Minister’s Letter to health bosses a missed opportunity

Health Minister’s Letter of expectations to health bosses a missed opportunity to address workforce crisis

28 MAY 2018
MEDIA RELEASE - ASMS

“The Health Minister has given hospital bosses a clear signal about the Government’s health priorities but has missed an opportunity to focus on one of the main ways to achieve those priorities – the specialist workforce in our public hospitals,” says Ian Powell, Executive Director of the Association of Salaried Medical Specialists (ASMS).

He was commenting on Health Minister David Clark’s first annual letter of expectations to the chairs of the country’s 20 district health boards and their subsidiary entities for the 2018/19 year (https://www.asms.org.nz/wp-content/uploads/2018/05/Letter-of-expectations-for-District-Health-Boards-and-Subsidiary-Entities-for-2018-19.pdf).

Mr Powell says while senior doctors support the general tone of the letter, overall it is disappointing.

“We welcome the Government’s intention to focus on primary care, mental health, public delivery of health services, and improved equity in health outcomes. These are all worthwhile. The focus on public delivery of health services especially represents a significant change in approach from the previous government.

“This clear signal on public delivery will strengthen hospital specialists’ confidence in the Government’s commitment to public hospitals who have been under threat of privatisation. It sends a strong message to would-be privatisers such as Taranaki DHB, which is trying to pressure the Health Minister to support its attempt to privatise its hospital laboratory not to go down this ideological and financially irresponsible path.”

However, Mr Powell says the letter of expectations does not require DHBs to address the precarious situation of their specialist workforce.

“This is a significant oversight by the Minister as senior doctors and dentists are a stressed and stretched workforce, and they have been shouldering the burden of an under-resourced public health system for years to the detriment of their own health.”

ASMS research shows high levels of burnout (50%) among hospital specialists (https://www.asms.org.nz/news/asms-news/2016/08/12/burnout-rife-among-senior-doctors-dentists-working-public-hospitals/), along with presenteeism, including working while infectious (https://www.asms.org.nz/news/asms-news/2015/11/19/superheroes-dont-take-sick-leave-presenteeism-in-the-senior-medical-workforce/) and with 25% of specialists surveyed intending to leave DHB employment in the next five years (https://www.asms.org.nz/wp-content/uploads/2017/07/Future-intentions-of-the-New-Zealand-DHB-based-senior-medical-workforce_168309.4.pdf).

ASMS drew these issues to the Health Minister’s attention in its Briefing to the Incoming Minister in October last year (https://www.asms.org.nz/wp-content/uploads/2017/11/BIM-2017_168920.6.pdf). These are highlighted in the following two graphs in the ASMS BIM.

Estimated staffing shortfall at selected DHBs:

Indicators of the health and wellbeing of the senior medical workforce:

“The workforce section of the Minister’s letter of expectations fails to fully grasp the significance and impact of the serious specialist shortages that hospitals are dealing with. It also doesn’t acknowledge the failure of the Ministry of Health, Health Workforce New Zealand and the DHBs themselves to adequately plan for the country’s medical workforce needs.”

Mr Powell says Dr Clark also unfortunately continues his predecessor’s decision to ignore the importance of clinical leadership for DHBs.

“Clinical leadership is the key lynchpin that will help DHBs turn their situation around, and it’s very disappointing that it has been ignored in this letter. It’s clinical leadership and good engagement that will ensure the ongoing quality and accessibility of patient services, as well as helping to improve the DHBs’ financial performance. As the Minister should know, what makes good clinical sense also makes good financial sense.

“As with Jonathan Coleman, David Clark’s ignoring of clinical leadership is a clear signal to DHBs that clinical leadership is not that important. His ignoring is a body blow to those hospital specialists who have been fighting for it for so many years but have been obstructed by a leadership culture of managerialism. We need a David Clark Mark 1, not a Jonathan Coleman Mark 2.”

He says the Minister also demonstrates some naivety when he links better resourcing of primary care with a reduction in the pressure on emergency services, as evidence suggests that one does not automatically lead to the other.

“It is also disappointing that Dr Clark does not encourage DHBs to follow the successful approach of Canterbury DHB in the development of health professional-led health pathways between community and hospital care. This approach is based on extensive clinical leadership and developing strong relationships across the Canterbury health system. Too many other DHBs have adopted a narrow approach based on limiting formal contracts and commercial ‘tool kits’.

“There’s a lot that is good in this letter of expectations,” says Mr Powell. “DHBs have received a very clear message about what the Government wants them to focus on, and those are all things that are important to senior doctors.

“Unfortunately, however, the Minister has missed a chance to send DHBs a clear message that they must also address the shortages and pressures facing their workforce, and to encourage clinical leadership as one of the deciding factors in the success of the public health system.

“Those are significant omissions and a very negative message to those who have been struggling to hold our public health service together for so long.”

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