximum of 30 hours per week).

• Primary and secondary education — from 5 to 19 years of age 

Education is free between the ages of 5 and 19 at state schools (schools that are government owned and funded) if they’re a New Zealand citizen or a permanent resident. Schooling is compulsory from age 6-16. The education system for schools is made up of 13 Year levels. Primary education starts at Year 1 and goes to Year 8 (around 5-12 years of age). Secondary education goes from Year 9 to Year 13 (around 13-17 years of age).

• Further education— higher and vocational education.

Trades academies teach trades and technology programmes to students in Years 11-13 (ages 15-18). They are run through schools and other providers.

Industry training organisations (ITOs) represent particular industries (for example, agriculture, building and construction, motor trade) and offer training and qualifications for those sectors.

Institutes of technology and polytechnics teach professional and vocational education and training from introductory studies to degrees.

New Zealand has 8 state funded universities. Each university offers degrees in a large choice of subjects and has strengths in specialised professional degrees.

Literacy:

Adult literacy in New Zealand was measured in 2006 using the Adult Literacy and Life Skills survey to assess basic proficiency levels across different domains. Prose literacy is defined as the ability to read and understand continuous text such as news articles and instruction manuals. Document literacy is the ability to read and understand discontinuous texts such as maps, job applications, and timetables. Numeracy is the ability to read and process mathematical/numerical information in diverse situations. Level 3 approximates the skill level required for successful secondary school completion and is considered the “suitable mimimum level for coping with the demands of everyday life and work in a complex, advanced society” (Ministry of Social Development, 2016).

Table 20 outlines the proportion of individuals achieving level 3 proficiency or above by age and gender. The results show just over half of the population achieve level 3 in each of the 3 categories. Table 21 shows the differences between ethnicities, with the proportion of Māori and Pacific people achieving level 3 literacy in each of the domains almost half that of Europeans. Pacific people perform particularly poorly in numeracy, with only 14% achieving at a level 3 standard or above.

Table 20: Adult literacy by age and gender 2006

Table 21: adult literacy by ethnicity 2006

References:

Ministry of Education. (n.d.). Education in New Zealand. Available from: https://www.education.govt.nz/our-work/our-role-and-our-people/education-in-nz/.

Ministry of Social Development. The Social Report 2016 – Te pūrongo oranga tangata. Wellington Ministry of Social Development 2016.

Social protection schemes implemented by the government:

An excerpt from a report by the Welfare expert advisory group (Welfare Expert Advisory Group, 2019) a group established in 2018 to undertake a review of New Zealand’s social welfare system serves to summarise the origins of the system and its shortfalls.

“A social contract between the Government and its citizens was established in New Zealand legislation with the Social Security Act 1938. Government would provide financial assistance for New Zealanders unable to achieve an adequate standard of living (which remains central to the social security system), alongside other critical support such as access to health care, education, housing, and adequate employment. In return, people receiving financial support would participate in training or other activities and seek employment when appropriate. This social contract is now out of balance.

The current system is based on conditionality including sanctions and is tightly targeted, with inadequate support to meet even basic needs. The experience of using the system is unsatisfactory and damaging for too many of the highest need and poorest people. We heard overwhelmingly during our consultation that the system diminishes trust, causes anger and resentment, and contributes to toxic levels of stress. There is little evidence in support of using obligations and sanctions (as in the current system) to change behaviour, rather, there is research indicating that they compound social harm and disconnectedness” (Welfare Expert Advisory Group, 2019).

Social protection schemes implemented by the government cover a broad range of circumstances including the loss of employment or inability to work, urgent or unexpected costs, help with living expenses, raising, children or caring for someone else, and superannuation for seniors aged 65+ (Ministry of Social Development, n.d.).

The main benefits for those of working age are:

• Jobseeker Support – for people who can usually look for or prepare for work. It also includes people who can only work part-time or cannot look for work at the moment (e.g., they have a health condition, injury, or disability).
• Sole Parent Support – Sole Parent Support is for single parents, with at least one dependent child under 14 years, who can look for or prepare for part-time work.
• Supported Living Payment – Supported Living Payment is for people who have, or care for someone with, a health condition, injury or disability that severely limits their ability to work on a long-term basis.
• Other benefits include the Youth Payment and Young Parent Payment (YP/YPP), Emergency Benefit (EB), Emergency Maintenance Allowance (EMA), Jobseeker Support Student Hardship (JSSH), Widow’s Benefit Overseas (WBO), and Sole Parent Support Overseas.
• Supplementary benefits: The Accommodation Supplement is a weekly payment to assist people on low incomes with their rent, board, or the cost of owning a home.

The Disability Allowance is a weekly payment to assist people who have on-going costs because of a disability. Temporary Additional Support is a weekly payment that helps people to cover essential living costs that cannot be met from their income and through other resources.

Hardship assistance:

Hardship assistance includes but is not limited to: Special Needs Grants (SNGs), Benefit Advances (ADVs) and Recoverable Assistance Payments (RAPs). These forms of assistance are designed to help people who have immediate needs.

Seniors (65+)

NZ Superannuation and the veterans pension:

To be eligible for NZ Superannuation you need to be: 65 years or over, a New Zealand citizen or permanent resident, and living in New Zealand, the Cook Islands, Niue or Tokelau at the time you apply. You must also have lived in New Zealand (or a country New Zealand has a Social Security Agreement with) for a specific period. You don’t have to be retired from work to get NZ Superannuation as it’s not income tested.

Social protection schemes implemented by development partners or international:

The most recent statistics available from the March 2020 quarter show that 10.3% of the working age population were receiving a main benefit. Job seekers accounted for 5% of these, sole parents 2%, and supported living 3.1%, with other main benefits the remaining 0.2%. People with a health condition account for over 50% of those on a main benefit (Welfare Expert Advisory Group, 2019). There is also a trend for an increase in the number of hardship grants allocated over the same time period. Māori make up 36% of all working age people receiving a benefit as the primary recipient and over 50% of Māori children are growing up in households receiving the main benefit (Ministry of Social Development, 2016).

References:

Ministry of Social Development. (2016). The Social Report 2016 – Te pūrongo oranga tangata. Wellington Ministry of Social Development 2016.

Ministry of Social Development. (n.d.). Benefits and payments. Work and Income website. Available from: https://www.workandincome.govt.nz/eligibility/index.html.

Welfare Expert Advisory Group. (2019). Whakamana Tāngata: Restoring dignity to social security in New Zealand. Welfare Expert Advisory Group. Available from: http://www.weag.govt.nz/assets/documents/WEAG-report/aed960c3ce/WEAG-Report.pdf

New Zealand is a constitutional monarchy whose head of State is the Sovereign, Queen Elizabeth II of New Zealand. The Governor-General is the Queen’s representative in New Zealand. New Zealand’s Parliament consists of the Sovereign and the House of Representatives. New Zealand’s Parliament has only one chamber (the House of Representatives) and there is no upper house such as a senate. The House of Representatives consists of members of Parliament who are elected as the people’s representatives for a term of up to 3 years. New Zealand has no single written constitution or any form of law that is higher than laws passed in Parliament, with the rules about how government works contained in a number of Acts of Parliament.

New Zealand’s House of Representatives is elected using the mixed member proportional representation (MMP) voting system. Each elector has two votes — one for a local member of Parliament and one for a preferred political party. Political parties are represented in Parliament in proportion to the share of votes each party won in the party vote in the general election (New Zealand Parliament, 2016).

There are two tiers of government in New Zealand – Central government and Local government.

• Central government makes decisions affecting New Zealand as a whole.
• Local government looks after the interests and needs of specific communities through regional, city or district councils.

Central government:

• runs housing, welfare, education, health, justice, immigration, the police, energy, the national road, and rail systems, defense, foreign policy, and public finances,
• regulates employment, import and export, and workplace safety,
• levies personal income tax, business taxes, and GST (the goods and services tax that is added to almost all goods and services in New Zealand).

Local government bodies:

• provide local services like water, rubbish collection and disposal, sewage treatment, parks, reserves, street lighting, roads, local public transport, and libraries,
• process building and environmental consents and administer other regulatory tasks,
• levy taxes on property, which are called ‘rates’.

There are two levels of local government – regional councils and territorial authorities (district and city councils).

• Regional councils are primarily responsible for environmental resource management, flood control, air and water quality, pest control, and, in specific cases, public transport, regional parks and bulk water supply.
• Territorial authorities are responsible for a wide range of local services, including roads, water reticulation, sewerage and refuse collection, libraries, parks, recreation services, local regulations, community and economic development, and town planning.

Sometimes, city and district councils combine to create a unitary council. In November 2018, NZ had 78 councils:

• 11 regional councils
• 61 territorial authorities (50 district councils and 11 city councils)
• 6 unitary councils.

Councils must consult with their community when making decisions (Immigration New Zealand, n.d.-a; n.d.-b; New Zealand Government, 2020).

References:

Immigration New Zealand. (n.d.-a). Central Government. Ministry of Business, Innovation & Employment website. Available from: https://www.newzealandnow.govt.nz/living-in-nz/history-government/central-government.

Immigration New Zealand. (n.d.-b). Local Government. Ministry of Business, Innovation & Employment website. Available from: https://www.newzealandnow.govt.nz/living-in-nz/history-government/local-government.

New Zealand Government. (2020). How government works. New Zealand Government website. Available from: https://www.govt.nz/browse/engaging-with-government/government-in-new-zealand/.

New Zealand Parliament. (2016). Our system of government. New Zealand Parliament website. Available from: https://www.parliament.nz/en/visit-and-learn/how-parliament-works/our-system-of-government/.

In 1840, when the Treaty of Waitangi was signed, New Zealand became a colony of Britain, ruled by a governor. In 1852 New Zealand was divided into provinces, each with their own government and elected representatives. There was also a national government, with an elected House of Representatives (lower house) and a Legislative Council (upper house) whose members were appointed by the governor. The national government was responsible for things such as courts, crime, currency, and marriage law. However, the governor was still above the national government until 1856. Even after that some issues, such as relations with foreign countries or matters related to Māori, were still the responsibility of the governor and the British government.

Relations with Māori became tense between settlers who wanted more land and Māori who didn’t want to give up their land, leading to war in 1860. Because government troops were provided by the British government, the New Zealand government couldn’t take over responsibility for Māori affairs until it provided its own military. It did this from 1864, leading to more independence from Britain. From 1865 the governor became more of a figurehead, and political power was held by the national and provincial governments. In 1876 provincial governments were abolished.

In the late 1890s New Zealand showed its sense of independence by deciding not to become part of Australia. In 1907 it became the Dominion of New Zealand, a symbolic recognition of the colony’s maturity. While New Zealand fought with Britain in the First World War, it was able to make its own decisions about how to contribute to the war effort. In 1920 New Zealand became a founding member of the League of Nations, a forerunner of the United Nations. In 1948 New Zealanders became New Zealand citizens – before that they had been British citizens. New Zealand gained full legal independence when Parliament passed the Constitution Act 1986. In 2003 a new Supreme Court was created, replacing Britain’s Privy Council as New Zealand’s final court of appeal (McIntyre, 2012).

 Te tiriti o Waitangi (Te Ara – The encyclopedia of New Zealand, n.d.).

The Treaty of Waitangi, signed in 1840 between Māori and the British Crown, is not law, but since 1975 many New Zealand laws have referred to the principles of the treaty. The first law to do so was the Treaty of Waitangi Act 1975, which established the Waitangi Tribunal. The act says that Māori can bring a claim to the tribunal about a Crown policy or practice (amongst other things) which was or is ‘inconsistent with the principles of the Treaty’.

Since the 1975 act, there have been many other official references to treaty principles, all attempting to define the meaning of the Treaty of Waitangi in contemporary New Zealand society. Treaty principles have been referred to in court cases, new laws, Waitangi Tribunal findings, a 1989 government statement.

The treaty text itself is not regarded as a law because the English and Māori versions do not have exactly the same meaning and it focuses on the issues relevant at the time it was signed. Instead, the intentions and goals of the treaty are considered.

Treaty principles include:

• The treaty set up a partnership, and the partners have a duty to act reasonably and in good faith.
• The Crown has freedom to govern.
• The Crown has a duty to actively protect Māori interests.
• The Crown has a duty to remedy past breaches.
• Māori retain rangatiratanga over their resources and taonga and have all the rights and privileges of citizenship.
• The Crown has a duty to consult with Māori.
• The needs of both Māori and the wider community must be met, which will require compromise.
• The Crown cannot avoid its obligations under the treaty by conferring authority on some other body.
• The treaty can be adapted to meet new circumstances.

Pacific people in NZ

Close links with and employment opportunities in New Zealand have led to considerable migration of Pacific peoples to New Zealand. New Zealand citizenship and rights of residence have encouraged the migration of Cook Islanders, Niueans and Tokelauans. Samoans, Tongans, and Fijians are not New Zealand citizens, so migration from these countries has been more strongly affected by periodic changes in New Zealand government policy. Smaller numbers of people from other Pacific Islands have also migrated here.

Prior to the Second World War Pacific Island communities in New Zealand were very small, with the largest numbering only a few hundred. Faced with labour shortages in the post-war period, the New Zealand government encouraged Pacific migrants. Programmes brought young men over as agricultural and forestry workers, and young women as domestics. An acute labour shortage in manufacturing in the early 1970s drew many more.

The oil crisis and economic recession of the 1970s led to a reversal of aid and immigration policy. In 1974 the Kirk government clamped down on people overstaying the time allowed by their visas. Pacific Islanders attracted the most attention, with Samoans and Tongans particularly affected, and ‘dawn raids’ by police on the homes of suspected overstayers were introduced. Immigration policy continued to be tightened under the National government that won power in 1975.

Periodic amnesties allowed migrants to more easily acquire citizenship, but a stereotype developed of Pacific Islanders as troublesome, as school drop-outs or as bearers of health problems. Rates of immigration fluctuated in line with the New Zealand’s economy. The government briefly trialled visa-free status for Fijians, Samoans, and Tongans in late 1986 and early 1987, then backtracked when numbers of arrivals were greater than expected. From the later 1980s the shrinking of New Zealand’s manufacturing sector substantially reduced the number of unskilled and semi-skilled jobs available. Between 1991 and 1993 more Samoans and Tongans left New Zealand than arrived (Fraenkel, 2012).

References:

Fraenkel, J. (2012). Pacific Islands and New Zealand – Immigration and aid. Te Ara – the Encyclopedia of New Zealand. Available from: https://teara.govt.nz/en/pacific-islands-and-new-zealand/page-2.

McIntyre, W. D. (2012). Self-government and independence. Te Ara – The enclyclopedia of New Zealand. Available from: https://teara.govt.nz/en/self-government-and-independence.

Te Ara – The encyclopedia of New Zealand. (n.d.). Te tiriti, the treaty. Available from: https://teara.govt.nz/en/te-tiriti-the-treaty.

Elections are held every 3 years with the next election due in October 2020.

New Zealand was ranked first equal with Denmark in 2019 with a score of 87/100 (Transparency International New Zealand, n.d.).

References:

Transparency International New Zealand. (n.d.). Corruption perceptions index. Transparency International website. Available from: https://www.transparency.org.nz/corruption-perceptions-index/.

New Zealand is considered a stable country, scoring in the 93^rd percentile for government effectiveness and above the 98^th percentile for all other measures (Table 22) (World Bank, n.d.).

Table 22: NZ world Bank political stability indicators, 2018 (World Bank, n.d.)

References:

World Bank. (n.d.). Worldwide governance indicators. The World Bank website. Available from: https://info.worldbank.org/governance/wgi/Home/Reports.

New Zealand has a universal health care system that covers 100% of citizens and all eligible residents. Government funding of health and disability services means that eligible people receive free inpatient and outpatient public hospital services, subsidies on prescription items, and a range of support services for people with disabilities in the community. The responsiveness of the health care system to patient needs compares well internationally as expressed by waiting times for health care appointments and the involvement of patients in care and treatment, with 59% able to see a specialist in <4 weeks and 72% able to see a doctor or nurse the same day or the next day when needed (OECD, 2015). Anyone who has an accident or injury, including visitors, is usually covered by the government personal injury scheme, ACC. This helps to pay for the treatment and rehabilitation costs incurred by the accident.

OECD data (OECD, 2019) report that the spending on health care has doubled in the last 20 years, increasing from NZD1810 per person or 7.47% of GDP in 2000, to NZD4728 or 9.34% of GDP in 2018 (Table 23) (OECD, 2019). The Government spending on healthcare is ~80% of total health expenditure, with the remaining 20% accounted for by private insurance (~7%) and out of pocket expenses (~13%).

Table 23: Total health care spending per capita and as a proportion of GDP for select years 2000-2018 (OECD, 2019)

All people are encouraged to enrol with a general practitioner (GP), and they are expected to visit them in the first instance if they are sick and it’s not an emergency. It is free to enrol with a GP practice and the government subsidises the fee for enrolled patients. General practices are private businesses and set their own fees for consultations and other health services. While the fees charged must be within a certain threshold agreed to by district health boards (DHBs) and PHOs, the level of co-payment is determined by the practices. The cost of a visit will be lower if you’re enrolled with the practice because the Government subsidises the fee for enrolled patients. Some general practices join a Very Low-Cost Access (VLCA) programme run by their primary health organisation (PHO). This means they get extra Government funding to keep their fees at low levels for all enrolled patients. Most general practices offer zero fee visits for children aged 13 and under, and most non-VLCA practices offer cheaper visits for Community Services Card holders and their dependants (Ministry of Health, 2019). Hospital and specialist services are free.

References:

Ministry of Health. (2019). Visiting a doctor or nurse. Available from: https://www.health.govt.nz/your-health/services-and-support/health-care-services/visiting-doctor-or-nurse.

OECD. (2015). Government at a Glance 2015: New Zealand. Available from: https://www.oecd.org/gov/New-Zealand.pdf.

OECD. (2019). Health at a Glance. OECD iLibrary. Available from: https://www.oecd-ilibrary.org/docserver/4dd50c09-en.pdf?expires=1590900931&id=id&accname=guest&checksum=BCC881772EE98968D2EB1E3A0E0684C2.

Because of universal health coverage for accidents and acute care, private insurance uptake in NZ is low and accounts for 5-7% of health care costs a year (Ministry of Health, 2016; OECD, 2019). However, if a condition is a non-emergency condition, in the public system, people usually need to go through an assessment process and qualify for ‘elective’ treatment. Common elective treatments include hip or knee replacement, heart surgery, cataract removal, and diagnostic services such as endoscopy, laparoscopy, MRI scans, tonsillectomy, and grommets. Private health insurance helps with the cost of many non-urgent procedures and provides faster access to private hospitals for the treatment.

About one third of adults (35%) and 28% of children were covered by private health insurance in 2015 (Ministry of Health, 2016) with Māori and Pacific people less likely to report having private insurance. Most private health insurance (~80%) is paid for by the individual or a family member.

References:

Ministry of Health. (2016). Private Health Insurance Coverage 2011–15: New Zealand Health Survey. Ministry of Health website. Available from: https://www.health.govt.nz/publication/private-health-insurance-coverage-2011-15-new-zealand-health-survey.

OECD. (2019). Health at a Glance. OECD iLibrary. Available from: https://www.oecd-ilibrary.org/docserver/4dd50c09-en.pdf?expires=1590900931&id=id&accname=guest&checksum=BCC881772EE98968D2EB1E3A0E0684C2.

As described above under 02.01.01 and 02.01.02.

For non-emergencies, primary care is the first contact for most New Zealanders when they need health care assistance and are referred to secondary/tertiary care services as required. The exception is those who attend an emergency department directly and are referred on to hospital specialist services.

While access to health services is universal, there is clear evidence of barriers to access differentially affecting certain populations. The Health Quality & Safety Commission (HQSC) has developed the Atlas of Healthcare Variation which shows the variation in healthcare received by different geographical regions and population groups based on a survey of 79,000 people (Health Quality and Safety Commission NZ, 2021). The key findings relating to health service access included difficulties with cost, access, and the quality/type of care received:

• 15% of all respondents reporting a time when they wanted health care from a GP or nurse but couldn’t get it. More women (18%) than men (11%) reported this difficulty and there was a clear age gradient, and there was a clear age gradient with 23% of respondents aged 15-44 years having difficulty compared with <10% of those aged 65+. There was also a difference between regions, ranging from 8-27%.
• 17% reported not accessing healthcare in the last year because of cost, including the cost of the appointment, cost of taking time off work, and transport cost. Cost as a barrier was higher for younger patients and for Māori and Pacific (Table 24). Transport costs were higher for Māori and Pacific people (19%) compared to others (8%) and 29% of those aged <65 years compared with 5% aged 65+ reported the cost of taking time off work as a barrier.
• 8% of respondents reported not picking up a medication prescription because of cost, again much higher in Māori and Pacific people compared to other ethnicities (Table 25).

The Pacific population is experiencing unmet health needs and variations in the quality of health care. The three major barriers for Pacific are cost, transport, and language. Other barriers include family commitments, difficulty in meeting appointment times, difficulty in understanding the nature and necessity of an appointment, lack of access to after hour services, communication barriers, inflexible employment, and feeling cultural discomfort when discussing health issues with non-Pacific practitioners. Additionally, structural problems include long waiting times, lack of discussion time with doctor, crowded clinics, and the bringing and minding of children (Ministry of Health, 2019).

Table 24: Proportion of respondents reporting cost as a barrier to picking up a prescription by age and ethnicity (Health Quality & Safety Commission NZ, 2021)

Table 25: Cost as a barrier to healthcare access by Age and Ethnicity (Health Quality & Safety Commission NZ, 2021)

References:

Health Quality & Safety Commission NZ. (2021). Health Service Access. Health Quality and Safety Commission website. Available from: https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/atlas-of-healthcare-variation/health-service-access/.

Ministry of Health. (2019). Visiting a doctor or nurse. Available from: https://www.health.govt.nz/your-health/services-and-support/health-care-services/visiting-doctor-or-nurse.

Public funding

New Zealand’s health and disability system is mainly funded from general taxation. The health system’s funding comes mainly from Vote Health, which totalled just over $20 billion in the 2020 budget. Other significant funding sources include the Accident Compensation Corporation (ACC), other government agencies, local government, and private sources such as insurance and out-of-pocket payments. The Ministry of Health allocates more than three-quarters of the public funds and it manages through Vote Health to DHBs, which use this funding to plan, purchase and provide health services, including public hospitals and most public health services, within their areas.

Most of the remaining public funding provided to the Ministry (approximately 19 percent) is used to fund important national services, such as disability support services, public health services, specific screening programmes, mental health services, elective services, Well Child and primary maternity services, Māori health services and postgraduate clinical education and training. About 1 percent of Vote Health funding is spent on running the Ministry, which supports, oversees, governs, and develops the wider health and disability sector (Ministry of Health, 2016).

Private funding

As outlined previously, private health insurance and household out of pocket expenses account for ~20% of the total healthcare spend for New Zealand with ~80% of private health insurance costs covered by the individual or their family member.

References:

Ministry of Health. (2016). Funding. Ministry of Health website. Available from: https://www.health.govt.nz/new-zealand-health-system/overview-health-system/funding.

Most health services are publicly funded for eligible individuals. Government funding of health and disability services means that eligible people may receive free inpatient and outpatient public hospital services, subsidies on prescription items and a range of support services for people with disabilities in the community.

The Government recommends that people who are not eligible for publicly funded services, or those who only have cover under the Reciprocal health agreements with Australia and the United Kingdom, also have health insurance, because the reciprocal agreements only cover immediate and necessary treatment on the same basis as New Zealanders. Visits to a general practitioner, non-urgent or discretionary services, rehabilitation, and repatriation are not funded within the reciprocal agreement (New Zealand Government, n.d.). As noted previously, about one third of the population has private health insurance. There is no data on how many non-eligible residents do not have health insurance.

References:

New Zealand Government. (n.d.). Getting publicly funded health services. New Zealand Government website. Available from: https://www.govt.nz/browse/health/public-health-services/getting-publicly-funded-health-services/.

As previously outlined, out-of-pocket expenditure on health accounts for ~13% of New Zealand’s total health care expenditure, estimated at NZD738 per capita and equates to 1.8% of final household consumption costs (OECD, 2015).

While NZ has universal health coverage as outlined previously, cost is a significant barrier to healthcare access for many individuals in NZ, with 20% of people not visiting a GP or nurse and 9% not filling a prescription because of the cost. This is further magnified by ethnicity, as even when controlling for social deprivation, Māori were more likely to report unmet need due to cost (Health Quality & Safety Commission, 2019).

References:

Health Quality & Safety Commission. (2019). A window on the quality of Aotearoa New Zealand’s health care. Wellington Health Quality & Safety Commission.

OECD. (2015). Government at a Glance 2015: New Zealand. Available from: https://www.oecd.org/gov/New-Zealand.pdf.

No.

The government of the day decides on funding for health care in their yearly budget cycle, which is then administered by the Ministry of Health (Ministry of Health, 2019).

References:

Ministry of Health. (2019). What we do. Ministry of Health website. Available from: https://www.health.govt.nz/about-ministry/what-we-do.

As above.

The Ministry leads the health and disability system and has overall responsibility for the management and development of that system (Ministry of Health, 2019). It steers improvements that help New Zealanders live longer, healthier, and more independent lives. The Ministry ensures that the health and disability system is delivering on the Government’s priorities, and that health sector organisations are well governed and soundly managed from a financial perspective. To do this, the Ministry:

• advises the government;
• funds, monitors, and drives the performance improvements of health sector Crown entities, including district health boards (DHBs);
• supports the planning and accountability functions of health sector Crown entities, including DHBs;
• regulates the sector and ensures legislative requirements are being met.

References:

Ministry of Health. (2019). What we do. Ministry of Health website. Available from: https://www.health.govt.nz/about-ministry/what-we-do.

About three-quarters of Vote Health (~16 billion) goes to fund the 20 District Health Boards (DHBs). DHBs use this funding to plan, purchase, and provide health services for the population of their district, to ensure effective and efficient services for all of New Zealand. DHBs oversee funding for all levels of care, including primary care such as general practitioners (GPs), nurses, pharmacists, and community health services. They also oversee funding for hospital services, aged care services and services provided by non-government health providers, including Māori and Pacific providers.

The next largest proportion of funding is for health and disability services that are funded at a national level and managed by the Ministry. Other big-ticket items include capital expenditure and funding for the support, oversight, governance, and development of the health and disability sectors, including the Ministry’s operating costs.

New Zealand’s health and disability system also includes private non-governmental providers, and professional and regulatory bodies for all health professionals, including medical and surgical specialties, nurses, and allied health groups. In recent years, the Ministry has been working increasingly with other government social sector agencies to improve health and social sector outcomes (Ministry of Health, 2019).

References:

Ministry of Health. (2019). What we do. Ministry of Health website. Available from: https://www.health.govt.nz/about-ministry/what-we-do.

As above.

More than one-third of adults (35%) and 28% of children were covered by PHI. PHI coverage was highest for the age groups between 35 and 64 years (35–44 years, 41%; 45–54 years, 42%; 55–64 years, 41%) and lowest for those aged 75 years and over (16%). Māori and Pacific people were less likely to report having PHI cover than non-Māori and non-Pacific people, respectively, after adjusting for age and sex differences. After examining a range of demographic and socioeconomic factors, household income was found to have the strongest association with PHI coverage. There was variation in PHI coverage for adults between district health boards (DHBs), with highest coverage in Auckland (45%), Waitemata (43%), and Canterbury (40%). The proportion of adults with PHI coverage has decreased from 40% in 1996/97 to 35% in 2011–15. For children, coverage has decreased from 31% in 1996/97 to 28% in 2012–15. Most adults (79%) with PHI cover report that they either pay for the PHI themselves or it is paid by a family member (Ministry of Health, 2016).

References:

Ministry of Health. (2016). Private Health Insurance Coverage 2011–15: New Zealand Health Survey. Ministry of Health website. Available from: https://www.health.govt.nz/publication/private-health-insurance-coverage-2011-15-new-zealand-health-survey.

The Reserve Bank of New Zealand is the prudential regulator and supervisor of all insurers carrying on insurance business in New Zealand and is responsible for administering the Insurance (Prudential Supervision) Act 2010 (RBNZ, 2020).

References:

RBNZ. (2020). Household debt. Reserve Bank of New Zealand website. Available from: https://www.rbnz.govt.nz/statistics/key-graphs/key-graph-household-debt.

Statistics NZ estimates that 53.2% of households incur in health related expenses, with 36% of households incurring in costs related to outpatient health services (Statistics NZ, n.d.).

References:

Statistics NZ. (n.d.). Household expenditure. Stats NZ website. Available from: http://nzdotstat.stats.govt.nz/wbos/Index.aspx?_ga=2.259203594.168960312.1597910624-1262864191.1590712808&_gac=1.211378849.1597910681.EAIaIQobChMIs7GTiamp6wIVlg4rCh0IHggFEAAYASAAEgKNY_D_BwE#.

No.

No.

The most recent Medical Council of New Zealand (MCNZ) statistics from 2018 (Table 26) (Medical Council of New Zealand, 2018) showed that NZ had 333 doctors per 100,000 people. There is a reliance on international medical graduates (IMG) who account for 40% of the medical workforce. Available data report 33 neurologists in the public sector in 2015 (Ranta et al., 2015) and 72 Geriatricians in 2012 (New Zealand Parliament, n.d.). The proportion of medical doctors of Māori and Pacific ethnicity remains low relative to the proportion of these ethnicities in the NZ population (table 27) (Medical Council of New Zealand, 2018).

Doctors: 

Table 26: Number of medical doctors, neurologists, and geriatricians in NZ

Table 27: proportion of medical doctors by ethnicity and relative to the total population

Nurses:

Nursing council workforce statistics for 2018/19 counted over 50,000 registered nurses, equating to ~1,000 nurses per 100,000 population (Table 28) (Nursing Council of New Zealand, n.d.). This compares with 1160 per 100,000 in Australia, 990 per 100,000 in Canada, and 790 per 100,000 in the UK based on the most recent OECD data. Registered nurses practice independently and in collaboration with other health professionals, perform general nursing functions, and delegate to and direct enrolled nurses, health care assistants and others. Nurse practitioners have advanced education, clinical training and the demonstrated competence and legal authority to practice beyond the level of a registered nurse. Enrolled nurses practice under the direction and delegation of a registered nurse or nurse practitioner to deliver nursing care and health education across the life span to health consumers in community, residential or hospital settings.

As with the medical workforce, Māori (7.6%) and Pacific people (4%) are underrepresented when compared against their proportions of the total NZ population (table 29) (Nursing Council of New Zealand, n.d.).

Table 28: NZ nursing workforce (Nursing Council of New Zealand, n.d.)

Table 29: proportion of registered nurses by ethnicity (Nursing Council of New Zealand, n.d.)

Social workers:

New Zealand has 8,742 social workers registered in NZ as of August 2020 (Social Workers Registration Board website).

References:

Medical Council of New Zealand. (2018). The New Zealand Medical Workforce in 2018. Wellington Medical Council of New Zealand. Available from: https://www.mcnz.org.nz/assets/Publications/Workforce-Survey/434ee633ba/Workforce-Survey-Report-2018.pdf

New Zealand Parliament. (n.d.). Indicator 34: Specially trained physicians. Available from: https://oag.parliament.nz/2013/ageing/our-ageing-population-indicators/indicator-34.

Nursing Council of New Zealand. (n.d.). Tatauranga Ohu Mahi, Workforce Statistics. Available from: https://www.nursingcouncil.org.nz/Public/Publications/Workforce_Statistics/NCNZ/publications-section/Workforce_statistics.aspx?hkey=3f3f39c4-c909-4d1d-b87f-e6270b531145.

Ranta, A., Tiwari, P., Mottershead, J., Abernethy, D., Simpson, M., Brickell, K., et al. (2015). New Zealand’s neurologist workforce: a pragmatic analysis of demand, supply, and future projections. NZ Med J. 128(1419):35-44. Available from: https://pubmed.ncbi.nlm.nih.gov/26365844/.

Social Workers Registration Board website. Available from: https://swrb.govt.nz/.

Geographical maldistribution of the medical workforce is a major challenge, particularly for primary care and rural and provincial hospitals, which can struggle to recruit and retain the medical specialists they need (Medical Council of New Zealand, 2018). The distribution of the workforce between specialties is also challenging, with general practice, cardiothoracic surgery, clinical genetics, dermatology, palliative care, orthopaedic surgery, and psychiatry facing shortages (Health Workforce New Zealand, 2016).

The 2015 Health of the Health Workforce report released by Health Workforce NZ in 2016 outlines similar concerns to those of the medical workforce for the nursing, midwifery, allied health professions, and kaiāwhina (non-regulated health workers) (Health Workforce New Zealand, 2016).

References:

Health Workforce New Zealand. (2016). Health of the Health Workforce 2015: A Report by Health Workforce New Zealand. Wellington Ministry of Health. Available from: https://www.health.govt.nz/system/files/documents/publications/health-of-health-workforce-2015-feb16_0.pdf.

Medical Council of New Zealand. (2018). The New Zealand Medical Workforce in 2018. Wellington Medical Council of New Zealand. Available from: https://www.mcnz.org.nz/assets/Publications/Workforce-Survey/434ee633ba/Workforce-Survey-Report-2018.pdf

There were 14,475 practising internationally qualified nurses on the Register on the 31^st of March 2019: 104 Nurse Practitioners, 14,180 Registered Nurses, and 191 Enrolled Nurses. This represents 27% of the overall practising nurse workforce, 28% of Nurse Practitioners, 27% of Registered Nurses, and 8% of Enrolled Nurses (Nursing Council of New Zealand, n.d.).

MCNZ registration data indicate that the proportion of IMGs in the workforce as of 30 June 2017, was 42.6 percent. Although some IMGs only come to New Zealand for short periods, many are relocating permanently (Medical Council of New Zealand, 2018). The distribution of hospital doctors and GPs throughout the country is largely consistent with the NZ population spread. However, regions that are harder to staff tend to have a higher proportion of IMGs.

References:

Medical Council of New Zealand. (2018). The New Zealand Medical Workforce in 2018. Wellington Medical Council of New Zealand. Available from: https://www.mcnz.org.nz/assets/Publications/Workforce-Survey/434ee633ba/Workforce-Survey-Report-2018.pdf

Nursing Council of New Zealand. (n.d.). Tatauranga Ohu Mahi, Workforce Statistics. Available from: https://www.nursingcouncil.org.nz/Public/Publications/Workforce_Statistics/NCNZ/publications-section/Workforce_statistics.aspx?hkey=3f3f39c4-c909-4d1d-b87f-e6270b531145.

New Zealand has a public long term care system, coordinated by the Needs Assessment Service Coordination (NASC) agency, which is contracted by the MoH Disability Support Services unit to allocate ministry funded disability support services and to provide assistance with access to other supports (NASC, n.d.). This is a universal service available to all NZ citizens or residents who qualify for publicly funded health services.

Every person who wishes to receive funded disability support services must have a needs assessment to assess their requirements and this is prioritised based on need. The NASC role is to work with individuals and their families to identify their support needs, outline what services are available, and determine their eligibility for publicly funded support services. Any help received from existing supports such as other family members is taken into account during the assessment. Some services such as household support are means tested, but others including “personal cares” (e.g., assistance with showering, dressing, medications) are not.

References:

Ministry of Health. (2011). Needs Assessment and Support Services for Older People: What you need to know. Available from: https://www.health.govt.nz/system/files/documents/publications/support-services-older-plev2.pdf.

Needs assessment Service Coordination (NASC). (n.d.). Needs assessment Service Coordination services (website). Available from: https://www.health.govt.nz/your-health/services-and-support/disability-services/getting-support-disability/needs-assessment-and-service-coordination-services

Long-term care may be provided in an institutional setting or at home and may be formal, informal, or a combination of these. Much long-term care is provided informally by family members. The Government’s role may involve direct delivery of care services, the provision of respite services and carer support, or financial assistance.

Aged residential care

Aged residential care facilities are mostly owned by private firms and non-profit organisations. Providers operate within a fixed-price environment, with different fees for different levels of care, rest-home care being the lowest level. A resident’s contribution towards the cost of their care is capped at a maximum amount (unless they choose to purchase additional services). The maximum amount is based on the fixed price of rest home level care, regardless of the amount of care required. This covers a range of services, including accommodation and assistance with activities of daily living, food, laundry, nursing care, GP visits, and prescribed medication and healthcare. It does not cover spectacles, hearing aids, dental care, unfunded medical treatments, or personal items such as toiletries. Residents with assets over a threshold pay the cost of their care, up to the maximum amount. Their DHB pays for the additional cost of dementia, hospital, or psycho-geriatric care. Residents with assets below the threshold qualify for the residential care subsidy. People who fail the asset test because they own their own home may qualify for an interest-free Residential Care Loan. The loan is repayable when the home is sold or 12 months after the person’s death, whichever is earlier.

Home based support services:

Home-based support services for older people fall into two main categories: household management support, which provides help with activities such as housework and shopping, and personal care, which covers care needs, including assistance with showering and dressing. A person wishing to receive home-based support services funded by a DHB must first have their needs assessed by NASC. Personal care services are provided free regardless of a person’s financial position, while household management support is means tested and generally limited to people on low incomes holding a Community Services Card.

Disability Support Services

Disability Support Services for most people aged under 65 and their families, are centrally funded by the Ministry of Health. Services include home-based support, residential care, supports for carers in the home, and respite services. Provision of services is subject to a needs assessment carried out by NASC. Income and asset testing does not apply.

Long term care following injury

Long-term care needs resulting from accidents are dealt with by ACC through its National Serious Injury Service (NSIS).

Other support services:

Respite care services may be allocated as part of the service co-ordination process following a needs assessment and can take the form of residential respite in an aged care setting, or authorisation of a certain number of days of Carer Support Subsidy, or day care, including dementia day care. Where Carer Support Subsidy allocations are made, the older person requiring care, or the informal carer, makes their own arrangements for respite either in-home or in a residential care setting.

The Carer Support Subsidy is funded by a DHB to provide subsidised funding to assist informal (unpaid full-time) carers to take a break from their caregiving role. The Carer Support Subsidy contributes toward the cost of alternative care (e.g., in-home care, residential respite care, day care) for the client, for a specific number of days per year based on the assessed need (Ministry of Health, 2011; The Treasury, 2013; Ministry of Health, 2019).

All NASC assessments are carried out using the interRAI – a suite of clinical assessment instruments designed to comprehensively assess individuals’ abilities and functioning (Ministry of Health, 2018). For the 2019/2020 year, 13% females and 8% of males aged 65+ had at least one interRAI assessment completed. The median age for home care assessments was 83yrs and for long term care facilities (LTCF) was 85yrs. Those aged 85+ years accounted for almost half (47.5%) of all interRAI assessments.

Table 32 shows the proportion of the different types of interRAI assessments carried out and table 33 displays the proportion of each type by ethnicity. While the number of Māori and Pacific people getting any interRAI assessment approximates their proportion of the 65+ population, they are slightly over-represented in home-care assessments and under-represented in LTCF assessments (Table 32) (interRAI, n.d.).

Table 32: Proportion of interRAI assessments by type (interRAI, n.d.)

Table 33: Proportion of interRAI assessments by type and ethnicity (with proportion of 65+ population as a reference (Ministry of Health, 2018)

Long term care costs in NZ were estimated by Treasury in 2013 to be ~1.5% of GDP and accounted for ~18% of the health spend for the country (The Treasury, 2013). This expenditure is projected to rise as the population ages to 2.3% of GDP and 21% of health expenditure in the next 30 years.

References:

interRAI. (n.d.). Data visualisation. interRAI New Zealand website. Available from: https://www.interrai.co.nz/data-and-reporting/.

Ministry of Health. (2011). Needs Assessment and Support Services for Older People: What you need to know. Wellington Ministry of Health.

Ministry of Health. (2018). interRAI. Minstry of Health website. Available from: https://www.health.govt.nz/our-work/life-stages/health-older-people/needs-assessment/interrai#:~:text=interRAI%20is%20a%20suite%20of,and%20in%20aged%20residential%20care.

Ministry of Health. (2019). Long-term Residential Care for Older People: What you need to know (revised 2019). Wellington Ministry of Health.

The Treasury. (2013). Long term care and fiscal sustainability. New Zealand Treasury. Available from: https://treasury.govt.nz/sites/default/files/2013-07/ltfs-13-bg-lcfs.pdf.

As above.

As above.

Long-term care in New Zealand is currently funded on a pay-as-you-go basis by government, alongside (or instead of) out-of-pocket payments by individuals (The Treasury, 2013).

 References:

The Treasury. (2013). Long term care and fiscal sustainability. New Zealand Treasury. Available from: https://treasury.govt.nz/sites/default/files/2013-07/ltfs-13-bg-lcfs.pdf.

As above, long term care is funded on a pay-as-you-go basis by government and is based on the priorities and thresholds for access to services determined by NASC agencies on behalf of the Ministry of Health.

As above.

Priorities for funding are set by the Healthy Ageing Strategy (Ministry of Social Development, 2009).

References:

Ministry of Social Development. (2009). Healthy Ageing Strategy. Available from: https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/corporate/annual-report/2008-09/older-people.html.

LTC budgets are allocated to each of the 20 District Health Boards (DHBs) who then allocate funding to the different services (Ministry of Health, 2016). DHB funding in turn is calculated on a population-based funding formula (PBFF) which assigns a higher weighting to people with higher health needs, Māori and Pacific people, and people who are financially less well off (The Treasury, 2017).

 References:

Ministry of Health. (2016). DHB spending on services for older people. Ministry of Health website. Available from: https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/older-peoples-health-data-and-stats/dhb-spending-services-older-people.

Social Workers Registration Board website. Available from: https://swrb.govt.nz/.

The Treasury. (2017). District Health Board Financial Performance to 2016 and 2017 Plans. Available from: https://treasury.govt.nz/sites/default/files/2017-05/dhb-performance-feb17.pdf.

As above.

Yes – as above.

No (Claire et al., 2012).

References:

Claire Dale, M., St. John, S., Hanna, J. (2012). New Zealand’s long-term care arrangements, and a cross-country comparison. The University of Auckland Business School.

The main out-of-pocket cost for LTC is by those who exceed the income and asset threshold to receive the residential care subsidy. Approximately 36% of total expenditure on residential aged care is paid for by the individual’s own state pension or other savings and income (Claire et al., 2012). DHBs contribute ~$1.1 billion on aged residential care alone, with residents contributing an additional $800 million (excluding extra charges) (NZACA, 2020).

References:

Claire Dale, M., St. John, S., Hanna, J. (2012). New Zealand’s long-term care arrangements, and a cross-country comparison. The University of Auckland Business School.

NZACA. (2020). Aged Residential Care Industry Profile 2019/20. NZACA.

No.

No.

Table 34 (OECD, 2018) outlines the number of nurses and carers involved in LTC in NZ for 2018 based on OECD data. This shows there were 36,450 FTE covered by ~50,000 LTC workers across both in home and institutional care at a ratio of ~5 FTE per 100 population aged 65+. While there is no available data on FTE by worker type, the FTE headcount ratio of combined nurses/carers suggests that the FTE for nurses and carers by workplace is ~70-75% of the headcount.

Table 34: OECD data for LTC nurses and Carers in NZ (OECD, 2018)

References:

OECD. (2018). Long term care resources and utilisation. OECD.Stat website. Available from: https://stats.oecd.org/index.aspx?DataSetCode=HEALTH_LTCR.

Registered and enrolled nurses working in LTC are trained at accredited institutions that meet the requirements for registration with the Nursing council of New Zealand.

Industry Training Organisations (ITOs) are part of a formal system for increasing and developing skills in the workplace. ITOs arrange training and set qualification standards, and work with the industry to determine skill development needs. Health and safety training is included within ITO training programmes. Careerforce is the ITO for New Zealand’s health and community support services, including aged care (Careerforce, n.d.-a). Private training establishments (PTEs) also provide training for aged care work, from entry level up to post-graduate level. PTEs must be registered with the NZ Qualifications authority and meet national standards (Immigration NZ, n.d.).

The standard qualification required for work in aged care is the NZ certificate in Health and Wellbeing (Tertiary Education Commission, n.d.) which provides the skills and knowledge required to provide person-centred support in the health sector. Level 2 provides entry level skills and knowledge required to work in the health sector. Levels 3 and 4 build on this base knowledge to facilitate working effectively in the community and with increasingly complex patients (such as those with dementia or requiring palliative care) (Careerforce, n.d.-b).

Key findings from an analysis of the 2019 annual care and support worker data collected from providers by the Ministry of Health (2020) indicate about one third (36%) of aged residential care staff have no qualifications compared with only 17% of those in the community.

References:

Careerforce. (n.d.-a). Working in the Aged Care Sector. Careerforce website. Available from: https://www.careerforce.org.nz/our_sectors/aged-care/.

Careerforce. (n.d.-b). Qualifications. Careerforce website. Available from: https://www.careerforce.org.nz/qualifications/#C4.

Immigration New Zealand. (n.d.). Working in aged care. New Zealand Immigration website. Available from: https://www.newzealandnow.govt.nz/resources/working-in-aged-care

Ministry of Health. (2020). Care and Support Workforce Qualification Attainment. Wellington: Ministry of Health.

Tertiary Education Commission. (n.d.). Qualifications. Careers.govt.nz website. Available from: https://www.careers.govt.nz/qualifications/view/2470/8144.

New Zealand law requires nurses, physiotherapists, and occupational therapists to be registered with a professional body or council in New Zealand before they can work in those roles in New Zealand.

The Ministry of Health administers the Health and Disability Services (Safety) Act 2001. This Act requires providers of health services to be certified against the relevant Standards. The relevant standards are the Health and Disability Services Standards (NZS8134:2008) (Ministry of Health n.d.) and consist of 4 overarching standards that provide the foundation for quality of services and set out the rights for consumers, and ensure all providers are clear about their obligations and responsibilities.

Staffing in aged care is guided by the NZ standard indicators for safe aged care and dementia care for consumers (SHNZ HB 8163:2005). However, these guidelines are from 2005, with a 2019 report by the NZ Nurses Organisation (NZNO) and E tū Union into aged care staffing “In safe hands? How poor staffing levels and rationed care are harming aged care residents and staff” outlining how they are no longer fit for purpose (New Zealand Nurses Association, Etū, n.d.). Critiques include:

• Residents entering care much later in life which often means their needs are more complex
• Adherence to the standards is voluntary
• Residential care homes allocating staff based on revenue
• The 1:5 staff to resident ratio in 2012 is now closer to 1:10 in many facilities despite the increased complexity of resident needs.

 References:

Ministry of Health. (n.d.). Services Standard. Available from: https://www.health.govt.nz/our-work/regulation-health-and-disability-system/certification-health-care-services/services-standards.

New Zealand Nurses Association, Etū. (n.d.). In safe hands? How poor staffing levels and rationed care are harming aged care residents and staff. New Zealand Nurses Association.

The Aged Residential Care Industry Profile 2019/20 by the NZ Aged Care Association (NZACA) reported an annual care staff turnover of ~25%, ranging from 33% of registered nurses to 17% of enrolled nurses and 23% of carers (NZACA, 2020). Reported vacancies were 7.5% for registered nurses and 3.2% for caregivers. Home support worker annual turnover is estimated at 30% (Etū, n.d.).

References:

Etū. (n.d.). Let’s bring this home. Available from: https://www.etu.nz/wp-content/uploads/2019/09/Lets-bring-this-home-Home-Support-September-2019.pdf.

NZACA. (2020). Aged Residential Care Industry Profile 2019/20. NZACA.

The LTC system in NZ relies heavily on migrant workers for caregiving roles.

In 2017, the Care and Support Workers (Pay Equity) settlement was agreed between the government and relevant unions following a successful argument in court that caregiver’s pay is less than would be paid to a male with the same skill set in a different occupation, because caregivers are predominantly female (Ministry of Social Development, 2018).

The 2019 report into aged care staffing by the NZNO and E tū Union (New Zealand Nurses Association, Etū, n.d.) outlines significant concerns about working conditions in the ARC sector particularly around unsafe staffing levels and the need to ration care because of this.

Similarly, home support workers face difficulties with their working conditions including:

• Turnover of workers is still 30%.
• For many support workers, guaranteed hours have been reduced.
• Many new workers are employed on minimal permanent hours.
• Support workers are subsidising their job by not being reimbursed properly for travel time and costs and being requested to provide tools for the job, including their own phone for employers’ use.
• Many clients’ care times have been slashed – for some clients, what was 30 minutes of care has been reduced to only 15 minutes. We have seen rostered times for medication reduced to just seven minutes.
• Support workers are often not rostered for travel time nor rest breaks, being told to take rest breaks from clients’ care time. Some eat their meals while driving between clients (Etū, n.d.).

 References:

Etū. (n.d.). Let’s bring this home. Available from: https://www.etu.nz/wp-content/uploads/2019/09/Lets-bring-this-home-Home-Support-September-2019.pdf.

Ministry of Social Development. (2018). Care and Support Workers (Pay Equity) Settlement Agreement Factsheet. Available from: https://www.msd.govt.nz/documents/what-we-can-do/providers/factsheet-pay-equity.pdf.

New Zealand Nurses Association, Etū. (n.d.). In safe hands? How poor staffing levels and rationed care are harming aged care residents and staff. New Zealand Nurses Association.

There is no central body for volunteering in LTC but many organisations such as Age Concern NZ, a charitable organisation dedicated to people over the age of 65, provide services such as their Accredited Visiting Service (AVS) – a befriending service that provides regular visits to older people who would like more company (Age Concern, n.d.). Many residential care facilities also run their own volunteering programs, with people from the community giving time to provide company, transport, and activities.

References:

Age Concern. (n.d.). Loneliness Research. Age Concern New Zealand website. Available from: https://www.ageconcern.org.nz/Public/Info/Research/Loneliness_and_Social_Isolation_Research.aspx.

Yes – health.

Health.

Health.

No.

Yes.

The NZ Dementia Framework (NZDF) (Ministry of Health, 2013) was released by the Ministry of Health in 2013 as a guiding framework for the provision of dementia prevention, intervention, and care within the NZ health system. Led by a small group of dementia NGO’s clinicians, academics, and providers, “Improving dementia services in NZ – Dementia action plan 2020-2025 (2020)” (Mate Wareware Advisory Ropu, et al., 2021) was released as a plan for the whole dementia sector and outlined the most urgent steps for the next five years.

References:

Mate Wareware Advisory Ropu, et al., (2021). Improving Dementia Mate Wareware Services in Aotearoa New Zealand: Action Plan. Available from: https://cdn.alzheimers.org.nz/wp-content/uploads/2021/09/Dementia-Mateware-Action-Plan.pdf.

Ministry of Health. (2013). New Zealand Framework for Dementia Care. Wellington Ministry of Health.

Following the release of the NZDF, the government allocated funding for a range of actions including the development and implementation of dementia care pathways, dementia prevention, and improved dementia training (Ministry of Health, 2014).

References:

Ministry of Health. (2014). Improving the lives of people with dementia. Ministry of Health New Zealand. Available from: https://www.health.govt.nz/system/files/documents/publications/improving-the-lives-of-people-with-dementia.pdf.

NZ dementia framework:

In the 2012/13 annual planning process, the Ministry asked DHBs to develop their own dementia care pathways by June 2013. In the 2013/14 year, DHBs are expected to implement their dementia care pathways and develop regional governance groups. The Ministry’s annual planning process will monitor the progress of the development and implementation of these pathways. The development and implementation are expected to be undertaken in collaboration with the primary health care and community care sectors and to align with this framework. The framework can also be used to guide workforce training, planning, and recruitment and retention.

Dementia action plan:

Sets out several objectives with associated actions and suggested lead organisations, but no formal monitoring per se.

NZ dementia framework:

Goal: “The NZ dementia framework aims to help people with dementia and their families and whānau to maximise their independence and wellbeing by reducing stigmas and providing clear, comprehensive information, and an integrated, holistic approach to dementia care and support.”

To this end, it provides a guide that district health boards (DHBs) can use as they work with primary, secondary, and community health and social support services (including social, information, emergency, and housing) to develop clear, consistent, well-resourced and easily accessible dementia care pathways. The framework promotes national consistency in dementia care while allowing for flexibility to adapt to local priorities and encourage innovation. DHBs are already developing their own service models and pathways for dementia care, and this framework is deliberately non-prescriptive so that the DHBs will be able to use it in different ways to achieve the same ends. The framework lists good practice examples that DHBs and the health sector can refer to, but the list of examples is a guide only and is by no means comprehensive. Furthermore, the framework highlights some goals that may take time to achieve. It is anticipated that steady progress can be made towards these goals with the aim of significantly improving dementia health and support services within five years.”

It outlines 3 overarching principles:

1. Following a person-centred and people-directed approach;
2. Providing accessible, proactive, and integrated services that are flexible to meet a variety of needs;
3. Developing the highest possible standard of care.

Dementia action plan:

Goal: “To improve the wellbeing of people living with dementia while decreasing the impact of dementia on them, as well as on Aotearoa New Zealand communities, on the health system, and on the economy.”

The Plan is underpinned by seven interlinked principles:

1. Wellbeing focussed and person-centred – people living with dementia, their whānau/families and care partners are empowered to be at the forefront of decision-making about their care and support, so they thrive; living with autonomy, meaning and dignity; participating in and contributing to their families and communities for as long as possible,
2. Human rights – people living with dementia are citizens, whose lives matters and have the same human rights as everyone else, including those in the Convention on the Rights Persons with a Disability,
3. Acknowledges Te Ao Māori and the principles of Te Tiriti o Waitangi –a kaupapa Māori approach underpins the design, development and delivery of solutions and programmes that will work in Aotearoa New Zealand for Māori whanau,
4. Comprehensive and integrated – services cover the whole life-course of dementia from developing dementia to end of life, with all parts of the sector working together to support people living with dementia and to implement the plan,
5. Equity – people living with dementia have access to appropriate services that deliver high-quality health and wellness outcomes so they can reach their full potential whoever they are, whatever their circumstances, and wherever they live in Aotearoa New Zealand,
6. Evidence-based and consistent – services are grounded in evidence and best practice, incorporating person-centred care with health care, to deliver solutions that are nationally consistent, effective, sustainable, and affordable,
7. Specific populations – services, solutions and resources recognise and respond appropriately to the unique needs of the special groups within Aotearoa New Zealand’s population. These will include Pacific people, Asian people, the Deaf community, and people who have become hearing impaired, refugees, people living alone, LGBTIQA people, people with intellectual and developmental disabilities, people with young-onset dementia, people living with chronic and severe neurological and/or psychiatric conditions, those with addictions, homeless older people and people housed in corrections facilities.

NZ Dementia Framework:

“We would like to acknowledge the valuable input we received from people with dementia and their families and whānau and would like to thank Alzheimers Auckland for coordinating the group sessions for us.”

Dementia Action Plan:

“The consultation incorporated a broad range of stakeholders including people living with dementia and their care partners, … and a further 25 individuals provided feedback specifically on their experience with Cognitive Stimulation Therapy”.

NZ Dementia Framework:

The NZDF is more of a best practice guidance for DHB’s to use when they develop their own region-specific dementia pathways. DHBs are expected to implement their dementia care pathways and develop regional governance groups. The Ministry’s annual planning process will monitor the progress of the development and implementation of these pathways.

There is no specific resourcing or budgeting associated with the recommended action points in the NZDF but implies the DHB’s need to implement and provide governance or monitoring and that the MoH will in turn monitor the DHBs.

The NZDF also comments on governance and monitoring.

Governance:

DHBs should develop regional and local governance groups to:

• help implementing their dementia care pathways in line with the framework,
• ensure that a wide range of expertise (e.g., secondary care, primary health care, allied health, community services, volunteer services, family and whānau) is involved in developing dementia care pathways and services at the local and regional level,
• ensure that new models of care, good practice examples and research are shared locally, regionally, and nationally,
• develop measureable outcomes of the pathways’ effectiveness,
• identify and facilitate national and regional collaboration opportunities,
• develop regional approaches for complex cases (e.g., alcohol or drug addiction related dementia, people with Down syndrome, young onset dementia and tertiary services).

Monitoring and evaluation should:

• include measurable outcomes,
• identify gaps and ensure improvements in dementia care and support,
• include national and international benchmarking,
• evaluate outcomes from the perspective of people with dementia and their families and whānau.

Dementia Action plan:

The dementia plan for 2020-2025 outlines 4 objectives with associated actions and suggested lead organisations, and are explicit that these are the most urgent ones to undertake.

The plan comments on factors required for successful implementation and notes that “Work is still needed on detail such as volumes, costs, outcomes and measures/indicators”.

The actions from the Dementia Plan are intended to support the Healthy Ageing Strategy’s Priority actions 2019–2022. This Plan also has links to and supports other strategies and plans, including:

• Health Ageing Strategy 2016 which sets out the strategic direction for the next 10 years for the delivery of services so that older people live well, age well, and have a respectful end of life in age-friendly communities. The current focus is on the priority actions for 2019 to 2022.
• Better Later Life – He Oranga Kaumātua 2019-2034 which sets out the actions needed for Aotearoa New Zealand to embrace the opportunities that an ageing population and longevity brings.
• The Carers’ Strategy 2008 and the Carers’ Strategy Action Plan 2019 to 2023 which provides resources and support to support care partners.
• The Aotearoa New Zealand Disability Strategy 2016 which has a vision for Aotearoa New Zealand as “a non-disabling society – a place where disabled people have an equal opportunity to achieve their goals and aspirations, and all of Aotearoa New Zealand works together to make this happen”.
• Government Inquiry into Mental Health and Addiction 2018 which provided advice to Government about changes needed to the system.
• The Health and Disability Kaiāwhina Workforce Action Plan 2015-2020 which is a five-year action plan with a 20-year vision for the Aotearoa New Zealand health and disability Kaiāwhina (non-regulated) workforce.

All areas of dementia are covered.

Dementia pathways are operationalised through regional health pathways which are localised and provide region specific information and guidance. There are nine regional pathways in NZ – Northland, Auckland, Midlands, Whanganui & MidCentral, Wellington/Wairarapa,Hutt, Nelson Marlborough, West Coast, Canterbury, and Southern (Health Navigator, 2019).

References:

Health Navigator. (2019). Dementia | Mate korongenge. Health Navigator New Zealand. Available from: https://www.healthnavigator.org.nz/health-a-z/d/dementia/#Clinical%20pathways.

NZ Dementia framework:

The NZDF tends to frame dementia as a physical condition, given the focus on cardiovascular and lifestyle risk reduction strategies. Regional pathways define dementia more precisely. For example, the Midlands dementia pathway (Ministry of Health, 2013) defines dementia as “an acquired, actively progressive, and largely irreversible clinical syndrome that is characterised by widespread impairment of mental function generally associated with a decline in activities of daily living and impairment in social function”.

 References:

Ministry of Health. (2013). New Zealand Framework for Dementia Care. Wellington Ministry of Health.

Yes.

Yes.

Yes.

Yes.

Yes.

The Sustainable Development Goals (SDGs) are a set of 17 interconnected goals outlined by the United Nations (UN) to achieve a more sustainable future for all people by addressing global challenges including poverty, inequality, and climate change (United nations, n.d.). Both the NZDF and Dementia plan reflect aspects of the SDGs, including:

• Good health and wellbeing with a focus on dementia prevention and living well with dementia;
• Reduce inequalities and discrimination against those with dementia and their carers;
• Peace, Justice, and Strong institutions by standing up for the rights of those with dementia;
• Sustainable cities.

References:

United Nations. (n.d.). Sustainable development goals. UNSDGs website. Available from: https://www.un.org/sustainabledevelopment/sustainable-development-goals/.

NZ Dementia Framework: 

• The framework principles recognise the need for person-directed services that are accessible, proactive and integrated, and flexible to the needs of family/whanau.
• The overarching factors outlined by the dementia framework are explicit in their acknowledgement of the need for culturally appropriate services and family/whānau support and advocacy.
• Woven throughout the documents key elements are the requirements to recognise, acknowledge, and support family and whanau throughout the dementia journey.

Dementia Action Plan: 

• links to the Mahi Aroha-Carers’ Strategy Action Plan 2019-2023 (Ministry of Social Development, 2019) which sets out to recognise carers and their contributions, support the wellbeing of carers, and improve their access to support and services.
• One of the stated goals of the plan is to “decrease the impact of dementia on…whānau/families and communities”.
• A priority area identified is the need to support family/whānau and the action plan outlines what these are and who should be involved.

References:

Ministry of Social Development. (2019). Carers’ Strategy Action Plan 2019–2023. Available from: https://www.msd.govt.nz/documents/about-msd-and-our-work/work-programmes/policy-development/carers-strategy/carers-strategy-action-plan-2019-2023.pdf.

In the section on meeting challenges to maximise wellbeing (p36), there is explicit acknowledgement of abuse and neglect, and how to address it. Firstly, it emphasises the need to take abuse concerns seriously from a patient, regardless of their capacity. This is then followed by sections on education and information for family/whānau, health navigators, and the health service about what constitutes abuse and the steps to take to address any concerns raised. There is also reference to the Ministry of Health family violence guidelines: elder abuse and neglect (Ministry of Health, 2007).

The Dementia Action Plan does not explicitly address the mistreatment and abuse of people with dementia.

References:

Ministry of Health. (2007). Family Violence Intervention Guidelines: Elder Abuse and Neglect. Ministry of Health New Zealand website. Available from: https://www.health.govt.nz/publication/family-violence-intervention-guidelines-elder-abuse-and-neglect.

Both the NZ Dementia framework and Dementia Action plan emphasise the importance of person-centred care. Indeed, one of the three guiding principles of the Dementia framework is “following a person-centred and people-directed approach” which includes empowerment to participate in decisions and choices that affect them (regardless of capacity) and the need to support self-determination. Similarly, the first guiding principle for the Dementia Action Plan is person-directed describing this as “people living with dementia, their whānau / families and care partners are placed at the forefront of decisions about their care and support and empowered to contribute to decision-making”.

NZ Dementia Framework:

One of the overarching factors identified by the dementia framework is the need for regional and local governance groups that:

• help to implement their dementia care pathways in line with the framework,
• ensure that a wide range of expertise (e.g., secondary care, primary health care, allied health, community services, volunteer services, family and whānau) is involved in developing dementia care pathways and services at the local and regional level,
• ensure that new models of care, good practice examples and research are shared locally, regionally, and nationally,
• develop measureable outcomes of the pathways’ effectiveness,
• identify and facilitate national and regional collaboration opportunities,
• develop regional approaches for complex cases (e.g., alcohol or drug addiction related dementia, people with Down syndrome, young onset dementia and tertiary services).

Another overarching factor is the need for monitoring and evaluation which should

• include measureable outcomes,
• identify gaps and ensure improvements in dementia care and support,
• include national and international benchmarking,
• evaluate outcomes from the perspective of people with dementia and their families and whānau.

Dementia Action Plan: 

The dementia plan identifies four priority action areas to focus on over the next three years:

• Dementia incidence reduction,
• Supporting people living with dementia and their family/whānau care partners to live well,
• Build accepting and understanding communities,
• Strengthen capability across the sector.

Each of these objectives have actions associated with them and suggest the organisations best placed to lead. The action area of strengthening capabilities includes the recommendations for quality assurance and governance including the establishment of a national cross-sector leadership group with clear lines of accountability at DHB, regional, and national levels and the development of national indicators, measures, and standards in the dementia sector.

NZ Dementia framework:

One of the three key principles of the framework is the requirement to provide accessible, proactive, and interactive services and highlights the need for services to partner and engage the person with dementia and their family/whānau. The framework also identifies workforce education and training as important overarching factors and describes requirements for educational and training opportunities that should

• be based on best practice,
• focus on the meaning of a people-centred and people-directed approach,
• include input from people with dementia and their families and whānau,
• include experiential learning,
• address different learning styles and abilities, including English as a second language,
• recognise the different needs of cultural diversity and cultural groups and finds ways to address those needs,
• respond to the needs of people with co-existing conditions and/or impairments,
• be supported by the health and social support service providers.

Throughout the framework, guides and resources are provided for health and social service providers throughout the dementia journey.

Dementia Action Plan:

The dementia plan acknowledges the need to strengthen capability across the sector and identifies the need to “make training support across the medical, disability and social support services more available across the sector in all DHB area”.

NZ Dementia framework:

When outlining the guiding principles of the framework and overarching factors, the framework talks in general terms about the roles/responsibilities of the MoH, DHBs, and then “health and social services” more generally. The document gets more specific when going into detail about each of the key elements of the framework, identifying specific agencies, and providing “good practice examples” of how some agencies/organisations have addressed some of the issues raised. For example, the key element of “early intervention and ongoing support” (p21) outlines issues to consider for the person with dementia, their family/whānau, and what specific services the health navigator can consider liaising with to successfully address the issues.

Dementia Action Plan:

The priority objectives outlined by the dementia plan also suggest who the lead organisations should be for the associated action areas. For example, the plan suggests health promotion agencies/sector NGO’s lead risk factor reduction drives, DHBs/primary care sectors lead the development of cognitive impairment pathways, or that the MoH leads the establishment of national cross sector leadership groups.

NZ Dementia Framework:

One of the principles of the framework is for the “provision of accessible, proactive and integrated services that are flexible to meet a variety of needs”. It then goes on to describe an ideal integrated service such that:

• service models are adapted to meet local needs and are supported by local and regional dementia care pathway governance structures,
• care planning is consistent, coordinated, and flexible across all services (including DHBs, primary and secondary health care, government organisations, non-government organisations and private sector organisations), ensuring seamless continuity of care and support,
• interdisciplinary assessment and care planning focuses on functional, psychological, and social goals,
• gaps in services that cannot be filled locally are met by a sub-regional or regional approach,
• the person with dementia’s care team is responsible for identifying a suitable navigator.

Dementia plan:

One of the guiding principles of the plan is integrated care where “all parts of the dementia sector work together in the implementation of the plan”. The action areas of the plan highlight the need for working collaboratively and for national cross-sector stewardship and leadership.

NZ Dementia framework:

The framework notes that one of its purposes is to provide “a guide that district health boards (DHBs) can use as they work with primary, secondary, and community health and social support services (including social, information, emergency and housing) to develop clear, consistent, well-resourced and easily accessible dementia care pathways.”

Throughout the document, there are references to the need to link in with other services e.g., with primary care for risk reduction strategies, drug and alcohol services for addiction and dementia support, palliative care services for end-of-life care, or with specialist mental health for management of BPSD or depression and anxiety in the person with dementia or their carers.

Dementia Action Plan:

The dementia plan states it is intended to fit within the second Healthy Ageing Strategy Action Plan and that it also links to, and supports, other strategies and plans including:

• Better Later Life – He Oranga Kaumātua 2019-2034 which sets out the actions needed for New Zealand to embrace the opportunities that an ageing population and longevity brings.
• The Carers’ Strategy 2008 and the Carers’ Strategy Action Plan which provides resources and support to support care partners. The 2019 to 2023 Action Plan is currently out for consultation.
• The New Zealand Disability Strategy 2016 which has a vision for New Zealand as “a non-disabling society – a place where disabled people have an equal opportunity to achieve their goals and aspirations, and all of New Zealand works together to make this happen”.
• Government Inquiry into Mental Health and Addiction 2018 which provided advice to Government about changes needed to the system.

In the action plan, it also outlines the need to work between and across organisations to achieve the desired outcomes.

NZ Dementia Framework:

The framework acknowledges potential barriers to access due to difficulties with language or communication, a lack of understanding of dementia, or other cultural reasons that delay or prevent access to, or uptake of, services. The principles of the framework note the need for age and culturally appropriate services, as well as an explicit identification of the need to reduce funding barriers to access as much as possible.

Dementia plan:

The dementia plan acknowledges that access to services is “inequitable across specific groups such as Māori, Pasifika, ethnic minorities particularly refugees, people living alone, and people living with young-onset dementia, deafness, intellectual disability, or neurological or psychiatric illness; and across urban-rural and District Health Board (DHB) boundaries” and that their needs must be recognised and responded to so that equitable access to appropriate services and care can be provided. The plan also highlights a priority research area of “culturally appropriate ways of describing and approaching dementia with NZ’s non-pakeha cultures”.

NZ Dementia framework:

The framework does acknowledge the need for “Health and social support services [to] promote earlier recognition of dementia and participation within their communities” and that the aim is to “provide a positive experience of care and support by strengthening the culture of partnership and engagement with both the person with dementia and their family and whānau.”

Dementia Action Plan:

The Dementia plan acknowledges inequities in availability and access to services. Equity is one of the eight principles of the dementia plan and is acknowledged in the action area on supporting people living with dementia and their family/whānau “services must be equitable in terms of access, tailored to individuals’ needs, and their quality must be assured”.

NZ Dementia framework:

The first key element of the dementia framework is on awareness and risk reduction with the stated aim of using “both local and national efforts to make New Zealanders more aware of the importance of living a healthy and active lifestyle, which may reduce the risk of developing dementia. Greater awareness will also increase the social acceptance, inclusion, and wellbeing of those living with dementia”. This includes recommendations and good practice examples of initiatives at local, regional, and national level for dementia awareness, stigma reduction, and education on risk reduction strategies.

Dementia Action Plan:

One of the four key action areas identified in the plan is to reduce the incidence of dementia. The plan outlines the need for health promotion agencies/sector NGO’s to “Work with colleagues involved with other key non-communicable diseases and population health to design a health promotion programme that includes dementia prevention / brain health protection”. 

NZ Dementia framework:

The framework recognises NZ’s ageing population and an increasing population of people with dementia. It notes that the framework was developed because “The Ministry of Health (the Ministry), together with the health and social support sector, recognises dementia care needs to be improved nationwide in a way that maximises the independence and wellbeing of the person with dementia and their family and whānau while ensuring safety and affordability of services”. It does not specifically address sustainability.

Dementia Action Plan:

The dementia plan identifies the increasing population of people with dementia as a reason it needs to be a priority area but does not specifically make a link between this and sustainability. It does however note that dementia “represents a major challenge for New Zealand creating major human, social, economic, health, workforce and economic costs” and that “the current services are not capable of meeting the need”. 

NZ Dementia framework:

The dementia framework was developed by representatives from each DHB, the national dementia cooperative, and primary health care services, as well as people with dementia and their carers. The acknowledgements included representatives from many organisations including representatives from Dementia Associations, the aged care sector, Universities, DHBs, Primary care and Allied health.

Dementia Action plan:

Development of the dementia plan was facilitated by Alzheimer’s NZ and the NZ Dementia cooperative. Contributors included members of both organisations, as well as representatives from Dementia NZ, dementia researchers from the University of Auckland, the District Health Boards, and a representative from a national retirement village group. Amongst this group were old age psychiatrists, geriatricians, and people with dementia and their carers. The group then worked with their communities and alongside the Ministry of Health to create the document.

NZ Dementia framework:

The dementia framework was released in 2013 and “highlights some goals that may take time to achieve. It is anticipated that steady progress can be made towards these goals with the ultimate aim of significantly improving dementia health and support services within five years”.

The framework also outlined that “in the 2012/13 annual planning process, the Ministry asked DHBs to develop their own dementia care pathways by June 2013. In the 2013/14 year, DHBs are expected to implement their dementia care pathways and develop regional governance groups. The Ministry’s annual planning process will monitor the progress of the development and implementation of these pathways”.

Dementia Action Plan:

The Dementia plan was released in early 2020, just prior to COVID-19, and outlines recommendations for 2020-2023. The four priority action areas have associated targets for the four-year period and some that are for development with the aim of implementation in 2023 and beyond. There is no specific mention of monitoring targets and milestones.

The plan also describes “enablers” required for successful implementation of the plan which include:

• Allocation of sufficient financial resource by government,
• A knowledgeable, skilled, and supported workforce,
• Stronger links across the dementia sector,
• A partnership focussed commissioning model,
• Systematic and routine population monitoring of a core set of dementia indicators.

NZ Dementia Framework:

There is no specific named stakeholder in the dementia framework but it does note that “The framework provides DHBs and the health and social support sectors with a guide for developing their dementia care pathways”.

Dementia Action plan:

Does not name any key stakeholder but does suggest lead organisations for each of the priority action areas, such as dementia associations, academic researchers, and DHBs.

NZ Dementia Framework:

The framework outlines five key elements:

• Dementia awareness and risk reduction,
• Assessment, diagnosis, early intervention, and ongoing support,
• Living well [with dementia],
• Meeting challenges to maximise wellbeing,
• End of life considerations.

Each of these elements is expanded on by the provision of ‘good practice points’ which describe evidence-based recommendations for the provision of comprehensive and person-centred approaches and provide links to useful websites and resources.

Dementia Action Plan:

The dementia plan outlines four action areas for the next four years and gives a brief description of how they can be achieved and who should be the lead organisations for each of the points:

• Reducing the incidence of dementia,
• Supporting people living with dementia and their family/whānau care partners/supporters to live their best possible lives,
• Building accepting and understanding communities,
• Strengthening leadership and capability across the sector.

NZ Dementia Framework:

Dementia awareness and risk reduction is the first key element of the dementia framework. Its stated aim is to “use both local and national efforts to make New Zealanders more aware of the importance of living a healthy and active lifestyle, which may reduce the risk of developing dementia. Greater awareness will also increase the social acceptance, inclusion, and wellbeing of those living with dementia.”

Local, regional, and national good practice points are provided, for example:

– “dispel the myths and assumptions of dementia by promoting accurate information and raising awareness of positive aspects of living with dementia as a chronic condition.” 

– “recommend that education on dementia be included in applicable national training programmes for health practitioners (e.g., nurses, doctors, allied health professionals) and the unregulated workforce (e.g., home and community support workers)”.

There are also recommendations for inclusive communities maximising media opportunities and future planning (for example, advance care planning and choosing an EPOA).

Dementia Action Plan:

One of the four action areas of the dementia plan is “Building accepting and understanding communities – Stigma and a lack of awareness, poor understanding and barriers to inclusion are among the most devastating things that people living with dementia and their support people experience – making it harder to get the help and support they need and increasing their isolation.”

Action areas include a recommendation to

– “Improve understanding of dementia and ageing within Aotearoa New Zealand communities by promoting and supporting Alzheimers NZ’s Dementia Friendly Recognition Programme and the Office for Seniors’ WHO Age Friendly Cities Programme” and to

– “Design and implement a multi-level multi-channel campaign to raise awareness, increase understanding of dementia and tackle stigma and discrimination” with suggested lead organisations being health promotion agencies and sector NGOs.

NZ Dementia framework:

Dementia prevention and risk reduction are included in the same section as dementia awareness. Good practice points provided include encouraging people to live healthy and physically active lifestyles, provide education to primary health care services on the importance of risk reduction strategies, encourage cooperation between agencies to improve the health and wellbeing of the local population and engage with national public health campaigns to add the message ‘What is good for the heart is good for the brain’.

Dementia Action Plan:

The dementia plan includes the action point on Reducing the incidence of dementia. Action points recommend working with health promotion agencies to work with colleagues involved with other key non-communicable diseases and population health to design and implement a health promotion programme that includes dementia prevention/brain health protection.

NZ Dementia framework:

The second key element of the dementia framework centres around assessment, diagnosis, early intervention, and ongoing support. It addresses each of the aspects in turn.

Assessment:

The aim is to “empower anyone who recognises changes in their own or someone else’s memory or cognitive abilities to seek an assessment and have timely access to an assessment”. The framework outlines good practice points for health services to follow. These include specific recommendations for:

• Assessment in primary care, when to refer to specialist services and what specialist services should have available (such as access to CT scans and formal neuropsychological testing),
• Diagnosis.

Diagnosis:

The aim is to “provide earlier diagnosis for people with dementia. An earlier diagnosis will allow the person and provide them with information to promote self-management and rehabilitation, thus ensuring that they are able to live with a sense of wellbeing for as long as possible.”

Recommendations include considerations for when making the diagnosis of dementia as well as how to approach other underlying or co-morbid diagnoses (such as MCI, depression, and substance use).

Early intervention and ongoing support:

The aim is to “encourage people with a recent diagnosis of dementia to participate in ongoing, culturally appropriate support that is tailored to meet their needs and maximise their abilities and independence…[and] is also to help the person with dementia and their family and whānau navigate through the health and social support system”. 

Good practice points are provided for the management of the person with dementia, meeting the needs of family and whānau, and expectations of health navigators (a named first point of contact with a good knowledge of dementia as well as health and social services which can help the person and their whānau understand the diagnosis and assist with navigation through the system).

Dementia Action Plan:

The dementia plan outlines a priority action of supporting people living with dementia and their family/whānau care partners/supporters to live their best possible lives.

Action areas include recommendations to:

• implement options to improve the provision of timely and accurate diagnosis and comprehensive management planning in primary care;
• align core features of DHB Cognitive Impairment Pathways to reinforce a national approach, including investigating health technology options for cognitive testing to arrive at a recommendation for national adoption;
• coordinate and support access to needed services including emergency support;
• include information, education, support, and flexible, available and accessible respite services;
• start working with specific populations (such as Pasifika/those living alone) to identify unique needs and develop solutions for each.

NZ Dementia framework

Workforce training is one of the overarching factors included in the framework, outlining the requirements for education and training opportunities such as the need to follow best practice and for experiential learning and input from people with dementia and their families and whanau. Woven throughout the key elements of the framework are the knowledge and experiential requirements of health care workers.

Dementia plan:

The fourth priority action area of the dementia plan is on Strengthening leadership and capability across the sector. Action areas include:

• The development and implementation of a workforce strategy that addresses the long-term growth needs of the dementia and aged care sector, and the impact of the ageing workforce, so there are sufficient numbers of appropriately skilled and qualified people available when needed and the need to,
• Improve training support for best-practice medical care and disability and social support services and make this education more available across all parts of the dementia and aged care sector, home and community care, primary care, and within the core health service.

NZ Dementia Framework:

Family and whānau support are specifically mentioned in the framework as an overarching factor that needs to be provided across all areas and stages of dementia care. It outlines the need for an easily accessible and navigable service provided by appropriately skilled staff and the importance of encouraging participation at all points of service provision. Woven throughout the key elements are good practice points for how to best educate, inform, and involve whānau at each stage of the dementia process.

Dementia Action plan:

A priority action area of the dementia plan is “Supporting people living with dementia and their family/whānau care partners/supporters to live their best possible lives” so that “people with dementia and their family/whānau care partners/supporters can enjoy more full, active and meaningful lives”.

Associated objectives include recommendations for dementia navigation services as well as whānau support and flexibility across a variety of settings such as home, day activities, respite, and residential care.

Dementia framework:

The framework outlines clear expectations of local, regional, and DHB governance to develop measurable outcomes of dementia pathways. There is also a specific mention of the need for monitoring and evaluation of developed pathways that are benchmarked both nationally and internationally, identify gaps that need addressing, and that evaluate outcomes from the perspective of people with dementia and their whanau.

Dementia Action Plan

The action areas outlined by the dementia plan include recommendations for monitoring and information systems such as the need to design and roll out agreed national indicators, measures, and standards with clears lines of accountability at DHB, regional and national levels to monitor their implementation.

NZ Dementia Framework:

The dementia framework does not specifically address research and innovation. When describing the purpose of the framework, the importance promoting “national consistency in dementia care while allowing for flexibility to adapt to local priorities and encourage innovation” is mentioned. The need to “ensure that new models of care, good practice examples and research are shared locally, regionally and nationally” is described when outlining governance considerations but this is the only point in the document where research is mentioned.

Dementia Action Plan:

The dementia plan includes research/innovation in their priority action area on strengthening leadership and capability across the sector. A specific objective is to “increase investment in research on dementia, in particular on the epidemiology of dementia in Aotearoa New Zealand, on culturally appropriate ways of describing and approaching dementia for tangata whenua and within Aotearoa New Zealand, and on what works to support people living with dementia”.

No.

New Zealand does not have dementia-specific legislation but the protection of the vulnerable and those deemed to be without decision-making capacity is covered by general health and disability law (Human Rights Commission, 2018).

References:

Human Rights Commission. (2018). This is not my home: A collection of perspectives on the provision of aged residential care without consent. Auckland Human Rights Commission.

Yes.

The New Zealand Bill of Rights Act (1990) (Parliamentary Counsel Office, 2013) outlines the illegality of arbitrary detention and deprivation of liberty in all but legally authorised situations. New Zealand is also a signatory to the International Covenant on Civil and Political Rights (ICCPR) (Ministry of Justice, 2020a) and the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) (Ministry of Justice 2020b).

The Protection of Personal and Property Rights (PPPR) Act (1988) (Parliamentary Counsel Office, 1988) is the main piece of legislation in NZ and sets out in detail the criteria and thresholds that must be met for an individual to be deemed to lack decision making capacity for personal care and welfare or property matters.

The Mental Health (Compulsory Assessment and Treatment) Act (1992) (Parliamentary Counsel Office, 1992) has been used to protect the rights of a person with dementia on an urgent basis in the absence of any legal protection under the PPPR act.

The Code of Health and Disability Services Consumers’ Rights 1996 (Health & Disability Commission, 1996) gives legally enforceable rights to all consumers of health and disability services, and places corresponding obligations on providers of those services.

Right 7(4) of the code provides an exception to the general requirement in the Code that services should only be provided to a person who has made an informed choice and given informed consent. Right 7(4) states: “Where a consumer is not competent to make an informed choice and give informed consent, and no person entitled to consent on behalf of the consumer is available, the provider may provide services where – a) it is in the best interests of the consumer; and b) reasonable efforts have been taken to ascertain the views of the consumer; and c) Either, – ˚ If the consumer’s views have been ascertained and having regard to those views, the provider believes, on reasonable grounds, that the provision of the services consistent with the informed choice the consumer would make if he or she were competent; or ˚ If the consumer’s views have not been ascertained, the provider takes into account the views of other suitable persons who are interested in the welfare of the consumer and available to advise the provider.”

References:

Health & Disability Commission. (1996). Code of Health and Disability Services Consumers’ Rights, regulations 1996. Health & Disability Commissioner website. Available from: https://www.hdc.org.nz/your-rights/about-the-code/code-of-health-and-disability-services-consumers-rights/.

Ministry of Justice. (2020a). International Covenant on Civil & Political Rights (ICCPR). Available from: https://www.justice.govt.nz/justice-sector-policy/constitutional-issues-and-human-rights/human-rights/international-human-rights/international-covenant-on-civil-and-political-rights/.

Ministry of Justice. (2020b). Convention on the Rights of Persons with Disabilities. Available from: https://www.justice.govt.nz/justice-sector-policy/constitutional-issues-and-human-rights/human-rights/international-human-rights/crpd/.

Parliamentary Counsel Office. (1988). Protection of Person and Property Rights Act 1988. New Zealand Legislation website. Available from: http://www.legislation.govt.nz/act/public/1988/0004/latest/whole.html.

Parliamentary Counsel Office. (1992). Mental Health (Compulsory Assessment and Treatment) Act 1992. New Zealand Legislation website. Available from: http://www.legislation.govt.nz/act/public/1992/0046/latest/DLM262176.html?search=qs_act%40bill%40regulation%40deemedreg_mental+health+_resel_25_h&p=1&sr=1.

Parliamentary Counsel Office. (2013). New Zealand Bill of Rights Act 1990. New Zealand Legislation website. Available from: http://www.legislation.govt.nz/act/public/1990/0109/latest/DLM224792.html.

Yes. 

As described by Iris Revuecamp in her essay “Plugging the gaps – Strengthening the rights of mentally incapacitated adults pending substantive law reform” (Human Rights Commission, 2018).

There are, in essence, two components to the current legal framework as it relates to healthcare decision-making where an adult does not have capacity to make decision(s) – where a competent adult has made an advance decision relating to the provision of future healthcare, should particular circumstances arise (an advance directive); and where another individual supports an adult to make a decision, or makes a decision on behalf of that person, if they themselves lack the capacity to do so. The law in New Zealand only allows certain people to make decisions on behalf of mentally incapacitated adults. These are limited to attorneys appointed under Enduring Powers of Attorney (EPOAs); providers of health and/or disability services (in certain limited circumstances); court appointed welfare guardians or property managers; other persons appointed by the Court for specific purposes; and/or the Court.

There are several concerns arising from the operation of the framework which applies to EPOAs. These include a lack of knowledge and understanding of EPOAs by both those working with, and those acting as, EPOAs;14 a lack of detailed guidance or support available to EPOAs or those working with EPOAs;15 an absence of a quick and simple mechanism to challenge decisions made or actions taken by an EPOA,16 and the lack of monitoring of EPOAs (p39).

References:

Human Rights Commission. (2018). This is not my home: A collection of perspectives on the provision of aged residential care without consent. Auckland Human Rights Commission.

Mental Health Act (MHA):

• Individuals subject to the MHA have legal recourse to challenge their treatment and/or detention. They also receive oversight from District Inspectors to ensure they have their rights upheld. The office of District Inspectors is established by statutory authority under the Mental Health (Compulsory Assessment and Treatment) Act 1992, to ensure that people subject to compulsory assessment and treatment are advised of their rights, complaints of breaches of their rights are investigated and services are improved where required, in order for their rights to be upheld (Ministry of Health, 2003).

Protection of Personal and Property Rights (PPPR) Act (1988):

• Enduring Power of Attorney (EPOA): Section 103 of the Protection of Personal and Property Rights Act 1988 allows for an application to be made to the court for the review of a decision of an EPOA. However, the number of applications for review of the decisions of EPOAs are few and far between. In 2015, there were 16 such applications, with 12 in 2016 and 10 in 2017 (Human Rights Commission, 2018).
• Welfare Guardian – As with an EPOA, there is lack of monitoring once the orders are made. The court-appointed lawyer’s role ends at the time orders are made, and the court has no other involvement other than if a further application is made; or shortly before the orders expire, when the orders are the subject of a review. In terms of the use of the Court as a mechanism for reviewing the reasonableness of decisions made by welfare guardians and/or property managers, there were 25 such applications in 2017. This suggests that the Court is used infrequently to check the appropriateness of the actions of welfare guardians and/or property managers (Human Rights Commission, 2018).

The Code of Health and Disability Services Consumers’ Rights and the use of Right 7(4)

• There is no national consensus about the limits of right 7(4) leading to varying approaches adopted across the country by DHBs, Needs Assessment Service Co-ordination Agencies (NASC) and local residential care providers as to whether right 7(4) provides sufficient legal authority to provide long-term care and/or to detain a person in residential care.

As Iris Revuecamp notes “The regulatory controls [rely] for the most part, on the raising of concerns or complaints by the person themselves, or someone being available to do so on their behalf. This fails to take into account that many people who lack capacity to make decisions do not have people available to advocate on their behalf – making them particularly vulnerable to abuse and neglect in the absence of routine visits and monitoring by their families and/or friends, or, unfortunately, perhaps because of the care (or lack thereof) of their families and/or friends” (Human Rights Commission, 2018).

References:

Human Rights Commission. (2018). This is not my home: A collection of perspectives on the provision of aged residential care without consent. Auckland Human Rights Commission.

Ministry of Health. (2003). Guidelines for the Role and Function of District Inspectors appointed under the Mental Health (Compulsory Assessment and Treatment) Act 1992. Available from: https://www.moh.govt.nz/notebook/nbbooks.nsf/0/043E82835A19A74D4C2568B500770432/$file/GuidelinesForTheRoleAndFunctionOfDistrictInspector.pdf.

While formal provisions for the transition of dementia care to community-based service are not explicit in any legislation, there is the requirement to provide care and oversight in the least restrictive way possible.

There is a complex framework of regulatory controls relating to the provision of health and disability services to mentally incapacitated persons including the Health and Disability Commission (HDC), the National Advocacy Service, the Retirement Commissioner, the regulation of registered health practitioners by registration authorities, the monitoring of health and disability places of detention by the Ombudsman, and the threat of possible criminal liability for failing to meet duties owed to a vulnerable adult (Human Righs Commission, 2018). The office of the ombudsman also provides a formal monitoring function, and this has recently been extended to monitoring and inspection of privately run facilities that include secure dementia units (Ombudsman New Zealand, 2021).

As noted earlier, while there are regulatory controls in place, they rely on concerns being raised by the individual or family members and do not take into account that many people who lack capacity to make decisions do not have people available to advocate on their behalf. Some regulatory controls such as certification audits of residential care facilities and DHB monitoring do not require a complaint to be laid but these review mechanisms are usually more focussed on policies and procedures rather than the individual. There are generally no regulatory controls for those lacking capacity who are not in institutions.

References:

Human Rights Commission. (2018). This is not my home: A collection of perspectives on the provision of aged residential care without consent. Auckland Human Rights Commission.

Ombudsman New Zealand. (2021). Aged care monitoring. Ombudsman website. Available from: https://www.ombudsman.parliament.nz/what-we-can-help/aged-care-monitoring.

Yes. In line with international obligations as a signatory to the UN convention of rights of persons with disabilities (UNCRPD) and the UN convention against torture (UNCAT), New Zealand’s Health and disability services (Restraint Minimisation and safe practice) Standards were released in 2008 (Standards New Zealand, n.d.).

References:

Standards New Zealand. (n.d.). Health care services standards. Ministry of Business, Innovation & Employment. Available from: https://www.standards.govt.nz/sponsored-standards/health-care-services-standards/.

Right 7(5) of the Health and Disability Commissioner (Code of health and disability services consumer rights) Regulations 1996 states ‘Every consumer may use an advanced directive in accordance with common law” (Health and Disability Commission, 1996).

References:

Health & Disability Commission. (1996). Code of Health and Disability Services Consumers’ Rights, regulations 1996. Health & Disability Commissioner website. Available from: https://www.hdc.org.nz/your-rights/about-the-code/code-of-health-and-disability-services-consumers-rights/.

While no dementia specific legislation exists regarding discrimination, the Human rights act 1993 (Legislation 3, 1993) and the NZ Bill of Rights Act (Parliamentary Counsel Office, 2013) prohibit discrimination on the grounds of disability (which includes intellectual or psychological disability and any other loss or abnormality of psychological or physiological structure or function).

References:

Legislation 3. (1993). Human Rights Act. Available from: http://www.legislation.govt.nz/act/public/1993/0082/latest/DLM304475.html.

Parliamentary Counsel Office. (2013). New Zealand Bill of Rights Act 1990. New Zealand Legislation website. Available from: http://www.legislation.govt.nz/act/public/1990/0109/latest/DLM224792.html.

The Human rights commission notes that discrimination on the basis of family status is prohibited under the NZ Human Rights Act. The commission has been involved in a number of legal cases related to payments to individuals who provide care to disabled adult family members and has voiced concern over the New Zealand Public Health and Disability Amendment Act (No2) 2013 which prohibits payments being made to family members providing care except in some narrow circumstances and prevents any future claims being taken to the Human Rights Commission, the Human Rights Review Tribunal, or the courts alleging that the new policy is discriminatory (Human Rights Commission, 2020).

References:

Human Rights Commission. (2020). Caring for disabled adult family members. NZ Human Rights website. Available from: https://www.hrc.co.nz/enquiries-and-complaints/faqs/caring-disabled-adult-family-members/.

No. The PPPR act lays out the requirements and obligations of the nominated attorney but does not make explicit provision for protection of the attorney.

No.

The PPPR act (Parliamentary Counsel Office, 1988) outlines the requirements for nominating an Enduring Power of Attorney (EPOA) or a court order for those deemed incapable and do not have an EPOA in place.

EPOA

If meeting the threshold for the presumption of competence (section 93B(1)), an attorney can be nominated by an individual to act on their behalf should they lose the capacity to do so.

Welfare guardian

If the individual is deemed to lack the capacity to make personal care/welfare and/or property decisions and does not have an existing EPOA in place, an application can be made to the family court to decide on “the least restrictive intervention…having regard to the degree of that person’s incapacity” (Section 8). The court can make a range of orders including:

• An order appointing a welfare guardian and/or property manager (the equivalent of an EPOA),
• an order that the person be provided with living arrangements of a kind specified in the order and be required to reside there,
• an order that the person be provided with medical advice or treatment of a kind specified in the order.

 References:

Parliamentary Counsel Office. (1988). Protection of Person and Property Rights Act 1988. New Zealand Legislation website. Available from: http://www.legislation.govt.nz/act/public/1988/0004/latest/whole.html.

Yes.

The NZ Dementia Framework (Ministry of Health, 2013) was released in 2013 for DHBs to use as a framework for the development of local/regional guidelines. Nine regional dementia pathways have since been developed, covering all 20 DHBS throughout the country.

References:

Ministry of Health. (2013). New Zealand Framework for Dementia Care. Wellington Ministry of Health.

As outlined in the NZ dementia framework, all DHBs are monitored and evaluated by the Ministry of Health (on behalf of the government) to ensure the appropriate targets are being achieved.

Yes.

Yes.

Yes.

Yes.

Yes.

Yes.

Yes.

The guidelines were developed following the release of the NZ Dementia Framework in 2013 by multidisciplinary health networks in each region with input from interested stakeholders including primary and secondary care, allied health, Needs Assessment & Service Coordination (NASC) agencies, the aged care sector, and relevant NGOs (Health Navigator, 2019).

References:

Health Navigator. (2019). Dementia | Mate korongenge. Health Navigator New Zealand. Available from: https://www.healthnavigator.org.nz/health-a-z/d/dementia/#Clinical%20pathways.

Ministry of Health

Following the release of the framework in 2013, the Ministry of Health expectation was that DHBs would use it as a guide to develop and implement their own dementia care pathways in collaboration with primary health and community care sectors.

DHB expectation of the regional guidelines is to facilitate the ability of the primary care sector to diagnose and manage dementia to reduce burden specialist care and to streamline progress through the system.

Primary care expectations centred around guidelines for the assessment and management of dementia and when to refer to specialist care services.

The use of traditional medicine and healers to manage or treat dementia is not common in NZ. For Māori and Pacific cultures, there is a general acceptance of the cognitive changes, which are largely conceptualised as part of the normal ageing process.

As described earlier, the NZ dementia framework was rolled out as a guide that DHBs could use in their work with primary, secondary, and community health and social support services to develop clear, consistent, well-resourced, and easily accessible dementia care pathways. The aim of the framework was to promote national consistency in dementia care while allowing for flexibility to adapt to local priorities and encourage innovation. Nine regional dementia pathways were subsequently developed, providing local guidance on the assessment, management, and ongoing support for people with dementia and their family/whanau. These pathways provide guidance on care coordination and case management for the associated regions.

Yes, primary and specialist care, NASC agencies (see section 03.01.).

Yes, the role of the Ministry of Social Development (MSD) in coordination of pension, community services cards, finances etc.

Yes, the PPPR and welfare guardianship.

Yes, the NZ Transport Authority (NZTA) and driving assessment requirements for those with cognitive impairment.

Coordination, planning, and resourcing of care for people with dementia is implemented at the DHB level by the local NASC agency.

No.

Yes.

Unclear.

Yes.

Yes.

Yes.

Yes.

Care coordination is occurring at all three levels of care.

There is no anticipated change to dementia policy in the immediate future, despite evidence of a rapidly rising dementia numbers in NZ and the escalating economic and social costs associated with this.

In an article by New Zealand Doctor following the release of the 2019 budget (NZ Doctor, 2019), it was noted that “no additional investment has been directed at specialist services for people with dementia for more than 10 years and none is projected”.

References:

NZ Doctor. (2019). BUDGET 2019: People with dementia obviously don’t count. New Zealand Doctor website. Available from: https://www.nzdoctor.co.nz/article/undoctored/budget-2019-people-dementia-obviously-dont-count.

N/A

There are no expected policy changes related to dementia with the NZ dementia Framework still viewed as fit for purpose as a guiding document for the assessment, management, and ongoing support of people with dementia and their family/whanau.

The NZ dementia Framework is still viewed as fit for purpose and a guide for DHBs to use in the development of their local/regional guidelines. Regional dementia pathways have been developed since the release of the framework in 2013 and are updated on a regular basis.

The Ministry of Health, the DHBs, and Dementia Associations.

In 2019, the release of the ‘World Alzheimer’s Report 2019: Attitudes to Dementia’ was timed to coincide with September being World Alzheimer’s awareness month. With the report focussed on attitudes to dementia, many organisations got behind the international campaign to promote education and awareness about dementia during the month of September. These included:

• Alzheimer’s NZ organised “Memory walks” throughout the country to allow the community to show their support and raise awareness of the dementia challenges.
• Dementia NZ launched the “Still Me” campaign, designed to change attitudes to dementia by reminding people to see the person and not the condition.
• Local and regional dementia organisations also ran their own initiatives during the month and other organisations also got on board such as the Northland rugby team donning purple socks for one of their games in September (Health Central, n.d.)

References:

Health Central. (n.d.). Kicking off World Alzheimer’s month in New Zealand. Available from: https://healthcentral.nz/kicking-off-world-alzheimers-month-in-new-zealand/.

2016 – “Let’s get our heads around dementia” was a national Alzheimer’s NZ campaign focusing on the personal stories of six well known Kiwi personalities who have been affected by dementia. These individuals shared personal experiences of their family members who have been diagnosed with the condition, with stories aired on TV and shared online through our website and YouTube channel.

2014 – 2016 – Funded by the Ministry of Health, a national 3 phase, 3 year “About Dementia” campaign was launched by Alzheimer’s NZ to improve the acceptance of dementia and to reduce the stigma associated with it, as well as to facilitate better access to diagnosis and support services. Focusing on three key messages of hope, respect and action, an advertising campaign was launched across multiple platforms including traditional TV, print and radio advertising, as well as promotion on social media sites such as Facebook and other online outlets including online banners and various websites.

2012 – ‘We can Help’ campaign to build public awareness and understanding of dementia, and to encourage people to see their doctor so they can get the help they need.

Reply from Law Society – “The Ethics paper at Universities does cover this issue – Chapter 5.5 of the Ethics, Professional Responsibility and the Lawyer text covers this situation. Lawyers then must continue their education and this topic is one that would be covered by seminars and NZLS CLE [continuing law education]”.

Reply from Hamilton City Council – no formal training provided.

The New Zealand findings from the 2019 World Alzheimer’s Report survey on Attitudes to Dementia are presented in the table 36 (ADI, 2019). These show that there is still a way to go to address some of the preconceptions and perceptions held about dementia.

Table 36: NZ survey results on Attitudes to dementia (ADI, 2019)

Alzheimer’s NZ commissioned a telephone survey in 2017 to explore awareness and understanding of dementia in NZ (Alzheimer’s NZ, 2017). The focus of the survey included:

• Self-assessed knowledge of dementia.
• 54% of respondents said they knew ‘a lot’ or ‘a fair amount’ about dementia with those who were female, older, better educated, or who had a family member with dementia (80%) were more likely to do so.
• Pacific respondents were less likely to say they knew much about dementia (21%) compared to other ethnicities.

Attitudes to people with dementia:

• 87% of respondents agreed people with dementia can become isolated from friends and the community.
• 83% agreed people with dementia can still be involved in activities in the community such as attending a wedding, church, social clubs, or other social events.
• 58% agreed people with dementia can still enjoy life to the fullest.
• 87% said they would continue to include someone in social activities if that person was diagnosed with dementia.
• 10% said they would not want to tell people if a family member was diagnosed with dementia and 27% agreed they would find it hard to talk to someone with dementia.
• Pacific respondents were less likely to agree (66%) that people with dementia can become isolated from friend and community, than the overall (87%).

Attitudes to caring:

• 58% agreed caring for someone with dementia is often lonely.
• 50% agreed that caring for someone often means your own health suffers. Those 60 years old and over had higher agreement on carers being very lonely (70%) and their health suffering (60%) compared to their younger counterparts (54% and 47% respectively).
• Those who know or have known someone with dementia were more likely to agree caring for someone with dementia can often be lonely (61%) than those who did not (45%). In particular, those who know or have known an immediate (parent/sibling/partner/child) family member were more likely to agree with (75%).

Knowledge of risk and prevention

• Respondents were also mostly confident that eating a healthy diet (75%) having an active social life (67%), maintaining a healthy blood pressure (62%) and not smoking (60%) reduced the risk of dementia.
• Respondents concerned about getting dementia had particularly high confidence for maintaining a healthy blood pressure (69%), having an active social life (72%) and doing mentally stimulating things (90%).
• 27% thought dementia was a normal part of aging and the same number said they thought dementia can be cured.
• 16% of respondents incorrectly identified dementia as a disease that can be inherited.
• Pacific (58%) and Asian (49%) respondents were more likely to think dementia can be cured than other ethnicities (25%).

A recent study by Dudley et al., (2019) explored the understanding of mate wareware (dementia) from a Māori perspective. The study noted the general tolerance and acceptance of a whanau member with cognitive difficulties and importance of honouring their identity as kaumatua (elders) of the community.

Cheung et al., (2019) have recently explored the attitudes of Asian communities in NZ to dementia. They identified specific cultural interpretations of dementia in this community including framing it as a normal part of ageing, using folk explanations (e.g., having a “ghost in the brain”), as well as the use of pejorative or negative terminology for the disease such as “older person’s crazy disease” or “stupid”.

Similar findings have been seen in Pacific communities in NZ (Kautoke, personal communication) with dementia conceptualisations ranging from a neurological condition to spiritual explanations. As with the Asian findings, there were many pejorative terms used to describe dementia such as “fakasesele” (crazy) and ‘’atamai vaivai” (weak minded).

References:

ADI. (2019). World Alzheimer Report 2019: Attitudes to dementia. Alzheimer’s Disease International. Available from: https://www.alz.co.uk/research/WorldAlzheimerReport2019.pdf.

Alzheimer’s NZ. (2017). Awareness and understanding of dementia in New Zealand 2017.

Cheung G., Appleton K., Boyd M., Cullum S. (2019). Perspectives of dementia from Asian communities living in New Zealand: A focus group of Asian health care professionals. Int J Geriatr Psychiatry. 34(12):1758-64. https://doi.org/10.1002/gps.5189.

Dudley M., Menzies O., Elder H., Nathan L., Garrett N., Wilson D. (2019). Mate wareware: Understanding ‘dementia’ from a Māori perspective. NZ Med J. 132(1503):66-74. Available from: https://pubmed.ncbi.nlm.nih.gov/31581183/.

The 2017 Alzheimer’s NZ telephone survey described above included questions from previous surveys carried out in 2014 (Alzheimer’s NZ, 2014) and 2015 (Alzheimer’s NZ, 2015), allowing a measure of progress in the intervening years. Compared to 2014, respondents in 2015:

• Reported the same knowledge base (i.e., knowing at least a “fair amount” about dementia).
• Were more likely to report knowing someone with dementia.
• More likely to identify dementia as a fatal condition.
• Less likely to be reluctant to tell others if they or a family member had dementia.

References:

Alzheimer’s NZ. (2014). Awareness and understanding of dementia in NZ 2014.

Alzheimer’s NZ. (2015). Awareness and Understanding of Dementia: July 2015 report.

As above.

New Zealand does not have a national surveillance and monitoring system to provide high quality data on dementia. While there are some systems, such as the government Integrated Data infrastructure (IDI) (Statistics NZ, 2019) which holds linked microdata from a variety of sources, it has been shown to vastly underestimate dementia prevalence due to poor diagnostic coding and a general lack of data from both primary and secondary services (Walesby et al., 2020).

For example:

Primary care – while the expectation is that most diagnosis and management of dementia occurs in primary care, coding for dementia is not mandatory or associated with any funding so the numbers are likely undercounted.

Secondary/tertiary care – while all inpatient admissions are coded for diagnosis (including dementia), outpatient clinic diagnoses are not routinely coded so the number of those with dementia seen in older persons services (e.g., memory services, geriatric clinics, and mental health services for the elderly) is not known.

Some services such as NASC agencies capture the diagnosis of dementia as part of their interRAI assessment, but only ~10% of the 65+ population get this assessment.

Research-led institutions may gather data to investigate dementia related questions but not in a routine way.

References:

Statistics NZ. (2019). Integrated Data Infrastructure. Stats NZ website. Available from: https://www.stats.govt.nz/integrated-data/integrated-data-infrastructure/#:~:text=The%20Integrated%20Data%20Infrastructure%20(IDI,%2Dgovernment%20organisations%20(NGOs).

Walesby K., Exeter D., Gibb S., Wood P, Starr J., Russ T. (2020). Prevalence and geographical variation of dementia in New Zealand from 2012 to 2015: Brief report utilising routinely collected data within the Integrated Data Infrastructure. Australas J Ageing. https://doi.org/10.1111/ajag.12790.

Prevalence rates reported by the Deloitte Access Economics report in 2017 (Deloitte Access Economics, 2017) are considered the best estimates for dementia prevalence in NZ. In the absence of NZ dementia prevalence studies, the Deloitte estimates are based on the Alzheimer’s Disease International (ADI) World Alzheimer’s report 2015 estimates for Australasia (Prince et al., 2015).

In turn, the ADI prevalence calculation for the population aged 60+ for Australasia was based on a systematic review and meta-analysis that identified four prevalence studies meeting the inclusion criteria – Gisborne 1980’s, Hobart 1980’s, Canberra 1990’s and a prevalence study on Indigenous Australians in the Kimberley region of Western Australia in 2008. The estimated prevalence for the <60 population was based on a 2003 study in Kensington/Chelsea in England.

These estimates were then used to calculate prevalence rates for the total NZ population as well as the 4 main ethnic groups in NZ – European, Māori, Pacific, and Asian – using age-gender relativities. The Deloitte report does comment “While there is evidence that the incidence of dementia may be higher for Māori and Pacific peoples in New Zealand, due to a higher prevalence of cardiovascular risk factors, no data were available to enable modelling of the extent of this difference.” 

Critique of the prevalence estimates for NZ

• The population sampled in studies used to estimate the Australasia dementia prevalence is not representative.
• Study location: Only one of the four studies used to calculate Australasia dementia prevalence was a NZ study and this was carried out in Gisborne in 1983.
• Ethnicity: Three of the studies did not provide a breakdown by ethnicity and the fourth was in an Indigenous Australian population that found a much higher prevalence in their population compared to the Australian population as a whole.
• Study year: Other than the indigenous Australian study in 2008, the remaining studies used in the prevalence calculation are 25-35 years old and even if the demographics are representative, other variables such as risk factors may not be representative of the current population.
• Prevalence calculations do not adjust for the differential risk factors for dementia between ethnicities in NZ.
• The Lancet commission on Dementia prevention and intervention in 2017 identified nine potentially modifiable risk factors for dementia, with each of the risk factors carrying a relative risk 1.4-1.9 times higher compared to those who did not have the risk factor.
• All these risk factors differentially affect Māori and PI ethnicities compared to Pakeha, and many of them increase the risk of dementia if they are present in midlife so there is an argument to be made that dementia prevalence is underestimated in these populations.

References:

Deloitte Access Economics. (2017). Dementia Economic Impact Report 2016. Available from: https://www2.deloitte.com/nz/en/pages/economics/articles/dementia-economic-impact-report-2016.html.

Prince, M., Wimo. A., Guerchet, M., Ali, G., Wu, Y., Prina, M. (2015). World Alzheimer’s report 2015: The Global Impact of Dementia: An analysis of prevalence, incidence, cost, and trends. London Alzheimer’s Disease International 2015. Available from: https://www.alzint.org/u/WorldAlzheimerReport2015.pdf.

Table 39 outlines the years of lives lost (YLL) due to dementia from the 2019 Global burden of disease report (Institute for Health Metrics and Evaluation, n.d.). Alzheimer’s and other dementias ranked as the 7^th highest cause of YLL, up from 12^th 20 years earlier, at 20,000 years.

Table 39: Deaths, Years lived with disability (YLD), and Disability Adjusted Life Years (DALYs) caused by dementia in 2017 (Institute for Health Metrics and Evaluation, n.d.)

References:

Institute for Health Metrics and Evaluation. (n.d.). Global Burden of Disease (GBD). IHME website. Available from: http://www.healthdata.org/gbd.

Table 40 outlines the deaths, Years lived with disability (YLD), Years of lives lost (YLL), and Disability Adjusted Life Years (DALYs) level 4 caused by Alzheimer’s disease and other dementias in 2019 according to the Global Burden of Disease study (Institute for Health Metrics and Evaluation, n.d.). Dementia was the third most common cause of death with over 2,000 deaths attributable to dementia, almost twice as many as in 2000 (where dementia ranked 6^th with 1,144 deaths).

Table 40: Deaths, Years lived with disability (YLD), and Disability Adjusted Life Years (DALYs) caused by dementia in 2017 (Institute for Health Metrics and Evaluation, n.d.).

References:

Institute for Health Metrics and Evaluation. (n.d.). Global Burden of Disease (GBD). IHME website. Available from: http://www.healthdata.org/gbd.

There is no available data on the geographical spread of dementia in NZ. However, given the relationship between the risk factors for dementia and the social determinants of health, there is a possibility that the prevalence of dementia is higher in areas with greater deprivation. These risk factors also disproportionately affect Māori and Pacific people so in the regions where they comprise, a greater proportion of the population may also have an increased prevalence of dementia. For example, South Auckland is the most ethnically diverse region of NZ, with 38% of the population identifying as European or other, 24% as Asian, 21% as Pacific, and 16% as Māori (Counties Manukau District Health Board, 2015).

References:

Counties Manukau District Health Board. (2015). Counties Manukau Health. Population profile. CMDHB 2015.

In the absence of any prevalence studies, the calculation of the average age of dementia onset is not possible.

Cullum et al., (2018) reported on 1106 referrals to a specialist memory service and calculated a mean age of onset of 74.6 years. They also showed that the onset of dementia in Māori and Pacific people referred to a specialist memory clinic was 8.5 years and 5 years earlier respectively, when compared to those of European/Pakeha ethnicity (table 41).

Table 41

References:

Cullum S., Mullin K., Zeng I., Yates S., Payman V., Fisher M., et al. (2018). Do community-dwelling Maori and Pacific peoples present with dementia at a younger age and at a later stage compared with NZ Europeans? Int J Geriatr Psychiatry. 33(8):1098-104. https://doi.org/10.1002/gps.4898.

There is no NZ data the average life expectancy for dementia in NZ.

When discussing ethnicity, the Deloitte report comments that “While there is evidence that the incidence of dementia may be higher for Māori and Pacific peoples in New Zealand, due to a higher prevalence of cardiovascular risk factors, no data were available to enable modelling of the extent of this difference”. Cullum et al. (2018) findings also suggest a higher incidence/prevalence due to the increased burden of risk factors in Māori and Pacific people.

References:

Cullum S., Mullin K., Zeng I., Yates S., Payman V., Fisher M., et al. (2018). Do community-dwelling Maori and Pacific peoples present with dementia at a younger age and at a later stage compared with NZ Europeans? Int J Geriatr Psychiatry. 33(8):1098-104. https://doi.org/10.1002/gps.4898.

There is no NZ specific data on subgroups of dementia.

There is no NZ data on the link between poverty and dementia in NZ.

The risk factors associated with dementia in NZ are the same as those identified by The Lancet commission on dementia, intervention, and care. There is a comment in the NZ Dementia Framework that “Māori also have a higher rate of risk factors for dementia when conditions such as depression, head trauma, and substance abuse disorders are considered” (Ministry of Health, 2013). As noted in a section above, there is also evidence that Māori and Pacific people develop dementia at a younger age, possibly in the context of a higher risk factor burden.

References:

Ministry of Health. (2013). New Zealand Framework for Dementia Care. Wellington Ministry of Health.

Table 42: School leavers by age, ethnicity, and qualification (Ministry of Education, n.d.)

Table 43

References:

Ministry of Education. (n.d.). School Leaver’s Attainment. Education Counts website. Available from: https://www.educationcounts.govt.nz/statistics/schooling/senior-student-attainment/school-leavers.

The proportion of drinkers by age and ethnicity and drinks per capita are described by Te Hiringa Hauora Health Promotion Agency (2019).

References:

Te Hiringa Hauora Health Promotion Agency. (2019). Key facts about drinking in New Zealand: Infographic. Available from: https://www.hpa.org.nz/research-library/research-publications/key-facts-about-drinking-in-new-zealand-infographic.

Following the release of the NZ dementia Framework in 2013 (Ministry of Health, 2013), DHBs were required to develop dementia pathways as a guide for primary and secondary care. Nine regional pathways were subsequently developed (Health Navigator, 2019), each with region specific advice and guidance on dementia assessment and subsequent management. Most diagnostic assessments for dementia are self or family referrals to primary care and follow the relevant regional pathway. A checklist is also provided as a prompt for which other diagnoses to consider and when to refer to secondary services for further advice/assessment.

References:

Health Navigator. (2019). Dementia | Mate korongenge. Health Navigator New Zealand. Available from: https://www.healthnavigator.org.nz/health-a-z/d/dementia/#Clinical%20pathways.

Ministry of Health. (2013). New Zealand Framework for Dementia Care. Wellington Ministry of Health.

There is no data on the proportion of people with dementia in NZ who have received a diagnostic assessment due to limitations posed by the “diagnosis gap” as a result of those who have dementia but do not interact with health/social services, those who have dementia diagnosed but not recorded, and those who have cognitive impairment but may not receive a dementia related diagnosis. Furthermore, primary care diagnosis coding is not consistent and outpatient clinic diagnoses are not routinely coded.

While access to diagnostic assessment in primary care is reasonably consistent throughout the country, there is a geographical difference in access to specialist memory service assessments for diagnosis and management of complex cases, with only seven of the 20 DHBs offering this dedicated service (Stone et al., 2019).

References:

Stone C., Copeland B., Collier C., Cheung G. (2019). Memory clinic survey in New Zealand: a second look. Australas Psychiatry. 27(5):486-90. https://doi.org/10.1177/1039856219852299.

NASC agencies (Ministry of Health, n.d.) are typically involved in the coordination of care for people with dementia and the funding required for this. Those assessed in secondary care may get additional assistance from the multidisciplinary treating team to facilitate access to, and coordination of, services.

References:

Ministry of Health. (n.d.). Needs Assessment and Service Coordination services. Ministry of Disabled People website. Available from: https://www.health.govt.nz/your-health/services-and-support/disability-services/getting-support-disability/needs-assessment-and-service-coordination-services.

NASC agencies coordinate the ongoing support services for people with dementia. Additional support is provided by NGO’s such as regional branches of Alzheimer’s NZ and Dementia NZ.

Based on the NZ Dementia framework, regional dementia pathways (as outlined earlier) outline the process of assessment and access to support services, as well as the local organisations responsible for providing them. The links between primary care and secondary/specialist services are also detailed in the pathway.

The majority of dementia diagnoses are made in primary care, and this usually carries an additional fee to top up the government subsidy for primary care. There is no cost to those assessed in secondary or specialist care.

As detailed in the overview of the health system (part 2) and long-term care system (part 3), New Zealand provides a universal health care system that funds most dementia care services, but there are some services that are means/asset tested.

Access to long-term care is coordinated through the local NASC agency (see part 3).

The Deloitte Dementia Economic Impact report 2016 (Deloitte Access Economics, 2017) details a comprehensive cost analysis of dementia in NZ. Direct health system costs were estimated at NZD$1.1 billlion in 2017, ~75% of which was due to the costs associated with aged care.

Of the NZD$1.1 billion, most of this was covered by the government, with out-of-pocket costs and private insurance accounting for the remaining.

When the wider economic costs of dementia are accounted for, there is an extra NZD$570 million of economic costs in the form of lost productivity (both from the individual with dementia and those leaving work to care for them), informal care costs, and other costs associated with providing care for a person with dementia.

References:

Deloitte Access Economics. (2017). Dementia Economic Impact Report 2016. Available from: https://www2.deloitte.com/nz/en/pages/economics/articles/dementia-economic-impact-report-2016.html.

Yes – see part 3.

While there are no specific diagnostic services per se in primary care, there is an expectation that primary care is the first point of contact for the assessment of cognitive impairment and that they will be able to assess and manage most uncomplicated dementias. All primary care practitioners have access to the regional dementia pathways which outline the process of assessment and management of dementia, as well as the threshold for referral to secondary or specialist services.

As with the regional pathways for the assessment of dementia, there is also a pathway for the management of dementia, which includes a section on assessment, recognition, and management of the behavioural and psychological symptoms of dementia (BPSD), and when to consider referral to specialist services.

Yes – see part 3.

Yes – see part 3.

Yes – In addition to the other available services, there are also specialist palliative care services to support those receiving palliative care at home or in residential care. These services work alongside primary care and community nursing services and provide support as a person with dementia approaches the end of life (BPAC NZ, 2020).

References:

BPAC NZ. (2020). Understanding the role of palliative care for people with advanced dementia. Available from: https://bpac.org.nz/2020/palliative1.aspx.

Yes – see parts 2 and 3.

Eligibility for community-based services is assessed based on need and is funded nationwide. However, despite funding availability, not all community services are available nationwide, and this is especially evident in smaller, more rural towns and communities.

As outlined in part 3, while most services are publicly funded, provision of services is by both the public and private sector.

All people receiving funded community-based care must undergo a formal needs assessment utilising the interRAI suite (Ministry of Health, 2018). For the 2019/20 year, 28% of those receiving a home care assessment and 49% of those receiving a long-term care facility assessment had a diagnosis of dementia. Assuming one assessment per person, this equates to ~8700 people with dementia in the community and ~18,000 people with dementia in aged residential care.

References:

Ministry of Health. (2018). interRAI. Minstry of Health website. Available from: https://www.health.govt.nz/our-work/life-stages/health-older-people/needs-assessment/interrai#:~:text=interRAI%20is%20a%20suite%20of,and%20in%20aged%20residential%20care.

There is no formal system in NZ for care managers/dementia advisors to assist with the coordination of care, treatment, and support. While NASC agencies will coordinate funding and access to services, they don’t tend to get involved with the broader care and management. Some NGOs and local dementia organisations will fulfil this role, as will the MDT of those being managed under specialist services, but there is no formal system in place to facilitate navigation through the system.

Family and close contacts are regarded as useful sources of information in the assessment process.

The Best Practice Advocacy Centre (bpac^nz) (BPAC NZ website) a not-for-profit organisation delivering educational and continuing professional development programs to health professionals in NZ, summarises the guidance provided for the management of BPSD. They recommend firstly conducting a thorough and holistic review of the symptoms including understanding the symptoms in the context of the individual, assessing for any other underlying causes, or contributing factors and identifying target behaviours.

Non-pharmaceutical interventions are recommended as first line and include recommendations for both behavioural and environmental interventions.

Pharmacological interventions available for the second-line management of BPSD include:

• Acetylcholinesterase inhibitors (Donepezil or Rivastigmine are funded in NZ),
• Selective serotonin reuptake inhibitors (SSRIs) for depression, anxiety, or agitation,
• Antipsychotic medications for aggression, delusions, or hallucinations.

References:

BPAC NZ website. Available from: https://bpac.org.nz.

The availability of social interventions for dementia in the community varies by region.

Yes – see part 3. As noted earlier, while funding from NASC agencies is allocated based on need, there is some regional variability as to what services are available, particularly in smaller or more rural towns. Services available include assistance with personal cares, help around the home and with shopping etc., as well as community programs.

See part 3. Access to care for eligible residents with dementia is universal and, other than aged residential care, is not means tested.

Yes. There are two main associations:

• Alzheimer’s New Zealand, and
• Dementia New Zealand.

Both organisations have a national and regional offices.

Dementia NZ has offices in:

• Auckland
• Waikato
• Lakes
• Hawkes Bay
• Wellington
• Canterbury.

Alzheimer’s NZ has offices in:

• Eastern Bay of Plenty
• Gisborne
• Manawatu
• Marlborough
• Nelson
• Northland
• Otago
• South Canterbury
• Southland
• Taranaki
• Taupo
• Tauranga
• Wairarapa
• Whanganui.

Both organisations work in collaboration with their local branches/affiliates to provide support, education, and information for people affected by dementia and their carers. They work closely with the NASC agencies to coordinate and/or provide a variety of services including:

• assistance with household tasks,
• assistance with personal care needs, such as showering, dressing, or supervising medication,
• day programmes,
• carer relief,
• respite services,
• residential care,
• support with ready-made meals,
• subsidised taxi chits to help with transport costs.

Yes. Both Alzheimer’s NZ and Dementia NZ have been involved in many policy developments related to dementia. Most recently, they have been involved in the development of the Dementia Action Plan 2020-2025 (Mate Wareware Advisory Ropu, et al., 2021). Alzheimer’s NZ also had input into the NZ Dementia Framework (Ministry of Health, 2013).

Alzheimer’s NZ has provided submissions on a range of other issues including the Health and Disability Review, The End-of-Life Choice Bill, and the Government inquiry into mental health and addiction (Alzheimer’s NZ, 2021).

References:

Alzheimer’s NZ. (2021). Advocacy. Available from: https://www.alzheimers.org.nz/our-voice/policy-documents-and-submissions.

Mate Wareware Advisory Ropu, et al., (2021). Improving Dementia Mate Wareware Services in Aotearoa New Zealand: Action Plan. Available from: https://cdn.alzheimers.org.nz/wp-content/uploads/2021/09/Dementia-Mateware-Action-Plan.pdf

Ministry of Health. (2013). New Zealand Framework for Dementia Care. Wellington Ministry of Health.

NGO services are available down to the local level but there is a variability in availability or these services in smaller or more rural towns and communities.

Services provided by NGOs are generally free for the PLWD and funded based on need by the NASC agency.

Table 48: Number of medical doctors, neurologists, and geriatricians in NZ

References:

Cheung G., Sims A., Copeland B., Collins C., Bharathan S. (2018). The third New Zealand Psychiatry of Old Age services and workforce survey. Australas Psychiatry. 26(4):405-9. https://doi.org/10.1177/1039856218765891.

New Zealand Parliament. (n.d.). Indicator 34: Specially trained physicians. Available from: https://oag.parliament.nz/2013/ageing/our-ageing-population-indicators/indicator-34.

Ranta, A., Tiwari, P., Mottershead, J., Abernethy, D., Simpson, M., Brickell, K., et al. (2015). New Zealand’s neurologist workforce: a pragmatic analysis of demand, supply, and future projections. NZ Med J. 128(1419):35-44. Available from: https://pubmed.ncbi.nlm.nih.gov/26365844/.

Table 49: Number of medical doctors, neurologists, and geriatricians in NZ

References:

Cheung G., Sims A., Copeland B., Collins C., Bharathan S. (2018). The third New Zealand Psychiatry of Old Age services and workforce survey. Australas Psychiatry. 26(4):405-9. https://doi.org/10.1177/1039856218765891.

New Zealand Parliament. (n.d.). Indicator 34: Specially trained physicians. Available from: https://oag.parliament.nz/2013/ageing/our-ageing-population-indicators/indicator-34.

Ranta, A., Tiwari, P., Mottershead, J., Abernethy, D., Simpson, M., Brickell, K., et al. (2015). New Zealand’s neurologist workforce: a pragmatic analysis of demand, supply, and future projections. NZ Med J. 128(1419):35-44. Available from: https://pubmed.ncbi.nlm.nih.gov/26365844/.

Yes.

Yes.

Yes.

Yes.

Yes.

Yes.

Yes.

See part 3.

See part 3.

As described above.

Yes.

Yes.

Yes.

Yes.

There are almost 40,000 beds across 668 facilities throughout the country (NZACA, 2020). Dual service beds are beds certified to provide both rest home and hospital level care, depending on the type of care required by the resident.

References:

NZACA. (2020). Aged Residential Care Industry Profile 2019/20. NZACA.

As previously described, long-term care facility (LTCF) interRAI assessments are required for all residents entering residential care and capture the diagnosis of dementia if it is present. According to this data, 49% of all assessments documented a diagnosis of dementia, equating to ~19,500 individuals.

Yes. There are 4,810 dementia specific beds throughout the country (NZACA, 2020). In addition to this, there are 972 psychogeriatric beds, the majority of which are occupied by individuals with dementia.

References:

NZACA. (2020). Aged Residential Care Industry Profile 2019/20. NZACA.

Yes, all hospital admissions have their diagnoses coded – including dementia. Table 51 details 2151 hospital admissions for the 2016/2017 year that had an ICD code for dementia recorded as their primary diagnosis (Ministry of Health, 2019).

Table 51: Hospital admissions and dementia diagnosis for the 2016/2017 year (Ministry of Health, 2019)

References:

Ministry of Health. (2019). Publicly funded hospital discharges – 1 July 2016 to 30 June 2017. Ministry of Health Website. Available from: https://www.health.govt.nz/publication/publicly-funded-hospital-discharges-1-july-2016-30-june-2017.

Table 52 (Eldernet website) details the number of different types of long-term care facilities offered by the 668 providers throughout NZ. Many facilities offer more than one level of care.

Table 52: number of facilities by facility type throughout NZ (Eldernet website).

*Mental health (community and residential), supported living

References:

Eldernet website. Available from: https://www.eldernet.co.nz/search?sort=default&center=-41.00822368854606%2C173.16449849999998&zoom=5&tab=providers&maxProviders=40.

Community centres provide a variety of services for PLWD and their carers including day centres and social clubs for older people as well as respite and day programs for PLWD. For example, Vaka Tautua, a Pacific focussed provider, runs ethnic-specific weekly day programmes involving music and dance, exercise, regular health education seminars and check-ups, and arts and crafts-making (Vaka Tautua website).

References:

Vaka Tautua website. Available from: https://www.vakatautua.co.nz/matua-ola-manuia.

Yes, there are dementia specific programs offered in some of the social centres, many of which are based in dementia facilities. These offer day-programs with varying agendas, but their main purpose is to act as a carer respite service.

Mental health hospitals and institutions don’t tend to play a role in the provision of residential dementia care, with DHB run facilities accounting for only 0.3% (120 beds) of the total beds (NZACA, 2020).

References:

NZACA. (2020). Aged Residential Care Industry Profile 2019/20. NZACA.

Yes. Donepezil, rivastigmine, galantamine, and memantine are all approved for use in NZ. However, only Donepezil (generic) and Rivastigmine transdermal patch (generic) are subsidised by the government.

Yes. Both Donepezil and Rivastigmine patches are available in generic form PHARMAC (n.d.).

 References:

PHARMAC. (n.d.). Community Schedule. PHARMAC website. Available from: https://www.pharmac.govt.nz/wwwtrs/ScheduleOnline.php?code=A2232.

Yes.

Yes.

Yes.

Yes – as above.

Yes.

GPS tracking is available but not subsidised by the government.

Donepezil: NZD$6.64 per 90 10mg tablets ($0.07 per dose)

Rivastigmine patch: NZD$48.75 per 30 9.5mg 24hr patches ($1.60 per dose)

Memantine (no data)

Galantamine (no data)

The Dementia Worldwide Cost Database (DWCD) (Wimo et al., 2017) estimates the amount of informal care time required based on dementia severity, depending on the level of assistance and oversight required. When weighted by New Zealand prevalence of the different dementia severities, each individual with dementia in the community receives on average 21.7hrs of informal care per week (Deloitte Access Economics, 2017).

In the absence of any NZ specific data, the Deloitte report (Deloitte Access Economics, 2017) used international data to estimate that ~92% of people with dementia in the community receive informal care from one or more carers.

References:

Deloitte Access Economics. (2017). Dementia Economic Impact Report 2016. Available from: https://www2.deloitte.com/nz/en/pages/economics/articles/dementia-economic-impact-report-2016.html.

Wimo A., Guerchet M., Ali G. C., Wu Y. T., Prina A. M., Winblad B., et al. (2017). The worldwide costs of dementia 2015 and comparisons with 2010. Alzheimers Dement. 13(1):1-7. https://doi.org/10.1016/j.jalz.2016.07.150.

Caregivers in NZ are more likely to be female (63%), with a median age of 49yrs and the largest age bracket being in the 50–54-year band (Welfare Expert Advisory Group, 2019). From the 2013 census, there were ~430,000 unpaid carers in NZ, 13% of the adult population (Grimmond, 2014). Ethnicity of carers generally reflects proportions of the population, but there is some evidence that Māori and Pacific provide more unpaid care to household members. A higher proportion of Europeans provide care to non-household members (Grimmond, 2014).

There is poor data on a number of subgroups of the carer population, with the Welfare Expert Advisory Group (WEAG) noting insufficient data, and/or a likely undercount of:

• Younger carers,
• Older carers who look after partners, or grandparents caring for grandchildren,
• Patterns of caregiving amongst those from culturally and linguistically diverse backgrounds,
• LGBT carers (Welfare Expert Advisory Group, 2019).

References:

Grimmond D. (2014). The economic value and impacts of informal care in New Zealand. New Zealand Infometrics. Available from: https://cdn.auckland.ac.nz/assets/auckland/about-us/equity-at-the-university/equity-information-staff/information-for-carers/The%20economic%20value%20of%20informal%20care%20in%20New%20Zealand%20Final%20copy.pdf

Welfare Expert Advisory Group. (2019). Current state: Carers of people with health conditions or disabilities. Wellington: Welfare Expert Advisory Group. Available from: http://www.weag.govt.nz/assets/documents/WEAG-report/background-documents/9513d6b9b0/Carers-of-HCD-010419.pdf.

Those providing care are:

• More likely to receive government assistance and less likely to receive income from other sources.
• Hold similar qualifications to the NZ population and are more likely to have higher skilled occupations.
• More likely to not work or work part-time, which accounts for most of the income gap.
• Women are more likely to reduce hours than men.
• Co-residential carers are less likely to be in paid employment.
• Households earn ~10% less (Welfare Expert Advisory Group, 2019; Grimmond, 2014).

References:

Grimmond D. (2014). The economic value and impacts of informal care in New Zealand. New Zealand Infometrics. Available from: https://cdn.auckland.ac.nz/assets/auckland/about-us/equity-at-the-university/equity-information-staff/information-for-carers/The%20economic%20value%20of%20informal%20care%20in%20New%20Zealand%20Final%20copy.pdf.

Welfare Expert Advisory Group. (2019). Current state: Carers of people with health conditions or disabilities. Wellington: Welfare Expert Advisory Group. Available from: http://www.weag.govt.nz/assets/documents/WEAG-report/background-documents/9513d6b9b0/Carers-of-HCD-010419.pdf.

Available supports and eligibility criteria for access are detailed by the Welfare Expert Advisory Group (2019) and the Ministry of Social Development (n.d.).

References:

Ministry of Social Development. (n.d.). A guide for carers. Ministry of Social Development website. Available from: https://www.msd.govt.nz/what-we-can-do/community/carers/guide-for-carers/index.html.

Welfare Expert Advisory Group. (2019). Current state: Carers of people with health conditions or disabilities. Wellington: Welfare Expert Advisory Group. Available from: http://www.weag.govt.nz/assets/documents/WEAG-report/background-documents/9513d6b9b0/Carers-of-HCD-010419.pdf.

NZ is a multicultural country so social norms and traditions tend to vary between the different ethnic groups. As already outlined in part 8, those providing care are predominantly female.

The LiLACS NZ study, a longitudinal study of Māori and Non-Māori New Zealanders of advanced age, interviewed primary carers of participants about aspects of caregiving (Lapsley et al., 2020). Their findings included:

• Carers were more often women, particularly female spouses (because of their longevity and usually younger age), and children (because sex role conventions make it more likely that women will care for parents and parents-in-law).
• Males were cared for over a longer period and receiving more hours of care overall.
• Compared to Non-Māori, Māori received more hours of informal care and their carers were younger, more likely to be offspring, more likely to live in the same household and more likely to be of different ethnicity.

Those from Pacific cultures feel an obligation and responsibility to care for their elderly at home (Tamasese et al., 2014) and this is reflected in the lower proportion of Pacific people in aged residential care. An excerpt from Pacific Perspectives on Ageing in New Zealand highlights some of the challenges faced:

“What both the Elders and the younger people agreed on was that the care of Elders was simpler, supported, and possible within a communal village context. The Elders said that if they were carrying out the same responsibility at home in the Pacific the village structure would support the care of Elders better than the nuclear household living arrangements of New Zealand. In the New Zealand context if each household or family is caring for their own Elders, the pressures grow if there are inadequate familial, government or community supports” (Tamasese et al., 2014).

References:

Lapsley H., Hayman K. J., Muru-Lanning M. L., S. A. Moyes, Keeling S., Edlin R., et al. (2020). Caregiving, ethnicity, and gender in Māori and non-Māori New Zealanders of advanced age: Findings from LiLACS NZ Kaiawhina (Love and Support) study. Australas J Ageing. 39(1):e1-e8. https://doi.org/10.1111/ajag.12671.

Tamasese K, Parsons L, Waldergrave C. (2014). Pacifc perspectives on ageing in New Zealand Wellington The Family Centre. Available from: https://www.massey.ac.nz/massey/fms/Colleges/College%20of%20Humanities%20and%20Social%20Sciences/Psychology/HART/publications/reports/Pacific_Elders_NZLSA_2014.pdf?6A68389EA6EAB37148E4AE22BA963822.

While not specific to dementia, the NZ Longitudinal study of ageing (NZLSA) surveyed a representative sample of ~3000 of 50-84yr olds and showed carers reported poorer mental health, with an increasing burden of care associated with poorer physical health.

The impact of unpaid care on employment and social protection uptake is outlined earlier in this section (Alpass et al., 2014).

References:

Alpass F, Keeling S, Pond R. (2014). The New Zealand Longitudinal Study of Ageing summary report: Caregiving 2014. Available from: https://www.massey.ac.nz/massey/fms/Colleges/College%20of%20Humanities%20and%20Social%20Sciences/Psychology/HART/publications/reports/Caregiving_NZLSA_2014.pdf?1F25ED5CDD43EFD9D5B694DCDD702858.

No.

Yes, see above.

As outlined beforehand, the key providers of support are the Ministry of Health and Ministry of Social Development (MSD) who provide the funding for the various support services.

Yes.

The Human Rights Act 1993 prevents discrimination against those with disabilities or impairments if the person wants to continue working and is still able to perform the required standard (Legislation 3, 1993).

References:

Legislation 3. (1993). Human Rights Act. Available from: http://www.legislation.govt.nz/act/public/1993/0082/latest/DLM304475.html.

Yes.

While not specific to dementia, there are several transport assistance options for those with dementia including:

• National travel assistance is available for those who have a high cost of transport due to distance for those needing frequent specialist medical or disability services.
• Supergold card travel is free outside of peak times for those aged 65+.
• Discount taxi vouchers reduce the cost of taxi travel due to permanent disability, including dementia (Seniorline, n.d.).

References:

Seniorline. (n.d.). Transport. Available from: https://www.seniorline.org.nz/living-in-your-own-home/transport/.

No.

The NZ Dementia framework released by the Ministry of Health in 2013, only mentions research once in the entire document when discussing governance considerations for dementia care provision by the District Health Board which “ensures that new models of care, good practice examples and research are shared locally, regionally, and nationally” (Ministry of Health, 2013).

The NZ Dementia action plan released in 2020 notes the need to “Increase investment in research on dementia, in particular on the epidemiology of dementia in New Zealand, on culturally appropriate ways of describing and approaching dementia for tangata whenua and within Aotearoa New Zealand, and on what works to support people living with dementia” 

References:

Ministry of Health. (2013). New Zealand Framework for Dementia Care. Wellington Ministry of Health.

No.

Yes, at times.

Yes.

Government

While not dementia specific, the government provides research funding that can be applied for incontestable funding rounds. The main health research funding by the government is through the Health Research Council (HRC) – a crown agency dedicated to funding and fostering outstanding research. Other government avenues include the Ministry of Business, Innovation and Employment (MBIE) Ageing well Science Challenge, contestable funding for research into older people.

NGOs and Trusts

There are several NGOs and trusts that can be applied to for research funding. This includes the Alzheimer’s NZ Charitable Trust.

Not specifically for dementia.