MECA negotiations on a cusp: but of what?
Article by Ian Powell, Executive Director - The Specialist, Issue 86, March 2011
March 2011
‘Cusp’ is an interesting word. It has particular usages in astrology, astronomy and anatomy, for example. In plain language it is a point that marks the beginning of a change; hence the expression, ‘on the cusp of a new era’. This is a reasonable description of the current stage of our national DHBs multi-employer collective agreement (MECA).
We are on the cusp of something but what? It could involve a significant paradigm shift in the ability of DHBs to enhance effectiveness and efficiency and achieve laudable government objectives. This would be through providing a sustainable pathway to terms of employment that enables DHBs to markedly improve recruitment and retention in order to generate sufficient senior medical and dental staff capacity to deliver. This would be a great cusp to advance from.
Alternatively, through lack of DHB and government will and leadership, we could miss out on this opportunity and the workforce brittleness that undermines achieving the health system’s potential could further deteriorate with the consequential negative repercussions that would inevitably follow.
Time and workforce capacity
Late last year Associate Professor Robin Gauld (Otago University Medical School) conducted a survey of DHB-employed ASMS members on the implementation of the government’s policy statement on clinical leadership, In Good Hands. The government has correctly recognised that if it its health policy objectives are to be achieved’ effective comprehensive clinical leadership will be required in DHBs.
But Dr Gauld’s survey results deliver a sobering message with ASMS members’ assessment of DHBs’ performance ranging from poor to mediocre. He constructed a 13-point clinical governance scale but not one single DHB achieved at least a 50% pass.
The most revealing factor was lack of time. Respondents reported that only 20% of them had sufficient time to participate in clinical leadership or development activities. Lack of time is the immediate consequence of specialist shortages in our public hospitals.
‘Business Case’ path
The ‘business case’ jointly developed between the ASMS and the 20 DHBs last December focused on addressing this issue and on the significant quality improvement and cost effectiveness gains that could be achieved through clinical leadership. The intention had been to forward the agreed document to government before Christmas. However, for tactical reasons, the DHB chief executives concluded that the timing was not right and that there needed to be an accompanying ‘operational’ document (which would have to be agreed with the ASMS).
On the one hand, this was a surprise change of tack. On the other hand, it was still consistent with our broad direction. Further, both the ASMS and DHBs had envisaged this sort of thing being in the ‘business case’ itself but ran out of time in respect of the deadline we were then working to. This ‘operational document’ might aptly be described as the missing chapter of the ‘business case’.
Resumption of negotiations; ups, downs and ups
Negotiations resumed this year on 9 February and continued on 15 March. The post-‘business case’ focus has been on costing various scenarios on remuneration in order to achieve an outcome consistent with the parameters of the ‘business case’. Unfortunately, on the 15th the DHBs’ negotiating team found itself in the position of not having a mandate (or being very uncertain over their mandate) in order to continue this process. The ASMS negotiating team started to doubt the commitment of the DHBs to the full ‘business case’.
As a result it was agreed to cancel the next date of negotiations on 23 March and instead use that day to hold a ‘crisis’ meeting with key DHB representatives further up the pecking order and the ASMS. The purpose was to get an understanding of what the road-blocks were and whether we could progress through the impasse that had emerged.
The ‘crisis’ meeting proved to be useful in getting negotiations back on track. The DHBs representatives included Northland Chief Executive Karen Roach (who chairs the DHBs Employment Relations Strategy Group which oversees all negotiations) and Hutt Valley Chief Executive Graham Dyer (who is her deputy on the ERSG). Discussion was both frank and constructive as the parties discussed their respective frustrations.
My reading of the DHBs representatives is that they are struggling to cope with the combined pressures of the Minister of Health (on the one hand, saying that the senior doctor workforce in DHBs is the government’s top investment priority and, on the other hand, saying repetitively there is no more money) and the negative attitudes of some chief executives. They seem to be akin to possums caught in headlights (at risk of morphing into cornered rats) which appear to have affected the clarity of communication between their Employment Relations Strategy Group and negotiating team.
Reaffirmed path forward
Arising out of this discussion the DHBs and ASMS reaffirmed a commitment to resolve the ‘operational document’ (within the framework of the ‘business case’); resolve the relationship between this document and the MECA; and to endeavour to settle the terms of the MECA itself (largely now down to remuneration) by the end of April (subject to ratification by the DHBs’ chief executives and the ASMS National Executive following an indicative ballot of members as well as the go-ahead from government).
Consequently it was agreed that the ASMS and DHBs would meet on 31 March to finalise the ‘operational document’ (and its relationship with the MECA) and resume formal negotiations for hopefully only two further days (18 April and 29 April). Meanwhile the DHBs would continue to keep government informed of progress.
If the ASMS’s current national collective agreement negotiations with the DHBs don’t achieve terms of employment that enable us to retain those we train, retain those we currently employ, and recruit effectively in an internationally competitive medical labour market, senior doctors will not have the time necessary to ensure that DHBs achieve the government’s objectives. And this would be on the cusp of something very bad.
Ian Powell
EXECUTIVE DIRECTOR
