Dr Shane Reti made 19 unauthorised visits to EDs earlier this year.
Health officials were blindsided by Dr Shane Reti’s 19 unauthorised visits to hospital emergency departments and strongly criticised the ambulance service Hato Hone St John for facilitating them, according to emails obtained by the Herald.
Correspondence newly released under the Official Information Act reveals the depths of the political storm that erupted after National’s health spokesperson accompanied ambulance crews into EDs for months without informing Te Whatu Ora - Health New Zealand.
In one email, Te Whatu Ora’s chief of staff told a senior aide to Health Minister Dr Ayesha Verrall that the frequency of Reti’s ED visits was “not acceptable”.
In a formal letter a few weeks later, Te Whatu Ora accused St John of disregarding Te Whatu Ora’s “core interests” by exposing it to negative media attention and political controversy.
“As a funder, we must have confidence you have robust processes in place to ensure integrity and political neutrality in your operations,” said a senior executive at the national health authority.
The Herald revealed in July that Reti had repeatedly shadowed ambulance crews from St John and Wellington Free Ambulance on night shifts between January and May.
On nearly all of those rides, Reti accompanied paramedics and patients into public hospital EDs, where he said he witnessed close-up the enormous pressures that understaffed and overcrowded acute services are working under.
“I wanted to see what the after-hours provision was like,” the Whangārei-based MP said in an interview at the time — but his ride-alongs prompted a controversy that reverberated for weeks after.
Although St John and Reti insisted they followed the ambulance service’s procedures for observers, political opponents accused Reti of conducting an elaborate campaign stunt that put patients’ privacy at risk.
Privacy experts said his presence could have violated patient rights because some of the people he encountered may not have been in a fit state to give informed consent.
One complaint was made to the Health and Disability Commissioner, which is still being assessed.
The episode also strained the relationship between Te Whatu Ora and the two ambulance charities that make up a large part of the country’s emergency medical response.
Te Whatu Ora officials were not aware that Reti had visited EDs on these rides until the Herald approached Verrall’s media advisers for comment on July 12.
According to the emails released under the OIA, our enquiry prompted a flurry of messages between Verrall’s aides, Te Whatu Ora officials and the ambulance services.
Te Whatu Ora demanded a list of MPs who had accompanied ambulance crews into its hospitals. St John responded that Reti had been into hospital facilities 17 times with its services.
Labour’s Tracey McLellan, the MP for Banks Peninsula, went on one ride with St John but did not go into any Te Whatu Ora facilities.
Wellington Free Ambulance said it took Reti on two rides. According to its records, the mayors of Lower Hutt, Porirua and South Wairarapa also shadowed its crews.
In one email, a St John executive said Reti’s rides with them had been organised through the ambulance service’s chief executive, Peter Bradley, “over a period of time and weren’t presented as a larger plan to visit all parts of New Zealand”.
Reti told the Herald in July: “I co-ordinate with the CEO and say, ‘Peter, I’d like to now go to Whanganui and New Plymouth on these dates’. He reaches out to the area commanders there. They reach out to their local commanders, and they establish that, yes, it’s going to work, and they establish that there’s an ambulance team that I can work with, and then I just organise the logistics.”
Asked why St John allowed him to accompany its crews so many times, Reti said: “I think they felt that there was benefit to their staff, that their voice would be heard. And secondly, I think they wanted me to see what they could do and what the holes were.”
“There was [a] risk to them,” Reti added. “But I think they wanted me to see what the health front line after dark looks like.”
As independent entities, St John and Wellington Free Ambulance were entitled to determine who could observe on their vehicles — a practice they insisted was governed by protocols that always took into consideration the wellbeing and privacy of patients.
But Te Whatu Ora had its own process that it expected to be followed when those visitors entered EDs and other hospital facilities during those shifts.
Because they could intrude on the privacy of patients and families who were extremely unwell and distressed — or potentially get in the way of clinicians trying to deliver treatment — Te Whatu Ora expected to be notified in advance of any non-essential visitors.
When politicians wanted to visit, the customary practice was for MPs to seek permission from Te Whatu Ora’s chief executive or the Health Minister beforehand.
On one previous occasion, according to the emails, Reti was given permission to visit Rotorua Hospital, but it was agreed that he would not enter the ED as part of that trip.
In July, when they discovered Reti had visited EDs repeatedly for months without their knowledge, Te Whatu Ora officials scrambled to find out how many times it happened and where he went.
“Just received a phone call and it seems the political interest has heightened re this,” one Te Whatu Ora official wrote to a counterpart at St John on July 13.
That day, Peter Alsop, Te Whatu Ora’s chief of staff, emailed a senior aide to Verrall saying: “The frequency of taking visitors (particularly St John) on to Te Whatu Ora premises is not acceptable and we will be following up with the providers.”
“Usual protocol is for them to notify us via Naso [the National Ambulance Sector Office] (along with Te Whatu Ora comms/media and ACC comms/media),” Alsop added. “This did not occur for the instances listed. Both providers have been reminded about the proper protocols they should have followed to notify us beforehand.”
On July 26, Te Whatu Ora followed up with a formal letter to St John stating its protocols for non-essential visitors.
Strict processes were necessary for any guests the ambulance service wanted to bring into EDs who were not necessary for the delivery of health services, to protect patients and staff and avoid services being disrupted.
“It has also been a long-standing expectation that, if you are undertaking activity that is likely to draw media intention [sic] or bring risk to Te Whatu Ora or ACC, we are made aware in advance,” the letter added. “While not your intention, your approach, as we understand it from recent events, has not had sufficient regard for these core interests.”
In the case of MPs, it went on, “We must also consider additional expectations related to serving the Government of the day and acting with integrity and political neutrality … As a service provider operating closely alongside us, this context is also particularly relevant to you. As a funder, we must have confidence you have robust processes in place to ensure integrity and political neutrality in your operations.”
A similar letter was sent to Wellington Free Ambulance on August 2.
Reti, who may be the next Health Minister if a National-led government emerges after the October 14 general election, said the controversy had not caused him to regret the experience.
“It is my job as auditioning Health Minister to pitch my ideas to Kiwis on what National will do to improve the health system,” he said. “If constructive suggestions are brought forward from this experience to help New Zealanders and our hard-working front line, then why is it not a good thing?”
Wellington Free Ambulance said it is undertaking an internal review of its processes relating to observers. St John said it is politically neutral and has a good working relationship with Te Whatu Ora.
Doug Gallagher, St John’s acting chief executive for ambulance operations, said senior managers from St John and Te Whatu Ora have been discussing “an agreeable approach for ambulance ride-alongs where access to emergency departments is concerned. A patient-centric approach is top of mind for both organisations.”
No MPs have been allowed on its ambulances as observers in the past three months.
With Wellington Free Ambulance:
March 22, Wairarapa Hospital in Masterton.
May 14, Wellington Regional Hospital.
With St John:
January 27, Whangārei Hospital.
February 9, Auckland City, Waitākere and Middlemore Hospitals in Auckland.
March 6, Waikato Hospital in Hamilton.
April 10, Timaru Hospital.
April 12, Christchurch Hospital.
April 14, Te Nīkau Hospital in Greymouth.
April 15, Dunedin Hospital.
April 16, Southland Hospital in Invercargill.
April 17, Nelson Hospital.
April 24, Gisborne Hospital.
April 27, Hawke’s Bay Hospital in Hastings and City Medical in Napier.
May 6, Palmerston North Hospital.
May 7, Whanganui Hospital.
May 13, Taranaki Base Hospital in New Plymouth.
Reti also shadowed an ambulance crew in Rotorua on April 30, but they did not visit an ED that night.
Source: Te Whatu Ora emails released under the Official Information Act.
Alex Spence is a senior investigative journalist based in Auckland. Before joining the Herald, he spent 17 years in London where he worked for the Times, Politico, and BuzzFeed News. He can be reached at alex.spence@nzme.co.nz or by text or secure Signal messaging at 027 235 8834.
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