GUEST BLOG: Ian Powell – “I can confirm they are hypotheticals drawn largely from anecdotes and issues the minister has heard about.”

Before reading further hold on to the words in my heading above. Then consider who said, “I can confirm they are hypotheticals drawn largely from anecdotes and issues the minister has heard about”.

Further, who did the comment refer to, what was its context and meaning, and what is the significance of this meaning?

The context is a review of the regulatory health professions presently being undertaken by the Ministry of Health for Health Minister Simeon Brown.

However, the ideological origin of the review is the coalition Government agreement between the National and Act parties.

Former health minister Annette King was responsible for enacting of legislation governing health professional regulation in 2003

Regulation of health professions is covered by the Health Practitioners Competence Assurance Act 2003. Its overriding purpose was to provide a framework for the regulation of health practitioners to protect the public where there is a risk of harm from professional practice.

The Act included the requirement for scopes of practice for each of the regulated occupations. Eighteen regulatory authorities cover 26 professions. The authorities that cover the largest professions are the Medical and Nursing Councils.

Health Ministry discussion document

As part of the review the health ministry published a discussion document under the misleading ‘milk and honey’ title of ‘Putting Patients First: Modernising health regulation’.

But drill down further and a more sinister picture emerges. My drilling down was recently published by Newsroom (24 April): Threatening political meddling in health regulatory authorities.

Ministry discussion document originates from ideology

My main points about this discussion document were:

• It is based on a false construct that too much regulatory “red tape” was making it more difficult to ensuring that New Zealanders “have access to timely, quality healthcare”.
• There was a complete absence of evidence to justify its contentions. In fact, contentions were contradicted by evidence.
• It is ideologically loaded and weak arguing by insinuations and with an obviously pre-determined outcome in mind.
• It raised several questionable scenarios to justify regulatory change that could, in fact, be resolved within the existing system (discussed further below).
• The biggest threat implicit in the document was political interference in the functioning of the regulatory authorities thereby weaking their responsibility to protect the public from harm.

The risks for patients being diagnosed and treated by the medical profession was succinctly outlined by the Chair of the Medical Council, Dr Rachelle Love (a Christchurch head and neck surgeon) on Radio New Zealand’s Nine to Noonprogramme (8 May): Increased political control risk.

In rebutting the claims of the Ministry’s discussion document, Dr Love said that what it proposed risked leading to increased political control. Instead, the real issue was the retention of doctors which was ignored by the Ministry.

General practitioners don’t pull their punches

Steve Forbes in a paywalled article published by NZ Doctor (17 April) reported Dr Angus Chambers, general practitioner and Chair of the General Practices Owners Association (GenPro) concerns. The latter was at his forthright best.

The forthright Dr Angus Chambers

He described the consultation practice for the Health Ministry’s discussion document  as poorly designed and amounted to a consultation process with a preordained outcome. If implemented, it would lower both standards of care and clinical safety guidelines.

Dr Chambers assessed the process as being “completely cynical” adding, as reported by Forbes, that:

There are good reasons for the different specialised regulatory authorities to oversee various health professionals, he says. But he is concerned the consultation paper is designed to get a “quick-fix response from the public”. 

Further:

Opening the floodgates to new, less-qualified health professionals, such as physician associates, to plug workforce gaps isn’t the solution, Dr Chambers says.

“If we had enough GPs, we wouldn’t need these additional professions.” 

General practitioner and Chair of Women in Medicine Dr Orna McGinn also questioned the credibility of the process in her LinkedIn page:

The document presents a case to further politicise the health landscape via deregulation and undermining of commitments to uphold Te Tiriti o Waitangi and thereby address inequities in health access and outcomes.

We note that two government statements concerning practitioner scope and regulation were published before closure of the consultation period. This raises doubts as to the validity and legality of the process.

Scenarios scam

The dubious use of the above-mentioned scenarios in the Ministry of Health’s discussion document to justify the ‘preordained outcome’ highlighted by Dr Chambers unsurprisingly attracted strong and angry responses.

No wonder than NZ Nurses Organisation Chief Executive Paul Goulter called it poor quality and that it should be withdrawn.

The scenarios led to the Association of Salaried Medical Specialists (ASMS) formally complain to both the Public Services Commissioner and Director-General of Health over their use.

Two of the scenarios claimed that podiatrists being unable to prescribe some feet medicines and approval for new occupational groups, such as physician associates, were being obstructed by the existing regulatory system.

Soon after the Health Ministry released its discussion document, approval for both issues occurred.

The former made sense while the latter (which was a ministerial decision) did not. But both demonstrated that working through the existing regulatory system led to the sought outcomes.

ASMS meanwhile also pursued the scenarios controversy with the Health Ministry under the Official Information Act. The response from a Ministry official to ASMS, as reported in another paywalled Forbes article (6 May) was:

I can confirm they are hypotheticals drawn largely from anecdotes and issues the minister has heard about.

The answers to my opening questions

The official’s response  reinforces what many suspected. The Ministry’s discussion document was largely written from within Health Minister’s office.

A feature of his office is the absence of health system experience understanding, including about the intent of the Health Practitioners Competence Assurance Act discussed above, is poor.

Simeon Brown bases health policies on anecdotes and issues he has heard about

Returning to my above opening questions, the Health Ministry made the comment, and it was referring to their health minister Simeon Brown.

The context was a false construct that the health professions regulatory authorities were contributing to the health workforce crisis.

The meaning was that political involvement was required even though this poses serious risks to the authorities prime legislative responsibility to protect the public from harm.

As for the significance of its meaning it highlights the serious risks of harm to the health and wellbeing of the public (and to health professionals) when decision-making is ideologically driven and designed by those with at best minimal health system experience.

Jonathan Swift reportedly first opined that you can’t make a silk purse out of a sow’s ear

No wonder, as I observed in my above-mentioned Newsroom article, the failure of the discussion document’s authors was not being able to make a silk purse out of a sow’s ear. They should have listened to Jonathan Swift.

Given the ideological origin and consequential high level of predetermination they never had even a dog’s chance.

 

 

 

 

 

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