Wednesday 3rd March 2021
Repeated COVID-19 lockdowns, with no exemptions or funding support for significant numbers of private primary healthcare practices is putting the viability of thousands of businesses and the wellbeing of the public at risk, warns the New Zealand Chiropractors’ Association (NZCA).
Acting NZCA President Dr Cassandra Fairest, chiropractor says: `We warned last year that a crisis in health care provision may be on the horizon and now it is well and truly here. Media regularly reports on the incredible impact on communities and various industries but our Auckland colleagues and their patients are forgotten victims of the latest lockdown’.
`We have had reports of two chiropractic practices closing their doors forever due to this latest lockdown. After 12 weeks of no hands-on patient care in the past year they just can’t afford to continue. Most other countries are allowing highly skilled allied health workers such as chiropractors to continue, even under elevated levels with appropriate PPE and infection controls. Are primary healthcare providers less trusted than real estate agents, supermarkets and takeaway restaurants to manage Covid-19 precautions?’
The peak body for chiropractic in New Zealand says that many primary health providers, such as chiropractors, dental health practitioners, acupuncturists, physiotherapists and other allied health professions rely on face to face consultations and fee-based income to survive. Prolonged or repeated restrictions on the delivery of healthcare will lead to widespread insolvency of some businesses and leave thousands of New Zealanders without an option for healthcare in their communities.
Cassandra Fairest says: `The NZCA Council has written to COVID-19 Response Minister Chris Hipkins (see below) to again plead our case. Late last year the Ministry asked for submissions on balancing the risk of spread with keeping allied health services going for community well being. We have been told that ‘independent advisors’ decided the risks outweigh the benefits but have not been given any detail about how they came to this conclusion’.
`Ironically, our members have seen a sharp rise in people seeking care during the pandemic yet during Level 3, chiropractic practices remained closed to anything but an incredibly restrictive criteria for urgent care. While telehealth options over a video consultation can suit certain cases, it is of very limited benefit for hands-on providers. Even Level 2 restrictions impact on the flow and viability of some practices with Auckland facing prolonged difficulties’.
`The Ministry of Health restrictions are particularly hard on chiropractors that depend on hands-on interactions and are paid out of pocket fees by the public. They are highly trained health professionals who have excellent knowledge
and ability to screen for COVID symptoms, practice infection control and appropriate PPE use, and have exceptional contact tracing information built into their patient management systems already. These practitioners and their clients that depend on their services are being severely affected by the pandemic response. Of course, many industries are struggling but at least some can still operate with physical distancing or click and collect and still have some income. Our members face a gruelling scenario if rolling lockdowns continue and it is going to end up costing the country in deteriorating public health and elevated longer term healthcare costs’.
Hospitality, tourism, the creative arts, and some other industries are receiving targeted assistance, however those healthcare businesses with no public funding streams, which make up a large portion of essential healthcare services, seem to be a forgotten sector. Chiropractors work in the field of health promotion and wellbeing, something which should be of high importance given the pandemic that we are facing. Having access to healthcare services and the benefits it provides to both the public and the economy should ideally be placed ahead of the ‘nice to haves’ such as dining out or an adventure holiday. Even before COVID-19, there was a need for Government support of a broader range of healthcare options which currently completely miss out on any funding, such as that given to GP practices and the DHBs and hospital system.
Chiropractors are regulated primary health care professionals registered under the HPCA Act with close to 700 annual practicing certificate holders practising in solo, group, and multidisciplinary clinics around New Zealand. New Zealand chiropractors have significant training (a minimum 5-year tertiary degree) and a broad yet highly skilled scope of practice and clinical expertise. They provide care for the public in a wide range of health concerns, including spinal problems, posture, certain neurological issues and chronic pain. Importantly, particularly with the heightened levels of mental health concerns being seen this year, chiropractors help many people with anxiety, sleeping difficulties and stress related disorders through their ability to assist the nervous system. There has also been an increase in the number of people seeking chiropractic care for postural related strain and stress from working at home. These health concerns highlight how important it is that the public can have access to chiropractors during increasing alert levels.
New Zealand’s chiropractors are taking the lead to inform, and inspire people to improve their health and prevent pain and disability by educating the public to have a greater understanding of the relationship between their spine and nervous system and how this affects their function and overall wellbeing.
At a time when people are dealing with significant stress and different health concerns, now more than ever we need to ensure the public has access to all health care services when they need it.
Cassandra Fairest, 021 242 3073
Peter Boyes 027 554 0500 or [email protected]
2 March 2021
Hon. Chris Hipkins
Minister for COVID-19 Response
Cc: Hon. Andrew Little
Dear Minister Hipkins,
Re: Greater Access to Provide Chiropractic Care Under COVID-19 Alert Levels 3 and 4
Chiropractors are primary health care professionals registered under the HPCA Act, with close to 700 APC holders practising in solo, group, and multidisciplinary clinics around New Zealand. We have significant training (a minimum 5-year tertiary degree) and a broad yet highly skilled scope of practice . Our clinical expertise includes manual spinal and extremity care, radiography and radiology, orthopaedics, pediatrics, neurology, rheumatology, physiology and pathology. Our desire is to be ready to help wherever and whenever we can.
Doctors of Chiropractic also provide care and imaging services for acute and chronic neuro-musculo-skeletal conditions. Reports indicate that this need is growing and increasing in pressure, as are mental health issues such as anxiety which many of our patients are now experiencing due to increased stress, including the inability to access care when required. Posture-related stress and discomfort has also increased significantly, due to the required change in workplace (ie. working from home) under elevated alert levels. Allowing chiropractors who are deemed essential to be able to provide care to patients under elevated alert levels will assist in keeping public hospital emergency departments and general practitioner waiting rooms free for other urgent work and COVID-19 assessment and treatment.
Unfortunately, due to the extraordinary circumstances the COVID-19 pandemic has created throughout our country, many chiropractors have had their businesses and ability to provide care severely restricted. Our services were deemed essential in 2020; however that status comes with extreme restrictions to normal practice under elevated alert levels, particularly when levels 3 and 4. Under Alert Level 3, chiropractors must close their practices, as under current New Zealand Chiropractic Board guidelines we are able to provide urgent and emergency care only. For instance, under those restrictions, there may be only a handful of the public that would be eligible for care under the current criteria. This means that in Auckland, our chiropractors have now had to close their practices for 12 weeks in the past 11 months.
Due to this latest lockdown, we are now hearing that some practices will have to close permanently. These are long-established, previously successful practices that cannot withstand the financial pressure they have been subjected to under these circumstances. The only funding available to us is the wage subsidy, or resurgence payment. Many chiropractors have utilised the interest-free small business loan. Unfortunately, despite government assurances, banks are reluctant to lend further to small business owners due to the pandemic, and many of our members are now under significant financial stress.
It is worth noting that New Zealand is one of the only countries worldwide that has not included chiropractors as front-line healthcare providers. In cities like London, where the pandemic has raged, chiropractors have remained open to assist in taking load off the NHS and the government has encouraged the public to see chiropractors. In high alert levels in Sydney, chiropractic practices were open and able to operate with specific spacing between patients, and stringent cleaning in between visits. Our chiropractors in New Zealand have electronic booking systems, which enables rapid and accurate contact tracing, and also display QR codes so patients can check-in with the app. Our sitting President, Dr Hayden Thomas, had a conversation today with the Secretary-General for the World Federation of Chiropractic, who was surprised to hear that chiropractors in New Zealand were unable to provide care to the public with such little community spread. He commented that chiropractors in the UK, USA, Denmark and Canada were still open and able to operate despite severe lockdown restrictions in their countries. These country’s health systems are running as per normal, apart from the addition of infection and minimisation protocols, so as to keep their entire healthcare systems operational. It would appear that New Zealand is not in alignment with the same healthcare objectives currently.
Many of our chiropractors have sourced and hold ready stocks of appropriate PPE, at significant personal outlay. Our guidelines for use of PPE from our Regulatory Authority are stringent, our practitioners are highly skilled, and willing to do whatever it takes in order to be able to keep
their practices open so that we can provide care for those who would like access to it.
I have attached a copy of submission made to Martin Chadwick, CAHPO, that was declined with no discussion. Your further review of the points in the document would be greatly appreciated; as would any relevant commentary.
NZCA members are engaged and in support of the national programme to defeat COVID-19. We would encourage the Ministry to urgently review these issues and we thank you for your consideration. To discuss how we can better support and serve the health sector at this time and into the future, please contact me in the first instance.
Dr Cassandra Fairest ( B.Chiro, MNZCA)
New Zealand Chiropractors’ Association
Email: [email protected]
PO Box 3217 Richmond Nelson 7050. Email: [email protected] Ph: 0800 006 922