GUEST BLOG: Ian Powell – Health alert: Health Minister threatens patient safety

What would I do as a health commentator and health systems blogger without the excellent daily (Monday-Friday) online coverage by NZ Doctor with its focussed and industrious journalists? The short answer is not very well.

A recent instance was the Steve Forbes paywalled article (12 September) on the Government’s decision seeking to amend the Health Practitioners Competence Assurance (HPCA) Act 2003: Health minister signals sweeping changes.

Purpose of Health Practitioners Competence Assurance Act

Annette King was the health minister responsible for the adoption of HPCA Act

The Act that Minister Brown seeks to amend was successfully advocated by former Labour health minister Annette King.

At the time I was Executive Director of the Association of Salaried Medical Specialists. We did have some misgivings about aspects of her parliamentary bill. However, good engagement meant that much of this was able to be satisfactorily resolved.

Overall, the Act has proven to be a successful piece of lawmaking. It provides an external morality that aligns well with the internal moralities (health professional cultures).

This alignment, in turn, provides Aotearoa New Zealand’s health system its greatest strength, especially in today’s despairing times.

I discussed the importance of aligning internal and external moralities in an earlier post nearly two years ago (20 September 2023): Aligning moralities.

HPCA Act is all about patient safety

It is important to understand what the HPCA Act is and why it is important. Expressly it is about patient safety.

To better ensure patient safety the Act provides a framework for the regulation of health practitioners in order to protect the public where there is a risk of harm from professional practice.

This framework includes the scopes of practice for the various regulated health professional groups. It also includes establishing the regulatory authorities responsible for their registration; the largest are the medical, nursing and dental councils.

Ideological based threat to patient safety

On 12 September Minister of Health Simeon Brown issued a media release stating the Government’s intention to amend the Health Practitioners Competence Assurance Act 2003.

Purportedly, so the Minister confidently asserts, this is by making workforce regulation more “efficient and responsive”: Health workforce regulatory changes.

Simeon Brown’s embellished assertions risk greater patient harm

One thing the health minister is not short of is embellished assertions. His release includes the following:

Patients will get faster access to care under new changes to modernise health workforce regulation, Health Minister Simeon Brown says.

“Outdated and bureaucratic red tape is holding back our health workforce and keeping patients waiting too long for care,” Mr Brown says.

“These changes are about putting patients first. By streamlining regulation, recognising overseas qualifications more quickly, and making regulators more accountable, we’ll get more health professionals into the workforce sooner, reduce wait times, and improve access to care across the country.

“Regulatory decisions directly affect how many doctors, nurses, and other health professionals are available to patients. These changes aim to speed up access to care and support new ways of delivering health services, while keeping patient safety front and centre.

“Right now, patients and the Government have almost no way to ensure 18 different regulators are working in the same direction. These changes give patients a voice and let us set clear expectations across the system, so regulators focus on improving access to care.”

Superficially this sounds great. There is only one problem with it – it is complete nonsense. Instead it is based on simplistic ideology.

Christopher Luxon’s promise of an evidence-based government undermined

In the 2023 election campaign Christopher Luxon claimed that a government led by him would be evidence-based.

If this was a genuine claim then clearly he is not leading his government, at least in health. His health minister’s own statement is completely evidence-free.

Even worse but unsurprisingly consequentially, if implemented, rather than protecting patient safety, Brown’s initiated legislative amendments would put patients at greater risk of harm.

The key features of the health minister’s proposed amendment are:

• fast-tracking registration for overseas healthcare workers;
• health regulators would be expected to follow many of the planning and reporting standards used by Crown agencies, including statements of intent, performance and output measures;
• the health minister would be able to appoint a committee to independently review registration decisions without having to go to court; and
• the health minister would be able to issue policy directions to health regulators, to help meet politically determined health targets.

The Minister’s announcement did not come out of the blue. It followed his release in March of the questionable and unsubstantiated Putting Patients First: Modernising workforce regulation discussion document. I discussed this in a previous post (23 May): Hypotheticals from anecdotes and hearsay.

Incisive insights

The strength of the above-mentioned Steve Forbes article is not just that he fairly summarises the health minister’s announcement. He drills down further into its pitfalls.

This includes reporting the insights of Otago University Associate Professor Ben Gray (general practice and public health) who identifies that the announcement presumes the main barrier to attracting overseas-trained doctors to work here is delays in the registration process.

He then states:

But if they had listened to the evidence presented during the consultation [on Putting Patients First], they would know it’s not the registration process, but the fact overseas doctors aren’t staying in the country after they are registered. 

Medical Council Chair is evidence-based; retention is the problem, not retention

This is consistent with earlier comments from Medical Council Chair Dr Rachelle Love which Forbes repeats. Back in April Dr Love confirmed that 60% of overseas-trained doctors leave New Zealand within two years of registration.

In her own words:

Over the past two years, only 0.5 per cent of doctors who have applied for registration have been declined. Over 99 per cent of doctors are able to get registration. So, the idea that the registration process is driving people overseas isn’t supported by the data.  

We can just fling open the doors, and that’s what we’ve been asked to do. But I really want to draw attention to what I think is a far bigger issue. Why are these people leaving?

Dr Ben Gray highlights danger of political interference

Dr Gray meanwhile has more to say on allowing the health minister to appoint a committee to review registration decisions independently.

That would bypass the council and the courts,” he says. “Interfering in the Medical Council’s registration process is really risky….  

This is about politicians thinking they know better without being cognisant of what the risks are. And having someone going to the minister to plead their case is highly problematic. 

That’s why there must be a clear separation between the public service and regulatory bodies like the Medical Council and the Government.

The problem with Simeon

What the health minister is seeking to do is amend the HPCA Act through including additional factors that are irrelevant to its patient safety purpose and have no practical benefit to registration decision-making.

Instead what he is attempting would have the effect of watering down the ability of the regulatory authorities to focus exclusively on its current core function of protecting the public.

Simeon Brown: no evidence, only ideology, anecdotes and hearsay

The problem is not just that Simeon Brown has not provided evidence to support his proposed amendments to the core legislation responsible for patient safety. Worse still, he has not even tried to find supporting evidence.

Driven by his ideologically based ‘values’ he has instead relied on anecdotes delivered by soundbites. The winner is simplistic ideology and the loser is patient safety.

What could be more core to the health system than patient safety? What could be more core than legislation exclusively focussed on ensuring that health practitioner regulatory authorities protect the safety of the public?

 

 

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