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AUTUMN 2023 InTouch | 9 establishing therapeutic dosage. More experienced physiotherapists mentored less experienced physiotherapists, but the provision of professional CAM knowledge was often ad hoc and intermittent. Only some physiotherapists knew about the potential to loan CAM from MDANZ, but all participants in this study recognised this was not a viable long-term option and furthermore it created issues with provision of physiotherapy service for set up, provision of consumables and ongoing maintenance of machines. When people with NMD had a good relationship with their physiotherapist and wider health professional team, advocacy and action by individual health professionals went some way to mitigating these systemic variations in service. Summary This research has demonstrated that “inequity of provision” (Survey 2) of CAM and related service provision creates ethical concerns for health professionals and an unfair health service. “It is an ethical dilemma, because of the [limited] resources and because there are a number of people meeting the criteria.” (Physiotherapist 3) Furthermore, despite CAM being recommended in various respiratory guidelines, when clinically indicated, for people THE “AMBULANCE AT THE BOTTOM OF THE CLIFF” with NMD, long-term use of CAM is not funded by the health system. Ultimately, the greatest burden of these variations in health service is borne by people with a NMD. Recommendations Several recommendations arise from this research, including upskilling of physiotherapists and development of ongoing educational resources and the creation of pathways to ensure consistent provision of CAM consumables. However, this research highlights that current CAM funding and resourcing creates inequities. We recommend that CAM should be funded within the health service and not privately by individuals and that national guidelines should be developed. Associate Professor Meredith Perry (on behalf of the research team), University of Otago Figure 2: While the majority of CAMs were funded by the former DHBs, a significant number of CAM available within a region were funded by other streams. Following on from this research, MDANZ Member Services Manager, Denise Ganley, says she “is working closely with Scott Arrol, Motor Neurone NZ CEO, who has agreed to join forces to see what can be done about a national strategy for funding of CAM. I have also reached out to other Neurological Alliance member organisations to see if anyone else wants to join. With a united force, the aim is to try and make some progress under the proposed changes to the priority and funding equity for people with disabilities.” Funding streams for CAM across Te Whatu Ora regions