Prioritisation of Funding by Health Workforce NZ: Third Time Lucky
Article by Angela Belich - The Specialist, Issue 89, December 2011
Health Workforce New Zealand has replaced the Clinical Training Agency as the funder of RMO training positions and has been attempting to find a way to shape the future clinical workforce by giving a priority to the positions it funds at DHBs. Funding will then be available more readily to the higher priority disciplines than the low priority ones. It is fair to say that throughout this process it has always been made clear that they will continue to fund RMOs already in training schemes though potential impacts on the number of registrars available to provide services don’t seem to have been considered.
Initially Health Workforce New Zealand sought feed back on a paper proposing priorities for its investment in clinical graduate training for all clinical disciplines giving a time frame for feedback from 1 June (when the Association received the request) until 8 June. This approach posed particular dangers to funding for RMO training positions because it is likely that any priority given to funding clinical disciplines other than medicine would be taken from the funding available to medical training. This approach seems now to have been put on the back burner. As well the paper was very difficult to follow and did not follow any credible methodology.
In September a further template for investment by Health Workforce New Zealand was put out for consultation. This time the attempt was limited to medical disciplines. The paper was still very difficult to follow. It was based on giving a weighting to various medical disciplines according to their ‘vulnerability’ and their contribution to the governments current health targets (the full paper is available on our website www.asms.org.nz). We discussed the paper with our members through our electronic publications and have discussed it at meetings (JCCs) with our members and DHB managers at many, if not most, DHBs.
Feed back from our members included these comments:
“I have doubts as to whether this is going to fix our shortage of specialists and am not sure of the robustness of the data and assumptions on which this has been based….. I question how we can meet the health target of 4 weeks FSA to treatment and not value the RMOs.”
“I find it obviously a difficult document to understand, and does not drill down into sub-specialties where the vulnerabilities, particularly at a local level, become much more obvious. It does not seem to take into account current shortages or shortfalls in level of care. In my own area of practice… does not get its own analysis ... This does not come across as a sophisticated way to plan, as it does not take into account factors other than the health targets listed. !”
“I have tried quite hard to read and understand this document and I am still confounded by it. Even when you add the data up you get to a different score from the numbers quoted! I don't understand how relying on general registration makes a service more vulnerable. I am concerned as to the validity of the process involved and I am also concerned as to what this document is going to be used for and how that may be done.”
“My specialty is listed, but with such a small workforce I think it is ridiculous to give us a relatively low priority rating effectively on the back of a staff of about 5!”
“,[Our specialty] has been ranked the second most vulnerable specialty in terms of workforce, however as it has not been included in the government’s list of health targets it ranks very low on the contribution score. The society has major concerns regarding the health status of the New Zealand population….. New Zealand has significantly worse...statistics than other OECD countries.”
Overall the feeling was the document lacked rigour and did not drill down into the non-surgical sub–specialities. A number of people commented that the maths was wrong. Managers at DHBs with a training focus said that they spent considerably more than they received from HWNZ on training and that therefore the impact of a change in HWNZ funding would not be definitive. Comment was also made that the funding now dispensed by HWNZ had been taken from DHBs or their predecessors in the first place
The consensus was that the paper was
- difficult to understand, poorly conceived and lacked rigour
- used short term targets to assess long- term needs (specialty training commenced in 2012 would often not be complete until a decade later) and therefore assumed , implicitly, that the current health targets would not be reached for a decade
- ignored current shortfalls in the specialist workforce due to unfilled vacancies, shortages that are so long standing that they haven’t been conceptualised as vacancies and unmet need that would be met in most of the developed world
- ignored non-surgical sub specialities
- dealt cavalierly with very small specialties
Finally the process does not address the question posed by “Securing a Sustainable Senior Medical and Dental Officer Workforce in New Zealand: The Business Case” – even if this process gets the training in medical specialities to exactly match the future needs of New Zealand it becomes pointless if the new specialists then leave the country. The voluntary bonding system is unlikely to perform this task unless it becomes less voluntary.
A far more fine-grained approach would be better perhaps based on the medical workforce needed in 10 to 20 years to match the estimation of health needs in the long-term that has been done by the Ministry of Health’s National Health Board. The approach agreed by the DHBs and ASMS and set out in “Securing a Sustainable Senior Medical and Dental Officer Workforce in New Zealand: The Business Case” (especially Appendix One) which compares the numbers in each speciality in New Zealand to the number we needed to reach Australian levels offers the beginnings of a better approach. Health Workforce New Zealand’s own workforce service reviews sometimes strayed into this area though most recommendations made by these on the specialist workforce seem to have been ignored.
Decisions of this magnitude need to be made after marshalling the best data available and after careful discussion with local College leaders mindful that, in a country New Zealand’s size, a bad decision can quickly lurch into catastrophe. Recently it’s been suggested that Health Workforce New Zealand will be looking at a more clinically driven process. If that’s the case it should be welcomed.
