EXECUTIVE 10 September 2018
Dear Member,

This is the fourth Executive Direct for 2018, reporting on a recent meeting of your National Executive held in Wellington on 30 August. We normally send members an Executive Direct after each Executive meeting and also put these on our website (www.asms.nz). The Executive will next meet on 28 November.

The Executive discussed the Association’s strategic direction, interest in developing a possible senior medical and dental officer staffing accord for DHBs, a proposed mechanism to discuss shared RMO-SMO workforce issues, the expected collapse of the national forensic pathology service, the Government’s review of the State Sector Act, the reversal of the privatisation of Taranaki DHB’s anaesthesia services along with a number of other matters.

The meeting also confirmed dates for a special ASMS anniversary conference next year, as well as the Annual Conference and national Branch Officers’ workshop, and considered a range of other issues.

Association’s strategic direction

The National Executive considered a draft document outlining the Association’s strategic direction and priorities until 2021. The National Executive is responsible for governing the Association, and the national office is tasked with implementing that strategic direction and providing expert advice. The strategy under consideration would guide the Association for the next three years, when the current Executive’s term ends, and will underpin the Association’s approach to the 2020 DHB MECA negotiations.

It takes into account a number of significant dates over that period, including MECA negotiations and DHB Board elections, as well as the environment our members currently work in. It considers how to improve the environment, the decision-makers and influencers the Association needs to engage with, and the focus of work across the various teams within the national office over that period.

After some discussion it was agreed that President Murray Barclay and Executive members Tim Frendin and Julian Vyas would work with national office staff to finalise the strategy.

Initiative for senior medical and dental officer staffing accord for DHBs

The Executive has decided the Association will advocate for a senior medical and dental officer safe staffing according which also enables distributed clinical leadership between the Minister of Health, the Association and the 20 DHBs.

This follows earlier advocacy by the Association to build a sustainable senior medical and dental workforce, including the Business Case developed by the then ASMS National Executive and the DHBs’ Chief Executives’ national group, and published in 2009 (https://www.asms.org.nz/wp-content/uploads/2014/07/The-Business-Case-Nov-2010.pdf). This document had two key elements – the sustainability of the specialist workforce in DHBs, and distributed clinical leadership.

While DHBs subsequently reneged on the Business Case, ASMS has endeavoured to maintain the underlying principles of sustainability and distributed clinical leadership. The Minister of Health’s recent announcements of his successful intention to seek a nursing staffing accord between  the New Zealand Nurses Organisation and DHBs (and formally witnessed by him) has provided ASMS with an opportunity to also look at how we might make further progress.

Subsequently, on 6 September, National President Professor Murray Barclay, Vice President Dr Julian Fuller and I met the Minister of Health Hon Dr David Clark primarily to discuss this issue.  We were pleased with the Minister’s positive response to our initiative.

Proposed initiative for mechanism to discuss shared RMO-SMO workforce issues

During the latter stages of last year’s DHB MECA negotiations, ASMS initiated a proposal  in which DHBs, ASMS and the Resident Doctors’ Association (RDA) would jointly discuss issues that affect both parts of the medical and dental professions employed by DHBs.  The RDA responded positively.  Initially the DHBs appeared interested but then this waned.

The value of proceeding with this initiative has been highlighted further in the period since as issues have arisen over balancing the needs of safe working hours and ensuring the quality and continuity of training (and patient care).

After some discussion, the ASMS Executive has decided to invite the RDA and the 20 DHBs to a meeting to discuss the formation of a national process to consider matters relevant to the employed senior and resident medical and dental workforce.

Again, we raised this initiative with David Clark at our 6 September.  We were not seeking anything from him other than a supportive attitude, which he provided.

I have now formally written to both the DHBs and RDA about attending a meeting to discuss this further.

National forensic pathology service

The Executive expressed dismay at the bewildering decision of the Minister of Justice, Hon Andrew Little, to take advice from officials over that provided by the medical specialists who make up the vulnerable national forensic pathology service. The Ministry of Justice intends to break up the national service into partly privatised, regional providers. This has caused a great deal of concern among forensic pathologists, who fear for the impact on forensic pathology services as a result.

The Executive was updated on the Association’s efforts to change the outcome of this process, including meetings with the Minister and his officials, and media coverage of the vulnerability of forensic pathology if the national service is dismantled. To date, the Minister continues to refuse to intervene in his Ministry’s flawed procurement process.  It is unfortunately that Mr Little believes he knows more about how to deliver a forensic pathology service than the forensic pathologists.

Review of State Sector Act

The National Executive considered a report on the Government’s review of the State Sector Act, subsequently announced by State Services Minister Chris Hipkins (https://www.beehive.govt.nz/release/joined-more-convenient-services-reach-public-service-reform-plan). The Minister has begun a public consultation process ahead of what he describes as the most significant reform of New Zealand’s public service in 30 years.

The review is likely to have implications for the public health sector and, by extension, the Association’s members. The most important issue for the Association is whether the new Act will restrict the right of senior doctors and dentists to speak out. At present this is protected by MECA Clause 40 and Schedule 1 B of the Employment Relations Act. If a requirement for political neutrality becomes part of the new Act that binds senior doctors, it may potentially over-ride both the MECA and Schedule 1B.

We examine the background to these issues in more detail in the next issue of The Specialist magazine.

Reversal of privatisation of Taranaki DHB anaesthesia

The Executive considered a report on Taranaki DHB’s decision to bring its anaesthesia service back in-house. The service was controversially semi-privatised in 2000 when 70% of the anaesthetists were able to form a company and sell their services back to the DHB. The anaesthesia service has subsequently operated in a split public/private model since 2000, with directly employed SMOs becoming a majority over time.

The DHB has a history of reversing past privatisation efforts. The anaesthesia decision follows a decision two years ago to bring the radiology services in-house due to the DHB’s concerns over managerial and quality control. The radiology service had been privatised in the late 1990s.

More recently, the Association discovered last year that the DHB planned to privatise its hospital laboratory service and was commencing a tendering process. There had been no consultation with the Association as required under the MECA. The Association moved swiftly to address the breach of the MECA through the Employment Relations Authority and also by submissions to the Minister of Health, David Clark. It took a while for the penny to click with the leadership of Taranaki DHB.  But eventually they bowed to the Minister’s opposition to privatisation and ASMS pressure.

Significantly, the Minister also made it clear that he expects less reliance by DHBs on externally provided services.

2019 conference and meeting dates

The Executive confirmed the following dates for Association events next year:

  • The special anniversary conference to mark the Association’s 30th year will be held on 27 June.
  • The Annual Conference for 2019 will be held on Thursday and Friday 28-29 November.
  • The National Executive will meet on 20-21 February, 2 May, 26 June, 5 September, and 27 November 2019.
  • The Branch Officers national workshop will be held on Friday 28 June, immediately after the special anniversary conference.

Forthcoming book about Helen Kelly

The Executive approved a donation of $6000 towards the costs of a book about former Council of Trade Unions President Helen Kelly, who died in 2016. She was a strong advocate for the rights of working people and a supporter of the Association.

Kind regards,

Ian Powell