“Thank you for your service” – the great decluttering of New Zealand health

“Thank you for your service” – the great decluttering of

New Zealand health

Sarah Dalton | Executive Director

Back in the day, T.S. Eliot gloomily wrote “April is the cruellest month” – a weird thing to say about spring, and now, living on our heating planet, it belies our long, benign autumns.1 However, this year at least, several DHB leaders might be inclined to agree.

In a surprising announcement, Health Minister Andrew Little told us Cabinet has decided to go the whole hog and do away with every DHB. Along with the 20 DHBs, another 30 PHOs are likely to go in a massive bureaucratic clear out aimed, we think, at streamlining and nationalising our health system, and getting much more bang for the Vote Health buck. The sector was caught offguard by the decision, which went much further than the recommendations in the health and disability review led by Heather Simpson. The minister has effectively said to the DHBs “You no longer spark joy, thank you for your service” and, in a masterful, Marie Kondo-esque stroke, swept them all away.

“The sector was caught offguard by the decision, which went much further than the recommendations in the health and disability review led by Heather Simpson.” I can list lots of things about the current system I won’t miss – haggling over local interpretations of the CME clauses ad nauseum, lobbying for a proper health workforce census and work focused on SMO supply, trying to find out who’s really running MECA negotiations (it’s never the people in the room), negotiating equitable pay and conditions for those of our members working in the contracted-out sector – NGOs, trusts, iwi providers. It’s very much a multi-tiered system with, believe it or not, privileged conditions in DHBs. And I know that for many of you working in the DHBs, it doesn’t feel privileged at all. You are struggling with short-staffing, lack of succession planning, patchy recovery arrangements after hours, and massive clinical encroachment on non-clinical time. You feel as though your pay and conditions are not keeping pace with living costs – let’s not even start on housing – and you are probably right. Yet, your employers – even the ones who tell us they’re championing the rights of those who earn least – are not even committing to paying a living wage to all their staff, let alone those in contracted-out services. And one of the tactics used to deal with these shortfalls and disparities is to bolt a salary ceiling firmly in place, while arguing they’re busy raising the floor. In our view, neither is the case, and there is no benefit to any working person when downward pressure is applied to salaries and conditions. We know that, despite Vote Health costing taxpayers a fair chunk of our contribution to the public good, we need that investment to increase. And the biggest resource we need to invest in is our people. It is you. Whether these arguments will carry any more weight with the streamlined Health NZ, due to open its doors in July next year, is moot. But at least it should be clearer to us who we’re dealing with – and that the people in the room are the people calling the shots. If we can’t achieve that, we can’t achieve much at all. In the meantime, we are pressing on with our full programme of research and advocacy, and with our ASMS–DHB MECA negotiations. We very much appreciate the feedback you’re sending us. It’s feisty, mostly well-informed, contradictory, and deeply held. Please keep talking to us. We are listening. REFERENCES 1. Please, no emails explaining The Waste Land to me – just accept my apologies for a lazy metaphor!