Trust and confidence Dr Julian Vyas | ASMS President
Trust and confidence are critical to the successful function of any organisation. It is vital to the success of Health NZ and the Māori Health Authority that they enjoy the confidence of the public and, just as importantly, their workforces. The pressing need to redress the current, chronic failures of engagement with the health workforce is recognised by the Transition Unit, and the test will be whether this carries over once Health NZ becomes our new employer. Health unions have been highlighting critical staffing shortages for years. When I look back at editions of The Specialist over a decade or more, the same issues are reported time and time again: •
not enough senior dental and medical staff for the workload
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managerialism hindering proper distributive clinical leadership
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lack of capacity within the hospital estates.
Yet for just as long, there has been a begrudging approach (at best) from DHBs to even acknowledge the evidence, data, and experience ASMS has on these issues. It seems that while the DHBs trust us to make lifechanging decisions on behalf of our patients, when it comes to hearing our workplace concerns, we are viewed as untrustworthy. The DHBs consistently questioned ASMS’ staffing surveys that revealed estimated specialist staffing shortages of around 24%. Covid-19 arrived and suddenly the shortfalls across the entire health workforce were well and truly exposed. So much so that DHBs were forced to contravene the Government’s (red) traffic light rules and request that staff who were close contacts of a Covid-positive person, or even Covid positive themselves, should still come to work if they were ‘well in themselves’ – because of staffing shortfalls. Perversely, I could go to work but not go to Countdown. So, dare I presume that there shall be no further denial of a need to recruit more health care staff – not least, doctors and dentists? Last week’s Budget, and Minister Little’s post-Budget speech, recognised the need for workforce development. However, this appears more focused on community/primary care services. With the Government’s announcement of a special taskforce and national approach to clear patient backlog and assuming identification of unmet need is as successful as it needs to be, it seems inevitable that there will be even greater demand placed upon hospital services. Yet, as ASMS has repeatedly pointed out,
our current member workforce is just not sufficient to support this added need. As Aldous Huxley said: “Facts don’t cease to exist because they are ignored.” To maximise the ability of health staff to deal with current and likely future patient need, Health NZ must not allow a continued ‘blind eye’ to be turned to the needs of the workforce.
It seems that while the DHBs trust us to make life-changing decisions on behalf of our patients, when it comes to hearing our workplace concerns, we are viewed as untrustworthy. Staff must not be permitted to remain as fatigued and as unsupported by the system as they currently are. Clinicians must not be placed in invidious situations of having to ration patient access to health care. (We must not forget that even before Covid, some DHBs had already been using a variety of means to restrict the number of patients on waiting lists at any time). We must be properly consulted with and included in devising solutions to improve the provision of health services. Underpinning all this is the keenly awaited Health Charter. This will set out the expectations for both employer and employees in the new system. It should also reflect what is best practice for an employer in terms of properly engaging, listening to, and supporting its workforce. New Zealand needs to recruit more health care staff. Estimates suggest that by 2030, there will be a global shortfall in health care workers of 18 million. Economic reality is that salaries equivalent to those in other countries (especially Australia) are unlikely to be possible here for several years. Therefore, our health system must create other ‘positive attributes’ and support better staff wellbeing to help attract IMGs and retain the people we already have. All of this comes back to Health NZ needing to regain the trust and confidence of members, by showing that it will properly tackle the existing workplace dysfunctionalities and that it truly values and respects its workers in return. Kia kaha
WWW.ASMS.ORG.NZ | THE SPECIALIST
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