1. Sugary drinks

The National Executive considered a request from the New Zealand Dental Association to support its consensus statement on sugary drinks.  The statement canvasses the research indicating that sugary drinks are a problem and sets out seven steps, including the introduction of a teaspoon of sugar icon on packaging, warning advertising, regulation of advertising to children, a social marketing campaign aimed at switching consumption to water, especially at schools and by local government. The statement stops short of advocating a sugar tax.  ASMS members have been at the forefront of advocacy on this issue.

After deliberating on this request the National Executive adopted the following three resolutions:

1. That the National Executive agrees to endorse the consensus statement on sugary drinks.
    
2. That the National Executive agrees to the use of the Association logo in line with the Association’s endorsement of the consensus statement.
    
3. That the National Executive agrees to Association representation at the meeting to discuss further steps to be convened by the NZ Dental Association.

2. Funding model for vocational medical training

The National Executive discussed at some length a ‘below the radar’ policy discussion initiated by the Government’s health workforce advisory agency, Health Workforce New Zealand, which is part of the Ministry of Health.  This involves a move to change the method of funding vocational medical training.  On 11 July, Executive Director Ian Powell attended a HWNZ national workshop held in Auckland to discuss a funding model paper prepared by Professor Des Gorman, Chair of HWNZ.

Broadly the attendees came from DHBs largely (including chairs, chief executives, chief medical officers, chief operating officers and HR managers) along with colleges, professional associations including NZMA, doctors unions (Resident Doctors Association and ASMS), Ministry of Health and the Medical Council. Relative to the DHB and Health Ministry bureaucracy, the medical profession was under-represented.

This has been a difficult discussion because of the abstract and conceptual nature of the proposal.  It is difficult to see it in a practical context and could mean many things to many people.  Nevertheless a thoughtful submission from the Council of Medical Colleges was helpful.  On the other hand, the national submission from the DHBs was disappointing, particularly with its taking of an unduly negative view of the role of the colleges.

The workshop itself included an underlying but also understated tension between those who over-dramatised the issue and those who believe that tweaking rather than radical change was required.

A second workshop will be held in October. Concern remains that there is still not anything tangible to focus on and the momentum may be driven too much by over-statement of the current situation in a way that might, in effect, marginalise subsequent engagement and lead to a blunt instrument to address what might better be addressed through a more refined approach.

3. Collective bargaining with non-DHB employers

The National Executive was updated on negotiations involving our 16 collective agreements outside DHBs, most of which are settled, covering around 220 members. Settlements have been reached and ratified with ACC, Ngati Porou Hauora, Golden Bay PHO and Ashburn House. Negotiations are either ongoing or about to commence with Otara Union Health (very protracted), Hokianga Health and Te Runanga o Toa Rangatira.

4. Bullying and harrassment

Issues relating to bullying and harassment have been a serious part of the industrial team’s work for some time. This relates to members who have suffered bullying, and others who have been accused of it. Our experience has been that generally DHBs do not deal well with these issues and that as a result of this there are never any ‘winners’ through bullying complaints. We have seen members leave DHBs ‘voluntarily’ on several occasions as a result of what can only be described as punitive and bullying anti-bullying procedures.

Two members of the industrial team (Lloyd Woods and Sarah Dalton) attended a very useful international bullying research conference in Auckland last March, including the assessment that ‘zero tolerance’ and similar punitive systems actually increase bullying and that the greatest determinant of the likelihood of being bullied is not what you do for your living, but where you work. Instead the way to deal with bullying is through low level resolution with restorative outcomes. However, the best approach overall is to develop a workplace culture where the bullying does not occur in the first place.

In discussions with the National Bipartite Action Group (DHBs and health unions) and with the RDA in particular, discussion has focused on the Cognitive Institute’s work at the Royal Melbourne Hospital.

As a result of further investigations, a team of DHB and health union representatives will be visiting the Royal Melbourne later this month.  This will include ASMS Deputy Executive Director Angela Belich and Senior Industrial Officer Lloyd Woods.  They will also have separate discussions with the industrial team of the Victoria branch of the Australian Medical Association.

The National Executive received a report on these developments and endorsed the approach.

5. First international conference of doctors unions

The Executive Director reported on his attendance at the first international conference of doctors unions.  This event was initiated and organised by Marburger Bund, the German doctors union which has developed close relations with ASMS over the years. Held on 13-14 June in Germany’s largest university hospital, Charité Campus in Berlin Mitte, there were representatives for 24 countries.  In addition to formal sessions, there were also opportunities for informal networking.

There were a series of snapshot presentations (including one from ASMS) on two main subjects – the outcome of doctors’ migration and integration of foreign doctors and working time arrangements for doctors.  There was also a thorough presentation from the European Public Service Unions on the European Working Time Directive.

Two resolutions were adopted by the conference on the two main themes of the conference.

Migration of Doctors
The participants of this first international conference of doctors’ trade unions support the implementation of the 2010 WHO Code of Practice on the International Recruitment of Health Personnel. It is vital that source and destination countries benefit equally from migration and therefore it is particularly important that all countries strive to train enough doctors to meet their own internal needs.

Furthermore, it is a primary objective of doctors’ trade unions to ensure that migrant doctors enjoy the same working conditions as domestically trained doctors and don’t suffer any discrimination.

To support migrant doctors the participants of the 1st International Conference of Doctors’ Trade Unions agree:

• To provide information on working conditions, recognition of medical training and language requirements to doctors who want to migrate to or who are new to their chosen host country.
   
• To make their members, upon request and whenever possible, aware of doctors’ trade unions abroad so as to help them to find union support in their chosen host country.
   
• To exchange, as far as possible, information on migration issues with other doctors’ trade unions.

Working Time
Patient safety and the health and safety of doctors should be the guiding principles of any working time regulations that cover doctors. Excessive working hours not only pose a threat to patients and the physical and mental health of doctors but make the medical profession less attractive and, as a result, aggravate the existing shortages of doctors in many countries.

The participating doctors’ trade unions:

• Call upon the responsible authorities to enforce existing working time regulations.
   
• Are committed to fight against any attempts to reduce the health and safety provisions in existing working time regulations.
   
• Aim to reduce long working hours in accordance with their members’ needs and preferences, especially, with regard to a better reconciliation of work and private life.

While in Germany, the Executive Director used the opportunity to be briefed on recent changes to employment law that would significantly weaken and obstruct the collective bargaining rights of Marburger Bund and other relatively smaller unions representing professional employees such as pilots. Marburger Bund is challenging the new law in the federal Constitutional Court.

Other subjects discussed with Marburger Bund included:

• recent collective bargaining outcomes
   
• a new model employment contract for resident doctors working in private practices
   
• concerns over the Trans-Atlantic Trade and Investment Partnership (similarities with the Trans Pacific Partnership Agreement were noted)
   
• a survey conducted by Marburger Bund on the working pressures which doctors have to endure in German hospitals that revealed the immense pressure faced by hospital doctors – more than half (59%) report frequent mental stress and more than two-thirds (69%) said that they did not have enough time to treat patients
   
• support for foreign doctors in Germany.

He was also able to stopover in London for a series of meetings with the British Medical Association, other health unions, Professor Martin McKee of the London School of Hygiene & Tropical Medicine, health economist Sean Boyle, the Hospital Consultants & Specialists Association, Trade Union Congress, prominent controversial health blogger Roy Lilley and the Medical Protection Society.

Subjects included the NHS, including funding, the effect of austerity on privatisation, a patient safety controversy at North Middlesex Trust hospital, the new ‘Sustainability and Transformation Plan’, the ‘junior doctors’ contract dispute, and autonomous working practice for staff and associate specialist (‘middle grade’) doctors.

6. National Office adapting to changes

The Executive Director advised the National Executive on the implications of the significant changes ASMS has undergone over the last 18 months in the national office, with a large expansion in both numbers and roles. Numbers have increased in the areas of industrial representation (three new industrial officers), communications, policy and administration. Roles (and functions) have expanded with the employment of an experienced journalist in the position of Director of Communications, the creation of the new Principal Analyst and Director of Policy & Research positions, the creation through re-designation of additional senior industrial officer positions and explicit role designations for all team, and more explicit role designation in the administration team (eg, communications and membership support).

Since ASMS’ formation, the national office has functioned on the basis of high trust and informal processes. This has worked well but with these changes adaptation is required, including increased collaboration between our four teams (industrial, policy, administration and communications). In the area of information technology we have established an IT committee chaired by the Executive Officer and including the Director of Communications and two industrial officers and the Principal Analyst (Policy & Research).  The national office has also begun staff coordination sessions when all teams get together.

We are also receiving the helpful ongoing advice of Dr Michael Macaulay (Director, Institute for Governance & Policy Studies and Associate Professor, Public Management) on an approach named ‘integrity management’, which is an academic field that is evolving into a management philosophy to help organisations conduct business, even in the most challenging of markets, without compromising their ethics.

To support this work, longstanding senior employee Executive Officer Yvonne Desmond is undertaking a sabbatical of nearly three months.  This sabbatical is wider than ‘integrity management’. It also includes ‘events management’ and office systems, including information technology. Part of it includes a trip to Europe in which she will visit a number of including the German doctors union Marburger Bund, Medical Protection Society in England, and the Irish Hospital Consultants Association.  On her return she will also meet with Medical Assurance Society and Grant Thornton Ltd.  Then she will work with Senior Industrial Officer Lloyd Woods, who has recently completed a Masterate of Public Policy at Victoria University, on preparing advice for ASMS.

7. Other matters

Other matters discussed included:

1. The National Executive discussed how it might become involved in the Council of Medical Colleges Choosing Wisely campaign.  It was agreed to discuss this further with the CMC.
    
2. The Executive Director reported on his attendance at the twice yearly industrial coordination meeting of the Australian Medical Association and the Australian Salaried Medical Officers Federation in late April in Canberra (also attended by the RDA).  Subjects discussed included the Productivity Commission’s report on the industrial relations framework in Australia, AMA’s review of its National Code of Practice - Hours of Work, Shift Work and Rostering for Hospital Doctors document in preparation for the 2016 AMA Safe Hours Audit, a reducing reliance on international medical graduates in the Australian medical workforce, the recommendations of a review of medical intern training, an updating of an AMA policy statement of doctors’ personal safety in the workplace, budget cuts and new health legislation in Western Australia, and moves to reduce the number of acute hospitals in Adelaide.

ASMS branch representatives: next executive meeting

Members are invited to forward any issues they may wish to be raised with the National Executive at its next meeting on 1 September to your local Branch President or Vice President (this includes non-DHB employed members who work in the geographic area of these regions). It is possible branch officers might conclude that some of these matters might more appropriately be addressed by the national office.

Below is the list of branch officers:

National Executive: Regional representatives

In addition to National President, Hein Stander (Gisborne) and Vice President, Julian Fuller (Waitemata), the Executive comprises eight regional representatives. They are:

Members are welcome to raise issues and comments with their regional representatives above by clicking on the relevant email address. This includes non-DHB employed members who work in the geographic area of these regions.

Side note: Participation requested - workforce intentions survey

DHB-based members will be sent an invitation on Monday to participate in a survey on future work intentions of the DHB-based senior medical workforce.  The focus of this survey is on intentions to leave DHB employment and possible changes to FTE in the next five years.  These surveys provide the ASMS with vital information concerning our membership and are key to providing us with insight into future workforce planning issues.  We hope you will take the time to participate.

Kind regards

Ian Powell
EXECUTIVE DIRECTOR