Publications

2004 Annual conference Reports

Presidential Address

EMPOWERMENT - VICTIMS NO MORE

Friends, colleagues, guests, kia ora.  Welcome to the 16^th Annual Conference of the Association of Salaried Medical Specialists.  It is great to see so many gathered to celebrate and share, to debate and deliberate, to ponder and plan.  Last evening and the next two days provide our annual chance to review, respond and renew our energies.

This meeting and the past year would not be possible without your national office.  Ian Powell thought that a national DHB MECA would reduce his airpoints tally.  Yet he has journeyed to every DHB, and some more than once, has spent many many hours in negotiations, and many more on the phone behind the scenes.  Knowing the hours and days he rings me I can assure you his workload and dedication more than matches many an SMO.  Angela Belich has been part of the MECA negotiations, prepares many submissions to policy makers, and fights for those members outside of DHBs.  Henry Stubbs has assisted those finding potholes in the road of employment, and worked long on the proposed new constitution we will be considering.

Yvonne Desmond runs the show that looks after these three so that they can look after you, and is ably assisted in responding to the demands and anxieties of members by Kathy Eaden and Barbara Narasy.  These officers ensure that your elected National Executive can govern the ASMS, with extra wisdom provided by Vice President David Jones and National Secretary Brian Craig.

On behalf of you as delegates, and those you represent, I thank each and every one of them.

A year ago I said we were at a watershed, entering a brave world anew; a world offering a challenge to make a difference as an individual as a health worker, and as a national organisation.  And what a year we have had!

We have achieved a national DHB MECA.  We have been pilloried on Holmes – and responded with more than a sound bite.  We have endured the threat of RMO strike.  We have seen many efforts to fragment our profession; and the temptation to retreat and act as victims.

To act as if no one understands how we place the patient at the centre of our decision-making.  To act as if no one understands the demands to perform to the utmost at all times of day or night.  To act as if no one understands how vulnerable we are to multiple avenues of investigation and trial.  To act as if no one understands the battles we wage with management, both local and distant, just to maintain services.

The Road to MECA
          In most things success depends on knowing how long it takes to succeed.
          Charles Louis de Montesquieu

Two years ago the 2002 Annual Conference decided to embark on the road to a MECA.  Negotiations commenced 29 April 2003 and the road since has been twisty, rough and even rocky.  There have been times when it seemed that the whole process would disintegrate; times when frustrations have more than bubbled to the surface. 

Through it all your negotiating team kept every door open, used every channel of negotiation, formal and informal, stuck to many principles, and achieved the very best outcome short of extremely messy and divisive industrial action.  Combining and enhancing, uniting while advancing, twenty-one separate agreements into a single national MECA, it was never going to achieve every wish, fulfil every individual desire, right every wrong, correct every imbalance.  The outcome offers different advantages for diverse members; different advances for diverse DHBs; different quanta for diverse gain.  Perhaps some members may feel victimised, sacrificed for the greater good?

But pay and rations are only the most visible, not the most valuable achievement of the MECA.  Your negotiating team spent many sessions battling to build in clauses empowering SMOs.  Clauses to underpin clinical leadership; clauses to guarantee non-clinical time (the 70:30 split); clauses to enhance SMO involvement in consultation, public debate, patient safety and primacy of responsibility to patients; and clauses to define job descriptions and after hours expectations.  Also clauses covering telephones, tools of trade, sabbaticals and secondments, and safe and suitable workplaces.

There is also commitment to joint national working parties to address availability allowances, absences of RMOs, accrual of leave, limitations on hours of work.  And ground breaking agreement over provisions for appointment processes, recruitment and retention benefits, and an alternative to suspension when investigating clinical practice.

We should celebrate what your team has achieved on behalf of members.

Empowerment

We now have a foundation for empowerment.  For senior medical staff to lead their organisations effectively and efficiently.  For doctors and dentists to move on from reactionary or reclusive, defensive or defeatist practice.  At this Conference the Minister of Health will discuss how she expects DHBs to engage SMOs, and Ken Clark will illustrate some of the challenges and successes of clinical leadership.

Already membership workshops with Henry Stubbs and Angela Belich have espoused the power of the enhancements the MECA provides beyond pay and rations.  The gauntlet is down, it is for members to pick it up and move forward in their workplaces, to use the armoury provided to lead, not defend.  We want to move from clinicians fighting for patients, to clinicians leading hospitals, to clinicians leading DHBs.

When clinicians are effectively leading and listening, relationships and reactions to RMO concerns will not lead to the surprises and suffering from the recent RDA notice of a national strike.  We will talk and task together, not tear each other apart.  It is indeed unfortunate that the planned strike was to coincide with this very Conference; that ASMS statements of concern for patients, of the need for resolution, of the inability of SMOs to merely fill in for RMOs, were taken by the RDA as lack of, rather than evidence for, support.  It is difficult to fathom the antipathy of some RMOs to their senior colleagues, and yet resist the temptation to reflect some SMO perceptions of the values of their junior colleagues.

Growing apart, or growing up together
          Once the toothpaste is out of the tube, it is very hard to get it back in.
          H.R. Haldeman

There is a growing disengagement between “senior” and “junior” doctors.  Not only as a result of, but contributed to by restrictions of working hours, we see consultants left as the only personal continuity in patient care.  Not only as a result of, but contributed to by restrictions of working hours, we see residents struggling to gain sufficient experience to fulfil College training requirements.

Residents are showing consultants that life outside of medicine is important, that looking after oneself is not selfish, but essential to longevity, to service without dependency on alcohol or other nefarious supports.  That a career of caring does not require complete sacrifice of self.

Consultants have “been there, done that”, know how tough it can be to work the hours of tedium and turmoil, are the mentors and teachers of the future consultants.  They rely on and need to trust the honesty, dedication and skills of those in training, but slip easily into criticism of their junior colleagues for perceived failings of dedication or responsibility.

And, if these opinions become pervasive, then we have been driven apart.  Not deliberately but insidiously.  Not actively but as a falling apart; a division which can deteriorate so easily into derision.

Only by talking together, walking together, working out together what we expect from each other, individually and collectively, can we learn from each other.  Learn how to look after ourselves.  Learn how to look after our profession.  Learn how to look after our patients.

We must grow up together, or else we will surely grow apart.

Scopes of practice
          Between the idea and the reality, between the motion and the act, falls the shadow.
          T.S. Eliot

Our nursing colleagues have pursued a MECA of their own.  The political fallout and victimisation of a mainly female workforce make our difficulties seem small indeed.  Complications have ranged from pay parity to professional boundaries, from ivory tower ideology to career constrictions.  Confusion over “scopes of practice”, and the multifarious meanings of the phrase, has amplified the need for the relevant registration Councils to agree on implementation of the medusa known as the HPCA Act.

Nurses who want to do what doctors do will never be a cheap replacement.  Those who wish completely autonomous independent practice will never satisfy the public demand for cooperative teamwork and the safety net of shared concern.  Yet drivers of change with imported ideologies gain policy ears and force victim responses from those whose “patches” are poached.  Responding with angst will not turn the tide.  Instead we need to espouse our well founded ideals, work with those who truly understand the boundaries and barriers, with our complementary colleagues, our everyday team-mates, for the good of the patient at the centre of care.

Through all the difficulties the ASMS has maintained a strong reciprocal supportive relationship with the NZNO, including when the NZMA withdrew from negotiating a practice nurse MECA. 

Our shared belief in the strength of a collective health workforce has shown those who would hunt shadows that ideas can be turned into reality, motions into acts.

Victims, no more
          A face seen, is an argument understood.
          Koro Dewes

When general surgeons, provincial hospitals, and the medical profession were roundly attacked and vilified on TVNZ’s Holmes programme, the ASMS fought back.  We have protested loudly and long, through the highly protective complaints system of the media.  Our endeavours have been keenly followed and supported by the Ministry and the Minister.  We have carried the attack, refusing to be victims.

When the Minister of Finance asked the Minister of Health why no more operations were happening for all the extra money he was giving, the ASMS led the response with public statements and meetings with Treasury.  We have engaged those who need to know, and let them know, the reality of modern medicine.

It is salutary to reflect on how much could be achieved if those in the corridors of regulation and legislation could sit down more with those of us who spend our lives dealing intimately with patients and staff at the coalface of care.  To translate our actions into their words.  And in understanding their incentives, we are the best placed to translate their words into action.

It is hard to be bold, without appearing brash.  To be strong without appearing selfish; to be principled without appearing protectionist; and to be confident without appearing confrontational. 

But, as individuals and as an organisation, we have a negotiated and ratified opportunity to take those characteristics which led us into our vocation, to build on them collectively, to move beyond victimisation into clinical leadership – together.

Waiho i te toipoto, kaua i te toiroa

Let us keep close together, not wide apart

 

Jeff Brown
National President