President's Column: Questions and Answers

JULIAN VYAS, ASMS PRESIDENT

The findings of the Te Whatu Ora Pulse survey have yet to be shared in detail with workers. Results seen by ASMS suggest senior medical staff scored the question about having sufficient resourcing to adequately care for their patients at just 15 per cent. Sadly, this appalling state of affairs is not new. But its documentation is a resounding vindication of all that ASMS has been telling health leaders for decades. Much has been written in the past about the moral injury that clinicians experience due to their inability to help their patients – feelings often amplified by the fact that treatments are actually available, and it’s just poor local resourcing that prevents our patients from getting them. Now we are really seeing the detrimental effects of this under-resourcing on our colleagues. In the last few months, I’ve heard more and more from members experiencing moral injury through witnessing their colleagues’ loss of wellbeing, and the creeping sense that there is no current solution. I also hear more and more of specific services suddenly facing critical workforce losses when senior colleagues simply leave, having had a ‘gutsful’ of systemic inertia and dysfunction.

The Pulse survey itself is a good example of that dysfunction. To date, Te Whatu Ora has only shared the most cursory high-level data and, even then, not consistently across districts. Fuller data from a single district has found its way into the public domain. Many responses in it reiterate a lack of support for and engagement from Te Whatu Ora with its staff. I can’t help but speculate that the ongoing delay to properly publish the data reflects an absence of any cohesive plan to address the more troubling findings. The damage to staff morale and trust arising from the delay in acknowledging let alone addressing these issues is nigh on incalculable. Just as a patient with systemic lupus erythematosus has auto-antibodies that attack their own body, so the dysfunction of Te Whatu Ora is harming its own workforce.

Minister Verrall recently announced a 24-point plan to reduce the burden of clinical demand on an already overstretched hospital system, through the provision of more direct patient care by the community and primary care sectors closer to their homes. I must confess a modicum of scepticism that the requisite increase in health professionals can be simply ‘dialled up’. We all know that the essential increase in workforce numbers will not happen before this coming winter, and probably not even for the next few winters. Beyond the basic recruitment logistics, individuals and teams will need local training, team development, and a conscious integration of community and district services to avoid duplication of effort. This will take much more than the next 2–3 months to achieve. Yet winter 2023 is pretty much here. I regret that there is not also a 25th point in the plan which explains what the health system will do to protect its workforce while we wait for the other 24 points to kick in.

If we cannot rely on our employer to ensure our safety and wellbeing, it becomes a case of ‘physician, heal thyself’. Whilst a mass exodus ‘across the ditch’ does not seem imminent, I am still aware of colleagues who are planning this move, as well as others contemplating ways to reduce their public sector FTE, including more work in the private sector. It would be a massive irony if a New Zealand Labour government – the party of Michael Savage, and of strong trade union connections – presided over the decline of the public health sector, for reasons of failing to adequately protect its workforce.

I take no joy in saying that, for members, this winter will be arduous, frustrating, fatiguing, and (for some) possibly the last straw. (In light of the feature addressing leave balances in this issue, but acknowledging the people who face barriers to taking that leave, taking leave is part of our own wellbeing.) Be assured ASMS remains tireless in presenting all these concerns to the health leaders who actually have the power to address them. Now, perhaps more than ever, we need all our members to be a part of this work – to identify when patient care is suffering due to under-resourcing, to call out managerial inertia, to refuse to enable unsafe workplaces and rosters, and (if our concerns continue to be ignored) to be willing to show group solidarity for just how important our patients and the public health system are.