ASMS Direct - Issue 2010-8

25 June 2010

Dear Member

We welcome any feedback on the contents of the 8^th issue for 2010 of ASMS Direct, our national electronic publication. This copy of ASMS Direct focuses on:

1. Update on National DHB MECA Negotiations

2. June issue of The Specialist

3. In Good Hands Survey: Rate your DHB on Clinical Leadership.

4. Medical Council Statement

5. Further CTU Media Statement on Health Spending

1. Update on National DHB MECA Negotiations

Negotiations for the national DHB multi-employer collective agreement (MECA) covering senior medical and dental officers represented by the ASMS and employed by the 20 DHBs are continuing in a largely positive manner. To date, much of our discussions with the DHBs have been in the form of workshops on important underpinning issues. As previously reported a constructive workshop on the recruitment and retention status of the senior medical workforce was held in April where, for the first time nationally, the DHBs acknowledged the seriousness of the medical workforce situation.

The second workshop was held on 18 May on the subject of the Australian specialist labour market. One of the features was the sharing of data on the extent of the base salary gap with Australia and consequential discussion on the impact on New Zealand including the ability of DHBs to achieve government objectives in the health system. The DHBs and ASMS agreed that Australia poses a major threat to the New Zealand health system and that the MECA negotiations should seek to address this in some way and to some degree.

The third workshop was held on 17 June on the theme of clinical leadership in the context of the government’s policy statement In Good Hands and the Time for Quality national agreement between the ASMS and DHBs. In the context clinical leadership is not simply formal leadership positions (eg, clinical directors, heads of department) but potentially involves all senior medical staff at all levels of their DHB including departmental, service and workplace. There was good discussion on both the considerable benefits of and obstacles for comprehensive clinical leadership including senior doctor workforce shortages.

The fourth workshop is scheduled for 22 July. The subject is the implications for senior medical officers of the Resident Medical Officers Commission’s recommendations, endorsed by the government, in respect of increasing their role in RMO training and also, consequentially, front line service provision. At this stage this is the last of the scheduled workshops.

Meanwhile we have had two days of formal negotiations with the second on 18 June. While we have concerns over some of the DHBs’ position, there has been useful progress. However, the key fiscal elements which will be critical to a settlement (including salaries) have yet to be discussed. We have agreed to hold them over at least until the workshops have been completed. A third day of negotiations is scheduled for 2 August.

2. In Good Hands Survey: rate your dhb on clinical leadership

In March last year, the Minister of Health, Tony Ryall, issued In Good Hands: Transforming clinical governance in New Zealand. The aim of In Good Hands is to promote greater clinical leadership in the DHB system. On its release, Mr Ryall stated that: ‘The new Government is serious about re-engaging doctors and nurses in the running of front line health services and we expect DHBs to act on this report’.

The ASMS is exploring the extent to which In Good Hands has been implemented in DHB hospitals and, to this end, has partnered with researchers at the University of Otago to survey our membership. The survey has been mailed to all DHB employed ASMS members.

The intention of the survey is to provide information to advise the government, DHBs and ASMS on the extent to which DHBs are implementing In Good Hands. It is an opportunity for ASMS members to rate their own DHB. But this requires a high response rate.

Please complete and return the survey as soon as possible. If you have not received the survey by the end of June, please contact the national office 04 499 1271 or asms@asms.org.nz.

3. June issue of The Specialist

By now all members should have received the June issue of The Specialist. The front page article on the loss of registrars to Australia seeking specialist positions led to a prominent article in the Sunday Star Times last weekend. This, in turn, generated further Radio New Zealand, private radio and newspaper coverage (including the NZ Herald today).

4. Medical Council Statement

The Medical Council has asked TNS Global, a market research company to update on research it undertook for the Council in 2007. The research will look at perceptions of the Council’s objectives and performance specifically:

· Determining the key audiences understanding of its role and functions.

· Whether the Council’s communications (through publications and media comments) are clearly understood and effective.

· Medical practitioners awareness and understanding of –

o Council’s role and functions:

§ Health

§ Registration

§ Competence and Conduct

§ Education

§ Standards and guidelines (including policy)

§ The Executive (Chief Executive and Chair)

o The difference between competence and discipline and our role in these areas

o Purpose and use of the annual practising certificate fee

o Efficacy of communications through our publications as well as public comments made through the media.

Key audiences for this research are ‘stakeholders’ (eg, medical groups and colleges, Health and Disability Commissioner, ACC, Ministry of Health, advocacy groups); the public; and doctors (including specialists, GPs and international medical graduates).

The Medical Council hopes that this research will lead to::

· A greater understanding of the way the Council’s objectives and performance is perceived by stakeholders, practitioners and the public and recommendations on how communications with different audiences can be improved

· The research may also form the basis of social marketing or the development of consumer documents.

The research will be undertaken from July to late September and will include an online survey of 500 doctors.

5. Further CTU Media Statement on Health Spending

On 16 June the Council of Trade Unions made a further media statement on health spending following a debate in Parliament. In it CTU Economist and Policy Director Dr Bill Rosenberg said:

Minister of Health Tony Ryall’s statement in Parliament yesterday, which implied that the Health budget is both keeping up with inflation and demographic change and will deliver “massively improved front-line services”, does not withstand scrutiny.

A pre-Budget CTU analysis (available at http://union.org.nz/health-working-papers) showed that a $512 million increase in operational funding for Health was needed simply to keep up with an estimated 2.4 percent rate of inflation and an increased and ageing population. However, Treasury and Reserve Bank forecasts of inflation in 2011 now predict CPI is likely to rise by between 3.3 percent and 3.9 percent excluding the increase in GST, adding between $34 million and $58 million to the “stand still” requirement.

Cost shifting as a result of the cuts in ACC entitlements will also erode the Health budget. The Budget included new services and restructuring costs of $158 million which will add a further $118 million, even allowing for productivity gains, bringing the total shortfall to between $152 million and $176 million.

There is no free lunch. If your boss gives you a pay increase just big enough to cover the increased cost of living you can’t start doing things you couldn’t afford before. If you did, something else would have to give. The Health budget shortfall can only be met by some combination of cuts in services, deterioration in quality of services, increased user charges or increased District Health Board deficits.

Ian Powell
EXECUTIVE DIRECTOR

Association of Salaried Medical Specialists

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