GUEST BLOG: Ian Powell – ‘Delusional’ and ‘a spit in the ocean’ – absolutely; but also sinister!

On 26 November Minister of Health Dr Shane Reti and Commissioner of Health New Zealand (Te Whatu Ora) Lester Levy made what was promoted (ie, spun) as a major health workforce announcement:

Official announcement.

This was that 50 new senior doctors, along with extra specialist nurses, would be employed by Health New Zealand.

It was also reported that that there would be a peculiar ‘bidding process’ for these positions. No less than Commissioner Levy would make the final decision over these ‘bids’.

Health Minister Shane Reti claims announcement will help fill critical workforce gaps

Reti claimed that this would help fill critical workforce gaps, particularly in regional or provincial hospitals. It would, he asserted, help reduce wait times and support vulnerable specialties like dermatology.

Previously I have posted (10 August) on the demoralising impact of disingenuous and misleading ‘good news’ spin by health bosses on overworked, fatigued and burnt-out health professionals:

Health professionals to health bosses; stop the spin.

I would not have thought this possible but the Reti-Levy announcement has taken this kind of demeaning media ‘spin’ to an even higher level. Hospital corridor discussions have no difficulty in seeing through this nonsense.

Hospital corridor discussions know the difference between fact and fiction (NZ Doctor)

Sceptical media coverage

Perhaps the gentlest, but nevertheless firm and accurate, response came in a Kathryn Ryan interview on Radio with Sarah Dalton, Executive Director of the Association of Salaried Medical Specialists (26 November):

ASMS on 50 new senior doctors farce.

Among other things the interview was brought out that estimated senior doctor shortages in Health New Zealand hospitals were in the vicinity of 1,000 to 1,200.

Te Whatu Ora claim there are 1,700 vacancies for all hospital doctors (senior and junior/resident) and general practitioners.

However, this is disingenuous as it only includes the hospital positions that it choses to advertise. The reality is that shortages can be higher than vacancies by a variable factor of two or three to one.

That same day Newsroom managing editor Jonathan Milne had no difficulty seeing through the smoke and mirrors:

Sleight of hand.

Dr David Galler made mincemeat out of the Reti-Levy announcement

And, on 27 November, in an on-the-button Radio New Zealand Morning Reportinterview retired intensive care specialist and now health commentator Dr David Galler intelligently made mincemeat of the announcement:

A band-aid.

Gritty masterclass

Lisa Owen Checkpoint interview trumps media coverage

However, this coverage was trumped a Lisa Owen Radio New Zealand Checkpoint interview with Dr Norm Gray, clinical head of Wairarapa Hospital’s emergency department (26 November):

Delusional spit in the ocean.

Lester Levy knows more about recruiting overseas senior doctors than senior doctors involved in trying to recruit them!!!

Dr Gray gave a gritty, but matter-of-fact, masterclass in cutting to the chase which included effectively rebutting various Commissioner Levy claims. Among his observations were:

• When ask whether the announcement had given him hope, he replied not at all. Instead it left him despondent and despairing.
• The number of new senior doctor specialists was negligible.
• His hospital even now can’t recruit from overseas.
• The announcement was “delusional” with facts contradicting its fiction.
• Wairarapa Hospital is already short of around 20 senior doctor positions.
• The announcement was not even a drop in the bucket; instead it was a “spit in the ocean.”
• The intended bidding process was wrong; there should not be competition.
• Around one-third of locally trained doctors leave New Zealand because work conditions and remuneration are not comparable with overseas options. [Note: Australian specialist core salaries are at least over 60% higher]
• Commissioner Levy’s claim that this announcement would succeed because it was a “different approach” was “delusional”.
• His overall conclusion was that the announcement was an embarrassment for the government that would come back to bite it.

From delusional to sinister

Dr Gray is right. The Reti-Levy announcement is delusional, arguably deliberately so. However, in the context of the announcement itself and Levy’s “different approach” (bidding process), there is also a sinister element potentially undermining employment law.

Something sinister

In the national collective agreement covering the core terms of conditions of senior doctors and dentists employed by Health New Zealand, there is an important entitlement covering hours of work and job sizing. Specifically:

13.1  An employee’s hours of work and job size shall be mutually agreed and shall objectively reflect the requirements of the service and the time reasonably required for the employee to complete their agreed duties and responsibilities, as set out in their job description.

13.2  An employee’s job size is the average weekly number of hours the employee is required to undertake:

(a)  routine duties and responsibilities, including such scheduled activities as out-patient clinics, theatre lists and departmental meetings;

(b)  non-clinical duties and responsibilities [refer to Clause 48.2(d)];

(c)  duties at locations other than the usual workplace; and

(d)  rostered after hours’ on-call duties, including telephone consultations and other relevant discussions.

This is one of the strongest hours of work clauses in a collective agreement in New Zealand; arguably the strongest. [Disclosure: I was the advocate who first negotiated and then subsequently strengthened it over the years; just saying!]

It requires agreement over the hours of work and an objective methodology (as one can get in medicine and dentistry) to determine the average time necessary to perform the agreed duties and responsibilities.

Senior doctors in hospitals and related services don’t work as isolated individuals. They are part of a team, usually known as departments and services.

Consequently, to job size a specific position requires an implied or explicit agreement on the total senior doctor job size of the department or service.

The unilateral nature of the Reti-Levy announcement coupled with the top-down determinative “different approach” of Levy runs contrary to, and potentially breaches, this employment law obligation.

 

 

 

 

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion