Preliminary thinking on Paritutu health support service released

Allen and Clarke Policy and Regulatory Specialists Limited today released its preliminary thinking on the possible future shape of a health support service for residents of Paritutu and others who have been exposed to dioxin.

Allen & Clarke Director, Matthew Allen said final decisions on the future recommendations to the Ministry of Health were yet to be made, but they wanted to signal to interested parties the direction of their thinking.

“We’d also like to thank the more than 130 people who shared their views with us. Without them, we wouldn’t have been able to progress this far.”

“We thought it fairer to indicate our thinking now rather than simply record what people said as part of the recent consultation. This way, any serious concerns about the direction we are heading can be brought to our attention now when there is still an opportunity to influence our recommendations.”

Mr Allen stressed the broad support for using evidence and best practice to guide the development of any service.

“Many submitters appreciated the need to ensure that recommendations are backed up by evidence demonstrating effectiveness in meeting health needs, and being in sync with other services provided in New Zealand.” Mr Allen said.

“We received the clear message that many people are upset and angry that they have been exposed to a chemical through no fault of their own which may put them at increased risk of developing cancer or becoming unwell. Any new health service will need to be of use to, and valued by, those affected. This is a key consideration in all our work”.

Allen & Clarke’s preliminary thinking indicates support for: Training and information to health providers supporting exposed people A free annual health check, with personalised care plans being developed for exposed persons by their GP Referral, as required, to health promoting services such as advice on nutrition, physical activity and counselling and support programmes for quitting smoking and reducing alcohol use Referral, as required, to counselling and other mental health services Referral to screening and other tests as required The establishment of a database for those exposed to dioxin.

Allen & Clarke is also exploring options for: Finalising eligibility for accessing the health support service – though criteria are unlikely to require medical testing or the existence of specified health conditions Improving GPs’ knowledge on genetic counselling and when it is appropriate for people who have been exposed to dioxin Making genetic advice more widely available – given the constraints on access to genetic counselling More definite advice on the usefulness of DNA testing and genetic counselling for people exposed to dioxin: Allen & Clarke has sought advice from an expert and this will be released when available A clinical route for accessing blood serum dioxin testing – some submitters have argued that the uncertainty around their dioxin levels is causing stress and potentially harming their health. One option would be to fund blood tests on the basis of a clinical assessment and counselling Services for children and grandchildren of those exposed – the science currently available seems to provide some reassurance against any risks being passed on, but there needs to be a watching brief on new research and further consideration of how best to support children and grandchildren in the future.

Allen & Clarke believe some options are not viable: Shortcuts for access to service not based on clinical need. This is out of step with access to other publicly funded health services.

“The focus of the health support service will be on supporting people to keep well, and speedily identifying any conditions should they develop. We believe it is only fair that added emphasis goes on supporting those who have been exposed. However, if someone develops a health condition, then, as with all New Zealanders who develop a health condition, the health system response should be based on individual clinical priority, not on the cause of that condition.”

Mr Allen said there was a lot of support from submitters for further blood dioxin testing.

“We recognise that there may be some misunderstanding about what a blood test for dioxin can really tell you or what it involves. One approach might therefore be to make tests available once individuals are fully informed about the tests. If they, in discussion with their clinician, believe a test would be beneficial, and knowledge of the test result is likely to give them some peace of mind or an ability to move on, then that may provide some justification.”

“The community has told us that there is considerable concern about the potential impacts on children and grandchildren of their parents’ and grandparents’ exposure to dioxin. Evidence from international bodies does not indicate that a wide range of conditions are associated with parents’ exposure to dioxin, with the exception of spina bifida and even here the evidence is limited.

“Our thinking is to look further at the provision of more specialist assessments for diagnosis of more subtle forms of spina bifida. We also propose inclusion of children and grandchildren in any exposure database as a separate category. In the future, as further evidence comes to light, this may mean reassessing what services should be made available”.

Allen & Clarke emphasised that they wanted people’s views on all their preliminary thinking and that final decisions are not expected till early next year.

Those interested in providing further information to inform Allen & Clarke’s final recommendations are asked to do so by 31 October or to contact Allen & Clarke as soon as possible if this timing poses a problem.

Allen & Clarke will be continuing with further work on all options including developing the detail of what services may entail, how they might be accessed, extent of provision and funding. Allen & Clarke’s final recommendations to the Ministry of Health will be provided in February 2008 and the Ministry of Health expects to have the service up and running from mid 2008.

ENDS

Background information

People living in Paritutu have been concerned for a long time about dioxin exposure from the Ivon Watkins-Dow (IWD) plant. A recent serum dioxin study showed that some residents have TCCD at levels significantly above those of the general New Zealand population.

The Ministry of Health has concluded that the dioxin levels found amongst a group of Paritutu residents may have health consequences for individuals and may cause increased rates of disease, in particular cancer, on a population basis. This means that there could be a small additional increase in cancers as a result of exposure to a small group, but because of the nature of cancer and the exposure it would be impossible to determine which individual cases of cancer were actually caused by the exposure. The extent of the increased cancer risk is difficult to precisely determine, but is estimated that it may be up to 10% above the national cancer mortality rate for Paritutu residents.

The health support service project involves developing and consulting on options for a health support service for residents and former residents who may have been exposed to dioxin from the Ivon Watkins-Dow plant in New Plymouth between 1962 and 1987, and on the provision of health information and advice to medical practitioners and other health professionals supporting exposed persons.

The Ministry of Health decided to out-source the project to an external provider. The project was put out to tender in September 2006 and Allen and Clarke Policy and Regulatory Specialists Ltd were appointed in March 2007. The project is now expected to be completed in February 2008.

Allen & Clarke’s terms of reference are to research, scope and consult on options for such a programme, including to: review existing research define the criteria for accessing the proposed services develop and analyse options for an early intervention programme develop guidelines, recommendations and specifications for a programme develop a programme for ongoing health information and advice for health professionals consult with the community, Government agencies, and other stakeholders on the proposed programme identify resource and implementation implications develop a monitoring and evaluation framework complete a final report and implementation plan report findings to the Ministry of Health and the community.

Following their review earlier this year, in July 2007 Allen & Clarke released a discussion paper, Health Support Services for People Exposed to Dioxin, setting out options for health support services and requesting that interested parties consider whether the proposed options would meet their health needs and expectations. 132 submissions were received and have now been reviewed.

In addition to considering eligibility criteria for the inclusion of people likely to have been exposed to dioxin while living in Paritutu between 1962 and 1987 in the health support service, the project is also considering whether eligibility for access to such services should be extended to include other exposed groups (for example, occupationally-exposed people and Vietnam veterans).

For the terms of reference and questions and answers on the health support service project see here.

For more information on Allen & Clarke see here.

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