Publications
The Specialist
Issue 63 - June 2005
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- MECA on workforce development and edcuation provides an important way forward
- Adherence - sticky business
- Let's get ready to rumble!
- Goodbye to 'medical misadventure'
- Controversial proposal to privatise hospital laboratories
- The medical workforce in the next ten years and after
- The national DHB MECA on advancement through salary scales
- Budget 2005/2006
- National office changes
- ASMS Annual Conference 3-4 November – delegates required
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MECA on workforce development and edcuation provides an important way forward
Appendices to collective agreements are more often than not seen as convenient places to dispose of things that the parties to them (unions and employers) want to shelve or put in the ‘too hard basket’. Over the years the ASMS has been as guilty of this as any health employer.
The national DHB collective agreement (MECA) also has an appendix but, unlike several past experiences, this one has teeth. Nowhere are the gums more powerful and the teeth sharper than Clause 6.1 of the Appendix covering workforce development and education (refer to box). The term ‘appendix’ does not diminish the significance of its contents; they of form part of the MECA.
Range of National Issues
The preamble to the Appendix outlines why those matters contained in it have been placed there with the statement that the parties (ASMS and all the DHBs) recognise the ‘importance of taking a collaborative approach on key national issues that impact on the work environment and the ability to provide quality public health care in a safe and effective manner.’ Further, it states that the ‘parties have agreed to establish joint processes charged with the task of completing reports, including recommendations.’
The national issues identified for this collaborative work are the development of national guidelines for working hours, strategies for DHBs without registrars, standardising the disparate availability allowances, accrual and debiting of annual leave, intellectual property rights, workforce development and education, involvement in DHB decision-making, and infectious diseases.
Workforce Development and Education
The section on workforce development and education (6.1) offers great potential and opportunities for the ASMS to take up and pursue in order to achieve tangible benefits for members and to improve their working lives and work environment, all of which is of considerable benefit to the health system. The section begins with a requirement for each DHB and the ASMS to form a joint taskforce to endeavour to agree upon workforce development and education plans in the following areas—staffing levels, provision of professional development and education, and recruitment and retention strategies to support the staffing plans.
Staffing Plans
The first area is the requirement for each DHB and the ASMS to endeavour to reach agreement over agreed staff plans with the express purpose of addressing the ‘appropriate number and composition’ of senior medical/dental officers to ‘meet the objective needs’ facing each DHB. Simplistically this involves assessing in each department or service what currently exists, what is needed, what is the gap (if any) and how best it might be addressed.
There are several factors to take into account in assessing staffing needs, including numbers, such as:
- Relevant national health strategies.
- DHB strategic and other relevant plans.
- Unmet community need (consistent with the statutory requirement of DHBs to undertake community needs analysis).
- Job sizing and job description requirements of the MECA, including that at least 30% of the time for routine duties and responsibilities (excluding working on after-hours call duties and clinical leadership roles) is allocated for non-clinical duties not directly related to the treatment of an individual patient.
- The MECA standards for professional development and education, particularly secondment and sabbatical, discussed further below.
These factors provide the basis and foundation for assessing the required staffing levels. They offer an excellent opportunity to pursue key ASMS objectives of providing comprehensive, accessible quality patient services, fairer recognition of the workload pressures on and needs of our members, and recognition of professional standards such as sufficient time to recognise non-clinical duties (i.e. 30% minimum).
Provision of Professional Development and Education
The second area is the responsibility of each joint DHB-ASMS taskforce to develop ‘an agreed plan for the effective provision of and access to high quality professional development and education’ inclusive of continuing medical education, secondment and sabbatical.
CME, normally two weeks paid leave per annum, is already part of the regular employment landscape. But the MECA adds to this by its extension to secondment and sabbatical, both of which DHBs are now required to actively encourage SMOs to undertake (Clause 37 of the MECA). In the case of secondment, the recommended professional standard specified in the MECA is two weeks every three years (Clause 37.2) while, for sabbatical, it is three months after every six years.
This planning exercise will need to involve collectively developed implementation plans in each department or service about how and when SMOs take both secondment and sabbatical consistent with the time-frames established by the MECA. It will also have to be built into the staffing plans discussed above (that is, each department/service staffing plan should be based on the premise that each ASMS member will be on secondment around two weeks every three years and on three months sabbatical after every six years).
Recruitment and Retention Strategies
The third area of responsibility for each joint DHB-ASMS taskforce will be to develop agreed recruitment and retention strategies to support the staffing plans discussed above. At this stage it is speculative as to what might be involved. It may well be that the fair and reasonable application of job sizing (inclusive of the 30% minimum time for non-clinical duties) coupled, where applicable, with appropriate placement on the salary scale, may mean that no further work is necessary. But, equally so, it may be that even with the full application of the MECA, special transparent and equitable enhancements, such as supplementary allowances, may be necessary in order to achieve the agreed staffing plans.
The MECA appendix on workforce development and education provides an important means of achieving key objectives of ASMS members. Its potential and capacity are reinforced by the monitoring regime established by the further requirement that the DHBs and ASMS will form a national coordination committee to monitor the work of the individual DHB taskforces and to convene a national conference to consider progress and developments arising out of these local initiatives.
These are exciting times and exciting opportunities which the ASMS with its broad approach to effective unionism needs to utilise.
Ian Powell
EXECUTIVE DIRECTOR
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Below is Clause 6 of the Appendix to the MECA covering workforce development and education. 6 Workforce Development and Education 6.1 In recognition of the senior medical and dental officer workforce (a) Develop an agreed staffing plan for the appropriate number and (b) Develop an agreed recruitment and retention strategy to support this (c) Develop an agreed plan for the effective provision of and access to high 6.2 The parties will form a joint national co-ordination committee of equal (a) Monitor and share information on the work in progress of each Workforce (b) Convene a national conference of the parties covered by this Agreement |
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Adherence - sticky business
Sticky patients
Once upon a doctor-patient relationship in a health system not so far away the celestial body of compliance was discovered. Or rather, the lack of it. Many a medic found it a hard pill to swallow, that many patients were not swallowing theirs. Of course it was always someone else’s patients who were the bad ones. Someone else was not as good at communicating, at educating, at exhorting, as oneself. Only trouble was that each published study confirmed the increasingly candid picture that patients did not comply. Not just occasionally, but routinely. Not maliciously, but because that is just human nature.
Then enlightened practitioners stepping off the pedestal of professional pride urged that the very word was part of the problem. That “compliance” itself smacked of paternalism and disempowerment. That writing about the word showed just why the patient continued not to take her medicine.
And so adherence was invented. A “sticking to” an agreed path. But did adherence improve merely with the use of the word? Or with efforts to understand it and what could be done to make it stickier?
Sticky managers
And travelling in the same stellar system on a parallel relationship were the revolving bodies known affectionately as health managers. Some fiery few of whom saw medics as annoying gum sticking to their shoes trying to walk the corridors of new found power. Medics who would not comply with directives, would not comply with contracts, would not be managed. To whom those very medics responded by “sticking to principles”, sticking up for the patient, sticking up for the profession, sticking it up…
And so the sticky business of running hospitals and the business of illness got stickier. Until, after what seemed like light-years, and out of dark energy, emerged into the firmament the solid mass now known as MECA.
But momentum, straight line or angular, is preserved unless significant force causes it to change. Hence some relationships have continued to career on their paths. Some CEOs have not bothered to implement the simplest of pay scale translations months after their signatures were dry on the MECA. Some SMOs have ignored requests for mutual planning for possible radiographer strikes. Some HR managers have blithely continued to coerce conflict out of their interpretation of clauses in the MECA. Some senior doctors have continued to “stick to their principles” to the extent that they believe they have the one and only answer to all the ills in the universe.
Sticky agreements
So the perceptions get stuck, get sticky, and stick in the craw of those trying to implement the power of the provisions of the MECA. How can the enormous efforts of DHBs and ASMS in producing the MECA be translated into adherence to the words in its pages? Into adherence to the principles and processes it espouses? Into sticking to the letter and the intent of the agreement?
For it is a truly powerful organ for change. For those who want to change. For those who want to glue together the best of professionalism, the best of health management, the best of clinical governance, the best of the passionate, persuasive, perfectionist SMO workforce with 2500 individual answers to what ails us. The MECA requires engagement. Requires adherence. Requires sticking to the agreed path to cohesive, not coercive, progress.
Sticky work
It requires that each workplace develop its own driving combination of SMOs and management, appropriate for its geography and demography. To lead and direct change. To negotiate where possible and demand where necessary. To harness the power of professional persuasion.
To collectively and individually adhere to the principles of the MECA. For the good of SMOs stuck in their daily grind, for the good of the places they stick to working in, for the good of the managers and related professions they stick to working with.
For the good of the patients whose dreams and desires they adhere to.
Jeff Brown
National President
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Let's get ready to rumble!
Both the ASMS and the NZ Nurses Organisation (NZNO) are facing major challenges. But these are both challenges that the two organisations have elected to be pro active over, in their respective memberships’ interests, and to initiate rather than something which has been imposed on us.
The NZNO’s challenge follows and builds upon its earlier achievement of a national DHB collective agreement (MECA). It is now seeking to negotiate a national MECA for nurses working in primary care, largely employed by GPs but also other primary care providers such as community trusts and other non-government organisations. Traditionally the NZNO has been in a weak bargaining position to negotiate on behalf of its primary care members because they are employed by small dispersed employers. Nurses’ capacity to exercise effective industrial action, for example, has been weak compared with their colleagues employed by the much larger DHBs.
But the industrial landscape has changed with the NZNO’s success in achieving the first national DHB nursing MECA since 1992. Owing to its enhanced conditions it has significantly changed the nursing labour market and consequentially improved the bargaining position of the NZNO. Primary care providers are acutely aware that they now will have serious recruitment and retention issues to address. It would also put pressure on the government as the key funder of primary care. Given that taxpayers monies are at stake the government is likely to be cautious over the potential fiscal liability that primary care employers might leave it to inherit. It will also pose an interesting challenge over who will represent the primary care employers in these negotiations. While there is little doubt over who it is when negotiating with DHBs, disparate often disconnected primary care employers are different.
The ASMS’s challenge also arises out of the achievement of another challenge, our own national DHB MECA. This challenge is to ensure that the professional standard recognised by the MECA of sufficient time for SMOs to undertake non-clinical duties not directly related to the care of an individual patient is achieved. The web-like nature of the MECA recognises that the professional standard for sufficient time is at least 30% of the time for routine scheduled duties and responsibilities (e.g. lists, clinics, ward rounds) significantly enhances the ability to achieve this important objective.
Providing that one is actually doing it (or committed to doing it), the achievement of the 30% minimum for members will be very difficult if not impossible for DHBs to ultimately stop, especially in the context of the DHBs’ MECA obligation and responsibility to provide an environment in which SMOs can provide a ‘very high standard of individual clinical practice’.
The achievement of the 30% minimum for non-clinical duties is not a matter of if but when. The challenge for the ASMS will be to organise ourselves so it is achieved in full. This can be pursued by initiating job sizing reviews, through the promising joint DHB-ASMS Consultation Committees created by the MECA, and by being prepared to ‘name, shame and blame’ those DHBs which might seek to resist the implementation of this professional standard and as a result reduce their noble sentiments expressed in the MECA as insincere weasel words. And at the back of all of this is our strengthened legal capacity, as a last resort, to achieve this critical objective.
Those enlightened DHBs who respect and are committed to implementing this professional standard for non-clinical duties will in turn earn the respect of their SMOs, earning this respect is an invaluable commodity for managers in the health system. Conversely those who respond negatively and practice weasel words will earn their disrespect, an all too familiar liability in the health system.
The objective is achievable; it is a question of whether the process of achieving it is positive through constructive collaboration or negative through conflict with obstructive managers and DHBs. The ball is in the DHBs’ court in terms of the process to be embarked upon. The ASMS’s overwhelming preference is for the former but we would be fools if we were not to anticipate and prepare for the latter.
Let the challenge proceed and let’s get ready to rumble!
Ian Powell
Executive Director
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Goodbye to 'medical misadventure'
At the ASMS 2002 Annual Conference the Minister of ACC Ruth Dyson announced that she was doing a review of the medical misadventure provisions under ACC with a view to bringing the provisions in line with the “no fault” orientation of the rest of the ACC legislation. This would cover both medical mishap and medical error.
This was at a time when doctors were concerned about the many different avenues that a single patient complaint about a doctor could take and the years even those complaints which were groundless would take to resolve.
The review is now complete and the legislation passed and from 1 July 2005 both medical misadventure and medical error will be replaced by the much simpler and fairer concept of treatment injury (see box).
The review should serve as a model for other government agencies seeking to consult the profession. It was a process in which consultation was real and actually led to changes in the proposal. It is not all that common for the Association to congratulate Ministers but in this case it seems appropriate.
So now the multiple avenues for complaint are minus one!
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The ACC treatment injury provisions - s impler, fairer, faster The changes:
The impact of the changes:
Source: ACC Treatment Injury Presentations to DHBs - May 2005 |
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Controversial proposal to privatise hospital laboratories
On 3 June the Otago and Southland DHBs jointly announced their recommendation to the Minister of Health to fully privatise their hospital laboratories and hand them over to a private consortium, known as Southern Laboratories, based on the two overseas owned private community laboratory providers active in the southern region, Medlab and Southern Community Laboratories.
The most immediate impact is on ASMS members and other staff working in the laboratories who have been gutted by this unilateral proposal. They were disengaged from the process, had their expertise disregarded and now have their employment and professional careers threatened by this proposal. It also has wider implications for the quality of health services provided by the DHBs and also potentially for other DHBs.
This is arguably the biggest privatisation of public hospital health services since privatisation first appeared on the health agenda when the former National government announced its market experiment in 1991. The process has more in common with the styles of Arthur Daley in the former British television comedy Minder or the recently knighted David Jason character of Del Boy.
Ironically, for it to proceed it would require the approval of the political party (Labour) now leading the current government which, when in opposition, vehemently opposed privatisation of public health assets; in other words, a blatant political U-turn would be required. Despite this, however, the DHBs have given the impression that her role is as a “rubber stamp”.
The DHBs appear to be playing a politically risky game by making public but unsubstantiated claims of $3-4 million annual savings in order to bring the Minister into line within months of the next general election; an arguably clumsy endeavour to use simplistic embarrassment to make it difficult for the Minister to decline the proposal. Interestingly, DHB spokespeople have not mentioned that a similar level of saving was available in the joint DHB proposal.
Prior to the formation of DHBs in 2001, hospital (secondary and tertiary) and community (primary) laboratories were funded separately (the former through the predecessors of DHBs and the latter by the Ministry of Health). In the main public hospitals provided hospital testing while private businesses in most cases provided community testing (again there were some exceptions).
However, DHBs then assumed funding responsibilities for both laboratory services. For some time it was business as normal as the DHBs inherited the funding contracts with private businesses that over the years have increasingly come under the control of private monopolies. Now, however, the terms of these private providers are coming up to their expiry date requiring re-negotiation.
The major difficulty facing DHBs has been the demand and volume driven nature of the funding contracts with the privately owned community laboratories. In contrast with hospital laboratories this funding was uncapped. Although the main problem identified has been with community rather than hospital testing, this has led to a range of possibilities being considered in several DHBs including different forms of privatisation.
These DHBs have responded in different ways. For example, Waikato resolved to (a) continue to run its hospital laboratories (without any bidding process), also allow its smaller hospital laboratories outside Hamilton to provide community testing services, and (b) negotiate with one (not two) private provider to provide community testing elsewhere in the DHB (mainly Hamilton). In principle this is a sensible approach although there are concerns that more emphasis should have been given to building Waikato Hospital’s capacity to provide regional tertiary services and also allow it to expand, where GPs wished, its community testing in Hamilton.
The Capital & Coast and Hutt Valley DHBs have adopted a sensible approach in marked contrast with the Otago-Southland extreme measure. They first decided, like Waikato, not to subject their hospital laboratories to commercial bidding but instead require them to collaborate and work together in a more closely integrated manner (for example, information technology). Second, they are putting their community testing funding contracts out to tender for the current private providers, potential new private providers and the DHBs themselves to bid for.
Otago and Southland, however, adopted a fundamentally different approach working through their funding and planning divisions. In an unusual step and in contrast with the Waikato and Capital & Coast/Hutt Valley examples, they put all laboratory testing, both hospital and community, up for commercial tendering.
This unusual approach imposed serious constraints on the robustness and form of the decision-making process. By introducing the element of commercial sensitivity, it allowed the DHBs to exclude advice from their own internal clinical and operational experts. It also put considerable pressure on potential bidders to make an all-or-nothing, winner takes all, bid for both hospital and community testing.
Two bids were made—the private laboratories and the DHBs’ own hospital laboratories—both bids (there was no other option) were for all laboratory testing. The latter bid, from the DHBs’ hospital laboratories, also included support from the Canterbury DHB in limited areas where there was capacity concerns (in a manner consistent with the government’s advocacy of greater inter-DHB collaboration over the provision of clinical services).
The reason behind this unusual approach is most likely the rigid approach in the two DHBs, especially Otago, of a ‘Chinese Wall’ between its funding and providing functions replicating the artificial distinction that prevailed in the 1990s market era with the now disbanded national Health Funding Authority. This rigid ‘Chinese Wall’ leads to a lack of an integrated and coordinated relationship, fragmentation and a lack of sufficient interest in building public hospital capacity. Otago is not the only DHB to suffer from this rigid demarcation between funding and providing but is among the worse.
The formal recommendation to the DHBs was delegated to a group comprising the two board chairs, the two chief executives and the two general managers of the Funding and Planning divisions. Such was the robustness of the proposal from the DHBs’ own hospital laboratories that they agreed to recommend its proposal rather than that from the private laboratories. This was the advice forwarded to the Ministry of Health in the week leading up to the 3 June announcement.
However, in an extraordinary decision, at around 5pm the evening before the two boards were to consider the recommendation supporting the proposal from the DHBs’ hospital laboratories, a new offer was tabled from the private laboratories which significantly undercut their previous proposal on price. This led to a new recommendation to the boards in favour of the private laboratories which was then quickly accepted by them. The hospital laboratories were never given the opportunity to respond to this second bid and, along with the Ministry of Health, were perplexed and bewildered by this turn of events.
The Arthur Daley/Del Boy reference above has clear applicability here. At the very least the process was very flawed and suspect. At worse, the integrity of the process is highly questionable. For example, why did the DHBs act so quickly without scrutinising its risks and implications, and why did they not discuss it with those with the managerial and clinical expertise in running hospital laboratories?
The ASMS is strongly contesting this proposal and using its best endeavours to ensure that the Minister of Health is not influenced by the misleading propaganda of the DHBs’ hierarchy. The DHBs approach makes a mockery of the commitment in the MECA for greater empowerment of senior medical staff. One of our first steps has been to formally write to both DHBs seeking detailed information under the Official Information Act. Should the DHBs decline to provide this information on the grounds of commercial sensitivity this will expose the claims of the DHBs that their process was not secretive as a falsehood.
The privatisation proposal is inconsistent with the government’s policy, which all DHBs are required to adhere to, of an explicit preference for public rather than private provision of publicly funded hospital services and also for capacity building in public hospitals. It has serious downstream risks such as fiscal, quality and range of services, locked-in long-term rigidity, RMO training, the interface between the laboratories and other DHB medical staff, and recruitment and retention.
In the final analysis it will depend on whether the Minister is influenced by the apparent public relations strategy to influence and embarrass her into approval. This will come down to a question of the astuteness, robustness and fortitude of the Minister in considering a recommendation that is inherently risky, contrary to her government’s policy, and arises out of a questionable and hurried process.
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The medical workforce in the next ten years and after
The Medical Reference Group (MRG) of the Health Workforce Advisory Committee (HWAC) published its long awaited consultation document “Fit for Purpose and For Practice: a Review of the Medical Workforce” in May[1].
The document received a small flurry of publicity on its release principally centred around its chair, Dr George Salmond’s comments suggesting that work presently done by doctors could be done by technicians. The example he gave was of cataract surgery which, he said, was successfully done in India by a small number of specialists and a lot of other trained people and didn’t require highly trained specialists to ensure a successful outcome[2]. His reported views were refuted by other commentators (including ASMS National President Dr Jeff Brown) on this point and the public response[3] made it clear that this was not a scenario that enjoyed much public approval.
The MRG document is about far more than this despite use of words such as “flexibility” and “innovation” which have been used in the past as code for “deskilling”, “deprofessionalising” and “cheap”. However it is a clear expectation in the document that “expensively trained and highly skilled and remunerated health workers should not be providing services that can be delivered safely and effectively by less highly qualified and remunerated workers.”[4]
The issues that the MRG emphasises are:
- “Strengthening and increasing the primary health care workforce, particularly in general practice.
- Change and innovation in the structure and process of both undergraduate and postgraduate medical education.
- Innovative approaches to balance service commitments and training requirements and improve inter-disciplinary communication, teamwork and patient care.
- Well-structured, ongoing vocational guidance and mentoring for medical students and recent graduates.
- Better informed and organised support for vocational decision-making and early career development.
- Clear strategies, policies and well-designed and publicised incentive schemes for the recruitment and retention of doctors in areas of special need.
- Better gathering, analysis and reporting of workforce information.
- A systemic, sector-wide approach that links health sector strategies and workforce development.
- Leadership at all levels across the health system to drive service and workforce redesign and development.”[5]
The MRG paints a stark picture of an aging, increasingly female medical workforce with the too few young doctors depredated by student debt trying to cope with the ever greater demands of their aging, chronically diseased and increasingly ethnically diverse patients who make greater demands on them in a situation of diminished trust. Forty percent of this happy group have gained their first medical qualification out of New Zealand.
The impact of the aging population and of the workforce is expected to hit in 2011 “unless preventive action is taken“[6]. MRG makes the point that simply increasing numbers will not be enough and that other measures need to be taken. Among the measures it suggests are an urgent review of the relationship between the education and health sectors roles in health practitioner training, a review of undergraduate training “including training undergraduates in primary health care settings” and urgent action on student debt. Most significantly the MRG says it’s “deeply concerned about the general practice workforce situation“[7]. It notes that action needs to be taken as English speaking well trained doctors will be aggressively recruited by other countries that face the same increasing demand and aging populations as New Zealand.
The document raises the issues of concern to ASMS members but in the now familiar HWAC context of distaste for specificity. They eschew the dull numeric (and admittedly often inaccurate) discipline of workforce planning for the exciting approach of workforce development. This approach has the merit that is not as yet disproven and it will be difficult to prove that it doesn’t work.
Other features are familiar as well. There is an emphasis on primary care which mirrors the government’s priorities but a failure to grapple with the time lags inherent in the approach. Putting in place measures in primary care may eventually take pressure off the demand for secondary care and for hospital specialists but it will take decades for this to happen. Moreover, it doesn’t matter how effective primary care is, the diseases of aging will hit sooner or later and it is inevitable that this will require increasing levels of secondary care.
Despite its necessarily neutral language the document is permeated with an appropriate sense of urgency. Given the long lead time required to train doctors and the even longer lead time to train specialists the opportunity of increasing numbers of New Zealanders trained in medicine for a crisis beginning in 2011 is swiftly diminishing. The message we are getting from members is that this crisis is hitting now with a mismatch between RMO availability and service demands.
The ASMS will be making a submission on the consultation document to which members might like to submit comments. Members should make individual submissions as well. The consultation period closes on 29 July.
Angela Belich
Assistant Executive Director
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[1] Health Workforce Advisory Committee Fit for purpose and for practice: a review of the medical workforce in New Zealand. Consultation Document , May 2005, available on http://www.hwac.govt .nz
[2] RNZ ” Nine to Noon” Thursday 26 May 2005
[3] See for instance “Leave Surgery to Specialists“ Waikato Times 24/05/2005 p6
[4] P45 “Fit for purpose and for practice”
[5] Media Release HWAC Report 18 May 2005
[6] P16 “ Fit for purpose and for practice”
[7] P29 “Fit for purpose and for practice”
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The national DHB MECA on advancement through salary scales
The national DHB collective agreement (MECA) consolidates and improves upon the gains made by the ASMS in the 1990s and early 2000s under the then single DHB (and their predecessors) collective negotiations in ensuring that our members can advance through their salary scales with a minimum of fuss and bother. This involved the gradual removal of obstructions and unreasonable excuses for non-advancement through arbitrary thresholds of ‘excellent or exceptional performance’ and ‘merit’ which became code words for managerial discretion.
The MECA builds upon those gains and puts in place a much fairer system based on the ethos of professionalism and with minimal transaction cost. Advancement through both salary scales (Clause 11.3 of the MECA) is annual based on a simple threshold of ‘satisfactory performance’ of one’s agreed duties and responsibilities (e.g. job descriptions). Unless one is advised in writing prior to one’s due date of step advancement of concerns over performance, advancement will then proceed to the next step. Advancement is not to be denied if failure to achieve satisfactory performance is due to factors beyond one’s control.
It is important to recognise that the performance criteria and processes which existed in some former DHB collective agreements are removed. There is no place for, or requirement to, agree upon criteria and processes outside the MECA. The criteria are in effect one's normal duties and responsibilities (job descriptions). Nor is there scope for an escalation of the threshold for advancement the further up the scale one advances.
If a DHB is considering denying advancement for anyone to the next salary step then it must advise that person in writing at the earliest practical opportunity before the due date of advancement in order to provide a reasonable opportunity to address the concerns . Anyone who is declined advancement is entitled to a review of that decision by a review panel agreed between the ASMS and DHB.
The MECA clause on salary progression is based on the premise that the senior doctor/dentist who works hard and works well should advance annually and, in effect, automatically, to the next step.
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Budget 2005/2006
The budget is not the pre–election spend up that some predicted. The main outcomes were a “Kiwi savings scheme” (with elements both for superannuation and purchase of first homes) which kicks in in 2007 and taxation changes which will include changes to the marginal rates in 2008.
This government has continued its commitment to the student loan system which now appears to be a consensus policy between Labour and National.
The budget increases the medical trainee intern grant for 6th year medical students by $10,000 a year (to $26,765 per year). The grant has been the subject of long term campaigning by the Medical Students Association. They should be congratulated on finally achieving this success.
The budget also talks about establishing a “bonded merit scholarship” programme which will give up to 500 of the most academically gifted students $3000 toward their course fees and bond them to work in New Zealand for a period.
The Minister of Health has announced, accurately, that Vote Health is the largest ever. This is the result of the commitment made in 2002 to the health funding package which committed the government to a regular increase in Vote Health over the next few years. The opposition has echoed the government’s concerns about the actual results achieved for this massive investment.
The increases include provision for the cancer control council, the meningococcal vaccine campaign, extending funding for GP visits to 18 to 24 year olds, funding the nurses pay deal and the upgrading or rebuilding of hospitals.
A particular disappointment for the Council of Trade Unions was the failure to direct further funding to the aged care sector which is facing a crisis.
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National office changes
The National Executive has approved some minor changes in designation of current positions and also the creation of a new Industrial Officer position. Industrial Officer, Henry Stubbs, is now the ASMS’s Senior Industrial Officer while Industrial & Policy Adviser, Angela Belich, becomes Assistant Executive Director . Along with Executive Officer, Yvonne Desmond, these three positions are equal in the national office internal structure except that in the absence of the Executive Director, Angela Belich assumes that responsibility (this will be the case until 18 July when the Executive Director is overseas in part to participate in several BMA activities in Britain and on leave).
Further, in a significant step a new Industrial Officer has been appointed in order that we can be better handle the heavy industrial workload that regularly confronts national office staff. Kirsty Campbell commenced work with us in April. Although she is a New Zealander she has lived in Australia for some time working in various union roles mainly with the Australian Finance Sector Union.
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ASMS Annual Conference 3-4 November – delegates required
The ASMS meets the costs and makes all travel and accommodation arrangements for ASMS members to attend its 17th Annual Conference as delegates. It will be held at Te Papa on 3-4 November (Thursday, Friday). Members who have not already registered are reminded and encouraged to make leave arrangements and register without delay.
Dinner and Pre Conference Function
In addition to the Conference there is a Conference dinner on Thursday 3November. Delegates are also invited to attend an informal cocktail function on the evening of Wednesday 2 November. The function will be sponsored by Medical Assurance Society again and this year it will be held at the Boatshed on Wellington’s Taranaki Wharf.
Leave
Clause 30.1 of the MECA includes provision for members to attend Association meetings and conference on full pay. Members are advised to start planning now and encouraged to make leave arrangements and register without delay.
Registration of Interest Form
Please help us to plan for another great Conference and to assist with travel and accommodation reservations by taking a minute to fill out a registration form and either post, fax or email the details back to our Membership Support Officer, Kathy Eaden, at ke@asms.org.nz. The ASMS meets these costs for delegates.
Your interest in registration will be confirmed with your local branch secretary as each branch is allocated a set number of delegates. Extra members are welcome to attend the Conference as observers.
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