Category: Health

Source: New Zealand Ministry of Health

Summary

This notice authorises Medical Referees to permit cremations to be carried out without complying with the requirement in regulation 7(1) of the cremation regulations for a medical or nurse practitioner to complete form AB or to see and identify the body after death for the purpose of completing form B in situations when:

1. the death is not unexpected; and
2. the medical history and current conditions of the decease are known by a medical or nurse practitioner undertaking their role in accordance with section 46B(2) or 46B(3) of the Burial and Cremation Act (the Act); and
3. the deceased had been a resident in one of the following settings prior to their death, where a registered nurse is available on site:
   • residential care facilities
   • rest homes,
   • other long term-in-patient facilities.

This authorisation comes into force on 20 December 2024 and will expire on 31 December 2025.

Further guidance can be found on the Health New Zealand website.

Text of authorisation notice

1. Pursuant to regulation 12(b) of the Cremation Regulations 1973 (the Regulations), I, Dr Shane Reti, Minister of Health, for the reason of there being a shortage in the medical workforce servicing aged residential care settings, authorise Medical Referees to permit cremations to be carried out without complying with the requirement in regulation 7(1) for a medical practitioner or nurse practitioner to complete form AB or to see and identify the body after death for the purpose of completing form B in situations when:
   1. the death is not unexpected; and
   2. the medical history and current conditions of the deceased are known by a medical or nurse practitioner undertaking their role in accordance with section 46B(2) or 46B(3) of the Burial and Cremation Act 1964 (the Act); and
   3. the deceased had been a resident in one of the following settings prior to their death, where a registered nurse is available on site:
      • Residential care facilities,
      • Rest homes,
      • Other long term-in-patient facilities.
2. This authorisation is subject to the following conditions:
   1. the Medical Referee must receive advice from a trusted source who has seen the body and has a reasonable level of assurance of the cause of death; and
   2. the Medical Referee must record the identity, contact details and occupation of the trusted source; and
   3. the trusted source must verify:
      1. The identify of the deceased; and
      2. That the deceased died of natural causes; and
   4. the Cremation Authority must confirm whether there is a biomechanical aid in the body.
3. For the avoidance of doubt, this authorisation does not exempt a medical practitioner or nurse practitioner from their performing their obligations under section 46B of the Act.
4. The authorisation comes into force on 20 December 2024 and will expire on 31 December 2025.

Dated at Wellington this 27th day of November 2024

Hon Dr Shane Reti
Minister of Health

Minimum legislative information

Title	Authorisation under the Cremation Regulations 1973
Empowering Act and provisions	The cremation regulations are made under Burial and Cremation Act 1964. Under regulation 12b of the Cremation Regulations, the Minister of Health may in the event of an epidemic or for other sufficient reason, permit cremations to be carried out, or authorise Medical Referees to permit cremations to be carried out, in any place, without complying to regulation 7 of the Cremation Regulations.
Replacement empowering Act and provisions	N/A
Maker name	Minister of Health
Administering agency	Ministry of Health
Date made	27 November 2024
Publication date	12 December 2024
Notification date	Not notified
Commencement date	20 December 2024
End date (when applicable)	31 December 2025
Instrument classification	Principal

Source: New Zealand Ministry of Health

The 2014 report from the Royal Society of New Zealand (RSNZ) and the 2021 report from the Office of the Prime Minister’s Chief Science Advisor (OPMCSA) on the risks and benefits of community water fluoridation (CWF) concluded that CWF is a safe and effective public health intervention to prevent dental caries.

This current review updates the evidence regarding CWF published since the OPMCSA report of 2021.

The current review supports that conclusion on the basis that;

• the evidence that has been published since 2021 indicates ongoing clear benefits from CWF even during the period when alternative forms of fluoride (such as fluoride toothpaste) are available and 
• CWF promotes equity by decreasing the incidence and severity of dental caries in individuals in areas of high socioeconomic deprivation as much as, or more than individuals in areas of less deprivation and 
• there has been no high-quality evidence published since those 2014 and 2021 reports to suggest a causal link between fluoride exposure at the levels used in Aotearoa New Zealand for CWF and significant harm to health.

Individuals living in countries with high naturally occurring fluoride in drinking water are at greater risk of dental fluorosis. However, the risk and severity of this complication in the setting of CWF is very low. Aotearoa New Zealand does not have high naturally occurring fluoride levels in drinking water.

Source: New Zealand Ministry of Health

The Code of Practice for Diagnostic and Interventional Radiology: ORS C1 2024 (C1 2024) is issued by the Director for Radiation Safety under section 86 of the Radiation Safety Act 2016 (the Act).

 C1 2024 specifies the technical requirements that a person who deals with the diagnostic and interventional radiological equipment outlined in the scope of C1 2024 must comply with in order to comply with the fundamental requirements of the Act. 

This code came into force on 1 December 2024.

Scope

C1 2024 applies to radiation practices associated with radiological equipment used for diagnostic radiology procedures, interventional radiology procedures, and the use of cone beam computed tomography enabled equipment in dentistry and research. Practices include manufacture, possess, control, manage, use, service and repair, transport, store, import, export, sell, supply and disposal of equipment.

Compliance with C1 2024 does not imply compliance in related areas such as health practitioners’ clinical competence, occupational safety, hazards in the workplace, resource management and transport of hazardous substances. 

Consultation and notification

In September 2023, the Ministry of Health reviewed the now revoked C1 2018 and concluded that revisions were required. In August 2024, a second round of consultation was conducted on the changes made to the public consultation version of C1 as a result of the submissions received. 

On 19 November 2024, the Director for Radiation Safety gave notice in the New Zealand Gazette that C1 2024 is issued and comes into force on 1 December 2024.

Changes in C1 2024

Holder of a source licence

C1 2024 replaces the term ‘managing entity’ used in the revoked C1 2018 with terms referred to in the Act. In almost all cases, the new term used is ‘holder of a source licence’.

Equipment requirements

C1 2024 no longer provides a definitive set of tests and conditions that must be met irrespective of the local clinical situation. The C1 2024 equipment-related safety and performance requirements must now be established by the source licence holder, in conjunction with clinical staff and a medical physics expert, that are specific to the local situation. Equipment reference values must be recorded, regularly reviewed, and be made readily available for compliance monitoring purposes. The holder of a source licence is also required to use the equipment reference values to remedy equipment, or suspend the use of equipment, that is operating outside of acceptable performance parameters based on its reference values.  

Training and authorisation

C1 2024 introduces explicit training requirements for people who are appointed by the holder of a source licence to perform the radiation protection and safety roles required by C1 2024. Explicit training requirements for a Radiation Safety Officer (RSO) have been set out in a new Appendix 2. 

Radiation shielding approvals

C1 2024 introduces a new requirement for the holder of a source licence to ensure that a medical physics expert, or another qualified expert, approves all radiation shielding installed as part of a place or structure.  

Standards and conditions for continuous individual monitoring of workers

C1 2024 alters the obligations of the holder of a source licence when it comes to the continuous individual monitoring of radiation doses to workers. Also, the holder of a source licence is required, to the extent practicable, to use a dose monitoring provider that is accredited to an appropriate standard. Continuous individual monitoring is now required if a worker may receive three tenths of a radiation dose limit. 

Justification of occupational and public exposures

C1 2024 introduces an explicit requirement for the holder of a source licence to consider occupational and public exposures, as well as patient exposures, when justifying each radiological exposure. This change means that the fundamental requirement set out in section 9(1) of the Radiation Safety Act 2016 are fully reflected in the justification requirements of C4 2024. 

Other changes

C1 2024 makes a significant number of technical clarifications and wording changes to improve readability, clarity of meaning, and to adopt the terminology used in the Act.  

What this means for clinical practice

The Director for Radiation Safety has aimed to make the minimal amount of change for the people who must comply with C1 2024 while addressing the issues raised in the review of the now revoked C1 2018. 

Guidance notes

The changes made in C1 2024 mean that the Diagnostic X-ray Testing Frequency Guidelines (G1 2021)  and the Compliance Guide for Dental Radiology including Dental Cone Beam CT: ORS G4 (G4 2021)  have been superseded. The Director for Radiation Safety intends to publish updated guidance to compliment C1 2024 in due course.  Please contact [email protected] if you require a copy of a superseded compliance guide. 

Application of revoked C1 2018

On 1 December 2024, ORS C1 2018 was revoked. The provisions of the revoked C1 2018 no longer apply. However, the provisions of the revoked C1 2018 may apply to any matter that occurred while it was in force from 9 November 2018 to 31 October 2024. 

add removePrevious versions

On 19 November 2024, the Director for Radiation Safety gave notice in the New Zealand Gazette that the Code of Practice for Diagnostic and Interventional Radiology: ORS C1 2018 is revoked on 1 December 2024.  The revoked C1 2018 came into force on 9 November 2018 and has been replaced by the Code of Practice for Dental Radiology: ORS C1 2024 (C1 2024). A copy of the revoked C4 2018 is available below.

Revoked Code of Practice for Diagnostic and Interventional Radiology: ORS C1 2018 (DOCX, 350 KB)

Revoked Code of Practice for Diagnostic and Interventional Radiology: ORS C1 2018 (PDF, 585 KB)

Source: New Zealand Ministry of Health

The Code of Practice for Dental Radiology: ORS C4 (C4 2024) is issued by the Director for Radiation Safety under section 86 of the Radiation Safety Act 2016 (the Act). C4 2024 specifies the technical requirements that a person who deals with the dental radiological equipment outlined in the scope of C4 2024 must comply with in order to comply with the fundamental requirements of the Act.

The requirements of C4 2024 do not limit the general application of the fundamental requirements of the Act.

This code came into force on 1 December 2024.

Scope

C4 2024 applies to radiation practices associated with radiological equipment used for intraoral, panoramic and cephalometric dental procedures. Practices associated with cone beam computed tomography equipment are dealt with in the Code of Practice for Diagnostic and Interventional Radiology: ORS C1 .

Practices can include: manufacture, possess, control, manage, use, service and repair, transport, store, export, import, sell, supply and disposal of equipment.

Compliance with C4 2024 does not imply compliance in related areas such as health practitioners’ clinical competence, occupational safety, hazards in the workplace, resource management and transport of hazardous substances. 

Consultation and notification

In May 2023, the Ministry of Health reviewed the now revoked C4 2018 and concluded that revisions were required. In August 2024, a second round of consultation was conducted on the changes made to the public consultation version of C4 as a result of the submissions received.  

On 19 November 2024, the Director for Radiation Safety gave notice in the New Zealand Gazette that C4 2024 is issued to come into force on 1 December 2024.

Changes in C4 2024

Holder of a source licence

C4 2024 replaces the term ‘managing entity’ used in the revoked C4 2018 with terms referred to in the Act. In almost all cases, the new term used is ‘holder of a source licence’.  

Radiation Safety Officer

C4 2024 introduces a new requirement for the holder of a source licence to appoint a radiation safety officer (RSO). This change means that appointing an RSO is now a general requirement of radiation safety codes of practice. The training requirements for an RSO are set out in a new Appendix 2. 

The Director for Radiation Safety considers that, for the purposes of C4 2024 only, people who are, or deemed to be, registered with the Dental Council of New Zealand, and who hold an annual practicing certificate, can be considered to have met the training requirements for an RSO. This condition applies only for the activities specified for the registered practitioner in Schedule 3 of the Radiation Safety Regulations 2016. 

On this basis, a registered practitioner who meets these conditions can be appointed as an RSO by virtue of being deemed to meet the training requirements set out in Appendix 2 of C4 2024. The holder of the source licence can still appoint an RSO who is not a registered practitioner who meets these conditions, however,  such an RSO would need to meet the training requirements set out in Appendix 2 of C4 2024.  

Radiation risk assessment

C4 2024 introduces a new requirement for the holder of a source licence to carry out and maintain a radiation risk assessment. This change means that radiation risk assessments are now a general requirement of radiation safety codes of practice. Radiation risk assessments form the basis for establishing a management system to enhance radiation protection and safety. Establishing a management system to enhance radiation protection and safety was a requirement of the revoked C4 2018 that has been retained for C4 2024.  

Diagnostic reference levels in optimisation

C4 2024 introduces explicit requirements to use, generate or compare diagnostic reference levels (as the situation requires) for optimisation purposes when equipment is commissioned, serviced, or modified (including software updates). This change means that diagnostic reference levels will be used in optimisation activities under all diagnostic and interventional radiology codes of practice. The use of diagnostic reference levels are the primary means to ensure optimisation of radiation safety. Optimisation of radiation safety were requirements of the revoked C4 2018 which have been retained for C4 2024.   

Justification of occupational and public exposures

C4 2024 introduces an explicit requirement for the holder of a source licence, in conjunction with the dental practitioner, to consider occupational and public exposures, as well as patient exposures, when justifying each radiological exposure. This change means that the fundamental requirement set out in section 9(1) of the Radiation Safety Act 2016 is reflected in the justification requirements of C4 2024. 

Other changes

C4 2024 makes a significant number of technical clarifications and wording changes to improve readability and clarity of meaning. 

What the changes mean for dental practice

The Director for Radiation Safety has aimed to make the minimum amount of change for the people who must comply with C4 2024 while addressing the issues raised in the review of the now revoked C4 2018. In many instances, the new, explicit, requirements of C4 2024 formalise what has been implied by the related, but more general, requirements of the revoked C4 2018. 

Guidance notes

The changes made for C4 2024 mean that the Compliance Guide for Dental Radiology including Dental Cone Beam CT: ORS G4 (G4 2021)  and the Diagnostic X-ray Testing Frequency Guidelines (G1 2021) have been superseded. The Director for Radiation Safety intends to publish updated guidance to compliment C4 2024 in due course. Please contact [email protected] if you require a copy of a superseded compliance guide. 
 

Application of revoked C4 2018

On 1 December 2024, ORS C4 2018 was revoked. The provisions of the revoked C4 2018 no longer apply. However, the provisions of the revoked C4 2018 may apply to any matter that occurred while it was in force from 28 June 2018 to 31 October 2024. 

add removePrevious versions

On 19 November 2024, the Director for Radiation Safety gave notice in the New Zealand Gazette that the Code of Practice for Dental Radiology: ORS C4 2018 is revoked on 1 December 2024. The revoked C4 2018 came into force on 28 June 2018 and has been replaced by the Code of Practice for Dental Radiology: ORS C4 2024 (C4 2024). A copy of the revoked C4 2018 is available below.  

Revoked code of Practice for Dental Radiology: ORS C4 2018 (PDF, 367 KB)
Revoked Code of Practice for Dental Radiology: ORS C4 2018 (DOCX, 133 KB)

Source: New Zealand Ministry of Health

Most New Zealand’s buildings are ‘naturally’ ventilated, meaning they rely on the opening of windows (and/or doors) by occupants. Ventilation habits are often inefficient, probably because we have a relatively poor innate sense of when a room is under-ventilated. Most members of the public under-estimate how effective windows can be in improving ventilation and air quality.

With increased recognition following the COVID-19 pandemic of the role of ventilation in reducing the risk of spreading illness, National Institute of Water and Atmospheric Research (NIWA) were commissioned by the Ministry of Health to:

• assess the state of ventilation (inferred from measurements of carbon dioxide) in a sample of mostly naturally ventilated buildings occupied by people more vulnerable to the acute health effects of COVID-19 infection
• explore the potential for improving ventilation through changes in ventilation behaviour
• explore the potential for using carbon dioxide monitoring data to promote pro-ventilation behaviour change.

This research helped to inform updated ventilation guidance on the Health Information and Services website. 

Source: New Zealand Ministry of Health

The Government has tasked the Ministry of Health with consulting on whether there should be additional safety measures for puberty blockers, such as regulations under the Medicines Act.

On 21 November 2024 the Ministry of Health published its evidence brief and position statement on puberty blockers.

The Evidence Review found a lack of good quality evidence for the effectiveness or safety of puberty blocking treatment in young people with gender dysphoria. We do not have good evidence to say that the medicines used improve the longer-term outcomes for young people with gender-related health needs – nor that the potential longer-term risks are low.  

add removeWhat are puberty blockers?

Puberty blockers are medicines called gonadotrophin releasing hormone agonists.

They are known as puberty blockers when used as part of gender-affirming care to delay the start of puberty for a young person.

The same medicines are used to treat precocious (very early) puberty in children. In adults, they are used to treat endometriosis, breast and prostate cancers, polycystic ovary syndrome and other conditions.

Puberty blockers are different to gender-affirming or cross-sex hormone therapy. 

In response to the Evidence Review, the Ministry of Health issued a Position Statement, to communicate expectations of prescribers and other practitioners involved in providing care for young people with gender incongruence and dysphoria.

add removeWhat the Position Statement does

The Position Statement sets out that treatment should be started only by prescribers who are experienced in gender-affirming care and working as part of an interprofessional team offering a range of supports and services.

Patients and families should be fully informed of the lack of evidence for long-term effects from these medicines.

The Ministry has issued the Position Statement to:

• put additional safeguards in place to protect children and young people from any potential harm
• set out clear expectations for health practitioners
• provide a firm basis for regulatory oversight of prescribers by the Medical Council of New Zealand
• uphold the rights of children and young people not to be subjected to medical or scientific experimentation without consent and not to be subject to discrimination.

Further safety measures being considered

The Ministry is considering whether further measures need to be put in place to ensure no children or young people are unduly exposed to unknown risks.  

The further measures being considered include updating clinical guidance, increased monitoring of prescriptions, and regulatory measures.  

For example, a regulation made under the Medicines Act could restrict prescribing of puberty blockers in the context of gender-affirming care, without affecting prescribing for other conditions. ​

Purpose of consultation

The Ministry wishes to take into account all information and views before any decisions on further safety measures are made.  

In particular, the Ministry seeks input from organisations that represent people who may be affected by safety measures or that may be involved in how safety measures are used in practice.  

What we are asking about

We have a series of questions that ask about:

• whether additional safety measures are needed
• whether prescribing should be further restricted  
• which young people with gender-related health needs should be able to receive this treatment if prescribing is further restricted
• what impacts there could be from additional safety measures.

Source: New Zealand Ministry of Health

This literature review summarises the latest national and international evidence of the safety and long-term impacts of puberty blockers on adolescents. It is accompanied by the Ministry’s position statement which sets out next steps to ensure young people with gender incongruence and gender dysphoria have access to quality care.

In 2023, the Ministry of Health undertook an extensive review of the evidence of the safety and long-term impacts of puberty blockers for adolescents with gender dysphoria.

The evidence brief represents detailed assessment of the evidence. It found limitations in the quality of evidence for both the benefits and risks (or lack thereof) of the use of puberty blockers.

Health agencies are now working to develop an appropriate response for the New Zealand context. This includes strengthening the evidence base and developing updated guidelines for clinicians.

The Ministry has developed an accompanying position statement which sets out the next steps in more detail.

This is an evolving area of research, and the Ministry will continue to monitor the evidence as it develops.

Evidence brief

Supplementary material

Source: New Zealand Ministry of Health

Purpose

This position statement accompanies the release of an evidence brief which examines the safety and long-term impacts of puberty blockers when used in the context of gender-affirming care.

This statement summarises the brief’s findings and sets out the Ministry of Health’s expectations for their use.

In addition, it outlines our next steps that will ensure young people with gender incongruence and gender dysphoria have access to quality care. It also provides relevant information for health professionals, rainbow communities, and the general public.

Background

In September 2022, the Ministry of Health updated its position on the safety and reversibility of puberty blockers when used for gender-affirming care. This was in light of work underway in other jurisdictions examining the clinical effects of puberty blockers on adolescents. The evidence brief examines the risks and benefits of puberty blockers when used for gender-affirming care.

Source: New Zealand Ministry of Health

In 2024, the Ministry of Health completed the first review of the End of Life Choice Act 2019.

The End of Life Choice Act is the law that makes assisted dying legal in New Zealand. The Act came into force on 7 November 2021, following a public referendum held alongside the 2020 General Election. The Act is administered by the Ministry of Health.

Under the legislation, the Ministry of Health is required to review the operation of the Act within three years of it coming into force, and every five years after that.

The review of the Act was undertaken in 2 parts:

• a review of the operation of the Act by the Ministry of Health
• an online process to gather public opinion about changes that could be made to the Act.

This publication provides a summary of the feedback received through the online process. The online process was open for submissions from the public from 1 August to 26 September 2024. The Ministry received 2759 submissions from organisations and individuals as part of that process.

The Ministry’s review of the operation of the Act can be found at Review of the End of Life Choice Act 2019.