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Ministerial Address
HON RUTH DYSON: Address to Association of Salaried Medical Specialists 18th Annual Conference, 3 November 2006: Workforce empowerment
Minister of Labour, Minister for ACC, Minister for Disability Issues, Minister for Senior Citizens, Associate Minister for Social Development and Employment (Child, Youth and Family)
Rau rangatira maa,
tenei te mihi ki a koutou i runga i te kaupapa o te ra.
Tena koutou, tena koutou, tena koutou katoa.
[Distinguished guests, greetings to you gathered here for this purpose today. Greetings once, twice, three times to you all.]
Good morning,
I'd like to thank your executive director, Ian Powell for inviting me to speak to you today.
I'd like to acknowledge your National President and chair of this session Dr Jeff Brown [paediatrician from Palmerston North], your Vice President
Dr David Jones, [respiratory physician at
I'd also like to acknowledge Dr James Judson, the Association's second life member and key player in the formation of the ASMS back in 1989, who is attending today as an
I am delighted to have been invited to address you on the topic of workforce empowerment. Not least, because it confirms my understanding that your members are keen to be involved and take the opportunity to grow and innovate and accept further responsibility for achieving better health outcomes.
This is a time of opportunity. More and more people and organisations are coming to see that current workforce arrangements simply are not sustainable in a world of increased health demands, expectations and global competition for practitioners. We are at the “time and tide”, and it will not wait for any man – or woman. There is a raft of initiatives underway to empower specialists, and everyone else working in the health sector.
Before discussing workforce empowerment, I want to acknowledge the work that you are doing to help improve services while maintaining the standards that your Association and others have worked so hard to achieve.
I am pleased with the work that DHBs jointly are doing on health workforce development. They have established six workforce strategy groups looking at the major health worker types including one focusing on the medical workforce. In addition DHBs have several major national projects covering, for example, a framework for health careers, a branding project to improve recruitment, and the health workforce information programme to maintain an up to date record of the workforce.
Today I would like to discuss potential barriers to, and the drivers for, empowerment. I’d also like to talk about some of the gains it can bring – such as enabling clinicians to develop new models of work and to work at the height of their skills.
You are right to seek to further empower practitioners. To get a sustainable workforce and improved health outcomes, doctors and other health workers need to grow and innovate and take greater responsibility for their activities and inter-professional relationships. Government is committed to helping you to do that.
Last year we removed a major barrier to doctors’ empowerment when we passed the new ACC treatment injury and patient safety legislation. You told us that the old fault-seeking regime was a major obstacle to improving patient safety and reducing treatment injuries. The fear of blame was constraining practitioners in fully disclosing events and focusing on remedying situations. It also seriously disadvantaged the public by significantly delaying ACC claim settlements and thus people’s return to a normal life.
Our government was concerned that this requirement had been a long-standing obstacle to improving patient safety and reducing treatment injuries. Requiring claimants to prove fault caused delays in their obtaining cover and created an adversarial environment between claimants, health professionals and ACC. It was anticipated that removing fault would immediately result in faster processing of claims.
At the same time ACC‘s duty to provide harm reporting also changed. ACC no longer routinely reports individual cases or competency concerns to the Health and Disability Commissioner or to the registration authority or employer in question. Where ACC has a reasonable belief that there is a risk of harm to the public, staff must report the risk to the authority responsible for patient safety in relation to that specific treatment. If information suggests there is a risk – say from an organisation, a type of treatment, a practitioner – then it makes a report to the relevant authority.
It is already apparent that the new approach to treatment injury is having the desired results of:
- Ensuring that people injured as a result of treatment get cover quicker and
- Reducing the friction that previously existed between health professionals, ACC and claimants wishing to get cover for medical misadventure.
We can already see the new legislation making a real difference. The average time taken to decide a claim has reduced from 5 months to just 15 days. That is a real achievement which removes so much financial and emotional stress from people and families and lets them plan for their future.
From the public perspective the legislation has had real gains for doctors too. Delays in rehabilitation were also frustrating for doctors. And the end of the “blame” regime has allowed better recording of how and when errors occur, empowering councils and colleges to look at ways of reducing risk in the future.
I am proud of these legislative changes, but law can only achieve so much. The real engine of empowerment has to be the health professions themselves and the academic and professional bodies that train, recognise and support them. The professions must embrace the need to change the way they work while maintaining or improving the quality of services clients receive. The other side of this coin is that health managers need to recognise that senior doctors and other health workers can make very valuable contributions to decision-making and the development of new work models.
I also know that, quite understandably, doctors and other health professionals are seeking a better work-life balance. The majority of medical students and doctors in training are now women, who are especially likely to need to mix family and career responsibilities. Increasingly, men are also wanting to spend more time with their kids and I applaud that. Practices and employers need to give doctors that flexibility if they want to retain their staff.
The solution is not just more places in the medical schools and clinical training courses. Indeed questions of whether current training is optimal are getting louder. That’s why Pete Hodgson asked the Workforce Taskforce to look at streamlining medical education and clinical training. I know Pete is really pleased with the energy and breadth of thinking that the Taskforce is bringing to this work. We are both keenly awaiting the Taskforce’s report next year and hope that you are also. The Taskforce brings together a range of widely respected health practitioners and medical educationalists and we ask that the profession consider its findings with an open mind and the understanding that the status-quo is not sustainable.
Streamlined training is essential. However, it’s not the whole answer either. Being a doctor is a worthwhile and rewarding job, but not everyone wants to be a doctor and a lot couldn’t be if they wanted to. Whatever changes happen, a love of science mixed with great people skills will remain non-negotiable pre-requisites for becoming a doctor.
The answer has to be professional empowerment – and client empowerment too. Doctors and other health professionals should be empowered to focus on those skills that only they have and to identify new, leading-edge ways to improve people’s quality of life. Similarly, people should be empowered to recognise and respond to changes in their own conditions, manage routine treatments and make positive lifestyle choices.
Just as the Government has sought the advice of senior clinicians and educationalists in reviewing doctors’ education and training (they comprise the majority of the Workforce Taskforce), we encourage DHBs to involve senior clinicians in developing the new working models. They have so much experience and understanding to bring to the conversations.
There are now significant overlaps of skills and scopes of practice between different health professions. Letting other professions undertake some of the tasks traditionally seen as part of a doctor’s role will not reduce safety. All registered professions are required to be competent at the tasks within their scopes. Changing and sharing tasks should also increase work satisfaction as people get to work to their full abilities, and have less stress as they can partly cover for each other.
But again, the workforce in other health professions is not infinitely elastic either. They face the same demographic pressures as doctors. I believe this leads us to a model where people take increased responsibility for managing their own conditions. The health system and individual professionals will have to empower people to undertake more of their own care and take more responsibility for decisions that affect their health. This is a vital role. Better health comes from a partnership, health practitioners ensure that people are fully informed and supported, and each of them needs to make their own decision to stop smoking or get active. Empowered doctors, empowering clients.
I also think that we will see people demanding to have more control over their treatment. People are rightly much more questioning about treatments than they used to be, they are also increasingly confident in their own abilities and insistent on fitting their treatments around their lives, not their lives around their treatments. This is good.
Medical professionals are the first line in assessing those with occupational diseases so it is important that you have a working knowledge of what is known as Schedule 2.
Schedule 2 of the Injury Prevention, Rehabilitation and Compensation Act 2001 provides fast track cover under the ACC scheme for those workers that develop certain diseases caused by occupational factors. Having compensation and rehabilitation available to those that develop occupational diseases reduces the significant burden that these diseases place on New Zealanders.
As medical knowledge improves, the Schedule requires updating to include further diseases that have a causal link to employment. As many of you may know, I have put out a consultation document proposing up to 25 more occupational diseases be added to schedule 2. In order for submitters to be able to fully consider the proposed additions, I have extended the time for submissions on the consultation document and these will now close on 1 December.
I encourage any of you with an interest in occupational medicine to send a submission.
The Government is committed to updating schedule 2 as soon as possible, but there is also a need for greater knowledge within the Medical profession for it to be effective.
Having a working knowledge of Schedule 2 will ensure that all people with occupational diseases receive the compensation and rehabilitation that they are entitled to under the Act.
To ensure that Medical professionals are informed about Schedule 2 diseases and how to deal with ACC on such issues, ACC is putting out information specifically tailored to medical professionals. This information should be available to you shortly.
Finally I want to conclude by emphasising that:
- I have the utmost respect for the skills and public service ethos that doctors bring to their work; and
- like Pete Hodgson, am confident that you will play your part in developing new ways of working, so that different health professions work in teams, as respected equals, each bringing their own valuable skills and knowledge.
To this end I ask DHBs to take an open-minded and consultative approach in developing new work roles, structures and relationships, and to value the input that senior doctors and other health workers can contribute.
Thank you for the opportunity to talk to you, and I trust will you have a successful annual conference.