Health Minister plonked in middle of MECA negotiations
Article by Ian Powell, Executive Director - The Specialist, Issue 87
June 2011
Health Minister Tony Ryall has been plonked right in the middle of the ASMS’s precariously placed national DHB MECA negotiations. But this is neither by design nor statutory responsibility.
It is not always appreciated but the Minister of Health has a different role in collective agreement negotiations to that of the Minister of Education or the Minister of State Services (slightly complicated because Mr Ryall is also the latter).
In education, while Boards of Trustees are the employer of school teachers (and other school employees) for the purpose of hiring, firing and general management, the State Services Commission has the legal designation of ‘employer party’ for the purpose of their MECA negotiations. The SSC, in turn, delegates this authority to the Ministry of Education which consequentially brings in the Minister.
In the case of DHBs the SSC does not have this designation and consequently the Ministry of Health is not a legal participant in collective negotiations. Instead this rests with the DHBs who have to work together nationally. This is also unlike Australian states where the departments (and government) are direct participants (sometimes the legal employer).
But it is not as simple as that in New Zealand. Health is necessarily labour intensive and its workforce is the key determinant of value. This depends on having sufficient workforce capacity which requires effective recruitment and retention. In turn, this costs money and the government is the funder of DHBs which means the Minister of Health can’t be uninterested in what happens in negotiations.
More specifically Mr Ryall has been right on the button with two important challenges he has identified:
1. Genuine distributive clinical engagement and leadership in DHBs is critical for the achievement of comprehensive quality improvement and substantially improved financial cost effectiveness, including removal of wastage. One of the consequences of this was the excellent policy advice to DHBs on clinical leadership, In Good Hands.
2. There is a senior doctor workforce crisis in DHBs and it is the government’s number one priority.
Completing the loop is the survey of ASMS members on the implementation of In Good Hands conducted by Associate Professor Robin Gauld, University of Otago (reported in the March issue of The Specialist). It revealed a picture of DHB performance over achieving clinical leadership which ranged from poor to mediocre and reported that only 20% of respondents believed they had enough time to be involved in clinical leadership and in project/programme work.
There is now a blueprint for resolving this – Securing a Sustainable Senior Medical and Dental Workforce in New Zealand: the Business Case – which was jointly developed by ASMS and DHB representatives and subsequently adopted by both (although some within the DHBs are trying to wiggle out of it).
It provides the blueprint for engaging senior medical staff in distributive clinical leadership throughout all DHBs with strong emphases on quality improvement, removal of wastage, and substantially improved cost effectiveness. Further, to deliver on it there needs to be an investment in the remuneration of senior doctors and dentists to generate the workforce capacity to provide the time necessary to engage in distributive clinical leadership.
The Minister can not settle the MECA whose negotiations have become precarious due to unexpected DHB behaviour (erratic or unprincipled depending on one’s point of view). But he can give consistent messages to DHBs, both privately and publicly, that the Business Case is the blueprint for meeting his challenges and moving forward that he would reasonably expect competent DHB leaders to adhere to. The wins are all round – government, DHBs, the senior medical workforce, taxpayers, and above all patients.
Go tell them Tony not to shoot a gift horse in the mouth! You have nothing to lose but non-achievement of your challenges!
Ian Powell
Executive Director
