Changes/updates to thyroid testing policy
Belinda Hodson made this Official Information request to Waikato District Health Board
The request was partially successful.
From: Belinda Hodson
Dear Waikato District Health Board,
Please provide all policy updates/changes to all thyroid tests (TSH, Free T3, RT3, thyroid anti-body etc.) recommended by Pathlab and approved by the Waikato DHB for implementation by Pathlab; and implemented by Pathlab, during the period 1st January 2010 to 20 July 2018; along with:
a) the rationale for these updates/changes and the citation list of the clinical publications supporting these changes/updates (clinical research studies and other clinical papers including guidelines referenced); plus
b) the associated ‘clinical updates’ for these changes/updates that have been posted in the clinicians information area of Pathlab's website.
2. Copies of reports of these updates/changes provided to the Waikato District Health Board by Pathlab or produced by the Waikato District Health Board which monitor the impact of these updates/changes on patient's health and well-being.
Yours faithfully,
Belinda Hodson
From: Rebecca Walker
Waikato District Health Board
Good Morning
This is to acknowledge receipt of your request for information. I have passed through to the appropriate service and will provide a response as soon as the information is available, noting the requirement to provide reply by 24 August.
Kind regards
Rebecca
Rebecca Walker | PA to Tanya Maloney, Executive Director Strategy, Funding and Public Health | Waikato DHB
Level 9, KPMG building, 85 Alexandra Street, Hamilton
p 027 208 0968 | e [email address]
Give and Earn Respect – Whakamana Stronger Together – Kotahitanga Fair Play – Mauri Pai
Listen to me, talk to me – Whakarongo Growing the good – Whakapakari
-----Original Message-----
From: Belinda Hodson [mailto:[FOI #10839 email]]
Sent: Monday, 29 July 2019 17:59
To: OIA Contact
Subject: Official Information request - Changes/updates to thyroid testing policy
Dear Waikato District Health Board,
Please provide all policy updates/changes to all thyroid tests (TSH, Free T3, RT3, thyroid anti-body etc.) recommended by Pathlab and approved by the Waikato DHB for implementation by Pathlab; and implemented by Pathlab, during the period 1st January 2010 to 20 July 2018; along with:
a) the rationale for these updates/changes and the citation list of the clinical publications supporting these changes/updates (clinical research studies and other clinical papers including guidelines referenced); plus
b) the associated ‘clinical updates’ for these changes/updates that have been posted in the clinicians information area of Pathlab's website.
2. Copies of reports of these updates/changes provided to the Waikato District Health Board by Pathlab or produced by the Waikato District Health Board which monitor the impact of these updates/changes on patient's health and well-being.
Yours faithfully,
Belinda Hodson
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From: Carole Muriwai
Waikato District Health Board
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Carole Muriwai
PA to Phil Grady – Interim Executive Director of Strategy, Funding and
Public Health
L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton
| Tel (07) 834 3646 | email [1][email address]
Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
[2]cid:image004.png@01D44F56.40DA3110
[3]cid:image003.png@01D44F56.40D01EF0Give and earn respect -
Whakamana[4]cid:image003.png@01D44F56.40D01EF0Listen to me; talk to me –
Whakarongo[5]cid:image003.png@01D44F56.40D01EF0Fair play – Mauri
Pai[6]cid:image003.png@01D44F56.40D01EF0Growing the good –
Whakapakari[7]cid:image003.png@01D44F56.40D01EF0Stronger together –
Kotahitanga
This electronic message, together with any attachments is confidential and
may be privileged. If you are not the intended recipient: 1.do not copy,
disclose or use the contents in any way. 2.please let me know by return
email immediately and then destroy the message. Waikato DHB is not
responsible for any changes made to this message and/or any attachments
after sending by Waikato DHB. Before opening or using attachments, check
them for viruses and effects. Waikato DHB takes no responsibility for
affected attachments. Click on link www.waikatodhb.health.nz/disclaimer to
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From: Belinda Hodson
Dear Carole Muriwai,
In this OIA, we asked for citation lists supporting all thyroid testing policy changes/updates. A reference to BPAC guidance has been made but not citation lists e.g. published clinical studies and other research papers supporting Waikato DHB approved /Pathlab thyroid testing policies.
Can you/Pathlab please provide these as requested.
Yours sincerely,
Belinda Hodson
From: Belinda Hodson
Dear Carole Muriwai,
Thank you for providing this response to the OIA request. In this response it says:
“The hospital chemical pathologist advised the group that we are following BPAC Guidelines. He reviewed all evidence submitted by TANZi and remains unconvinced.
GPs used to order T3, T4, TSH – for unknown reasons, there is interference between the tests and the follow-ups are extremely expensive and convoluted with no outcome i.e. they are causing patients harm.”
Please provide copies of the clinical studies carried out by Pathlab or the Waikato DHB, citation lists and other NZ or international clinical data that supports this last sentence about patients being harmed by GPs ordering the T3, T4 and TSH test. If you wish to classify this as another OIA Request because it is a question arising from the response to this OIA, waiting for 20 working days for a response from today is fine.
Yours sincerely,
Belinda Hodson
From: Carole Muriwai
Waikato District Health Board
Good morning Belinda
Just acknowledging your 2 emails I received yesterday afternoon relating to your OIA request.
Regards
Carole Muriwai
PA to Phil Grady – Interim Executive Director of Strategy, Funding and Public Health
L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton | Tel (07) 834 3646 | email [email address]
Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
Give and earn respect - WhakamanaListen to me; talk to me – WhakarongoFair play – Mauri PaiGrowing the good – WhakapakariStronger together – Kotahitanga
-----Original Message-----
From: Belinda Hodson [mailto:[FOI #10839 email]]
Sent: Wednesday, 11 September 2019 15:52
To: Carole Muriwai
Subject: Re: OIA - Pathlab - B Hodson
Dear Carole Muriwai,
Thank you for providing this response to the OIA request. In this response it says:
“The hospital chemical pathologist advised the group that we are following BPAC Guidelines. He reviewed all evidence submitted by TANZi and remains unconvinced.
GPs used to order T3, T4, TSH – for unknown reasons, there is interference between the tests and the follow-ups are extremely expensive and convoluted with no outcome i.e. they are causing patients harm.”
Please provide copies of the clinical studies carried out by Pathlab or the Waikato DHB, citation lists and other NZ or international clinical data that supports this last sentence about patients being harmed by GPs ordering the T3, T4 and TSH test. If you wish to classify this as another OIA Request because it is a question arising from the response to this OIA, waiting for 20 working days for a response from today is fine.
Yours sincerely,
Belinda Hodson
-----Original Message-----
Carole Muriwai
PA to Phil Grady – Interim Executive Director of Strategy, Funding and Public Health
L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton | Tel (07) 834 3646 | email [1][email address]
Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
[2]cid:image004.png@01D44F56.40DA3110
[3]cid:image003.png@01D44F56.40D01EF0Give and earn respect - Whakamana[4]cid:image003.png@01D44F56.40D01EF0Listen to me; talk to me – Whakarongo[5]cid:image003.png@01D44F56.40D01EF0Fair play – Mauri Pai[6]cid:image003.png@01D44F56.40D01EF0Growing the good – Whakapakari[7]cid:image003.png@01D44F56.40D01EF0Stronger together – Kotahitanga
This electronic message, together with any attachments is confidential and may be privileged. If you are not the intended recipient: 1.do not copy, disclose or use the contents in any way. 2.please let me know by return email immediately and then destroy the message. Waikato DHB is not responsible for any changes made to this message and/or any attachments after sending by Waikato DHB. Before opening or using attachments, check them for viruses and effects. Waikato DHB takes no responsibility for affected attachments. Click on link www.waikatodhb.health.nz/disclaimer to view the company policy website. If you are not redirected to the company policy website then copy and paste the URL into a new browser window.
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Please use this email address for all replies to this request:
[FOI #10839 email]
Disclaimer: This message and any reply that you make will be published on the internet. Our privacy and copyright policies:
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This electronic message, together with any attachments is confidential and may be privileged. If you are not the intended recipient: 1.do not copy, disclose or use the contents in any way. 2.please let me know by return email immediately and then destroy the message. Waikato DHB is not responsible for any changes made to this message and/or any attachments after sending by Waikato DHB. Before opening or using attachments, check them for viruses and effects. Waikato DHB takes no responsibility for affected attachments. Click on link www.waikatodhb.health.nz/disclaimer to view the company policy website. If you are not redirected to the company policy website then copy and paste the URL into a new browser window.
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From: Carole Muriwai
Waikato District Health Board
Good morning Ms Hodson
Please see attached reply to your email you sent.
Regards
Carole Muriwai
PA to Phil Grady – Interim Executive Director of Strategy, Funding and Public Health
L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton | Tel (07) 834 3646 | email [email address]
Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
Give and earn respect - WhakamanaListen to me; talk to me – WhakarongoFair play – Mauri PaiGrowing the good – WhakapakariStronger together – Kotahitanga
-----Original Message-----
From: Belinda Hodson [mailto:[FOI #10839 email]]
Sent: Wednesday, 11 September 2019 15:52
To: Carole Muriwai
Subject: Re: OIA - Pathlab - B Hodson
Dear Carole Muriwai,
Thank you for providing this response to the OIA request. In this response it says:
“The hospital chemical pathologist advised the group that we are following BPAC Guidelines. He reviewed all evidence submitted by TANZi and remains unconvinced.
GPs used to order T3, T4, TSH – for unknown reasons, there is interference between the tests and the follow-ups are extremely expensive and convoluted with no outcome i.e. they are causing patients harm.”
Please provide copies of the clinical studies carried out by Pathlab or the Waikato DHB, citation lists and other NZ or international clinical data that supports this last sentence about patients being harmed by GPs ordering the T3, T4 and TSH test. If you wish to classify this as another OIA Request because it is a question arising from the response to this OIA, waiting for 20 working days for a response from today is fine.
Yours sincerely,
Belinda Hodson
-----Original Message-----
Carole Muriwai
PA to Phil Grady – Interim Executive Director of Strategy, Funding and Public Health
L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton | Tel (07) 834 3646 | email [1][email address]
Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
[2]cid:image004.png@01D44F56.40DA3110
[3]cid:image003.png@01D44F56.40D01EF0Give and earn respect - Whakamana[4]cid:image003.png@01D44F56.40D01EF0Listen to me; talk to me – Whakarongo[5]cid:image003.png@01D44F56.40D01EF0Fair play – Mauri Pai[6]cid:image003.png@01D44F56.40D01EF0Growing the good – Whakapakari[7]cid:image003.png@01D44F56.40D01EF0Stronger together – Kotahitanga
This electronic message, together with any attachments is confidential and may be privileged. If you are not the intended recipient: 1.do not copy, disclose or use the contents in any way. 2.please let me know by return email immediately and then destroy the message. Waikato DHB is not responsible for any changes made to this message and/or any attachments after sending by Waikato DHB. Before opening or using attachments, check them for viruses and effects. Waikato DHB takes no responsibility for affected attachments. Click on link www.waikatodhb.health.nz/disclaimer to view the company policy website. If you are not redirected to the company policy website then copy and paste the URL into a new browser window.
This email has been filtered by SMX. For more information visit [8]smxemail.com
References
Visible links
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Please use this email address for all replies to this request:
[FOI #10839 email]
Disclaimer: This message and any reply that you make will be published on the internet. Our privacy and copyright policies:
https://fyi.org.nz/help/officers
If you find this service useful as an Official Information officer, please ask your web manager to link to us from your organisation's OIA or LGOIMA page.
-------------------------------------------------------------------
This electronic message, together with any attachments is confidential and may be privileged. If you are not the intended recipient: 1.do not copy, disclose or use the contents in any way. 2.please let me know by return email immediately and then destroy the message. Waikato DHB is not responsible for any changes made to this message and/or any attachments after sending by Waikato DHB. Before opening or using attachments, check them for viruses and effects. Waikato DHB takes no responsibility for affected attachments. Click on link www.waikatodhb.health.nz/disclaimer to view the company policy website. If you are not redirected to the company policy website then copy and paste the URL into a new browser window.
______________________________________________________________________________
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From: Belinda Hodson
Dear Carole Muriwai,
Thank you for your 16th September 2019 reply to the two emails I sent on 12 September 2019 in reply to OIA raised on 29 July 2019 “Changes/updates to thyroid testing policy”. One email on 12 September 2019 requested additional information and the other requested information that was asked for in the OIA but not provided in the response, with no reason given for not providing the information.
1. Information that was asked for in the OIA but not provided in the response with no reason given
In the 29 July 2019 OIA, I asked for citation lists supporting thyroid testing policy changes/updates. A reference to BPAC guidance was made but not citation lists e.g. published clinical studies and other research papers supporting Waikato DHB approved /Pathlab thyroid testing policies.
In the 16th September 2019 reply Phillip O'Grady states:
“As this information is publicly available through a search of the relevant reputable medical journals we will not be providing this information. As you are able to access this information yourself, we are refusing your request under section 18(d) of the OIA.”
Some of the studies will be available through a search of the relevant reputable medical journals. However, as a member of the public, I do not have access to all databases used by medical professionals and chemical lab pathologists to source clinical publications. In addition, a general search will not tell me which out of hundreds of clinical studies are the ones being used to support Pathlab and the Waikato DHB in their development of thyroid policies changes and updates. It is the specific citations used by Pathlab and the Waikato DHB that I am asking for, not a general list. It is thus not possible for me to accurately locate the specific citation lists for Pathlab and the Waikato DHB’s thyroid testing updates/changes and that is why it is reasonable for me to request this list directly from yourselves. The clinical publications included in the Thyroid Association of NZ’s letter of complaint to the Waikato DHB on Pathlab’s thyroid testing policies which was referenced in the response to this OIA, are not being used to inform changes/updates to the Waikato DHB and Pathlab’s thyroid testing policies so it is clear that the Waikato DHB and Pathlab are using evidence from some clinical publications on thyroid testing and not others. A search on my own will not identify which ones. I once again ask that these citation lists are provided.
2. Additional information to the 29 July 2019 OIA
With regards to the following statement made in the response to my 29 July 2019 OIA Request, I asked for copies of the clinical studies carried out by Pathlab or the Waikato DHB, citation lists and other NZ or international clinical data that supports this statement about patients being harmed by GPs ordering the T3, T4 and TSH test:
“The hospital chemical pathologist advised the group that we are following BPAC Guidelines. He reviewed all evidence submitted by TANZi [Thyroid Association NZ] and remains unconvinced.
GPs used to order T3, T4, TSH – for unknown reasons, there is interference between the tests and the follow-ups are extremely expensive and convoluted with no outcome i.e. they are causing patients harm.”
It is reasonable to request the specific citations used to back this claim as there is disagreement about this in the international endocrinology community and so a general search in a publicly accessible medical database of reputable journals, is not going to identify which citations the hospital chemical pathologist is referring to, in support of their statement above. Interferences extends to other illnesses present in patients that may affect thyroid test results e.g. non-thyroidal illness. My request for citations includes clinical studies/supporting data on actual patients that shows that non-thyroidal illness is present in patients in many cases at the time they are having their thyroid blood tests taken.
I once again ask for copies of the clinical studies carried out by Pathlab or the Waikato DHB, citation lists and other NZ or international clinical data that supports this last sentence about patients being harmed by GPs ordering the T3, T4 and TSH test.
Yours sincerely,
Belinda Hodson
From: Belinda Hodson
Dear Carole Muriwai,
Further to my reply on 16th September, I have lodged a complaint with the Ombudsmen's office on reasons for refusing to provide citation lists for: (i) thyroid testing policies and (ii) supporting data/citations for the chemical pathologist's statement that GPs testing of patients Fee T3, Free T4 and TSH and the associated process causes patients harm.
Yours sincerely,
Belinda Hodson
From: Belinda Hodson
Dear Carole Muriwai,
I am writing to you to update you on the additional information I have provided to the Ombudsman regarding my complaint to them about the reason for refusing to provide citation lists for Waikato DHB/Pathlab thyroid testing policies; and the statements made by the Waikato DHB chemical pathologist about GPs testing patients' T3 and T4 and their process around this harming patients.
I asked for thyroid policies and citation lists from 3 DHBs through OIA requests i.e Auckland, Canterbury and Capital and Coast DHB. In each case, their response differed and they provided citation lists where these were included in the guidance and policy their medical specialists refer to. One lot of guidelines and associated citations came from their database that is not accessible to the public. This is further confirmation that citations in support of different DHBs' thyroid policies differ; and trying to determine what a NZ DHB or medical lab prefers to use, cannot be determined by a member of the public searching through publicly available sources of medical reputable journals.
Yours sincerely,
Belinda Hodson
From: Carole Muriwai
Waikato District Health Board
Dear Ms Hodson
Thank you for your email. I have noted that you have contacted the Ombudsman and will await to hear from them.
Regards
Carole Muriwai
PA to Phil Grady – Interim Executive Director of Strategy, Funding and Public Health
L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton | Tel (07) 834 3646 | email [email address]
Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
Give and earn respect - WhakamanaListen to me; talk to me – WhakarongoFair play – Mauri PaiGrowing the good – WhakapakariStronger together – Kotahitanga
-----Original Message-----
From: Belinda Hodson [mailto:[FOI #10839 email]]
Sent: Friday, 11 October 2019 15:39
To: Carole Muriwai
Subject: RE: OIA - Pathlab - B Hodson
Dear Carole Muriwai,
I am writing to you to update you on the additional information I have provided to the Ombudsman regarding my complaint to them about the reason for refusing to provide citation lists for Waikato DHB/Pathlab thyroid testing policies; and the statements made by the Waikato DHB chemical pathologist about GPs testing patients' T3 and T4 and their process around this harming patients.
I asked for thyroid policies and citation lists from 3 DHBs through OIA requests i.e Auckland, Canterbury and Capital and Coast DHB. In each case, their response differed and they provided citation lists where these were included in the guidance and policy their medical specialists refer to. One lot of guidelines and associated citations came from their database that is not accessible to the public. This is further confirmation that citations in support of different DHBs' thyroid policies differ; and trying to determine what a NZ DHB or medical lab prefers to use, cannot be determined by a member of the public searching through publicly available sources of medical reputable journals.
Yours sincerely,
Belinda Hodson
-----Original Message-----
Good morning Ms Hodson
Please see attached reply to your email you sent.
Regards
Carole Muriwai
PA to Phil Grady – Interim Executive Director of Strategy, Funding and Public Health
L9 KPMG Building | 85 Alexandra St, Hamilton | Private Bag 3200 | Hamilton | Tel (07) 834 3646 | email [email address]
Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui Give and earn respect - WhakamanaListen to me; talk to me – WhakarongoFair play – Mauri PaiGrowing the good – WhakapakariStronger together – Kotahitanga
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Please use this email address for all replies to this request:
[FOI #10839 email]
Disclaimer: This message and any reply that you make will be published on the internet. Our privacy and copyright policies:
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If you find this service useful as an Official Information officer, please ask your web manager to link to us from your organisation's OIA or LGOIMA page.
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This electronic message, together with any attachments is confidential and may be privileged. If you are not the intended recipient: 1.do not copy, disclose or use the contents in any way. 2.please let me know by return email immediately and then destroy the message. Waikato DHB is not responsible for any changes made to this message and/or any attachments after sending by Waikato DHB. Before opening or using attachments, check them for viruses and effects. Waikato DHB takes no responsibility for affected attachments. Click on link www.waikatodhb.health.nz/disclaimer to view the company policy website. If you are not redirected to the company policy website then copy and paste the URL into a new browser window.
______________________________________________________________________________
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From: Carole Muriwai
Waikato District Health Board
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Tçnâ koe
Please see response to your request.
Ngâ mihi
Carole Muriwai
PA to Phil Grady – Acting General Manager Strategy and Funding
L1 Farmers Building | Alexandra St, Hamilton | Private Bag 3200 | Hamilton
| Tel (07) 834 3646 | email [1][email address]
Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
[2]cid:image004.png@01D44F56.40DA3110
[3]cid:image003.png@01D44F56.40D01EF0Give and earn respect -
Whakamana[4]cid:image003.png@01D44F56.40D01EF0Listen to me; talk to me –
Whakarongo[5]cid:image003.png@01D44F56.40D01EF0Fair play – Mauri
Pai[6]cid:image003.png@01D44F56.40D01EF0Growing the good –
Whakapakari[7]cid:image003.png@01D44F56.40D01EF0Stronger together –
Kotahitanga
This electronic message, together with any attachments is confidential and
may be privileged. If you are not the intended recipient: 1.do not copy,
disclose or use the contents in any way. 2.please let me know by return
email immediately and then destroy the message. Waikato DHB is not
responsible for any changes made to this message and/or any attachments
after sending by Waikato DHB. Before opening or using attachments, check
them for viruses and effects. Waikato DHB takes no responsibility for
affected attachments. Click on link www.waikatodhb.health.nz/disclaimer to
view the company policy website. If you are not redirected to the company
policy website then copy and paste the URL into a new browser window.
This email has been filtered by SMX. For more information visit
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From: Belinda Hodson
Dear Carole Muriwai and Phil O'Grady,
Thank you for replying to the OIA Request raised on 29 July 2019 “Changes/updates to thyroid testing policy”. On 30th July 2019 I raised a second OIA request asking for policies and citation lists on all thyroid reference ranges. Your response on 9th September 2019 was a combined response to both OIA requests.
I have received your reply to my complaint #512377 lodged with the Ombudsman’s office dated 17 January 2020. Thank you for providing this information. Last year I lodged a second complaint with the Ombudsmen’s office #511220 regarding citations for the thyroid reference ranges.
The 17 January 2020 from your organisation does not specifically mention thyroid reference ranges. Can you please clarify the following:
1. Do the citations listed in your 17 January 2010 response include the citation lists used by Waikato DHB/Pathlab to determine reference ranges as requested in my 30 July OIA request, or is the 17 January 2020 response a response to citations for thyroid testing policies only and not the thyroid reference ranges?
Yours sincerely,
Belinda Hodson
From: Carole Muriwai
Waikato District Health Board
I am on leave until Tuesday 28 January, please contact
[email address] if you require anything urgently.
This electronic message, together with any attachments is confidential and
may be privileged. If you are not the intended recipient: 1.do not copy,
disclose or use the contents in any way. 2.please let me know by return
email immediately and then destroy the message. Waikato DHB is not
responsible for any changes made to this message and/or any attachments
after sending by Waikato DHB. Before opening or using attachments, check
them for viruses and effects. Waikato DHB takes no responsibility for
affected attachments. Click on link www.waikatodhb.health.nz/disclaimer to
view the company policy website. If you are not redirected to the company
policy website then copy and paste the URL into a new browser window.
From: Phil Grady
Waikato District Health Board
Dear Ms Hodson
I am writing to confirm that the citations listed in our letter of 17
January does include a citations list used by Waikato DHB and Pathlab to
determine reference ranges (as requested in your OIA request of 30
January). In addition to assist you I am listing the thyroid reference
ranges applied in the Waikato DHB by our Community Labs.
Test Age Interval Units
TSH All 0.3 - 5.0 mU/L
FT4 4 - 7D 12 - 27 pmol/L
FT4 1 - 4W 11 - 22 pmol/L
FT4 1M - 1Y 8 - 20 pmol/L
FT4 >1Y 7 - 16 pmol/L
FT3 0 - 10Y 3.0 - 10.0 pmol/L
FT3 >10 Y 3.6 - 6.5 pmol/L
Regards
Phil Grady
Phil Grady
General Manager Strategy, Funding and Public Health (Acting)
Waikato District Health Board
Waikato DHB Values: “People at Heart” – Te iwi Ngakaunui
[1]cid:image004.png@01D44F56.40DA3110
[2]cid:image003.png@01D44F56.40D01EF0Give and earn respect -
Whakamana[3]cid:image003.png@01D44F56.40D01EF0Listen to me; talk to me –
Whakarongo[4]cid:image003.png@01D44F56.40D01EF0Fair play – Mauri
Pai[5]cid:image003.png@01D44F56.40D01EF0Growing the good –
Whakapakari[6]cid:image003.png@01D44F56.40D01EF0Stronger together –
Kotahitanga
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