ASMS Direct - Issue 2009-16
25 September 2009
Dear Member
We welcome any feedback on the contents of the 16th issue of ASMS Direct for 2009. This copy of ASMS Direct focuses on:
1. September issue of The Specialist.
2. Horn Report: new powerful bureaucracy proposed.
3. World Health Professions Alliance urges action on H1N1.
4. Reminder – 21st ASMS Annual Conference.
1. September issue of The Specialist
The September issue of the ASMS’s quarterly publication, The Specialist, is now out. Hopefully you have received it by now (or else in a day or two). The main feature of this issue is full coverage of the report of the Ministerial Review Group (the Horn Report). Other features are:
- Preparing for the national DHB MECA negotiations next year.
- Analysis of the SMO Commission into competitive terms and conditions of employment.
- National President Jeff Brown on ‘rocks’ and ‘other places’.
- Chief medical advisers.
- Medical Protection Society on disclosure of health information to third parties.
- Comments on some other important workforce reports.
2. The Horn Report (Ministerial Review Group) – new powerful bureaucracy proposed
The Horn Report recommends that the government create a new powerful bureaucracy, the National Health Board (NHB), which, in summary, would be similar to the disbanded Health Funding Authority (of the late 1990s) in terms of funding DHBs (an important background difference is that population based funding for DHBs did not apply then). But it would be expanded beyond this to include planning, overseeing and directing DHBs, including on service provision. However, while the Ministry of Health could also perform this expanded role, the NHB as a crown entity would be more arms length and less accountable than the Ministry. This has caused some debate within government because it would go in the opposite direction of reducing bureaucracy including time wastage.
The proposed NHB would be a crown entity rather than public service organisation such as a ministry. When a new crown entity is established enabling legislation is required. One of the important benefits is that it ensures parliamentary (and consequently public) scrutiny. However, the Horn Report sneakily proposes avoiding this by instead converting the Crown Health Funding Agency (a small crown entity of around 20 staff with the narrow function of managing DHBs’ debts) into a much larger body (NHB) with far greater responsibilities and powers. There is some debate over the legality and appropriateness of this and it could be open to judicial review.
The Horn Report provides four reasons for reducing the role of the Ministry of Health and creating the National Health Board. They are:
1. The Ministry has too many diverse responsibilities. Separation would allow the Ministry to focus on its core tasks of “policy and regulation” leaving the NHB to focus on “improving performance”. This neglects the increased monitoring and advisory role the Ministry will have in reference to the NHB (and any other new structures). Further, in a country of around four million people two central bureaucracies is excessive. The experience of the former Health Funding Authority included duplication and competitive tensions between the two structures.
2. The Ministry’s performance should be independently reviewed but it can’t be if it does it itself. Separation is supposed to overcome this. However, this neglects the point that the Auditor-General has auditing functions for government departments and agencies while the State Services Commission can also performance monitor. Further, there have also been independent university reviews.
3. “Separation forces greater clarity around the objectives for, and operational requirements of, the implementation functions that will now be carried out by the NHB.” This is debatable, especially in a small country such as New Zealand, with no evidence provided in the Horn Report to sustain this contention.
4. As a crown entity the NHB would be “more distant from the Minister” which “should provide greater confidence about how the NHB would behave.” This “reduces both the reliance on subjective factors and the scope for lobbying and special pleading.” These are a mix of unsubstantiated assertions and reasons why it should not be supported. The reference to lobbying and special pleading could reasonably be expected to include the ASMS, other medical organisations such as the colleges, and other health professional bodies.
3. World Health Professions Alliance urges action on H1N1
The World Health Professions Alliance, which comprises dentistry, medicine, nursing, and pharmacy through their international organisations (eg, World Medical Association), issued a media release on 31 August calling for action to prepare for an H1N1 pandemic at a country and community level.
The Alliance has endorsed a set of key principles to promote operational activities that can be implemented at the country level in response to the continued spread of the H1N1 pandemic. The principles have been developed by the World Health Organization, UNICEF, the International Federation of the Red Cross and Red Crescent and the UN Office for the Coordination of Humanitarian Affairs. They re-emphasise some key interventions and directly complement current World Health Organisation technical guidance and National Pandemic Influenza plans. The Alliance further states:
The priority actions are based on the need for all countries to plan for the worst. The document says that the future evolution of the pandemic cannot be predicted, but worldwide the overwhelming majority of cases are experiencing only mild symptoms. However, some people, such as pregnant women and people with underlying medical conditions, are at greater risk. And it warns that the impact of the pandemic is more severe in those countries with weak health systems.
The document calls on countries to identify and prioritise high risk groups, to train health workers to identify symptoms, increase stocks of medical supplies and to educate the community about home care. It also says that target groups to receive the first doses of vaccination need to be identified and plans should be drawn up for mass vaccination when the vaccine is available.
…This "Call to Action" marks an important step in the ongoing and future response to the pandemic (H1N1) and it underscores the critical importance of UN agencies, civil society, NGOs and international bodies working together to ensure countries, particularly those in resource-constrained settings, are prepared to respond to the pandemic and the potential impact it may have on populations.
4. Reminder: 21st ASMS Annual Conference, 3-4 December 2009
The 21st ASMS Annual Conference will be held in Wellington (at Te Papa) on 3-4 December (Thursday-Friday). It is a unique opportunity to discuss the exciting mix of industrial, health policy, medico-legal and political subjects. Information on registration was provided in the June and September issues of The Specialist. If you are interested please contact ASMS Membership Support Officer, Kathy Eaden ke@asms.org.nz.
Preparation for our national DHB MECA negotiations early next year will be a central theme of the Conference. Another feature will be an address by Minister of Health, Tony Ryall.
Best wishes
Ian Powell
EXECUTIVE DIRECTOR
