ACC has failed to respond to two OIA requests within the specified timeframe. The requests were made with the website FYI and can be accessed here:
https://fyi.org.nz/request/3043-acupunct...
https://fyi.org.nz/request/3044-correspo...

Both requests were made on August 13th. ACC responded on the day of the 20 working days deadline, September 10th, to ask for a 25 working day extension on each request under section 15A of the OIA. That new deadline passed yesterday, on October 15th, and ACC still has not responded to either request.

Having viewed section 15A of the OIA today, I also see that ACC failed to notify me that I could complain to an Ombudman about the extension (I was under the impression I had to wait until the deadline passed), as is required under part 4(c) of section 15A of the OIA.

As the extended deadline of 25 working days until the 15th of October passed yesterday and I have had no further response from ACC, I have lodged the above complaint with the Ombudsman.

I have made a new request to the Ministry of Health regarding the second part of this request (https://fyi.org.nz/request/3278-correspo...) and sent the following to ACC's Government Services via email:

Dear Government Services team,

I recently had an Official Information Act request refused under section 18(f) (https://fyi.org.nz/request/3044-correspo...). I had asked for the following:

1. All documents and correspondence pertaining to the development of the Acupuncture Treatment Profiles document available here http://www.acc.co.nz/PRD_EXT_CSMP/groups...

2. Any correspondence about acupuncture or other alternative modalities between ACC and Dr David St George, since he took up the position of the Ministry of Health's Chief Advisor of Integrative Health.

My request was refused under section 18(f), after it was estimated that more than 60 hours of additional work would be required to respond to it. This happened after the deadline was extended for an extra 25 working days under section 15(A), then after that deadline had passed and I made ACC aware via Twitter that I had laid a complaint with the Ombudsman. I received notification that my request had been refused within 10 minutes of notifying ACC of this.

I understand that the Ombudsman's guidelines regarding section 18(f) (see pp9-11 http://www.ombudsman.parliament.nz/syste...) says, quoting the Law Commission's review of the OIA:

"Agencies familiar with the scheme of the Act should already regard s. 18(f) as a provision of last resort"

The guideline also notes that amendments to the OIA state:

"If a request is likely to be refused under section 18(e) or (f), the Department, Minister of the Crown, or organisation must, before that request is refused, consider whether consulting with the person who made the request would assist that person to make the request in a form that would remove the reason for the refusal."

I note that the Government Services team's response to my request, which refuses it under section 18(f), proceeds to offer assistance in refining my request. I am disappointed that it took over 2 months and knowledge of a complaint to the Ombudsman for this offer of assistance to be made, particularly given that the response implies that it was clear from the start that my request was likely to be refused under section 18(f).

Particularly in light of the fact that the assurance "that ACC will do all it can to respond to your request before the new due date, if that is at all possible" appears to have been disingenuous or otherwise not taken seriously, I am proceeding with my complaint to the Ombudsman. I hope that in the future I will not have to wait unreasonable lengths of time for a response.

However, I do thank you for your offer to refine my request so that you could help me in identifying the documents that most interest me.

My request was broken into two parts. As the second part regarded an employee of the Ministry of Health, I consider that I might make the same request there so as not to unnecessarily burden ACC.

Regarding the first part of my request, I am most interested in the sources of the information in the Acupuncture Treatment Profiles document. For example, I would like to know the source of statements such as:

"Moxibustion... Relieves pain" [page 10]
"Qi is the vital force of life which... Is the material substrate of the Universe" [page 11]
"Brain... Is considered to be the same in substance as marrow" [page 12]
"the Kidney produces marrow" [page 12]

I believe it may help me to refine my search if ACC could first provide me with a summary or overview of the process through which the Acupuncture Treatment Profiles document was developed. If you have other suggestions regarding how I could refine my request, I would be happy to consider these also.

Sincerely,

Mark Hanna
Society for Science Based Healthcare

In the interest of keeping this request transparent, I received the following email from ACC at 5:27pm on Friday 20/11/2015:

"Dear Mr Hanna

I apologise for not being able to respond to you sooner.

I can confirm that estimates for future claim and treatment costs are completed before the end of each financial year, which is 30 June. After having spoken to our Finance team, my understanding is that they are usually completed between April and end of May each year, for the coming financial year. So as an example, the 2014/15 estimates were completed around May 2014. As these are part of a larger body of work in accounting, it is difficult to determine the exact date that each estimate was calculated. However, I can certainly enquire further if you are interested in specific dates?

I also queried the estimates provided by Hon Dyson and was advised that the information provided was specifically created for that Parliamentary Question. It is not ACC’s usual practice to estimate costs of specific treatments for longer than one financial year in advance. In other words, the information provided in response to the question was not in line with how the estimates are calculated and was a ‘one off’. I was also advised that previous estimates, such as those provided for that Parliamentary Question, are not stored/archived as they are not used for accounting purposes.

In reference to your questions regarding the development of the Treatment Profiles document, I would like to sincerely apologise the delay. I have searched through the documents I could readily access but have so far been unable to locate the sources of the particular terms you mentioned in your email. However, I am currently in the process of engaging with staff members who are involved in the provision of acupuncture services and should be able to provide you with information around the this next week. Staff absences have unfortunately delayed this much longer than expected.

If it might be useful to you, I may also be able to arrange for a staff member from our Clinical Services area to connect with you, either by phone or by email (whichever you prefer). They may be able to answer some of your questions straight away. We can then provide you with a written response containing the information you would like stated officially.

In the meantime, and especially since I am aware of the length of time that has elapsed since you first requested information around this topic, please feel free to contact me directly if you have any questions or would like an update. I am also more than happy to assist you with further clarifications or subsequent requests that would enable you to obtain the information that you require. My direct dial number is [number].

Once again, please accept my apologies for not being able to respond sooner (my hope was to provide you with a lot more information by this stage)."

In the interest of keeping this request transparent, I sent the following email to ACC at 10:20am on Thursday 26/11/2015:

"Thanks for getting back to me about this. Your answers to my questions about the predictions are exactly the information I was after, thank you for that.

I'll look forward to hearing if the other staff members you are talking to are able to offer any more information regarding my request around the Acupuncture Treatment Profiles document. It would be great if you'd be able to arrange for a staff member from your Clinical Services area to email me, thank you for this offer.

If you find it helpful for finding the information I have been asking about, I recently heard back from the Ministry of Health regarding my request for correspondence between ACC and Dr David St George (https://fyi.org.nz/request/3278-correspo...). Part of this correspondence (the last message of #4) referred to a person who peer reviewed the Acupuncture Treatment Profiles document I have been asking about, although unfortunately their name was withheld. As I'm not convinced the decision to withhold this information was justified under the OIA it is my intention to complain to the Ombudsman.

As a reminder, I am continuing to annotate our correspondence to my relevant OIA requests made on the website fyi.org.nz, which makes it publicly viewable. However as I am doing this only in the interest of transparency I will be removing information such as your direct dial number.

Sincerely,

Mark Hanna
Chair, Society for Science Based Healthcare"

In the interest of keeping this request transparent, I received the following email from ACC at 4:56pm on Friday 27/11/2015:

"Hi Mark

Thanks for emailing me back. I am now (finally)having a meeting with the clinical services staff on Tuesday so it’s a great that I have your email to take along with me :) I hope that’s alright? That was the only available time.

No problem about posting things online – transparency is important. And thank you so much for withholding my DDI. I would personally prefer for my name not to be published online as well – because it is unique and it is rather easy to track people in the digital age. But not a big deal and no harm done if you have put it up. I do understand that, as a public servant, my name may not always be able to stay out of the public eye.

I will email you soon about the staff member who could engage with you about the treatment profiles. In the meantime, feel free to email me anytime if you have any other questions.

Thanks!"

In the interest of keeping this request transparent, I received the following email from ACC at 9:59pm on Thursday 10/12/2015:

"Have there been any updates regarding my OIA request since your meeting last week?

There’s also something else I’d like to ask you about that’s related to my OIA requests. I've recently run across some information that's made me see a couple of responses to previous requests in a new light, and I’m hoping you can help me make sense of it.

I've found that four statistical analysis reports were prepared by Dr Carl Scarrott for the Osteopathic Council of New Zealand in 2009. These reports were prepared based on data released by ACC, and it seems at least some of this was prepared by Peter Woods at ACC. Here are links to where the reports can be found online. Each of them has a section near the start regarding the nature of the data provided by ACC:

Multiple Profession Claims (http://philip-bayliss.com/resources/Mult...)
Market Analysis by Provider and Injury Type with Trend Analysis (http://philip-bayliss.com/resources/Mark...)
Initial Referrals and Aspects of ‘Patient Journey’ (http://philip-bayliss.com/resources/Init...)
Demographic Profiles (http://philip-bayliss.com/resources/Demo...)

For the data provided for some of the reports, information was given for individual claims categorised by their Read Code. Some examples of the information given are the number of visits to each type of practitioner and the cost of the claim to ACC.

In my August OIA request regarding a breakdown of spending on acupuncture, one of the things I asked for was:

"Any more specific breakdowns of acupuncture spending by injury that are available for this period, for example categorised by site and type of injury."

The response I received from ACC regarding this was that:

"In the response to http://fyi.org.nz/request/1890-breakdown..., ACC advised that it could not provide information around the spending on acupuncture treatments on specific body parts. This is because acupuncture costs are registered against a claim, and one claim can involve many body parts. In response to that request, ACC provided the total spend on acupuncture for each year.

ACC is able to provide the amount spent on acupuncture services broken down into categories of injury diagnosis."

The injury diagnosis categories are very broad, such as "Soft Tissue Injury" which consists of 94% of ACC's spending on acupuncture. However, looking at the reports from 2009 it seems that more specific information about claims does exist, as Read Codes associated with claims can be as specific as "Neck sprain S550".

It seems to me that this information would have been relevant to earlier requests, so I'm quite disappointed that it wasn't mentioned in response to my request or the earlier one from Daniel Ryan.

I would like to request information on ACC’s spending on acupuncture categorised by Read Claim, but I also want to avoid a repeat of how my latest request was handled in that it took 2 months for ACC to tell me that it would take too much time to collate the information. Could you help me understand what difficulties would likely be involved in releasing this information so I can make a request that isn’t too difficult and still gives me access to the information I am after?

The main question I am hoping to answer is how much money ACC has spent on specific injury types. The injury diagnosis categories are too broad to be useful for this application, but the Read Codes are specific enough.

I primarily want to do this for the 2014/15 financial year. I would also like to see the same data for previous years, particularly after ACC's review of the efficacy of acupuncture in the management of musculoskeletal pain was completed in 2011, but I don’t know how much more difficult it would make a request if I were to ask for this data as well.

I also realise that there may be privacy concerns that prevent ACC from releasing some information about individual complaints. If this would be a significant hurdle for the request I’d like to make, I’d be happy to narrow it down so I can still get access to information that would let me answer my question. If you could help me understand what data exists, that would help me to narrow down a request.

I intend to request this information using fyi.org.nz. So if I’ve given enough information in this email for the data I am after to be identified, it would be great if you could let me know as soon as possible so I can submit a request for it through FYI.

Sincerely,

Mark Hanna
Chair, Society for Science Based Healthcare"

Oops, I made a copy/paste mistake at the start of my previous annotation. I should have said that I sent the email to ACC, not received it from them.

In the interest of keeping this request transparent, I received the following emails from ACC at 3:21pm on Monday 14/12/2015:

"Hi Mark

Yes! I sent you an email but perhaps it disappeared into the web somewhere or it is a “user error” issue. I will re-send it to you immediately."

"Hi Mark

I can now confirm that I have found a contact for your queries around acupuncture :)

Her name is [Name] and she works within the Clinical Service Directorate. She has a lot of experience in this area and will be able to provide you with information and documents much more readily. On top of that, she can tell you what kind of information we hold, what documents might contain the information in which you are interested, whether it may be quicker to go elsewhere, etc.

As you prefer to be in contact by email I have advised her that I would forward her email address to you. It is [email].

I thought it would be best to allow you to connect with [her] before collating any more information. This is because you may want to change your request once you have had a chance to talk to her depending on what she might be able to provide straight away and what we actually hold . But I have given her a copy of your emails to me (with the terms used in the Treatment Profiles that you mentioned) so that she has an idea of what to start putting together.

If there is anything else I can assist with, please let me know. Once again, I am truly sorry for the delays. However, I hope that things will move much more smoothly from now on as you will be going straight to the source :)"

In the interest of keeping this request transparent, I sent the following email to ACC at 2:07pm on Thursday 17/12/2015:

"Hello [Name],

I'm sure [Name] has explained everything to you, but I just thought I'd touch base with you and give you my own overview to make sure we're on the same page.

On August 13 I made two OIA requests:

One was about a breakdown of ACC's spending on acupuncture and predictions of that spending (https://fyi.org.nz/request/3043-acupunct...)

The other was about two things: information about the development of ACC's "Acupuncture Treatment Profiles" document (http://www.acc.co.nz/PRD_EXT_CSMP/groups...), and correspondence between ACC and Dr David St George from the Ministry of Health (https://fyi.org.nz/request/3044-correspo...)

I made both these requests through the website FYI, which keeps the whole process transparent by making everything publicly available online. I've been continuing to annotate these requests with emails sent and received regarding them, although I have not been disclosing personal information such as names and contact details.

My OIA request about spending was answered, although I've since found that there may be more detailed information available.

My second OIA request was denied on the basis that it would be too much work to collate the information. I've since found out about correspondence between ACC and Dr David St George via a separate OIA request to the Ministry of Health (https://fyi.org.nz/request/3278-correspo...), but I'm still trying to find information about the development of the treatment profiles document.

I'm hoping you'll be able to help me understand what information is available, so I can make a request for information which ACC can give me and which will also provide answers to my questions.

Regarding the treatment profiles document, I'm interested to find out how they were developed and approved. The main question I'm looking to answer is how evidence-based it is, which is why I'm particularly interested in finding the evidence that was used in its development.

For the funding query, I sent [Name] an email on the 10th of December about the new information I've found. You might have seen this already, but I've included a copy of that email below for your reference.

Any advice you can give me about what information is available that might be able to answer my questions would be greatly appreciated.

Sincerely,

Mark Hanna
Chair, Society for Science Based Healthcare"

In the interest of keeping this request transparent, I received the following email from ACC at 3:55pm on Wednesday 23/12/2015:

"Hi Mark,

[Name] has given me a bit of background and of course had copied me into her email to you. On that note – and before we go any further - I should probably clarify that she's possibly over-sold my experience in this area a tad!

I've been with ACC for quite a while and am certainly aware of some of the background to the situation with acupuncture in the legislation, but was never directly involved in that area as such. In my current role I manage the stakeholder relationships with all allied health groups, including the acupuncturists, and in previous roles within ACC I've been predominantly provider-facing and so have occasionally become involved in matters involving this profession. But I should make it clear that I don't personally have a background in acupuncture. Before I joined ACC, my own clinical background was in nursing and midwifery.

Nonetheless, what I can do is liaise with other parts of the business (and with some of my external stakeholders) to gather any relevant information and fill in any gaps in my own knowledge, to see where I might be of help you. To do that, it would help to first get a sense for what information you've already received, as the reality is that I might not have an awful lot to add.

I'm not sure where you're based geographically, but I'd be more than happy to meet with you in the New Year and talk through what you need / what you feel is missing and what we're able to provide. I'm based in Wellington, but have teams in Auckland and Dunedin, so do have to travel around the country on a semi-regular basis, if that would help. Certainly, it would be good to have an opportunity to met you face to face and hear a little about the Society from you, as my knowledge of what you do is limited and I'd be keen to know more.

I'll be on leave from tomorrow afternoon, returning on the 11th January so if I don't hear from you before then, I hope you have a restful break and I look forward to touching base in the New Year.

Kindest regards,
[Name]"

In the interest of keeping this request transparent, I sent the following email to ACC at 12:33pm on Friday 22/01/2016:

"Hi [Name],

Sorry it's taken me a while to get back to you, thanks for your patience. I hope you've enjoyed your summer break :)

All the OIA requests I've made about this in the past have been on the website FYI.org.nz, which conveniently means I can link to them. Here's a summary of the main requests that other members of the Society for Science Based Healthcare and myself have made about ACC and acupuncture:

- Spending on acupuncture, chiropractic, and osteopathy from 2002/03 to 2011/12 (https://fyi.org.nz/request/955-money-spe...)
- Spending on acupuncture by injury diagnosis category for 2002/03 to 2013/14 (https://fyi.org.nz/request/1822-acupunct...)
- Spending on acupuncture by treatment diagnosis for 2014/15, and estimated spending on acupuncture for 2003/04 to 2015/16 (https://fyi.org.nz/request/3043-acupunct...)
- Literature reviews on the effectiveness of acupuncture (https://www.fyi.org.nz/request/1891-lite...)

Unfortunately the breakdowns of spending by injury diagnosis category haven't been very useful. Nearly all of the injuries fall under the "Soft tissue injury" category, and I can't line up these categories against the literature reviews ACC has done or against the Treatment Profiles document.

I'm also aware of some older data regarding spending and estimates from the Parliament website:

- Spending on acupuncture from 1994/95 to 2003/04 (http://www.parliament.nz/en-nz/pb/busine...)
- Estimated spending on acupuncture from 2004/05 to 2008/09 (estimates made in 2004) (http://www.parliament.nz/en-nz/pb/busine...)

I've not yet found much at all about the history of the Acupuncture Treatment Profiles document. In response to an OIA request I made to the Ministry of Health (https://fyi.org.nz/request/3278-correspo...), they released correspondence from 2011 that mentioned the person who peer-reviewed the Treatment Profiles, but their name was withheld so I'm still none the wiser. I understand this will have been done to protect their privacy, but I'd expect they might be able to help with finding out what evidence the document is based on.

Unfortunately the document I received from the Ministry of Health isn't text-searchable, but if you look for the last email of thread #4 you should find the right bit. I'd be happy to provide you with a searchable transcript if that would help. The recipient was Dr David St George, the Ministry of Health's Chief Advisor of Integrative Care. I'm not sure who sent the email as their name was also withheld, although they'd have been an employee of ACC at the time.

[Removed details about meeting in person for privacy reasons]

Sincerely,

Mark Hanna
Chair, Society for Science Based Healthcare"